Restoration or implant placement: a growing treatment planning quandary

Each year endosseous dental implants gain greater acceptance among clinicians and patients. This has come about for several reasons, including excellent success rates published in long-term studies, improvements in fixture and abutment designs, more predictable surgical placement techniques, and increased consumer desire to have tooth replacement. Regardless of the implant system, the placement and functional success of endosseous implants is greater than 90% (1, 14, 40). Thoughtful decision-making is vitally important as patients seek professional advice on retaining their teeth or replacing them with implants. Is a tooth with a questionable prognosis restored or intervened with a dental implant? Answering such questions is a challenge for clinicians and patients alike. The restorative dentist and surgeon working together must consider many factors in treatment planning. While the predictability of implants has greatly improved, it is not 100%, making it difficult to recommend the extraction of a tooth with a less than optimal prognosis. Should a tooth with a large post and core restoration and a failing endodontic procedure be re-treated conventionally or should it be extracted? Is it better to replace such a tooth with an implant? If the implant fails to integrate or if the restoration is an esthetic failure, would it have been better to retain the tooth? The American Academy of Periodontology’s position paper on dental implants cites that all patients should be informed of the risk of failure and alternative treatments prior to implant placement and restoration. The greater than 98% implant success reported in some studies may be a dangerous benchmark if questionable teeth are too often extracted. This chapter discusses the clinical and economic