Background: The clinical decision between retaining a compromised tooth via root canal treatment (RCT) and
prosthodontic restoration or extracting it and placing a dental implant remains a central dilemma in modern dentistry.
Both treatment modalities have high reported success, but long-term comparative data on survival and complication
profiles from matched cohorts are essential for evidence-based practice.
Methods: Using data collected from a university dentistry clinic’s patient record from 2010 to 2022, researchers ran a
retrospective cohort analysis. There were a total of 518 patients who were randomly assigned to one of two groups. One group received a single-tooth implant and crown to replace a missing tooth, while the other group received
endodontically treated teeth restored with a post-and-core and a crown. The main result was whether or not the tooth or implant remained in place. Surviving without any technical or biological issues was the secondary goal. A p-value of
less than 0.05 was used to establish statistical significance when data were examined using log-rank tests and KaplanMeier survival analysis.
Results: As a whole, the duration of follow-up was 9.8 ± 1.3 years. There was no statistically significant difference
between the RCT group's 93.7% ± 1.8% 10-year cumulative survival rate and the Implant group's 96.2% ± 1.5% survival rate (p=0.11). Having said that, the 10-year success rates showed a notable disparity. The success rate of the Implant group, at 91.6% ± 2.1% (p=0.02), was significantly higher than the RCT group's 84.3% ± 2.9%.The primary reasons for failure in the RCT group were non-restorable tooth fracture (56.3% of failures) and endodontic pathosis (31.3%). In the Implant group, prosthetic complications like screw loosening or abutment fracture (45.0% of complications) were more common, while peri-implantitis accounted for 20.0% of failures.
Conclusion: Both RCT with prosthodontic restoration and single-tooth implants offer excellent and comparable longterm survival rates. However, dental implants demonstrate a higher 10-year success rate, characterized by a different profile of complications that are often more prosthetic and manageable in nature compared to the more catastrophic biological failures associated with RCT-treated teeth. This distinction is critical for informed consent and clinical decision-making.
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