WHICH IS BEST: TOOTH OR IMPLANT?
implants placed adjacent to natural teeth develop open contacts
over their period of service.
• Teeth have a natural attachment to gingival tissues, the epithelial
attachment. If this is maintained well, gingival health can be optimum. Implants do not have this natural attachment.
• There is growing concern about the prevalence of peri-implantitis.
Estimates range from 10% to over 40% after several years of service.
A recent study of 588 patients over a period of nine years showed 45%
of all implant patients showed mild-to-severe peri-implantitis. 1
• There is also concern that one of the causative factors for development of peri-implantitis is related to sensitivity to the elements in
most implants—titanium, vanadium, and aluminum. Research
continues on the viability of zirconia implants. 2
• Supporting structures of teeth can develop periodontal disease.
Well-known studies show at least 35% of adults have mild-to-severe
periodontitis, causing gingival pathology, bone degeneration, tooth
mobility, and eventually tooth loss.
• Many implants show significant bone loss during service, requiring
additional surgery, grafting, and potential implant failure. Although
this phenomenon has had significant research, the challenge is still
• Teeth have optimum anatomical form that provides natural contour
conducive to optimum periodontal health.
• Many implants have a diameter much narrower than natural teeth,
providing unnatural soft-tissue contour and potentially difficult
• Implants do not have the problem of dental caries, while retained
teeth continue to have this challenge.
Upon observing the preceding statements, it is obvious that there
are positive and negative characteristics for both teeth and implants.
WHAT DENTAL TREATMENTS ARE AVAILABLE FOR SEVERE
CARIES, PERIODONTAL DISEASE, OR OCCLUSAL DISEASE?
Severe dental caries is present in many patients. However, preventive treatments are very effective. A simple revenue-producing, staff-accomplished, 30-minute preventive appointment can reduce or even
eliminate caries in most patients as follows:
• Educate patient regarding oral hygiene.
• Make alginate impression.
• Make stone cast (Whip Mix Snap-Stone).
• Make suck-down trays extended 1 mm apical to the gingival line.
• Show patient how to use trays with approximately six drops of 5,000
ppm fluoride in each tray (Colgate PreviDent 5000 Gel is a well-
• The patient should leave tray in the mouth for five minutes after
breakfast and five minutes before bed every day.
Retention of natural teeth
should be our goal as dentists.
Implants are a fantastic adjunct
to our services, but they should
not replace our long-proven
• Emphasize to the patient that this technique must be accomplished
every day for success.
Severe tooth destruction is reparable as follows, assuming financial
resources are available:
• Patient education
• Endodontic treatment if necessary
• Tooth buildups and/or posts and cores
• Crowns and fixed prostheses
• Fluoride trays as above or 5,000 ppm fluoride toothpaste daily
Periodontal treatment, conventional or conservative, is effective
for all but the most severe periodontal disease situations.
Occlusal wear, noted early enough, can be reduced or eliminated
by the proper use of occlusal splints.
ARE DENTISTS REMOVING MORE TEETH THAN
Many teeth can be retained when treated by competent, conservative
practitioners. In my opinion, patients should have thorough informed
consent relative to the advantages and disadvantages of tooth removal.
They should have an opportunity to speak with other patients who
have had implants placed. Tooth removal is final and cannot be reversed.
In my opinion, yes, too many teeth are being removed.
Dental root-form implants have been among the most major advancements of all time in dentistry. They are serving millions of patients well,
but they are not without challenges—some well-known and others still
to be determined. Dentists can help retain teeth that in the past were
hopeless. Are we using these rehabilitative and preventive procedures,
or are we removing teeth that could be saved relatively easily? Implants
are an adjunct to dental treatment—not a replacement for conventionally well-proven, long-lasting procedures. I strongly suggest keeping
natural teeth whenever feasible.
1. Derks J, Schaller D, Håkansson J, Wennström JL, Tomasi C, Berglundh T.
Effectiveness of implant therapy analyzed in a Swedish population: prevalence of
peri-implantitis. J Dent Res. 2016;95( 1): 43-49. doi: 10.1177/0022034515608832.
2. Periodontal disease affects nearly half of the US population. Science in the News.
American Dental Association website. http://www.ada.org/en/science-research/
Published June 15, 2015. Accessed July 6, 2017.
Additional educational information from
Gordon J. Christensen, Practical Clinical Courses
Two-day course in Utah
Implant Surgery—Level 1—September 29–30, 2017
Affordable Treatment of Complex Rehabilitative Needs
(Item No. V1964)
Restoring Implants—A Comparison & Demonstration of Techniques
(Item No. V2379)
Predictable Removable Partial Dentures (Item No. V2551)