Saving teeth with severe bone loss through periodontal regeneration (PR) can provide benefits equal to (or even greater than) replacing them with dental implants or bridges, according to a major long-term study presented by the European Federation of Periodontology (EFP) at EuroPerio11, the world’s leading gum health and implant dentistry conference.
The study followed patients for 20 years, comparing those who had their teeth saved with advanced regenerative procedures to those who had the same teeth extracted and replaced with implants or fixed bridges. The results were clear: saving the tooth is just as effective, but costs less in the long term and may provide a better experience for some patients.
In severe cases of gum disease (periodontitis), the tissues supporting the tooth, including the bone, can deteriorate, sometimes all the way to the tip of the root (apex). Traditionally, these teeth are considered “unsalvageable” and are often extracted. But periodontal regeneration uses surgical techniques and materials to rebuild lost bone and tissue, making it possible to save the tooth.
“We want to push the boundaries of ‘unsalvageable,’” says Dr. Cortellini. “Our goal was to demonstrate that, in the right patients, even very damaged teeth can be successfully treated and retained.”
The randomized controlled trial included 50 patients with severe periodontitis (stage III or IV). Each patient had at least one tooth with attachment loss extending to or beyond the apex, a sign of severe tissue destruction. Participants were divided into two groups:
PR group: received periodontal regenerative treatment to try to save the tooth
TER group: had the tooth extracted and replaced with an implant or fixed bridge
After 20 years, both treatment options—retaining the natural tooth or replacing it with an implant—proved successful. The group that retained the natural tooth had lost only four teeth, while the replacement group had only two implant failures. The gum health of patients who retained their natural teeth remained stable over time, with healthy attachment levels maintained two decades after treatment.
In terms of cost, retaining the natural tooth was significantly more cost-effective in the long term, even when ongoing care and maintenance were taken into account. Importantly, the two groups had similar results in terms of complications and treatment success.
“Replacing a tooth is not necessarily better than keeping it,” Cortellini explains. “Both can become problematic over time, especially in patients with a history of gum disease. But if we can save the tooth, we can postpone extraction for many years, which is good for both the patient and the dental care system.”
Not only do regenerative procedures cost less upfront, but this study also shows that 20 years later, they are still significantly less expensive than implants or bridges, largely because the teeth that are saved typically require less long-term repair. “Even after two decades, periodontal regeneration is still more cost-effective,” Cortellini points out.
Regeneration is a complex technology that is not suitable for every patient or every tooth. It works best for patients who are in good overall health, do not smoke, are highly motivated, and maintain good oral hygiene.
“Even if you are the best periodontist in the world, it’s hard to have long-term success if the patient is not a good fit,” Cortellini says. “Patient selection, follow-up care and patient compliance are key.”
“This landmark study proves once again that with the right doctor and the right patient, regeneration can be just as effective or more effective than replacing even severely damaged teeth,” said Lior Shapira, Scientific Chairman of EuroPerio11.
Not only is this a clinically viable option, but it can also offer significant long-term savings to patients. While we do see the cost gap narrowing slightly over time, overall it remains more cost-effective to keep your natural tooth. At the same time, it’s important to recognize that regeneration is not a one-size-fits-all solution. Continued innovation in biomaterials will also help more patients benefit from the benefits of regeneration. “
The most important message is simple: keep your tooth if you can!” concluded Cortellini. “Tooth replacement is a great option, but regeneration can provide decades of stability, allowing people to keep their teeth. Our study tells us to think twice before extracting a tooth. If that was your tooth, wouldn’t you want to try to keep it first?”
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