Dentists and patients are facing a perplexity between saving a compromised tooth through endodontic treatment and restoration or by extraction and replacement with an implant. The purpose of this paper was to compare the success rates of these two treatments. Success was measured as the longevity of the tooth or implant. Studies which met strict inclusion criteria to ensure best evidence were included. Searches were performed in Ovid Medline, Pubmed, Scopus database, and the Cochrane Library. Evidence-based groups were formed following the assessment of inclusion/exclusion criteria. The overall success rates for primary endodontic, nonsurgical retreatment, and surgical treatment were (86.02%), (78.2%), and (63.4%), respectively, implants was 90.9%. In conclusion, choice between implant and endodontic therapy cannot be exclusively based on outcome as both treatments differ in the biological process, diagnostic modalities, failure patterns, and patients preferences. More research is required with improved study designs before long-term success rates can be compared. 1. Introduction Preservation of a patient’s natural dentition remains an important outcome in securing oral health. Endodontic treatments have been shown to successfully retain compromised teeth which were fractured, carious, or traumatised [1], for many decades. However, modern developments in implant provision provide greater choice for patients and clinicians, and, therefore, the decision between a root canal therapy and implant treatment is a commonly occurring dilemma in practice. Outcomes of dental therapy as discussed in the literature fall into one of the four categories: success, survival with intervention, survival without intervention, and failure [2]. The majority of endodontic studies used the term “success” when describing treatment outcomes using clinical and radiographic parameters for the evaluation process. Recent studies pertaining to endodontic prognosis have adopted “strict” and “lenient” categories when illustrating successful outcomes. While complete radiographic healing and absence of any clinical signs or symptoms were characteristic of the “strict” category, reduction in size of radiolucency together with clinical normalcy defines the “lenient” criteria [3, 4]. In contrast, most outcome studies of implants used “survival” as the criteria of success. Thus, the difference in methodologies and definition of outcome measures makes comparison between the two treatment options very difficult for the researcher [5]. Investigators have disputed that survival/longevity is an
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