Indications for Extraction before Implant Therapy: Focus on Endodontic Status.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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.