Periodontal Regeneration vs Dental Implants: Study Finds Similar Survival but Higher Implant Complications
USA: A new retrospective study published in the Journal of Periodontology reports that periodontal regeneration (PR) and dental implants offer similar long-term survival outcomes for patients with advanced periodontal disease, but implants are associated with significantly more complications—largely driven by peri-implantitis.
The findings highlight the importance of individualized treatment planning based on tooth-specific risk factors and overall periodontal prognosis.
Led by Yousef T. Amrou from the Department of Periodontics and Oral Medicine at the University of Michigan, the study examined whether saving teeth through regenerative techniques or replacing them with implants yields better clinical and economic results over time. Direct comparisons between these two treatment paths have been limited, making this analysis an important contribution to the ongoing debate about when to preserve a compromised tooth versus when to extract and replace it.
The research team evaluated records from 130 patients, covering 176 treatment sites—88 treated with periodontal regeneration and 88 managed with implants. The average follow-up extended over 6.4 years. The study also analyzed cost-effectiveness using the incremental cost-effectiveness ratio (ICER).
The analysis led to the following findings:
- Both periodontal regeneration and dental implants showed similar long-term survival and success rates, with mean survival times of 9.3 years for regenerated teeth and 12.65 years for implants.
- Despite longer mean survival for implants, the difference did not provide a clear clinical advantage.
- Implant treatment was associated with a much higher complication rate—26% compared with just over 9% in the periodontal regeneration group.
- Most implant-related complications were due to peri-implantitis, making implants more than three times as likely to develop complications than regenerated teeth.
- Outcomes of periodontal regeneration were heavily dependent on tooth-specific factors such as one-wall defects, furcation involvement, and higher periodontal risk scores.
- Teeth categorized as PRS 2 or 3 had a dramatically increased risk of tooth loss—up to 35 times higher than those with PRS 1.
- Implant therapy was found to be more cost-effective only when the natural tooth had a poor prognosis or significant furcation involvement.
- In high-risk cases, the incremental cost-effectiveness ratio (ICER) decreased by about 60% per additional implant survival year, making implants a more economical option in select situations.
- For most other patients, neither treatment showed a clear cost-effectiveness advantage.
The authors caution that the study's retrospective nature and reliance on electronic health record data introduce limitations, including potential inconsistencies and missing information. Additionally, treatment approaches were not standardized, and the follow-up period may not be long enough to fully evaluate late-onset complications such as peri-implantitis.
Despite these limitations, the findings emphasize that neither approach can be universally recommended. Instead, patient-specific factors—especially periodontal risk, anatomical complexity, and cost considerations—should guide treatment planning. The researchers note that future long-term randomized trials are needed to better define when periodontal regeneration or implant therapy offers the most predictable benefit.
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
Next Story