Reports & Studies

Tooth or implant?

PD Dr. Kristina Bertl, PhD MSc MBA

Should severely periodontally compromised teeth be retained or replaced with an implant? Unfortunately this is a question that we are often faced with in our daily clinical practice and, as implant therapy is a very expensive treatment, obviously we also need to think about whether one of the two options – 1) retaining the tooth or 2) replacing it with an implant – will be more cost-effective for the patient.

Tooth or implant?
Tooth or implant?

The answer to the question about cost efficiency obviously very much depends on the relevant healthcare system, but nonetheless a research group from Canada (Nagpal et al., 2024) looked at this question and used a systematic literature search to summarize the evidence available on this issue.

When addressing this issue, obviously it is necessary to consider several (cost) factors:

  • costs for implant treatment (surgical and prosthetic)
  • costs for any periodontal surgery
  • costs for supportive periodontal and implant therapy
  • costs in the event of any complications
  • and many more.

Nagpal et al. were able to identify a total of twelve studies on this issue, nine of which dealt with the cost efficiency of retaining teeth in severely periodontally compromised patients, and three of which looked into the cost efficiency of replacing periodontally compromised teeth with implants. Two very important conclusions became apparent: 1) From a financial perspective, it is cheaper to retain the patient’s own teeth; and 2) in the long term, the biggest cost factor is the supportive periodontal treatment.

The first point gives us a clear answer to the question we asked above, while some important information should be added to the second point, namely even if individual teeth that are severely periodontally compromised are replaced with implants, for the vast majority of patients this does not mean that no further supportive periodontal therapy will be needed – quite the contrary! Supportive periodontal therapy is usually still needed, and patients with a history of periodontitis are also risk patients for peri-implant diseases. This in turn means that for periodontitis patients in particular, even when they have implants, regular and frequent supportive periodontal and implant therapy will be needed and therefore choosing the implant solution actually does not result in any savings for the most costly element (supportive periodontal therapy). In addition, people should be aware that implant solutions also often suffer mechanical and/or biological complications, which in turn increase the costs for the implant solution.


  1. Nagpal D, Ibraimova L, Ohinmaa A, Levin L. The cost-effectiveness of tooth preservation vs implant placement in severe periodontal disease patients: a systematic review. Quintessence Int. 2024 Jan 23;55(1):76-85. doi: 10.3290/j.qi.b4500025.