Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review.
BACKGROUND
Dentists and patients are regularly confronted by a difficult treatment question: should a tooth be saved through root canal treatment and restoration (RCT), be extracted without any tooth replacement, be replaced with a fixed partial denture (FPD) or an implant-supported single crown (ISC)?


OBJECTIVE
The purpose of this systematic review was to compare the outcomes, benefits, and harms of endodontic care and restoration compared to extraction and placement of ISCs, FPDs, or extraction without tooth replacement.


METHODS
Searches performed in MEDLINE, Cochrane, and EMBASE databases were enriched by hand searches, citation mining, and expert recommendation. Evidence tables were developed following quality and inclusion criteria assessment. Pooled and weighted mean success and survival rates, with associated confidence intervals, were calculated for single implant crowns, fixed partial dentures, and initial nonsurgical root canal treatments. Data related to extraction without tooth replacement and psychosocial outcomes were evaluated by a narrative review due to literature limitations.


RESULTS
The 143 selected studies varied considerably in design, success definition, assessment methods, operator type, and sample size. Direct comparison of treatment types was extremely rare. Limited psychosocial data revealed the traumatic effect of loss of visible teeth. Economic data were largely absent. Success rates for ISCs were higher than for RCTs and FPDs, respectively; however, success criteria differed greatly among treatment types, rendering direct comparison of success rates futile. Long-term survival rates for ISCs and RCTs were similar and superior to those for FPDs.


CONCLUSIONS
Lack of comparative studies with similar outcomes criteria with comparable time intervals limited comparison of these treatments. ISC and RCT treatments resulted in superior long-term survival, compared to FPDs. Limited data suggested that extraction without replacement resulted in inferior psychosocial outcomes compared to alternatives. Long-term, prospective clinical trials with large sample sizes and clearly defined outcomes criteria are needed.
Torabinejad
Mahmoud
M
School of Dentistry, Loma Linda University, Loma Linda, Calif., USA.
Anderson
Patricia
P
Bader
Jim
J
Brown
L Jackson
LJ
Chen
Lie H
LH
Goodacre
Charles J
CJ
Kattadiyil
Mathew T
MT
Kutsenko
Diana
D
Lozada
Jaime
J
Patel
Rishi
R
Petersen
Floyd
F
Puterman
Israel
I
White
Shane N
SN
D003362:Cost-Benefit Analysis; D003442:Crowns; D019250:Dental Implants, Single-Tooth; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent; D003830:Denture, Partial, Fixed; D006801:Humans; D012390:Root Canal Therapy; D016019:Survival Analysis; D014081:Tooth Extraction / Q000523:psychology*; D016896:Treatment Outcome