Implanteren of toch restaureren?

Een tandarts ziet zich soms voor de lastige keuze gesteld om een carieus gebitselement, al dan niet met een wortelkanaalbehandeling, verder te restaureren of het gebitselement te extraheren en een implantaat te plaatsen. Vergelijkend onderzoek op dit gebied is schaars en moeilijk uit te voeren. Maar in een recente aflevering van de J Am Dent Assoc worden nu bevindingen gemeld van een literatuuronderzoek naar ‘de levensduur van implantaten vergeleken met gerestaureerde gebitselementen’. Een van de slotopmerkingen betreft de onomkeerbaarheid van extraheren.

Excerpt

For the past few decades, dental implants have served as reliable replacements for missing teeth. However, there is an increasing trend toward replacing diseased teeth with dental implants. The authors conducted a systematic review of long-term survival rates of teeth and implants. They searched the MEDLINE database for relevant publications up to March 2013. They considered studies in which investigators assessed the long-term effectiveness of dental implants or that of tooth preservation. They included only studies that had follow-up periods of 15 years or longer. The authors selected 19 articles for inclusion. Investigators in nine studies assessed the tooth survival rate, whereas investigators in 10 studies assessed the implant survival rate. When comparing the overall long-term (that is, 15 years or more) tooth loss rate with that of implants, the authors observed rates ranging between 3.6 and 13.4 percent and 0 and 33 percent for teeth and implants, respectively. They could not perform a meta-analysis because of the substantial differences between the studies. Practical Implications. The results of this systematic review show that implant survival rates do not exceed those of compromised but adequately treated and maintained teeth, supporting the notion that the decision to extract a tooth and place a dental implant should be made cautiously. Even when a tooth seems to be compromised and requires treatment to be maintained, implant treatment also might require additional surgical procedures that might pose some risks as well. Furthermore, a tooth can be extracted and replaced at any time; however, extraction is a definitive and irreversible treatment.

Bron

Levin L, Halperin-Sternfeld M. Tooth preservation or implant placement: A systematic review of long-term tooth and implant survival rates. J Am Dent Assoc 2013; 10: 1119-1133.