SCIENCE & TECH
Which is best: Tooth or implant?
IN THIS MONTHLY FEATURE,
Dr. Gordon Christensen addresses the most frequently
asked questions from Dental Economics readers. If you
would like to submit a question to Dr. Christensen,
please send an e-mail to firstname.lastname@example.org.
As a prosthodontist, I have been placing and restoring implants for more than 30 years and have observed significant
and impressive success. However, now that we have watched
root-form implants for many years, we are far more knowl-
edgeable about their advantages and limitations. I will briefly
discuss my observations based on research and my personal
experience, having had the opportunity to watch thousands
of teeth and implants in service over several decades.
WHAT CONDITIONS NECESSITATE TOOTH
Numerous conditions cause dentists to suggest tooth re-
moval, and most dentists know these conditions well.
However, with proper clinical skills, even most of the fol-
lowing types of problems can be treated successfully with-
out tooth removal:
• Dental caries involving most or all of the coronal portion
of the tooth
• Bruxism and the accompanying occlusal wear destroying
most or all of the coronal portion of the tooth
• Ongoing periodontal disease with major tooth mobility
• Severe bone loss and subsequent major tooth mobility
• Vertically fractured teeth
• Portions of the tooth broken off apical to the bone
• Tooth resorption with inability to remove enough of the
resorption to properly restore
• Accidents causing tooth fracture, intrusion, and bone
• Lack of patient cooperation with oral hygiene
• Lack of patient cooperation with diet
• Inadequate financial ability to pay for treatment
• Combinations of two or more of the above conditions
PATIENT MOTIVATION TO REMOVE TEETH
We dentists must accept some of the responsibility for patient
desire for tooth removal. Patients can become extremely
frustrated with the constant need for dental restorations
I AM FRUSTRATED WI TH THE CURRENT TREND I see with dentists removing teeth that are restorable
and placing implants and crowns or fixed prostheses in their place. Some of my previous patients who have
moved away are being encouraged by their new dentists to have their teeth removed and replaced with
implant-supported fixed prostheses at a major cost. Knowing my previous patients well, I am aware that
some of them have functionally restored teeth, and yet they are being advised to have them removed.
Some of these patients have come back and asked for my opinion on this concept. Am I incorrect? Should
we still encourage patients to retain teeth that require significant restorative and/or periodontal treatment?
and continued dental caries, periodontal breakdown, or
occlusal wear. Are we counseling patients adequately about
how to reduce or eliminate dental caries activity, how to slow
down periodontal disease, and how to prevent significant
occlusal wear? I am confident many of us could do better.
What about patient behavior relative to diet, oral hygiene, and many other factors negative to optimum oral
health? Changing adult behavior is almost impossible
without education and motivation. I had no dental education as a child, and I had many carious lesions requiring
significant restorative treatment as I entered dental school.
After knowing what causes dental caries and how to prevent
the disease, I have had almost no caries for several decades.
If both dentists and patients really worked together, almost
all oral disease would be prevented!
WHAT ARE THE CHARACTERISTICS OF NATURAL
TEETH RELATIVE TO IMPLANTS?
There are several distinguishing attributes that differentiate
natural teeth and dental implants:
• The periodontal ligament allows teeth to have a shock-
absorbing characteristic. Teeth move in the bone
throughout life, usually maintaining contact areas and
constantly adjusting to occlusal and muscular forces.
• Implants do not exhibit appreciable movement. Commonly,
This 30-year-old man
could have been easily
convinced that removal
of his teeth, placement
of implants, and a
fixed prosthesis would
solve his esthetic and
He listened to a more
conservative plan, and
the result is evident.
DDS, MSD, PhD,
is a practicing
Provo, Utah. He is
the founder and CEO
of Practical Clinical
in 1981 for dental
cofounder (with his
wife, Dr. Rella
CEO of Clinicians