Radiographic quantification of alveolar bone level changes. Predictors of longitudinal bone loss

Association of Neutral Zone Position with Age, Gender, and Period of Edentulism

PURPOSE

The changing dynamics of an aging mouth influence the position of the neutral zone (NZ). While the advantage of the NZ concept in complete denture treatment is quite established, what is not clearly understood is its position in relation to the crest of the residual ridge due to conflicting reports from previous studies. The purpose of this study was to investigate the distance and direction of NZ position in relation to crest of the residual ridge in edentulous patients and its association with age, gender, and period of edentulism.

MATERIALS AND METHODS

A cross-sectional study was conducted in 133 patients (70 males, 63 females) with a mean age of 58.81 ± 11.78 years. NZ recording was done using admix material by following standard procedures. Two metallic wires were adapted, one on the ridge and another on the center of the occlusal rims, and standardized digital radiographs were made. The position of NZ in relation to the crest of the residual ridge was recorded by noting the direction and measuring the distance between the adapted wires digitally at five locations (right molar, right premolar, incisor, left molar, left premolar regions).

RESULTS

Age, gender, and period of edentulism had no significant association with the position of NZ. No specific trend was observed in the in NZ position with a non-significant correlation.

CONCLUSIONS

Distance and the direction of neutral zone position in relation to crest of the residual ridge in edentulous patients bear no significant relationship with factors such as age, gender, and period of edentulism.

Periodontal tissue responses after insertion of artificial crowns and fixed partial dentures

PURPOSE

The purpose of this review was, first, to critically evaluate published evidence on the effects of artificial crowns and fixed partial dentures (FPDs) on adjacent periodontal tissue health, and second to synthesize this evidence into meaningful summaries. Restoration qualities that contribute to inflammatory responses were identified based on strength of evidence, and variables that should be controlled in future investigations were outlined. Such information is necessary to accurately predict the prognosis of periodontal tissues adjacent to crowns or FPDs.

METHODS

Clinical trial and epidemiologic evidence published in English was collected. The effects of crowns or FPDs on gingival inflammation, probing depths, and bone loss were evaluated based on accuracy of measurement, reliability of measurement, and/or appropriateness of data analysis.

RESULTS

Crowns and FPDs increased the incidence of advanced gingival inflammation adjacent to restorations, particularly if restorations had intracrevicular finish line placement, poor marginal adaptation, or rough surfaces. However, because of the limitation in the accuracy and reliability of probing depth measurements, reports of greater mean probing depths of crowned teeth, which tended to be less than 1 mm greater than control teeth, should be questioned. Finally, crowns and FPDs in general did not accelerate the rate of adjacent bone loss.

CONCLUSION

Clinically deficient restorations, as well as clinically acceptable restorations, can contribute to gingival inflammation. However, with the limitations of the applied methods of measurement, current evidence has not shown an increased attachment loss adjacent to crowns or FPDs. Future trials should document periodontal health before therapy and periodically after restoration insertion so that each tooth serves as its own control. In future studies, the periodontal disease history of the patient, the influence of the restoration on plaque formation, and the composition of the crevicular microflora must be recorded.

Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994

BACKGROUND

The aim of this study was to assess the prevalence and extent of gingival recession, gingival bleeding, and dental calculus in United States adults, using data collected in the third National Health and Nutrition Examination Survey (NHANES III).

METHODS

The study group consisted of 9,689 persons 30 to 90 years of age obtained by a stratified, multi-stage probability sampling method in 1988 to 1994. The weighted sample is representative of U.S. adults 30 years or older and represents approximately 105.8 million civilian, non-institutionalized Americans. Gingival recession, gingival bleeding, and dental calculus were assessed at the mesio-buccal and mid-buccal surfaces in 2 randomly selected quadrants, one maxillary and one mandibular. Data analysis accounted for the complex sampling design used.

RESULTS

We estimate that 23.8 million persons have one or more tooth surfaces with > or = 3 mm gingival recession; 53.2 million have gingival bleeding; 97.1 million have calculus; and 58.3 million have subgingival calculus; and the corresponding percentages are 22.5%, 50.3%, 91.8%, and 55.1% of persons, respectively. The prevalence, extent, and severity of gingival recession increased with age, as did the prevalence of subgingival calculus and the extent of teeth with calculus and gingival bleeding. Males had significantly more gingival recession, gingival bleeding, subgingival calculus, and more teeth with total calculus than females. Of the 3 race/ethnic groups studied, non-Hispanic blacks had the highest prevalence and extent of gingival recession and dental calculus, whereas Mexican Americans had the highest prevalence and extent of gingival bleeding. Mexican Americans had similar prevalence and extent of gingival recession compared with non-Hispanic whites. Gingival recession was much more prevalent and also more severe at the buccal than the mesial surfaces of teeth. Gingival bleeding also was more prevalent at the buccal than mesial surfaces, whereas calculus was most often present at the mesial than buccal surfaces.

CONCLUSIONS

Dental calculus, gingival bleeding, and gingival recession are common in the U.S. adult population. In addition to their unfavorable effect on esthetics and self-esteem, these conditions also are associated with destructive periodontal diseases and root caries. Appropriate measures to prevent or control these conditions are desirable, and this may also be effective in improving the oral health of the U.S. adult population.

Radiographic periodontal findings in an elderly Finnish population

By means of panoramic radiography and additional intraoral radiographs, the occurrence of calculus, the extent of horizontal bone loss, the depth and number of infrabony pockets, the number of furcation lesions, and the number of interproximal restoration overhangs were studied in 169 dentate 76-, 81-, and 86-year-old subjects (54 male and 115 females) living at home. Alveolar bone loss (horizontal or vertical) among the participants was common, and in only 8 subjects (5%) was it judged non-existent. It was slight in 30 subjects (18%), moderate in 53 (31%), and advanced in 78 (46%). Infrabony pockets were found in 51% of the subjects and furcation lesions in 28%. The presence of calculus did not correlate with the other parameters. The number of interproximal overhangs was associated with the number of infrabony pockets and of furcation lesions (R=0.3, p<0.001 and p<0.0001) and the number of infrabony pockets with the number of furcation lesions (R=0.4, p<0.0001). Our study shows that periodontal findings are common in the dentate elderly, and associations recently found between periodontal infections and several serious diseases make radiographic examination an integral part of the oral examination of the elderly patient.

A 10-year study of the progression of destructive periodontal disease in adult and elderly Chinese

This study describes the progression of destructive periodontal disease among Chinese aged 20 to 80 with limited access to dental health facilities and minimal traditions for oral hygiene procedures. These individuals were followed for 10 years to determine whether the rates for progression of periodontal disease were markedly different than for populations with more access to oral health care. At baseline, participants had been examined for tooth mobility, plaque, calculus, gingival conditions, attachment levels, and probing depths on 4 sites of each tooth present. These probing depth and attachment level recordings were repeated at follow-up, although third molars were excluded from examination. A total of 398 persons remained dentate at follow-up. The analysis demonstrated that virtually all subjects experienced > or = 2 mm attachment loss over the 10-year period, and frequently in a large proportion of the sites present. Attachment loss > or = 3 mm was also widespread, but the distribution of persons according to the extent of > or = 3 mm attachment loss was positively skewed in all age groups. Positive skewness was even more pronounced when attachment loss of > or = 4 mm was considered. Some types of teeth, such as mandibular incisors and maxillary molars, had higher progression rates than did, for example, maxillary incisors. The mean individual attachment loss rates did not differ significantly between age groups, and were remarkably similar to those reported for populations whose access to and tradition for oral health care is widespread.

Caries lesions and dental restorations as predisposing factors in the progression of periodontal diseases in adolescents. A 3-year longitudinal study

The present study used a novel approach to assess the relationship between untreated caries lesions and defective and non-defective dental restorations and the incidence of gingival inflammation and the progression of chronic inflammatory periodontal diseases at the approximal surfaces of posterior teeth and at the adjacent surface of the neighboring tooth in adolescents over a period of 3 years. Two hundred-twenty-seven (227) 13-year-old schoolchildren were examined clinically and radiographically at baseline and annually at three subsequent occasions. At each site the alveolar bone height and presence of gingival bleeding were assessed. Incipient caries lesions, manifest caries, and defective and non-defective restorations were identified at the same site and also at the adjacent approximal tooth surface at all examinations, both clinically and radiographically. The data were analyzed by the multi-level logistic regression and variance components analyses. On average, 32, 8.5, 7, and 10% of the sites, respectively, were diagnosed as having incipient caries, manifest caries, and defective and non-defective restorations. There was a significant association between the presence of untreated manifest caries lesions, non-defective and defective dental restorations, and the progression of periodontal support loss. Also there was an association between presence of defective restorations and manifest caries and the incidence of gingival inflammation. Consistently, factors detected at the involved site and at the adjacent site had significant effects. The present study indicates that untreated cavities and dental restorations are predisposing factors with a significant negative effect on periodontal health in adolescents.(ABSTRACT TRUNCATED AT 250 WORDS)

Utility of radiographic crestal lamina dura for predicting periodontitis disease-activity

The relationship between radiographic crestal lamina dura and periodontitis disease-activity was studied longitudinally in 51 treated adult patients on a systematic 3-month maintenance program. The presence or absence of crestal lamina dura at 1809 interproximal sites was scored from periapical and bitewing radiographs taken at baseline of a 36-month maintenance care period. Semi-annual clinical evaluations by 2 independent examiners were carried out on each patient, with disease recurrence defined as sites revealing a > or = 3 mm increase in probing depth from baseline, or a > or = 2 mm increase in probing depth together with a > or = 2 mm loss of relative attachment level from an occlusal reference stent. Over the 36-month study period, 23 (45%) patients exhibited disease recurrence at 55 (3%) interproximal tooth sites scored for baseline crestal lamina dura. Absence of detectable baseline crestal lamina dura yielded high sensitivity (87-100%), but low specificity (17%) and low positive predictive values (0.8-3.2%), for localized periodontitis recurrence. In contrast, no sites exhibiting an intact baseline crestal lamina dura demonstrated periodontitis recurrence up to 24 months from baseline (100% positive predictive values). Presence of radiographic crestal lamina dura was positively associated with clinical periodontal stability (summary odds ratio for sites = 2.6, P = 0.0004), and negatively associated with periodontitis recurrence (summary odds ratio for sites = 0.4, P = 0.0004), for the 36-month study period. Evaluation of radiographic crestal lamina dura status appears valuable for assessing the risk of periodontitis disease-activity at inter-proximal tooth sites in patients on maintenance care programs.

A 6-year follow-up study of oral function in shortened dental arches. Part I: Occlusal stability

In this clinical 6-year follow-up study subjects with shortened dental arches (SDA, n = 55), characterized by the absence of molar support, are compared with subjects with complete dental arches (CDA, n = 52) with respect to occlusal stability. In addition, a small group of subjects with SDA and removable partial dentures in the lower jaw (SDA+RPD, n = 19) is included in this study. The aim of this study was to describe effects regarding occlusal stability in subjects with SDA during a 6-year period. The applied parameters for occlusal stability are: number of occlusal contacts in the anterior region, overbite, interdental spacing and alveolar bone support. The results of this study show that: (i) SDA do provide durable occlusal stability; (ii) free-end RPD do not contribute to occlusal stability in SDA; and (iii) SDA with periodontally involved teeth show continuing periodontal breakdown.

Six-year progression of destructive periodontal disease in 2 subgroups of elderly Chinese

Two groups of elderly chinese were selected from a large epidemiological sample on the basis of a low ("best" group) or a high ("worst" group) number of sites with attachment loss levels > or = 6 mm and/or pocket depth > or = 4 mm and at least 16 teeth present. Six years later the patients were clinically reexamined and the subgingival microflora was assessed. This paper presents the clinical characteristics of destructive periodontal disease progression among the two subgroups. The "best" group lost an average of 1.8 teeth, contrasting the average loss of 5.3 teeth among the "worst" group. Virtually all teeth lost among the "worst" group had a baseline attachment loss level > or = 4 mm, in contrast to 48% among the "best" group. While dental caries could be identified as a cause of tooth loss in both groups, the excess tooth loss among the "worst" group seems attributable to periodontal destruction. The average of 1.21 mm attachment/site lost among the "best" group was not statistically significantly different from the 1.36 mm/site lost among the "worst" group during the 6 years. Individual mean losses of attachment ranged from a gain of 0.03 mm to a loss of 3.19 mm. An attachment loss > or = 2 mm at a site was highly positively associated with a high initial attachment loss level (> or = 4 mm) at that site among the "best" group, whereas a highly negative association was seen among the "worst" group.(ABSTRACT TRUNCATED AT 250 WORDS)

Associations between six DNA probe-detected periodontal bacteria and alveolar bone loss and other clinical signs of periodontitis

The purpose of the present study was to assess the associations between the presence and amounts of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, B. intermedius, Eikenella corrodens, Wolinella recta, and Fusobacterium nucleatum in the periodontal pocket and the degree of alveolar bone loss and other clinical signs of periodonitis, such as probing pocket depth, attachment level, and presence of bleeding on probing at the same site. The study material comprised 16 subjects with or without approximal sites showing longitudinal alveolar bone loss who were selected from a group of 142 subjects monitored radiographically over the past 4 years. In this group 105 sites were examined, of which 58 showed recent alveolar bone loss greater than or equal to 1 mm. Subgingival plaque was collected with absorbent paper points and hybridized with 32P-labeled DNA probes specific for the above-mentioned bacteria. The amount of each bacterial species was correlated with the degree of bone loss over time and the three clinical measurements by means of Spearman rank correlation. A. actinomycetemcomitans showed poor correlations with all three clinical signs of periodontal inflammation, whereas B. gingivalis and W. recta demonstrated significant positive correlations with the three clinical measurements and with attachment level and pocket depth, respectively. In addition, the amount of A. actinomycetemcomitans, B. gingivalis and W. recta showed significant positive correlation with the extent of alveolar bone loss at the site. In contrast, the amounts of B. intermedius, E. corrodens, and F. nucleatum showed negative correlations with all four measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

A 6-year study on the pattern of periodontal disease progression

The present longitudinal radiographic investigation was designed to study the change in the alveolar bone height over 6 years in relation to tooth type, age and the presence of previous bone loss in a group of 142 subjects (age 18-67 years) who were not under systematic periodontal treatment. The subjects were examined radiographically at baseline, and after 2 and 6 years, and sites showing significant (greater than or equal to 1 mm) change in the alveolar bone height during 2 consecutive examinations were identified. 90.2% of all examined sites showed no bone loss during the 6 years, while 8.6% and 1.2% of the sites exhibited bone loss during one or both examination periods, respectively. 3 groups of subjects within the studied population were identified. Approximately 5% of the subjects had high rates of periodontal disease progression whilst approximately 70% demonstrated very few or no sites with bone loss, and approximately 25% had a moderate level of disease progression during the study period. The results also showed that the number of sites exhibiting alveolar bone loss during the study period varied with respect to tooth type, age of the patient and presence of bone loss at baseline. In addition, significantly different rates of bone loss were disclosed with relation to tooth type (P less than 0.01), age (P less than 0.0001) and initial bone loss (P less than 0.01). It was concluded that periodontal disease progression occurs infrequently and may take the form of discrete or recurrent episodes of loss of periodontal support which can be influenced by the location of the site, age of the subject and previous periodontal disease experience.

Some predictors of radiographic alveolar bone height reduction over 6 years

The present study was undertaken to 1) develop a model to predict the proportion of sites with alveolar bone height reduction over 6 years by means of a few factors, 2) build a second model to predict the initial values of the dependent variable, and 3) describe the relationship between initial bone loss and the bone loss over 6 yr with age. 142 subjects (18-67 yr) were examined radiographically at baseline and 6 yr later using a standardized method. For each subject, the proportion of sites depicting significant alveolar bone height reduction during the study was assessed. Explanatory variables were: presence of initial bone loss, local plaque retaining factors, age, sex, number of missing teeth at baseline and rheumatoid arthritis. Employing multiple regression analysis, the combined effect of initial bone loss, plaque retaining factors, age and rheumatoid arthritis provided the best model suited to predict the proportion of sites undergoing bone loss over time. However, age, plaque retaining factors and number of missing teeth were the best predictors of initial bone loss. A logistic regression model was then used to study the significance of these predictors at the site level. This model indicated that alveolar bone loss over time at a given site is related mainly to presence of local factors and initial bone loss at that site as compared to the effect of other sites with local factors and initial bone loss in the subject. Age demonstrated a linear relationship with initial bone loss and a curvilinear relationship to periodontal disease progression.(ABSTRACT TRUNCATED AT 250 WORDS)

Validity and reliability of alveolar bone level measurements made on dry skulls

The validity of the radiographic alveolar bone level measurements in relation to direct measurements, and the reliability of both the direct and the radiographic measurements were estimated on dry skulls. The CEJ-AC distances in the proximal areas of teeth in 6 dry skulls were assessed directly, on periapical radiographic films taken with the Eggen film holder only and on films taken with the film holder and a rubber impression material. The validity of the bone level measurements made on films taken by the 2 radiographic techniques was evaluated by comparing each of these 2 with the direct measurements by means of the paired t-test. The reliability of the measurements made by each of the 3 methods was estimated by means of the test-retest, the paired t-test and the direct error estimation methods. It was found that both radiographic methods significantly underestimated the proximal bone level (p less than 0.001). There were no significant differences between the test-retest scoring of the bone level in any of the 3 methods. However, the measurements made by both radiographic techniques showed better correlations, and smaller error due to the measurement technique than the direct measurements. When repeated radiographic exposures were made, the exposure technique in method C produced no error, while the estimated error variance in method B was 0.07. It was concluded that the validity and the reliability of both radiographic methods were satisfactory and that the observed underestimation has little impact on longitudinal studies monitoring the alveolar bone level changes.

Pattern of alveolar bone loss and reliability of measurements of the radiographic technique

The purposes of this paper were to study the pattern of bone loss among different teeth at the individual level and to study the effect of using different aggregated units of analysis on measurement error. Bone loss was assessed in standardized periapical radiographs from 293 subjects (18-68 years), and the mean bone loss score for each tooth type was calculated. These were then correlated by means of factor analysis to study the bone loss pattern. Reliability (measurement error) was studied by the internal consistency and the test-retest methods. The pattern of bone loss showed a unidimensional pattern, indicating that any tooth will work equally well as a dependent variable for epidemiologic descriptive purposes. However, a more thorough analysis also showed a multidimensional pattern in terms of four dimensions, which correspond to four tooth groups: 'incisors', 'upper premolars', 'lower premolars', and 'molars'. The four dimensions accounted for 80% of the total variance. The multidimensional pattern may be important for the modeling of bone loss; thus different models may explain the four dimensions (indices) used as dependent variables. The reliability (internal consistency) of the four indices was satisfactory. By the test-retest method, reliability was higher when the more aggregated unit (the individual) was used.