How hard should we fight to save a tooth? The answer depends on several factors. There is no definitive set of research to guide us in each specific case, but clinical research and experience certainly help shape our decisions.
In today’s case, the periodontal defect around #28 jeopardized the stability and prognosis of the tooth. Since it was a bridge abutment, extracting it would have resulted in the need for two implants in addition to the extraction and socket graft. A significantly more conservative approach, which the patient and we preferred, was periodontal surgery with bone grafting. The before and after radiographs show complete fill of the defect after 6 months of healing. Post-surgical probing depths are 3mm, and the prognosis for the tooth is now good. Unfortunately, it may be developing a root canal problem as you can see on the post-surgical radiograph (although it is asymptomatic). Even still, we believe that salvaging it will be successful for many years. Since complications with implants (peri-implant mucositis or peri-implantitis, component loosening or failure) are relatively common over long time spans – often decades – postponing placement starts the clock ticking much later in life. Delaying implant placement is philosophically similar to delaying prosthetic knee or hip replacement, which is now the standard approach for orthopedic surgeons.
Some teeth cannot be saved, in which case implant therapy is often the best approach. But when teeth can be stabilized for years or longer, even with a compromised prognosis, they are often worth the effort.
Amy and David