Clinicians are often faced with the dilemma of whether to extract or maintain periodontally compromised teeth. Although extraction and implant placement may seem like an attractive quick-fix option, this article shows how the evidence for the benefits of this approach is poor. The authors make the argument for the value of periodontally compromised teeth and for the importance of increasing awareness of the potentially good long-term outcomes of questionable teeth. We discuss how, under the right conditions, such as the periodontal experience and expertise of the treating clinician, the strategic value of the tooth along with good long-term compliance and the commitment of the patient, implants can still be considered as a replacement for missing teeth but not of periodontally compromised teeth.
Abstract
Introduction
Periodontitis is one of the most common diseases of the oral cavity, triggered by a dysbiosis in the oral microbiome, resulting in loss of periodontal supporting tissues (Tonetti et al. 2018) and, if left untreated, in a high risk of tooth loss. In advanced cases (as shown in Fig. 1), clinicians have to deal with situations where they should decide whether to extract and replace periodontally compromised teeth or try to maintain them. This review article aims to discuss i) the value of periodontally compromised teeth, ii) the advantages/disadvantages of extracting or maintaining them, and iii) the clinical scenarios and related factors that lead to a final decision.
Fig. 1a: Photo of 35-year-old female patient affected by stage III grade C generalized periodontitis, with multiple teeth with a questionable long-term prognosis
Fig. 1b: Radiograph of 35-year-old female patient affected by stage III grade C generalized periodontitis, with multiple teeth with a questionable long-term prognosis
Fig. 1a
Fig. 1b