Save vs Extract

Question 1

What qualifies for a “questionable” prognosis?

Answer 1

Becker 1984

1. ~50% Bone Loss
2. Pockets 6-8mm
3. Class II furcation involvement with minimal interadicular space
4. Presence of a deep palatoradicular groove
5. Mesial furcation involvement of Max 1st bicuspid
6. Teeth with extensive decay which might not be restorable

Question 2

McGuire and Nunn 1996

Answer 2

Good - Control of etiologic factors and adequate support to be easy to maintain by patient w/ proper maintenance

Fair - 25% CAL - FI-1 location/depth allow proper maintenance

Poor - 50% CAL - FI-2 - Location/depth allow proper maintenance w/ difficulty

Questionable - >50% CAL - Poor C:R - poor root form - FI-2 not accessible - FI-3 - 2+ mobility - root proximity

Hopeless - Inadequate attachment to maintain tooth

Question 3

What general factors are considered in Kwok and Caton?

Answer 3

Compliance

Smoking

Diabetes

Other systemic

Question 4

What local factors are considered in Kwok and Caton?

Answer 4

Attachment loss

Deep PD

Parafunctional habits

Anatomic factors prone to plaque retention

Question 5

Torabinejad

Answer 5

Systematic Review

143 studies

Single implant success: 95%
RCT success: 84%
EXT/no replacement - inferior psychosocial outcomes

Question 6

Fugazzotto 2001

Answer 6

Root Resected Molars vs Molar Implants
15yrs

700 molars
1400 implants

Root Resection: Distal root of Mand molar (75%) - all others 95-100%
Implant: lone standing second molar mandible (85%) - all others 97-98%

Highest risk of failure for both - lone standing terminal abutments

Failure with untreated parafunction: 37.8% implant failure

Question 7

Guldener

Answer 7

Endo with fiber post/composite core or just composite

Fiber: 94.3%
Composite: 76%

Question 8

Grossmann

Answer 8

C:R for FPD

Ideal: 1:2 or 1:1.6

Acceptable (control of occlusion/perio): 1:1.5

Minimum (consider splinting): 1:1

Question 9

Tada 2015

Answer 9

RPD abutment C:R

NO DIFFERENCE IN Survival FROM 0.75 - 1.25

• *0.75**: Satisfactory
• *0.76-1.0**: Acceptable
• *1.01-1.25**: Questionable
• *1.26-1.5**: Unsatisfactory
• *>1.5**: Poor

Question 10

Tomasi

Answer 10

Prevalence of PIM: Weighted mean 43%

Prevalence of PI: Weighted mean 22%

Question 11

How does PI progress?

Answer 11

Derks et al. 2016

0.4mm/year

non-linear accelerating pattern