Survival of molar teeth after resective periodontal therapy - A retrospective study

Faculty of Dentistry, The University of Hong Kong, Hong Kong, SAR, China.
Journal Of Clinical Periodontology (Impact Factor: 4.01). 06/2012; 39(9):850-60. DOI: 10.1111/j.1600-051X.2012.01918.x
Source: PubMed


To study outcomes of molar teeth after resective therapy performed with the intention to prolong the lifespan of teeth having one or more unsaveable roots, and without which tooth extraction would be inevitable.
Clinical records of 149 subjects who had undergone resective therapy were retrieved. Demography and dental history were recorded, and a recall examination was undertaken. Cox regression models were performed.
Of the 149 resective therapies, 132 (88.6%) were performed for periodontal reasons. Eighty-nine (59.7%) teeth subjected to resective therapies had been extracted by the time of recall (mean 10 years post-resection). The median survival period was 74 months. Factors significantly associated with shorter survival duration of teeth subjected to resective therapy were: age at resective therapy; pre-operative radiographic bone height of the remaining root(s) <50%; pre-treatment mobility II or above and not being splinted to neighbouring teeth nor incorporated as a bridge abutment.
There was increased risk of tooth loss with increasing age at resection, grade II mobility or above, and reduced pre-operative radiographic bone heights around roots to remain. Splinting of a resected tooth to neighbouring teeth appeared to confer a protective effect towards its survival.

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    • "For periodontally compromised molars with furcation involvement (FI), survival has been found inferior compared to single-rooted or non-FI teeth, with higher effort and more complex treatment being required to retain such teeth (Dannewitz et al. 2006, Pretzl et al. 2009, Lee et al. 2012). In addition, it was speculated that long-term retention of such teeth might increase local bone loss, thereby compromising the eventual replacement of these teeth with implants (Friberg et al. 1991). "
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    ABSTRACT: AimThe comparative cost-effectiveness of retaining or replacing molars with furcation involvement (FI) remains unclear. We assessed the cost-effectiveness of retaining FI-molars via periodontal treatments versus replacing them via implant-supported crowns (ISCs).Methods Using tooth-level Markov-models, we followed a molar with FI degree I or II/III in a 50-years-old patient over his life-time. Tooth-retaining periodontal treatments (scaling and root planning, flap debridement, root resection, guided-tissue-regeneration, tunnelling) were compared with tooth-replacement using ISCs. We analysed costs, time until first re-treatment, and total time of tooth or implant retention. The model adopted a private-payer-perspective within German healthcare. Transition probabilities were calculated based on current evidence. Monte-Carlo microsimulations were performed, and robustness of the model and effects of heterogeneity assessed using sensitivity analyses.ResultsDespite requiring re-treatment later than other strategies, ISCs were the most costly therapy. Compared with most periodontal treatments, ISCs were retained for shorter time than natural teeth regardless of the degree of FI, the patients’ age, or risk profile (smoker/non-smoker).Conclusions Based on available data and within its limitations, our study indicates that retaining FI-molars via periodontal treatments might be more cost-effective than replacing them via ISCs. Changes in the underlying evidence or the setting might alter these results.This article is protected by copyright. All rights reserved.
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    ABSTRACT: Therapeutic decision making and successful treatment of furcation- involved molars has been a challenge for many clinicians. Over recent decades, several techniques have been advocated in the treatment of furcated molar teeth, including nonsurgical periodontal therapy, regenerative therapy, and resective surgical procedures. Today, root resection is considered a relevant treatment modality in the management of furcation- involved multirooted molars. However, root resective procedures are very technique-sensitive and require a high level of periodontal, endodontic, and restorative expertise. Given the high documented success rates of implant treatment, the clinician is increasingly confronted with the dilemma of whether to treat a furcated molar by traditional root resective techniques or to extract the tooth and replace it with a dental implant. This article reviews the outcomes of root resective therapy for the management of furcation-involved multirooted teeth and discusses treatment alternatives including implant therapy. Treatment guidelines for root resective therapy, along with advantages and limitations, are presented to help the clinician in the decision-making process.
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