Clinical Research| Volume 45, ISSUE 5, P532-537, May 2019

Indications for Extraction before Implant Therapy: Focus on Endodontic Status

Published:March 08, 2019DOI:



      The aim of the present study was to evaluate endodontic status and diagnosis of teeth before extraction and their impact on treatment planning and treatment outcomes of dental implant therapy.


      Data were retrieved from patient files and radiographs of 596 Swedish individuals provided with implant therapy. Patients were categorized according to diagnosis in conjunction with tooth extraction as follows: PERIO (reason for extraction: periodontitis), CARIES (reason for extraction: caries, apical periodontitis, and/or root fracture), OTHER (reason for extraction: trauma and other), and MIX (a combination of these). Details on treatment planning (timing of implant installation and use of prophylactic antibiotics) and outcomes (early/late implant loss and peri-implantitis) were assessed from patient records or by clinical examination. Tooth status (endodontically treated: yes/no; apical lesion: yes/no) and diagnosis category were explored as independent parameters by logistic regression analyses.


      For the majority of patients (64%), tooth extraction was based on a caries or caries-related diagnosis. Fifty-one percent of all extracted teeth were endodontically treated. Every third tooth showed radiographic signs of an apical lesion. Immediate implant installation at such sites was less common. Endodontic status before extraction was not associated with the use of antibiotics or with treatment outcomes. The diagnosis category MIX was associated with early implant loss. PERIO was indicative of a higher risk for peri-implantitis.


      Endodontic status before extraction had a limited impact on treatment planning and was not associated with early/late implant loss or peri-implantitis. Immediate implant installation after tooth extraction was less commonly performed at sites with apical lesions.

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        • Dahlström L.
        • Lindwall O.
        • Rystedt H.
        • Reit C.
        Working in the dark': Swedish general dental practitioners on the complexity of root canal treatment.
        Int Endod J. 2017; 50: 636-645
        • Dahlström L.
        • Molander A.
        • Reit C.
        The impact of a continuing education programme on the adoption of nickel-titanium rotary instrumentation and root-filling quality amongst a group of Swedish general dental practitioners.
        Eur J Dent Educ. 2015; 19: 23-30
        • Pak J.G.
        • Fayazi S.
        • White S.N.
        Prevalence of periapical radiolucency and root canal treatment: a systematic review of cross-sectional studies.
        J Endod. 2012; 38: 1170-1176
        • Burns L.E.
        • Visbal L.D.
        • Kohli M.R.
        • et al.
        Long-term evaluation of treatment planning decisions for nonhealing endodontic cases by different groups of practitioners.
        J Endod. 2018; 44: 226-232
        • von Arx T.
        • Roux E.
        • Burgin W.
        Treatment decisions in 330 cases referred for apical surgery.
        J Endod. 2014; 40: 187-191
        • Ng Y.L.
        • Mann V.
        • Gulabivala K.
        Outcome of secondary root canal treatment: a systematic review of the literature.
        Int Endod J. 2008; 41: 1026-1046
        • Tzimpoulas N.E.
        • Alisafis M.G.
        • Tzanetakis G.N.
        • Kontakiotis E.G.
        A prospective study of the extraction and retention incidence of endodontically treated teeth with uncertain prognosis after endodontic referral.
        J Endod. 2012; 38: 1326-1329
        • Jung R.E.
        • Zembic A.
        • Pjetursson B.E.
        • et al.
        Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years.
        Clin Oral Implants Res. 2012; 23: 2-21
        • Pjetursson B.E.
        • Thoma D.S.
        • Jung R.E.
        • et al.
        A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years.
        Clin Oral Implants Res. 2012; 23: 22-38
        • Derks J.
        • Håkansson J.
        • Wennström J.L.
        • et al.
        Effectiveness of implant therapy analyzed in a Swedish population: early and late implant loss.
        J Dent Res. 2015; 94: 44S-51S
        • Derks J.
        • Schaller D.
        • Hakansson J.
        • et al.
        Effectiveness of implant therapy analyzed in a Swedish population: prevalence of peri-implantitis.
        J Dent Res. 2016; 95: 43-49
        • Zhou W.
        • Han C.
        • Li D.
        • et al.
        Endodontic treatment of teeth induces retrograde peri-implantitis.
        Clin Oral Implants Res. 2009; 20: 1326-1332
        • Sarmast N.D.
        • Wang H.H.
        • Sajadi A.S.
        • et al.
        Classification and clinical management of retrograde peri-implantitis associated with apical periodontitis: a proposed classification system and case report.
        J Endod. 2017; 43: 1921-1924
        • Lindeboom J.A.
        • Tjiook Y.
        • Kroon F.H.
        Immediate placement of implants in periapical infected sites: a prospective randomized study in 50 patients.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101: 705-710
        • Marconcini S.
        • Barone A.
        • Gelpi F.
        • et al.
        Immediate implant placement in infected sites: a case series.
        J Periodontol. 2013; 84: 196-202
        • Del Fabbro M.
        • Boggian C.
        • Taschieri S.
        Immediate implant placement into fresh extraction sites with chronic periapical pathologic features combined with plasma rich in growth factors: preliminary results of single-cohort study.
        J Oral Maxillofac Surg. 2009; 67: 2476-2484
        • Crespi R.
        • Capparè P.
        • Crespi G.
        • et al.
        Immediate implant placement in sockets with asymptomatic apical periodontitis.
        Clin Implant Dent Relat Res. 2017; 19: 20-27
        • Jung R.E.
        • Zaugg B.
        • Philipp A.O.
        • et al.
        A prospective, controlled clinical trial evaluating the clinical radiological and aesthetic outcome after 5 years of immediately placed implants in sockets exhibiting periapical pathology.
        Clin Oral Implants Res. 2013; 24: 839-846
        • Derks J.
        • Håkansson J.
        • Wennström J.L.
        • et al.
        Patient-reported outcomes of dental implant therapy in a large randomly selected sample.
        Clin Oral Implants Res. 2015; 26: 586-591
        • Hämmerle C.H.
        • Chen S.T.
        • Wilson Jr., T.G.
        Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets.
        Int J Oral Maxillofac Implants. 2004; 19: 26-28
        • Sanz M.
        • Chapple I.L.
        Clinical research on peri-implant diseases: consensus report of Working Group 4.
        J Clin Periodontol. 2012; 39: 202-206
        • Aida J.
        • Ando Y.
        • Akhter R.
        • et al.
        Reasons for permanent tooth extractions in Japan.
        J Epidemiol. 2006; 16: 214-219
        • Trovik T.A.
        • Klock K.S.
        • Haugejorden O.
        Trends in reasons for tooth extractions in Norway from 1968 to 1998.
        Acta Odontol Scand. 2000; 58: 89-96
        • SKaPa
        Swedish Quality Registry for caries and periodontal disease–annual report. Swedish Quality Registry for Caries and Periodontal Disease.
        Swedish Quality Registry for Caries and Periodontal Disease, Karlstad, Sweden2016
        • Zadik Y.
        • Sandler V.
        • Bechor R.
        • et al.
        Analysis of factors related to extraction of endodontically treated teeth.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: e31-e35
        • Touré B.
        • Faye B.
        • Kane A.W.
        • et al.
        Analysis of reasons for extraction of endodontically treated teeth: a prospective study.
        J Endod. 2011; 37: 1512-1515
        • Vire D.E.
        Failure of endodontically treated teeth: classification and evaluation.
        J Endod. 1991; 17: 338-342
        • Orstavik D.
        • Kerekes K.
        • Eriksen H.M.
        The periapical index: a scoring system for radiographic assessment of apical periodontitis.
        Endod Dent Traumatol. 1986; 2: 20-34
        • Durack C.
        • Patel S.
        • Davies J.
        • et al.
        Diagnostic accuracy of small volume cone beam computed tomography and intraoral periapical radiography for the detection of simulated external inflammatory root resorption.
        Int Endod J. 2011; 44: 136-147
        • Patel S.
        • Dawood A.
        • Mannocci F.
        • et al.
        Detection of periapical bone defects in human jaws using cone beam computed tomography and intraoral radiography.
        Int Endod J. 2009; 42: 507-515
        • Kirkevang L.L.
        • Horsted-Bindslev P.
        • Orstavik D.
        • Wenzel A.
        Frequency and distribution of endodontically treated teeth and apical periodontitis in an urban Danish population.
        Int Endod J. 2001; 34: 198-205
        • Zhao D.
        • Wu Y.
        • Xu C.
        • Zhang F.
        Immediate dental implant placement into infected vs. non-infected sockets: a meta-analysis.
        Clinl Oral Implants Res. 2015; 27: 1290-1296
        • Schwarz F.
        • Derks J.
        • Monje A.
        • Wang H.L.
        J Periodontol. 2018; 89: S267-S290