Journal of Dental and Oral Health

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Dilemma ????? Tooth or Implants

Vishal Sahayata

Correspondence Address :

Vishal Sahayata, B.D.S, M.D.S
Periodontist, Senior lecturer at Department of Periodontology and Oral Implantology
Faculty of Dental Science
Dharmsinh Desai University
Email: drvishalsahayata@yahoo.co.in

Received on: December 15, 2016, Accepted on: December 24, 2016, Published on: December 31, 2016

Citation: Vishal Sahayata (2016). Dilemma ????? Tooth or Implants

Copyright: 2016 Vishal Sahayata. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Dental implants are increasingly being used as a means of tooth replacement. The most complex and debatable question is whether to extract a periodontally compromise tooth and its subsequent replacement with a dental implant or its retention by means of comprehensive periodontal therapy.
Usually, the decision to extract a tooth is based on multiple patient and site risk factors, periodontal, endodontic and restorative criteria and the strategic role of the tooth in the dentition. Decision is also influenced by dentist's clinical experience, access to technology & postgraduate education, patient preferences and economic parameter [1-3].
Current clinical evidence has positioned implants as one of the first choices and has influenced the decision making in a number of cases which may be treatable [4-6]. It has been suggested that planned or strategic extractions will prevent further bone destruction in a periodontally compromised potential implant site [7]. However such an approach is not always supported by the current evidence [8] as extraction will result in resorption of alveolar bone that cannot be completely controlled [9-11].
Early extraction of periodontally involved teeth and their replacement with dental implants has advantages like better long-term prognosis, better function, cost-benefit, aesthetics, and patient satisfaction when compared to periodontally compromised tooth. However, it is questionable to which extent these postulations are supported by the current evidence as extraction of periodontitis-affected teeth does not eliminate the host related factors and may predispose for the development of peri-implantitis. Therefore, it's better to treat periodontally compromised teeth as long as possible. Admittedly, the good- or poor- prognosis of periodontally involved teeth is not always easy to predict and traditional well documented and evidence based means to treat periodontal diseases are not always used to their full potential. 
Recently implant-survival has improved a lot and there is a widespread belief within the dental profession and the public that dental implants have a higher predictability for success and tend to have fewer complications than periodontally compromised treated teeth. In a sense, environment has been created that implants can solve all problems.
Concluding, the direct comparison of teeth vs. implants is difficult to make because implants should be considered as a treatment for tooth loss and not as tooth substitute. Before implant dentistry was available, significantly more effort was placed on preserving teeth. Today, when a tooth has hopeless or even questionable prognosis, the first treatment alternative is extraction and replacement with a dental implant if possible. Therefore, it's high time to revisit the concept of periodontitis management and to re-evaluate the inclusion criteria of periodontal patients qualifying for dental implants to reduce implant failures.

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