AAP Reaffirms its Position on Making Reasonable Efforts to Save Natural Dentition via Evidence-Based Treatment Planning

AAP Reaffirms its Position on Making Reasonable Efforts to Save Natural Dentition via Evidence-Based Treatment Planning

CHICAGOMay 25, 2010 As the field of dental implantology continues to have a significant effect on dental treatment planning, the American Academy of Periodontology (AAP) recently reaffirmed its position that, whenever reasonable, efforts should be made to save a patient’s natural dentition. What’s more, the AAP stressed that an evidence-based approach must always be taken when considering an individual’s treatment options, especially when it comes to surgical procedures such as tooth extraction and dental implant placement.

According to Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology, “There has been some discussion that more and more dentists, GPs and specialists alike, are favoring extraction and implant surgery, rather than saving the natural dentition. The reason often given is that the patient believes implant surgery is quicker and requires less effort than undergoing periodontal therapy and following a long-term oral health regimen. While it is important to consider the patient’s preferences, it is the AAP’s long-standing belief that evidence-based treatment planning produces better patient outcomes.”

Dr. Low also commented that there may be a misperception among some patients and dentists that traditional periodontal treatment is not effective. “The fact that traditional periodontal treatment, including both non-surgical and surgical techniques, has very high success rates has been shown in longitudinal studies,”1-3 explained Dr. Low. “It has also been shown that periodontal surgery, when not followed by good professional and personal care, will in many cases fail.”4,5

What’s more, the AAP maintains that implant surgery is not a “no-maintenance” alternative to natural dentition, because even implants require proper oral hygiene to prevent bone loss (peri-implantitis), which recent research has shown to be more prevalent than many dentists and patients realize.6

While implants do provide a useful option for patients whose natural dentition is unable to be maintained, sustained progress in periodontics has made preservation more attainable. For example, recent scientific advances in regeneration have made restoring lost periodontal tissues more predictable then ever. According to Dr. Low, “It is critical that all dental professionals ensure that patients are aware of all possible treatment options, and that an evidence-based approach is used to determine what the best possible course of treatment should be.”

Dr. Low summed up by saying, “The entire dental team of general dentist, periodontist, and hygienist must first work together in educating patients on proper oral hygiene in an effort to prevent periodontal disease and preserve the natural dentition. In addition, the dental team must provide a united front in ensuring that when periodontal treatment is needed, the patient understands the options and ultimately accepts the recommended course of treatment, maintenance, and at-home regimen.”


  1. Hirshfeld L, Wasserman B. A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol. 1978 May; 49(5):225-37.
  2. Oliver RC. Tooth loss with and without periodontal therapy. Periodontal Abstr. 1969 Mar; 17(1)8-9.
  3. Goldman MJ, Ross IF, Goteiner D. Effect of periodontal therapy on patients maintained for 15 years or longer. A retrospective study. J Periodontol. 1986 Jun; 57(6):347-53.
  4. Lindhe J, Nyman S. Long-term maintenance of patients treated for advanced periodontal disease. J Clin Periodontol. 1984 Sep; 11(8):504-14.
  5. Lindhe J, Westfelt E, Nyman S, Socransky SS, et al. Healing following surgical/non-surgical treatment of periodontal disease. A clinical study. J Clin Periodontol.1982 Mar; 9(2):115-28.
  6. Lindhe J, Meyle J; Group D of European Workshop on Periodontology. Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol. 2008 Sep; 35(8 Suppl):282-5.

About the AAP:

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide. For more information, contact the AAP Public Affairs Department at meg@perio.org or 312-573-3242.


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