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.     

Progression of Periodontitis and Tooth Loss Associated with Glycemic Control in Individuals Undergoing Periodontal Maintenance Therapy: A 5‐Year Follow‐Up Study

Background: Prospective studies that investigated the influence of glycemic control in the progression of periodontitis and tooth loss during periodontal maintenance therapy (PMT) programs have not previously been reported. The aim of the present study is to evaluate associations between glycemic control status and progression of periodontitis and tooth loss among individuals during PMT. Methods: A total of 92 individuals, all recruited from a prospective cohort with 238 participants undergoing PMT, participated in this study. Diabetes control was assessed according to percentage of glycated hemoglobin (HbA1c). Individuals were matched for sex and smoking and were divided into three groups: 23 individuals with diabetes and poor glycemic control (PGC), 23 individuals with diabetes and good glycemic control (GGC), and 46 controls with no diabetes (NDC). Full‐mouth periodontal examination, including bleeding on probing (BOP), probing depth (PD), and clinical attachment level, was performed at all PMT visits during a 5‐year interval. Results: Progression of periodontitis and tooth loss were significantly higher among PGC compared to GGC and NDC. The final logistic model in the final examination included: 1) for the progression of periodontitis, HbA1c ≥6.5% (odds ratio [OR] = 2.9), smoking (OR = 3.7), and BOP in >30% of sites (OR = 4.1); and 2) for tooth loss, HbA1c ≥6.5% (OR = 3.1), smoking (OR = 4.1), and PD 4 to 6 mm in ≤10% of sites (OR = 3.3). Conclusions: PGC individuals, especially smokers, presented with a higher progression of periodontitis and tooth loss compared to NDC and GGC individuals. This result highlights the influence of glycemic control in maintaining a good periodontal status.     

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.     

Incorporating Severity and Risk as Factors to the Fardal Cost‐Effectiveness Model to Create a Cost–Benefit Model for Periodontal Treatment

Background: A previously described economic model was based on average values for patients diagnosed with chronic periodontitis (CP). However, tooth loss varies among treated patients and factors for tooth loss include CP severity and risk. The model was refined to incorporate CP severity and risk to determine the cost of treating a specific level of CP severity and risk that is associated with the benefit of tooth preservation. Methods: A population that received and another that did not receive periodontal treatment were used to determine treatment costs and tooth loss. The number of teeth preserved was the difference of the number of teeth lost between the two populations. The cost of periodontal treatment was divided by the number of teeth preserved for combinations of CP severity and risk. Results: The cost of periodontal treatment divided by the number of teeth preserved ranged from (US) $1,405 to $4,895 for high or moderate risk combined with any severity of CP and was more than $8,639 for low risk combined with mild CP. The cost of a three‐unit bridge was $3,416, and the cost of a single‐tooth replacement was $4,787. Conclusion: Periodontal treatment could be justified on the sole basis of tooth preservation when CP risk is moderate or high regardless of disease severity.     

Long‐term tooth loss in periodontally compromised but treated patients according to the type of prosthodontic treatment. A retrospective study

If prosthodontic treatment is considered after periodontal therapy, the questions arise i) does prosthodontic treatment affect the treatment outcome of the dentition in general and ii) which type of prosthesis is related to best treatment outcome of abutment teeth? Our goal was to compare long‐term tooth loss after comprehensive periodontal therapy in patients with or without prosthodontic treatment. Ninety patients' charts with a total of 1937 teeth who had received comprehensive periodontal treatment 5–17 years ago by the same periodontist were retrospectively evaluated. Sixty‐five patients received fixed dental prostheses (FDP; n = 29) and/or removable partial dentures anchored with clips (RPDC; n = 25) or double crowns (RPDD; n = 25). Twenty‐five patients were also periodontally compromised but treated without prosthodontic treatment and served as a control group. A total of 317 teeth and 70 abutment teeth were lost during 9·7 ± 4·1 years of observation. Thereof, 273 teeth and 48 abutment teeth were lost due to periodontal reasons. Mean tooth loss amounted to 1·2 ± 1·5 (controls) and 4·4 ± 3·4 (partial dentures). Abutment tooth loss was 0·4 ± 1·1 (FDP), 1·0 ± 1·2 (RPDC) and 1·3 ± 1·0 (RPDD). Poisson regressions identified prosthodontic treatment, age, socio‐economic status, diabetes mellitus, mean initial bone loss and aggressive periodontitis as factors significantly contributing to tooth loss. Age, diabetes and non‐compliance contributed to abutment tooth loss. Not considering biomechanical factors, patients with prosthodontic reconstructions under long‐term supportive periodontal therapy were at higher risk for further tooth loss than patients without prostheses. Not only the type of partial denture but also the patient‐related risk factors were associated with abutment tooth loss.     

Long-term evaluation of endodontic and periodontal treatment

One hundred and ninety-five teeth in 35 patients with periodontitis who had received both endodontic and periodontal treatment were evaluated 9 years after endodontic treatment and 8 years after periodntal treatment. Some 91.4% of cases were well maintained and 8.6% showed a deterioration in their periodontal condition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal codition. Twelve of the 195 teeth with endodontic treatment were lost, eight for periodontal reasons, three as a result of fracture and one because of caries, and the periodontal condition of 10 teeth had worsened. An apical lesion formed on one tooth. The results indicate that the risk of endodontic failure in this group of 195 teeth is very low, and that there is little risk of tooth loss for periodontal reasons, provided that the patients receive suppportive periodontal treatment.     

Retrospective study of tooth loss in 92 treated periodontal patients

BACKGROUND/AIMS: In this retrospective study, the efficacy of periodontal therapy and maintenance in preventing tooth loss was evaluated. METHODS: The study included 92 patients with 2310 teeth diagnosed with chronic adult periodontitis and observed over a mean period of 6.7 years, with each patient receiving surgical therapy in two or more quadrants. The group was divided into two subgroups: those who complied with the recommended maintenance schedule and those whose compliance was erratic. Individual tooth prognosis was assigned according to radiographic parameters. RESULTS: At the completion of active periodontal therapy, 2184 teeth were present. During the maintenance period, 44 teeth were lost due to periodontal reasons. Tooth mortality revealed a mean annual adjusted tooth loss rate of 0.07/year. Molars were the teeth most frequently lost; canines the least. The number of teeth lost in the three prognostic categories was: one (0.07%) for teeth with good prognoses, 21 (3.63%) for questionable prognoses and 22 (11.34%) for hopeless prognoses. Patients complying erratically with supportive periodontal therapy were at a 5.6 times greater risk for tooth loss following active therapy than regularly compliant patients. Conclusions: The results demonstrated a low tooth mortality rate in periodontal patients following active treatment combined with a strict maintenance program.     

Periodontal profile classes predict periodontal disease progression and tooth loss

1 Background

Current periodontal disease taxonomies have limited utility for predicting disease progression and tooth loss; in fact, tooth loss itself can undermine precise person‐level periodontal disease classifications. To overcome this limitation, the current group recently introduced a novel patient stratification system using latent class analyses of clinical parameters, including patterns of missing teeth. This investigation sought to determine the clinical utility of the Periodontal Profile Classes and Tooth Profile Classes (PPC/TPC) taxonomy for risk assessment, specifically for predicting periodontal disease progression and incident tooth loss.

2 Methods

The analytic sample comprised 4,682 adult participants of two prospective cohort studies (Dental Atherosclerosis Risk in Communities Study and Piedmont Dental Study) with information on periodontal disease progression and incident tooth loss. The PPC/TPC taxonomy includes seven distinct PPCs (person‐level disease pattern and severity) and seven TPCs (tooth‐level disease). Logistic regression modeling was used to estimate relative risks (RR) and 95% confidence intervals (CI) for the association of these latent classes with disease progression and incident tooth loss, adjusting for examination center, race, sex, age, diabetes, and smoking. To obtain personalized outcome propensities, risk estimates associated with each participant's PPC and TPC were combined into person‐level composite risk scores (Index of Periodontal Risk [IPR]).

3 Results

Individuals in two PPCs (PPC‐G: Severe Disease and PPC‐D: Tooth Loss) had the highest tooth loss risk (RR = 3.6; 95% CI = 2.6 to 5.0 and RR = 3.8; 95% CI = 2.9 to 5.1, respectively). PPC‐G also had the highest risk for periodontitis progression (RR = 5.7; 95% CI = 2.2 to 14.7). Personalized IPR scores were positively associated with both periodontitis progression and tooth loss.

4 Conclusions

These findings, upon additional validation, suggest that the periodontal/tooth profile classes and the derived personalized propensity scores provide clinical periodontal definitions that reflect disease patterns in the population and offer a useful system for patient stratification that is predictive for disease progression and tooth loss.     

Supportive periodontal therapy for high‐ and low‐risk patients

Aim: The validity of the risk assessment in predicting tooth loss due to periodontitis or disease progression was explored. Methods: Systemic factors, smoking status, bleeding on probing (BoP) percentage, number of residual pockets (probing pocket depth ≥6 mm), tooth loss, and alveolar bone loss in relation to age were the variables of the risk assessment. Based on an improving or deteriorating risk assessment in 2005 compared with 1999, 89 patients were divided into either a high‐ or low‐risk group. Findings were compared with the 2008 outcome. Results: Using BoP ≤ 20% as the cut‐off, the relationship between BoP and interleukin‐1 genotype status was neither significant in 2005 nor in 2008. Neither the high‐ nor low‐risk group was predictive for tooth loss. Patients displayed similar proportions of probing pocket depths ≥6 mm in 2005 and in 2008. Linear stepwise regression analysis demonstrated that only the number of supportive periodontal therapy visits explained the number of teeth lost due to periodontitis (P < 0.01). Conclusions: The categorization of patients into high‐ and low‐risk groups, according to the periodontal risk assessment model applied within a supportive periodontal therapy period of 3 years, had limitations in predicting future tooth loss.     

Tooth loss and implant outcomes in patients refractory to treatment in a periodontal practice

Aim: The aim of this study was to investigate the factors associated with continued significant tooth loss due to periodontal reasons during maintenance following periodontal therapy in a specialist periodontal practice in Norway. Material and Methods: A case–control design was used. Refractory cases were patients who lost multiple teeth during a maintenance period of 13.4 (range 8–19) years following definitive periodontal treatment in a specialist practice. Controls were age‐ and gender‐matched maintenance patients from the same practice. Characteristics and treatment outcomes were assessed, and all teeth classified as being lost due to periodontal disease during follow‐up were identified. The use of implants in refractory cases and any complications relating to such a treatment were recorded. Results: Only 27 (2.2%) patients who received periodontal treatment between 1986 and 1998 in a specialist practice met the criteria for inclusion in the refractory to treatment group. Each refractory subject lost 10.4 (range 4–16) teeth, which represented 50% of the teeth present at baseline. The rate of tooth loss in the refractory group was 0.78 teeth per year, which was 35 times greater than that in the control group. Multivariate analysis indicated that being in the refractory group was predicted by heavy smoking (p=0.026), being stressed (p=0.016) or having a family history of periodontitis (p=0.002). Implants were placed in 14 of the refractory patients and nine (64%) of these lost at least one implant. In total, 17 (25%) of the implants placed in the refractory group were lost during the study period. Conclusions: A small number of periodontal maintenance patients are refractive to treatment and go on to experience significant tooth loss. These subjects also have a high level of implant complications and failure. Heavy smoking, stress and a family history of periodontal disease were identified as factors associated with a refractory outcome.     

New Attempts to Modify Periodontal Risk Assessment for Generalized Aggressive Periodontitis: A Retrospective Study

Background : Periodontal risk assessment (PRA) model was designed for risk evaluation of treated patients with periodontal disease. However, its use on generalized aggressive periodontitis (GAgP) had been scarcely reported. This study aims to investigate the association of original PRA/modified PRA (MPRA) and compliance of periodontal maintenance with long‐term treatment outcomes of Chinese patients with GAgP. Methods: Eighty‐eight patients from a GAgP cohort, who completed active periodontal treatment (APT) and accepted reevaluation 3 to 11 years (mean of 5.5 years) afterward, were enrolled. PRA was modified (three strategies involving replacement of bleeding on probing with bleeding index >2, counting sites with probing depth ≥6 mm and changing method of bone loss [BL] calculation) to classify patients into different risk groups based on data at the first recall after APT. PRA and three MPRA models were investigated regarding long‐term association with tooth loss (TL) and alteration of bone level (?BL). Results: Based on original PRA, 87 patients (98.8%) had a high‐risk profile. According to three MPRA models, annual TL per patient values were greater in high‐risk groups than in low‐to‐moderate risk groups (MPRA‐1, 0.20 ± 0.33 versus 0.04 ± 0.14; MPRA‐2, 0.18 ± 0.32 versus 0.05 ± 0.14; MPRA‐3, 0.17 ± 0.32 versus 0.05 ± 0.15; P <0.05). By MPRA‐1, irregular compliers with low‐to‐moderate risk profile had greater ?BL (0.027 ± 0.031, indicating bone increment) than those with high risk (?0.012 ± 0.064, tendency for BL). For regular compliers, no significant differences of annual TL or ?BL were found between risk groups. Conclusions: MPRA models could be used for evaluating the long‐term outcomes of Chinese patients with severe GAgP, especially irregular compliers. High‐risk patients of MPRAs exhibited more TL and less bone fill than low‐to‐moderate risk ones.     

Tooth loss in periodontal patients

OBJECTIVE: To compare tooth loss between patients who received surgical therapy for chronic periodontitis and those who received nonsurgical therapy alone. METHODS: A retrospective chart study was conducted at Dalhousie University. All patients who had periodontal treatment and were active cases for at least 10 years were included (n = 335). The sample consisted of 120 males (35.8%) and 215 females (64.2%). Ages ranged from 16 to 77 (mean = 46.1 +/- 12.0 years). All patients received nonsurgical therapy; 44.8% received periodontal surgery as well. Variables recorded were demographics, initial attachment loss, treatment type, recall frequency, patient compliance and history of extracted teeth. Independent t-tests or chi-squared tests were used to compare these for surgical and nonsurgical patients. ANOVA was used to test for interactions between initial attachment loss, age, gender, compliance and type of therapy a patient received as reasons for tooth loss. RESULTS: 521 teeth were lost in 69 patients (20.6% of sample). Of teeth lost, 61.8% were due to periodontal disease; 24.8% to caries; 13.2% to other reasons. Patients initially diagnosed with early attachment loss lost an average of 0.37 (+/- 1.33) teeth. Patients diagnosed with moderate attachment loss lost an average of 1.50 (+/- 2.54) teeth and those diagnosed with advanced attachment loss lost an average of 3.11 (+/- 3.01) teeth. Those who received surgical therapy lost more teeth (mean = 1.31 +/- 2.36) than those who received nonsurgical treatment (mean = 0.68 +/- 1.87; p = 0.001). However, initial attachment loss was the only factor that could predict tooth loss. The type of therapy (surgical or nonsurgical) was not statistically significant. CONCLUSIONS: Most periodontal patients (79.4%) who received treatment at this dental school clinic did not lose any teeth due to periodontal disease over at least 10 years. Although patients who had surgical therapy lost more teeth than those who had nonsurgical therapy alone, this was not an important predictor of tooth loss.     

Tooth loss in well-maintained patients with chronic periodontitis during long-term supportive therapy in Brazil

AIM: The objective of this retrospective study was to assess the reasons for tooth loss in a sample of patients who underwent periodontal therapy and supportive periodontal therapy (SPT) in a Brazilian private periodontal practice. MATERIAL AND METHODS: A sample of 120 subjects who had been treated and maintained for 10 years or longer was selected from patients attending a periodontal practice. All patients followed a similar treatment: basic procedures, re-evaluation and periodontal surgery where indicated. Reasons for tooth loss were categorized as periodontal, caries, endodontal, root fractures and extraction of retained or partially erupted third molars. RESULTS: Of the 2927 teeth present at the completion of active periodontal treatment, 53 (1.8%) were lost due to periodontal disease, 16 (0.5%) for root fracture, six (0.2%) to caries, five (0.2%) for endodontic reasons and 31 (1.0%) were lost to extraction of retained or partially erupted third molars. Logistic regression analysis was performed to investigate the association between five independent variables with tooth loss due to periodontitis. Only age (> 60 years) and smoking were statistically significant (p < 0.05). CONCLUSION: The findings of this survey were consistent with previous studies. Older subjects and smokers were more susceptible to periodontal tooth loss. In addition, patients with generalized chronic periodontitis were treated and maintained for long-term periods with low rates of tooth loss.     

Cigar, pipe, and cigarette smoking as risk factors for periodontal disease and tooth loss

BACKGROUND: Our purpose was to test the hypotheses that cigar and pipe smoking have significant associations with periodontal disease and cigar, pipe, and cigarette smoking is associated with tooth loss. We also investigated whether a history of smoking habits cessation may affect the risk of periodontal disease and tooth loss. METHODS: A group of 705 individuals (21 to 92 years-old) who were among volunteer participants in the ongoing Baltimore Longitudinal Study of Aging were examined clinically to assess their periodontal status and tooth loss. A structured interview was used to assess the participants' smoking behaviors with regard to cigarettes, cigar, and pipe smoking status. For a given tobacco product, current smokers were defined as individuals who at the time of examination continued to smoke daily. Former heavy smokers were defined as individuals who have smoked daily for 10 or more years and who had quit smoking. Non-smokers included individuals with a previous history of smoking for less than 10 years or no history of smoking. RESULTS: Cigarette and cigar/pipe smokers had a higher prevalence of moderate and severe periodontitis and higher prevalence and extent of attachment loss and gingival recession than non-smokers, suggesting poorer periodontal health in smokers. In addition, smokers had less gingival bleeding and higher number of missing teeth than non-smokers. Current cigarette smokers had the highest prevalence of moderate and severe periodontitis (25.7%) compared to former cigarette smokers (20.2%), and non-smokers (13.1%). The estimated prevalence of moderate and severe periodontitis in current or former cigar/pipe smokers was 17.6%. A similar pattern was seen for other periodontal measurements including the percentages of teeth with > or = 5 mm attachment loss and probing depth, > or = 3 mm gingival recession, and dental calculus. Current, former, and non- cigarette smokers had 5.1, 3.9, and 2.8 missing teeth, respectively. Cigar/pipe smokers had on average 4 missing teeth. Multiple regression analysis also showed that current tobacco smokers may have increased risks of having moderate and severe periodontitis than former smokers. However, smoking behaviors explained only small percentages (<5%) of the variances in the multivariate models. CONCLUSION: The results suggest that cigar and pipe smoking may have similar adverse effects on periodontal health and tooth loss as cigarette smoking. Smoking cessation efforts should be considered as a means of improving periodontal health and reducing tooth loss in heavy smokers of cigarettes, cigars, and pipes with periodontal disease.     

Risk factors for tooth loss in an adult population: a radiographic study

Aim: The aim of the present study was to estimate the incidence and identify risk factors for tooth loss during a 5‐year period in a randomly selected Danish population. Material and Methods: In 1997 and 2003, 473 randomly selected adults received a full‐mouth radiographic examination. The total number of teeth was 12,444. For each tooth, the following information was recorded from the radiographs: marginal bone level, filling, crown, root canal post, root filling, apicectomy, periapical status and caries lesion. Unconditional and conditional logistic regression analyses were used to identify risk factors for tooth loss. Results: During the study period, 107 teeth in 60 individuals were lost. On the individual level, reduced marginal bone level and apical periodontitis (AP) were highly associated with tooth loss. On the tooth level, a reduced marginal bone level, AP and apicectomy were strongly associated with tooth loss. Canines were not lost often, whereas tooth loss was more frequently observed in molars and premolars than in incisors. Conclusions: A reduced marginal bone level and AP were associated with tooth loss over time. Furthermore, there was a higher risk of tooth loss in the posterior regions than in the anterior region.     

上海市65~74岁老年人失牙状况流行病学调查和危险因素分析

目的 了解上海市65~74岁老年人失牙状况分布特征,并分析失牙相关危险因素及其与牙周状况的关系,为今后开展口腔卫生保健工作提供依据。方法 按照第4次全国口腔健康流行病学调查要求,采取随机抽样方法,于2015年对上海市776名65~74岁年龄段老年人进行问卷调查和口腔检查。所得数据采用SPSS 21.0软件包进行非参数检验,对危险因素进行单因素分析,并通过Logistic回归模型进行独立危险因素分析。结果 上海市65~74岁年龄组老年人平均失牙数为5.94,平均缺失磨牙数为2.59。有牙周袋的老年人占42.3%,附着丧失≥4 mm的检出率为83.0%。男性失牙数和缺失磨牙数显著高于女性（P<0.05）。吸烟是非功能牙列的危险因素,吸烟量≥6支/d时,无法维持功能牙列的危险度是不吸烟人群的1.881倍（95%CI为1.231~2.872,P<0.01）。受教育年限≤6年及从事重体力劳动也是牙缺失的重要危险因素。结论 性别、口腔卫生习惯、吸烟、受教育程度、职业等因素是影响上海市65~74岁年龄组老年人牙缺失状况的重要因素。     

Tooth loss after active periodontal therapy. 2: tooth-related factors

Objective: To assess tooth‐related factors contributing to tooth loss over a period of 10 years after completion of active periodontal therapy (APT). Material and Methods: All patients who had received APT by the same experienced periodontist, 10 years before beginning the research, were recruited until 100 patients were re‐examined. Examinations included, at the patient level: test for interleukin‐1 polymorphism, compliance to supportive periodontal therapy (SPT), mean plaque scores during SPT; at the tooth level: assessment of baseline bone loss (type, amount), tooth type, furcation status and abutment status. Logistic multilevel regression was performed for statistical analysis. Results: Hundred patients with 2301 teeth at the baseline (completion of APT) were retrospectively examined. One hundred fifty‐five teeth were lost over 10 years after APT. Logistic multilevel regression identified high plaque scores, irregular attendance of SPT and age as patient‐related factors significantly accounting for tooth loss. Tooth‐related factors significantly contributing to tooth loss were baseline bone loss, furcation involvement and use as an abutment tooth. However, in patients with regular SPT, 93% of teeth with 60–80% bone loss at the baseline, survived 10 years. Conclusion: The following tooth‐related risk factors for tooth loss were identified: baseline bone loss, furcation involvement, and use as an abutment tooth.     

Predicting tooth loss during a population-based study: role of attachment level in the presence of other dental conditions

BACKGROUND: Our objectives were to quantify: 1) the association between incident tooth loss and prior periodontal attachment level; and 2) the contribution to tooth loss made by non-periodontal conditions in increasingly periodontally involved teeth. METHODS: The Florida Dental Care Study was a prospective cohort study of persons who at baseline had at least 1 tooth and were 45 years or older. In-person interviews and clinical examinations were conducted at baseline, and at 24 and 48 months, with telephone interviews at 6-month intervals in between. A regression model was used to simultaneously quantify tooth-specific predictors of tooth loss, with person-level factors taken into account. RESULTS: Of the 687 persons who participated for a 48-month clinical examination, 36% lost 1 or more teeth during follow-up, and 5.0% of all teeth were lost. Attachment level up to 2 years before tooth loss was strongly predictive of incident tooth loss, with increases in risk for each millimeter in attachment loss. Certain other tooth-specific conditions (tooth mobility, bulk restoration fracture, decayed surfaces, filled surfaces, tooth type and arch location, root fragment) were strongly and independently associated with increased risk for tooth loss, while others were not (prosthetic crown coverage, cusp fracture, root surface defect). Propensity to choose extraction over other treatment alternatives, as reported by participants at baseline, was also strongly predictive of tooth loss. CONCLUSIONS: Increasingly severe attachment level was consistently associated with an increased risk for tooth loss in this sociodemographically diverse sample, with or without other tooth-specific conditions taken into account.     

Prospective study of complier individuals under periodontal maintenance therapy: analysis of clinical periodontal parameters, risk predictors and the progression of periodontitis

Aim: This prospective study aimed to evaluate the progression of periodontitis and the influence of risk variables among individuals attending a programme of periodontal maintenance treatment in an academic environment.
Material and Methods: A total of 150 individuals diagnosed with chronic moderate-advanced periodontitis, and who had finished active periodontal treatment, were incorporated into the periodontal maintenance therapy. Social, demographic and biological variables of interest from subjects were collected at quarterly recalls, over a 12-month period. The effect of variables of interest and confounding on the periodontal status and progression of periodontitis was tested by univariate and multivariate logistic analysis.
Results: A total of 130 subjects (86.7%) showed stable periodontal status, whereas 20 subjects (13.3%) presented periodontitis progression. Twenty-eight subjects (18.66%) presented tooth loss that resulted in a total of 47 lost teeth (1.38%). Diabetes was not found to be associated with periodontitis progression ( p =0.67). Smoking was significantly associated with a greater progression of periodontitis (OR=2.7, 95% CI 1.01–7.22).
Conclusions: Periodontal maintenance programmes in academic environment can stabilize the periodontal condition obtained after active periodontal therapy as well as control the action of risk variables for the progression of periodontitis.