Endodontic therapy or extraction and tooth replacement with implants? Decision-making criteria

Stefanescu S.V.; Iuga M.M.; Al-Yamoor R.; Espada Salgado F.M.; Buciu A.; Teja K.V.; Bilsborrow S.; Vasundhara K.A.; Fava M.; Esposito L.; Traino F. · Giornale Italiano di Endodonzia (2026) · DOI: 10.32067/gie.2026.555

Resumen

Objective: The decision between preserving a compromised tooth through endodontic therapy or replacing it with a dental implant remains a frequent clinical dilemma. This narrative review aims to evaluate the available evidence regarding clinical outcomes, success rates, prognostic factors, and patient-related considerations associated with endodontic treatment and implant therapy to support evidence-based clinical decision-making. Materials and Methods: A comprehensive literature search was performed in electronic databases including PubMed, EMBASE, Wiley Online Library, Cochrane Library, and ScienceDirect up to October 2025. Studies evaluating outcomes of endodontic therapy and dental implant treatment in human subjects were included. A total of 13 studies (including cohort, case-control, cross-sectional, and one randomized controlled trial) were selected. Data extraction focused on study characteristics, interventions, follow-up duration, and clinical and patient-reported outcomes. Risk of bias was assessed using a domain-based approach adapted from the RoB 2 tool, modified to account for the inclusion of predominantly non-randomized studies. Results: Both endodontic therapy and dental implant treatment demonstrated high long-term survival rates when performed under appropriate clinical conditions. Endodontically treated teeth showed survival rates exceeding 85–90%, while implant survival ranged from 90% to 97%. However, heterogeneity in study design, follow-up duration, and outcome definitions limited direct comparisons. Most included studies presented some concerns to high risk of bias, primarily related to confounding, participant selection, and variability in outcome assessment. Patient-reported outcomes indicated comparable levels of satisfaction and quality of life between treatments, although implant therapy was associated with higher reported levels of pain and fear in some studies. Biological complications differed between modalities, with peri-implant diseases affecting implants and persistent infection or restoration failure influencing endodontic outcomes. Conclusions: Both treatment modalities represent predictable therapeutic options. Preservation of the natural tooth through endodontic therapy should generally be considered the first-line approach when prognosis is favorable, while dental implants serve as a reliable alternative when tooth preservation is not feasible. Clinical decision-making should integrate biological, restorative, systemic, and patient-centered factors. The strength of the evidence is limited by the predominance of observational studies and the overall moderate to high risk of bias across included studies.

Instituciones: Universidad Privada de Tacna; Universidad Nacional Jorge Basadre Grohmann