November 1, 2003
by Oral Health
Re: Implant Treatment versus Eendodontic Re-treatment: A Contemporary Dilemma, Milan Somborac, DDS, October 2003
I believe the article is a little to the biased side. He is comparing a 1996 implant success rate study (97%, reference 2) to a 1989 endodontic retreatment success rate study (66%, reference 3).
In the 1996 implant study quoted by Somborac, a total of 107 implants were placed, all the same brand (Branemark), and all placed under strict and well controlled conditions, by experienced specialists. Patients with insufficient bone quality were excluded from the study. All cases were single implants placed adjacent to healthy supporting tissues and teeth, and no canine guidance was included. All patients had excellent general health. Seventeen patients were excluded from the study (maybe that is where the failures were) for unfavorable reasons. And the success rate after five years was 96.6% (not quite 97%).
In the 1989 retreatment study quoted, old patients’ charts were pulled out, with a total of 1,300 cases of endodontic retreatment, only 267 of which were originally treated after 1980. These cases were treated by Grad students, predoctoral students, and by two specialists in private practice. Half of the cases “retreated” were done by surgical approach (not conventional retreat), and half of these had no retrofill at all. Everything done without microscopes, without MTA, etc. No distinction was made regarding the patients’ general health. The authors divided the cases in “success”, “failure”, and “uncertain”. The uncertain category included teeth that had large areas of periradicular periodontitis, that are now little and asymptomatic, with these teeth being in normal occlusal function. So “uncertain” plus “success” adds up to 83.9% (not 66%).
Dr. Torabinejad talked about comparing apples to oranges in his “President’s Message” (JOE, August, 2003 issue). At least, they’re both vegetables. Comparing apples and oranges would be the same as comparing the 1989 retreatment study to the good old “needle” and ” laminate” stainless steel dental implants. With all due respect, Dr. Somborac’s article is comparing apples to rocks.
Alex Fleury, DDS, MS
Texas A&M University System, Baylor College of Dentistry, Department of Endodontics, Dallas, TX