Ethical Issues in Replacing a Periodontally Involved Tooth with Dental Implants: Thoughts, Beliefs, and Evidence

Over the past decade, the use of osseointegrated implants as a foundation for prosthetic replacement of missing teeth has become widespread. However, certain risk factors might predispose individuals to lower success rates and to a greater hazard for implant failure. The misleading public notion (sometimes supported by dentists) that implants will survive forever leads, in some cases, to early extraction of teeth. We, as dental professionals, should avoid basing our treatment planning on thoughts and beliefs and stick as much as possible to evidence-based practice. Implants are not a magic solution for every diseased tooth. Implants probably will not survive forever and the procedure is not without risk. Although it seems tempting to get rid of an unhealthy tooth and replace it with an implant, this is not always the gold standard of treatment. Natural teeth can serve our patients for the long term with proper management and maintenance. The option of replacing the tooth with an implant should not be a major factor leading to extraction. Furthermore, we must remember that most of the available literature concerning dental implants is rather short term with regard to patients' life expectancy. Ethic considerations as well as careful explanation to the patient are of utmost importance in those cases.