Comparative outcomes of endodontically treated teeth versus dental implant-supported prostheses: a systematic review

Abstract

Objective: The objective of this study was to compare the clinical and patient-related outcomes of root canal therapy (RCT) and dental implants (DIs) in managing severe tooth damage, supporting evidence-based treatment decisions.

Material and methods: A systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Six databases were searched: Cochrane Library, Embase, Medline, LILACS, Scopus, and Web of Science. Studies comparing clinical and patient-reported outcomes in adult patients treated with either RCT or DIs were included. The Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias. Due to significant heterogeneity among studies, meta-analysis was not feasible, and findings were synthesised qualitatively. PROSPERO registration: CRD42024584113.

Results: Out of 1,876 initial records, 12 studies met inclusion criteria: 7 cohort studies, 4 case-control studies, and 1 randomised controlled trial. Most studies had low to moderate risk of bias. Both RCT and DIs demonstrated high survival rates, with RCT slightly outperforming DIs in terms of success. Failure rates ranged from 0.7% to 12.0%, with no significant differences between treatments. DIs were associated with a higher frequency of postoperative interventions and complications. Patient-reported outcomes such as pain, satisfaction, and quality of life (QoL) were comparable across both modalities.

Conclusion: RCT and DIs both offer viable and effective solutions for restoring severely damaged teeth, with high survival and success rates and low failure rates. Both treatments were also associated with favourable patient-reported outcomes, including minimal pain, high satisfaction, and improved QoL. The decision between treatments should consider clinical factors, patient preferences, cost, accessibility, potential complications, and patient-centred outcomes. Shared decision-making is essential for optimal patient care.

Figure 1

Flowchart of the systematic review process [21].

Figure 2

Risk of bias assessment for (a) case-control studies, (b) cohort studies, and (c) randomised controlled trial. The ROBVIS tool^® was used to generate this figure [22].

Figure 3

Global quality assessment for (a) case-control studies, (b) cohort studies. The ROBVIS tool^® was used to generate this figure [22].