Evidence based algorithm for prevention, identification and management of surgical complications
The ultimate goal of surgical endodontic treatment is to preserve natural teeth. A frequent dilemma is the decision whether to preserve the natural tooth by endodontic treatment or to extract the tooth and replace it with an alternative, such as fixed partial dentures or a dental implant [22, 23]. In case a complication occurred during an endodontic treatment, this dilemma may be even more intense since the prognosis of the tooth and the possible further complications may be unpredictable. On the other hand, it should be recognized that not every complication should necessarily lead to a surgical failure. As long as the surgical main goal (i.e., correct management of the apical part of the root [2, 3]) was achieved in spite of the complication, the treatment outcome may not be compromised. However, if the complication development compromised the main surgical goal, a less predictable outcome should be anticipated [2, 3].
The contemporary dentistry principle is that every reasonable effort should be made in order to preserve natural teeth, since the basic goal of dental implants is to replace missing teeth, and not present teeth [22, 23]. Thus, the long-term prognosis, the capabilities offered by the modern endodontic treatment to address the complication, the alternatives in case of treatment failure, the posttreatment quality of life, and the patient’s preferences should all be recognized and incorporated in the practitioner’s decision making [22, 23].
Endodontic clinical trials often use “success” as the outcome variable, based on strict clinical and radiographic evaluations. In contrast, implant research often uses “survival,” defined as “retention of the tooth or implant, depending on the intervention,” as the outcome variable, thus leading to a confusion when attempting to compare these two treatment modalities . Doyle et al.  compared the long-term survival of single-tooth implant restorations with matched teeth receiving initial nonsurgical endodontic treatment and restoration and reported a comparable 10-year survival rate of both treatment modalities . Thus, choices between implant and endodontic therapies cannot be solely based on outcomes measurement .
The required additional treatments, especially in case of failure, and the patient’s quality of life should also be taken under consideration. For example, endodontically treated natural teeth may provide more effective masticatory function compared with implant-supported restorations . In addition, although the success of implant and endodontically treated teeth may be comparable, implants may require more postoperative treatments to maintain them . Thus, natural endodontically treated teeth may grant improved dental function and less required further treatments than implant [24, 26, 27].
As part of the treatment consideration and decision-making process, specific patient- and practitioner-related matters, which might affect the risk of complications and the ability to manage those complications in case they occur, need to be considered. Thus, several questions need to be elucidated:
Are my patients different from those presented in the literature (i.e., in terms of motivation, socioeconomic status, systemic considerations)?
Is the treatment feasible in my setting?
Will the potential benefits of treatment outweigh the potential risks for my patient?
This book is aimed to provide endodontic practitioners with knowledge and practical tools to incorporate an evidence-based approach for prevention, identification, and management of surgical complications, in their daily decision-making process.
Farrar JN. Radical and heroic treatment of alveolar abscess by amputation of roots of teeth. Dental Cosmos. 1884;26(3):135–9.