The effect of periodontal therapy in diabetics

Abstract The present investigation was performed to study the frequency of recurrence of periodontitis in diabetic subjects, who, prior to the initiation of a 5-year period of monitoring, were treated for moderate to advanced periodontal disease. 20 patients with diabetes, type 1 (LDDM) or type 2 (N1DDM) and 20, sex and age matched, controls with similar amounts of periodontal tissue destruction, were selected for the study. Following a screening examination, all patients were subjected to non-surgical periodontal therapy (oral hygiene instruction, supra-and subgingival scaling). 3 months later, the baseline examination for the study was performed. This included assessments of several parameters such as: number of teeth, plaque, gingivitis, probing pocket depth and probing attachment level. 6 months after the baseline examination, all 40 subjects were recalled for a 2nd examination. Sites which at this 6-month examination exhibited bleeding on probing, and had probing depth >5 mm, were scheduled for additional surgical therapy (modified Widman flap). Following this selective additional therapy, the main period of monitoring was initiated. During this period, a plaque control program was repeated every 3 months. Re-examinations regarding plaque, gingivitis, probing depth and probing attachment level were performed 12, 24 and 60 months after the baseline examination. The findings from the examinations disclosed that diabetics and non-diabetics alike, treated for moderately to advanced forms of adult periodontitis, during a subsequent 5-year period, were able to maintain healthy periodontal conditions. Thus, the frequency of sites which exibited signs of recurrent disease was similar in the 2 study groups.     

Clinical indicators of probing attachment loss following initial periodontal treatment in advanced periodontitis patients

Abstract. 16 advanced periodontitis patients were subjected to initial periodontal treatment and monitored every 3rd month during 42 months. Clinical characteristics tit baseline and during the 42-month maintenance period were investigated for their association with probing attachment loss over the 42-month period, both on a patient level and on a site level. On a patient level , averaged full-mouth plaque and bleeding on probing scores over the maintenance interval showed little association with probing attachment loss. Little association was also observed for % sites with depth ≥6 mm at baseline. However, a notable relationship was seen for % sites ≥6 mm at 3 months. This finding initiated a separation of the 16 subjects into 2 groups based upon % sites ≥6 mm at 3 months (groups' high 'and' low'). Site level analyses for these groups showed little association between frequent presence of plaque at the sites over the maintenance interval and probing attachment loss. Frequent bleeding on probing showed limited relationship with attachment loss for group 'low', but an appreciable association for group'high". The findings suggest that advanced periodontitis patients with multiple residual probing depths a6 mm at re-evaluation run a greater risk of developing sites with additional attachment loss than patients with few such residual depths. For such higher risk patients, bleeding on probing at maintenance examinations may be a useful indicator of subsequent deterioration at a site level.     

Progression of periodontal disease in patients with mild to moderate adult periodontitis

Abstract The aim of the present study was to determine the progression rate of periodontal disease in patients treated for localized or generalized mild to moderate adult periodontitis. 52 patients with a mean age of 53.7 years (S.D. 12. 6 years) were instructed in optimal home care procedures and exposed to initial periodontal therapy, before reconstructive therapy was initiated. Following completion of the prosthetic procedures, supportive therapy was offered to a limited extent and maintenance visits were irregularly scheduled corresponding to traditional dental care. Clinical periodontal parameters from 4 sites per tooth were assessed at the initial examination, at the time of reevaluation after initial therapy and at the re-examination after 8-years. Full sets of intraoral radiographs from the initial and the 8-year re-examination were analyzed with respect to changes in the radiographic alveolar bone height as a % of the total tooth length. As the result of the home care instructions, the mean plaque index (plaque control record) amounted to 21% at the end of initial periodontal therapy. 8 years later, the re-examination revealed a mean plaque index of 49% and a mean gingival bleeding index of 24%. At the initial examination, the 52 patients presented with an average of 18.7 teeth. During treatment. 26 teeth were sacrificed and 19 teeth were lost over the 8 years of supportive therapy. Bicuspids were the most frequent teeth to be lost over the observation period. As a result of initial therapy, the mean pocket probing depths decreased significantly. However, after 8 years, only minor differences were found when compared to the initial examination. At all examinations, the buccal and the oral aspects presented with shallower pockets compared to the interproximal sites. The comparison of the changes in the mean probing attachment levels over the observation period at mesial, buccal, distal and oral sites revealed a gain in clinical attachment after initial therapy and a mean loss of attachment ranging from 0.48 mm to 0.79 mm from the initial to the re-examination after 8 years. The buccal aspects demonstrated the highest mean clinical attachment loss followed by the oral sites. The radio-graphic assessment of the changes in the mean alveolar bone height revealed a statistically significant, but a clinically insignificant, loss of alveolar bone height of less than 2% of the tooth length. The patient population was grouped into 21 patients seeking supportive therapy less than once per year over 8 years. 14 patients having had one maintenance visit per year and 17 patients who were recalled more than once per year. With respect to the distribution of the number of sites with different changes in probing attachment level, no statistically significant difference between the groups was observed. When frequency analyses of the radiographically assessed changes in the alveolar bone height were performed, similar results were obtained. With the parameters and the statistical methods applied in this study, no significant influence of the age nor the recall frequency on the progression rate of periodontal disease could be detected in this group of patients presenting initially with mild to moderate adult periodontitis. Recall visits corresponding to conventional dental care did not prevent further loss of attachment, resulting in a deterioriation of the periodontal conditions compared to the results achieved after initial therapy and in 45 out of 52 patients compared to the baseline examination.     

4-year observations of basic periodontal therapy

A total of 2214 sites from incisors, cuspids, and premolars were studied in 46 adult periodontitis patients following treatment consisting of plaque control and root debridement. The periodontal status at 24 months was used as baseline for observations during the subsequent 24-48 month interval which included 4 recall visits for debridement at the 24-, 30-, 36-, and 42-month time points. The data were analyzed for pooled groups of sites of different probing depth at 24 months: less than or equal to 3.5 mm, 4.0-6.5 mm, and greater than or equal to 7.0 mm. The results showed little change during the 24-48 month interval in mean scores for bleeding on probing, probing depth, and probing attachment level for all 3 groups of sites. Individual sites with probing attachment loss during the 24-48 month period were identified. The frequency of such sites was similar, irrespective of 24-month probing depth. The sites identified with probing attachment loss during the 24-48 month interval generally differed in location from those identified as having probing attachment loss during the preceeding 0-24 month period. Often, the loss of probing attachment during the 24-48 month interval seemed to be a reversal of a prior gain in probing attachment during the 0-24 month interval. This study in non-molar teeth of subjects with generally good level of compliance failed to demonstrate that sites with deeper probing depth were more difficult to maintain than shallower sites.     

Effect of nonsurgical periodontal therapy

Incisors, cuspids and premolars in 49 patients with advanced chronic periodontitis were treated with initial, nonsurgical periodontal therapy. The results were monitored by probing attachment level measurements for 6 sites of each tooth every 3rd month during a period of 24 months. Amongst sites with initial probing depth greater than or equal to 4.0 mm, sites with probing attachment loss were identified using regression analysis. Scores for plaque, bleeding, suppuration on probing and probing depth, obtained for these sites during the 24-month study, were analyzed to determine whether any of the scores could be used diagnostically as an indicator of probing attachment loss. Diagnostic sensitivity and predictability were calculated for different levels of each of the scores. The results showed that sites with probing attachment loss were more frequent for sites with high scores for plaque, bleeding, residual probing depth and suppuration than in sites with low scores. However, the diagnostic sensitivity and predictability of these clinical indicators was generally low. Thus, records of plaque, bleeding, suppuration and probing depth do not obviate the need for probing attachment level measurements for identification of sites with probing attachment loss following initial, nonsurgical periodontal therapy.     

Short-term effects of initial periodontal therapy (hygienic phase)

Abstract The aim of the present study was to evaluate the effect of non-surgical periodontal therapy on probing pocket depths and probing attachment levels using a patient group with moderate to advanced periodontitis. 68 patients with moderate to advanced periodontitis underwent hygienic phase therapy including oral hygiene instructions, scaling and root planing and elimination of plaque retentive factors. Assessments of the plaque control record (PCR), bleeding on probing (BoP), probing depths and probing attachment levels were performed at baseline examination and 3 to 5 months following active treatment. The measurements were obtained at 4 interproximal aspects of each tooth with a thin calibrated probe. Mean BoP values decreased from 63.2±21.9% at baseline to 16.6±7.3% after therapy, and mean PCR decreased from 78.6±16.4% to 12.7±7.1%, respectively. A reduction in mean probing pocket depth from 3.96±1.39 mm at baseline to 3.30±1.16 mm after therapy was noted. Sites with initial probing depths of 1–3 mm showed no change, sites with initial values of 4–6 mm revealed a reduction of 1.03±1.04 mm, while initial pockets of 7–9 mm decreased in depth by 2.28±1.62 mm. A gain in the mean probing attachment level from 4.16±1.80 mm to 3.74±1.71 mm was observed as a result of treatment. The group with the shallow initial probing depths of 1–3 mm showed no alteration in probing attachment level. Pockets with baseline values of 4–6 mm showed gain of clinical attachment of 0.69±1.43 mm. The greatest gain in clinical attachment of 1.51±1.75 mm was obtained in sites with initially deep pockets of 7–9 mm. From the results of this study, it can be concluded that non–surgical periodontal therapy is an effective means to reduce probing pocket depths and to improve clinical attachment levels in patients with moderate to advanced periodontitis.     

The effect of smoking on the response to periodontal therapy

Abstract This study evaluated the effect of smoking on the clinical response to non-surgical and surgical periodontal therapy. 74 adult subjects with moderate to advanced periodontitis were treated according to a split-mouth design involving the following treatment modalities: coronal scaling, root planing, modified Widman surgery, and flap with osseous resectional surgery. Clinical parameters assessed included probing depth, probing attachment level, horizontal attachment level in furcation sites, recession, presence of supragingival plaque and bleeding on probing. Data were collected: initially, 4 weeks following phase-I therapy, 10 weeks following phase-II therapy and on a yearly basis during 6 years of maintenance care. Data analysis demonstrated that smokers exhibited significantly less reduction of probing depth and less gain of probing attachment level when compared to non-smokers immediately following active therapy and during each of the 6 years of maintenance (p< 0.05). A greater loss of horizontal attachment level was evident in smokers at each yearly exam during maintenance therapy (p < 0.05). There were no differences between groups in recession changes. In general, these findings were true for the outcomes following all 4 modalities of therapy and were most pronounced in the deepest probing depth category (≥ 7 mm). Statistical analysis showed a tendency for smokers to have slightly more supragingival plaque and bleeding on probing. In summary, smokers responded less favorably than non-smokers to periodontal therapy which included 3-month maintenance follow-up.     

Five-year maintenance follow-up of early-onset periodontitis patients

OBJECTIVES: The purpose of this study was to evaluate the clinical and microbiological status of patients with early-onset or aggressive periodontitis (EOP) who had received supportive periodontal care (SPC) every 3-6 months for a period of 5 years, following active periodontal treatment. MATERIAL AND METHODS: The study population consisted of 25 individuals with early-onset periodontitis. Clinical examination and recordings of probing pocket depth (PPD) and clinical attachment level (CAL) were performed at baseline prior to treatment (T0), 3 months following the termination of active periodontal treatment (T1) and annually at the SPC appointments (T2,T3,T4,T5). Microbiological samples were obtained at the 5-year SPC (T5). Subgingival plaque samples for each individual were collected from one deep pocket (>5 mm), based on pretreatment measurements, randomly selected in each quadrant. The levels of Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola were determined using oligonucleotide probe hybridization. RESULTS: During the 5-year period, the mean of SPC/patient was 12.7 sessions. A significant improvement was observed in PPD, CAL, gingival bleeding index and suppuration following treatment. However, between T1 and T5, 134 sites in 20 patients deteriorated with a CAL loss of> or =2 mm. Out of these 134 sites showing disease progression, microbial samples were randomly obtained in 13 sites (9.7%) from 8 patients. Among other factors, smoking and stress were found to have significant predictive value on the future attachment loss. P. gingivalis, T. denticola and total bacterial load were statistically significantly higher in patients who experienced disease progression during the 5-year maintenance period. CONCLUSIONS: For most EOP patients, regular SPC was effective in maintaining clinical and microbiological improvements attained after active periodontal therapy. However, a small percentage of sites was identified as progressive in 20 patients. Variables found to be related to periodontal progression were the presence of as well as the high bacterial counts of P. gingivalis, T. denticola and total bacterial load, number of acute episodes, number of teeth lost, smoking and stress.     

Long-term maintenance of patients treated for advanced periodontal disease

The aim of the present investigation was to evaluate the periodontal conditions of a group of patients who, following active treatment of extremely advanced periodontal disease, had been maintained for 14 years in a well-supervised maintenance care program. The present sample included 61 subjects out of an initial group of 75 individuals who in 1969 were referred to and treated by the authors. Following an initial examination, the patients were given detailed instructions in proper plaque control measures and were subjected to scaling and root planning and surgical elimination of pathologically deepened pockets. After the termination of the active treatment phase, the patients were placed in a maintenance care program including recall appointments every 3-6 months. At the initial examination, immediately after the completion of the active treatment phase and then once a year, all patients were examined regarding oral hygiene, gingival conditions, probing depths and clinical attachment levels. In addition, the interproximal alveolar bone height was determined from full mouth radiographs obtained before active treatment, at the completion of active therapy and 1, 3, 5, 8, 10, 12 and 14 years after treatment. The results from the repeated examinations demonstrated that treatment of advanced forms of periodontal disease resulted in clinically healthy periodontal conditions and that this state of "periodontal health" could be maintained in most patients and sites over a period of 14 years. It was also demonstrated that the treatment and maintenance programs described were equally effective in young and older patients. The individual mean values describing probing depths, attachment levels, and bone heights did not vary significantly over the 14 years of observation. A more detailed analysis of the data revealed, however, that a small number of sites in a few patients lost a substantial amount of attachment. This attachment loss occurred at different time intervals during the course of the maintenance period. Thus, 43 surfaces in 15 different patients were exposed to recurrent periodontal disease of a significant magnitude. This recurrent inflammatory periodontal disease caused the loss of 16 teeth in 7 different patients during the maintenance period. The data reported question the validity of using individual mean values to describe alterations of the periodontal conditions during maintenance following active periodontal therapy.     

Utility of 5 major putative periodontal pathogens and selected clinical parameters to predict periodontal breakdown in patients on maintenance care

Abstract The predictive utility of 5 major putative periodontopathic microbial species, “superinfecting” organisms, and several clinical periodontal parameters were assessed relative to periodontitis recurrence over a 12-month period in 78 treated adult patients participating in a 3-month maintenance care program. At baseline, pooled subgingival microbial samples were collected from each patient, and whole-mouth evaluations of probing depth, relative periodontal attachment level, furcation involvement, and indices of plaque and gingival inflammation were carried out. 67 (85.9%) subjects were culture-positive at baseline for presence of either Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia. Campylobacter rectus or Peptostreptococcus micros, with 48 (61.5%) subjects yielding one or more of these species at or above designated threshold proportions of ≥0.01% for A. actinomycetemcomitans, ≥0.1% for P. gmgivalis, ≥2.5% for P. intermedia, ≥2.0% for C. rectus, and ≥3.0% for P. micros. Subgingival yeasts were recovered from 12 subjects, staphylococci from 7, and enteric rods/pseudomonads from 6; however, no subjects revealed 21.0% baseline proportions of these “superinfecting” organisms in subgingival specimens. Periodontitis recurrence in subjects was defined as any periodontal site exhibiting either a probing depth increase of 2:3 mm from baseline, or a probing depth increase of 22 mm from baseline together with a loss in relative periodontal attachment of 22 mm from baseline. 15 (19.2%) study subjects showed periodontitis recurrence within 6 months of baseline, and 25 (32.1%) within 12 months. The mere baseline presence of the 5 major test species and “superinfecting” organisms were not significant predictors of periodontilis recurrence over 12 months. However, a 2.5 relative risk for periodontitis recurrence over 12 months was found for subjects yielding one or more of the 5 major test species at or above the designated baseline threshold proportions (p=0.022. Mantel-Haenszel %2 test). The positive predictive value for periodontitis recurrence of a microbiologic analysis encompassing the 5 major test species at or above the designated threshold proportions improved with increasing time from baseline, up to approximately 42% at 12 months. Baseline variables jointly providing in multiple regression analysis the best predictive capability for periodontitis recurrence in subjects over a 12-month period were recovery of one or more of the 5 major test species at or above designated threshold proportions, the proportion of sites per subject with 25 mm probing depth, and the mean whole-mouth probing depth. These findings indicate that one or more of 5 major putative periodontal pathogens in elevated subgingival proportions together with increased probing depth predispose adults on maintenance care to recurrent periodontitis.     

Progression of periodontitis in a sample of regular and irregular compliers under maintenance therapy: a 3-year follow-up study

Background: To our knowledge, prospective studies (matched for sex, smoking, and diabetes) that investigated the influence of compliance in the progression of periodontitis and tooth loss in periodontal maintenance therapy (PMT) programs were not previously reported. Methods: A total of 58 regular complier (RC) and 58 erratic complier (EC) individuals were recruited from a prospective cohort with 238 patients under PMT and matched by sex, diabetes, and smoking habits. A full‐mouth periodontal examination that included bleeding on probing (BOP), probing depths (PDs), clinical attachment levels, and number of teeth were determined at all PMT visits during a 3‐year interval. The influence of variables of interest was tested through multivariate logistic regression. Results: The progression of periodontitis and tooth loss was significantly lower among RC compared to EC patients. A higher progression of periodontitis was observed among EC patients who smoked. The final logistic model for the progression of periodontitis in the RC group included smoking (odds ratio [OR]: 4.2) and >30% of sites with BOP (OR: 2.8), and the final logistic model for the progression of periodontitis in the EC group included smoking (OR: 7.3), >30% of sites with BOP (OR: 3.2), PDs of 4 to 6 mm in 10% of sites (OR: 3.5), diabetes (OR: 1.9), and number of lost teeth (OR: 3.1). Conclusions: RC patients presented a lower progression of periodontitis and tooth loss compared to EC patients. This result highlighted the influence of the pattern of compliance in maintaining a good periodontal status. Moreover, important risk variables such as smoking and diabetes influenced the periodontal status and should be considered when determining the risk profile and interval time for PMT visits.     

A clinical and microbiological comparison of the effects of water and 0.02% chlorhexidine as coolants during ultrasonic scaling and root planing

The maxillary teeth of 10 patients with moderately advanced chronic periodontitis were treated in a split-mouth design study. The baseline examination included plaque and bleeding scores, probing depths and probing attachment levels. 2 sites in each quadrant were selected for dark-field microscopic analysis. Each quadrant was randomly assigned to test or control and instrumented with an ultrasonic scaler using either 0.02% chlorhexidine or water as the coolant. Measurements were repeated 2, 6 and 10 weeks later, together with additional plaque sampling. Ultrasonic instrumentation with either chlorhexidine or water was equally effective in reducing bleeding scores and improving probing attachment levels. 42% of chlorhexidine- and 38.7% of water-treated sites showed gains of 1 mm or more in clinical attachment. Mean reductions in probing depth were similar (0.9 mm chlorhexidine, and 0.8 mm water). At the final examination, the chlorhexidine-treated quadrants had significantly more sites with probing depths in the 1-3 mm category and less in the greater than 3 mm category than the control quadrants (P less than 0.05). Both treatments reduced the microscopic counts of motiles and spirochaetes, resulting in a subgingival microbiota consistent with periodontal health. The results indicate that chlorhexidine has a slight adjunctive effect in the reduction of pocket depth when used as a coolant during ultrasonic root planing for the treatment of chronic periodontitis.     

Clinical characteristics of periodontal sites with probing attachment loss following initial periodontal treatment

Abstract Periodontal sites which had undergone probing attachment loss were identified in 16 advanced periodontitis patients subjected to initial periodontal treatment and monitored every 3rd month for 42 months. Many sites with probing attachment loss showed no increase in probing depth and bled on probing at a few of the examinations during maintenance. Others showed increase in depth, frequent bleeding and suppuration. An arbitrary classification of ‘questionable periodontitis’ sites was used and included sites with the following characteristics: probing depth at 42 months 3.5 mm + bleeding on probing at no more than 5 of the 14 examinations 3-42 months + no suppuration on probing 3-42 months. The % sites in this category ranged from 21-35%, depending upon method used to determine probing attachment loss. Widely varying characteristics of sites identified with probing attachment loss were evident for all surface locations and all subgroups of initial probing depth. From a traditional viewpoint, a significant proportion of the losing sites might not have been afflicted with periodontitis. On the other hand, deterioration does not necessarily have to be coupled with obvious inflammation, particularly following therapy.     

Retrospective comparison of clinical variables between compliant and non-compliant patients

BACKGROUND: The aim of this retrospective study was to evaluate if patients with moderate to advanced periodontitis had comparable periodontal conditions at baseline and during supportive periodontal therapy (SPT) whether they were compliant or not. METHOD: Patient-related variables were compared: age, tooth mobility, furcation involvement, number of teeth, pocket probing depth, plaque index. Compliant patients (n = 142) received complete periodontal treatment and were followed over at least 10 years (group A). Non-compliant patients either discontinued supportive periodontal therapy (n = 42, group B) or dropped out before or during periodontal surgery (n = 44, group C). RESULTS: At baseline, there were no significant differences between the 3 groups except for mobility. During SPT, mean pocket probing depth and plaque index differed significantly. CONCLUSION: These results indicate that non-compliant patients compared to compliant patients had similar periodontal conditions at baseline, but responded less favourably to periodontal surgery and maintenance.     

Relationship of cigarette smoking to attachment level profiles

OBJECTIVES: The present investigation examined clinical features of periodontal disease and patterns of attachment loss in adult periodontitis subjects who were current, past or never smokers. MATERIAL AND METHODS: 289 adult periodontitis subjects ranging in age from 20-86 years with at least 20 teeth and at least 4 sites with pocket depth and/or attachment level >4 mm were recruited. Smoking history was obtained using a questionnaire. Measures of plaque accumulation, overt gingivitis, bleeding on probing, suppuration, probing pocket depth and probing attachment level were taken at 6 sites per tooth at all teeth excluding 3rd molars at a baseline visit. Subjects were subset according to smoking history into never, past and current smokers and for certain analyses into age categories <41, 41-49, >49. Uni- and multi-variate analyses examined associations between smoking category, age and clinical parameters. RESULTS: Current smokers had significantly more attachment loss, missing teeth, deeper pockets and fewer sites exhibiting bleeding on probing than past or never smokers. Current smokers had greater attachment loss than past or never smokers whether the subjects had mild, moderate or severe initial attachment loss. Increasing age and smoking status were independently significantly related to mean attachment level and the effect of these parameters was additive. Mean attachment level in non smokers <41 years and current smokers >49 years was 2.49 and 4.10 mm respectively. Stepwise multiple linear regression indicated that age, pack years and being a current smoker were strongly associated with mean attachment level. Full mouth attachment level profiles indicated that smokers had more attachment loss than never smokers particularly at maxillary lingual sites and at lower anterior teeth. CONCLUSIONS: In accord with other studies, smokers had evidence of more severe periodontal disease than past or never smokers. At all levels of mean attachment loss, smokers exhibited more disease than never smokers. Difference in mean attachment level between smokers and never smokers at individual sites was not uniform. Significantly more loss was observed at maxillary lingual sites and lower anterior teeth suggesting the possibility of a local effect of cigarette smoking.     

Influence of different curette insertion depths on the outcome of non-surgical periodontal treatment

This study was undertaken to compare the effects of scaling and root planing (Sc/RP) performed from approximately 1 mm coronal to (test Sc/RP) or at the bottom of (control Sc/RP) the probeable pocket to the gingival margin. 2 male and 5 female patients with moderate to severe periodontitis participated in the study. Initial examination was performed with respect to probing pocket depth (PPD) and probing attachment level (PAL) using a pressure-controlled periodontal probe and stents. The patients received repeated instruction in oral hygiene, and their plaque control reached an excellent level. Baseline examination including PPD and PAL measurements was then performed. Following the baseline examination, single-rooted teeth in 1 quadrant of each dentition were randomly selected and subjected to the test Sc/RP (test teeth) or control Sc/RP (control teeth). The PPD and PAL were measured 1 and 3 months following Sc/RP. It was demonstrated that: (i) the PPD reduction following Sc/RP was larger at the sites with initially deep pockets than at the sites with shallow pockets; (ii) the mean PPD reduction at the sites with an initial PPD > or =3.5 mm was significantly larger in the control teeth than in the test teeth; (iii) there was a significant PAL gain in the initially deep pockets but not in the initially shallow pockets; (iv) the PAL gain in the initially shallow pockets was significantly larger in the control teeth than in the test teeth. In the treatment of periodontitis, trauma caused by Sc/RP to the most coronal part of the connective tissue attachment seems to be of minor importance compared to the effective removal of subgingival deposits.     

Long-term effects of supportive therapy in periodontal patients treated with fibre retention osseous resective surgery. II: tooth extractions during active and supportive therapy

BACKGROUND: Long-term tooth retention is the main objective of periodontal treatment. The aim of this retrospective study was to describe the prevalence and reasons of tooth extraction during active periodontal therapy (APT) and supportive periodontal care (SPC) in periodontal patients. MATERIAL AND METHODS: Three hundred and four periodontal patients were examined. APT consisted of non-surgical periodontal treatment and fibre retention osseous resective surgery, where needed, to obtain no sites with PD>3 mm. All patients participated in an SPC programme for 3-17 years (mean time 7.8 years). RESULTS: At the initial examination, 45% of the patients had moderate periodontitis and 41% severe periodontitis. During APT, 576 teeth were extracted (7.5%). The main reason for tooth extraction during APT was the presence of advanced periodontal lesions (44%). The number of tooth extractions was higher in cases with severe periodontitis. Extracted teeth showed a mean bone loss of 76% of the total root length. During SPT, a total of 67 teeth were removed (0.9%) in a subgroup of 50 patients. The clinical problems were primarily related to the incidence of root fracture (48%) and secondarily to the progression of periodontal disease (30%). CONCLUSION: Prevalence of tooth extraction during APT is associated with the severity of periodontal disease. Tooth loss during supportive periodontal care may be negligible when a meticulous SPC programme is performed in patients where minimal probing depth is consequential to APT.     

Relationship between the prognosis of periodontitis and occlusal force during the maintenance phase – a cohort study

Takeuchi N, Ekuni D, Yamamoto T, Morita M. Relationship between the prognosis of periodontitis and occlusal force during the maintenance phase – a cohort study. J Periodont Res 2010; 45: 612–617. © 2010 John Wiley & Sons A/S Background and Objective: Few studies have longitudinally investigated the relationship between periodontal disease progression and occlusal factors in individual subjects during the maintenance phase of periodontal therapy. The aim of this cohort study was to investigate the relationship between biting ability and the progression of periodontal disease in the maintenance phase. Material and Methods: A total of 194 patients were monitored for 3 years during the maintenance phase of periodontal therapy. The subjects with disease progression (Progress group) were defined based on the presence of ≥ 2 teeth demonstrating a longitudinal loss of proximal attachment of ≥ 3 mm or tooth‐loss experience as a result of periodontal disease during the study period. The subjects with high occlusal force were diagnosed as men who showed an occlusal force of more than 500 N and women who showed an occlusal force of more than 370 N. The association between biting ability and the progression of periodontitis was investigated using logistic regression analysis. Results: There were 83 subjects in the Progress group and 111 subjects in the Non‐progress group. A backward, stepwise logistic regression model showed that the progression of periodontal disease was significantly associated with the presence of one or more teeth with a high clinical attachment level (CAL) of ≥ 7 mm (odds ratio: 2.397; 95% confidence interval: 1.306–4.399) ( p = 0.005) and low occlusal force (odds ratio: 2.352; 95% confidence interval: 1.273–4.346) ( p = 0.006). Conclusion: The presence of one or more teeth with a high CAL of ≥ 7 mm and low occlusal force might be possible risk factors for periodontal progression in the maintenance phase of periodontal therapy.     

Longitudinal changes in periodontal disease in untreated subjects

About 300 subjects, 20-79 years of age were recruited for a longitudinal study on the effect of periodontal therapy. The result of a baseline examination have been reported earlier. Following this baseline examination, the subjects were monitored for 24 months without therapy. Re-examinations were performed after 12 and 24 months. All teeth including the 3rd molars were included in the examinations. Presence of plaque was assessed at 4 surfaces per tooth and gingivitis, probing pocket depth, probing attachment levels were assessed at 6 locations per tooth. Out of the subject sample examined at baseline, 57 individuals failed to return for either the 1st, the 2nd or both re-examinations. An analysis was performed regarding the periodontal status at baseline, of the respondents and non-respondents. The results from the follow-up examinations of the participating 20 to 79 year-old subjects revealed that the sample underwent, during a 2-year period, only minor changes with respect to a series of different parameters characteristic of periodontal disease. Thus, the mean values of probing pocket depth and probing attachment level failed to change between baseline and the re-examinations after 1 and 2 years. Even if the mean values underwent only minor changes, however, certain subjects within each age category improved their periodontal conditions, whereas other subjects worsened. Furthermore, the findings of the re-examinations revealed that there was a strong correlation between improving plaque levels and gingivitis. The relationship between supragingival plaque levels and changes with respect to probing depth and attachment levels were weak.     

维持性血液透析患者的龋病和牙周病状况调查

目的比较维持性血液透析治疗的终末期肾脏病患者组和健康人群组龋病和牙周病患病率的差异,初步探讨终末期肾脏病和龋病、牙周病之间的关系。方法选择符合纳入标准的进行维持性血液透析治疗的患者作为病例组(82例),同时选择在体检中心进行口腔检查的正常人群作为健康对照组(86例)。两组采用统一的方法进行龋病和牙周状况的检查。龋病状况检查采用世界卫生组织推荐的龋失补牙数进行诊断和记录,牙周状况检查包括菌斑指数、牙石指数、探诊出血、牙周袋深度和临床附着水平。结果维持性血液透析组和健康对照组的患龋率分别为87.8%和81.4%,两组患龋率间差异无统计学意义(P>0.05);病例组的菌斑指数、牙石指数、探诊出血、牙周袋深度和临床附着水平均高于对照组(P<0.05),病例组的牙周炎患病率(97.6%)高于对照组(88.4%),差异有统计学意义(P<0.05)。结论维持性血液透析组患者的龋齿水平与健康对照人群无明显差异,但牙周炎的患病率和严重程度高于健康人群。