MANDIBULAR MOLAR ROOT RESECTION

VERSUS

IMPLANT THERAPY A RETROSPECTIVE NONRANDOMIZED STUDY

Zafiropoulos GG, Hoffmann O, Kasaj A, Willershausen B, Deli G, Tatakis DN.

Journal of Oral Implantology, 2009

INTRODUCTION

INTRODUCTION

Molar teeth with furcation involvement represent a treatment challenge that is further complicated by the multitude of available treatment options.

INTRODUCTION

Degree of furcation involvement is a major determinant for the indicated treatment modality.

One of the available treatments for molar with degree III furcation involvement is root resective therapy.

INTRODUCTION

- Although several studies have evaluated the outcomes of root resective therapy, only a limited number have directly compared root resective therapy with implant therapy.

- Published literature on the outcomes of root resective therapy and dental implants, revealed that success and complication rates vary depending on teeth treated and anatomical site.

- Because of such site-specific difference, in order to be valid, this study compared the therapeutic outcomes at the same anatomic site.

INTRODUCTION

Purpose of study:To compare the longterm complication and survival rates of root resected mandibular molars relative to that of dental implants replacing mandibular molars.

MATERIALS AND METHODS

MATERIAL AND METHODS

Patient population:- Sixty patients ( 40 men, 20 women; mean age 49.9 years) treated from January 1993 to December 2001 were included in this retrospective study.

- All patients had history of chronic periodontitis with a minimum of 4 sites with CAL loss >4mm, radiographic evidence of bone loss, and BOP in at least 4 sites.

MATERIAL AND METHODS

Inclusion criteria: 1 - Grade III furcation involvement.2 - Radiographically estimated residual bone ≥ 50% of the length of the retained root.3 - Root resective surgery performed on the 1st, or the 1st and 2nd molar.4 - No existing conditions that might interfere with periodontal or implant treatment.5 - No known drug allergies.6 - Maintenance for at least 48 months.

MATERIAL AND METHODS

Exclusion criteria :1 - Root resective surgery on 2nd molar only.2 - Implant treatment either in edentulous mandibular molar areas or in the 2nd mandibular molar only.3 - Active periodontal disease.4 - Bruxism.5 - Smoking >10 cigarettes per day.6 - The presence of pregnancy, diabetes, history of medication, or drugs abuse.

MATERIAL AND METHODS

- Patients were placed in either the hemisection-treated group (H), or the implant-treated group (I):

Table 1 Study population demographics

Group H Group I

Patient 32 28

Average age in years(min-max) 49(35-73) 51(29-67)

Smoker 14 14

Teeth or implant 56 36

Teeth or implant in smoker 20 18

Average months in maintenance (min-max) 65(48-93) 65(58-80)

TREATMENT PROCEDURES

TREATMENT PROCEDURES

Group (H):

1 - Endodontic treatment.2 - Custom-made gold posts & composite build-ups.3 - Root resection & extraction of the mesial root. 4 - The extraction site was filled with xenograft and autologous bone and covered with resorbable membrane. 5 - FPD included the 2nd premolar. When both molars were treated, FPD included 2nd 1st molar and premolar.

TREATMENT PROCEDURES

Group (I):

1 - Atraumatic extraction.2 - Socket preservation by the use of nonresorbable dPTFE membrane.3 - Implants were placed 8 months after extraction.4 - Final restorations were delivered 6 months after implant placement.

TREATMENT PROCEDURES

Postoperative care:1 - Clindamycin 600mg/day for 4 days.2 - Oral analgesic diclofenac 100mg/day for 4 days.3 - 0.1% chlorhexidine twice/day for 3 weeks.4 - Follow-up twice/month during the first 2 months, then once a month for the following 10 months.

TREATMENT PROCEDURES

Complications

Salvageable Nonsalvageable

- CAL Loss >5mm.- Peri-implantitis with an augmentable osseous defect.

- Root caries or caries at the crown margin.- Apical abscesses.- Root fractures.- Peri-implantitis with a non-augmentable osseous defect(>50%).

RESULTS

- The occurrence and timing of post-treatment complication as well as CAL, BOP PLI were evaluated.

RESULTS

Table2 Complication and Time until complication

Group Complication Teeth/implant Time in months

Group H(N=56)

No complication 38(67,9%) 64.1(48-39)

Total complication 18(32.1%) 32.6(4-65)

Salvageable 6(10.7%) 22.7(4-36)

Non-Salvageable 12(21.4%) 37.6(7-65)

Group I(N=36)

No complication 32(88.9%) 65.4(58-80)

Total complication 4(11.1%) 30.5(2-60)

Salvageable 3(8.3) 40(2-60)

Non-Salvageable 1(2.8%) 2

RESULTS

DISCUSSION

- The results indicated that both root resected mandibular molars and mandibular molar implants could be expected to have on average, a complication-free survival of 6 years.

- Root resected molars showed greater risk for complications.

- Survival rates of implants decrease with longer follow-up periods.

DISCUSSION

-The prognosis of dental implants placed where teeth lost due to periodontal disease was worse than implants placed as a result of teeth lost for other reasons.

- Treatment of implants with bone loss exceeding 50% of the implant length does not lead to satisfactory long-term results.

DISCUSSION

- A multitude of factors may influence treatment outcome of tooth resective therapy. Among theses are tooth type, parafunctional habits, endodontic therapy, and prosthodontic treatment.

- 50% of the complications in root-resected molars were due to root caries, suggesting that more effective anti-caries measurement could reduce the rate of failures.

- Case selection is very critical for root-resective therapy. Each case must be carefully evaluated to assess whether adequate endodontic, prosthodontic, and maintenance therapy is feasible, including considerations related to surgical access and patient motivation.

DISCUSSION

Conclusion

Within the limitations of this retrospective study, the results indicated that implants replacing periodontally involved mandibular molars had fewer complications than hemisected mandibular molars.

Further studies are needed to confirm and allow generalization of these findings.

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