Title	Retention of Periodontally Hopeless Teeth Has No Detrimental Effect on Adjacent Teeth When Periodontal Treatment Is Completed
Clinical Question	For a patient with a periodontally hopeless tooth, does maintaining the hopeless tooth as opposed to extracting it lead to a poorer prognosis for adjacent teeth?
Clinical Bottom Line	Retention of periodontally hopeless teeth does not have a negative impact on the periodontal support or proximal bone levels of non-hopeless adjacent teeth in patients who receive periodontal treatment. In patients who do not receive treatment, the retention of hopeless teeth leads to increased proximal bone loss of adjacent teeth. This is based on two retrospective studies and one follow-up study and is applicable to patients who wish to retain hopeless teeth due to factors such as finances or personal preference.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18052695 Machtei/2007 93 patients, ages 16 to 68 years, with 110 hopeless teeth and adjacent teeth Retrospective study Key results Patients with residual PD >6 mm after non-surgical periodontal therapy were treated with surgical open flap debridement. Hopeless teeth were defined as teeth with proximal bone loss of ≥70%. Hopeless teeth retained after surgery experienced a mean bone gain of 0.82 ± 0.34 mm. Teeth adjacent to extracted hopeless teeth experienced slightly greater radiographic bone gain. However, the difference was only significant for teeth distally adjacent to retained hopeless teeth (1.5% ± 2.1%) as opposed to when hopeless teeth were extracted (11.36% ± 3.3%). Overall, periodontal surgery resulted in the arrest of proximal bone loss around hopeless teeth with no detrimental effects on adjacent teeth. 1507046 Wojcik/1992 10 patients with one hopeless tooth and one mesial adjacent non-hopeless tooth Follow-up study Key results Patients received periodontal treatment 8 years prior to evaluation. At re-examination, there were no statistically significant differences in probing depth, radiographic bone loss, or width of the periodontal ligament space. Retained hopeless teeth did not negatively affect the periodontium of adjacent teeth. 2795418 Machtei/1989 129 patients with 145 hopeless teeth and adjacent teeth Retrospective study Key results Patients received no periodontal treatment during the study. Teeth adjacent to retained hopeless teeth experienced statistically significant mean annual bone loss (3.12%) compared to those adjacent to extraction sites (0.23%). Without treatment, retention of hopeless teeth had a negative effect on the periodontal health of adjacent teeth.
Evidence Search	(retention OR retained OR extraction) AND (bone loss OR prognosis) periodontal hopeless teeth adjacent
Comments on The Evidence	No meta-analyses or systematic reviews were found during the evidence search, and the most recent relevant published article is from 14 years ago. Machtei 2007 is a well-designed retrospective study that includes 93 patients. The article has strict inclusion/exclusion criteria and measured the radiographic bone distance at proximal sites to assess bone levels. While the article concludes that long-term retention of hopeless teeth does not negatively affect the periodontal support of adjacent teeth, the mean follow-up was only 4.40 ± 0.23 years. This is a relatively short time period. The study also did not specify if patient or sensor positioning was standardized when radiographs were made. Slight alterations in positioning may affect measurements made on two-dimensional images. Wojcik 1992 is a follow-up study conducted 8 years after initial evaluation. This is a longer follow-up period than Machtei 2007. The study specifies that a long-cone parallel technique and Rinn positioning device were used when making radiographs. While more consistent than the previous, this technique does not provide the ability to take standardized radiographs. A serious limitation of this study is the small sample size. Only 10 patients from the initial study were available at follow-up. Machtei 1989 is a retrospective study that includes 129 patients. The exclusion criteria specify that patients with “contributory systemic conditions” were excluded but makes no mention of smoking status. Smoking is a well-recognized risk factor for periodontitis and may serve as cofounder in this study.
Applicability	Retention of periodontally hopeless teeth in patients who receive non-surgical and surgical periodontal therapy does not negatively affect the periodontal support and proximal bone levels of adjacent non-hopeless teeth. Retention of hopeless teeth in patients who receive no periodontal treatment leads to an increased loss of proximal bone on adjacent teeth compared to extraction of hopeless teeth. The evidence is applicable to any practitioner with patients who wish to retain a hopeless tooth due factors such as finances or personal preference. This may also be applicable in situations where extraction of hopeless teeth may be deferred for extended periods of time due to patient health or delay in providing of a definitive treatment plan.
Specialty	(Periodontics)
Keywords	Periodontally hopeless tooth, adjacent tooth, prognosis
ID#	3484
Date of submission	12/01/2021
E-mail	piehl@uthscsa.edu
Author	Ellen Piehl, DMD
Co-author(s)	Kaleb C. Esplin, DDS
Co-author(s) e-mail	esplin@uthscsa.edu
Faculty mentor	Angela Palaiologou-Gallis, DMD, MS
Faculty mentor e-mail	palaiologoua@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available