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Wurzelspitzenresektion oder Implantatinsertion

Gibt es Entscheidungskriterien für die Praxis?

Apicoectomy versus implant placement

How to perform clinical decision making?

  • Leitthema
  • Published:
Der MKG-Chirurg Aims and scope

Zusammenfassung

Das Abwägen zwischen dem Zahnerhalt durch Wurzelspitzenresektion und Zahnextraktion mit anschließender Implantatinsertion ist eine alltägliche klinische Aufgabe. Zur Klärung der Frage, welche der beiden Therapieoptionen bessere Erfolgs- und Überlebensraten liefert, erfolgte eine Analyse der Literatur. Es zeigte sich, dass derzeit keine klinischen Studien verfügbar sind, die WSR und Implantatversorgung direkt miteinander vergleichen. Eine retrospektive Studie, die das Überleben endodontisch behandelter Zähne dem von Implantaten gegenüberstellt, zeigt identische Ergebnisse für die Überlebensraten. Eine weitergehende Analyse der Literatur vermittelt, dass die Langzeitüberlebensprognose von wurzelspitzenresezierten Zähne immer dann kritisch zu bewerten ist, wenn neben der apikalen Läsion systemische Prognosefaktoren (z. B. Diabetes mellitus) oder lokale Prognosefaktoren (z. B. eingeschränkte Möglichkeit zur adäquaten Restauration des betroffenen Zahnes) berücksichtigt werden müssen. In diesen Fällen ist zu prüfen, ob Zahnextraktion und anschließende Implantatinsertion nicht zu einem besseren Langzeiterfolg führen.

Abstract

The decision-making process between retaining a tooth by apicoectomy and extracting and replacing it by an implant has to be performed in clinical practice frequently. The analysis of the current literature aimed at clarifying which if the two treatment options leads to improved survival and success rates. To date there are no clinical studies available that directly compare survival rates of teeth undergoing apicoectomy and implants. In a retrospective study, it has been shown that endodontically treated teeth show a survival rate after 12 months that is comparable to that of implants. In a further analysis of the current literature it became apparent that the long-term survival prognosis of teeth which underwent apicoectomy was questionable when additional systemic factors (e.g. diabetes mellitus) or local factors (e.g. questionable possibility for adequate restoration of the clinical crown) had to be taken into account. In these cases it should be checked whether extraction and subsequent implant placement lead to improved long-term success.

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  1. Mund-, Kiefer- und Gesichtschirurgische Klinik, Universitätsklinikum Erlangen, Glückstr. 11, 91054, Erlangen, Deutschland

    E. Nkenke

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Nkenke, E. Wurzelspitzenresektion oder Implantatinsertion. MKG-Chirurg 3, 121–129 (2010). https://doi.org/10.1007/s12285-009-0141-y

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