Periodontal regeneration versus extraction and dental implant or prosthetic replacement of teeth severely compromised by attachment loss to the apex: A randomized controlled clinical trial reporting 10-year outcomes, survival analysis and mean cumulative cost of recurrence
Pierpaolo Cortellini, Gabrielle Stalpers, Aniello Mollo, Maurizio S Tonetti, Pierpaolo Cortellini, Gabrielle Stalpers, Aniello Mollo, Maurizio S Tonetti
Abstract
Background: Periodontal regeneration can change tooth prognosis and represents an alternative to extraction in teeth compromised by severe intra-bony defects. The aim of this study was to compare periodontal regeneration (PR) with tooth extraction and replacement (TER) in a population with attachment loss to or beyond the apex of the root in terms of professional, patient-reported and economic outcomes.
Methods: This was a 10-year randomized controlled clinical trial. 50 stage III or stage IV periodontitis subjects with a severely compromised tooth with attachment loss to or beyond the apex were randomized to PR or TER with either an implant- or a tooth-supported fixed partial denture. Subjects were kept on a strict periodontal supportive care regimen every 3 months and examined yearly. Survival and recurrence analysis were performed.
Results: 88% and 100% survival rates were observed in the PR and TER groups. Complication-free survival was not significantly different: 6.7-9.1 years for PR and 7.3-9.1 years for TER (p = .788). In PR, the observed 10-year attachment gain was 7.3 ± 2.3 mm and the residual probing depths were 3.4 ± 0.8 mm. Recurrence analysis showed that the 95% confidence interval of the costs was significantly lower for PR compared with TER throughout the whole 10-year period. Patient-reported outcomes and oral health-related quality-of-life measurements improved in both groups.
Conclusions: Periodontal regeneration can change the prognosis of hopeless teeth and is a less costly alternative to tooth extraction and replacement. The complexity of the treatment limits widespread application to the most complex cases but provides powerful proof of principle for the benefits of PR in deep intra-bony defect.
Trial registration: ClinicalTrials.gov NCT04227964.
Keywords: dental implants; fixed partial dentures; health economics; periodontal regeneration; randomized controlled clinical trial; recurrence analysis; survival analysis.
Conflict of interest statement
The authors report no conflict of interest in this study.
© 2020 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.
Figures
References
- Cortellini, P. , Buti, J. , Pini Prato, G. , & Tonetti, M. S. (2017). Periodontal regeneration compared with access flap surgery in human intra‐bony defects 20‐year follow‐up of a randomized clinical trial: Tooth retention, periodontitis recurrence and costs. Journal of Clinical Periodontology, 44, 58–66. 10.1111/jcpe.12638
- Cortellini, P. , Cortellini, S. , & Tonetti, M. S. (2019). Papilla preservation flaps for periodontal regeneration of molars severely compromised by combined furcation and intrabony defects: Retrospective analysis of a registry‐based cohort. Journal of Periodontology, 91(2), 165–173. 10.1002/JPER.19-0010
- Cortellini, P. , Prato, G. P. , & Tonetti, M. S. (1995). The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures. Journal of Periodontology, 66, 261–266.
- Cortellini, P. , Prato, G. P. , & Tonetti, M. S. (1999). The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. International Journal of Periodontics & Restorative Dentistry, 19, 589–599.
- Cortellini, P. , Stalpers, G. , Mollo, A. , & Tonetti, M. S. (2011). Periodontal regeneration versus extraction and prosthetic replacement of teeth severely compromised by attachment loss to the apex: 5‐year results of an ongoing randomized clinical trial. Journal of Clinical Periodontology, 38, 915–924.
- Cortellini, P. , & Tonetti, M. S. (2001). Microsurgical approach to periodontal regeneration. Initial evaluation in a case cohort. Journal of Periodontology, 72, 559–569.
- Cortellini, P. , & Tonetti, M. S. (2004). Long‐term tooth survival following regenerative treatment of intrabony defects. Journal of Periodontology, 75, 672–678.
- Cortellini, P. , & Tonetti, M. S. (2005). Clinical performance of a regenerative strategy for intrabony defects: Scientific evidence and clinical experience. Journal of Periodontology, 76, 341–350. 10.1902/jop.2005.76.3.341
- Cortellini, P. , & Tonetti, M. S. (2015). Clinical concepts for regenerative therapy in intrabony defects. Periodontology 2000, 68, 282–307.
- Kwok, V. , & Caton, J. G. (2007). Commentary: Prognosis revisited: a system for assigning periodontal prognosis. Journal of Periodontology, 78(11), 2063–2071.
- McGuire, M. K. , & Nunn, M. E. (1996a). Prognosis versus actual outcome. III. The effectiveness of clinical parameters in accurately predicting tooth survival. Journal of Periodontology, 67(7), 666–674.
- McGuire, M. K. , & Nunn, M. E. (1996b). Prognosis versus actual outcome. II. The effectiveness of clinical parameters in developing an accurate prognosis. Journal of Periodontology, 67(7), 658–665.
- Nygaard‐Ostby, P. , Bakke, V. , Nesdal, O. , Susin, C. , & Wikesjo, U. M. (2010). Periodontal healing following reconstructive surgery: Effect of guided tissue regeneration using a bioresorbable barrier device when combined with autogenous bone grafting. A randomized‐controlled trial 10‐year follow‐up. Journal of Clinical Periodontology, 37, 366–373. 10.1111/j.1600-051X.2010.01532.x
- Ong, C. T. , Ivanovski, S. , Needleman, I. G. , Retzepi, M. , Moles, D. R. , Tonetti, M. S. , & Donos, N. (2008). Systematic review of implant outcomes in treated periodontitis subjects. Journal of Clinical Periodontology, 35, 438–462.
- Pjetursson, B. E. , Bragger, U. , Lang, N. P. , & Zwahlen, M. (2007). Comparison of survival and complication rates of tooth‐supported fixed dental prostheses (FDPs) and implant‐supported FDPs and single crowns (SCs). Clinical Oral Implants Research, 18(Suppl. 3), 97–113.
- Pjetursson, B. E. , Tan, K. , Lang, N. P. , Bragger, U. , Egger, M. , & Zwahlen, M. (2004). A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clinical Oral Implants Research, 15, 667–676.
- Pjetursson, B. E. , Thoma, D. , Jung, R. , Zwahlen, M. , & Zembic, A. (2012). A systematic review of the survival and complication rates of implant‐supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clinical Oral Implants Research, 23(Suppl. 6), 22–38.
- Pretzl, B. , Kim, T. S. , Steinbrenner, H. , Dorfer, C. , Himmer, K. , & Eickholz, P. (2009). Guided tissue regeneration with bioabsorbable barriers III 10‐year results in infrabony defects. Journal of Clinical Periodontology, 36, 349–356.
- Schmidlin, K. , Schnell, N. , Steiner, S. , Salvi, G. E. , Pjetursson, B. , Matuliene, G. , … Lang, N. P. (2010). Complication and failure rates in patients treated for chronic periodontitis and restored with single crowns on teeth and/or implants. Clinical Oral Implants Research, 21, 550–557.
- Sculean, A. , Kiss, A. , Miliauskaite, A. , Schwarz, F. , Arweiler, N. B. , & Hannig, M. (2008). Ten‐year results following treatment of intra‐bony defects with enamel matrix proteins and guided tissue regeneration. Journal of Clinical Periodontology, 35, 817–824.
- Slade, G. D. (1997). Derivation and validation of a short‐form oral health impact profile. Community Dentistry and Oral Epidemiology, 25, 284–290.
- Sousa, V. , Mardas, N. , Farias, B. , Petrie, A. , Needleman, I. , Spratt, D. , & Donos, N. (2016). A systematic review of implant outcomes in treated periodontitis patients. Clinical Oral Implants Research, 27, 787–844.
- Tan, K. , Pjetursson, B. E. , Lang, N. P. , & Chan, E. S. (2004). A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clinical Oral Implants Research, 15, 654–666.
- Tonetti, M. S. , Cortellini, P. , Pellegrini, G. , Nieri, M. , Bonaccini, D. , Allegri, M. , … Zuhr, O. (2018). Xenogenic collagen matrix or autologous connective tissue graft as adjunct to coronally advanced flaps for coverage of multiple adjacent gingival recession: Randomized trial assessing non‐inferiority in root coverage and superiority in oral health‐related quality of life. Journal of Clinical Periodontology, 45, 78–88. 10.1111/jcpe.12834
- Tonetti, M. S. , Greenwell, H. , & Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Clinical Periodontology, 45(Suppl. 20), S149–S161.
Source: PubMed