Prediction of marginal bone loss and tooth loss--a prospective study over 20 years

AIM: The purpose of the study was to investigate the influence of potential risk predictors/risk factors on the longitudinal marginal bone loss and tooth loss over 20 years. MATERIAL AND METHODS: A clinical and radiographic investigation of a sample of 513 individuals was performed in 1970 and 1990. Stepwise multiple regression analyses were adopted to calculate the influence of the potential risk predictors/risk factors on the longitudinal marginal bone loss and tooth loss. RESULTS: Russell's Periodontal Index in 1970 and smoking were significantly and positively correlated to longitudinal bone loss. Russell's Periodontal Index, marginal bone loss and Plaque Index at baseline were positively and significantly correlated to the longitudinal tooth loss, whilst age, the number of missing teeth in 1970 and the number of school years showed a significant negative correlation to number of teeth lost between 1970 and 1990. CONCLUSIONS: Smoking was found to be a significant risk factor in marginal bone loss, while plaque was a risk factor in tooth loss. However, the regression models explained a low percentage of the total variance, especially for marginal bone loss.     

Influence of smoking on marginal bone loss and tooth loss--a prospective study over 20 years

AIMS: The aim was to investigate the influence of smoking on longitudinal marginal bone loss and tooth loss in a prospective study over 20 years. In addition, the effect of cessation of smoking on bone loss and the interaction between smoking, plaque and marginal bone loss were evaluated. MATERIAL AND METHODS: A total of 507 dentate individuals from an epidemiological study were examined in 1970 and 1990. The clinical investigation included registration of number of remaining teeth and presence of plaque. The marginal bone level was determined by assessments on the proximal surfaces on the radiographs from 1970 and 1990. The marginal bone loss was defined as the difference in marginal bone level over 20 years. The subjects were interviewed about smoking habits. Stepwise multiple regression analyses were adopted to calculate the influence of the independent variables on longitudinal marginal bone loss and tooth loss. RESULTS: In 1970, 50.7% of the subjects were smokers, while the corresponding relative frequency in 1990 had decreased to 31.0%. Smoking was significantly correlated to an increased marginal bone loss over 20 years. Individuals who stopped smoking between 1970 and 1990 lost significantly less marginal bone during this period than those who declared that they smoked during the 20-year period. Smoking was not found to be significantly correlated to tooth loss over 20 years. CONCLUSIONS: The results support the hypothesis that smoking is a significant risk factor of periodontal disease.     

Radiographic quantification of alveolar bone level changes

The "random burst" theory has recently been proposed as an explanation of the pattern of periodontal disease progression. The theory predicts that the progression of bone loss at individual sites is not dependent upon previous bone loss and age. A longitudinal radiographic study was designed to test this hypothesis, and to describe the changes in bone level over 2 years in a group of 180 subjects (18-68 years of age) who were not under systematic periodontal treatment. The results indicated that 94% of the sites did not show significant changes in the alveolar bone level during the observation period. The mean annual bone loss for the total population was 0.11 mm. By regressing longitudinal bone loss upon age, it was shown that the rate of bone loss increased rapidly between 33 and 56 years of age while a different pattern was shown for the age intervals 18-32 and 57-68 years. Also, the rate of bone loss increased with increasing initial bone loss. This was less evident in the oldest age group. It was concluded that the progression of bone loss in the present material is consistent with a "burst" theory. However, the progression did not occur randomly with regard to previous loss of alveolar bone and time.     

Alveolar bone loss and crowding in adult periodontal patients

The present study aimed to examine whether local crowding and tooth angulation in the mandibular incisor region led to alveolar bone loss in patients with moderate periodontal disease. The sample comprised 27 patients from the Department of Periodontology aged 29-57 yr. Mesiodistal tooth angulation and crowding, defined as an overlap of 2 mm or more, were assessed from dental casts. Alveolar bone loss was assessed from intraoral standardized paralleling radiographs by two methods, the absolute bone level (ABL), recorded from the cementoenamel junction, and the relative bone level (RBL), a new measure, expressing the bone level relative to the two adjacent interradicular crests. Contralateral sites were used as controls. A significant difference in bone level was found between crowded and non-crowded sites by both methods (-1.7 mm, P less than 0.001). This indicates that in periodontal patients local crowding and tooth angulation predisposes to increased bone loss. Analysis of the correlations between tooth angulations and the two measures of bone loss indicated that the RBL value is a more sensitive measure of localized bone loss.     

Marginal bone loss over 5 years in an adult Danish population

PURPOSE: To evaluate marginal bone loss on the individual and tooth level, with focus on the importance of the baseline marginal bone level. MATERIALS AND METHODS: In 1997, 616 randomly selected individuals (mean age 42 years, range 21-63 years) underwent a full-mouth radiographic survey. In 2003, the survey was repeated for 473 of the same individuals (239 females and 234 males). The marginal bone level of each tooth was measured in mm from the cemento-enamel junction to the marginal bone. These measurements were used to calculate marginal bone loss during the 5-year period, and to analyse the average marginal bone loss for the individual, and tooth group in relation to age and to baseline marginal bone level, calculated as the average between measurements in 1997 and 2003 to circumvent regression to the mean. RESULTS: Marginal bone loss rate was on average 0.1 mm per year. For the individual, marginal bone loss was associated with both baseline marginal bone level and age. A significant difference was shown (p < 0.05) in marginal bone loss between different age groups, with a stronger association between marginal bone loss and baseline marginal bone level in the youngest age group. Moreover, marginal bone loss differed between tooth groups (p < 0.001), with molars and premolars losing marginal bone more rapidly than incisors and canines and showing a stronger association with baseline marginal bone level. CONCLUSIONS: Marginal bone loss over a 5-year period is associated with age and baseline marginal bone level. Younger individuals with a reduced marginal bone level were at high risk for further bone loss. Molars and premolars exhibit more rapid marginal bone loss than incisors and canines.     

Periodontitis progession in patients subjected to supportive maintenance care

The maintenance care following the initial active therapy phase plays an essential part in periodontal treatment to prevent disease progression and includes supportive periodontal therapy based on the patient's individual needs. The purpose of this study was to investigate the longitudinal proximal alveolar bone loss and tooth loss in periodontitis-prone patients during the active treatment and maintenance phase. In addition, the effect on disease progression of potential predictors was investigated. The investigation was conducted as a retrospective longitudinal study over a period of at least 10 years on a randomly selected population of patients referred for periodontal treatment in a specialist periodontal clinic. The mean number of teeth lost between baseline and the first re-evaluation was 2.4 and another 2.3 teeth were lost between the first and last re-evaluation. More than 50% of the periodontal pockets > or = 6 mm were reduced to < or = 5 mm at the re-evaluations. The mean longitudinal bone loss was 9% of the root length, corresponding to a mean annual marginal bone loss of about 0.09 mm. Smoking was significantly correlated to an increased longitudinal tooth loss, while the number of periodontal pockets > or = 6 mm at baseline was significantly correlated to an increased longitudinal bone loss. The magnitudes of marginal bone loss and tooth loss during a maintenance phase of 10-26 years were in accordance with the results from longitudinal studies performed on normal populations in Sweden.     

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

Abstract. 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 (≥ 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 ∼ 70% demonstrated very few or no sites with bone loss, and ∼ 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 <0.01), age ( P <0.0001) and initial bone loss ( P <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.     

Attachment loss with postmenopausal age and smoking

To determine whether postmenopausal bone loss and factors associated with osteoporosis affect tooth retention, we examined vertebral and proximal femoral (postcranial) bone mineral density in relation to tooth loss and attachment loss in a cross-sectional study of 135 postmenopausal women (age range 41–70 yr). Women had at least 10 teeth and no evidence of moderate or severe periodontal disease. Full-mouth attachment loss measurements were made using a pressure-sensitive probe, and bone density was determined by dual-energy X-ray absorptiometry. Attachment loss was correlated with tooth loss (number of remaining teeth, radiologically determined), but not with vertebral or proximal femur bone density. Multivariate analysis showed current smoking (p = 0.01), years since menopause (p = 0.02) and the interaction of age and current smoking (p < 0.01), to be statistically significant predictors of attachment loss in our study population.     

Predictors of tooth loss over 10 years in adult and elderly Chinese

Abstract This study describes the incidence of tooth loss over a 10–year period in a population of rural Chinese, initially aged between 20 and 80 years. Among the 587 persons who participated in a baseline examination in 1984, 440 persons were available for a follow-up study in 1994. A total of 31 persons, mainly aged 50+ years at baseline, had become completely edentulous. Between 45% and 96% of the persons lost at least one tooth, and the average number of teeth lost ranged between 1.0 and 7.2. The distribution of the number of teeth lost was skew, indicating that a minor group of subjects had a substantially higher risk of tooth loss than the majority. Logistic regression analysis identified six significant predictors of tooth loss among those who remained dentate: age, a high number of teeth with dentinal caries lesions, a high number of teeth with caries lesions of any type, presence of teeth with attachment loss 7 mm, presence of mobile teeth, and a low percentage of sites with subgingival calculus deposits. At the subject level, caries variables and periodontal disease variables seemed equally important predictors of the incidence of tooth loss over 10 years, but at the tooth level caries was a predominant cause of tooth loss in all age groups.     

Predictors of tooth loss in two US adult populations

OBJECTIVES: This study determines tooth loss rate over a 10-year period and identifies predictors of tooth loss in two separate US adult longitudinal study populations. METHODS: Subjects from the Baltimore Longitudinal Study of Aging (BLSA), consisting of 47 men and 47 women, ages ranging from 30 to 69 years, were compared to subjects from the VA Dental Longitudinal Study (VADLS) in Boston, MA, consisting of 481 men in the same age range. Baseline and follow-up examinations were performed on each cohort over a 10-year period. Using multivariate regression models, significant predictors of tooth loss were identified. RESULTS: A mean rate of tooth loss of 1.5 teeth lost per 10 years was noted in the VADLS cohort compared to 0.6 teeth lost per 10 years in the BLSA (P < .001). Combining subjects from both populations, significant predictors of tooth loss were baseline values of: percent of teeth with restorations, mean probing pocket depth score, age, tobacco use, alcohol consumption, number of teeth present, and male sex. However, the set of significant predictor variables differed between the two populations and sexes. In BLSA men, number of teeth present, percent of teeth with restorations, mean probing pocket depth score, and alcohol consumption, but not age, were significant, while in BLSA women, only age was a significant predictor. CONCLUSIONS: Over a 10-year period, the incidence of tooth loss, the rates of tooth loss, and the predictors of tooth loss were found to vary by population and by sex. These results illustrate the limits of generalizing tooth loss findings across different study cohorts and indicate that there may exist important differences in risk factors for tooth loss among US adult populations.     

The influence of endodontic infection on progression of marginal bone loss in periodontitis

Abstract The purpose of the present investigation was to determine magnitude and rate of proximal radiographic attachment loss in relation to endodontic infection in periodontally involved teeth. The investigation was conducted as a retrospective longitudinal study on a periodontitis-prone randomly selected referral population, including 175 single-rooted, root-filled teeth in 133 patients. An observation period of at least 3 years was required. Periapical conditions of the selected sample at baseline and re-examination were evaluated on radiographs, independently by 3 investigators. Each single-rooted, root-filled tooth of the sample was given a score according to the combined registrations. Radio-graphic attachment level was measured as the distance between the most coronal point of the alveolar bone and the apex at the mesial and distal sides of the tooth, and expressed as relative radiographic attachment level (RRAL) (radio-graphic attachment level at baseline/root length) at proximal sites for every tooth. Multiple regression analysis was used to study change in RRAL over time. Teeth in periodontitis-prone patients with progressing periapical pathology indicating a continuous root canal infection were found to lose comparatively more radiographic attachment than teeth with no signs of periapical pathology or teeth with an established periapical destruction which subsided during the observation period. An approximate 3-fold amplification of the rate of marginal proximal radiographic bone loss by endodontic infection in periodontitis-prone patients was found with an average 0.19 mm/year, while 0.06 mm/year was lost for teeth without endodontic infection or subsiding endodontic involvement.     

Frequency of alveolar bone loss adjacent to proximal caries in the primary molars and healing due to restoration of the teeth.

The frequency of alveolar bone loss adjacent to extensive proximal caries, and the effect of dental restorations on alveolar bone loss and healthy alveolar bone were examined in human primary molars. Proximal caries, contact loss, mesial drift and the presence of alveolar bone loss were recorded from 190 bite-wing radiographs from 60 boys and 46 girls. Proximal caries was evident in 297 quadrants. In 63.0% of quadrants, both primary molars had proximal caries. Contact loss was evident in 38.4% of the quadrants with proximal caries. Bone loss was found in 12.1% of the quadrants with proximal caries or 31.6% of those with contact loss. Analysis of variance for the presence of bone loss indicated statistically significant values (P less than 0.05) for one or two teeth with caries by quadrant, the presence or absence of contact loss, and age. A second examination was available for 41 children. Among these, eight out of the 36 bone defects disclosed at the first examination were present. At the second examination, after tooth restoration, healing of five bone defects was evident. These findings indicate a connection between the presence and treatment of extensive proximal caries and alveolar bone health in the primary dentition.     

Association between smoking different tobacco products and periodontal disease indexes

Six indexes of periodontal health were recorded in cigarette smokers, pipe/cigar smokers and nonsmokers from the Veterans Administration Dental Longitudinal Study. These indexes included calculus deposition, plaque accumulation, gingival inflammation, periodontal pocket depth, alveolar bone loss and tooth mobility. Cigarette smokers had significantly more calculus deposition than pipe/cigar smokers, although both smoker groups had more calculus than nonsmokers. Cigarette smokers accumulated slightly less plaque than pipe/cigar smokers, and both smoker groups accumulated less plaque than nonsmokers. Gingival inflammation and tooth mobility did not differ between smokers and nonsmokers, nor between the two smoker groups. Cigarette smokers had significantly greater pocket depth than nonsmokers, in contrast to pipe/cigar smokers who were not different from nonsmokers. Radiographic measurements indicated that cigarette smokers had significantly more alveolar bone loss than either pipe/cigar or nonsmokers. After covariance adjustment for age and calculus, all smokers had less plaque, gingival inflammation and tooth mobility than nonsmokers, similar periodontal pocket depth, but only cigarette smokers had greater bone loss. This finding of greater alveolar bone loss in cigarette smokers suggests a tobacco product-related effect in systemic physiologic action.     

Marginal bone loss in the primary dentition

Abstract. The present study was designed to determine the prevalence of bone loss in the primary dentition of children. Radiographs from children aged 7–9 were collected from 25 out of a total of 26 Public Dental Clinics in the County of Örebro, Sweden. These radiographs, representing 36.0%, 50.3% and 48.7% of all 7-, 8- and 9-year-old children ( n = 8666) living in the districts of the participating clinics, constituted a primary sample. In addition, the 9-year-olds were subjected to a more comprehensive sampling procedure to obtain a more complete sample (sample of 9-year-olds), resulting in a group of 2017 children (71.9%). The radiographs were evaluated with respect to presence of marginal bone loss (CEJ-MBL: distance between the cemento-enamel junction and the marginal bone level >2 mm), proximal calculus and number of decayed and filled proximal surfaces (dfs_p) in the posterior areas of the primary dentition. In the primary sample, the prevalence of bone loss for 1 proximal surfaces of the primary dentition in the 7-, 8- and 9-year-old children was 2.0%, 3.1% and 4.5%, respectively. The corresponding figures for proximal calculus were 2.5%, 3.1% and 4.2%. Mean number of dfs_p amounted to 2.3, 2.5 and 3.0. The prevalences of bone loss and proximal calculus as well as the mean number of dfs_p in the sample of 9-year-olds corresponded to the findings for the 9-year-old children in the primary sample. The analyses of the sample of 9-year-olds showed that most of the children with bone loss had 1 affected surface only. The largest CEJ-MBL distance for each individual with bone loss ranged from 2.5 to 6.0 mm. Children with bone loss displayed calculus more often than children without bone loss. The children with bone loss also showed higher mean dfs_p compared to children without bone loss.     

Patterns of initial tooth displacements associated with various root lengths and alveolar bone heights

The present study was designed to investigate the nature of initial tooth displacements associated with varying root lengths and alveolar bone heights. A three-dimensional model of the upper central incisor was developed for the finite element analysis. Tooth displacements were determined at various levels of the tooth and the apicogingival levels of the center of resistance and centers of rotation were calculated. The results showed that moment-to-force values at the bracket level for translation of a tooth decreased with shorter root length and increased with lower alveolar bone height. In addition, apicogingival levels of the center of resistance shifted more gingivally to the cervix, or the alveolar crest with a shorter root. Alveolar bone loss also shifted the center of resistance toward the alveolar crest, whereas its position was more apical relative to the alveolar bone heights exhibited very slight changes in both cases. The centers of rotation from a single force varied substantially with a short root and alveolar bone loss. However, the relative distances of the centers of rotation from the alveolar crest in comparison with the alveolar bone heights were constant at 0.4 mm, with variations in the root length and alveolar bone height. Because this study showed that root length and alveolar bone height affect the patterns of initial tooth displacements both in the center of resistance and the centers of rotation and also in the amount of displacement, forces applied during orthodontic treatment should take into consideration the anatomic variations in the root length and alveolar bone height so as to produce optimal and desired tooth movement.     

Personality factors, demographic variables, and indexes of periodontal disease in normal, community-dwelIing males

The present study examined the interrelationships of personality traits and six periodontal health status measures in 550 adult males, aged 29 to 74, who are participants in an ongoing longitudinal study of oral health and aging. Personality characteristics were assessed using Cattell's Sixteen Personality Factor Questionnaire, and periodontal health status was evaluated through the measurement of the following variables: plaque accumulation, gingival inflammation, calculus deposition, periodontal pocket depth, alveolar bone loss, and tooth mobility. A series of multiple regression analyses indicated that the personality traits of anxiety and extroversion had minimal associations with these periodontal disease indexes. Intelligence was weakly associated (inversely) with periodontal disease status. The best predictors of periodontal status were age and education, but these demographic variables accounted for, at most, only 12% of the variance in disease status. Other factors, such as hormonal imbalance, nutritional status, and cigarette smoking habits need to be included in multivariate models to develop a better understanding of interrelationships among factors related to periodontal disease.     

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)     

Peri-implant bone alterations in relation to inter-unit distances. A 3-year retrospective study

Abstract: The aim of the present retrospective study was to evaluate longitudinal alterations in radiographic bone topography at proximal sites of three‐unit implant‐supported fixed partial prostheses during the first 3 years after bridge installation, in relation to vertical and horizontal inter‐unit distances. The subjects were partially dentate patients who had received implant‐supported fixed partial prostheses during the year 1995 at the Brånemark Clinic, Göteborg, Sweden. For inclusion in the study, the patient had to have a three‐unit bridge construction supported by three implants in the posterior area of the jaw. Twenty‐eight patients having 35 screw‐retained prostheses on Brånemark standard implants fulfilled the inclusion criteria. Radiographs obtained at bridge installation and at 1‐ and 3‐year follow‐ups were assessed for implant positions, contact point level, bone level at implants and adjacent tooth and mid‐proximal bone crest level. The data were analysed with respect to two proximal units: tooth/implant units (n=35) and implant/implant units (n=70). Multiple regression analyses were used to evaluate the influence of various factors on the peri‐implant and periodontal bone level changes during the 3 years of follow‐up. At the tooth/implant units, the mean bone loss over the 3 years was 0.5 mm at the implant and 0.4 mm at the tooth. Multiple regression analysis failed to identify significant explanatory factors for the peri‐implant/periodontal bone level changes at the tooth/implant units (R²=0.28). At the implant/implant units, the peri‐implant bone loss was 0.6–0.7 mm and was significantly influenced by the vertical inter‐implant distance (P<0.01), the difference in bone level at baseline between two neighbouring implants (P<0.001) and the bone level changes at the opposed implant surface (P<0.001) (R²=0.49). Furthermore, the magnitude of apical displacement of the inter‐implant bone crest level during the 3 years of follow‐up was negatively associated with the horizontal inter‐implant distance (P<0.05). The results of the study demonstrated that both vertical and horizontal differences in implant positions might influence bone alterations in the inter‐implant area during the first 3 years of loading, while the data failed to show corresponding relationships for the bone changes at the proximal area between the implant and the neighbouring tooth.     

Marginal bone loss in 16-year-old Swedish adolescents in 1975 and 1988

The study was designed to compare the prevalence of marginal bone loss in 2 cohorts of 16-year-old adolescents, born in 1959 and 1972, respectively. Bitewing radiographs from 400 adolescents in each group were evaluated and the presence of bone loss (distance between the cemento-enamel junction and the alveolar crest greater than 2 mm), calculus, restorations and proximal dental caries were recorded. The prevalence of bone loss was 3.5% in 1975 as well as in 1988. Bone loss was found most frequently at the mesial and distal surfaces of the first maxillary molar. The prevalence of calculus was 12% in 1975 and 7% in 1988. The mean DFS for proximal surfaces was 3.1 in 1975 and 0.8 in 1988. No statistically verified dependence was found between bone loss and calculus, or bone loss and proximal caries.     

Long-term effect of orthodontic treatment on crestal alveolar bone levels

It was the purpose of the present study to evaluate crestal alveolar bone levels in individuals (Study group, n = 104) who had completed orthodontic treatment at least 10 years previously and compare the findings with adults who had untreated malocclusions (Control group, n = 76). Crestal alveolar bone levels were determined on both bitewing and periapical radiographs by direct measurement from the cemento-enamel junction to the alveolar crest. Data from the individual tooth surface measurements were subjected to analyses of variance partitioned on group (Study vs Control), radiographic method, tooth type, dental arch and surface location. There was no significant difference between crestal alveolar bone levels between the study and control group. A Group/Tooth/Surface interaction occurred for the distal surface of molars. The alveolar crest level was significantly less in the orthodontically treated group. Examination of the numerical data suggested that the measured dimension was low relative to normal values, and this effect may have been related to tooth intrusion during orthodontic treatment. It was concluded that orthodontic treatment during adolescence had no detrimental long-term effect upon crestal alveolar bone levels.