Periodontal Regeneration Versus Tooth Extraction and Replacement Denture in Teeth With Periodontal Hopeless Prognosis

Periodontal Regeneration vs Extraction and Replacement of Teeth Severely Compromised by Attachment Loss to the Apex: a 10-year RCT

Periodontal regeneration can change tooth prognosis and represents an alternative to extraction in teeth compromised by severe intrabony defects. The aim of this study is 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.

This was a single center 10-year randomized controlled clinical trial. 50 stage III or 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, complication free survival, recurrence analysis, oral health related quality of life and patient reported outcomes analyses will be performed.

Inclusion Criteria:

• Good general health
• Non-smokers or smokers with less than 20/day
• Good oral hygiene (FMPS<25%)
• Good control of periodontitis (FMBS<25%)
• Good compliance with treatment
• Presence of generalised stage III or IV periodontitis
• Radiographic bone loss to the apex or beyond the apex of the root at at least one interdental aspect
• Presence of severe clinical attachment level loss (>10 mm)
• Presence of clearly identifiable crest of bone in adjacent teeth
• Lack of function due to hyper mobility
• Vital or non-vital teeth

Exclusion Criteria:

• Medical contraindication to elective surgery
• Poor oral hygiene
• Incomplete control of periodontitis in the dentition
• Inadequate compliance
• Inability to provide informed consent