A Review of Endodontic Considerations in Implant-Supported Prostheses

Dental implants; Endodontics; Retrograde periimplantitis; Root canal therapy; Treatment planning; Osseointegration; Apical periodontitis.

Nirupama R1
Department of Prosthodontics and Crown &
Bridge, AB Shetty Memorial Institute of Dental
Sciences (ABSMIDS), Nitte (Deemed to be
University), Mangalore, Karnataka, India.
Shivprasad Rai
Senior Lecturer, Department of Orthodontics
and Dentofacial Orthopaedics, Manipal College
of Dental Sciences Mangalore, Manipal
Academy of Higher Education, Manipal, India.
Email: rai.shivaprasad@manipal.edu
2*

Saurabh Pawar3
Department of Prosthodontics, Crown & Bridge
and Oral Implantology, Dr. D. Y. Patil Dental
College and Hospital, Dr. D. Y. Patil
Vidyapeeth (Deemed to be University), Pune,
Maharashtra, India.
Dibya Jyoti Nath4
Department of Public Health Dentistry, Kalinga
Institute of Dental Sciences, KIIT (Deemed to
be University), Bhubaneswar, Odisha, India.
Ruchika Mukherjee5
Department of Prosthodontics and Crown &
Bridge, Sanaka Institute of Dental Sciences,
West Bengal University of Health Sciences,
Durgapur, West Bengal, India.
Arivu Stalin6
Department of Pediatric and Preventive
Dentistry, Dhanalakshmi Srinivasan Dental
College, Tamil Nadu Dr. M.G.R. Medical
University, Siruvachur, Perambalur, Tamil
Nadu, India.

European Journal of Prosthodontics and Restorative Dentistry (2026) 34,(4s) , 578-584

A Review of Endodontic
Considerations in ImplantSupported Prostheses

Objectives: To synthesise the contemporary evidence on the role of endodontic disease and treatment in the planning and delivery of implantsupported prostheses, and to derive a rational, patient-centred framework for the retain-versus-replace decision and for the prevention of endodontically related peri-implant complications. Methods: A structured search of PubMed/MEDLINE, the Cochrane Library and Web of Science was performed for English-language systematic reviews, meta-analyses, consensus statements and longitudinal studies, supplemented by hand-searching of reference lists. Evidence was appraised narratively across four domains: comparative treatment outcomes, restorability, the endodontic status of the implant recipient site, and the endodontic status of teeth adjacent to the planned implant. Results: Implant-supported single crowns and root canal-treated, restored teeth demonstrate comparably high long-term survival, but the endpoints are not equivalent; implants incur more biological and technical complications and additional interventions over time, whereas extraction is irreversible. Restorability — in particular an adequate ferrule, sufficient remaining coronal dentine and the absence of vertical root fracture — is decisive when a tooth is questionable. Periapical pathology at the recipient site does not preclude implant placement when thorough debridement, primary stability and adjunctive antibiotics are ensured; however, endodontic infection of adjacent teeth is a principal cause of retrograde peri-implantitis, mitigated by adequate implant-tooth spacing, prior endodontic treatment of pathological neighbours and a healing interval before placement. Conclusions: The endodontic health of the tooth, the recipient site and the adjacent teeth is integral to implant success. A biologically conservative “save the restorable tooth first” philosophy remains defensible wherever the endodontic and restorative prognosis is favourable, with the implant reserved for the truly unrestorable tooth. Clinical Relevance: Structured endodontic assessment and interdisciplinary treatment planning reduce peri-implant biological complications and support evidence-based decisions on whether to retain a tooth endodontically or to replace it with an implant-supported prosthesis.

Received-18-05-2026 Revised-22-06-2026 Accepted-27-06-20.26

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