Longitudinal comparison of the periodontal status of patients with moderate to severe periodontal disease receiving no treatment, non-surgical treatment, and surgical treatment utilizing individual sites for analysis.

BACKGROUND: The progression of periodontal disease without treatment and the response of existing periodontal disease to various types of treatment have been studied extensively. Many past studies have used the mean of the patient's probing depths or attachment levels to evaluate disease progression as opposed to following changes in individual sites or teeth. The purpose of the current study was to evaluate the response of individual teeth to treatment or non-treatment. METHODS: The records from a private periodontal practice were reviewed to find patients with complete periodontal examinations that were recorded at least 1 year apart. Patients who fit these criteria were divided into those who had none of the recommended treatment (untreated, n = 30); those who had only non-surgical treatment (partially treated, n = 20); and a control group who had completed all recommended treatment (surgically treated, n = 41). The data for each tooth of each patient were placed in a database and analyzed using the method of generalized estimating equations (GEE) to test for associations between increase or decrease in probing depths and various initial clinical parameters while adjusting for significant confounders. RESULTS: Teeth that received no treatment or non-surgical treatment showed significant increases in probing depths, worsening of prognosis, worsening of furcation involvement, and increases in mobility when compared to surgically treated teeth. Teeth that received surgical treatment showed significant decreases in probing depths. No significant difference was noted between teeth that had no treatment and teeth that had non-surgical treatment. CONCLUSIONS: When individual teeth are used as the basis for analysis, teeth that receive no treatment or non-surgical treatment show a significant worsening of probing depths, furcations, mobility, and prognosis when compared to teeth that receive surgical treatment, while surgically treated teeth show significant improvement in probing depths.     

Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance

Background: Limited evidence exists on the significance of residual probing pocket depth (PPD) as a predictive parameter for periodontal disease progression and tooth loss.
Aim: The aim of this study was to investigate the influence of residual PPD 5 mm and bleeding on probing (BOP) after active periodontal therapy (APT) on the progression of periodontitis and tooth loss.
Material and Methods: In this retrospective cohort, 172 patients were examined after APT and supportive periodontal therapy (SPT) for 3–27 years (mean 11.3 years). Analyses were conducted using information at site, tooth and patient levels. The association of risk factors with tooth loss and progression of periodontitis was investigated using multilevel logistic regression analysis.
Results: The number of residual PPD increased during SPT. Compared with PPD3 mm, PPD=5 mm represented a risk factor for tooth loss with odds ratios of 5.8 and 7.7, respectively, at site and tooth levels. The corresponding odds ratios for PPD=6 mm were 9.3 and 11.0 and for PPD7 mm 37.9 and 64.2, respectively. At patient level, heavy smoking, initial diagnosis, duration of SPT and PPD6 mm were risk factors for disease progression, while PPD6 mm and BOP30% represented a risk for tooth loss.
Conclusion: Residual PPD6 mm represent an incomplete periodontal treatment outcome and require further therapy.     

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根分叉病变是牙周炎病变波及多根牙根分叉区,导致根分叉处的牙周附着丧失和牙槽骨破坏。由于多根牙根分叉区解剖结构复杂,彻底清创难度较大,一旦伴有根分叉病变,病情进展较单根牙更快且附着丧失更明显。因此,伴有根分叉病变牙齿的失牙率也更高。根据根分叉病变的严重程度,临床医生可以选用相应的治疗方法,牙周非手术治疗是最基本的治疗,其他治疗手段包括牙周手术治疗(根据根分叉病变程度选择不同的术式)、牙周-牙体联合治疗、牙周-正畸联合治疗等,各种治疗方法的预后不尽相同。文章就根分叉病变的发生、发展、临床诊断、治疗及预后等相关问题做一综述。     

根分叉病变发生、发展与治疗研究进展

根分叉病变是牙周炎病变波及多根牙根分叉区,导致根分叉处的牙周附着丧失和牙槽骨破坏。由于多根牙根分叉区解剖结构复杂,彻底清创难度较大,一旦伴有根分叉病变,病情进展较单根牙更快且附着丧失更明显。因此,伴有根分叉病变牙齿的失牙率也更高。根据根分叉病变的严重程度,临床医生可以选用相应的治疗方法,牙周非手术治疗是最基本的治疗,其他治疗手段包括牙周手术治疗（根据根分叉病变程度选择不同的术式）、牙周-牙体联合治疗、牙周-正畸联合治疗等,各种治疗方法的预后不尽相同。文章就根分叉病变的发生、发展、临床诊断、治疗及预后等相关问题做一综述。     

A split-mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate

BACKGROUND: Complete unilateral cleft lip and palate (UCLP) is a hereditary or multifactorial malformation that can be corrected successfully with a combined orthodontic, surgical and restorative treatment. Such multidisciplinary treatment takes many years and demands a lot of attention to both patients' teeth and periodontium. OBJECTIVES: This split-mouth study aimed to compare the periodontal health as well as the microbial parameters between cleft and non-cleft region. MATERIAL AND METHODS: 75 patients (52 males, 23 females) between 8 and 20 years with a complete unilateral cleft lip and palate (before (n = 30), during (n = 34) and after (n = 11) the active orthodontic treatment) volunteered for this study. Four regions were defined for the split-mouth comparison: teeth neighbouring cleft (site 1), tooth in cleft (site 2), and the corresponding contra-lateral teeth, respectively, in the unaffected quadrants (sites 3 and 4). At all sites the following periodontal parameters were recorded: plaque and gingivitis indices, pocket depth, attachment loss, bleeding on probing, tooth mobility (visual and Periotest), radiographic bone loss and gingival width. In addition, three pooled subgingival plaque samples were taken (around tooth in cleft, teeth facing the cleft, and contra-lateral teeth of the latter). RESULTS: The differences between the teeth neighbouring the cleft and the corresponding contra-lateral opponents were of borderline significance (P 相似文献   

Retained "hopeless" teeth: lack of effect periodontally-treated teeth have on the proximal periodontium of adjacent teeth 8-years later.

We previously reported the lack of effect periodontally-treated teeth prognosed "hopeless" and retained for 3.4 +/- 1.5 years have on the proximal periodontium of adjacent teeth. We now report our findings for the same group of subjects following 8.4 +/- 0.7 years of "hopeless" tooth retention. Of the 17 "hopeless" and adjacent teeth originally measured in 17 subjects, 14 of the subjects were still available for re-evaluation. Measures used to assess the periodontium of proximal surfaces of adjacent teeth included pocket depths (PD), radiographic alveolar bone level (R-BL), and periodontal ligament space width (W-PL). Treatment for the subjects consisted of surgical therapy (N = 15) and scaling and root planing (N = 2). Of the 14 subjects re-examined, 2 were eliminated due to loss of adjacent tooth reference points and 2 due to extraction of the "hopeless" tooth (N = 10). Differences in measurements (i.e., nonadjacent to "hopeless" tooth value minus adjacent to "hopeless" tooth value) were analyzed using a repeated measures ANOVA. There were no significant differences for PD (P = 0.20), R-BL (P = 0.29), or W-PL (P = 0.16). These data confirm our original findings that retained periodontally "hopeless" teeth do not significantly affect the proximal periodontium of adjacent teeth following therapy.     

Tooth loss during maintenance following periodontal treatment in a periodontal practice in Norway

BACKGROUND: Periodontal therapy coupled with careful maintenance has been shown to be effective in maintaining periodontal health; however, a small number of teeth are still lost because of progressive periodontitis. AIM: To investigate factors associated with tooth loss due to periodontal reasons during maintenance following periodontal treatment in patients in a Norwegian specialist periodontal practice. The study also examined how initial prognosis related to actual outcome as measured by periodontal tooth loss. METHODS: Hundred consecutive patients (68 females, 32 males) who had comprehensive periodontal treatment and attended for 9.8 (SD: 0.7), range: 9-11 years of maintenance care, were studied. All teeth classified as being lost due to periodontal disease over the period were identified. RESULTS: Only 36 (1.5%) of the 2436 teeth present at baseline were subsequently lost due to periodontal disease. There were 26 patients who lost at least one tooth. Logistic regression analysis showed that tooth loss was significantly related to male gender (p=0.049; adjusted odds ratio: 2.8; confidence interval (c.i.): 1.0-8.1), older age, i.e.>60 years (p=0.012; adjusted odds ratio: 4.0; c.i.: 1.3-12.0) and smoking (p=0.019; adjusted odds ratio: 4.2; c.i.: 1.4-13.8). The majority 27 (75%) of the teeth lost due to periodontal disease had been assigned an uncertain, poor or hopeless initial prognosis; however, nine teeth (25%) lost had been assigned a good prognosis at baseline. The prognosis for 202 teeth was judged to have worsened over the period of the study. CONCLUSION: Compliance with maintenance following periodontal treatment was associated with very low levels of tooth loss in a referral practice in rural Norway. Male gender, older age (>60 years) and smoking were predictors of tooth loss due to progressive periodontitis.     

Retention of hopeless teeth: the effect on the adjacent proximal bone following periodontal surgery

BACKGROUND: Clinical wisdom often suggests that retention of periodontally hopeless teeth may accelerate the destruction of the adjacent periodontium. The purpose of this study was to examine the effect of retaining hopeless teeth on the adjacent alveolar bone following periodontal surgery. METHODS: A retrospective study was conducted based on intraoral radiographs. Teeth were considered hopeless if they had lost > or =70% bone height at either of the proximal surfaces. The minimal follow-up period after surgery was 24 months. All subjects completed periodontal therapy, including scaling and root planing (SRP), and periodontal surgery at these sites. Ninety-three subjects with 110 hopeless teeth were included in this study. Cases were sorted into two groups: retained, which included 57 hopeless teeth (50 subjects) that were maintained; and extracted, which included 53 hopeless teeth (43 subjects) that were removed at surgery. All radiographs were digitized, and measurements of radiographic bone distance (RBD) were made using computerized software. RESULTS: Mean follow-up was 4.40 +/- 0.23 years. For the retained hopeless teeth, there was a mean bone gain of 0.82 mm from baseline (7.18 +/- 0.35 mm) to the final examination (6.45 +/- 0.41 mm; P = 0.0061). Likewise, the postoperative percentage of RBD of the retained hopeless teeth showed a statistically significant improvement from baseline (57.46% +/- 1.5%) to the final examination (52.32% +/- 2.03%; P = 0.0032). Teeth adjacent to a hopeless tooth had a slight radiographic bone gain postoperatively, which was greater in the extracted group. However, it was significant only for the distal neighboring teeth (1.50% versus 11.36%, respectively; P = 0.0119). CONCLUSION: Long-term preservation of hopeless teeth following periodontal surgery is an attainable goal with no detrimental effect on the adjacent proximal teeth.     

Full-mouth treatment concepts for chronic periodontitis: a systematic review

Objectives: To systematically review the effectiveness of full-mouth treatment concepts for chronic periodontitis.
Material and Methods: A search was conducted for randomized, controlled clinical trials including full-mouth scaling with (FMD) or without (FMS) the use of antiseptics and quadrant scaling (control). Data sources included COHG, CENTRAL, MEDLINE and EMBASE. Reviewers independently conducted data abstraction and quality assessment. The primary outcome was tooth loss; secondary outcomes were the reductions of PPD and BOP and a gain of CAL.
Results: Of 216 identified abstracts, seven trials were included. Meta-analysis revealed a weighted mean difference (WMD) for the reduction of PPD between FMD and control of 0.53 mm [95% confidence interval (CI) (0.28, 0.77), p <0.0001] in moderately deep pockets of single-rooted teeth. The WMD for gain in CAL was 0.33 mm [95% CI (0.04, 0.63), p =0.03] in moderately deep pockets of single- and multi-rooted teeth. Comparing FMD and FMS, the WMD for the reduction of CAL amounted to 0.74 mm [95% CI (0.17, 1.31), p =0.01] in deep pockets of multi-rooted teeth in favour of FMS. For BOP a WMD –18.0% [95% CI (−34.30, −1.70), p =0.03] was calculated in deep pockets of single-rooted teeth in favour of FMD.
Conclusions: In adults with chronic periodontitis only minor differences in treatment effects were observed between the treatment strategies.     

Effects of furcation involvements on periodontal status and healing in adjacent proximal sites

BACKGROUND: In a recent study it was found that following non-surgical treatment, probing depth (PD) reduction in proximal sites is significantly less in the presence of a vertical destruction in the adjacent site of the neighboring tooth. The present investigation was undertaken to study whether the presence of a proximal furcation involvement also influences the periodontal conditions in the adjacent site of the neighboring tooth. METHODS: The investigation was conducted as a retrospective study on a consecutive referral population based on full-mouth oral radiographic examinations and PD and plaque score registrations. The statistical analyses were performed on a final sample of 136 patients, with 153 (periodontal status) and 123 (periodontal healing) second maxillary premolars with an adjacent first maxillary molar. RESULTS: Baseline pockets were significantly deeper, relative radiographic attachment levels significantly reduced, and periodontal PD significantly less reduced after non-surgical treatment in the distal sites of second maxillary premolars adjacent to first maxillary molars with a mesial furcation involvement of degree > or = 2, compared to distal sites adjacent to first maxillary molars with a mesial furcation involvement of degree < or = 1. CONCLUSIONS: Periodontal status and healing after non-surgical treatment in proximal sites are negatively influenced by the presence of a deep furcation involvement in the adjacent site in the same proximal space. The presence of a deep proximal furcation involvement should consequently be considered a risk factor for the adjacent site of the neighboring tooth.     

Retained "hopeless" teeth. Effects on the proximal periodontium of adjacent teeth

The retention of teeth diagnosed as periodontally "hopeless" may accelerate the destruction of the adjacent proximal periodontium. Studies determining the influence these teeth have on the health status of adjacent teeth appear nonexistent. It was the intent of this retrospective study to assess the status of the periodontium in adjacent teeth proximal to the periodontium of "hopeless" teeth. We evaluated 17 teeth, each being mesially adjacent to one "hopeless" tooth, in 17 subjects treated for periodontal disease. In each case, the "hopeless" and the adjacent teeth received the same treatment. Probing depths (P-D), radiographic alveolar bone level (R-BL) and the width of the periodontal ligament space (W-PL) were measured for both the adjacent interproximal and the nonadjacent interproximal surface for each hopeless tooth. At both pretherapy and posttherapy, there were no significant differences for any of the variables (P-D, R-BL and W-PL) for the adjacent interproximal surfaces with the nonadjacent interproximal surfaces. However, there was a significant reduction in the mean probing depth for the adjacent interproximal surfaces, pretherapy to posttherapy. No other significant changes were found in any of the other variables for either the adjacent or nonadjacent interproximal surfaces. These data suggest that teeth considered periodontally "hopeless" and retained have no effect on the proximal periodontium of adjacent teeth prior to and following therapy.     

Factors influencing the outcome of non-surgical periodontal treatment: a multilevel approach

AIM: To investigate, by means of multilevel analysis, factors that may affect the short-term clinical outcome of non-surgical periodontal treatment. MATERIALS AND METHODS: Forty-one patients randomly assigned to two protocols of non-surgical therapy were included. The impact of different covariates on the probability of "pocket closure" [i.e. probing pocket depth (PPD)相似文献   

Periodontal attachment loss assessed by linear and area measurements in vitro

Abstract The aim of the present study was to investigate the relationship between linear and area measurements of periodontal attachment loss, and to determine the root surface area on different tooth-types. Extracted permanent teeth were collected in a national survey including a systematic random sample of 500 Norwegian dentists. The response rate was 70%. Altogether 329 teeth were received, 81 of them (excluding 3rd molars) were subjected to both linear and area measurements of attachment loss. Using a dissecting microscope (10 ×), 4 to 8 duplicate linear measurements were recorded per tooth. The areas of both lost and remaining periodontal attachment were measured by a method based on controlled release of Cu and Co metal ions from coatings applied to the root surface. Linear loss of attachment for single-rooted teeth (n=63) was x?=44.0% and the area loss x?=49.2%. The corresponding measurements for multi-rooted teeth (n=18) were x?=30.3% and x?=35.1%, respectively. The correlation between linear and area loss was r=0.78 for single-rooted and r=0.75 for multi-rooted teeth (p<0.01). The lower correlation in multi-rooted teeth is probably due to the more complex root anatomy. It is concluded that there is a strong correlation between linear loss of attachment and area of periodontal support lost for teeth with early to moderate loss of attachment, and that linear measurements tend to underestimate the remaining periodontal attachment.     

A retrospective study on the prognosis of teeth with root fracture in patients during the maintenance phase of periodontal therapy

Abstract –  Teeth with root fracture generally have a poor prognosis requiring extraction; however, some patients do not wish to have these teeth extracted. Dentists do not have enough information regarding the prognosis of teeth with root fracture. This study retrospectively examined the prognosis of teeth with root fracture in the maintenance phase of periodontal treatment and assessed the factors influencing the prognosis of teeth with root fracture. The clinical records of 100 patients, who had entered the maintenance phase of periodontal therapy in a university hospital and had experienced fracture of tooth root, were analyzed. The following parameters were included in the evaluation: age and gender of the subjects, tooth type, restoration and root-filling of the teeth with root fracture, and number of teeth present. Survival probability was assessed using Kaplan–Meier analysis. The median survival time (95% confidence interval) was 42 months (22–62 months). Teeth with horizontal fracture had a significantly higher survival probability compared with teeth with vertical fracture. No significant differences were found in the survival probability with regard to gender and tooth type. In conclusion, teeth with horizontal root fracture have a better prognosis compared with teeth with vertical root fracture in patients undergoing periodontal maintenance.     

Prerequisite for treatment planning implant dentistry: periodontal prognostication of compromised teeth

In this era of increased dental implant use, there is a tendency to underestimate the long-term prognosis of a tooth with a compromised periodontium (treated or untreated). This can result in premature extraction of a tooth because of the rationalization that its retention can damage a future implant site, or its inclusion in prosthesis is too risky. Data in the literature was reviewed to ascertain if clinicians can assign an accurate prognosis to teeth based on currently used clinical periodontal parameters. Clinical trials were selected that addressed the ability of commonly used clinical periodontal parameters to predict disease progression leading to tooth loss. Currently, there is no single clinical parameter that can reliably forecast periodontal disease activity, tooth loss, or conversely, long-term tooth retention. Thus, combinations of parameters are evaluated in concert to guide the need for therapy and to assess treatment outcomes. The data indicate that the absence of clinical inflammation and a stable periodontium (eg, no increasing probing depths, no additional loss of bone, or clinical attachment) are advantageous for retaining teeth. With periodontal therapy, many teeth with an unfavorable periodontal forecast can be converted to teeth with a favorable long-term prognosis; therefore, caution should be taken when considering criteria for tooth removal. Presently, there is no precise way to delineate a quantifiable threshold for tooth removal based on periodontal status that is correct in every circumstance. The decision to extract a tooth will fluctuate depending on its clinical condition, and this action should be supported by the literature, clinical experience, and the patient's declared goals.     

The effect of occlusal discrepancies on periodontitis. II. Relationship of occlusal treatment to the progression of periodontal disease

BACKGROUND: A causal relationship between occlusal discrepancies and periodontal disease has been postulated in the past. However, minimal data are available concerning the effect of treatment of occlusal discrepancies on periodontitis. METHODS: The records from a private practice limited to periodontics were reviewed to find patients who had complete periodontal examination records, including occlusal analysis, that were recorded at least 1 year apart. Patients who fit these criteria were divided into a group that had none of the recommended treatment (untreated n = 30), those who had only non-surgical treatment (partially treated n = 18), and a control group that had completed all recommended treatment (surgically treated n = 41). The data for each tooth of each patient, including occlusal status, were placed in a database and analyzed using the generalized estimating equations method. RESULTS: Worsening in overall clinical condition, as measured by worsening in prognosis, indicated that teeth with no initial occlusal discrepancies and teeth with treated initial occlusal discrepancies were only about 60% as likely to worsen in overall clinical condition over time compared to teeth with untreated occlusal discrepancies. Teeth with untreated occlusal discrepancies were also shown to have a significantly greater increase in probing depth per year than either teeth without initial occlusal discrepancies or teeth with treated initial occlusal discrepancies (P < 0.001). In addition, teeth with untreated occlusal discrepancies had a significant increase in probing depth per year (P < 0.001), whereas teeth without initial occlusal discrepancies and teeth with treated initial occlusal discrepancies had no significant increase in probing depth per year (P > 0.05). CONCLUSIONS: This study provides strong evidence of an association between untreated occlusal discrepancies and the progression of periodontal disease. In addition, this study shows that occlusal treatment significantly reduces the progression of periodontal disease over time and can be an important adjunct therapy in the comprehensive treatment of periodontal disease.     

Gingivitis as a risk factor in periodontal disease

Background: Dental plaque has been proven to initiate and promote gingival inflammation. Histologically, various stages of gingivitis may be characterized prior to progression of a lesion to periodontitis. Clinically, gingivitis is well recognized.
Material & Methods: Longitudinal studies on a patient cohort of 565 middle class Norwegian males have been performed over a 26-year period to reveal the natural history of initial periodontitis in dental-minded subjects between 16 and 34 years of age at the beginning of the study.
Results: Sites with consistent bleeding (GI=2) had 70% more attachment loss than sites that were consistenly non-inflamed (GI=0). Teeth with sites that were consistently non-inflamed had a 50-year survival rate of 99.5%, while teeth with consistently inflamed gingivae yielded a 50-year survival rate of 63.4%.
Conclusion: Based on this longitudinal study on the natural history of periodontitis in a dentally well-maintained male population it can be concluded that persistent gingivitis represents a risk factor for periodontal attachment loss and for tooth loss.     

Periodontal and microbiological parameters in children and adolescents with cleft lip and /or palate

Objective.  To evaluate the oral hygiene and the periodontal condition of children and adolescents with cleft lip and/or palate (CLP).
Methods.  Forty-one children and adolescents, 4–18 years, with CLP and 41 normal controls participated. Clinical parameters examined were the plaque and gingival index and Community Periodontal Index of Treatment Needs. For teeth in the cleft area, probing pocket depth, bleeding on probing, and tooth mobility were also evaluated. Samples of subgingival plaque were collected from 21 randomly selected patients of each group.
Results.  The CLP group had generally poorer oral hygiene (plaque index significantly higher) compared with the control. Children in both groups presented mild degree of gingivitis. Teeth in the cleft area had significantly higher pocket probing depth and tooth mobility, compared with corresponding teeth in the control group. The microbial analysis did not reveal significant differences in the composition of the subgingival microbiota between groups. Teeth in the cleft presented higher isolation frequencies and mean percentages of periodontopathic bacteria.
Conclusion.  Youngsters with CLP showed poor oral hygiene and worse periodontal condition, compared with controls. The above results advocate their participation in an intensive preventive dental programme that should start at an early age, possibly decreasing the risk of future periodontal disease.     

Salvaging a tooth with a deep palatogingival groove: an endo-perio treatment--a case report

AIM: To describe the diagnosis and management of tooth 22 with a necrotic pulp and severe periodontal destruction associated with a deep palatogingival groove extending to the root apex. SUMMARY: Palatogingival grooves are uncommon in maxillary lateral incisors, but when present may contribute to the pathogenesis of periodontal and endodontic lesions. In the present case, the prognosis was considered poor, as the patient presented with a deep probing defect, advanced bone loss and grade III mobility of tooth 22. Root canal treatment was performed, followed by periodontal surgery, during which the groove was conditioned and sealed with conventional glass-ionomer cement and the osseous defect filled with indigenously prepared hydroxyapatite. The 18 month post-operative follow up showed substantial resolution of the osseous defect with gain in attachment and decreased tooth mobility. KEY LEARNING POINTS: Teeth with deep palatogingival grooves may be significantly compromised with severe periodontal and periapical bone loss. Following thorough evaluation, the careful application of endodontic and periodontal surgical procedures may restore satisfactory function.