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To save or to extract, that is the question. Natural teeth or dental implants in periodontitis‐susceptible patients: clinical decision‐making and treatment strategies exemplified with patient case presentations
Author(s) -
Lundgren Dan,
Rylander Harald,
Laurell Lars
Publication year - 2008
Publication title -
periodontology 2000
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.725
H-Index - 122
eISSN - 1600-0757
pISSN - 0906-6713
DOI - 10.1111/j.1600-0757.2007.00239.x
Subject(s) - medicine , citation , periodontology , periodontitis , dentistry , natural (archaeology) , original research , library science , computer science , history , archaeology
Dentitions damaged by severe periodontal disease often cause problems not only to the patient but also to the dentist, not least regarding the choice of therapy. Today!s arsenal of therapeutics makes the choice of best treatment strategy for the individual patient very sophisticated. Advanced periodontal breakdown will call for extensive cause-related treatment of the disease to achieve and maintain periodontal health. It may also require comprehensive prosthetic reconstruction to restore function and aesthetics to the patient (19, 20). It is well documented that properly treated natural teeth with healthy but markedly reduced periodontal support are capable of carrying extensive fixed prostheses for a very long time with survival rates of about 90%, provided the periodontal disease is eradicated and prevented from re-occurring (16, 20, 29, 31). However, this knowledge seems to have penetrated only minor parts of the dental society. During the last decades careful scientific documentation has provided a solid base for implant therapy as a reliable treatment modality to replace lost teeth (14, 17, 24, 25). Today we know that treatments including implant-supported single crowns or fixed partial dentures as part of a comprehensive therapy will generally have a good prognosis when performed on the correct indications and followed by proper oral hygiene measures and supportive care. The acquired knowledge related to implant-supported reconstructions has markedly penetrated dental society, gaining support from dentists and patients as well as from the dental implant industry. The treatment is often spectacular with rapid and clearly visible results both for the dentist and the patient. This, together with business-based promotion, may partly explain the widespread application of dental implant therapy. There are opinions among clinicians that the prognosis of complex, often time-consuming, and trying periodontal therapy may not match the high levels of success of treatment with implants. As a consequence more and more teeth are extracted and replaced with implants in patients suffering from moderate to advanced periodontal breakdown. This approach is based on the assumptions that implants perform better than periodontally compromised teeth and that their longevity is independent of the individual!s susceptibility to periodontitis. As a consequence, teeth that could be saved and used as supports for fixed partial dentures are extracted and replaced with implants, sometimes on doubtful indications.