The long-term success rate of dental implants has been well-documented in the literature1 and is a technology that has been a boon to the financial element of dentistry. Similarly, retention of teeth with moderate to advanced bone loss via various periodontal treatment methods has enjoyed similar to higher long-term success rates.2 The practitioner often relies on clinical experience and therapeutic familiarity when deciding whether to extract periodontally involved teeth and replace with dental implants vs. saving the natural dentition with regenerative or resective therapy. A relatively new concept, however, that should be incorporated into this decision matrix is the long-term cost effectiveness to the patient when comparing treatment modalities.
Retention of periodontally compromised teeth with initial, surgical, and supportive therapy has been shown to have high long-term success rates in the literature.3,4 Typical periodontal treatment for patients with moderate to advanced disease when first presenting to a dental office can consist of quadrant scaling and root planing, osseous surgery with or without regenerative therapy (Figs. 1 and 1a), and supportive periodontal maintenance at specific intervals. Estimated totals for this type of “start-up” treatment are in the range of $2,000 to $4,000 depending on geographic location (see Table A). This treatment, if maintained by the patient with diligent home care, has proven to be effective in terms of the prevention of further periodontal progression and tooth retention over a long-term period.5
When analyzing the cost to maintain this start-up treatment via supportive periodontal therapy with maintenance intervals of three to four times a year with or without local adjunctive antibiotics, dollar amounts range from $500 to $1,000 a year, again dependent upon geographic location. In a small subset of the population (less than 5%), periodontal disease can reoccur after treatment, excluding those patients who demonstrate blatant noncompliance with home care, and treatment will have to be rendered again, increasing the overall costs of this type of therapy.6
Although dental implants london have typically enjoyed high long-term survival rates,7 their associated initial financial impact is much higher than that of saving the natural dentition.8 Conservative valuations place start-up costs for implant treatment around two to three times higher than saving natural dentition via periodontal therapy (Table 2). In addition, implants are not without complications, and both biologic and/or mechanical complications can be associated with additional treatment costs to the patient. Recently, the literature has been replete with discussion of biologic complications in the form of peri-implant disease. Peri-implant diseases fall into two categories: peri-implant mucositis and peri-implantitis.
The term peri-implant mucositis describes a reversible inflammatory reaction in the mucosa adjacent to an implant,9a term that has become known as implant gingivitis. Typical treatment involves quadrant scaling and root planing with implant-friendly armamentarium. The literature also has shown that mechanical debridement in conjunction with systemic and/or local antibiotic placement has increased the efficacy of this type of treatment10, but it can obviously be associated with higher treatment costs (Fig. 2). Studies show that the prevalence of peri-implant mucositis can be as high as 50% to 80% of implants in function.11 Peri-implantitis has been defined as an inflammatory process that affects the tissues around an osseointegrated implant in function and, like periodontitis, results in loss of supporting bone.
Clinical treatment of this disease is often determined by severity, but in general often includes flap surgery, bone grafts london, membranes, growth factors, and/or soft-tissue grafts12 (Figs. 3 and 3a). The overall financial impact upon the patient for this type of treatment can be quite high considering the patient was already subject to initial start-up costs of treatment. (Table C). In addition, maintenance intervals after implant therapy should be equal to if not more stringent than those of natural teeth. The prevalence of peri-implantitis has been shown in some studies to range from 11% to as high as 47% of implant sites analyzed.13 A large disparity in percentages can be seen when comparing the prevalence of reoccurring periodontal disease after treatment vs. the percentage of implants that will demonstrate complications after prosthesis insertion. With that said, studies show that periodontal therapy has proven to be cost effective when compared to other types of tooth replacement therapy over a 15-year period evaluation.14…
This information was presented to a real patient in a private practice setting along with long-term survival rate percentages of each of the comparative treatments. After reviewing the survival rates as well as the financial costs in relation to each treatment plan, the patient accepted Treatment Plan A, citing the following reasons: desire to keep her own teeth, less cost, and quicker time to completion.
Another real scenario that took place in a private practice with actual dollar amounts can be seen with Table 3. A patient had already paid for treatment in Table 2 in the $5,000 to $7,000 range and presented to the office with moderate peri-implantitis. In addition to the invested money, she was now going to be responsible for the dollar amounts shown in Table 3.
After reviewing the additional costs and lengthy healing time involved with surgery to correct the ailing implant, the overall costs associated with treatment were in the $8,000 to $9,000 range with more than three years of treatment time invested. Of important note is that most insurance companies limit the amount of reimbursement for implant-related services. Accurate ADA coding and submissions when dealing with insurance companies must occur in order to facilitate services and expedite reimbursements.
In conclusion, when deciding between saving the natural dentition and extracting and placing tooth implants london, there are many factors to consider. In addition to long-term success rates, the practitioner and the patient need to consider the long-term economic impact the patient will endure. Both implants and periodontal therapy to save natural teeth have high initial success rates with implants usually demonstrating higher start-up costs. However, when looking at long-term retention rates, teeth often demonstrate fewer complications and have less of a financial impact when correction is needed….read more