Mohammed Talat Salem Mohammed¹, Ahmed Attia Abo El -Naga ² and Ashraf Ibrahim Ali ^{3 1- Teaching assistant, Department of fixed prosthodontics, Faculty of Dentistry, Mansoura University, Egypt. 2- Professor offixed prosthodontics, Faculty of Dentistry,Mansoura University, Egypt. 3- Assistant Professor of conservative dentistry, Faculty of Dentistry, Mansoura University, Egypt.} Abstract: Statement of the problem:In recent years, technical advances in endodontic treatment have allowed the badly broken down tooth; which would in the past have been extracted to be treated and restored to full function.  In addition, single tooth implants have emerged as a treatment for the replacement of these badly broken down teeth. In the individual case of a badly broken down tooth, which of these treatments should be used? The decision should, as in all evidence-based practice, be based on the best available evidence.  The paramount concern is prognosis. Aim of the work:To evaluate clinical outcome of titanium dental implants versus badly broken-down endodontically treated teeth. Patients& 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 were 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 were 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 were receivedendodontic 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 were receivedendodontic 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, 6 weeks, 6 and 12 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 between four groups(p=1). However, in term of radiographic evaluation in Group (I), there was a significance difference in the marginal bone level of the after 12 months (p < 0.001). Conclusion:When survival outcomes are applied to both treatment options, survival rates of and dental implants and badly broken down endodontically-treated teeth are similar.