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Keep the ones you’ve got
not the advice of the media, the fear instilled by fraudulent practices, or political influences.
Dodson TB: Science and conscience. J Oral Maxillofac Surg 73:22552256, 2015 Reprints not available
Keep the ones you’ve got Background.—Teeth lost to disease, injury, or congenital tooth agenesis are often replaced by dental implants, with this option widely incorporated into everyday dental practice. As a result, patients have enjoyed major improvements in oral health, better function, better esthetics, and improved phonetics compared to previous outcomes. However, gathering research is exposing the adverse outcomes associated with implants. Among these are biological complications and the unpredictability of implant therapy. Is it time to revisit saving teeth as a viable option rather than simply placing implants? Complications of Implant Therapy.—The complications noted with implant therapy have been reported by specialists in periodontology, oral surgery, prosthodontics, and implant dentistry. Biologically, persistent infections can develop around the implants, including peri-implant mucositis and peri-implantitis. Nearly every dental implant system is susceptible to peri-implant biological complications. In addition, the implants themselves may fail, which also puts restorations built on the implants at risk for failure. The resulting clinical scenario can be very difficult to treat, possibly requiring local mechanical therapy, antibiotics, resective surgery, regeneration, or removal. The long-term prognosis for implants has been shown to be far less promising than that for natural teeth, even when they are compromised by periodontal disease or endodontic problems. Saving Teeth.—The retention of compromised teeth and treatment of the problem is normally less expedient than implant placement. Often practitioners recommend implants even when teeth are only modestly compromised by caries, the need for endodontic therapy, or periodontal disease to provide the patient with a quick solution to the problem. Less trained individuals often recommend tooth
extraction rather than retention. This condemns many teeth that could be treated and returned to good function. Even those teeth that are compromised have a much greater life span than the average implant. Tooth maintenance to preserve the natural dentition has a long history of success. In addition, dentists are trained to preserve a functional dentition for a lifetime, and the reliance on implants rather than appropriate interventions to maintain a tooth’s usefulness will tend to diminish the dental professional’s expertise in this area. Patients are also short-changed when they are advised to forgo treatment in favor of a quick fix because implants’ long-term success is not guaranteed and problems are common.
Clinical Significance.—Dentists should carefully weigh the advantages and disadvantages of all the options available in oral health care delivery situations. Patients deserve to be informed completely about the possible downsides of implants as well as their advantages and about the positive aspects associated with retaining a tooth, even if a period of treatment is required to obtain excellent function. Practice patterns should change to retain more teeth because of the positive long-term outcomes achieved with successful therapy for tooth preservation.
Giannobile WV, Lang NP: Are dental implants a panacea or should we better strive to save teeth? J Dent Res 95:5-6, 2016 Reprints available from sagepub.com/journalsPermissions.nav
Volume 61
Issue 4
2016
173
Dodson TB: Science and conscience. J Oral Maxillofac Surg 73:22552256, 2015 Reprints not available
Keep the ones you’ve got Background.—Teeth lost to disease, injury, or congenital tooth agenesis are often replaced by dental implants, with this option widely incorporated into everyday dental practice. As a result, patients have enjoyed major improvements in oral health, better function, better esthetics, and improved phonetics compared to previous outcomes. However, gathering research is exposing the adverse outcomes associated with implants. Among these are biological complications and the unpredictability of implant therapy. Is it time to revisit saving teeth as a viable option rather than simply placing implants? Complications of Implant Therapy.—The complications noted with implant therapy have been reported by specialists in periodontology, oral surgery, prosthodontics, and implant dentistry. Biologically, persistent infections can develop around the implants, including peri-implant mucositis and peri-implantitis. Nearly every dental implant system is susceptible to peri-implant biological complications. In addition, the implants themselves may fail, which also puts restorations built on the implants at risk for failure. The resulting clinical scenario can be very difficult to treat, possibly requiring local mechanical therapy, antibiotics, resective surgery, regeneration, or removal. The long-term prognosis for implants has been shown to be far less promising than that for natural teeth, even when they are compromised by periodontal disease or endodontic problems. Saving Teeth.—The retention of compromised teeth and treatment of the problem is normally less expedient than implant placement. Often practitioners recommend implants even when teeth are only modestly compromised by caries, the need for endodontic therapy, or periodontal disease to provide the patient with a quick solution to the problem. Less trained individuals often recommend tooth
extraction rather than retention. This condemns many teeth that could be treated and returned to good function. Even those teeth that are compromised have a much greater life span than the average implant. Tooth maintenance to preserve the natural dentition has a long history of success. In addition, dentists are trained to preserve a functional dentition for a lifetime, and the reliance on implants rather than appropriate interventions to maintain a tooth’s usefulness will tend to diminish the dental professional’s expertise in this area. Patients are also short-changed when they are advised to forgo treatment in favor of a quick fix because implants’ long-term success is not guaranteed and problems are common.
Clinical Significance.—Dentists should carefully weigh the advantages and disadvantages of all the options available in oral health care delivery situations. Patients deserve to be informed completely about the possible downsides of implants as well as their advantages and about the positive aspects associated with retaining a tooth, even if a period of treatment is required to obtain excellent function. Practice patterns should change to retain more teeth because of the positive long-term outcomes achieved with successful therapy for tooth preservation.
Giannobile WV, Lang NP: Are dental implants a panacea or should we better strive to save teeth? J Dent Res 95:5-6, 2016 Reprints available from sagepub.com/journalsPermissions.nav
Volume 61
Issue 4
2016
173