In the dental implant era, why do we still bother saving teeth?

Abstract

Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long‐term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri‐implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow‐up protocols are implemented and that treatment planning is ethically responsible and evidence based.

Intraoral scanning reduces procedure time and improves patient comfort in fixed prosthodontics and implant dentistry: a systematic review

“…Prosthodontic patients have often suffered extensive loss of tooth structure and/or tooth loss, as a result of periodontal disease, caries, and dental trauma. Edentulism is associated with a decreased quality of life due to the importance of dentition in esthetics, mastication, and speech [ 48 ]. PROMs are defined as an instrument comprised of a set of questions that reflect the patient's perception of their functional well‐being and health status before and after treatment [ 49 ].…”

Long term clinical performance of 10 871 dental implants with up to 22 years of follow‐up: A cohort study in 4247 patients

“…Marginal bone loss (MBL) is, therefore, a critical factor affecting the clinical outcome 1,4 . Multifactorial reasons for implant failure and MBL are reported in the literature, however, they are not all fully understood 4‐7 …”

Orthodontic Extrusion vs. Surgical Extrusion to Rehabilitate Severely Damaged Teeth: A Literature Review

“…Nowadays, in the so-called "dental implant era" (Clark and Levin), clinicians often choose to extract compromised teeth and replace them with dental implants, even if less invasive options are feasible [2]. Moreover, the lower implants survival rate compared to teeth should be considered even in cases of severely compromised but properly treated and maintained teeth [2]. Placing a dental implant is not free from possible intraoperative and postoperative complications, such as neurological damage and sinus penetration.…”