HOPELESS TOOTH

EXTERNAL INTERNAL PATIENT

EVIDENCE EVIDENCE NECESSITIES

Scientific Clinical Preferences

Literature Experience and
Expectations
 EXTERNAL EVIDENCE

PROGNOSIS GOOD QUESTIONABLE HOPELESS

PPD 3mm, No BoP, Residual PPD 6mm, Insufficient CAL
CAL loss 25%, BoP +,CAL loss 50%, NO Acces to hygiene
FI degree 1 FI degree 2 or 3,
PERIODONTAL Access to hygiene Root proximity

NO SINTOMS NO SIMPTOMS SINTOMATIC

ABSENCE OF APICAL PRESENCE OF RADIOTRANSPARENCY
RADIOTRANSPARENCY RADIOTRANSPARENC ENDODONTIC
ENDODONTIC OR IN REGRESSION Y RETREATMENT
NOT POSSIBLE
Height: >4 mm Height: <3 mm Ferula < 1,5 mm
Ferula 1,5-2 mm Tot convergence Clinical Crown
Tot convergence >25 Lengthening (CCL)
PROSTHODONTI 15-20 Not possible
C
Factorii care stabilesc decizia
Factori
legai de
Factorul pacient Durata
implantar tratamentului

Factorul Estetica
parodontal

Factorul Factorul
endodontic financiar

Factori
Factorul
legai de
restaurativ Ratele de medic
supravieuire i
prognosticul
Factori legai de pacient

Ateptrile pacientului unul dintre cei mai importani factori n

luarea deciziei
Protocol de informare corect ( av.,dezav., riscuri, costuri)
Durerea n trat. endo sau paro vs.durerea n trat. cu implante
Factori legai de pacient
TRATAMENT CU BISFOSFONAI
DIABET ZAHARAT
Rate de succes scazute pt
dd. afectati parodontal Se evit interventiile
chirurgicale
DZ compensat nu afecteaza
ratele de succes ale
implantelor (nu e CI) si nici
ale tratamentului endodontic

Avila, G.; Galindo-Moreno, P.; Soehren, S.;

Doyle, SL.; Hodges, JS.; Pesun, IJ.; Baisden, MK.
& Bowles, WR. (2007). Factors affecting
outcomes for single-tooth implants and endodontic
restorations. J Endod, Vol.33,
No.4, pp.399-402.
Misch, CE.; Morelli, T. & Wang, HL. (2009). A
novel decision-making process for tooth retention
or extraction. J Periodontol,
Vol.80, No.3, pp.476-91.
Factori legai de pacient

Pacienii cu carioactivitate crescut (gur uscat dat efectelor

secundare ale unor mdm, Sjogren) - se prefera extracie si implante
Igiena oral deficitar se pastreaza dintii deorece implantele sunt
mai greu de igienizat decat dinii

Chang, M.; Wennstrm, JL.; Odman, P. & Andersson, B. (1999). Implant supported single tooth
replacements compared to contralateral natural teeth. Crown and soft tissue dimensions. Clin Oral
Implants Res, Vol.10, No.3, pp.185-94.
Abcesul parodontal
locul III urgene
45% din dinii cu abcese
parodontale au fost extrai in 3
ani
Factorul financiar
Implantele de 2-3x mai
scumpe dect trat
endodontic
Tratamentul cu
implante comparabil
cu metodele moderne
de trat. parodontal

Pennington, MW.; Vernazza, CR.; Shackley, P.; Armstrong, NT.; Whitworth, JM. & Steele, JG. (2009). Evaluation of the cost-
effectiveness of root canal treatment using conventional approaches versus replacement with an implant. Int Endod J, Vol.42,
No.10, pp.874-83.
Durata tratamentului

Tratamentul endodontic mult mai

rapid decat cel cu implante
Tratamentul parodontal ct i cel
cu implante dispensarizare pe
termen lung
Estetica

Dac este decisiv se pstreaz dinii (1)

Eecurile estetice depesc ca numr eecurile mecanice
Biotipul gingival subire se pstreaz dinii

1.Christensen, GJ. (2006). Implant therapy versus endodontic

therapy. J Am Dent Assoc,Vol.137, No.10, pp.1440-3.
 Factori legai de medic

Diferene ntre
preferinele terapeutice
ale specialitilor
Diferene n prezentarea
planurilor de tratament n
faa pacienilor
Medicii mai
experimentai aleg
soluiile mai simple i mai
puin agresive
Zitzmann NU, Scherrer SS, Weiger R, Lang NP, Walter C. Preferences of dental care providers in
maintaining compromised teeth in relation to their professional status: implants instead of periodontally
involved maxillary molars?. Clin. Oral Impl. Res. 22, 2011; 143150.
 Rate de
supravietuire a RATELE DE SUPRAVIEUIRE I PROGNOSTICUL
dintilor
nconjurai de
tesuturi
parodontale 99,5% la 50 de ani
sntoase
Rate de
supravietuire a
dintilor afectati
parodontal dar
tratati 92-93% la 10 ani

Rate de
supravietuire a
dintilor tratati
corect 91% la 10 ani
endodontic retrat dar cu patologie periapicala.... 80% la 5 ani

Rate de
supravietuire a
implantelor
... 96% implante solo 10 ani
 After 10 Years of
function the surviving
of oral implants is not
better than tooth, also
compromised, but
correctly treated

Holm-Pedersen P, Lang NP, Muller F

What are the longevities of theets and oral implants?
Clin. Oral Impl. Res. 18 (Suppl.3), 2007; 15-19
 Factor restaurativ
coronar
Raportul coroana- radacina = 1:1
Grosimea pereilor bontului mai mare
sau egal cu 1mm. - cand se masoara
Efectul de ferul (EOF sau LCC)
Inaltimea tes dentare deasupra osului
alv : minim 4 mm. ( 2 bw+0,5sg+1,5 fe)
Bonturi sub 3 mm.- RCR turnat
Dintii cu pivoti longevitate mai mica
ca a implantelor (Dawson, Cardacci,
)
2007Y, Sadan A. The prosthodontic concept of crown-to-root ratio: A review of the
Grossmann
literature. J Prosthet Dent
2005;93:559562.
Fokkinga WA, Kreulen CM, Bronkhorst EM, Creugers NH. Up to 17-year controlled 7%
clinical study on post-and-cores
and covering crowns. J Dent 2007;35:778786.
Creugers NH, Mentink AG, Fokkinga WA, Kreulen CM. 5-year follow-up of a prospective
clinical study on various types
of core restorations. Int J Prosthodont 2005;18:3439.
Factor restaurativ radicular

Canalul sa nu fie lrgit mai mult de 1/3

Lungime:2 conditii:
1. = cu lungimea coroanei clinice
2. Minim 3 mm. de sigilare apical
Lungimea pivot legat de nivelul osului: sa depaeasc cu cel
putin 4 mm.
 Factor parodontal
Dinti inghesuiti kissing roots- distanta
intre radacini mai mica de 0,8 mm.
factor de risc pentru pierderea de os
Pungile parodontale mai mari de
7mm.-prognostic rezervat.
Pierderea de os de mai mult de 65% -
prognostic rezervat.
Mobilitate gr.III Miller - prognostic
rezervat
Furcatie cls III Hamp- prognostic
nefavorabil 62% la 5 ani... Cls II -90%,
Cls I -100%

Hill RW, Ramfjord SP, Morrison EC, et al. Four types of periodontal treatment compared over two years. J Periodontol
1981;52:655-662.
Chace R Sr., Low SB. Survival characteristics of periodontally-involved teeth: A 40-year study. J Periodontol 1993;64:701-705.
Hovey LR, Jones AA, McGuire M, Mellonig JT,Schoolfield J, Cochran DL. Application of periodontal tissue engineering using
enamel matrix derivative and a human fibroblast-derived dermal substitute to stimulate periodontal wound healing in Class III
furcation defects. J Periodontol 2006;77:790-799.
 Factor
parodontal
Defectele osoase tip 1 perete
cel mai nefavorabil prognostic
Nivelul osului interproximal fat
de furcaie : apical prognostic
rezervat
Anomalii radiculare: perle de
smalt, anuri radiculare
igienizare deficitar- prognostic
sczut

Cortellini P, Tonetti MS. Focus on intrabony defects: Guided tissue regeneration. Periodontol 2000 2000; 22:104-13
Pontoriero R, Lindhe J. Guided tissue regeneration in the treatment of degree II furcations in maxillary molars. J Clin Periodontol
1995;22:756-763. 2.
Moskow BS, Canut PM. Studies on root enamel (2). Enamel pearls. A review of their morphology, localization, nomenclature, occurrence,
classification, histogenesis and incidence. J Clin Periodontol 1990; 17:275-281.
Factor parodontal
Dintii cu premolarizare rata de
succes 96% la 15 ani
Radacina distal a molari
mandibulari ... 75%
Implantele 97% la 15 ani
Implantele la molarul II mandibular
... 85%
Restul implantelor n pozitii molare
97-98%

Fugazzotto PA. A comparison of the success of root resected molars and molar position implants in function in a private practice:
Results of up to 15-plus years. J Periodontol 2001;72:1113-1123.
 Factor endodontic
Rata de supravieuire a dinilor tratai
endodontic de
o medici dentisti generalisti ...89,7% la 5 ani
o Specialisti endodontie.... 98,1% la 5 ani (1)
o Medici rezideni.... 85% la 10 ani (2)
Rata de supravieuire a dintilor retratati ortograd
e de 80% (3) mai ales cand exista leziuni
periapicale (4)- mai mica dect la implante
Rata de succes trat endo = trat implante
(Doyle,2006, Iqbal,2008)

1.Alley BS, Kitchens GG, Alley LW, Eleazer PD. A comparison of survival of teeth following endodontic treatment performed by
general dentists or by specialists. Ora(4)l Surg Oral Med Oral Pathol Oral Radiol Endod 2004;98:115-118.
2.Dammaschke T, Steven D, Kaup M, Ott KH. Longterm survival of root-canal-treated teeth: A retrospective study over 10 years. J
Endod 2003;29: 638-643.
3.Allen RK, Newton CW, Brown CE Jr. A statistical analysis of surgical and nonsurgical endodontic retreatment cases. J Endod
1989;15:261-266.
4.Van Nieuwenhuysen JP, Aouar M, DHoore W. Retreatment or radiographic monitoring in endodontics. Int Endod J 1994;27:75-81.
Esecul dintilor tratati endodontic se
datoreaza:
60% proteticii (neacoperire, fractur coronara, carii,
fractura bont)
30% parodontopatiilor
10% endodontiei (depasiri, fracturi verticale, resorbie
radiculara, infectii)
Succesul puntilor pe dd devitali dup 20 de ani ... 57% ,
pe dd vitali...69% (De Backer 2008)
Dd devitali neacoperiti : de 6x mai multe extractii decat
cei acoperiti (Aquilino 2002)
J Periodontology
2009