Strategic considerations in treatment planning: deciding when to treat, extract, or replace a questionable tooth

Cost-effectiveness of anterior implants versus fixed dental prostheses

For the restoration of an anterior missing tooth, implant-supported single crowns (ISCs) or fixed dental prostheses (FDPs) are indicated, but it is not clear which type of restoration is more cost-effective. A self-selected trial was performed with 15 patients with ISCs and 11 with FDPs. Patient preferences were recorded with visual analog scales before treatment, 1 month following restoration, and then annually. Quality-adjusted tooth years (QATYs) were estimated by considering the type of reconstruction for replacing the missing tooth and its effect on the adjacent teeth. A stochastic cost-effectiveness model was developed using Monte Carlo simulation. The expected costs and QATYs were summarized in cost-effectiveness acceptability curves. ISC was the dominant strategy, with a QATY increase of 0.01 over 3 years and 0.04 over 10 years with a higher probability of being cost-effective. While both treatment options provided satisfactory long-term results from the patient's perspective, the lower initial costs, particularly laboratory fees, were responsible for the dominance of ISCs over FDPs.

Is furcation involvement in maxillary molars a predictor for subsequent bone augmentation prior to implant placement? A pilot study

AIM

The aim of this pilot study was to analyze the interfurcal bone height in relation to the possible need for subsequent sinus floor elevation in patients with advanced periodontitis and furcation involvement of first and/or second maxillary molars.

MATERIAL AND METHODS

Seventeen dentate patients, who received cone beam computed tomography (CBCT) for detailed preoperative diagnosis and planning of surgical interventions at periodontally involved maxillary molars (17 first and 15 second molars), were consecutively recruited for the study. The minimal bone height in the interfurcal region was measured from CBCT and related to furcation involvement, residual bone above the root tips, and the clinical probing pocket depth (PPD).

RESULTS

The minimal interfurcal bone height measured 4.1 ± 2.6 mm on average with 75% of maxillary molars having ≤ 6 mm and almost 60% having only ≤ 4 mm bone height left below the sinus floor. A higher risk for reduced interfurcal bone height of ≤ 4 mm was given when residual PPD of ≥ 6 mm was remaining at two or more tooth sites (OR 0.10; 0.11).

CONCLUSIONS

The majority of periodontally involved maxillary molars had a substantially reduced interfurcal bone height, particularly with at least two sites with residual PPD ≥ 6 mm. This was a predictor for a subsequent need for sinus floor elevation when tooth replacement with a dental implant is desired.

Are implants more reliable than severely compromised endodontically treated teeth as abutments for zirconia-based FPDs? : In vitro results of long-term preclinical load simulation

OBJECTIVES

The aim was to study the impact of the defect size of endodontically treated incisors compared to dental implants as abutments on the survival of zirconia two-unit anterior cantilever-fixed partial dentures (2U-FPDs) during 10-year simulation.

MATERIALS AND METHODS

Human maxillary central incisors were endodontically treated and divided into three groups (n = 24): I, access cavities rebuilt with composite core; II, teeth decoronated and restored with composite; and III as II supported by fiber posts. In group IV, implants with individual zirconia abutments were used. Specimens were restored with zirconia 2U-FPDs and exposed to two sequences of thermal cycling and mechanical loading.

STATISTICS

Kaplan-Meier; log-rank tests.

RESULTS

During TCML in group I two tooth fractures and two debondings with chipping were found. Solely chippings occurred in groups II (2×), IV (2×), and III (1×). No significant different survival was found for the different abutments (p = 0.085) or FPDs (p = 0.526). Load capability differed significantly between groups I (176 N) and III (670 N), and III and IV (324 N) (p < 0.024).

CONCLUSION

Within the limitations of an in vitro study, it can be concluded that zirconia-framework 2U-FPDs on decoronated teeth with/without post showed comparable in vitro reliability as restorations on implants. The results indicated that restorations on teeth with only access cavity perform worse in survival and linear loading.

CLINICAL RELEVANCE

Even severe defects do not justify per se a replacement of this particular tooth by a dental implant from load capability point of view.

Patient preferences regarding 1-visit versus 2-visit root canal therapy

INTRODUCTION

Patient preferences should be taken into account by clinicians when treatment planning. The purposes of this study were to describe the number of visits patients preferred when undergoing root canal therapy (RCT) and to assess whether their preferences were related to hypothetical treatment success rates.

METHODS

Self-administered questionnaires were mailed to 351 consecutive patients scheduled for initial RCT appointments in the University of Iowa College of Dentistry's graduate or faculty endodontic clinic. The questionnaires ascertained demographic information; preferences for 1-visit versus 2-visit RCT given different hypothetical success rate scenarios for the 2 approaches, as well as patient dental history. Univariate frequency distributions were generated, and relationships between hypothetical success rates and patient preferences were evaluated.

RESULTS

Questionnaires were returned by 124 patients (35% response). Given equal success rates, 78% of respondents preferred 1-visit RCT, compared with 7% who preferred 2-visit RCT and 16% who would follow their dentist's recommendation. As success rates for 2-visit RCT went from equal to 5% better to 10% better to 20% better compared with 1-visit RCT, the proportion of respondents who preferred 2-visit RCT increased from 7% to 34% to 46% to 65%, respectively. Regardless of success rates, approximately 5% of respondents said they would prefer 2-visit RCT, and 20% would do whatever their dentist recommended.

CONCLUSIONS

Although most respondents preferred 1-visit RCT regardless of success rates, many would prefer 2-visit RCT if its success rate were greater than that of 1-visit RCT. This finding confirms the importance of discussing success rates and considering patients' wishes when treatment planning.

Oral rehabilitation considerations for partially edentulous periodontal patients

Traditional tooth-supported and implant-supported fixed/removable restorations are currently used to replace teeth lost due to periodontal disease. This article reviews the existing literature for oral rehabilitation of partially edentulous periodontal patients with various designs of removable dental prosthesis (RDP), fixed dental prosthesis (FDP) and implant-supported single crown (SC), by addressing their (a) general features, (b) survival and complication rates, along with considerations for treatment planning in periodontal patients, and (c) preference by patients. To answer these issues, relevant articles were searched and critically analyzed, and their data were extracted. Data reviewed indicated that despite many advantages, implant-supported restorations have higher complication rates than tooth-supported restorations. Systematic reviews on conventional RDPs are lacking, but existing literature reviews provide limited evidence suggesting the use of RDPs with design modifications along with strict periodontal care in periodontal patients. Numerous systematic reviews on conventional FDPs and implant-supported restorations provide a moderate level of evidence favoring their survival in periodontal patients; however, for long-term success of these restorations, the patient's periodontal condition needs to be stabilized. In terms of patient preference, no restoration is superior, as they all are governed by their cost, advantages, and disadvantages. Thus, in the wake of existing weak evidence for prosthodontic rehabilitation of periodontal patients by these restorations (especially, conventional RDPs and for FDPs and SCs in implant-supported restorations), longitudinal studies with standardized treatment protocol and methodology are needed to evaluate and compare tooth-supported and implant-supported restorations in periodontal patients with regard to survival rates, cost, maintenance, and patient-centered outcomes.

Refining definitions of periodontal disease and caries for prediction models of incident tooth loss

AIM

To assess the suitability of different definitions of caries and periodontitis for inclusion in tooth loss prediction models.

MATERIALS AND METHODS

The Study of Health in Pomerania (SHIP) is a population-based cohort study conducted in 1997-2001 (SHIP-0) and 2002-2006 (SHIP-1). This sample comprised 2,780 subjects aged 20-81 years with complete information on dental and periodontal status [DMFS status, clinical attachment loss (CAL) and probing depth (PD)]. Analyses on five-year tooth loss were limited to half-mouth data.

RESULTS

The predictive value of tested definitions was markedly age- and gender-dependent: in 20-39-aged men, the number of decayed or filled surfaces best predicted the number of lost teeth, whereas in young women CAL≥4 mm performed best. In older subjects, periodontal definitions were superior to caries definitions: mean CAL performed best in 40-59-year olds, whereas AL- or PD-related definitions predicted best in 60-81-year olds. On tooth level, mean CAL was the superior definition to assess 5-year incident tooth loss in all strata except for young men.

CONCLUSIONS

Caries parameters best predicted incident tooth loss in men aged 20-39 years; in the intermediate and oldest age group and in young women, mean AL was most informative. Therefore, prediction models need to be developed for different age and gender groups.

Dentigenous infectious foci - a risk factor of infective endocarditis

BACKGROUND

Dentigenous, infectious foci are frequently associated with the development of various diseases. The role of such foci in the evolution of endocarditis still remains unclear. This article presents the concluding results of an interdisciplinary study verifying the influence of dentigenous, infectious foci on the development of infective endocarditis.

MATERIAL/METHODS

The study subjects were 60 adult patients with history of infective endocarditis and coexistent acquired heart disease, along with the presence at least 2 odontogenic infectious foci (ie, 2 or more teeth with gangrenous pulp and periodontitis). The group had earlier been qualified for the procedure of heart valve replacement. Swabs of removed heart valve tissue with inflammatory lesions and blood were then examined microbiologically. Swabs of root canals and their periapical areas, of periodontal pockets, and of heart valves were also collected.

RESULTS

Microbial flora, cultured from intradental foci, blood and heart valves, fully corresponded in 14 patients. This was accompanied in almost all cases by more advanced periodontitis (2nd degree, Scandinavian classification), irrespective of the bacterial co-occurrence mentioned. In the remaining patients, such consistency was not found.

CONCLUSIONS

Among various dentigenous, infectious foci, the intradental foci appear to constitute a risk factor for infective endocarditis.

Correlations between photogrammetric measurements of tooth mobility and the Periotest method

OBJECTIVE

The purpose of the present study was to investigate whether or not the quantitative Periotest values of anterior teeth correlate with quantitative metric values of tooth mobility under vertical (VL) and horizontal load (HL) in periodontally healthy subjects.

MATERIALS AND METHODS

Thirty-one subjects with good periodontal conditions were included and subjected to two different tooth mobility measurement techniques. Periotest values were measured at reproducible measurement points in the vertical (vPT) and horizontal (hPT) dimensions of upper central and lateral incisors and canine teeth. Using the optical measurement technique (photogrammetry), tooth mobility was measured under load in the horizontal (HL) and vertical loading directions (VL) at different load forces. Pearson's correlation coefficients were used to determine exploratory associations.

RESULTS

The comparison between hPT and HL showed no correlations between the two measurements except for 'weak' and 'moderate' correlations for teeth 21 and 23. The analysis of correlations between vPT and VL data showed statistically significant correlations for both the left and right canine teeth that ranged from 'weak' to 'high'. Comparisons between hPT values and VL and between vPT and HL showed significant correlations at a few loading forces only.

CONCLUSION

Quantitative Periotest values cannot be used to draw conclusions about the metric assessment of tooth mobility. For this purpose, the photogrammetric technique could be an additional tool for scientific questions.