Patient-related risk factors for tooth loss in aggressive periodontitis after active periodontal therapy

Periodontitis in young individuals: Important factors for disease progression

AIM

To investigate the progression of periodontitis in young individuals and identify factors that contribute to progression rate and whether periodontitis stage and grade have an impact on disease progression.

MATERIALS AND METHODS

This retrospective cohort study was based on patients younger than 36 years at two periodontal clinics between 2003 and 2009. At least 10 years later, a clinical and radiographic examination was performed on 215 patients. The marginal bone loss between baseline and follow-up for the tooth with the most severe bone loss at follow-up was estimated by radiographic measurements. Linear regression analysis was used to investigate the influence of potential risk indicators on periodontitis progression.

RESULTS

Most patients (83%) were classified as periodontitis stage III at baseline. At follow-up, 70% of these patients remained in stage III. The frequency of patients with grade C decreased from 79% to 17% at follow-up. The median (Q25%; Q75%) of the longitudinal marginal bone loss was 0.5 mm (0.0; 2.0). High bleeding on probing (BOP) index at baseline, smoking and interruption of periodontal treatment were found to significantly increase longitudinal bone loss.

CONCLUSIONS

High levels of BOP at baseline, smoking and interruption of periodontal treatment increased the risk of marginal bone loss. The stage and grade at baseline had no significant impact on disease progression.

Self-Management Ability Questionnaire Validation in Portuguese Adults With Periodontitis

OBJECTIVES

We aimed to test the psychometric validity of the adapted and translated Self-Management Ability Questionnaire-Short Form (SMAQ-12) to Portuguese.

METHODS

The translation and adaptation of the SMAQ-12 followed international guidelines. We included 280 participants with chronic periodontitis from the Department of Periodontology of the Egas Moniz Dental Clinic. Participants completed the Portuguese version of the SMAQ-12 (SMAQ-12-PT), a 12-item scale with 3 conceptual domains (Role Management, Medical Management, and Emotional Management). The validity of the content, its construct and internal consistency, as well as test-retest reliability were used to estimate psychometric properties.

RESULTS

The SMAQ-12-PT showed an interclass correlation coefficient value of 0.90, with a 95% confidence interval (0.79-0.95; P < .001) and high reliability (Cronbach alpha coefficient ranging between 0.78 and 0.94). Confirmatory factor analysis revealed adequate model fit, with comparative fit index of 0.853, goodness-of-fit of 0.947, and a 0.052 value of root mean squared error of approximation.

CONCLUSIONS

The SMAQ-12-PT was found to be a valid and reliable instrument in the Portuguese population. Disease management representation for the specialty of periodontology and its impact on periodontal schedules and practices should be evaluated in future studies.

Compromised Teeth Preserve or Extract: A Review of the Literature

Multiple systems and associated factors have been described in the literature to assess the prognosis of teeth with periodontal disease. Nowadays there is a tendency among clinicians to consider implants as the best solution after tooth extraction, in cases of teeth with a questionable prognosis. However, the value of the natural tooth must be considered, as the proprioception of the periodontal ligament is preserved, and it adapts to stress during functional loads. We first review the literature focusing on analyzing the factors that should guide decision-making to maintain or extract a tooth with a compromised periodontium. Then, we propose a schematic diagram of prognostic indicators to reflect the main factors to consider and the survival rate that each one represents when preserving or extracting a tooth.

Evaluation of periodontitis-related tooth loss according to the new 2018 classification of periodontitis

The new 2018 classification of periodontal diseases is reported to be related to tooth loss due to periodontal disease (TLPD) during supportive periodontal therapy (SPT). However, few reports have evaluated this relationship for Asians or have analyzed the association of the new classification and TLPD by distinguishing between active periodontal therapy (APT) and SPT. In this study, we retrospectively applied the new classification to 607 Japanese periodontitis patients and examined the relationship between the new classification and annual TLPD rates per patient during the respective periods. TLPD rates were higher in patients in stage IV and/or grade C during both APT and SPT. TLPD during SPT was not associated with the presence or absence of TLPD during APT. Multivariate analysis revealed that stage IV and grade C as independent variables were significantly associated with the number of instances of TLPD not only during the total treatment period, but also during APT or SPT. Our results suggest that the new classification has a significantly strong association with TLPD during both APT and SPT, and that patients diagnosed with stage IV and/or grade C periodontitis had a higher risk of TLPD during both periods.

Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline

BACKGROUND

The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy.

AIM

To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss.

MATERIALS AND METHODS

This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders.

RESULTS

The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III.

CONCLUSIONS

The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.

Retrospective analysis of the effects of non-communicable diseases on periodontitis treatment outcomes

PURPOSE

We retrospectively analysed patients' dental and periodontal status according to the presence of non-communicable diseases (NCDs) and the effects of NCDs on periodontal treatment outcomes. Factors influencing disease recurrence were investigated using decision tree analysis.

METHODS

We analysed the records of patients who visited the Department of Periodontology, Pusan National University Dental Hospital from June 2014 to October 2019. As baseline subjects, 1,362 patients with periodontitis and who underwent full-mouth periodontal examinations before periodontal treatment were selected. Among them, 321 patients who underwent periodontal examinations after the completion of periodontal treatment and 143 who continued to participate in regular maintenance were followed-up.

RESULTS

Forty-three percent of patients had a NCD. Patients without NCDs had more residual teeth and lower sum of the number of total decayed, missing, filled teeths (DMFT) scores. There was no difference in periodontal status according to NCD status. Patients with a NCD showed significant changes in the plaque index after periodontal treatment. The decision tree model analysis demonstrated that osteoporosis affected the recurrence of periodontitis.

CONCLUSIONS

The number of residual teeth and DMFT index differed according to the presence of NCDs. Patients with osteoporosis require particular attention to prevent periodontitis recurrence.

Tooth loss and radiographic bone loss in patients without regular supportive care: A retrospective study

BACKGROUND

Very few studies have investigated the effect of patient and site factors on periodontal progression and long-term tooth loss in populations with minimal dental care. The aim of this retrospective study was to assess tooth loss and radiographic bone loss over at least 5 years in patients attending a national-health service primary care practice in Sicily and undergoing no regular care.

METHODS

Records of two hundred consecutive patients with at least 5 years follow-up were screened and demographic, clinical and radiographic data were retrieved. Analyses of associations between patient and site factors and tooth loss were performed.

RESULTS

After excluding not suitable patients, a total of 159 patient records with clinical and radiographic data with average 8.6 years follow-up were included. One hundred of these patients had no professional mechanical plaque removal (PMPR) carried out throughout the study follow-up. Nearly 65% of patients lost at least 1 tooth during the follow-up period, with a total of 400 extracted teeth (for periodontal and non-periodontal reasons). The annual tooth loss rate was slightly higher for "no PMPR" (untreated) patients (0.30 teeth/patient/year) compared with patients who had PMPR (0.27 teeth/patient/year). On a patient-level, only reduced frequency of daily tooth brushing was associated with tooth loss at logistic regression, whereas staging, grading and diagnosis of caries were associated with rates of tooth loss/year. At multilevel analysis including patient- and tooth-factors, age, diagnosis of caries and endodontic disease and percentage of bone loss at baseline were associated with tooth loss.

CONCLUSION

This study confirms the importance of tooth brushing, initial bone loss, caries and endodontic disease in predicting tooth survival in a primary care setting.

Development of a prognostic tool: based on risk factors for tooth loss after active periodontal therapy

Objectives

The aim of this study was to develop a prognostic tool to estimate long-term tooth retention in periodontitis patients at the beginning of active periodontal therapy (APT).

Material and methods

Tooth-related factors (type, location, bone loss (BL), infrabony defects, furcation involvement (FI), abutment status), and patient-related factors (age, gender, smoking, diabetes, plaque control record) were investigated in patients who had completed APT 10 years before. Descriptive analysis was performed, and a generalized linear-mixed model-tree was used to identify predictors for the main outcome variable tooth loss. To evaluate goodness-of-fit, the area under the curve (AUC) was calculated using cross-validation. A bootstrap approach was used to robustly identify risk factors while avoiding overfitting.

Results

Only a small percentage of teeth was lost during 10 years of supportive periodontal therapy (SPT; 0.15/year/patient). The risk factors abutment function, diabetes, and the risk indicator BL, FI, and age (≤ 61 vs. > 61) were identified to predict tooth loss. The prediction model reached an AUC of 0.77.

Conclusion

This quantitative prognostic model supports data-driven decision-making while establishing a treatment plan in periodontitis patients. In light of this, the presented prognostic tool may be of supporting value.

Clinical relevance

In daily clinical practice, a quantitative prognostic tool may support dentists with data-based decision-making. However, it should be stressed that treatment planning is strongly associated with the patient’s wishes and adherence. The tool described here may support establishment of an individual treatment plan for periodontally compromised patients.

The 2018 classification of periodontal diseases. Its predictive value for tooth loss

BACKGROUND

Predictive models and assessment tools for disease susceptibility and progression are necessary to enhance personalized medicine. The aim of this study is to assess the predictive accuracy of using the 2018 classification to predict likelihood of tooth loss.

MATERIAL AND METHODS

134 patients were screened 10 years after periodontal therapy. Data were extracted from 82 patients' records and periodontal diagnoses were assigned according to the 1999 and 2018 classifications at baseline, whereas patient- and tooth-related parameters were documented at baseline and at reexamination. Statistical analysis included descriptive statistics, hurdle regression with a zero and count model as well as logistic regression.

RESULTS

Significantly more teeth were lost during SPT in patients with Stage IV or Grade C (p<0.05). Patients' adherence seems to have an impact on the predictability of the 2018 classification (p<0.001). In comparison, neither classification system alone (1999 vs. 2018) showed a high predictive value for tooth loss (Area under the curve (AUC) = 59.2% vs. 58.2%).

CONCLUSION

Class III and IV/grade C of the 2018 classification of periodontal diseases show similar predictive accuracy for tooth loss as severe cases in the former classification. Patients adherence seems to influence the prognostic value of the classification. This article is protected by copyright. All rights reserved.

Predictors of tooth loss during long-term periodontal maintenance: An updated systematic review

AIM

To evaluate the risk factors / predictors of tooth loss in patients with periodontitis who underwent periodontal therapy and long-term periodontal maintenance (PM).

MATERIAL AND METHODS

PubMed, CENTRAL, EMBASE, Web of Science, LILACS and Scholar were searched up to and including September 2020. Studies limited to periodontitis patients who underwent active periodontal therapy (APT) and followed a regular PM programme with 5 years follow-up minimum were eligible for inclusion in this review. Studies were included if they reported data on tooth loss during PM. Random effects meta-analyses of number of tooth loss per patient per year were conducted.

RESULTS

Thirty-six papers regarding thirty-three studies were included in this review, with three prospective 30 retrospective trials. Subgroup meta-analysis showed no differences between prospective and retrospective studies, with an average of 0.1 tooth loss per year per patient (p < 0.001). Maxillary and molar teeth were more susceptible to be extracted during long-term PM. Baseline characteristics (smoking, diabetes mellitus, cardiovascular disease, being male and teeth with furcation lesions) showed no significance as predictor of tooth loss through meta-regression. The percentage of tooth loss due to periodontal reasons ranged from 0.45% to 14.4%. The individual outcomes in each study evidenced different patient-related factors (age and smoking) and tooth-related factors (i.e. tooth type and location) were associated with tooth loss during PM.

CONCLUSION

The majority of patients undergoing long-term PM have not lost teeth. On average, long-term PM effectively causes the loss of 1 tooth per patient every 10 years. Additional prospective trials may confirm these results.

Periodontal Surgery Combined with Multiple Extractions: A Case Report

BACKGROUND Dental extraction is the only treatment option for terminal stage periodontal disease. Remnants of the pathological periodontal tissue can still be present after the extraction. Periodontal flap surgery contributes to achieving a better regeneration process at the extraction site. This case report includes a unique unconventional approach to periodontal therapy, not commonly reported in the literature. CASE REPORT A 37-year-old man reported mobility and migration of the teeth in both jaws and was referred to the Periodontology Department of the University of Prishtina Dentistry School. The patient had no personal history of any current systemic condition or family history of similar gum conditions. After a clinical and radiographic evaluation (periodontal probing depth and gingival index), most of the front teeth of both jaws were diagnosed with terminal stage periodontal disease (stage 4, grade C). Modified Widman flap periodontal surgery was conducted on the maxilla and mandible to extract most of the front teeth. The sites of tooth extraction underwent profound debridement to remove the pathological soft tissues and sharp bone extrusions. The 4 postoperative follow-up visits at 1, 4, 8, and 10 weeks showed sufficient restitution of the wounds. He received temporary mobile prostheses for the areas with multiple extractions. After 10 weeks, he began treatment for a fixed prosthetic bridge. He had a satisfactory recovery and was followed up over 3 annual visits after his surgery. CONCLUSIONS Multiple extractions can be considered as a treatment option for terminal stage periodontitis.

Tooth loss in periodontally compromised patients: Retrospective long-term results 10 years after active periodontal therapy. Tooth-related outcomes

BACKGROUND

Estimating prognosis of periodontally affected teeth at the beginning of supportive periodontal care (SPC) is an important component for further treatment planning. This study aimed to evaluate tooth loss (TL) during 10 years of SPC in periodontally compromised patients and to identify tooth-related factors affecting TL.

METHODS

Patients were re-examined 120 ± 12 months after accomplishment of active periodontal therapy. TL was defined as primary outcome variable and tooth-related factors (abutment status, furcation involvement [FI], tooth mobility, mean periodontal probing depth [PD], and clinical attachment level [CAL] at beginning of SPC, and initial bone loss [BL]) were estimated based on an adjusted regression analyses model.

RESULTS

Ninety-seven patients (51 females and 46 males; mean age, 65.3 ± 11 years) lost 119 of 2,323 teeth (overall TL [OTL]: 0.12 teeth/patient/y) during 10 years of SPC. Forty of these teeth (33.6%) were lost for periodontal reasons (TLP; 0.04 teeth/patient/y). Significantly more teeth were lost due to other reasons (P <0.0001). TLP (OTL) only occurred in 5.9% (14.7%) of all teeth, when BL was at least 80%. Use as abutment tooth, FI degree III, tooth mobility degrees I and II, mean PD, and CAL positively correlated with OTL (P <0.05). For TLP, FI and tooth mobility degree III as well as mean CAL were identified as tooth-related prognostic factors (P <0.05).

CONCLUSIONS

During 10 years of SPC, most of the teeth (93.4%) of periodontally compromised patients were retained, showing the positive effect of a well-established treatment concept. Well-known tooth-related prognostic factors were confirmed.

Survival and success of implants in a private periodontal practice: a 10 year retrospective study

BACKGROUND

To assess long-term results of implants (XiVE/Frialit-2 Synchro) in a private periodontal practice according to survival and success rates (biological and technical complications) and to detect possible influencing factors, retrospectively.

METHODS

Implant placement of at least one implant took place 10 years ±6 months before clinical and radiographic re-examination. Incidence of implant loss as main and incidence of mucositis/ peri-implantitis as secondary outcome were detected. Also, patient-related and implant-related influencing factors were determined by regression analyses.

RESULTS

100 patients (59.0% female) with 242 implants were included into analysis. Survival rate was 94.0% (XiVE: 97.7%; Frialit-2-Synchro: 66.7%). Mucositis was found in 77.6% of all patients, moderate/severe peri-implantitis in 16.3%. In logistic regression analyses statistically significant influencing factors for implant loss was implant type (p < 0.001), for mucositis a wider implant diameter (p = 0.0438) and a high modified Plaque Index (p = 0.0253), for peri-implantits number of implants per patient (p = 0.0075) and a wider implant diameter (p = 0.0079). Technical complications were found in 47 implants (19.4%).

CONCLUSIONS

XiVE implants showed a high survival rate over a 10-year follow-up, on the other hand Frialit-2 Synchro implants had worse survival rates. Success rates regarding biological complications are in line with other implant systems.

Long-Term Outcomes of Tooth-Implant-Supported Rehabilitation of Periodontally Compromised and Treated Patients Refusing Bone Grafting Surgical Therapies

OBJECTIVE

To evaluate the long-term incidence of complications in abutment teeth and dental implants in periodontally treated and maintained patients, refusing bone grafting surgical therapies, rehabilitated with full-arch telescopic-retained retrievable prostheses (TRPs) and full-arch fixed prosthesis (FPs), both supported by teeth-implants combination.

MATERIALS AND METHODS

After active periodontal therapy, 18 patients were rehabilitated with full-arch TRPs, whereas 17 patients were rehabilitated with full-arch FPs. Patients were annually evaluated for technical and/or biological failures/complications.

RESULTS

During the 15-year observation period, 6 of 164 (3.6%) implants failed and 19 of 233 teeth were extracted (9.2%) in the TRPs group, whereas 6 of 152 (3.9%) implants failed and 23 of 221 (10.4%) abutment teeth were extracted in the FPs group. Differences in implant failures and abutment teeth loss between the 2 groups were not statistically significant. In both the groups, Cox regressions identified significant difference (P < 0.05) for mean initial bone loss, aggressive periodontitis, and smoking, as factors contributing to tooth loss and implant failures in general.

CONCLUSION

In periodontally treated patients, refusing bone grafting surgical therapies, rehabilitated with full-arch TRPs and full-arch fixed prostheses, both supported by teeth-implants connection, high survival rates can be expected if regular supportive periodontal therapy had been performed.

Effects of smoking on non-surgical periodontal therapy in patients with periodontitis Stage III or IV, and Grade C

BACKGROUND

To evaluate possible effects of smoking on clinical, biochemical, and microbiological outcomes of non-surgical periodontal treatment in patients with periodontitis Stage III or IV and Grade C.

METHODS

Conventional quadrant-wise non-surgical periodontal treatment was performed and whole-mouth periodontal measurements were recorded at baseline, 1, 3, and 6 months after completion of treatment. Saliva, gingival crevicular fluid, subgingival plaque, and blood samples were obtained at the same time points. Inflammatory cytokine levels, presence, and quantities of 11 different bacterial species were determined. Smoking status was validated by cotinine assay.

RESULTS

Fourteen smoker and 13 non-smoker patients completed the study protocol and revealed similar clinical findings except for the higher plaque scores in the non-smokers at 6 months (P <0.01). Significant differences were found between the study groups in biofluid cytokine levels at 1 and 3 months (P <0.01). Gram-negative bacteria were more abundant in the smokers at baseline and so were Gram-positive bacteria in the non-smokers (P <0.01). Gram-negative bacteria repopulated in the smokers faster than in the non-smokers (P <0.01).

CONCLUSIONS

The present findings suggest that smoker patients with periodontitis Stage III and IV, Grade C respond well to the non-surgical periodontal treatment during the 6-month follow-up. However, smokers exhibit faster repopulation of Gram-negative bacteria.

Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: a 4-year follow-up of a randomized controlled trial

OBJECTIVE

(1) To assess long-term outcomes 4 years following guided tissue regeneration (GTR) of intrabony defects in patients diagnosed with aggressive periodontitis (AgP) and (2) to identify predictors of clinical attachment level (CAL) gain and bone/graft density gain.

MATERIALS AND METHODS

In 15 patients, two deep intrabony defects were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). After 4 years, clinical and radiographic outcomes were evaluated and compared with outcomes at baseline and after 1 year.

RESULTS

After 4 years, 14 test sites and 13 control sites were available for analysis. One tooth was lost as a result of root fracture. There were significant improvements in all evaluated parameters after 1 and 4 years in relation to baseline, but no differences were observed between tests and controls. However, some non-significant changes were found between 1 and 4 years. Regression analyses showed that recurrence of periodontitis was a significant predictor for CAL gain (p = 0.001) and bone/graft density gain (p = 0.024) from 1 to 4 years.

CONCLUSIONS

GTR of intrabony defects in AgP with either standard or modified CM yielded similarly successful and maintainable clinical benefits for compromised teeth 4 years following the surgery. The use of MPM showed no additional benefit.

CLINICAL RELEVANCE

This study demonstrates that most of the positive outcomes of GTR in AgP may be preserved over 4 years. Periodontitis recurrence might influence long-term outcomes.

Tooth loss after periodontal treatment-Mining an insurance database

OBJECTIVES

The aim of this study was to evaluate tooth loss after periodontal treatment.

METHODS

The data was collected from the digital database of a major German national health insurance company. Periodontal treatment was the intervention in the treatment group. Kaplan-Meier survival analyses on the patient level with the primary outcome extraction were carried out over four years. A control group without treatment was matched and analysed. Differences were tested with the Log-Rank-test. Extraction incidences were calculated over a matched observation period six years before and four years after treatment for both treatment and control group.

RESULTS

A total of 415,718 periodontal treatments could be traced. Focussing on the outcome "extraction", the cumulative four-year survival rate was 63.8% after periodontal treatment. The matched control group without periodontal treatment showed a survival rate of 72.5%. These differences were significant (p < 0.0001). The extraction incidence over time was higher in a four-year period after periodontal treatment compared to a six-year period before periodontal treatment.

CONCLUSIONS

The outcome of periodontal treatment was acceptable. In about two thirds of the patients, extractions could be completely avoided within a four year period after treatment.

CLINICAL SIGNIFICANCE STATEMENT

This study within the German national health insurance system shows that extractions were not observed after periodontal treatment in the majority of cases. Although periodontitis is a chronic disease, patients suffering from periodontitis have a considerable chance to prevent further tooth loss.

Predictors of long-term outcomes in patients undergoing periodontal maintenance

AIM

This retrospective study aimed to characterize the baseline status of patients following periodontal maintenance, analysing the association between the long-term outcome of these patients, smoking, bruxism, and the main clinical and radiographic variables.

MATERIAL AND METHODS

A sample of 174 patients with moderate to severe periodontitis was refined into homogeneous subsamples according to smoking and bruxism and the rate of tooth loss due to periodontal disease (TLPD): 0, 1-2, and >2 teeth. The association and the distribution (χ² test) of the variables within the subsamples were analysed.

RESULTS

Smoking and bruxism were significantly associated with higher TLPD rates. Vertical and circumferential bone defects (p < .0001), and abfractions (p < .0001) were associated with bruxism and particularly with bruxism and TLPD >2. Furcation defects (p = .0002), fewer radio-opaque subgingival calculus (χ² p < .0001), a lower mean Gingival index (χ² p = .027), and increased mean recessions >1.5 mm (χ² p = .0026) were associated with smoking and higher TLPD rates. The mean baseline mobility, abfractions, and recessions characterized two basic types of TLPD.

CONCLUSIONS

Smoking, bruxism, and routine clinical and radiological parameters can be used to characterize the baseline status of patients with worse outcomes.

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 regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs

AIM

Compare the long-term outcomes and costs of three treatment modalities in intra-bony defects.

MATERIALS AND METHODS

Forty-five intra-bony defects in 45 patients had been randomly allocated to receive: modified papilla preservation technique with titanium-reinforced expanded-polytetrafluoroethylene (ePTFE) membranes (MPPT Tit, N = 15); access flap with expanded-PTFE membranes (Flap-ePTFE, N = 15) and access flap alone (Flap, N = 15). Supportive periodontal care (SPC) was provided monthly for 1 year, then every 3 months for 20 years. Periodontal therapy was delivered to sites showing recurrences.

RESULTS

Forty-one patients complied with SPC. Four subjects were lost to follow-up. Clinical attachment-level differences between 1 and 20 years were -0.1 ± 0.3 mm (p = 0.58) in the MPPT Tit; -0.5 ± 0.1 mm (p = 0.003) in the Flap-ePTFE and -1.7 ± 0.4 mm (p < 0.001) in the Flap. At 20 years, sites treated with Flap showed greater attachment loss compared to MPPT Tit (1.4 ± 0.4 mm; p = 0.008) and to Flap-ePTFE (1.1 ± 0.4 mm; p = 0.03). Flap group lost two treated teeth. Five episodes of recurrences occurred in the MPPT Tit, six in the Flap-ePTFE and fifteen in the Flap group. Residual pocket depth at 1-year was significantly correlated with the number of recurrences (p = 0.002). Sites treated with flap had greater OR for recurrences and higher costs of re-intervention than regenerated sites over a 20-year follow-up period with SPC.

CONCLUSIONS

Regeneration provided better long-term benefits than Flap: no tooth loss, less periodontitis progression and less expense from re-intervention over a 20-year period. These benefits need to be interpreted in the context of higher immediate costs associated with regenerative treatment. These initial observations need to be extended to larger groups and broader clinical settings.

Association between susceptible genotypes to periodontitis and clinical outcomes of periodontal regenerative therapy: A systematic review

Background

The aim of this review is to systematically investigate the effect of a susceptible genotype to periodontitis with the clinical outcomes of periodontal regeneration.

Material and Methods

Based on a focused question, an electronic search identified 155 unique citations. Three journals (Journal of Periodontology, Journal of Clinical Periodontology and Journal of Periodontal Research), references of relevant studies and review articles were hand-searched. Two independent reviewers implementing eligibility inclusion criteria selected the studies.

Results

Of the 155, four studies fulfilled the inclusion criteria. All studies were published between 2000 and 2004 and the samples’ size was 40 to 86 patients. Polymorphisms of Interleukin-1 (IL-1) gene were included in all. Three out of four studies failed to identify an association between susceptible genotypes to periodontitis and clinical outcomes of periodontal regeneration, while one found an association. The heterogeneity and small number of studies included prevented the conduct of a meta-analysis. No studies were identified evaluating the effect of other genotypes and as a result only IL-1 genotype studies were included.

Conclusions

Within the limits of the present review, no direct conclusion for the effect of a susceptible IL-1 genotype status to the clinical outcome after periodontal regeneration could be drawn. The need of more qualitative studies to explore a possible association emerges.

Key words:Periodontitis, genotype, periodontal therapy, regeneration, susceptibility, systematic review.

Loss of molars in periodontally treated patients: results 10 years and more after active periodontal therapy

AIM

To identify risk factors for loss of molars during supportive periodontal therapy (SPT).

MATERIALS AND METHODS

A total of 136 subjects with 1015 molars at baseline were examined retrospectively. The association of risk factors with loss of molars was assessed using a multilevel Cox regression analysis. Furcation involvement (FI) was assessed clinically at start of periodontal therapy and assigned according to Hamp et al. (1975).

RESULTS

Fifty molars were extracted during active periodontal therapy (APT) and 154 molars over the average SPT period of 13.2 ± 2.8 years. FI degree III (HR 4.68, p < 0.001), baseline bone loss (BL) > 60% (HR 3.74, p = 0.009), residual mean probing pocket depth (PPD, HR 1.43, p = 0.027), and endodontic treatment (HR 2.98, p < 0.001) were identified as relevant tooth-related factors for loss of molars during SPT. However, mean survival time for molars with FI III or BL > 60% were 11.8 and 14.4 years, respectively. Among the patient data, age (HR 1.57, p = 0.01), female gender (HR 1.99, p = 0.035), smoking (HR 1.97, p = 0.034), and diabetes mellitus (HR 5.25, p = 0.021) were significant predictors for loss of molars.

CONCLUSION

Overall, periodontal therapy results in a good prognosis of molars. Degree III FI, progressive BL, endodontic treatment, residual PPD, age, female gender, smoking, and diabetes mellitus strongly influence the prognosis for molars after APT.

Association of susceptible genotypes to periodontal disease with the clinical outcome and tooth survival after non-surgical periodontal therapy: A systematic review and meta-analysis

Background

The real clinical utility of genetic testing is the prognostic value of genetic factors in the clinical outcome of periodontal treatment and the tooth survival. A meta-analysis was undertaken to estimate the effect of a susceptible genotype to periodontitis on the clinical outcomes of non-surgical periodontal therapy and the tooth survival.

Material and Methods

A systematic search of MEDLINE-Pubmed, Cochrane Library and Scopus was performed. Additionally, a hand search was done in three journals. No specific language restriction was applied. Two reviewers screened independently titles and abstracts or full text copies. Quality assessment of all the included studies was held.

Results

Initial screening of electronic databases resulted in 283 articles. Ten studies met the inclusion criteria, nine of them examined the clinical outcome, while the other one investigated the tooth survival in susceptible individuals after non-surgical periodontal therapy. Eight of included studies were selected for the meta-analysis. IL-1 positive genotypes increase the risk of tooth loss, while no association found between the bleeding on probing (BOP), clinical attachment loss (CAL) and plaque index (PI) with the genotype status. Probing pocket depth (PPD) reduction in the first three months and in long-term results found to have a significant association with the genotype.

Conclusions

There is no difference in the clinical measurements after non-surgical periodontal treatment, apart from PPD. More publications are needed to identify a cause-effect relationship.

Key words:Periodontal disease, periodontitis, periodontal therapy, clinical outcome, tooth loss, susceptibility, polymorphism, genotype, meta-analysis, systematic review.

Predictors of tooth loss due to periodontal disease in patients following long-term periodontal maintenance

AIM

To analyse patient-related factors (PRFs) and tooth-related factors (TRFs) associated with tooth loss due to periodontal disease (TLPD) in patients undergoing periodontal maintenance (PM).

MATERIAL AND METHODS

The sample consisted of 500 patients (mean follow-up of 20 years). The impact of PRFs on TLPD was analysed with Poisson regression and multivariate logistic regression. The simultaneous impact of PRFs and TRFs was analysed with multilevel logistic regression and Cox regression.

RESULTS

Tooth loss due to periodontal disease was 515 (mean 0.05 patient/year). The significant PRFs were severe periodontitis (p < 0.001), aggressive periodontitis (p < 0.001), smoking (p = 0.018), bruxism (p = 0.022) and baseline number of teeth (p = 0.001). These PRFs allowed characterizing patients losing more teeth. The whole TRFs analysed were significant, depending on the type of tooth and the category of each factor (e.g. mobility 0, 1, 2, and 3). The significant PRFs increased the risk of TLPD by 2 to 3 times while TRFs increased the risk to a higher extent. Mobility was the main TRF.

CONCLUSIONS

Severe periodontitis, aggressive periodontitis, smoking, bruxism and baseline number of teeth, as well as the whole TRFs analysed, were associated with TLPD.

Are herpes virus associated to aggressive periodontitis? A review of literature

Periodontal Disease includes a wide variety of infectious entities with various clinical manifestations in the oral cavity and responses to treatment. The determinants of clinical manifestations of periodontal disease include the type of infectious agent, the host immune response and environmental factors. Aggressive periodontitis (AP) is defined as a type of inflammation with specific clinical and laboratory features, which distinguish it from other types of periodontitis, with high incidence rates in a sub-group of individuals. Bacteria have been frequently mentioned as the agent inciting gingival inflammation and tissue destruction that underlies the pathogenesis of periodontitis. However, recent studies, with some controversial results, have suggested that the herpes family of viruses, including CMV and EBV-1 as well as papillomaviruses, HIV, Human T-lymphotropic virus type 1, Torquetenovirus and hepatitis B and C occur with high frequency in active periodontal lesions. There is a lack of information about this disease and the role of herpesviruses in its pathophysiology. This review provides a critical analysis of the scientific evidence linking bacteria and viruses with AP and their potential impact on clinical characteristics, prognosis and therapy.

Maintenance periodontal therapy after systemic antibiotic and regenerative therapy of generalized aggressive periodontitis. A case report with 10-year follow-up

Aggressive periodontitis (AgP) is an inflammatory disease characterized by rapid attachment loss and bone destruction. This case report presents the 10-year results in a subject with generalized AgP treated by a regenerative periodontal therapeutic approach and the adjunctive use of antibiotics, following a systematic maintenance periodontal therapy. The use of enamel matrix derivatives (EMD) and adjunctive antibiotic therapy to treat AgP yielded improvements in clinical parameters and radiographic bony fill. This combined therapeutic approach following a systematic supportive periodontal therapy supports the long-term maintenance of teeth with previous advanced periodontal defects, demonstrating successful stability after 10-years follow-up. Clinical Relevance: The combined treatment protocol using EMD plus adjunctive antibiotic therapy, associated with a systematic supportive periodontal therapy, benefits the long-term maintenance of teeth with previous advanced periodontal defects in subjects presenting AgP, supporting this approach as an alternative in the treatment of AgP.

Impact of Patient Compliance on Tooth Loss during Supportive Periodontal Therapy

Periodontal treatment consists of active periodontal therapy (APT) and supportive periodontal therapy (SPT). Regular SPT is recommended to prevent and control the occurrence of periodontal disease following APT. A patient’s compliance with SPT is considered one of the most important factors affecting long-term periodontal status. Tooth loss is generally considered the final outcome of periodontitis. This review aimed to analyze the relationship between patient compliance with regular SPT and tooth loss. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline for systematic reviews was used. A search of articles was conducted using MEDLINE (PubMed) and other databases. Quality assessments of selected studies were performed. To assess the effect of compliance on tooth loss during SPT, pooled risk ratio of tooth loss (RRTL) was used as the primary outcome. Pooled risk difference of tooth loss (RDTL) and weighted mean difference of tooth loss rate (WDTLR) were used as secondary outcomes. Subgroup analysis and meta-regression were conducted to evaluate the effects of different variables. In total, 710 articles were screened. Eight studies, which had a regular-compliance (RC) group and an erratic-compliance (EC) group with at least a 5-y follow-up period, qualified for the meta-analysis. The risk of tooth loss in the RC group was significantly lower than that in the EC group (pooled RRTL: 0.56 [confidence interval (CI): 0.38, 0.82]; pooled RDTL: –0.05 [CI: –0.08, –0.01]). The definition of compliance was a variable significantly related to risk ratio of tooth loss. Patients in the RC group had significantly lower tooth loss rate during SPT than did patients in the EC group (WDTLR: –0.12 [CI: –0.19, –0.05]). Teeth have less risk of being lost if patients are more compliant with supportive periodontal therapy. However, unidentified variables causing data heterogeneity and affecting the risk of tooth loss may have been present. More well-controlled prospective studies are needed in the future.

Periodontal pathogens and associated factors in aggressive periodontitis: results 5-17 years after active periodontal therapy

OBJECTIVES

To assess the association between presence of periodontal pathogens and recurrence of disease in patients with aggressive periodontitis (AgP) after active periodontal therapy (APT) and further influencing factors.

MATERIAL & METHODS

Microbiological samples were taken from 73 patients with AgP 5-17 years after APT at 292 sites (deepest site per quadrant). Real-time polymerase chain reactions were used to detect the periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. Uni- and multivariate analyses evaluated the associations between pathogens and recurrence of disease, smoking and adjunctive antibiotic therapy.

RESULTS

At re-examination A. actinomycetemcomitans could be detected in six patients (8.2%), P. gingivalis in 24 (32.9%), T. forsythia in 31 (42.5%) and T. denticola in 35 (48.0%). Increased levels of T. forsythia and T. denticola at re-examination were significantly associated with recurrence of disease in multivariate analyses (OR: 12.72, p < 0.001; OR 5.55, p = 0.002 respectively). Furthermore, high counts of T. denticola were found in patients with increased percentage of sites with clinical attachment levels (CAL) ≥ 6 mm compared to those with low counts (13.8% versus 3.2%, p = 0.005).

CONCLUSION

In patients with recurrence of disease T. forsythia and T. denticola were detected more frequently and in higher counts. Furthermore, T. denticola was found more frequently in patients with increased CAL.

Tooth loss in aggressive periodontitis: a systematic review

Aggressive periodontitis (AgP) is thought to have a faster rate of progression than chronic periodontitis (CP). However, there is a lack of studies systematically investigating disease progression and tooth loss in AgP. A systematic search of the literature was conducted by two independent reviewers for longitudinal studies including patients with AgP (previously known as 'periodontosis', 'juvenile' or 'early-onset' periodontitis) indicating measures of disease progression. Ovid MEDLINE(®) and Embase databases were searched for at least 5-year longitudinal human studies in AgP patients. In total, 16 studies were included in the review, from an initial search of 1,601 titles. Heterogeneity was detected for disease definition and clinical data reporting; hence meta-analysis was feasible only for the objective measure 'tooth loss'. The average tooth loss for all AgP cases was 0.09 (95% C.I. = 0.06-0.16) per patient-year. The corresponding values by diagnosis were 0.05, 0.14, and 0.12 tooth loss per patient-year, respectively, for LAgP, GAgP, and un-specified AgP. For studies reporting tooth loss during the 'observational period' (excluding extractions at initial therapy), the average tooth loss for AgP was 0.09 per patient-year. High heterogeneity was detected for these analyses. In conclusion, most studies report good long-term stability of treated AgP cases.

Long-term tooth loss in periodontally compromised but treated patients according to the type of prosthodontic treatment. A retrospective study

If prosthodontic treatment is considered after periodontal therapy, the questions arise i) does prosthodontic treatment affect the treatment outcome of the dentition in general and ii) which type of prosthesis is related to best treatment outcome of abutment teeth? Our goal was to compare long-term tooth loss after comprehensive periodontal therapy in patients with or without prosthodontic treatment. Ninety patients' charts with a total of 1937 teeth who had received comprehensive periodontal treatment 5-17 years ago by the same periodontist were retrospectively evaluated. Sixty-five patients received fixed dental prostheses (FDP; n = 29) and/or removable partial dentures anchored with clips (RPDC; n = 25) or double crowns (RPDD; n = 25). Twenty-five patients were also periodontally compromised but treated without prosthodontic treatment and served as a control group. A total of 317 teeth and 70 abutment teeth were lost during 9.7 ± 4.1 years of observation. Thereof, 273 teeth and 48 abutment teeth were lost due to periodontal reasons. Mean tooth loss amounted to 1.2 ± 1.5 (controls) and 4.4 ± 3.4 (partial dentures). Abutment tooth loss was 0.4 ± 1.1 (FDP), 1.0 ± 1.2 (RPDC) and 1.3 ± 1.0 (RPDD). Poisson regressions identified prosthodontic treatment, age, socio-economic status, diabetes mellitus, mean initial bone loss and aggressive periodontitis as factors significantly contributing to tooth loss. Age, diabetes and non-compliance contributed to abutment tooth loss. Not considering biomechanical factors, patients with prosthodontic reconstructions under long-term supportive periodontal therapy were at higher risk for further tooth loss than patients without prostheses. Not only the type of partial denture but also the patient-related risk factors were associated with abutment tooth loss.

New attempts to modify periodontal risk assessment for generalized aggressive periodontitis: a retrospective study

BACKGROUND

Periodontal risk assessment (PRA) model was designed for risk evaluation of treated patients with periodontal disease. However, its use on generalized aggressive periodontitis (GAgP) had been scarcely reported. This study aims to investigate the association of original PRA/modified PRA (MPRA) and compliance of periodontal maintenance with long-term treatment outcomes of Chinese patients with GAgP.

METHODS

Eighty-eight patients from a GAgP cohort, who completed active periodontal treatment (APT) and accepted reevaluation 3 to 11 years (mean of 5.5 years) afterward, were enrolled. PRA was modified (three strategies involving replacement of bleeding on probing with bleeding index >2, counting sites with probing depth ≥6 mm and changing method of bone loss [BL] calculation) to classify patients into different risk groups based on data at the first recall after APT. PRA and three MPRA models were investigated regarding long-term association with tooth loss (TL) and alteration of bone level (∆BL).

RESULTS

Based on original PRA, 87 patients (98.8%) had a high-risk profile. According to three MPRA models, annual TL per patient values were greater in high-risk groups than in low-to-moderate risk groups (MPRA-1, 0.20 ± 0.33 versus 0.04 ± 0.14; MPRA-2, 0.18 ± 0.32 versus 0.05 ± 0.14; MPRA-3, 0.17 ± 0.32 versus 0.05 ± 0.15; P <0.05). By MPRA-1, irregular compliers with low-to-moderate risk profile had greater ∆BL (0.027 ± 0.031, indicating bone increment) than those with high risk (-0.012 ± 0.064, tendency for BL). For regular compliers, no significant differences of annual TL or ∆BL were found between risk groups.

CONCLUSIONS

MPRA models could be used for evaluating the long-term outcomes of Chinese patients with severe GAgP, especially irregular compliers. High-risk patients of MPRAs exhibited more TL and less bone fill than low-to-moderate risk ones.

Antimicrobial or subantimicrobial antibiotic therapy as an adjunct to the nonsurgical periodontal treatment: a meta-analysis

The use of antibiotics in nonsurgical periodontal treatment is indicated in cases in which scaling and root planing present important limitations. However, their use is controversial due to the secondary effects associated with them and the disagreements regarding their prescription. The aim of this study is to determine the effectiveness of systemic antibiotics in the management of aggressive and chronic periodontitis. The study was based on a search of randomized, controlled clinical trials. Common data were concentrated and evaluated by means of an analysis of variance (ANOVA), and a meta-analysis of the results was performed. The meta-analysis (P < 0.05, 95% confidence interval, post hoc Bonferroni) determined that the supplementation of nonsurgical periodontal therapy with a systemic antibiotic treatment—amoxicillin with clavulanic acid and metronidazole or subantimicrobial dose doxycycline—provides statistically significant results in patients with aggressive or chronic periodontitis under periodontal treatment, whilst increasing the clinical attachment level of the gingiva and reducing periodontal probing depth.

Retention of questionable and hopeless teeth in compliant patients treated for aggressive periodontitis

AIM

The aim of this study was to determine the survival rates of questionable and hopeless teeth in patients with aggressive periodontitis (AgP) and chronic periodontitis (CP) during 15 years of supportive periodontal therapy (SPT).

MATERIALS AND METHODS

Thirty-four AgP and 34 CP patients (SPT≥10 years) with bone loss of ≥50% at ≥2 teeth were consecutively recruited. Bone loss was measured on digitized radiographs and teeth were categorized as "questionable" (≥50 to <70% bone loss) or as "hopeless" (≥70%). Progression in pocket probing depths (PPD) during SPT, tooth loss and reasons for extraction were analysed.

RESULTS

In AgP patients, 262 teeth were considered as questionable and 63 as hopeless (CP: 149/51). During active periodontal therapy, 25 questionable and 26 hopeless teeth were extracted (CP: 12/16). During 15.3 ± 4.1 years of SPT of AgP 28 questionable and 15 hopeless teeth were removed (CP: 28/12). The mean tooth loss per patient during SPT in total was 0.14 (AgP) and 0.16 (CP) teeth/year. There were no significant differences in tooth loss or longitudinal progression of PPD between AgP and CP patients.

CONCLUSIONS

In patients with AgP, 88.2% (209 of 237) of questionable and 59.5% (22 of 37) of hopeless teeth survived 15 years during regular SPT in a dental school department.