{"id":14782,"date":"2025-12-02T09:00:00","date_gmt":"2025-12-02T06:00:00","guid":{"rendered":"https:\/\/otexe.com\/?p=14782"},"modified":"2025-11-22T17:43:40","modified_gmt":"2025-11-22T14:43:40","slug":"therapeutic-conservatism-vs-surgical-progress-the-choice-between-tooth-preservation-and-implantation","status":"publish","type":"post","link":"https:\/\/otexe.com\/en\/therapeutic-conservatism-vs-surgical-progress-the-choice-between-tooth-preservation-and-implantation\/","title":{"rendered":"Therapeutic conservatism vs. surgical progress: the choice between tooth preservation and implantation"},"content":{"rendered":"

A key clinical decision in full-mouth rehabilitation is the choice between preserving compromised teeth and extracting them followed by implant-supported restoration. The selected option should be based on an integrative assessment of clinical, radiographic, and biopsychosocial factors, as well as the patient’s ability to maintain the chosen treatment over time. <\/p>\n

Assessment methodology<\/h2>\n

Before planning full-mouth rehabilitation, it is essential to systematically analyze a number of key parameters. Below is a structured checklist with clinical commentary for the practicing dentist. <\/p>\n

Periodontal status and oral hygiene<\/h3>\n

Assessment: bleeding index, probing pocket depths, presence of recessions, tooth mobility, radiographic bone support level, microbiological tests if necessary.<\/p>\n

Comment: In patients with progressive generalized periodontitis, the prognosis for tooth preservation reduces the likelihood of long-term success. In such cases, an interdisciplinary assessment is recommended \u2014 periodontal therapy with a follow-up evaluation after a set period before making a final decision regarding extraction. <\/p>\n

Caries risk and salivary function<\/h3>\n

Assessment: history of caries recurrence, condition of existing restorations, medication history (drugs causing xerostomia), head and neck radiation therapy, sialometry if indicated.<\/p>\n

Comment: A high frequency of recurrent caries and persistent xerostomia create an unfavorable prognosis for tooth preservation; in such patients, a strategy of full extraction and implant-supported prosthetics should be discussed as a predictable alternative.<\/p>\n

Restorative and endodontic status<\/h3>\n

Assessment: quality of existing restorations, recurrent caries under prostheses, perforations, coronal tooth structure integrity, success of previous endodontic therapy.<\/p>\n

Comment: Multiple failed restorations and previously repeatedly revised endodontically treated teeth more often lean toward a decision for full rehabilitation; stable crowns and high-quality endodontic treatment are arguments in favor of tooth preservation, provided adequate hygiene maintenance is possible.<\/p>\n

Occlusion, vertical dimension, and parafunctional habits<\/h3>\n

Assessment: occlusal contact conditions, loss of vertical dimension of occlusion, signs of bruxism, wear of dental hard tissues, periodontal adaptive capacity.<\/p>\n

Comment: Significant functional disorders may require comprehensive prosthetic rehabilitation (including full-arch implant-supported restorations) or load adaptation (preference for delayed loading). Protective measures (night guards, occlusal adjustment) must be planned. <\/p>\n

Bone volume and surgical feasibility<\/h3>\n

Assessment: CBCT to determine alveolar bone volume, presence of anatomical limitations, prognosis for the need for bone grafting.<\/p>\n

Comment: In cases of significant resorption, a discussion of bone augmentation or alternatives \u2014 such as tilted implants or All-on-4\/6 concepts \u2014 is required. It is important to consider the patient’s financial and time preferences when selecting a strategy. <\/p>\n

Outcomes and literature data<\/h2>\n

Comparing literature and clinical experience yields the following practical conclusions:<\/p>\n