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Instead, attempts to save the tooth with treatment, especially in cases of gum or periodontal disease, should sometimes be tried first, the lead researcher said. And although the study did not address expense, dental implants are not cheap, costing roughly $3,500 for the complete treatment.
"Preserving teeth by proper periodontal treatment and a careful and frequent maintenance program will probably give the same, and even better, results for the long run," said study co-author Dr. Liran Levin, an assistant professor of periodontology at the Israel Institute of Technology and a visiting assistant professor at the Harvard School of Dental Medicine in Boston.
He reviewed 19 published studies that looked at either implant survival rates or tooth survival rates over at least 15 years. The results are published in the October issue of the Journal of the American Dental Association.
Levin found that about 4 percent to 13 percent of teeth not implanted were lost. None to 33 percent of implants were lost. According to the U.S. National Institutes of Health, an implant is viewed as successful if it is functional for five years in 75 percent of cases.
"This is one of the first reviews comparing the long-term survival of dental implants as opposed to properly treated and maintained teeth," Levin said.
Dental implants are one of the biggest advances in dentistry in the past 40 years, according to the American Dental Association website. The procedure usually requires three phases once the natural tooth is extracted or missing. First, the dentist surgically places the implant -- a post-like device that serves as an anchor -- into the jawbone. The bone around the implant is allowed to heal. An artificial tooth is made to fit over the implants.
Based on the results of the review, Levin said he tells patients: "When advised to extract a tooth, don't rush into that. Try to seek a second opinion, be sure to treat the disease [if any] and eliminate it before going through dental implantation. Always ask about the possibility not to extract."
In some cases, of course, implants are preferred, Levin said. "There are several cases that usually require tooth extraction and are unsalvageable." For instance, he said, teeth with vertical root fractures or other structural problems.
However, some dentists are over-recommending implants, he said. "This might result from their belief that dental implants are better, which was proved wrong in our review, or from other reasons," he said.
Dr. Edmond Hewlett, a spokesperson for the American Dental Association and a professor of restorative dentistry at the University of California, Los Angeles School of Dentistry, said he doesn't get the sense that dentists are over-recommending implants.
The study, however, makes an important point, he said. "We can't assume an implant is going to be better than keeping the tooth," Hewlett said. "A lot of times keeping the tooth and nursing it along may actually be a better option, all things considered."
If a patient has gum disease, for instance, and the tooth is wiggling a bit, a patient may want to undergo periodontal treatment (such as gum surgery) and allow three to six months to see if the tooth responds, he said.
Some teeth, he agreed, are so damaged it would be difficult to treat them and implants are the best solution.
In the United States the cost for an implant --and the restorative crown that goes over it -- ranges greatly, but can be about $3,500. Treatments for saving teeth vary greatly, depending on what procedures are needed.
Insurance coverage differs, too, with extraction typically included, while coverage for the dental implants can range widely.
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