title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: Accademia Toscana di Ricerca Odontostomatologia (ATRO), Florence, Italy European Research Group on Periodontology (ERGOPERIO), Genova, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Cortellini
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Stalpers
authors.forename: Aniello
authors.initials: A
authors.lastname: Mollo
authors.forename: Maurizio S
authors.initials: MS
authors.lastname: Tonetti
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000601:surgery*; D001861:Bone Regeneration; D018786:Bone Substitutes; D055113:Chronic Periodontitis / Q000000981:diagnostic imaging / Q000601:surgery*; D003746:Dental Enamel Proteins / Q000627:therapeutic use; D019094:Dental Prosthesis, Implant-Supported; D003830:Denture, Partial, Fixed; D005260:Female; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000601:surgery; D010514:Periodontal Pocket / Q000601:surgery; D010516:Periodontal Splints; D011379:Prognosis; D011859:Radiography; D016019:Survival Analysis; D014081:Tooth Extraction; D014086:Tooth Mobility / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D018786:Bone Substitutes; D003746:Dental Enamel Proteins; D008567:Membranes, Artificial; C109069:enamel matrix proteins