Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: A randomized controlled clinical trial reporting 10‐year outcomes, survival analysis and mean cumulative cost of recurrence

Abstract

Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: A randomized controlled clinical trial reporting 10-year outcomes, survival analysis and mean cumulative cost of recurrence Abstract Background: Periodontal regeneration can change tooth prognosis and represents an alternative to extraction in teeth compromised by severe intra-bony defects. The aim of this study was to compare periodontal regeneration (PR) with tooth extraction and replacement (TER) in a population with attachment loss to or beyond the apex of the root in terms of professional, patient-reported and economic outcomes. Methods:This was a 10-year randomized controlled clinical trial. 50 stage III or stage IV periodontitis subjects with a severely compromised tooth with attachment loss to or beyond the apex were randomized to PR or TER with either an implant-or a tooth-supported fixed partial denture. Subjects were kept on a strict periodontal supportive care regimen every 3 months and examined yearly. Survival and recurrence analysis were performed.Results: 88% and 100% survival rates were observed in the PR and TER groups.Complication-free survival was not significantly different: 6.7-9.1 years for PR and 7.3-9.1 years for TER (p = .788). In PR, the observed 10-year attachment gain was 7.3 ± 2.3 mm and the residual probing depths were 3.4 ± 0.8 mm. Recurrence analysis showed that the 95% confidence interval of the costs was significantly lower for PR compared with TER throughout the whole 10-year period. Patient-reported outcomes and oral health-related quality-of-life measurements improved in both groups. Conclusions: Periodontal regeneration can change the prognosis of hopeless teethand is a less costly alternative to tooth extraction and replacement. The complexity of the treatment limits widespread application to the most complex cases but provides powerful proof of principle for the benefits of PR in deep intra-bony defect. | 769CORTELLINI ET aL.

Periodontal infrabony defects: Systematic review of healing by defect morphology following regenerative surgery

“…The emphasis on “3‐wall” bony defects was due to their higher chances of successful regeneration (Weinberg & Eskow, 2000). Recent developments in periodontal regenerative techniques and materials have pushed the boundaries of what is considered “regenerable” (P. Cortellini et al, 2020). Papapanou & Tonetti differentiated osseous defects into “suprabony” defects, “infrabony” and “interradicular or furcation” defects (Papapanou & Tonetti, 2000).…”

Analyzing the predictability of the Kwok and Caton periodontal prognosis system: A retrospective study

“…2,6,4 This tendency could be explained by the shift towards preserving the natural dentition over placing dental implants, and the popularity of regenerative therapies. 18,19 It has been shown that the health of the periodontium next to a retained hopeless tooth can be maintained by surgical intervention with frequent maintenance care. 20,21 Even for molars with Class II to III furcation involvement, a recent study 22 reported that these molars could still respond well to periodontal therapy, and every effort should be made to maintain these teeth whenever possible.…”

Clinical, radiographic and economic evaluation of short‐6‐mm implants and longer implants combined with osteotome sinus floor elevation in moderately atrophic maxillae: A 3‐year randomized clinical trial

“…Costs were determined by the actual costs of the necessary procedures derived from guide-price by the local government in Shanghai (see Table S1 for detail). Calculations of mean cumulative costs (MCCs) were performed as described (Cortellini et al, 2020;Shi et al, 2020).…”