Proximal bone loss adjacent to periodontally "hopeless" teeth with and without extraction

Extraction of teeth with severe attachment loss ("hopeless" teeth) is common practice in the dental office. Recent evidence questions the validity of this approach. The purpose of the present study was to examine the alveolar bone changes adjacent to "hopeless" teeth with and without extraction. A total of 145 teeth from 129 patients were included in this retrospective study. Teeth were defined as "hopeless" when Class III furcation involvement was present, or when alveolar bone loss exceeded 50%. Patients were pooled into two groups: A, 82 "hopeless" teeth (71 patients) that were retained throughout the experimental period, and B, 63 "hopeless" teeth (58 patients) that were extracted. The average observation period was 4 years with a minimum of 2 years. Alveolar bone changes were measured as a percentage of the anatomic root (radiographic apex-CEJ) using a Schei ruler. Results revealed significantly greater bone loss adjacent to teeth flanking retained "hopeless" teeth, 3.12% per year, at a rate 10 times that of the 0.23% annual bone loss in teeth flanking "hopeless" teeth that were extracted (P less than 0.0001). This study confirms that without periodontal treatment, the retention of teeth with severe periodontal breakdown has a negative effect on the adjacent teeth.