Yousef T. Amrou from the Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, and colleagues aimed to compare the long-term clinical performance and cost-effectiveness of periodontal regeneration versus dental implant therapy in patients with advanced periodontitis. Despite the increasing popularity of implants, direct comparative data between the two treatment modalities have remained scarce.
The research team analyzed data from 130 patients (176 treatment sites), including 88 PR-treated teeth and 88 dental implants. Participants, with a mean age of 63.7 years, were followed for an average of 6.4 years. The investigators assessed survival and success rates, complication frequency, and treatment costs using the incremental cost-effectiveness ratio (ICER) to evaluate economic viability.
The findings of the study were as follows:
- Both periodontal regeneration and dental implant treatments showed comparable long-term survival and success rates.
- The odds ratio for survival between the two groups was 0.36, and for success, it was 0.77, showing no significant difference.
- Teeth with one-wall defects and furcation involvement (FI) had nearly a fourfold higher risk of tooth loss among PR-treated cases.
- Patients with higher Periodontal Risk Scores (PRS 2 or 3) had a 22- to 35-fold greater chance of tooth loss compared to those with PRS1.
- The implant group reported a higher complication rate of 26.1%, mainly due to peri-implantitis, compared to 9.1% in the PR group (OR = 3.54).
- The mean survival time was 9.3 years for PR-treated teeth and 12.65 years for implants, as per Kaplan–Meier analysis.
- Cost-effectiveness analysis showed that implant therapy’s value depended on the tooth’s initial prognosis and degree of FI.
- A 60% reduction in the incremental cost-effectiveness ratio (ICER) per additional survival year ($187) was observed compared to teeth with a good prognosis (PRS1).
Overall, the findings suggest that while both approaches achieve comparable long-term results, implants may carry higher risks of biological complications and greater financial costs. The study highlights the importance of tailoring treatment decisions based on individual periodontal conditions, including furcation involvement and overall tooth prognosis, to ensure both clinical and economic efficiency.
The authors noted that the retrospective design and reliance on electronic health records introduced limitations, including incomplete data and a lack of standardized treatment. Moreover, the six-year average follow-up period might not fully capture late-onset complications such as peri-implantitis. Future randomized controlled trials with extended follow-up durations are needed to validate these findings and further refine individualized treatment protocols.
"Both periodontal regeneration and dental implant therapy offer viable long-term solutions for managing periodontally compromised teeth. While implants may provide slightly better survival rates, they also involve higher initial costs and greater complication risks. Personalized treatment strategies, guided by periodontal risk assessments and patient-specific factors, are essential for optimizing both outcomes and cost-effectiveness," the authors concluded.
Reference:
Amrou, Y. T., Alrmali, A. E., Almashni, H., Galindo-Fernandez, P., Wang, L., & A. Saleh, M. H. Cost-effectiveness and long-term outcomes of periodontal regeneration versus dental implants: A retrospective study. Journal of Periodontology. https://doi.org/10.1002/jper.70023
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