1993-2-Editorial - Saudi Dental Journal

ISSN (Print) 1013-9052
EISSN 1658-3558

The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia

Tel.	966-1-467-7328
Fax.	933-1-467-7308 / 966-1-467-7534
Email	saudidj@ksu.edu.sa

Editorial

Should implants change the indications for extraction?

In the past, the most common reason for tooth loss in adults after 40 years of age was periodontal disease (Berkhus 1929, Allen 1944, Pelton et al 1954). More recent studies (Ainamo 1984, Kay & Blinkhorn, 1985, Cahen era/1985, Agerholm & Sidi 1988) indicate that in Finland caries, rather than periodontal disease, was the predominant reason for tooth extractions in all age-groups. In other European countries periodontal disease, as a reason for tooth extraction, did not exceed caries until after the age of 40 to 60, however.

In Hongkong, where fluoridated water has been available since 1961, Corbert & Davies (1991) found that among people above 16 years of age caries was the main reason for tooth extractions in 60%, periodontal disease in 28%, prosthetic reasons in 6%, trauma in 4% and orthodontic reasons in 2%. Periodontal disease, as the cause for extraction, became more common after 40 years of age but did never exceed caries even in those aged 60 and above.

The introduction of preventive measures against dental diseases as regular oral hygiene and fluoridation has reduced tooth extraction as a therapy. Also, the more common use of orthodontics as well as the increased success of endodontic treatment have reduced the indications.

During the 70's the etiology of periodontal diseases became clear, maintenance care was pointed out and in the 90's guided tissue regeneration was introduced. These factors made it possible to save even severely periodontally involved teeth. The new resorbable membrane for guided tissue regeneration has made the future even more promising.
The increased fear of amalgam and metals in restored teeth and reported hypersensitivity against such restorations have resulted in new indications for tooth extractions - teeth which were replaced by implants.

However, implantologists extract teeth because of periodontal disease and replace them with implants. This is often done when it is still possible to treat and keep the affected teeth. Their motivations indicate that it is easier to replace periodontally affected teeth even when enough bone still remains around the tooth.

Today it is possible to increase the height and width of the alveolar bone by surgical augmentation. The same method has also made it possible to create osseointegration of implants placed in extraction alveolus as well as covering denuded threads of implants by placing various types of membranes.

With this background, it is clear that dentistry has reached a level where most teeth can be saved and, because of this reason, indications for tooth extraction should be limited to as few as possible. Teeth, which are possible to treat, should be restored and should not be replaced by implants. The patient's own teeth give him or her the feeling of a sound and healthy dentition. Replacement of teeth by prostheses, removable or fixed like bridges or implants, is a kind of mutilation.

Axel Bergenholtz, DDS, Dr. Odont

Professor and Chairman,
Department of Periodontology
University of Umea, Sweden and Member,
SDJ Editorial Board