Periodontal regeneration versus extraction and prosthetic replacement of teeth severely compromised by attachment loss to the apex: 5-year results of an ongoing randomized clinical trial

Aims: Aim of this randomized, long-term clinical trial was to compare clinical-and patient-based outcomes following periodontal regeneration or extraction and replacement of hopeless teeth with chronic perio-endo lesions and/or attachment loss to or beyond the apex. Methods: Fifty patients presenting with generalized severe periodontitis and at least one hopeless tooth to be extracted for periodontal reasons were entered in this study. The test treatment consisted in the application of a regenerative strategy to 25 hopeless teeth. The control treatment consisted in the extraction of the 25 hopeless teeth and their replacement with conventional or implant-supported fixed partial dentures. Results: In the control group, 14 teeth were replaced with implant-supported restorations, eight with tooth-supported bridges, two with Maryland bridges, while one was not replaced. All fixed partial dentures survived the 5-year follow-up period and 83% were free from biological complications. In the test group, 23 of the 25 regenerated teeth showed important clinical improvements: the two teeth with unsatisfactory outcomes were extracted at 1 year. The 23 successfully regenerated teeth (92%) were in good health and function at 5-year examination visit and 84% did not develop biological complications during the recall period. All patients consistently reported comfort in function at the experimental test and control units. In the test group, average clinical attachment level gains were 7.7 +/- 2.8 mm, radiographic bone gain 8.5 +/- 3.1 mm, probing pocket depth (PPD) reduction 8.8 +/- 3 mm. Residual PPDs were 4 +/- 1.7 mm. Most of the regenerated teeth showed a decrease in tooth mobility. Conclusions: Regenerative therapy can be applied at hopeless teeth and has the potential to change their prognosis; it is a suitable alternative to extraction of severely compromised teeth with intra-bony defects to or beyond the root apex.