Individualized Treatment Planning and the Need for Ridge Preservation

Takanari Miyamoto, DDS, PhD, MSD, MBA, maintains a private practice in LaVista NE, and is also an Associate Professor and Chair for the Department of Periodontics at Creighton University School of Dentistry in Omaha, NE.

Whether it is with students or patients he says issues related to determining the course of actions to take with dental implant treatment can be complex.

In the case of edentulism, Miyamoto says implants should always be presented as an option for tooth replacement and considers implant therapy to be the new standard of care relative to dentures. Nonetheless, he observes, the cost of dental implants and the need to undergo surgery often prompts patients to refuse implant therapy when given the option of traditional restorations.

“The decision about whether to attempt to treat periodontal disease or extract the diseased tooth and replace it with an implant is extremely complex due to the difficulty of determining the prognosis in these different scenarios,” he explains.

From the patient’s perspective, cost and being able to chew properly and comfortably are major considerations, and in certain circumstances, patients are likely to find it burdensome to undergo an expensive regenerative procedure rather than implant therapy, only to face an expensive implant placement procedure later. “Basically, patients want the option that will give the best long-term results, so if they are likely to lose the tooth in 5 years anyhow, most patients would rather get the implant now,” Miyamoto says.

It is for this reason, he asserts, having the best ability to make the right call is important. “It is increasingly important to be able to accurately weigh the prognosis of compromised dentition against the prognosis for dental implant success in the interest of better treatment planning for our patients.”

He says the decision depends primarily upon three elements: the overall prognosis of the dentition; the strategic value of the tooth; and the patient’s preference. But, he is quick to note, the “conclusion” is often subjective. “My point is, when we compare the prognosis of dental implants vs. the prognosis of periodontally compromised dentition, there is no right answer. The opinion from one dentist to another can be very different because we do not have global standards for assigning a prognosis for dentition and/or dental implants.”

Miyamoto’s own research has focused on efforts to assign a prognosis to dentition to help dentists understand whether they should treat or extract and replace with dental implants in a given situation.

He says a major contribution to improving the prognosis of implants concerns the use of regenerative procedures. For example, ridge preservation to prepare the site for implant placement may be performed at the time of extraction, prior to implant placement, or at the time of implant placement, depending on the specific situation. “Based on studies, if we do not perform ridge preservation procedures at the time of extraction, the patient may significantly lose soft and hard tissue needed for later placement of dental implants, so it is essential to render ridge preservation procedures at the time of extraction if we know that the patient will receive dental implants later at those sites.”

Miyamoto has a series of procedures for augmenting the housing of dental implants to prepare for implant placement that include: guided bone regeneration; socket preservation/regeneration; and soft tissue augmentation procedures. For bone grafting, materials can include allografts, xenograft, and alloplasts.

Among these materials, Miyamoto, says he has used GUIDOR® easy-graft® CLASSIC Alloplastic Bone Grafting System from Sunstar when he performs socket preservation procedures. “I place this bone grafting material at the time of extraction, along with the membrane—GUIDOR® Bioresorbable Matrix Barrier. I usually re-enter and place the implants after 2 to 3 months healing time. I’ve been using GUIDOR products for 2 years with successful results.”

Miyamoto believes that as scientific advances continue to improve outcomes, more US patients will benefit from these treatment options in the future.

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