Saving teeth through regeneration offers long-term benefits over implants

A major long-term study presented at EuroPerio11, the world's leading congress on gum health and implant dentistry by the European Federation of Periodontology (EFP), reveals that saving teeth with severe bone loss through periodontal regeneration (PR) offers benefits equal to - if not greater than - replacing them with dental implants or bridges.

The study followed patients for 20 years, comparing those who underwent advanced regenerative procedures to keep a tooth, with those who had the same tooth extracted and replaced with either an implant or a fixed bridge. The findings are clear: saving the tooth can work just as well, costs less in the long term, and may offer a better experience for some patients.

The idea that a tooth with severe loss of bone must always be removed isn't necessarily true. This study shows that regeneration is a powerful option that can give patients many more years with their own teeth."

Doctor Simone Cortellini from KU Leuven in Belgium, and one of the lead investigators

In cases of severe gum disease (periodontitis), the tissues that support the tooth, including the bone, can deteriorate, sometimes all the way down to the root tip (apex). Traditionally, these teeth are considered "hopeless" and often removed. But periodontal regeneration uses surgical techniques and materials to rebuild lost bone and tissue, potentially saving the tooth.

"We wanted to push the boundaries of what's considered 'hopeless'," said Dr Cortellini. "Our goal was to show that, in the right patients, even teeth with very advanced damage can be successfully treated and kept."

The randomised controlled trial involved 50 patients with severe periodontitis (Stage III or IV). Each had at least one tooth with attachment loss extending to or beyond the apex, a sign of extreme tissue destruction. Participants were divided into two groups:

• PR group: received periodontal regeneration to try to save the tooth
• TER group: had the tooth extracted and replaced with either an implant or a fixed bridge

Key findings after 20 years

After 20 years, both treatment options, saving the natural tooth or replacing it with an implant, proved to be successful. Only four teeth were lost in the group that kept their natural teeth, while just two implants failed in the replacement group. Gum health remained stable over time in patients who kept their teeth, with healthy attachment levels maintained two decades after treatment.

When it came to cost, keeping the natural tooth turned out to be significantly less expensive in the long run, even when factoring in ongoing care and maintenance. Importantly, both groups had similar results in terms of complications and treatment success.

"Replacing a tooth is not necessarily better than saving it," explained Cortellini. "In both cases, there's a chance of problems over time, especially in patients with a history of gum disease. But if we can save the tooth, we delay extraction for many years and that's a win for patients and for dental care systems."

Regenerative procedures are not only less expensive upfront, but this study also showed that over 20 years, they still cost significantly less than implants or bridges, largely because saved teeth often require fewer long-term repairs. "Even after two decades, periodontal regeneration still came out as more cost-effective," noted Cortellini.

Is regeneration right for everyone?

Regeneration is a complex technique that isn't suitable for every patient or every tooth. It works best in patients who are in good general health, do not smoke, are highly motivated and maintain excellent oral hygiene

"You can be the best periodontist in the world, but if the patient isn't a good candidate, you'll struggle to get long-term success," said Cortellini. "Patient selection, follow-up care and patient compliance are key."

"This landmark study reinforces that in the right hands and with the right patients, saving even severely damaged teeth through regeneration can be just as effective -if not more so - than replacing them," said Lior Shapira, EuroPerio11 scientific chair. "It's not only a clinically sound option, but also one that can lead to meaningful long-term savings for patients. While we did see the cost gap narrow slightly over time, preserving the natural tooth remained more cost-effective overall. At the same time, it's important to acknowledge that regeneration isn't a one-size-fits-all solution. Continued innovation in biomaterials will also help extend the benefits of regeneration to more patients."

"The most important message is simple: save the tooth if you can!" concluded Cortellini. "Tooth replacement is a good option, but regeneration can offer decades of stability and let people keep their own teeth. Our research tells us to think twice before extracting a tooth. If it were your tooth, wouldn't you want to try to keep it first?"