Monday, June 8, 2015

Are Dental Implants Forever?

In previous posts, we have discussed the differences between implants and root canal therapy.  We have made the argument, which is still seen playing out in many of our dental journals, that implants and root canals are not really alternative treatments.  If a tooth is restorable (no root fracture, stable periodontium) then maintaining the the natural tooth is the ideal treatment.

At Superstition Springs Endodontics, we work with the best dentists in the east valley, who understand and help their patients understand the value of the natural tooth. However, many patients get information from other sources that give them the impression that implants are just like teeth, but never get cavities, periodontal disease or any of the other challenges we have in maintaining our natural teeth. This view is not the whole story and doesn't help patients understand the unique challenges that implants have.

Those who propagate the idea that implants are a better and hassle-free version of natural teeth will use implant research to argue that an implant is more successful than traditional restorative dentistry.  Many patients and some dentists are convinced that dental implants are without complication and have unlimited lifespan.  It is not until recently that we have begun to see articles addressing the "Failure of Dental Implants" (JADA Aug 2014, p.835-842.)  Terms such as "ailing" implants and "reimplantation" are new on the scene.

However, an article in the Journal of Clinical Periodontology by Cairo et. al. reviewed the quality of reporting of randomized clinical trials in implant dentistry from 1989 - 2011.  Their systematic review found that the implant trials were mainly parallel trials, single center trials.

Methodological flaws noted were:
Random sequence generation only 37% of the time
No information given regarding allocation concealment 75% of the time
Correct sample size calculation only 12% of the time
Blinded examiner only 42% of the time

While these methodological flaws affected the reporting of these studies, they also noted that the quality of these studies only partially improved over time.  They found that allocation concealment was at a high risk of bias, there was a lack of reporting characteristics of drop-outs, and lack of CONSORT adherence.

The authors concluded that with these methodological flaws, and failure to adhere to CONSORT, the statistically significant results reported in this body of implant studies, caution is suggested in data interpretation and generalization of outcomes.

It is also noted that many of the methodological flaws seen in implant research are also found in endodontic research, dental research in general, and all throughout medicine as well. However, we should expect and demand that the quality of the research published and used to make treatment recommendations should be improving over time.


Greenstein, G. Cavallaro, John. "Failed Dental Implants: Diagnosis, Removal and Survival of Reimplantations" JADA 2014. 145(8), 835-842.

Cairo, F., Sanz, I., Matesanz, P., Nieri, M., Pagliaro, U. "Quality of Reporting of Randomized Clinical Trials In Implant Dentistry. A Systematic Review on Critical Aspects in Design, Outcome Assessment and Clinical Relevance"  J. Clin Periodontol 2012. 39(Suppl. 12), 81-107.


Enhance Dentist said...

Before performing any dental implant surgery, there should always be thorough consultation, careful study and checkup. I agree that not all cases of missing teeth should be replaced with dental implant when it can be restored naturally. Nice post!

Just dropping by.

David Kim,

Unknown said...

I really like that you say it is idea to keep the natural tooth. Dental implants should only be done if you have poor teeth that are beyond repair. They do last a long time. You still must care for them, but they will last. Just keep these things in mind when making the decision between a root canal and dental implant.

Brent said...

At my dental practice I always lean towards a more conservative approach. If at all possible I will keep the natural teeth intact. Sometimes a tooth is too far gone, and only then will I resort to dental implants.

Cass said...

Hi Doc,

This is great information. I sent this off to one of my patients this morning so they can get another look at what he needs done. It's great that you are putting this type of information up for patients and other dentists to see.

James, you are at the right blog post if you are seeing my notes here.

Thanks again Doc!
Palm Beach Dental

Brad Strong said...

Totally agree, great message. The trend is still in the wrong direction, I have seen some dentists that can't do decent endo, so they are just opting for extraction and implant. What a huge disservice to their patients.