Tooth‐related factors for tooth loss 20 years after active periodontal therapy–A partially prospective study

Long-term clinical outcomes of posterior monolithic and porcelain-fused zirconia crowns: A retrospective cohort study

STATEMENT OF PROBLEM

Monolithic zirconia crowns and porcelain-fused zirconia crowns have been evaluated with in vitro studies, but clinical evidence of their longevity is limited.

PURPOSE

The purpose of this retrospective cohort study was to compare the long-term cumulative survival and success rates of posterior monolithic and porcelain-fused zirconia crowns and to investigate risk factors associated with complications.

MATERIAL AND METHODS

The study included 235 patients and 255 crowns (dropout rate:10.9%). Clinical data were analyzed for single posterior monolithic zirconia crowns and porcelain-fused zirconia crowns placed consecutively during a 10-year period and for subsequent events during follow-up. Survival curves for the monolithic zirconia crown and porcelain-fused zirconia crown groups were drawn using Kaplan-Meier analysis. Statistical differences between groups were tested using the log-rank test (α=.05). The Cox proportional hazards analysis was used to identify risk factors for crown and abutment tooth complications.

RESULTS

The 10-year cumulative survival rates of the monolithic zirconia crown and porcelain-fused zirconia crown groups were 86.0% (95% CI, 72.8 to 99.1%) and 71.0% (95% CI, 54.6 to 87.9%), respectively. The monolithic zirconia crown group had a higher survival rate than the porcelain-fused zirconia crown group, but the difference was not statistically significant (P=.108). The 10-year cumulative success rate was higher in the monolithic zirconia crown group than in the porcelain-fused zirconia crown group, but the difference was not statistically significant (P=.071). Two risk factors were identified for crown complications alone: a molar rather than premolar crown (P=.014, hazard ratio [HR]=6.012) and a maxillary rather than a mandibular crown (P=.003, HR=9.487).

CONCLUSIONS

The 2 different types of crowns exhibited application site dependency for crown complications but not for abutment tooth complications.

A 30-year retrospective cohort outcome study of periodontal treatment of stages III and IV patients in a private practice

AIM

Tooth loss studies show that periodontal treatment is effective. However, it is not known whether these results can be projected into a lifetime of treatment. The aim of the study was to study all patients with stages III/IV of periodontitis over 30 years in a private practice.

MATERIALS AND METHODS

All patients referred between 1986 and 1990 were monitored for 30 years for tooth loss and prognostic factors. All dropouts were accounted for.

RESULTS

In all, 386 patients were followed, of whom 283 patients dropped out, leaving 103 patients (67 females and 36 males, average age 40.1 years) monitored over 30 years. Tooth loss was stable until 16 years, when the population was divided into groups of low (n = 65), moderate (n = 18) and high (n = 20) tooth loss, losing 1.05 (SD 1.27), 4.83 (SD 0.96) and 11.90 (SD 4.25) teeth, respectively. The strongest prognostic factors were first-degree relatives with periodontitis, periodontal treatment before the age of 35 years, diabetes and patients with teeth with initial hopeless prognosis.

CONCLUSION

The majority of patients with stages III and IV periodontitis could be successfully treated with conventional periodontal treatment over a period of 30 years. The findings suggest that retrospective studies with shorter observation times cannot automatically be projected onto the outcome of a lifetime of periodontal treatment.

Inflammation indices in association with periodontitis and cancer

Inflammation is a complex physiological process that plays a pivotal role in many if not all pathological conditions, including infectious as well as inflammatory diseases, like periodontitis and autoimmune disorders. Inflammatory response to periodontal biofilms and tissue destruction in periodontitis is associated with the release of inflammatory mediators. Chronic inflammation can promote the development of cancer. Persistence of inflammatory mediators plays a crucial role in this process. Quantification and monitoring of the severity of inflammation in relation to cancer is essential. Periodontitis is mainly quantified based on the severity and extent of attachment loss and/or pocket probing depth, in addition with bleeding on probing. In recent years, studies started to investigate inflammation indices in association with periodontal diseases. To date, only few reviews have been published focusing on the relationship between blood cell count, inflammation indices, and periodontitis. This review presents a comprehensive overview of different systemic inflammation indices, their methods of measurement, and the clinical applications in relation to periodontitis and cancer. This review outlines the physiological basis of inflammation and the underlying cellular and molecular mechanisms of the parameters described. Key inflammation indices are commonly utilized in periodontology such as the neutrophil to lymphocyte ratio. Inflammation indices like the platelet to lymphocyte ratio, platelet distribution width, plateletcrit, red blood cell distribution width, lymphocyte to monocyte ratio, delta neutrophil index, and the systemic immune inflammation index are also used in hospital settings and will be discussed. The clinical roles and limitations, relationship to systemic diseases as well as their association to periodontitis and treatment response are described.

Functional modulation of lysophosphatidic acid type 2 G-protein coupled receptor facilitates alveolar bone formation

Lipid biosynthesis is recently studied its functions in a range of cellular physiology including differentiation and regeneration. However, it still remains to be elucidated in its precise function. To reveal this, we evaluated the roles of lysophosphatidic acid (LPA) signaling in alveolar bone formation using the LPA type 2 receptor (LPAR2) antagonist AMG-35 (Amgen Compound 35) using tooth loss without periodontal disease model which would be caused by trauma and usually requires a dental implant to restore masticatory function. In this study, in vitro cell culture experiments in osteoblasts and periodontal ligament fibroblasts revealed cell type-specific responses, with AMG-35 modulating osteogenic differentiation in osteoblasts in vitro. To confirm the in vivo results, we employed a mouse model of tooth loss without periodontal disease. Five to 10 days after tooth extraction, AMG-35 facilitated bone formation in the tooth root socket as measured by immunohistochemistry for differentiation markers KI67, Osteocalcin, Periostin, RUNX2, transforming growth factor beta 1 (TGF-β1) and SMAD2/3. The increased expression and the localization of these proteins suggest that AMG-35 elicits osteoblast differentiation through TGF-β1 and SMAD2/3 signaling. These results indicate that LPAR2/TGF-β1/SMAD2/3 represents a new signaling pathway in alveolar bone formation and that local application of AMG-35 in traumatic tooth loss can be used to facilitate bone regeneration and healing for further clinical treatment.

Probing pocket depth reduction after non-surgical periodontal therapy: Tooth-related factors

BACKGROUND

To investigate tooth-related factors that influence the reduction of probing pocket depths (PPD) after non-surgical periodontal therapy (NST).

METHODS

Seven hundred forty-six patients with a total of 16,825 teeth were included and retrospectively analyzed. PPD reduction after NST was correlated with the tooth-related factors; tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration; using logistic multilevel regression for statistical analysis.

RESULTS

NST was able to reduce probing depth overall stratified probing depths (1.20 ± 1.51 mm, p ≤ 0.001). The reduction was significantly higher at teeth with higher probing depths at baseline. At pockets with PPD ≥ 6 mm, PPD remains high after NST. Tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration are significantly and independently associated with the rate of pocket closure.

CONCLUSIONS

The tooth-related factors: tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration had a significant and clinically relevant influence on phase I and II therapy. Considering these factors in advance may enhance the prediction of sites not responding adequately and the potential need for additional treatment, such as re-instrumentation or periodontal surgery, to ultimately achieve the therapy end points.

Have extraction patterns in German adults with severe periodontitis changed between 2000 and 2010? Results from two cohort studies

AIM

The aim of this study was to evaluate whether extraction thresholds in persons with severe periodontitis have changed between 2000 and 2010 and whether potential shifts have contributed to the reported decrease in tooth extractions in German adults over the last decades.

MATERIALS AND METHODS

Data from two German population-based cohort studies in Northeast Germany (Studies of Health in Pomerania; SHIP-START [baseline 1997-2001; 11-year follow-up] and SHIP-TREND [baseline 2008-2012; 7-year follow-up]) were used. In SHIP-START (SHIP-TREND), 522 (478) participants with severe periodontitis according to the CDC/AAP case definition were included. Patterns of maximum probing depth (PD) and maximum clinical attachment level (CAL) for retained and extracted teeth were compared between SHIP-START and SHIP-TREND participants.

RESULTS

No major differences in patterns of baseline maximum CAL of retained or extracted teeth were detected between SHIP-START and SHIP-TREND. Extraction thresholds were identified at the baseline at maximum CAL ≥6 and ≥9 mm. Tooth-level incidence rates for extraction for baseline maximum CAL of 6 mm were comparable between SHIP-START and SHIP-TREND (17.1 vs. 15.9 events per 1000 person-years).

CONCLUSIONS

After a decade, teeth in persons with severe periodontitis were still undergoing extraction with minor or moderate attachment loss. A change in extraction pattern did not contribute to the higher tooth retention rate.

The impact of a "successfully treated stable periodontitis patient status" on patient-related outcome parameters during long-term supportive periodontal care

AIM

To assess the importance of achieving a successfully treated stable periodontitis patient status (PPS) during long-term supportive periodontal care (SPC).

MATERIALS AND METHODS

This retrospective cohort study included 100 periodontitis patients, who continued for ≥7.5 years after active periodontal treatment with SPC and were judged as overall adherent. The effect of various predictors on three patient-related outcome parameters was assessed: (1) number of diseased teeth at last SPC, (2) number of teeth lost due to periodontitis, and (3) number of teeth lost due to any reason.

RESULTS

One-fifth of the patients were classified as stable after active periodontal treatment. After a mean follow-up of 10.77 years, 24 patients lost 38 teeth due to periodontitis. An unstable PPS and a higher number of diseased teeth per patient at first SPC, and inadequate oral hygiene levels over time, significantly increased the risk for a higher number of diseased teeth per patient at last SPC and for more lost teeth due to periodontitis. However, high adherence to SPC appeared to mitigate the negative effect of an unstable PPS, especially regarding tooth loss due to periodontitis. Further, tooth loss due to any reason was about 3 times higher than tooth loss due to periodontitis and was affected by a larger number of predictors.

CONCLUSIONS

Successfully treated patients with a stable PPS maintained a small number of diseased teeth and barely lost any teeth during long-term SPC compared to patients who did not achieve a stable PPS after active periodontal therapy.

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.

Tooth loss in complying and non-complying periodontitis patients with different periodontal risk levels during supportive periodontal care

OBJECTIVES

To evaluate yearly tooth loss rate (TLR) in periodontitis patients with different periodontal risk levels who had complied or not complied with supportive periodontal care (SPC).

MATERIALS AND METHODS

Data from 168 periodontitis patients enrolled in a SPC program based on a 3-month suggested recall interval for at least 3.5 years were analyzed. For patients with a mean recall interval within 2-4 months ("compliers") or > 4 months ("non-compliers") with different PerioRisk levels (Trombelli et al. 2009), TLR (irrespective of the cause for tooth loss) was calculated. TLR values were considered in relation to meaningful TLR benchmarks from the literature for periodontitis patients either under SPC (0.15 teeth/year; positive benchmark) or irregularly complying with SPC (0.36 teeth/year; negative benchmark).

RESULTS

In both compliers and non-compliers, TLR was significantly below or similar to the positive benchmark in PerioRisk level 3 (0.08 and 0.03 teeth/year, respectively) and PerioRisk level 4 (0.12 and 0.18 teeth/year, respectively). Although marked and clinically relevant in non-compliers, the difference between TLR of compliers (0.32 teeth/year) and non-compliers (0.52 teeth/year) with PerioRisk level 5 and the negative benchmark was not significant.

CONCLUSION

A SPC protocol based on a 3- to 6-month recall interval may effectively limit long-term tooth loss in periodontitis patients with PerioRisk levels 3 and 4. A fully complied 3-month SPC protocol seems ineffective when applied to PerioRisk level 5 patients.

CLINICAL RELEVANCE

PerioRisk seems to represent a valid tool to inform the SPC recall interval as well as the intensity of active treatment prior to SPC enrollment.

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.