الفهرس 
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Abstract
Statement of problem: Owing to the high survival and success rates of dental implants, they have become a popular treatment modality to replace missing teeth. Unfortunately however, their popularity may be related to the misconception that badly broken down endodontically teeth should be removed rather than maintained, and the missing tooth replaced by dental implant. Aim of the work : To evaluate clinical outcome of titanium dental implants versus badly broken-down endodontically treated teeth. Patients and methods : Thirty-two patients, eight of them were seeking for replacement of missing mandibular first molar and the other 24 patients were represented with badly broken down mandibular first molar seeking endodontic treatment were selected according to certain criteria. The patients enrolled in this study were divided into four groups (n=8) according to treatment planning decisions, as follows: group (I) : Patients had a missing mandibular first molar received two-piece titanium dental implants and titanium abutments; group (II) : patients had a badly broken down mandibular first molar with two adjacent sound dentin walls remaining around the tooth received endodontic treatment, prefabricated metal post and composite core; group (III) : patients had a badly broken down mandibular first molar with only one sound dentin wall remaining around the tooth received endodontic treatment, split cast metal post and core; and group (IV) patients had a badly broken down mandibular first molar with no sound dentin wall remaining around the tooth received endodontic treatment, split cast metal post and core. Metal-ceramic crowns were cemented to the abutments and teeth with self-adhesive resin cement. Follow-up visits were scheduled immediately after crown placement, six weeks, six and twelve months after crown insertion. The statistical analyses were done with Repeated measures ANOVA, post-hoc Bonferroni and Chi-square test at P value >0.05. Results: There was no statistically significant difference in terms of the survival outcome between the four groups (p <0.05). However, in term of radiographic evaluation, there was a significance difference in the marginal bone level of the after twelve months (<0.001). Conclusions: Within limitations of this clinical study: from survival outcome point of view, dental implants and badly broken down endodontically treated teeth are similar. Choice between dental implants and endodontic treatment of badly broken down teeth cannot be solely based on survival outcomes. Clinical Implications:Caution should be considered when deciding to extract a badly broken down endodontically treated tooth that is restorable and periodontally sound in favor of implant placement.