Maurizio S Tonetti1,2, Ronald E Jung3, Gustavo Avila-Ortiz4, Juan Blanco5, Jan Cosyn6, Stefan Fickl7, Elena Figuero8, Moshe Goldstein9, Filippo Graziani10, Phoebus Madianos11, Ana Molina8, Jose Nart12, Giovanni E Salvi13, Ignacio Sanz-Martin8, Daniel Thoma3, Nele Van Assche14, Fabio Vignoletti8. 1. Division of Periodontology and Implant Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong, China. 2. European Research Group on Periodontology, Genova, Italy. 3. Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland. 4. Department of Periodontics, The University of Iowa, Iowa City, Iowa. 5. Department of Surgery and Medical-Surgical Specialties (Dentistry area), Unit of Periodontology, University of Santiago de Compostela, Santiago, Spain. 6. Department of Dentistry, University of Ghent, Ghent, Belgium. 7. Division of Periodontology, University of Würzburg, Würzburg, Germany. 8. ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, Department of Dental Clinic Specialties, Faculty of Dentistry, University Complutense, Madrid, Spain. 9. Department of Periodontology, Hebrew University, Jerusalem, Israel. 10. Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy. 11. Department of Periodontology, Kapodistrian University, Athens, Greece. 12. Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain. 13. Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland. 14. Private Practice of Periodontology and Implantology, Geel, Belgium.
Abstract
BACKGROUND: The transition from a tooth requiring extraction to its replacement (with a dental implant) requires a series of clinical decisions related to timing, approach, materials, cost-effectiveness and the assessment of potential harm and patient preference. This workshop focused on the formulation of evidence-based consensus statements and clinical recommendations. METHODS: Four systematic reviews covering the areas of alveolar ridge preservation/bone grafting, immediate early and delayed implant placement and alveolar bone augmentation at the time of implant placement in a healed ridge formed the basis of the deliberations. The level of evidence supporting each consensus statement and its strength was described using a modification of the GRADE tool. RESULTS: The evidence base for each of the relevant topics was assessed and summarized in 23 consensus statements and 12 specific clinical recommendations. The group emphasized that the evidence base mostly relates to single tooth extraction/replacement; hence, external validity/applicability to multiple extractions requires careful consideration. The group identified six considerations that should assist clinicians in clinical decision-making: presence of infection, inability to achieve primary stability in the restoratively driven position, presence of a damaged alveolus, periodontal phenotype, aesthetic demands and systemic conditions. CONCLUSIONS: A substantial and expanding evidence base is available to assist clinicians with clinical decision-making related to the transition from a tooth requiring extraction to its replacement with a dental implant. More high-quality research is needed for the development of evidence-based clinical guidelines.
BACKGROUND: The transition from a tooth requiring extraction to its replacement (with a dental implant) requires a series of clinical decisions related to timing, approach, materials, cost-effectiveness and the assessment of potential harm and patient preference. This workshop focused on the formulation of evidence-based consensus statements and clinical recommendations. METHODS: Four systematic reviews covering the areas of alveolar ridge preservation/bone grafting, immediate early and delayed implant placement and alveolar bone augmentation at the time of implant placement in a healed ridge formed the basis of the deliberations. The level of evidence supporting each consensus statement and its strength was described using a modification of the GRADE tool. RESULTS: The evidence base for each of the relevant topics was assessed and summarized in 23 consensus statements and 12 specific clinical recommendations. The group emphasized that the evidence base mostly relates to single tooth extraction/replacement; hence, external validity/applicability to multiple extractions requires careful consideration. The group identified six considerations that should assist clinicians in clinical decision-making: presence of infection, inability to achieve primary stability in the restoratively driven position, presence of a damaged alveolus, periodontal phenotype, aesthetic demands and systemic conditions. CONCLUSIONS: A substantial and expanding evidence base is available to assist clinicians with clinical decision-making related to the transition from a tooth requiring extraction to its replacement with a dental implant. More high-quality research is needed for the development of evidence-based clinical guidelines.
Authors: Benjamin R Coyac; Qiang Sun; Brian Leahy; Giuseppe Salvi; Xue Yuan; John B Brunski; Jill A Helms Journal: J Periodontol Date: 2020-05-28 Impact factor: 6.993