ABSTRACTS - IAP 2017

 

PRE-CONGRESS HANDS-ON COURSES:

 

I. MUCOGINGIVAL ESTHETIC SURGERY

Giovanni Zucchelli
University of Bologna, Italy

Treatment of gingival recession has become an important therapeutic issue due to the increasing number of cosmetic request from patients. Patients aesthetic demand, due to the exposure, during smiling or function, of portions of the root surface, is the main indication for root coverage surgical procedures. Very often the most coronal millimeter/s of the root exposure is the only visible part of the recession when smiling, therefore the presence and/or the persistence after therapy, even of a shallow recession may be an aesthetic problem for the patient. Thus, complete root coverage, up to the cemento-enamel junction, is the goal to be achieved when patient complains about the aesthetic appearance of his/her teeth. New knowledge in soft tissue surgical management permits to achieve esthetic coverage in gingival recession with minimally invasive connective tissue grafts.

 

II. REGENERATIVE PERIODONTAL THERAPY

Giulio Rasperini
University of Milano, Italy

The ultimate Surgical techniques for periodontal Regeneration will be analyzed during the presentation.
Each technique as well as the decision making in different clinical scenario, will be shown explained and reproduced by the participants with hands on exercise on simulators.

 

 

 

THEORETICAL WORKSHOP

 

 

 

 

 

 

 



PHOTODYNAMIC THERAPY IN THE TREATMENT OF PERIODONTAL AND PERI-IMPLANT INFECTIONS

Theoretical Workshop
IAP, 2017, Brasov, Romania

Recent data have suggested a potential benefit of using antimicrobial photodynamic therapy (PDT) in the treatment of periodontitis and peri-implantitis. At present, there are still limited data from well designed preclinical (animal) and controlled clinical trials evaluating the possible benefits of PDT in the treatment of periodontal and peri-implant infections. Therefore, it is the aim of this lecture to give a critical overview on the available evidence on the use of PDT in the treatment of periodontal and peri-implant infections. The available data from preclinical and randomized controlled clinical studies indicate that the use of PDT may result in a significant reduction of periodontal inflammation and improved wound healing. Results from randomized controlled clinical studies indicate that, in certain situations, PDT may represent a valuable alternative for local antibiotics in patients enrolled in maintenance program showing incipient peri-implantitis. In patients with generalized aggressive periodontitis, nonsurgical periodontal therapy followed by systemic administration of Amoxicillin and Metronidazole or application of PDT resulted in significant clinical improvements compared to baseline, but the systemic administration of antibiotics resulted in significantly higher improvements in terms of probing depth reduction (i.e. less number of pockets < 6mm) compared to the application of PDT. Based on the available evidence, conclusions will be drawn on the potential clinical benefits of using PDT in the treatment of periodontal and peri-implant infections.


 

Pre-Congress Symposium: THE PERIO-ORTHO CONNECTION

1. ORTHODONTICS & GINGIVAL RECESSIONS: BIOLOGICAL CONSIDERATIONS
Andreas Stavropoulos
University Malmö, Sweden

Periodontology and Orthodontics are closely related disciplines. This is not only from a biological point of view, both dealing with the same tissue – the periodontium – but also in regards with the clinic: proper orthodontic treatment cannot be performed without a healthy periodontium, while improper orthodontic treatment may have detrimental consequences on the periodontal tissues. Among the possible adverse effects of orthodontic treatment on the periodontium regards recession development. The presentation will address relevant aspects of the biological background of gingival recession development in relation to orthodontics.

 

 

2. ORTHODONTICS & GINGIVAL RECESSIONS: CLINICAL CONSIDERATIONS
Christos Katsaros
University of Bern, Switzerland

Orthodontic tooth movement may support periodontal health through adaptation of alveolar bone and gingival tissues but can also worsen periodontal health in presence of active periodontal disease or under unfavorable anatomical conditions. This lecture will cover one aspect of the perio/ortho interrelation, namely the relation between orthodontic treatment and development of gingival recessions. Four main questions will be addressed: Does orthodontic tooth movement induce gingival recessions? Do orthodontically treated patients suffer in the long run more from gingival recessions compared to untreated individuals? Does prolonged fixed retention influence the development of gingival recessions? How can the periodontist assist in the prevention of development of gingival recessions? The understanding of the association between orthodontic tooth movement and the development of gingival recessions is important because of the high number of children, teenagers and adults who are treated orthodontically.

 

3. TREATMENT OF SOFT TISSUE DEFECTS FOLLOWING ORTHODONTIC THERAPY
Anton Sculean
University of Bern, Switzerland

Orthodontic therapy may, in some cases, be associated with the development of single or multiple soft and hard tissue defects (e.g. gingival recessions or fenestrations). Deep gingival recessions, especially if they are located in the lower frontal mandibular area, may hamper plaque removal and increase the risk for gingivitis, root caries or hypersensitivity. Thus, the main rationale to treat post-orthodontic soft tissue defects is to facilitate plaque removal and to prevent their further deterioration in order to ensure periodontal health. However, predictable coverage of single and multiple recessions is still a challenge for the clinician, especially if these defects are located in the mandibular frontal area. The present lecture will provide a concept for the predictable coverage of single and multiple adjacent gingival recessions using various modifications of the tunnel technique. Presentations of clinical cases and of surgical videos will illustrate this treatment concept along with their long-term outcomes.

 

4. PERIODONTAL TISSUE RESPONSE TO ACCELERATED TOOTH MOVEMENT
Alpdogan Kantarci
Forsyth Institute, Boston, USA

Remodeling of the alveolar bone in response to orthodontic forces occurs as a multicellular process during the growth or mechanical adaptation that comprises of a coordinated series activation, resorption, reversal, and formation. During the orthodontic tooth movement, the periodontal ligament reacts to the orthodontic forces. The tissue reaction to this movement is by bone apposition and periodontal fiber rearrangement is accompanied by osteoclastogenesis and osteogenesis. Several techniques have been used to enhance the rate and speed of the orthodontic tooth movement. While the clinical efficacy of these techniques is well established, the biological mechanisms underlying the enhanced tooth movement is not fully understood. This presentation is focused on the biological characterization of the tooth movement in conjunction with the surgical approaches and non-invasive alternative techniques. This presentation will discuss: The biology of tooth movement and bone response, mechanisms through which the speed of orthodontic tooth movement can be enhanced, current status of the accelerated orthodontics and possible alternatives with less invasive approaches.

 

5. THE ORTHODONTIC THERAPY AND PERIODONTAL REGENERATION
Vincenzo Iorio-Siciliano
University of Catanzaro "Magna Graecia"

One of the outcomes of periodontitis is the displacement of the teeth due to the loss of bone support. Migrations, rotations and extrusions are frequent in periodontal patients, especially in the terminal stages. After obtaining inflammation control, and therefore stopping the progression of periodontal disease, teeth can be realigned not only to achieve an aesthetic but also functional recovery of the teeth. In many periodontal compromised patients pockets with an intra-bony component are recorded and scientific evidences on orthodontic treatment after periodontal regeneration are scarce. The purpose of this presentation is to show some clinical cases to illustrate periodontal regeneration in periodontally compromised patients’ candidate to orthodontic therapy.


 

6. PERIODONTAL RISKS IN ADULT ORTHODONTIC THERAPY
Mariana Pacurar
University of Medicine and Pharmacy of Targu-Mures

Orthodontics, as well as other specialties of Dentistry has experienced a permanent evolution in recent years because of performance in radiological investigation techniques (Cone-beam CT, computerized tele-radiography) and technological progress and materials market (hybrid arches, auto-ligatured brackets, anchorage mini-implants). Orthodontic therapy is increasingly requested by a heterogenic population segment, with ages between 5 and 55 years, seeking a quick and effective treatment, with an emphasis on the improvement of facial aesthetics. The purpose of this conference is to present a synthesis of the most frequent periodontal risks during orthodontic treatment in adults, and elements related to the adult patient adherence.
 

 

7. DIGITAL ORTHODONTICS: NEW TREATMENT METHODS AND PROTOCOLS.
Friedrich Widu
Dr. Med. Dent- Specialization in Orthodontics

Malocclusions play an important role in the development of periodontitis. By orthodontic treatment of the malocclusion a good gingival health can be obtained. On the other hand there is a risk of worsen the periodontal health during orthodontic treatment. Especially for patients that have a history of periodontal disease, monitoring the health of the parodontium and of the patient compliance is crucial. Control of the applied forces and the resulting tooth movement is another decisive factor in achieving results without harming periodontal health. Root resorption because of excessive force or loss of bone level due to a new inflammatory process during treatment are undesired and may compromise the results. Treatment with aligners to obtain desired results is today a possible alternative to fixed appliances in many cases. The removable aligners offer to the patient the advantage of easier cleaning compared to a fixed appliance. Different software tools for digital set up and aligner fabrication or tele-monitoring of tooth movement increase the range of therapeutic possibilities. Early detection of failure of the orthodontic appliance or deterioration of gingival health increase the security of the treatment. Digital treatment planning and monitoring can also be an excellent platform of communication between the periodontist and orthodontist. This lecture gives and overview of new methods and protocols.
 

 

 

ABSTRACTS OF THE CONGRESS PROGRAM: 

 

1. DYSBIOSIS AND ETIOPATHOGENESIS OF PERIODONTAL DISEASE
George Hajishengallis
University of Pennsylvania

Recent human microbiome analyses and animal model-based mechanistic studies collectively suggest that the pathogenesis of periodontitis is not mediated by a select few bacteria (traditionally known as ‘periopathogens’) but rather involves polymicrobial synergy and dysbiosis. The dysbiosis of the periodontal microbiota represents an alteration in the relative abundance of individual members of the polymicrobial community (relative to their abundance in health) leading to dysregulated host-microbial interactions that mediate destructive inflammation and bone loss. Although necessary, the bacteria are not sufficient to cause periodontitis, as it is the host inflammatory response to this polymicrobial challenge that inflicts damage to the periodontium in individuals who are susceptible through genetic and/or environmental modifying factors. It is now well appreciated that the control of periodontal inflammation can indirectly exert antimicrobial effects. This is because periodontitis-associated bacteria, traditionally referred to as ‘periopathogens’, thrive in an inflammatory environment. Indeed, the release into the gingival crevicular fluid of inflammatory breakdown products of connective tissue favors the outgrowth of certain species (e.g., proteolytic and asaccharolytic) that can benefit from these microenvironmental alterations. In other words, an initial inflammatory response (e.g., due to incipient dysbsiosis associated with poor oral hygiene) may select for those bacteria that can give rise to full-blown dysbiosis, thereby exacerbating inflammation and ultimately causing clinically evident periodontitis in susceptible individuals. Therefore, the control of inflammation should not only inhibit tissue damage but also suppress a nutritionally favorable environment that fuels dysbiosis.

 

2. HOST-ASSOCIATED FACTORS IN PERIODONTAL DISEASE PATHOGENESIS
Alpdogan Kantarci
Department of Applied Oral Sciences, Forsyth Institute, Boston, USA

Periodontal disease requires the presence and activity of the microorganisms. It is not known when ‘resident/commensal” microbiota becomes “pathogenic”. The host defense mechanisms play pivotal role in defining the etiopathogenicity of the microbial communities. Host-microbe communication in periodontal environment is highly specialized and unique and involves various stages characterized by cellular as well as vascular and extracellular events. Inflammation comprises of a series of events that leads to a host response against trauma and microbial invasion, results in liquefaction of surrounding tissues to prevent microbial metastasis, and eventually healing of injured tissue compartments. Periodontal diseases are inflammatory processes, in which microbial etiological factors induce a series of host responses that mediate an inflammatory cascade of events in an attempt to protect and heal the periodontal tissues. In addition to the “on” signals that initiate the inflammatory events, periodontal tissues are capable of generating “off” or “stop” signals as checkpoint controls in inflammation. These control mechanisms are specific resolving cellular and biochemical circuits that have evolved to activate resolution, thus limiting uncontrolled dissemination of inflammation. Understanding the underlying mechanisms is critical for developing novel and effective strategies for treatment of periodontal disease and restoration of homeostasis. This presentation will discuss various aspects of host responses of the periodontium and how microorganisms, environmental and genetic factors modify these processes.

 

3. BIOMARKERS OF PERIODONTAL DISEASE PROGRESSION
Ricardo Teles
OraPharma Distinguished Professor

During my lecture, I will describe the difficulties in identifying progressing sites in periodontitis subjects and how multibiomarker approaches can be used to discriminate such sites. Particularly, I will report on the results from an ongoing multicenter study with the goal of finding biomarkers of periodontal disease progression. During this study, 500 participants were monitored for 12 months without intervention to allow for the identification of progressing sites. Subjects were clinically monitored and samples from subgingival plaque, gingival crevicular fluid (GCF), serum and saliva were collected at 2-month intervals. These samples are currently being processed through several “omics” platforms and my presentation will focus on a panel of 64 GCF inflammatory biomarkers measured using Luminex technology. Accurate identification of sites and subjects at risk for progression of periodontal disease has the potential of shaping the future of personalized periodontal diagnosis and therapy.

 

4. EARLY FORMS OF PERIODONTAL DISEASES: ETIOLOGY, PATHOGENEIS AND THERAPY
Joerg Meyle
University of Giessen, Germany

Early-onset periodontitis belong to the rare types of periodontal diseases. Often they start with very few clinical symptoms. The pathogenesis is characterized by changes in the immune response and a dysbiosis of the bacterial biofilm. From a clinical point of a view it is mandatory, that already in 14- to 15-year old teenagers the periodontal status is regularly examined and documented, in order to identify intial changes and to enable early therapeutic intervention. The current therapeutic concepts enable successful local therapy also in aggressive periodontitis. Even regenerative therapy is successful. The long-term supervision and maintenance of these patients is of crucial importance and a prerequisite for the avoidance of further rapid loss of attachment. The importance of immunological changes in early-onset periodontal diseases is not definitively understood. Inheritable genetic variations and familiar accumulation of this type of disease were regarded as major reasons, nowadays it is obvious that changes in the immune response which are caused by the inflammatory reaction itself may have an impact. Based on the current scientific evidence in many cases healing of these forms of diseases is possible and in conjunction with proper maintenance long-term stability of treatment outcomes can be achieved. The current scientific evidence will be presented in conjunction with clinical examples and treatment outcomes.

 

5. PERIODONTITIS AND SYSTEMIC DISEASES: WHAT IS THE CLINICAL RELEVANCE?
Steven Offenbacher
WR Kenan Jr Distinguished Professor

Many studies have shown a significant association between periodontal disease and systemic inflammation, as well as systemic conditions. However, these associations are not consistent and definitions of disease vary widely. New methods for periodontal disease classifications using unbiased, data-driven approaches to define disease classes with latent class analysis (LCA) provide new insight into the association between periodontal disease and serum markers of inflammation, prevalent and incident systemic disease that are not apparent using AAP/CDC or European definitions of periodontal disease. These new findings will be discussed in the context of how new clinical definitions provide a robust method of standardization of disease classification across different populations. In addition these new approaches using LCA improve models of risk for tooth loss, attachment loss and systemic disease.

 

6. PERIODONTITIS AND CARDIOVASCULAR DISEASE-POTENTIAL LINKS AND PATIENT MANAGEMENT
Phoebus Madianos
National and Kapodistrian University of Athens

During the last three decades, attention has focused on a potential link between periodontal disease and cardiovascular disease (CVD), two widespread inflammatory conditions, the latter been the leading cause of death worldwhile. Observational studies indicate that periodontitis may confer an elevated risk for myocardial infarction, stroke and peripheral artery disease. Clinical studies demonstrate that periodontal disease is associated with a systemic inflammatory response, as evidenced by the elevation of systemic inflammatory markers, such as C-reactive protein (CRP), as well as endothelial dysfunction, which are both prognostic factors for cardiovascular events. The identification of periodontal pathogens in atheromatous plaques suggests that hematogenous dissemination of oral microbes may be involved in the pathogenesis of atherosclerosis. Recently, specific periodontal pathogens, as well as systemic antibody responses to periodontal pathogens have been associated with subclinical atherosclerosis. Data from experimental studies render support to the clinical findings and provide evidence that pathogens like Porphyromonas gingivalis may accelerate the atherosclerotic process. Primary intervention studies are lacking, but pilot studies focusing on surrogate outcomes, such as systemic inflammation and endothelial function, provide evidence for a beneficial role of periodontal therapy. Further observational and intervention studies are required in order to establish causality between periodontitis and CVD, The purpose of this lecture is to summarize the state of the science regarding the impact of periodontitis on cardiovascular health and to discuss critical aspects of periodontitis management in CVD patinets.

 

7. NON-SURGICAL PERIODONTAL THERAPY: UPDATE AND NEW DEVELOPMENTS
Raluca Cosgarea
University of Cluj-Napoca, Romania
University Marburg, Germany

Periodontal therapy focuses on the removal of bacterial deposits from the roots through mechanical debridement (i.e. scaling and root planning) aiming at resolving the inflammation, arresting disease progression and re-establishing periodontal health. Furthermore, reduction or even complete elimination of the microbial load seems to be a necessity for obtaining long-term clinical stability. Non-surgical periodontal therapy is the first step in achieving these goals and is mandatory prior any type of periodontal surgical procedure. This lecture focuses on presenting evidence based current clinical concepts and new developments in non-surgical periodontal treatment.

 

 

8. PROTOCOLS OF USE OF METRONIDAZOLE AND AMOXICILLIN IN THE PERIODONTAL TREATMENT
Magda Feres
Guarulhos University, Brazil

Despite the well-documented benefits of the adjunctive use of metronidazol and amoxicillin in periodontal treatment, the optimal protocol of administration of these agents has not yet been established and therefore, the periodontal prescriptions of these drugs are normally based on those used in medicine. However, this is not ideal due to certain unique features of periodontal diseases that are not normally observed in medical infections, such as the microbial protection afforded by the subgingival biofilm structure and great variation in concentration of the drugs in different sites of the oral cavity. The lack of clear guidelines for the use of systemic antibiotics in the periodontal treatment has generated empirical and heterogeneous protocols, which is an undesirable situation, since differences in these protocols directly impact the effectiveness of the agents in controlling infection and the development of side effects. This presentation aims to discuss the latest developments on this topic, more specifically, on the clinical and microbiological effects of different protocols of use of metronidazole plus amoxicillin in the periodontal treatment, such as antibiotics dosages, duration of treatment and best moment to administrate the antibiotics in relation to mechanical treatment. The ultimate goal is to guide the clinicians’ decision on the protocol of use of these agents in daily clinical practice.

 

9. ESTHETIC TREATMENT OF SOFT TISSUE DEFECTS AROUND IMPLANTS

Giovanni Zucchelli
University of Bologna, Italy

The recession of the buccal soft tissue margin is a frequent complication of well osteo-integrated dental implants. The appearance of metallic structure or even their transparency through the thin buccal soft tissues are common reasons for patient aesthetic complains. Moreover, bad implant installation frequently results in excessive apical dislocation of the buccal soft tissue margin of the implant supported crown. Soft tissue plastic surgical procedures and bilaminar techniques in particular, can be successfully used in combination with a pre and postsurgical provisional prosthetic management to treat buccal gingival recessions and soft tissue dehiscence around dental implants and to provide the new implant supported crown with an esthetic transmucosal emergency profile.

 

10. PERIODONTAL REGENERATION: BIOLOGICAL BACKGROUND AND CLINICAL PERSPECTIVES
Mark Bartold
University of Adelaide

Over the past 20 years there have been some exceptional advances made in the field of periodontology. One of the major advances has been in our understanding of the biology and clinical outcomes of periodontal regeneration This presentation will consider the important developments over the years. In addition this presentation will discuss some of the major conceptual changes which have occurred in periodontal regeneration in recent years and how they have led to significant changes in our thinking and approach to periodontal therapy. A brief consideration of future developments will also be covered.

 

11. CONVENTIONAL PERIODONTAL SURGERY: STATE OF THE ART
Stefan-Ioan Stratul
Victor Babes University, Timisoara, Romania

Several recent US-based surveys reported than more than a quarter of the responding dentists performed conventional periodontal surgery at least occasionally. Certainly less spectacular than regenerative therapy, conventional periodontal surgery procedures maintained over the years a top-position in the general treatment plan of patients with chronic periodontitis. While access therapy and furcations treatment are regarded as periodontal additional therapies, crown lengthening procedures enjoy today a clinical revival and a privileged position in aesthetic dentistry. The lecture will review the classic techniques in periodontal pocket reduction surgery, distal wedge procedures and resective osseous surgery, as employed today in the clinical daily practice, and as reflected in recent clinical research literature. These various conventional surgical methods should be evaluated on the basis of their potential to facilitate removal of subgingival deposits and self-performed plaque control, thus enhancing the long-term preservation of the periodontium.

 

12. BONE REGENERATION – BIOLOGICAL BACKGROUND AND CLINICAL APPLICATIONS
Andreas Stavropoulos
University of Malmo, Sweden 

Presence of adequate amount of bone, allowing implant installation with sufficient initial stability and with its circumference completely covered by an adequate amount of bone is considered essential for successful implant treatment. Nevertheless, patients often present with less than adequate amount of bone for proper implant installation, requiring bone regenerative procedures. Bone regenerative procedures most often involve grafting of bone, bone substitutes, or combinations thereof. Autogenous bone is often considered the “gold standard”. However, is autogenous bone indeed the best material for all clinical indications or can it be replaced? Can autogenous be replaced completely or should it be used in combination with bone substitutes? The presentation will focus on the available evidence about what is the most indicated grafting material or combination in various clinical indications.

 

13. CLINICAL CONCEPTS IN REGENERATIVE PERIODONTAL THERAPY
Giulio Rasperini
University of Milano, Italy

In the last years the aesthetic demand from the patients has become the biggest challenge in Periodontology as well as in implant dentistry. Besides functional results is now important to achieve aesthetic success, particularly in the anterior areas, where the expectations of the patients are even higher. The introduction of new biological concepts, biomaterials and new surgical techniques during the last years, such as minimally invasive approach, Growth Factors, different Papilla Preservation Techniques, or Soft Tissue Wall approach, makes possible to answer to the patient’s demands and change the prognosis of compromised teeth with predictable long term results. Each technique as well as the decision making in different clinical scenario, will be analyzed during the presentation. The procedures will be shown in details and clarified with the projection of several macro-video. Hands on Course- Regenerative periodontal therapy: The ultimate Surgical techniques for periodontal Regeneration will be analyzed during the presentation. Each technique as well as the decision making in different clinical scenario, will be shown explained and reproduced by the participants with hands on exercise on simulators.

 

14. THE BERNESE CONCEPT FOR THE TREATMENT OF SINGLE AND MULTIPLE RECESSIONS
Anton Sculean
University Bern, Switzerland

Predictable coverage of multiple adjacent recessions and of single mandibular deep recessions is still a challenge for the clinician. The Modified Coronally Advanced Tunnel (MCAT) or the newly developed Laterally Moved Double Tunnel (LMDT) result in predictable coverage of single and multiple adjacent gingival recessions. The present lecture will provide a comprehensive treatment philosophy on the surgical risk factors and biologic principles that need to be considered to optimize the results. Presentations of clinical cases and of surgical videos will demonstrate the use of MCAT and LMDT while own data with a follow-up of up to 8 years support their clinical relevance. Novel approaches including combination of biologic materials and different types of collagens may represent novel alternatives to replace autogenous soft tissue grafts.

 

15. PERI-IMPLANTITIS: ETIOLOGY, PATHOGENESIS AND DIAGNOSIS
Giovanni E. Salvi
University of Bern, Switzerland

Peri-implant diseases have been defined as (i) development of mucosal inflammation around osseointegrated implants without loss of supporting bone (i.e. peri-implant mucositis) and (ii) presence of inflammation with additional loss of supporting bone (i.e. peri-implantitis). Peri-implant diseases are initiated by the formation of biofilm deposits around the neck of the implant or the abutment. Outcomes of experimental studies in animals indicate that tissue destruction at peri-implantitis sites is faster and more extensive compared with that at periodontitis sites. Although human periodontitis and peri-implantitis lesions share similarities with respect to etiology and clinical symptoms, they represent distinct entities from a histopathological point of view. In order to avoid implant loss, early diagnosis and treatment of peri-implantitis is of crucial importance.

 

16. CLINICAL CONCEPTS FOR THE TREATMENT OF PERI-IMPLANTITIS
Jamil Shibli
Guarulhos University, Brasil

Peri-implantitis is defined as an irreversible inflammatory process that affects the soft and hard tissues and is considered to be the most important cause of late dental implant failures. This process could impact negatively in daily clinical practice and several treatment have been proposed to solve the peri-implant diseases. This presentation will discuss the clinical endpoints as well as several factors that could affect the predictability of surgical and non-surgical therapy.

 

17. KEEPING COMPROMISED TEETH OR REPLACING WITH IMPLANTS
Niklaus P. Lang
University of Berne, Universities of Zurich, Hong Kong and London, UK

Answering this question is certainly not an easy enterprise and probably best dealt with by stating: "It just depends". However, for the practicing dentist a relatively reliable answer is of utmost importance, especially when reconstructions are planned to restore adequate function, obtain satisfying esthetics and obtain and maintain oral health. Therefore, the questions will be answered for various situations: For the healthy tooth with an almost intact periodontal support, for the periodontally compromised, but successfully treated abutment tooth, for the devitalized, but root canal treated tooth, for the endodontically compromised tooth with periodical pathology. These discussions will emphasize the importance of maintaining natural teeth even if they are affected by pathological findings. Post therapeutic treatment prognoses are well documented, especially for survival and complication rates of fixed partial dentures on tooth abutments, on implants and on both tooth and implant abutments. The major question is not to discuss the alternative between tooth abutments versus implant abutments, but to discuss predictability and longevity of teeth following active periodontal or endodontic therapy. In that respect, implants do not provide a higher value to the patient. They are not chosen to replace teeth, but to help replace already missing teeth. It has to be realized that that the long- term documentation of implant survival and complication rates are at its best 10 years old and that none of the systems sold today have more than 5-year data to offer. However, even for teeth jeopardized by periodontal or endodontic conditions the literature provides a number of long-term studies to answer the above proclaimed questions with high reliability always considering the single patient situation with great respect.