Treatment Planning 101: Part I

As our overall population ages and their desire to maintain their oral health increases, they present to our practices with more and more complex treatment needs and desires. With that, we are often times perplexed with many challenging tooth situations – furcation-involved teeth, teeth that require root canal treatment and retreatment, multiple missing teeth, fractured teeth and roots, etc. It is then we have to decide whether or not to extract the tooth/teeth in question, and/or what is the best treatment option for our patients going forward?

Often times, we make recommendations and treatment plan based on our own experience alone – or maybe what we were taught in school, or what worked best for Dr. Smith down the street, etc. However, when we are treatment planning and trying to help our patients make the best decisions for their overall oral health, we have to know some ‘numbers’ in the midst of complex treatment needs.

The ‘numbers’ I am referring to are the statistical numbers that have been found from well-done research, thus giving us a scientific basis for our decisions/recommendations to our patients. Without them, personally, I have a hard time being able to make clear recommendations to my patients about what is best for them and their overall oral health now and in the future.

With that being said, as dental implants have become more mainstream, and appear to be such a ‘predictable’ treatment option for our patients, we, the dental profession, sometimes have been quick to remove ‘hopeless’ or ‘questionable’ teeth and replace them with implants.

What more could we ask for?

Why not? A solution to almost all complex tooth issues that is long lasting and predictable (overall seemingly high success rate with some reports¹ showing over 90 percent), doesn’t decay and is just about as close to a natural tooth as we can get – what more could we ask for? And sometimes it is easier to simply remove the tooth/teeth in question that are less than ‘ideal’ and replace them with a more predictable solution: the dental implant. Right?

Well, recently in the Journal of American Dental Association², dental implant and restoration success rates have been questioned and may open up a bigger discussion about what truly defines ‘success’ in dental implants. This impacts dental implant overall success rates and possibly how we incorporate them into our treatment options for our patients going forward. In this study, there was a failure rate of dental implants of only 7 percent at four years, but when they added excessive bone loss, the failure rate went to over 18 percent in a four year period.

So, as you can see, after you do your research and start to get to ‘know the numbers’ and the criteria that is used, research studies can and should impact your decisions for you and your patients when some of these complex situations arise with a tooth or teeth and require future treatment.

In the next few articles, we will be shedding some light and research ‘numbers’ on some of these tough clinical situations that we see in our patients every day.

Jeff Lineberry, DDS, FAGD, Visiting Faculty and Contributing Author for Spear Education [http://www.jefflineberrydds.com/]

References

1. 10-year survival and success rates of 511 titanium implants with a sandblasted and acid-etched surface: a retrospective study in 303 partially edentulous patients. Clin Implant Dent Relat Res. 2012 Dec;14(6):839-51.
2. Outcomes of implants and restorations placed in general dental practices. A retrospective study by the Practitioners Engaged in Applied Research and Learning (PEARL) Network. The Journal of the American Dental Association (July 1, 2014) 145, 704-713.