Clinical decision-making regarding retention and treatment vs extraction and replacement of teeth can be a significant challenge. This systematic review and meta-analysis aimed to assess decision-making in clinical practice related to the retention and endodontic treatment of natural dentition vs extraction and replacement with implant-assisted restorations. The PubMed/MEDLINE, Scopus, Web of Science, and Education Resources Information Center (ERIC) databases were comprehensively searched for studies published through May 31, 2019. All randomized controlled trials and cohort studies that assessed the effect of endodontic treatment/retreatment and implant treatment were included. Primary outcomes included success, survival, and failure rates. Meta-analysis software was used for data analysis. Of 1550 identified articles, 5 were eligible for qualitative and quantitative analyses. All 5 of the included studies reported that both therapies are viable and predictable treatment options. The meta-analysis showed no significant difference between therapies when survival rates were considered to be successes, while a significant difference was found in favor of endodontic therapy when survival rates were considered to be failures. The available evidence suggests that both therapies have approximately similar outcomes, but endodontic therapy provides moderately better outcomes. Endodontic therapy should be considered the first option when possible.
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