Tooth Preservation vs. Extraction and Implant Placement in Periodontally Compromised Patients: A Systematic Review and Analysis of Studies

PURPOSE

The aim of this systematic review was to identify studies with a minimum of 5-years follow-up, reporting on the management of periodontally compromised teeth with either extraction and subsequent implant placement or teeth preservation with conventional periodontal treatment and application of regenerative procedures. The outcomes of these two approaches, based on clinical and radiographic data and the incidence of tooth- and implant-loss, were also investigated.

MATERIAL AND METHODS

A systematic search for studies reporting on clinical and radiographic outcomes of periodontal treatment or replacement of periodontally compromised teeth with implants was conducted in 3 electronic databases, followed by a hand-search in 8 journals. Only randomized controlled trials (RCTs), cohort studies, and case series with prospective design were included.

RESULTS

The initial search resulted in 1080 papers. After the first two screenings, 24 publications were selected for inclusion in this systematic review. The treatment protocols for the teeth preservation group contained non-surgical and/or surgical periodontal treatment with or without regeneration procedures. The implant studies included extraction of periodontally involved teeth and implant placement with or without bone and soft tissue augmentation, followed by restoration with fixed dental prostheses (FDPs). Survival rates ranged between 81.8% and 100% in the tooth retention group, and between 94.8% and 100% in the implant group. In the extraction group, no complications were reported for 76.09% of the implants. Similarly, no complications were reported for 86.83% of the tooth retention group. The lack of standardized comparable studies prohibited conduction of a meta-analysis.

CONCLUSION

Both treatment approaches, treatment of periodontally compromised teeth, or tooth extraction followed by implant placement, present high survival rates. The application of bone regeneration techniques improves the long-term prognosis of periodontally involved teeth. Hence, treatment of periodontally involved teeth with subsequent application of a rigorous maintenance protocol can be a viable alternative for a number of years, before proceeding to extraction and replacement with dental implants. More well-designed randomized controlled trials are needed in order to draw definite conclusions on the subject. This article is protected by copyright. All rights reserved.

Evaluation of efficiency and capacity of thermal, chemical and ultrasonic regeneration of tetracycline exhausted activated carbon

Emerging pollutants have received increasing attention because of their potential environmental risks. As conventional treatment processes are not able to completely remove emerging pollutants, such as drugs, for example, the adsorption process is considered a complementary treatment. However, after some time of use, the adsorbent solids used in this type of process become saturated and there may be a higher demand for replacement of these materials, resulting in a large amount of solid waste. In this context, the objective of this study was to evaluate regeneration techniques of adsorbent solid depleted with emerging tetracycline pollutant. For this, tests were performed using three regenerative methods - thermal, chemical and ultrasonic, where through them were analyzed the influence of temperature, type of solvent and sonification time, respectively. Virgin, saturated and regenerated solids were characterized by their physical structure, micro and mesopore distribution and scanning electron microscopy. For all techniques employed, the regeneration efficiency reached values ⁣⁣above 85%. Thermal treatments at 200°C, 100% methanol solution, 100% deionized water with 60 °C heating and ultrasonic treatment at 5 and 20 minutes were chosen as the most viable methods for the study of adsorption/desorption cycles. Compared to the others, the heat treatment at 200°C remained with consistent results until the sixth cycle, presenting a regenerative capacity of 90%. Therefore, it has been selected as the most suitable regenerative agent, ensuring that CAG can be regenerated and used repeatedly in the treatment of tetracycline contaminated waters.