MANDIBULAR MOLAR ROOT RESECTION VERSUS

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This presentation is a review of MANDIBULAR MOLAR ROOT RESECTION VERSUS IMPLANT THERAPY A RETROSPECTIVE NONRANDOMIZED STUDY Z
afiropoulos GG, Hoffmann O, Kasaj A, Willershausen B, Deli G, Tatakis DN. Journal of Oral Implantology, 2009

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MANDIBULAR MOLAR ROOT RESECTION VERSUS

  1. 1. M ANDIBULAR M OLAR R OOT R ESECTION V ERSUS I MPLANT T HERAPY A RETROSPECTIVE NONRANDOMIZED STUDY Zafiropoulos GG , Hoffmann O , Kasaj A , Willershausen B , Deli G , Tatakis DN . Journal of Oral Implantology, 2009
  2. 2. I NTRODUCTION
  3. 3. INTRODUCTION Molar teeth with furcation involvement represent a treatment challenge that is further complicated by the multitude of available treatment options .
  4. 4. INTRODUCTION Degree of furcation involvement is a major determinant for the indicated treatment modality. One of the available treatments for molar with degree III furcation involvement is root resective therapy.
  5. 5. INTRODUCTION - Although several studies have evaluated the outcomes of root resective therapy, only a limited number have directly compared root resective therapy with implant therapy . - Published literature on the outcomes of root resective therapy and dental implants, revealed that success and complication rates vary depending on teeth treated and anatomical site. - Because of such site-specific difference, in order to be valid, this study compared the therapeutic outcomes at the same anatomic site.
  6. 6. INTRODUCTION Purpose of study: To compare the longterm complication and survival rates of root resected mandibular molars relative to that of dental implants replacing mandibular molars.
  7. 7. M ATERIALS AND M ETHODS
  8. 8. MATERIAL AND METHODS Patient population: - Sixty patients ( 40 men, 20 women; mean age 49.9 years) treated from January 1993 to December 2001 were included in this retrospective study. - All patients had history of chronic periodontitis with a minimum of 4 sites with CAL loss >4mm, radiographic evidence of bone loss, and BOP in at least 4 sites.
  9. 9. MATERIAL AND METHODS Inclusion criteria: 1 - Grade III furcation involvement. 2 - Radiographically estimated residual bone ≥ 50% of the length of the retained root. 3 - Root resective surgery performed on the 1st, or the 1st and 2nd molar. 4 - No existing conditions that might interfere with periodontal or implant treatment. 5 - No known drug allergies. 6 - Maintenance for at least 48 months.
  10. 10. MATERIAL AND METHODS Exclusion criteria : 1 - Root resective surgery on 2nd molar only. 2 - Implant treatment either in edentulous mandibular molar areas or in the 2nd mandibular molar only. 3 - Active periodontal disease. 4 - Bruxism. 5 - Smoking >10 cigarettes per day. 6 - The presence of pregnancy, diabetes, history of medication, or drugs abuse .
  11. 11. MATERIAL AND METHODS - Patients were placed in either the hemisection-treated group (H), or the implant-treated group (I): Table 1 Study population demographics Group H Group I Patient 32 28 Average age in years(min-max) 49(35-73) 51(29-67) Smoker 14 14 Teeth or implant 56 36 Teeth or implant in smoker 20 18 Average months in maintenance (min-max) 65(48-93) 65(58-80)
  12. 12. T REATMENT P ROCEDURES
  13. 13. TREATMENT PROCEDURES Group (H): 1 - Endodontic treatment. 2 - Custom-made gold posts & composite build-ups. 3 - Root resection & extraction of the mesial root. 4 - The extraction site was filled with xenograft and autologous bone and covered with resorbable membrane. 5 - FPD included the 2 nd premolar. When both molars were treated, FPD included 2 nd 1 st molar and premolar.
  14. 15. TREATMENT PROCEDURES Group (I): 1 - Atraumatic extraction. 2 - Socket preservation by the use of nonresorbable dPTFE membrane. 3 - Implants were placed 8 months after extraction. 4 - Final restorations were delivered 6 months after implant placement.
  15. 17. TREATMENT PROCEDURES Postoperative care: 1 - Clindamycin 600mg/day for 4 days. 2 - Oral analgesic diclofenac 100mg/day for 4 days. 3 - 0.1% chlorhexidine twice/day for 3 weeks. 4 - Follow-up twice/month during the first 2 months, then once a month for the following 10 months.
  16. 18. TREATMENT PROCEDURES Complications - CAL Loss >5mm. - Peri-implantitis with an augmentable osseous defect. - Root caries or caries at the crown margin. - Apical abscesses. - Root fractures. - Peri-implantitis with a non-augmentable osseous defect(>50%). Salvageable Nonsalvageable
  17. 19. R ESULTS
  18. 20. - The occurrence and timing of post-treatment complication as well as CAL, BOP PLI were evaluated. RESULTS
  19. 21. RESULTS Table2 Complication and Time until complication Group Complication Teeth/implant Time in months Group H (N=56) No complication 38(67,9%) 64.1(48-39) Total complication 18(32.1%) 32.6(4-65) Salvageable 6(10.7%) 22.7(4-36) Non-Salvageable 12(21.4%) 37.6(7-65) Group I (N=36) No complication 32(88.9%) 65.4(58-80) Total complication 4(11.1%) 30.5(2-60) Salvageable 3(8.3) 40(2-60) Non-Salvageable 1(2.8%) 2
  20. 22. D ISCUSSION
  21. 23. - The results indicated that both root resected mandibular molars and mandibular molar implants could be expected to have on average, a complication-free survival of 6 years. - Root resected molars showed greater risk for complications . - Survival rates of implants decrease with longer follow-up periods. DISCUSSION
  22. 24. - The prognosis of dental implants placed where teeth lost due to periodontal disease was worse than implants placed as a result of teeth lost for other reasons. - Treatment of implants with bone loss exceeding 50% of the implant length does not lead to satisfactory long-term results. DISCUSSION
  23. 25. - A multitude of factors may influence treatment outcome of tooth resective therapy. Among theses are tooth type, parafunctional habits, endodontic therapy, and prosthodontic treatment. - 50% of the complications in root-resected molars were due to root caries, suggesting that more effective anti-caries measurement could reduce the rate of failures. - Case selection is very critical for root-resective therapy. Each case must be carefully evaluated to assess whether adequate endodontic, prosthodontic, and maintenance therapy is feasible, including considerations related to surgical access and patient motivation. DISCUSSION
  24. 26. C onclusion Within the limitations of this retrospective study, the results indicated that implants replacing periodontally involved mandibular molars had fewer complications than hemisected mandibular molar s . Further studies are needed to confirm and allow generalization of these findings.
  25. 27. Thank you

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