Thursday, October 22, 2009

Why save bad teeth?

Controversial topic, but definitely worth discussing. I’ve often come across patients keen on saving teeth which are virtually hopeless. Of course, there will be dentists out there who are willing to take on these cases. Most of these cases are extremely challenging, prone to failure and expensive. Should these teeth still be saved? I think the patient needs to make a very well-informed choice and come to a decision accepting responsibility for the outcome.

There will be some successes in salvaging one of these “hopeless” cases, but neither practitioner nor patient should be carried away by all the hype in “new technology”. Take a look at the case below. The best option for this patient (and I would do it for my own mother) is to extract those 3 lower front teeth abd replace them with implants. But there are patients and dentists out there who would take up the challenge save those teeth. It’s OK as long as everybody understands the outcome and long-term stability of such measures.

Why Save Bad Teeth? Dental ‘Heroics’ Unnecessary And Failure Prone
29 Aug 2009

For years, it was common practice for dentists to perform repeat root canals and other procedures to save teeth compromised by extensive decay, gum disease and bone loss. Today, the American Academy of Implant Dentistry (AAID) said times have changed and patients should forego prolonged dental heroics to save failing teeth and replace them with long-lasting dental implants.

“There really is no justification for undergoing multiple endodontic or periodontic procedures, and enduring the pain and financial burden, to save a diseased tooth,” said John Minichetti, DDS, speaking for the AAID. “The days are over for saving teeth till they fall out. Preserving questionable teeth is not the best option from both oral health and cosmetic perspectives.”

Losing a tooth is an emotional decision and patients must clearly understand the oral health and cosmetic implications of preserving questionable teeth. Even though patients often resist losing natural teeth, in many cases the best outcomes occur from extracting them and inserting implants, which look and function like natural teeth.

“Our patients expect restorative dental procedures to make their smiles more attractive and long- lasting. In most cases, implants deliver the best results, as the ultimate goal is to achieve an esthetic and functional restoration for years to come,” said Minichetti.

Published studies have shown there is a higher failure rate of root canal procedures vs. dental implants. In some cases, root canals fail because abscesses occur, and oral surgery is required to clean out the infected area.

Minichetti noted that a recent study published in the Journal of Oral Implantology showed that single-tooth dental implants are 98.5 percent successful after seven years and there was no discernable bone loss in almost all the implant sites. First-time root canals fail 5 percent of the time, according to the American Academy of General Dentistry, and at much higher rates in repeat procedures. Further, endodontic surgical re-treatments, according to published studies, have success rates ranging from 37 to 87 percent.

Saving compromised teeth in the esthetic zone with periodontal treatments also can have unfavorable cosmetic results, according to Minichetti. “Periodontal procedures to save decaying natural teeth can require raising the gum line and exposing teeth roots to anchor a new crown,” he said. “The crown needs something to hold onto, so you have to push the gum tissue up with unfavorable cosmetic impact.” He noted that patients should always ask the dentists how their smiles will look if they chose to save a questionable tooth in the esthetic zone with a periodontal procedure.

Source: American Academy of Implant Dentistry

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