A major long-term study in Belgium reveals that saving teeth with severe bone loss through periodontal regeneration (PR) offers benefits equal to—if not greater than—replacing them with dental implants or bridges.
The study by a team at KU Leuven—and presented at EuroPerio11—followed patients for 20 years, comparing those who underwent advanced regenerative procedures to keep a tooth, with those who had the same tooth extracted and replaced with either an implant or a fixed bridge. The findings are clear: saving the tooth can work just as well, costs less in the long term, and may offer a better experience for some patients.
The randomised controlled trial involved 50 patients with severe periodontitis (Stage III or IV). Each had at least one tooth with attachment loss extending to or beyond the apex, a sign of extreme tissue destruction. Participants were divided into two groups:
- PR group: received periodontal regeneration to try to save the tooth
- TER group: had the tooth extracted and replaced with either an implant or a fixed bridge
After 20 years, both treatment options proved to be successful. Only four teeth were lost in the group that kept their natural teeth, while just two implants failed in the replacement group. Gum health remained stable over time in patients who kept their teeth, with healthy attachment levels maintained two decades after treatment.
When it came to cost, keeping the natural tooth turned out to be significantly less expensive in the long run, even when factoring in ongoing care and maintenance. Importantly, both groups had similar results in terms of complications and treatment success.
“Replacing a tooth is not necessarily better than saving it,” Dr Cortellini said.
“In both cases, there’s a chance of problems over time, especially in patients with a history of gum disease. But if we can save the tooth, we delay extraction for many years and that’s a win for patients and for dental care systems.”
