Cost-effectiveness and long-term outcomes of periodontal regeneration versus dental implants: A retrospective study.

BACKGROUND: Direct comparative data on periodontal regeneration (PR) versus extraction and implant placement remain limited. Tooth-specific periodontal conditions such as furcation involvement and overall tooth prognosis may dictate success or failure of such treatment.

METHODS: A retrospective analysis was conducted on patients undergoing periodontal regenerative procedures or dental implants at the University of Michigan periodontics clinics. Clinical outcomes were assessed, including tooth and implant survival, success rates, and complications. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER).

RESULTS: In a cohort of 130 subjects (176 sites; 88 PR-treated teeth and 88 implants; mean age 63.7  ±  12.7 years) followed for 6.4 years on average, no differences in survival or success rates were found (odds ratio [OR]  =  0.36, p  =  0.2, and OR = 0.77, p = 0.56, respectively). In the PR group, a one-wall defect and ≥1 furcation involvement (FI) increased the risk of tooth loss by approximately fourfold, while Periodontal Risk Scores (PRSs) of 2 and 3 were associated with 22- to 35-fold greater risk than PRS1 (p  <  0.05). "The total complication rate in the implant group was 26.1%, largely due to peri-implantitis (PI), compared to 9.1% in the PR group (OR = 3.54, p = 0.006)." Kaplan-Meier analysis revealed mean survival times of 9.3 years for PR and 12.65 years for implants. Implant cost-effectiveness depended on initial tooth prognosis and FI, with a 60% reduction in ICER per additional year ($187) compared to teeth with a good prognosis (PRS1).

CONCLUSION: Both PR and dental implant treatments achieved comparable long-term survival and success rates. Cost considerations suggest personalized treatment decisions based on individual periodontal conditions like FI and overall tooth prognosis.

PLAIN LANGUAGE SUMMARY: This study compared the long-term outcomes and cost-effectiveness of 2 approaches-periodontal regeneration to preserve teeth versus dental implants to replace them-in patients with advanced periodontitis. The analysis found that both treatments generally achieved similar survival and success rates. However, implants tended to have more complications, especially due to peri-implantitis, while teeth with certain conditions, like molars with advanced furcation involvement or higher periodontal risk scores, were more likely to be lost over time. Although no clear cost-effectiveness advantage emerged for either approach, the findings emphasize that initial tooth health and other specific conditions significantly influence outcomes. Therefore, personalized treatment decisions considering the patient's unique periodontal situation may help improve both clinical results and cost efficiency.