Prior to the introduction of implants into the dental profession in the late 80's, severe periodontal disease was either treated, or extractions were done and removable prosthesis were fabricated. The introduction of implants gave us another option but in some cases, and perhaps too many, we have thrown out the baby with the bath water.
More than 20 years ago a 35 year-old woman presented with advanced periodontitis affecting her posterior dentition, most severe in the maxillary posterior teeth. Several alternatives were possible in management of this young patient.
The first option was temporary periodontal treatment and evaluate the long term effects if the patient was committed to careful maintenance.
The second option was to extract the remaining maxillary posterior teeth and make a removable appliance.
A third option would be to remove the maxillary posterior teeth, bone graft the sockets, perform sinus lifts bilaterally and subsequently replace with implants.
In this case the first treatment option was chosen. The patient was highly motivated and desirous of not losing her maxillary teeth. In addition, the economic investment for the other options was beyond her means at that time in her life. In today's terms, the cost of removing the 8 teeth, bone grafting bi-laterally, bi-lateral sinus lifts, 8 implants and 8 crowns would have probably cost this patient close to $50,000.
Now with a 20-year perspective, a patient who shows up every 3 months, has meticulous oral hygiene, is carefully debrided intermittently and has had the use of systemic antibiotics several times during the course of treatment
just to depress pathogens that were detected via culture, we can see radiographs taken this year compared to those taken in 2001.
While this is not possible in all cases, it took the perfect combination of a highly committed patient willing to practice effective oral hygiene, frequent visits for maintenance, and periodic culturing as needed to reach the outcome that we have today.
One final caveat - given her propensity for periodontal disease and the crown to root ratio among many of these implants given the amount of bone loss she would have had following extraction of these teeth, one wonders what would have happened in terms of peri-implantitis had implants been placed 20 years ago in a patient highly susceptible to periodontitis.
Those of us who have been placing implants for over 30 years unfortunately encounter patients that have developed peri-implantitis, a condition that is not easily treated. Once the implants are lost, the options become even more limited.
As always I appreciate your feedback
Victor M. Sternberg, D.M.D.
By Westchester Center for Periodontal & Implant Excellence
January 12, 2023