Evaluation and comparison of the endodontic condition of natural teeth adjacent to dental implants before and after implant placement

With the introduction of the concept of osseointegration, dental implants have become an established and widely utilized method for the restoration of missing teeth and the treatment of both complete and partial edentulism. As the use of implants has expanded and various types have been developed, the incidence of complications, both in terms of type and frequency, has also increased. From an endodontic perspective, one of the most critical surgical complications is damage to adjacent teeth. The causes of such damage are multifactorial, including surgical complications, iatrogenic factors, and the physiological effects of bone and soft tissue healing. In particular, pulpal or periapical damage to adjacent teeth may result from surgical errors or natural biological processes during the healing phase. The purpose of this study is to evaluate and compare the endodontic condition of healthy, natural teeth adjacent to the planned implant site both before and after surgery, throughout the healing process, and up to the stage of prosthetic rehabilitation. This analysis aims to improve our understanding of how surgical procedures affect the endodontic health of adjacent teeth and to identify potential complications, thereby contributing to the refinement of treatment strategies. A total of 74 teeth adjacent to implants in 31 patients were monitored and assessed throughout the study. Clinical evaluations were performed at defined intervals, including preoperatively and postoperatively at 1 week, 1 month, and 3 months. During these follow-ups, the sensitivity of adjacent teeth to palpation and percussion, as well as their responses to cold tests (Endo-Frost, Roeko, Langenau, Germany) and electric pulp tests (Parkell, Inc, Edgewood, NY), were documented. Furthermore, any pathological conditions such as the presence of abscesses or sinus tracts were recorded. Pain intensity was assessed using the Numeric Pain Rating Scale (NPRS). Radiographic images taken preoperatively and at 3 months postoperatively were analyzed for the presence or absence of periapical radiolucency, and the results were meticulously documented. While no statistically significant differences in tooth palpation sensitivity were found over time (p>0.05), the percussion sensitivity rate at week 1 was significantly higher compared to the preoperative period (p=0.011). There was no statistically significant difference in the positive percussion rates between week 1 and month 1 (p>0.05). However, the positive percussion rate at month 1 (2.2%) was significantly higher than that at month 3 (0%) (p=0.046). When comparing the changes in numerical values corresponding to each tooth's response to the electric pulp test (EPT) over time, no significant difference was observed between the preoperative and week 1 measurements (p>0.05). The week 1 measurements were significantly higher compared to month 1 (p=0.031), while no significant differences were found between month 1 and month 3 (p>0.05). Regarding the Numeric Pain Rating Scale (NPRS) results, the preoperative NPRS scores were significantly lower compared to the scores at week 1, month 1, and month 3 (p<0.05). In the analysis of the Numeric Pain Rating Scale (NPRS) results, which patients were asked to complete at each follow-up session, it was observed that the preoperative NPRS scores were significantly lower compared to those recorded at week 1, month 1, and month 3 (p<0.05). Throughout the study, no abscess, sinus tract formation, or periapical radiolucency was detected in the adjacent teeth. Additionally, all teeth demonstrated positive responses to cold test at all follow-up periods.