Tooth Retained Implant: No More an Oxymoron

Periodontally affected teeth are treated in one of the two ways. (1) Tooth retention after periodontal surgery, in which the degree of regeneration achieved is unpredictable. (2) Tooth extraction and implant placement. Implants have an osseointegrated surface which does not provide adequate shock absorption. Regeneration can be achieved by resecting the crown of the affected tooth and submerging the root. This technique has not had a clinical application so far as the tooth becomes difficult to restore. Placing an implant within the root can make the retained root restorable. At the same time, as the implant is placed within the root surface it achieves a periodontal integration which dampens occlusal forces better than osseointegration. Therefore, such a “tooth retained implant” may serve as an additional treatment option with significant benefits over tooth retention and implant placement alone. The hypothesis: Implants placed within retained roots have shown cementum deposition and attachment of periodontal ligament fibers over their surface. This periodontal attachment may be able to dampen forces better than in an osseointegrated implant. Moreover, since an implant is being placed, the crown of the tooth can be resected and submerged. This prevents epithelial migration, allows for the periodontal ligament cells to populate the wound and favors regeneration. Evaluation of the hypothesis: The technique of placing implants within cavities prepared in the root and then submerging them are simple for any practitioner placing implants routinely.