Prediction of marginal bone loss and tooth loss--a prospective study over 20 years

Clinical and radiographical performance of implants placed with simultaneous guided bone regeneration using resorbable and nonresorbable membranes after 22-24 years, a prospective, controlled clinical trial

Aim

The aim was to evaluate the performance of implants placed with simultaneous guided bone regeneration (GBR) using resorbable or nonresorbable membranes compared to implants placed in pristine bone without bone regeneration after an observation period of 22–24 years.

Material and Methods

The patient cohort of this clinical trial was treated from 1994 to 1996. Dehiscence defects were treated with GBR by either using resorbable collagen membranes (BG) or nonresorbable ePTFE membranes (GT). Implants placed in pristine bone served as a control (CT). Clinical parameters, marginal bone levels, and technical outcomes were evaluated following restoration placement and at the present follow‐up. A 3D radiographic analysis was conducted in order to assess buccal and oral bone dimensions. Implant survival was assessed with Kaplan–Meier analysis and a frailty model (level of significance 5%).

Results

Out of the originally 72 patients (mean age 75.4 ± 15.70 years) with 265 implants, 39 patients with 147 implants were included in the study after a median period of 23.5 years. Implant survival was 89.3% in group BG (n = 100), 90.2% in group GT (n = 37), and 93.8% in group CT (n = 105), without significant differences (Frailty proportional hazard model p = .79). Smoking had a negative effect on survival (p = .0122). Mean vertical marginal bone levels were −2.3 ± 1.4 mm (BG, n = 59), −3.0 ± 1.5 mm (GT, n = 21), and −2.3 ± 1.6 mm (CT, n = 52). The vertical buccal bone levels were −3.0 ± 1.9 mm (BG, n = 57), −3.5 ± 2.2 mm (GT, n = 21), and −2.6 ± 1.8 mm (CT, n = 49), without significant differences.

Conclusion

Implant placement with GBR procedures provides treatment outcomes with favorable implant survival rates (89.3%–93.8%) after 23.5 years. Smoking, however, affected implant survival negatively.

Periodontal disease and influence of periodontal treatment on disease activity in patients with rheumatoid arthritis and spondyloarthritis

The aim of this study was to assess the prevalence of periodontal disease and the effect of periodontal treatment in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Forty-four RA patients, thirty SpA patients and thirty-nine healthy volunteers were recruited to the study. Periodontal examination included the approximal plaque index (API), bleeding on probing (BoP), probing depth (PD) and number of teeth. Samples from the deepest periodontal pockets were taken for the detection of Porphyromonas gingivalis DNA with the use of the polymerase chain reaction. All subjects with periodontitis, who completed the study, received periodontal treatment consisting of scaling/root planing and oral hygiene instructions. Disease activity scores, clinical and laboratory parameters were assessed before and 4-6 weeks after periodontal treatment. No significant difference in the prevalence of periodontal disease and the presence of P. gingivalis DNA were found in RA and SpA patients compared to healthy controls. Significantly higher API (80% vs 63%; p = 0.01) and a lower number of teeth (20 vs 25, p = 0.001) were found in RA patients. BoP was significantly elevated in SpA patients (51% vs 33%, p = 0.02). Disease activity measured by the DAS28(CRP) was significantly reduced in RA patients after periodontal treatment (p = 0.002). Clinical and biochemical parameters were not improved in SpA patients. Nonsurgical periodontal treatment had an impact on the decrease in RA activity. Periodontal examination is necessary in patients with RA to detect and treat periodontitis at an early stage.

Does periodontitis represent a risk factor for rheumatoid arthritis? A systematic review and meta-analysis

Periodontitis is an inflammatory disease of dental supporting tissues (gingiva, periodontal ligament, and bone) and it has been suggested as a possible etiology for rheumatoid arthritis (RA). In this systematic review, we aim to verify if periodontitis represents a risk factor for RA. Electronic databases were consulted until March 2018 considering eligibility criteria focusing on: (P, participants) adults; (E, exposure) with periodontitis; (C, comparison) without periodontitis; and (O, outcome) development of RA. Quality assessment of studies and risk-of-bias evaluation were also performed. To undertake a quantitative analysis, the number of persons with RA and a total number of participants for the case group (with periodontitis) and control group (without periodontitis) were used to calculate the odds ratio (OR) with a 95% confidence interval (CI). A total of 3888 articles were identified, and nine studies were considered eligible. Seven of 9 articles suggested an association among diseases by the common pro-inflammatory profiles. The pooled analysis of 3 articles showed a higher RA prevalence for persons with periodontitis (n = 1177) than controls (n = 254) (OR 1.97; CI 1.68–2.31; p < 0.00001). However, considerable heterogeneity among studies was verified (I² = 96%, p < 0.00001). Periodontitis may represent a risk factor for RA by heredity, bacterial infection, and the pro-inflammatory profile shared between both diseases. Although most of the elective studies report an association between periodontitis and RA, the quantitative analysis showed a high heterogeneity, leading to the need for further studies.

Root abnormalities and nonsurgical management of generalized aggressive periodontitis

To investigate long-term nonsurgical treatment outcomes in patients with generalized aggressive periodontitis (GAgP) and the impact of root abnormalities (RAs) and other patient-level factors in relation to GAgP progression. Patients (n = 64) from a GAgP cohort who completed active nonsurgical periodontal treatment and consented to re-evaluation after 3 to 11 (mean 5.3) years, were enrolled. RAs were identified using radiographs. Periodontal parameters (e.g., probing depths [PDs], and tooth loss [TL]) were investigated. Multivariate analysis was performed to identify factors contributing to TL and bone level alteration (∆BL). After treatment, the mean number of sites with PDs > 5 mm decreased from 54.3 to 17.2. Annual TL was 0.11/patient. Twenty-one patients (32.8%) had >4 teeth with root abnormalities (RA-teeth) and exhibited a higher risk for TL (univariate odds ration [OR] = 3.52, multivariate logistic OR = 6.57). Factors correlated to ∆BL were sites with residual PD > 5 mm (β = -0.400) and observation time (β = -0.210). Nonsurgical treatment provides beneficial outcomes in GAgP patients. Higher incidence of RAs and high prevalence of residual deep pockets have a negative impact on long-term outcomes.

PRACTICAL IMPLICATIONS

in cases of GAgP with residual deep pockets and high incidence of RAs, clinicians must emphasize that long-term outcomes of nonsurgical treatment may be compromised.

Periodontal disease, tooth loss and incident rheumatoid arthritis: results from the First National Health and Nutrition Examination Survey and its epidemiological follow-up study

AIMS

Infection may be a rheumatoid arthritis (RA) risk factor. We examined whether signs of periodontal infection were associated with RA development in the First National Health and Nutrition Examination Survey and its epidemiological follow-up study.

MATERIAL AND METHODS

In 1971-1974, 9702 men and women aged 25-74 were enrolled and surveyed longitudinally (1982, 1986, 1987, 1992). Periodontal infection was defined by baseline tooth loss or clinical evidence of periodontal disease. Baseline (n = 138) and incident (n = 433) RA cases were defined via self-report physician diagnosis, joint pain/swelling, ICD-9 codes (714.0-714.9), death certificates and/or RA hospitalization.

RESULTS

Adjusted odds ratios (ORs) (95% CI) for prevalent RA in gingivitis and periodontitis (versus healthy) were 1.09 (0.57, 2.10) and 1.85 (0.95, 3.63); incident RA ORs were 1.32 (0.85, 2.06) and 1.00 (0.68, 1.48). The ORs for prevalent RA among participants missing 5-8, 9-14, 15-31 or 32 teeth (versus 0-4 teeth) were 1.74 (1.03, 2.95), 1.82 (0.81, 4.10), 1.45 (0.62, 3.41) and 1.30 (0.48, 3.53); ORs for incident RA were 1.12 (0.77, 1.64), 1.67 (1.12, 2.48), 1.40 (0.85, 2.33) and 1.22 (0.75, 2.00). Dose-responsiveness was enhanced among never smokers. The rate of death or loss-to-follow-up after 1982 was two- to fourfold higher among participants with periodontitis or missing ≥9 teeth (versus healthy participants).

CONCLUSIONS

Although participants with periodontal disease or ≥5 missing teeth experienced higher odds of prevalent/incident RA, most ORs were non-statistically significant and lacked dose-responsiveness. Differential RA ascertainment bias complicated the interpretation of these data.

Prediction of future marginal bone level: a radiographic study

AIM

The aim of the study was to predict the marginal bone level at a 5-year follow-up based on the information available from an initial radiographic examination and to evaluate the precision of the prediction by comparing the predicted bone levels with those actually observed at the follow-up.

MATERIALS AND METHODS

In 1997, 616 randomly selected dentate individuals underwent a full-mouth radiographic survey. In 2003, 473 of those individuals (77%) participated in a second radiographic examination. Marginal bone level, caries lesions, fillings, crowns, root fillings and periapical status were recorded on all teeth. On the basis of data available from the first examination, a linear mixed model regression analysis with the tooth as the unit of analysis was used to predict the marginal bone level 5 years later.

RESULTS

Number of teeth, smoking, and also presence of apical periodontitis and crowns were associated with bone loss and could be used as predictors of future marginal bone level.

CONCLUSION

The analysis of all teeth showed that the number of tooth- and person-specific factors at the first examination influenced the prediction of the marginal bone level at the 5-year follow-up examination. However, the performance of the combined prediction model was less satisfactory.

Tooth loss in individuals under periodontal maintenance therapy: prospective study

This prospective study aimed to evaluate the incidence, the underlying reasons, and the influence of predictors of risk for the occurrence of tooth loss (TL) in a program of Periodontal Maintenance Therapy (PMT). The sample was composed of 150 complier individuals diagnosed with chronic moderate-severe periodontitis who had finished active periodontal treatment and were incorporated in a program of PMT. Social, demographic, behavioral and biological variables were collected at quarterly recalls, over a 12-month period. The effect of predictors of risk of and confounding for the dependent variable TL was tested by univariate and multivariate analysis, as well as the underlying reasons and the types of teeth lost. During the monitoring period, there was a considerable improvement in periodontal clinical parameters, with a stability of periodontal status in the majority of individuals. Twenty-eight subjects (18.66%) had TL, totaling 47 lost teeth (1.4%). The underlying reasons for TL were: periodontal disease (n = 34, 72.3%), caries (n = 3, 6.4%), prosthetic reasons (n = 9, 19.2%), and endodontic reasons (n = 1, 2.1%). Additionally, subjects with 10% of sites with probing depth between 4 and 6 mm were 5 times more likely to present TL (OR = 5.13, 95% CI 2.04-12.09). In this study, the incidence of TL was small and limited to few individuals. Additionally, gender and severity of periodontitis were significantly associated with TL during the monitoring period.

Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study

 

OBJECTIVE

While risk factors for tooth loss in adults have been identified, limited studies describing factors associated with incident tooth loss in postmenopausal women exist. This study assessed both clinical and non-clinical risk factors for incident tooth loss.

METHODS

Postmenopausal women (N = 1341) were recruited between 1997 and 2000 from 1847 eligible Observational Study participants of the Buffalo, NY center of the Women's Health Initiative who had complete dental examinations to assess alveolar bone height, soft tissue attachment and general oral health, and completed questionnaires concerning demographics, general health, lifestyle and oral health (72.6% participation rate). Five years later (2002-2005), 1021 women (76.1%) repeated these examinations and questionnaires. Incident tooth loss was determined by oral examination.

RESULTS

After an average 5.1 years of follow-up (SD, 0.38), a total of 323 teeth were lost in 293 women, resulting in 28.7% of women with incident loss of at least one tooth. In multivariable models, diabetes history, gum disease history, smoking, previous tooth loss, BMI and plaque index, baseline clinical measures including alveolar crestal height (ACH) (OR = 1.22 per mm loss, 95% CI 1.11, 1.35), clinical attachment loss (CAL) (OR = 1.13 per mm loss, 95% CI 1.05, 1.23), and pocket depth (PD) (OR = 1.26 per mm loss, 95% CI 1.13, 1.41) were significant risk factors of incident tooth loss. In a community model that included no clinical measures, diabetes history (OR = 2.45, 95% CI 1.26, 4.77), prior gum disease (OR = 1.97, 95% CI 1.43, 2.70), ever smoking (OR = 1.42, 95% CI 1.06, 1.89), number of teeth lost at baseline (OR = 1.05 per tooth, 95% CI 1.02, 1.08), and BMI (OR = 1.15 per 5 km/m(2) increase, 95% CI 1.01, 1.33) were associated with an increased risk of incident tooth loss.

CONCLUSIONS

Clinical and questionnaire-based models were found to provide similar risk estimates for incident tooth loss in postmenopausal women. These models identified high-risk postmenopausal women where preventive strategies may be targeted.

Relationship of smoking and smoking cessation with oral health status in Japanese men

BACKGROUND AND OBJECTIVE

Smoking has been associated with the number of natural teeth a person has and with the likelihood of periodontitis. The purpose of this study was to determine the relationships between the number of teeth present and periodontal diseases with smoking habits in a cohort of Japanese men.

MATERIAL AND METHODS

The study group comprised 1088 men, 40-75 years of age. Oral examinations were conducted in dental clinics. Information on smoking status and on oral health behavior was collected from self-administered questionnaires. The relationship between oral health status and smoking status was estimated using adjusted odds ratios.

RESULTS

Compared with those whom had never smoked, the odds ratios of having more than eight missing teeth and having periodontitis, among current smokers, were 1.67 and 1.74, respectively. In those who had stopped smoking for 11 years or longer, there was no increase in the odds ratio of having more than eight missing teeth and periodontitis, compared with those whom had never smoked.

CONCLUSION

Smoking has a positive association with missing teeth and periodontitis. However, smoking cessation is beneficial for oral health. The odds of having more than eight missing teeth, or of having periodontitis, in those who had never smoked was similar to that of individuals who reported that they had stopped smoking for 11 years or more.

The effect of smoking on periodontal treatment response: a review of clinical evidence

BACKGROUND

Smoking has been identified as a significant risk factor for periodontal diseases and is regarded as being responsible for incomplete or delayed healing in patients following treatment.

AIM AND METHOD

The aim of this conventional review was to review, collate and tabulate the relative effectiveness of treatments of chronic periodontitis in smokers, non-smokers and ex-smokers.

OBSERVATIONS

The majority of clinical trials show significantly greater reductions in probing depths and bleeding on probing, and significantly greater gain of clinical attachment following non-surgical and surgical treatments in non-smokers compared with smokers. This benefit is also seen at class I and II furcation sites and in patients prescribed systemic or local antimicrobial treatments.

CONCLUSIONS

Data from epidemiological, cross-sectional and case-control studies strongly suggest that quitting smoking is beneficial to patients following periodontal treatments. The periodontal status of ex-smokers following treatment suggests that quitting the habit is beneficial although there are only limited data from long-term longitudinal clinical trials to demonstrate unequivocally the periodontal benefit of quitting smoking.

Disease progression: identification of high-risk groups and individuals for periodontitis

AIMS

While the role of bacteria in the initiation of periodontitis is primary, a range of host-related factors influence the onset, clinical presentation and rate of progression of disease. The objectives of this review are (1) to present evidence for individual predictive factors associated with a patient's susceptibility to progression of periodontitis and (2) to describe the use of prognostic models aimed at identifying high-risk groups and individuals in a clinical setting.

METHODS

Relevant publications in the English language were identified after Medline and PubMed database searches. Because of a paucity of longitudinal studies investigating factors including clinical, demographic, environmental, behavioural, psychosocial, genetic, systemic and microbiologic parameters to identify individuals at risk for disease progression, some association studies were also included in this review.

FINDINGS AND CONCLUSIONS

Cigarette smoking is a strong predictor of progressive periodontitis, the effect of which is dose related. High levels of specific bacteria have been predictive of progressive periodontitis in some studies but not all. Diabetics with poor glycaemic control have an increased risk for progression of periodontitis. The evidence for the effect of a number of putative factors including interleukin-1 genotype, osteoporosis and psychosocial factors is inconclusive and requires further investigation in prospective longitudinal studies. Specific and sensitive diagnostic tests for the identification of individuals susceptible to disease progression are not yet a reality. While factors assessed independently may not be valuable in predicting risk of future attachment loss, the combination of factors in a multifactorial model may be useful in identifying individuals at risk for disease progression. A number of multifactorial models for risk assessment, at a subject level have been developed but require validation in prospective longitudinal studies.

Problems of correlations between explanatory variables in multiple regression analyses in the dental literature

Multivariable analysis is a widely used statistical methodology for investigating associations amongst clinical variables. However, the problems of collinearity and multicollinearity, which can give rise to spurious results, have in the past frequently been disregarded in dental research. This article illustrates and explains the problems which may be encountered, in the hope of increasing awareness and understanding of these issues, thereby improving the quality of the statistical analyses undertaken in dental research. Three examples from different clinical dental specialties are used to demonstrate how to diagnose the problem of collinearity/multicollinearity in multiple regression analyses and to illustrate how collinearity/multicollinearity can seriously distort the model development process. Lack of awareness of these problems can give rise to misleading results and erroneous interpretations. Multivariable analysis is a useful tool for dental research, though only if its users thoroughly understand the assumptions and limitations of these methods. It would benefit evidence-based dentistry enormously if researchers were more aware of both the complexities involved in multiple regression when using these methods and of the need for expert statistical consultation in developing study design and selecting appropriate statistical methodologies.

Periodontal disease and the incidence of tooth loss in postmenopausal women

BACKGROUND

The role of periodontal disease as a predictor of incident tooth loss in postmenopausal women has not been determined. The aim of this cohort study was to determine the extent of the association between baseline periodontal status and incident tooth loss in a population of postmenopausal women.

METHODS

The study population included 106 dentate white postmenopausal women who participated in a cross-sectional study between 1989 and 1991 who were willing and eligible to have a repeat examination after 10 to 13 years. At baseline, full-mouth assessment of periodontal status was performed clinically and radiographically. Assessment of tooth loss during follow- up was assessed clinically by a periodontist. Odds ratio (OR) and its 95% confidence interval (CI) for each periodontal variable was obtained from separate multiple logistic regression analyses adjusting for the effect of age, household income, smoking, hormone therapy, snack consumption, and number of decayed teeth.

RESULTS

Sixty-one (57.5%) subjects lost at least one tooth during follow-up. Mean tooth loss per person was 1.81 +/- 2.77. After adjusting for confounders, each millimeter of alveolar bone loss at baseline increased the risk of tooth loss 3-fold (OR = 3.26; 95% CI: 1.60 to 6.64). The risk of tooth loss also increased 2.5 times for each millimeter of clinical attachment loss (OR = 2.50; 95% CI: 1.24 to 5.07). Probing depth (OR = 2.53; 95% CI: 0.98 to 6.53), gingival bleeding (OR = 1.99; 95% CI: 0.21 to 18.94), calculus (OR = 2.05; 95% CI: 0.91 to 4.61), and plaque (OR = 0.70; 95% CI: 0.13 to 3.34) were not significantly associated with incident tooth loss.

CONCLUSION

Periodontal disease, especially measured by alveolar bone loss, is a strong and independent predictor for incident tooth loss in postmenopausal women.

The natural history of periodontal disease in humans: risk factors for tooth loss in caries-free subjects receiving no oral health care

AIM

No long-term studies have reported on risk factors for tooth loss in subjects without home or professional dental care. The purpose of this report is to identify potential risk factors for tooth loss among male Sri Lankan tea labourers who participated in a 20-year investigation of the natural history of periodontal disease.

MATERIAL AND METHODS

Data for this report were obtained from the 455 subjects who participated in multiple examinations over the 20-year period from 1970 to 1990. Analyses included data from interim examinations in 1971, 1973, 1977, 1982 and 1985. Oral health assessments included the following: (1) attachment levels in millimetres on all mesial and mesio-buccal surfaces, excluding third molars; (2) plaque index; (3) gingival index; (4) calculus index; (5) caries index; and (6) missing teeth. Other variables included age, history of smoking and betel nut use. Statistical analyses included descriptive statistics and multivariate repeated-measures modelling with generalized estimating equations.

RESULTS

Tooth loss was significantly dependent upon interactions between the mean attachment loss and betel nut use (Z=3.40; p=0.0007) and history of missing teeth (Z=-3.70; p=0.0002). The effect of attachment loss on tooth loss was increased in the presence of betel nut and diminished when teeth were already missing at baseline.

CONCLUSION

History of missing teeth, betel nut use and increasing attachment loss were significant predictors of tooth loss over time. Betel nut use increased the effect of attachment loss on loss of teeth, while history of missing teeth diminished the effect of attachment loss on tooth loss.

Bone height changes in individuals with periodontal disease: a 17-year prospective longitudinal study

OBJECTIVE

The aim of this study was to analyse changes in bone height after 17 years in smokers and non-smokers with periodontal disease, and to compare these with clinical assessment outcome.

MATERIAL AND METHODS

Participants comprised 50 adults with periodontitis and 18 healthy controls from a randomly selected epidemiological sample. Their mean age at the end of the study was 54.2 (SD+/-3.09) years. The study included radiographic analysis compared with clinical data.

RESULTS

The periodontitis group had significantly (p<0.001) higher values than their healthy counterparts for plaque index (PLI), gingival index (GI), calculus index (CI), and bleeding on probing (BOP) at baseline and after 17 years. At the end of the follow-up, never-smokers with periodontitis had higher values for PLI (p<0.05) and ex-smokers and smokers had higher GI and BOP (p<0.001) than the controls. In all individuals with periodontitis, maxillary molars were most affected. Smokers had more severe marginal bone loss over time. Vertical bone defects were more often seen on the mesial side of teeth (p<0.05).

CONCLUSION

Marginal bone level in this prospective study did reveal tooth groups at higher risk for progression of periodontal disease.

Life-style Correlates of Tooth Loss in an Adult Midwestern Population

OBJECTIVES

To describe life-style correlates of tooth loss in a representative rural American population.

METHODS

Information on tooth loss as well as past medical history and life-style factors was obtained in a well-defined cohort of 2,764 persons 53-96 years of age in Beaver Dam, WI (1998-2000).

RESULTS

There were 1,992 (68.2%) persons missing some and 447 (15.3%) missing all of their teeth. In univariable analyses, age, cigarette smoking, heavy drinking, education, multivitamin use, and diabetes status were associated with tooth loss. Tooth loss was associated with poorer self-rated health and with difficulty eating solid food and inability to enjoy some food. In multivariable models age, education, smoking, heavy drinking, and diabetes were significantly associated with tooth loss.

CONCLUSIONS

Tooth loss is common in older persons and is associated with many risk factors including education, smoking, and heavy drinking. It is possible that modifying these may influence risk of tooth loss.

Some risk factors for periodontal bone loss in 50-year-old individuals. A 10-year cohort study

OBJECTIVE

The aim of this 10-year prospective study of 50-year-old individuals was to analyze the incidence of periodontal bone loss and potential risk factors for periodontal bone loss.

METHODS

The subject sample was generated from an epidemiological survey performed in 1988 of subjects living in the County of Värmland, Sweden. A randomized sample of 15% of the 50-year-old inhabitants in the county was drawn. At the 10-year follow-up in 1998, 320 (75%) of the 449 individuals examined at baseline were available for re-examination, out of which 4 had become edentulous. Full-mouth clinical and radiographic examinations and questionnaire surveys were performed in 1988 and 1998. Two hundred and ninety-five individuals (69%) had complete data for inclusion in the analysis of radiographic bone changes over 10 years. Non-parametric tests, correlations and stepwise multiple regression models were used for statistical analysis of the data.

RESULTS

The mean alveolar bone level (ABL) in 1988 was 2.2 mm (0.05) and a further 0.4 mm (0.57) (p=0.000) was lost over the 10 years. Eight percent of the subject sample showed no loss, while 5% experienced a mean bone loss of >/=1 mm. Smoking was found to be the strongest individual risk predictor (RR=3.2; 95% CI 2.03-5.15). When including as smokers only those individuals who had continued with the habit during the entire 10-year follow-up period, the relative risk was slightly increased (3.6; 95% CI 2.32-5.57). Subjects who had quit smoking before the baseline examination did not demonstrate a significantly increased risk for disease progression (RR=1.3; 95% CI 0.57-2.96). Stepwise multiple regression analysis revealed that smoking, % approximal sites with probing pocket depth >/=4 mm, number of teeth and systemic disease were significant explanatory factors for 10-year ABL loss (R(2)=0.12). For never smokers, statistically significant predictors were number of teeth, mean ABL, % periodontally healthy approximal sites and educational level (R(2)=0.20).

CONCLUSION

The inclusion of smokers in risk analysis for periodontal diseases may obstruct the possibility to detect other true risk factors and risk indicators.

Effect of Periodontal Therapy in Smokers and Non-Smokers With Advanced Periodontal Disease: Results After Maintenance Therapy for a Minimum of 5 Years

BACKGROUND

Longitudinal clinical studies show smoking is a risk factor for periodontal disease progression. It has also been documented that smoking impairs healing after periodontal therapy. However, the longitudinal effect of smoking on treatment results in patients who undergo long-term maintenance therapy has not been extensively investigated. This study clinically and radiographically compared smoking and non-smoking patients who had been treated for advanced periodontal disease and who received maintenance therapy for a minimum of 5 years.

METHODS

Twenty-nine patients were selected over a 6-month period when they presented for a regularly scheduled visit in a private office. Patients were selected on the basis of initially having lost 50% of bone support on 50% of their teeth; had received follow-up therapy for at least 5 years; were compliant at 75% of the appointments; and had plaque scores < 20% in 75% of the visits. All patients had received non-surgical and surgical therapy as required for pocket elimination. Fourteen were active smokers during the entire maintenance period. Clinical measurements of probing depths and presence of plaque and gingivitis and a new set of standardized radiographs were taken.

RESULTS

Smokers had higher mean radiographic bone loss values prior to treatment (7.52 +/- 1.39 versus 6.65 +/- 1.39) and at the final examination (7.32 +/- 1.42 versus 6.29 +/- 1.29) mean radiographic bone loss as well as initial, immediate post-therapy, and final percent of pockets > or = 6 mm (1.42% +/- 1.87% versus 0.60% +/- 1.11%). Differences were not statistically significant. Over 5 to 8 years, seven sites in four non-smokers and 11 sites in six smokers exhibited radiographic bone loss > or = 2 mm. One tooth in a non-smoker and three teeth in two smokers were lost. In a logistic regression analysis, smoking increased the odds ratio 10.7 times of having > or = 1 site with bone loss > or = 2 mm.

CONCLUSION

The present study on a small group of patients treated for advanced periodontal disease and well maintained over 5 to 8 years showed no statistically significant differences between smokers and non-smokers in clinical probing depth and radiographic bone loss measurements.

Influence of smoking on marginal bone loss and tooth loss--a prospective study over 20 years

AIMS

The aim was to investigate the influence of smoking on longitudinal marginal bone loss and tooth loss in a prospective study over 20 years. In addition, the effect of cessation of smoking on bone loss and the interaction between smoking, plaque and marginal bone loss were evaluated.

MATERIAL AND METHODS

A total of 507 dentate individuals from an epidemiological study were examined in 1970 and 1990. The clinical investigation included registration of number of remaining teeth and presence of plaque. The marginal bone level was determined by assessments on the proximal surfaces on the radiographs from 1970 and 1990. The marginal bone loss was defined as the difference in marginal bone level over 20 years. The subjects were interviewed about smoking habits. Stepwise multiple regression analyses were adopted to calculate the influence of the independent variables on longitudinal marginal bone loss and tooth loss.

RESULTS

In 1970, 50.7% of the subjects were smokers, while the corresponding relative frequency in 1990 had decreased to 31.0%. Smoking was significantly correlated to an increased marginal bone loss over 20 years. Individuals who stopped smoking between 1970 and 1990 lost significantly less marginal bone during this period than those who declared that they smoked during the 20-year period. Smoking was not found to be significantly correlated to tooth loss over 20 years.

CONCLUSIONS

The results support the hypothesis that smoking is a significant risk factor of periodontal disease.