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

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. I NTRODUCTION

3. INTRODUCTION Molar teeth with furcation involvement represent a treatment challenge that is further complicated by the multitude of available treatment options .

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. 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. 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. M ATERIALS AND M ETHODS

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. 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. 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. 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. T REATMENT P ROCEDURES

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.

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.

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.

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

19. R ESULTS

20. - The occurrence and timing of post-treatment complication as well as CAL, BOP PLI were evaluated. RESULTS

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

22. D ISCUSSION

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

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

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

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.

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