Dental Tribune Israel Edition

6 Dental Tribune Israel | 11/2016 Tooth or implant: what do you prefer? Prof. Liran Levin Head, Division of Periodontology, School of Dentistry, Faculty of Medicine and Dentistry Universality of Alberta, Canada Perio-prosthetic implant treatment plan is usually based on tooth prognosis evaluation and its comparison to the anticipated long-term implant survival. Different approaches for determining tooth prognosis were described in the literature. Over the past decade, the use of osseointegrated implants as a foundation for prosthetic replacement of missing teeth has become widespread. However, there is an increasing trend toward replacing diseased teeth with dental implants. When planning a treatment, the first step should be treating the disease. Proper diagnosis followed by the appropriate treatment for disease control must come before planning the reconstructive phase. Only after achieving a stable and disease-free conditions, the next step of the treatment should be planned. Unfortunately, nowadays, many times we are drawn to initiate a ‫׳‬definitive‫׳‬ treatment plan before controlling the disease. This leads frequently, to extraction of teeth that we would have saved and treated in the past in favor of placing implants. An implant should be a tool to replace a missing tooth and must not be a major consideration in the decision to extract a tooth. Proper periodontal and dental treatment should be performed first in order to try and keep our patients’ own dentition and only after all our reasonable efforts failed, we should turn to the alternative of extraction and replacement of the tooth. Tooth extraction should be regarded as amputation of an organ and not as a routine, unpreventable, way of treatment (1). Furthermore, careful look at the available tooth prognosis evaluation systems, it seems that we cannot really predict tooth prognosis in a good way, and too frequently we underestimate our ability to treat and maintain teeth (2). This, together with the lack of real long-term good evidence for implant success without complications (3) and with the raising awareness to peri- implant disease (4) should serve as a warning sign for us to try better to preserve the natural dentition. It should be kept in mind that extraction of a tooth will always be possible along the road, however, once extracted, there is no way back. We, as dental professionals, should avoid basing our treatment planning on thoughts and beliefs and stick as much as possible to evidence based practice. We should also do our best to treat and cure our patients rather than fixing and replacing their organs with prosthetic appliances (5). Referencec 1. Levin L. Give Teeth a Chance. Quintessence International 2013; 44: 383. 2. Halperin-Sternfeld M, Levin L. Do We Really Know How to Evaluate Tooth Prognosis? A Systematic Review and Suggested Approach. Quintessence International 2013; 44: 447-456. 3. Levin L, Halperin-Sternfeld M. Tooth preservation or implant placement: A Systematic Review of Long Term Tooth and Implant Survival Rates.The Journal of the American Dental Association (JADA) 2013; 144: 1119-1133. 4. Levin L. Peri-implantitis: The disease of the future. Quintessence International 2013; 44: 643. 5. Levin L. Cure – don’t just fix. Quintessence International 2016; 47: 179. Prof. Liran Levin

Dental Tribune Israel Edition

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