Severe Periodontal Bone Loss Research Articles

Radiologic Evaluation of Oral Health Status in Patients Admitted to the Intensive Care Unit: A Multi-Institutional Retrospective Study.

Introduction: Surveys distributed among intensive care unit (ICU) nurses reveal a significant need for dental care, with many acknowledging poor oral hygiene management. Poor oral health in ICU patients is linked to systemic problems, including aspiration pneumonia, necessitating pre-intervention assessments for bacterial diseases and dental risks. This study aims to evaluate the oral health status of ICU patients across three institutions through retrospective analysis. Methods: This retrospective study assessed the oral health status of ICU patients, using computed tomography (CT) images from three institutions over ten years. Through CT images, the oral status was evaluated in terms of total and lost tooth count and the presence of oral lesions (periapical lesions, cysts and tumors, caries, tartar, moderate to severe periodontal bone loss, tooth fractures). Variables included gender, age, the duration of ICU stay, and types of ICU. Statistical analysis was performed using chi-square tests, independent-sample t-tests, and logistic regression analysis. Results: Of the 450 participants, 430 were analyzed, revealing a prevalence of oral lesions in 67.0% of subjects. The prevalence of oral lesions was higher in males (71.5%) than females (57.7%, p = 0.006), and higher in those aged 40 and above (72.1%) compared to those under the age of 40 (47.8%, p < 0.001). This study found significant differences in oral health status based on gender, age, and ICU type, with surgical ICU patients generally having better oral health. Risk factors for oral lesions included gender, age, and duration of ICU stay. Conclusions: Most ICU patients have at least one oral lesion, regardless of the reason for their ICU admission. In particular, male ICU patients aged 40 and above have a higher prevalence of oral lesions, necessitating careful oral health assessment and treatment.

Detection of Periodontal Bone Loss on Periapical Radiographs-A Diagnostic Study Using Different Convolutional Neural Networks.

Interest in machine learning models and convolutional neural networks (CNNs) for diagnostic purposes is steadily increasing in dentistry. Here, CNNs can potentially help in the classification of periodontal bone loss (PBL). In this study, the diagnostic performance of five CNNs in detecting PBL on periapical radiographs was analyzed. A set of anonymized periapical radiographs (N = 21,819) was evaluated by a group of trained and calibrated dentists and classified into radiographs without PBL or with mild, moderate, or severe PBL. Five CNNs were trained over five epochs. Statistically, diagnostic performance was analyzed using accuracy (ACC), sensitivity (SE), specificity (SP), and area under the receiver operating curve (AUC). Here, overall ACC ranged from 82.0% to 84.8%, SE 88.8-90.7%, SP 66.2-71.2%, and AUC 0.884-0.913, indicating similar diagnostic performance of the five CNNs. Furthermore, performance differences were evident in the individual sextant groups. Here, the highest values were found for the mandibular anterior teeth (ACC 94.9-96.0%) and the lowest values for the maxillary posterior teeth (78.0-80.7%). It can be concluded that automatic assessment of PBL seems to be possible, but that diagnostic accuracy varies depending on the location in the dentition. Future research is needed to improve performance for all tooth groups.

Chondrosarcoma of the Mandible: A Challenging Lesion

Chondrosarcomas of the maxillofacial region are rare and account for 1-3 of chondrosarcomas of the entire body with a predilection towards the anterior maxilla and a lower incidence in mandible. Clinical and radiographic findings are non-specific hence histopathological evaluation forms the basis for definitive diagnosis. This is a case of a 27-year-old female with a complaint of pain and swelling in her lower right back tooth region for one month. The swelling caused gross facial disfigurement with no secondary changes. Intraorally the growth involved both buccal and lingual sulci causing mobility of involved teeth. Radiographically severe periodontal bone loss was noted surrounding 47. Incisional biopsy was taken and sent for histopathological evaluation. The histopathological examination revealed lobular pattern of growth filled with sheets of round to polygonal cells showing pleomorphism and bizarre hyperchromatic nuclei along with a typical mitotic figures surrounded by densely packed spindle-shaped cells. In some areas chondroid matrix deposition with lacunae containing atypical chondrocytes was evident. Ki-67 IHC was done which showed 10 positivity. Hence the lesion was diagnosed as Grade I Chondrosarcoma. It must be differentiated from chondroblastic osteosarcoma as it bears close resemblance with it. The treatment is completely different for both entities. Chondrosarcoma is chemo-resistant and radioresistant whereas osteosarcoma is a highly chemosensitive tumor. Surgical resection is the treatment of choice in chondrosarcoma hence hemi-mandibulectomy was carried out in this case.

Evaluation of relationship between odontogenic infections and maxillary sinus changes: A Cone Beam Computed Tomography-based study

IntroductionOdontogenic infections affects the maxillary sinus mucosa. Cone Beam Computed Tomography (CBCT) is helpful in diagnosis of maxillary sinusitis of odontogenic origin. This cross-sectional study was planned with the aim to assess maxillary sinus changes associated with odontogenic infection by evaluating CBCT images. Material and methodsIn cross-sectional analytical study, total 213 patients (404 sinuses) were evaluated on CBCT after thorough clinical examination of the individuals and taking into consideration the history of rhino or allergic rhinitis. Based upon CBCT images and clinical examination, patients were divided into, study group (odontogenic infection) and control group (no associated odontogenic infection). Effect of the size of periapical lesion, spatial relationship of lesion to the sinus floor and periodontal bone loss on maxillary sinus changes were evaluated. ResultsMucosal changes found in 200 sinuses (49.5%), mucosal thickening being the most prevalent and more commonly associated with odontogenic infections (p = 0.004). A significantly increased risk of mucosal thickening was observed with severe periodontal bone loss (p = 0.008). Size and spatial relationship of lesion to the maxillary sinus had no impact on the prevalence of mucosal thickening (p = 0.6, p = 0.4 respectively). Periodontal bone loss was 2.2 more likely to be associated with mucosal thickening than periapical or combined lesion. ConclusionsMost prevalent sinus change was mucosal thickening. Periodontal bone loss was significantly associated with mucosal thickening. CBCT is an appropriate method for sinus evaluation.

Clinical and radiographic evaluation of non-incised papilla surgical approach (NIPSA) versus modified minimally invasive surgical technique (M-MIST) in treatment of intraosseous defects in patients with stage III periodontitis

Background: Minimally invasive surgical (MIS) procedure" in multiple and isolated intra-osseous defects maintained the entire interdental papilla with significant improvement in clinical and radiographic outcomes compared to traditional periodontal surgeries. Methods: Thirty-two intra-osseous defects in 15 patients were enrolled for this study and were randomly allocated to both groups i.e. (16 defects) per group. Patients in group I (test group) went for Non-Incised Papilla Surgical Approach (NIPSA), while, in group II (control group), patients received Modified Minimally Invasive Surgical Technique (M-MIST). All clinical and radiographic periodontal parameters were measured at baseline, six months and twelve months. Results: Patients in both groups showed significant improvements in clinical and radiographic outcomes after twelve months of follow-up including reductions in CAL, potential effect in post-surgical patients’ satisfaction and intra-osseous defect fill. Absence of significant difference regarding intergroup comparisons. The minimal surgical flap design plays a very important role in the success of the therapy, creating and maintaining a stable space for the clot. Conclusions: NIPSA is viewed as a promising minimally invasive technique even in hopeless teeth with severe periodontal bone loss, clinical attachment loss to the apex and minimal keratinized tissue.

Evaluation of health screening data for factors associated with peri-implant bone loss.

Systemic health has a profound effect on dental treatment. The aim of this study was to evaluate peri-implant bone loss and health screening data to discover factors that may influence peri-implant diseases. This study analyzed the panoramic X-rays of patients undergoing health screenings at the Health Promotion Center at Seoul St. Mary's Hospital in 2018, to investigate the relationship between laboratory test results and dental data. The patients' physical data, such as height, weight, blood pressure, hematological and urine analysis data, smoking habits, number of remaining teeth, alveolar bone level, number of implants, and degree of bone loss around the implant, were analyzed for correlations. Their associations with glycated hemoglobin, glucose, blood urea nitrogen (BUN), creatinine, and severity of periodontitis were evaluated using univariate and multivariate regression analysis. In total, 2,264 patients opted in for dental health examinations, of whom 752 (33.2%) had undergone dental implant treatment. These 752 patients had a total of 2,658 implants, and 129 (17.1%) had 1 or more implants with peri-implant bone loss of 2 mm or more. The number of these implants was 204 (7%). Body mass index and smoking were not correlated with peri-implant bone loss. Stepwise multivariate regression analysis revealed that the severity of periodontal bone loss (moderate bone loss: odds ratio [OR], 3.154; 95% confidence interval [CI], 1.175-8.475 and severe bone loss: OR, 7.751; 95% CI, 3.003-20) and BUN (OR, 1.082; 95% CI, 1.027-1.141) showed statistically significant predictive value. The severity of periodontitis showed greater predictive value than the biochemical parameters of blood glucose, renal function, and liver function. The results of this study showed that periodontal bone loss was a predictor of peri-implant bone loss, suggesting that periodontal disease should be controlled before dental treatment. Diligent maintenance care is recommended for patients with moderate to severe periodontal bone loss.

Smoking and periodontal disease severity, probing pocket depth and bleeding on probing

Background and Objective: The purpose of the present study was to investigate whether severity of disease process differed between smokers and nonsmokers and to study characteristic differences in pattern of periodontal disease in smokers in a group of known chronic periodontitis patients. Materials and Methods: The study included 150 individuals in an age range of 35–60 years wherein periodontal evaluation including probing pocket depth (PPD) and bleeding on probing (BOP) was performed using Williams's periodontal probe. For both the parameters (PPD and BOP), mean scores were calculated from different quadrants of the oral cavity while the results obtained were subjected to statistical analysis. Results: The mean percentage of sites that presented with BOP was higher for nonsmokers compared with smokers. Furthermore, smokers had more number of pockets and pockets with increased PPD. On analysis of buccal and lingual sides, also, it was observed that smokers had more number of sites with PPD of ≥5 mm than nonsmokers. Conclusion: From the results, it could be concluded that smoking is associated with more severe periodontal attachment and bone loss and deeper periodontal pockets.

Assessment of relationship between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography

Background/purposeMaxillary posterior teeth have close anatomical proximity to the maxillary sinus floor. The aim of this retrospective study was to evaluate the associations between maxillary sinus membrane thickening and the adjacent teeth health by cone-beam computed tomography (CBCT).Materials and methodsCBCT images were collected from 235 Taiwanese patients. The sinus mucosal thickening >2 mm is considered a pathologic sinus membrane. Demographic data such as sex, age, the thickness of sinus membrane, and the adjacent teeth health were recorded, graded, and analyzed.ResultsA total prevalence of maxillary sinus membrane thickening of 36.6% (86/235) was found in this study. The sinus membrane thickening was significantly associated with periodontal bone loss (p < 0.001) and periapical lesions (p < 0.001), respectively. A multivariate logistic regression model demonstrated that males had a significantly higher risk of sinus membrane thickening than females (OR: 2.08, 95% CI = 1.21–3.56). The patients in the age group ≥60 years showed a 4.35-fold increased risk of sinus membrane thickening compared with the patients in the age group ≤35 years (95% CI: 1.94–9.77). Severe periodontal bone loss was significantly associated with mucosal thickening with an OR of 4.78 as compared with normal to mild group (95% CI: 1.69–13.58). The patients having teeth with apical lesions had a 5.04 time OR for sinus membrane thickening than those having teeth without apical lesions (95% C.I.: 2.37–10.69).ConclusionThe prevalence of maxillary sinus membrane thickening was more frequently occurred in male and older people. Periodontal bone loss and periapical lesions were significantly associated with maxillary sinus membrane thickening.

A New Papilla Preservation Technique for Periodontal Regeneration of Severely Compromised Teeth

IntroductionPeriodontal regeneration of hopeless teeth represents a major concern for clinicians, especially when these teeth are associated with the esthetic zone.Case PresentationThe case presented describes a non‐incised papillae surgical approach (NIPSA) to improve regenerative parameters in hopeless teeth. After treatment of a mandibular right canine with severe periodontal bone loss, clinical attachment loss to the apex, minimal keratinized tissue, and Class III mobility, there were important clinical improvements with no marginal soft tissue shrinkage and minimal morbidity for the patient.ConclusionNIPSA represents a promising minimally invasive technique even in hopeless teeth, facilitating the treatment of deep intrabony defects associated with high risk of soft tissue collapse and post‐surgical soft tissue shrinkage.

Significance of maxillary sinus mucosal thickening in patients with periodontal disease

To characterise and measure the Schneiderian membranes of individuals with periodontal diseases in China and to analyse the factors impacting maxillary sinus mucosal thickness using cone-beam computed tomography (CBCT). A cohort of 221 patients with periodontal disease was subjected to cross-sectional CBCT examination. Various parameters, including age, sex, alveolar bone loss, furcation lesions and vertical infrabony pockets, were analysed as correlates of mucosal thickening (MT). Sinus mucosal thickness ≥ 2 mm qualified as MT. MT was detected in 103 (48.9%) patients, increasing in frequency as the degree of alveolar bone loss advanced (mild, 14.5%; moderate, 29.5%; severe, 87.9%). The association between MT and vertical infrabony pockets was statistically significant (P < 0.001). The likelihood of MT increased with moderate [odds ratio (OR) = 1.02] and severe (OR = 4.62) periodontal bone loss (P < 0.001), as well as with furcation lesions (OR = 2.76) and vertical infrabony pockets (OR = 13.58). Relative to the case in patients with periodontitis and normal mucosa, the probability of MT increased dramatically as alveolar bone loss worsened. Periodontal pathologies (i.e. furcation lesions and vertical infrabony pockets) were also more likely to coincide with MT.

Factorial analysis of variables influencing mechanical characteristics of a post used to restore a root filled premolar using the finite element stress analysis combined with the Taguchi method.

To identify the contributions of various mechanical factors related to cast posts in a root filled tooth by integration of finite element analysis and the Taguchi method. The investigated factors included post-length (Post-L), post-diameter (Post-D), ferrule height (Ferrule-H) and periodontal bone loss (Bone-H). Three-dimensional finite element models of a mandibular premolar were developed to simulate a root filled tooth. For each investigated factor, three levels and values were selected, and based on a Taguchi orthogonal array, nine models were established. An inclination load of 100N was applied on the buccal cusp tip, and the dentine peak von Mises stress was used as the evaluation index. Among the four investigated factors, Bone-H was the predominant mechanical factor, with a contribution of more than 97%. Among the other three controllable factors of post-design, Post-D was the primary contributing factor and was almost five times more substantial than the least contributing factor, Ferrule-H. Bone-H was the predominant factor influencing the stress of the dentine on a post-restored root filled tooth, followed by the Post-D, Post-L and Ferrule-H. For patients with severe periodontal bone loss, a large post-diameter is essential for endodontic post-restoration treatment.

Cone‐Beam Computed Tomographic Evidence of the Association Between Periodontal Bone Loss and Mucosal Thickening of the Maxillary Sinus

The aim of the present study is to determine the relationship between dental findings and mucosal abnormalities of the maxillary sinus among dental patients, using cone-beam computed tomography (CBCT). Two hundred fifty CBCT scans of dental patients were studied. Dental findings of the upper posterior teeth, including periodontal bone loss, periapical lesions, and root canal fillings, were assessed. The presence of mucosal thickening and mucosal cysts of the maxillary sinus was recorded. Logistic regression analysis was used to determine the influence of periodontal bone loss, periapical lesions, and root canal fillings on these sinus mucosal abnormalities. Mucosal thickening was present in 42% of patients and in 29.2% of sinuses studied. Mucosal cysts were observed in 16.4% of patients and in 10% of sinuses studied. Both abnormalities were present more frequently among males than females. Severe periodontal bone loss was significantly associated with mucosal thickening (odds ratio: 3.02, P <0.001), whereas periapical lesions and root canal fillings were not. There was no association between dental findings and mucosal cysts. Severe periodontal bone loss was significantly associated with mucosal thickening of the maxillary sinus. Sinuses with severe periodontal bone loss were three times more likely to have mucosal thickening. Mucosal cysts were not associated with any dental findings.

Periodontal Disease and Incidence of Hypertension in the Health Professionals Follow-Up Study

Recent studies suggest a possible association between periodontal disease and hypertension; however, prospective evidence is limited. The study population consisted of 31,543 participants of the Health Professionals' Follow-Up Study (HPFS) prospective cohort who were 40-75 years old at baseline, had no prior hypertension history and had complete baseline information on oral health. Information on periodontal disease, hypertension and potential confounders was updated biennially. We used Cox proportional hazards models to study the relation between periodontal disease at baseline, during follow-up, periodontal bone loss severity, baseline number of teeth, and tooth loss during follow-up, and the risk of developing hypertension. Multivariate models included age, calendar time, race, comprehensive smoking index (CSI), diabetes, alcohol consumption, family history of hypertension, dental profession, body mass index (BMI), physical activity, fruit and vegetable intake, multivitamin use, calcium, vitamin D and vitamin E intake. We identified 10,828 cases of incident hypertension over 20 years of follow-up. After adjusting for potential confounders, we did not observe significant associations between incident hypertension and periodontal disease at baseline (relative risk (RR) = 1.04; 95% confidence interval (CI): 0.98-1.10), periodontitis during follow-up (RR = 1.01; 95% CI: 0.96-1.05), tooth loss during follow-up (RR = 1.03; 95% CI: 0.98-1.09), or when comparing men with 0-10 teeth to men with ≥ 25 teeth at baseline (RR = 1.05; 95% CI: 0.91-1.21). Participants reporting severe periodontal bone loss had a RR for incident hypertension of 1.02 compared to those without bone loss (95% CI: 0.77-1.35). We did not observe an association between periodontal disease measures and incident hypertension in this cohort of middle-aged men.

Periodontal Diseases and Rheumatoid Arthritis: A Coincident Model for Therapeutic Intervention?

There are remarkable similarities in the pathogenesis of periodontal diseases and rheumatoid arthritis. The mechanisms that drive antigen induced sequelae of oxidative stress are discussed in this review. A poorly modulated inflammatory response drives both diseases resulting in oxidative stress induced tissue injury. Immune complex formation in response to the periodontal pathogen Porphyromonas gingivalis triggering the production of ROS in both gingivae and synovium of RA patients has been reported. Elevated antibody levels to several periodontal pathogens in RA patients has implications on both RA and periodontal diseases. Periodontal patients are challenged individuals representing a multifactorial aetiopathogenesis with potential for therapeutic intervention in the context of free radical damage. Subjects with moderate to severe periodontal bone loss are significantly more likely than healthy individuals to have several co-existing systemic conditions resulting in ROS mediated damage. There is potential for dual induction of periodontal disease by existing inflammatory mechanisms of systemic diseases rather than exacerbation of low grade inflammation only; emphasizing the relevance of reducing inflammatory burden for disease control. Therapeutic strategies based on disease mechanisms include combined low dose non-steroidal anti-inflammatory drugs and doxycycline for synergistic reduction of matrix metalloproteinase activity in periodontal tissues and RA; sub-optimal dosing with CMT-8 and a biphosphonate clodronate to reduce pathologically elevated levels of MMPs, elastase and to restore alveolar bone in experimental periodontits demonstrating dual applications. Therapeutic interventions relevant to both diseases discussed in this review, have scope for a double hit in periodontal patients with co-existing RA and vice versa.

Periodontal Conditions in Rheumatoid Arthritis: Clinical and Radiographic Investigations

Periodontal conditions in 100 dentate adults with rheumatoid arthritis (RA) were compared with those of age and gender matched individuals without rheumatoid arthritis. The clinical parameters for periodontitis included probing pocket depths, attachment loss, gingival inflammation scores, plaque scoresand radiographic bone loss scores. The rheumatoid arthritis group had more missing teeth than the control group and a higher percentage of them had deeper pocketing and loss of periodontal attachment There were no significant differences between the two groups for gingival inflammation and bleeding. There was a tendency to adverse periodontal conditions amongst the rheumatoid arthritis patients with severe periodontal bone loss occurring more frequently than in the controls. The rheumatoid arthritis patients had more dental plaque deposits than the control group, a finding which could indicate a difference in periodontal care. It is suggested that this study provides evidence of a significant association between periodontitis and rheumatoid arthritis.

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

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

Radiographic Measures of Chronic Periodontitis and Carotid Artery Plaque

Chronic periodontitis (CP) is associated with stroke and subclinical atherosclerosis, but clinical measurement of CP can be time consuming and invasive. The purpose of this study was to determine whether radiographically assessed CP is associated with nonstenotic carotid artery plaque as an ultrasound measure of subclinical atherosclerosis. Panoramic oral radiographs were obtained from 203 stroke-free subjects ages 54 to 94 during the baseline examination of the Oral Infections and Vascular Disease Epidemiology Study (INVEST). CP exposure among dentate subjects was defined either categorically (periodontal bone loss > or =50% [severe] versus <50% bone loss) or via tertile formation (for dose-response investigation), with edentulous subjects categorized separately. In all subjects, high-resolution B-mode carotid ultrasound was performed. Carotid plaque thickness (CPT) and prevalence (present/absent) were recorded. Covariates included age, sex, smoking, diabetes, hypertension, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein cholesterol. Among dentate subjects with severe periodontal bone loss, mean CPT was significantly greater (1.20+/-1.00 mm versus 0.73+/-0.89 mm; P=0.003). CPT increased with more severe bone loss (upper versus lower tertile bone loss; P=0.049; adjusted for age, sex, and hypertension). This apparent dose-response effect was more evident among never-smokers. In a fully adjusted multivariate logistic regression model, severe periodontal bone loss was associated with a nearly 4-fold increase in risk for the presence of carotid artery plaque (adjusted odds ratio, 3.64; CI, 1.37 to 9.65). Severe periodontal bone loss is associated independently with carotid atherosclerosis. Panoramic oral radiographs may thus provide an efficient means to assess CP in studies of atherosclerosis risk.

Risk of severe periodontal disease in a Swedish adult population. A longitudinal study.

The aim of this study was to identify risk factors for severe periodontal disease progression in a Swedish adult population between the years 1973 and 1988-91. In 1973, a random sample of 474 dentate adults living in Jönköping County was examined clinically and radiographically. A questionnaire on demographic and socio-economic status, general health, and dental care habits was also used. During the years 1988-1991, 361 of the individuals examined in 1973 were re-examined. A total of 506 (6%) teeth or in average 1.4 teeth per subject were lost between the 2 examinations. 4 subjects had become completely edentulous. The mean loss of teeth in the different age groups 20-60 years was 0.2, 0.9, 1.4, 2.3, and 2.6, respectively. The periodontal bone level decreased by age both in 1973 and in 1988 91. The mean annual progression rate was 0.06 mm for all 357 individuals and varied between 0.04 and 0.07 mm per subject in the different age groups. The presence of periodontal disease progression was defined as bone loss of >20% at a proximal site between the 2 examinations. The most prevalent tooth types with bone loss of >20% at proximal sites were the maxillary and mandibular 2nd molars and the 1st maxillary molar, representing a % of 18.0, 12.8, and 13.5, respectively. The degree of association between severe periodontal disease progression and explanatory variables was investigated using logistic regression models. The dependent variable was no progression of periodontal disease or severe periodontal disease progression, i.e., subjects with periodontal bone loss >20% at > or =6 sites. Age was found to be correlated with severe periodontal disease progression by an odds ratio of 1.05 (CI: 1.02-1.07). The frequency of females in the group with severe bone loss was 58% and higher than in the non-progressing group, 50%. Only 9% in the group with no bone loss smoked as compared to 38% in the group of individuals with severe periodontal bone loss. % supragingival plaque, gingival inflammation, and deepened periodontal pockets (> or =4 mm) at baseline were related to severe periodontal disease progression by odds ratios of 1.03 (CI: 1.02-1.05), 1.01 (1.00-1.03), and 1.03 (1.00-1.05), respectively. In the multivariate logistic regression model, age (odds ratio 1.13 (CI: 1.06-1.19)), smoking (odds ratio 20.25 (5.07-80.83)), and % pockets > or =4 mm (odds ratio 1.15 (1.04-1.27)) remained significantly associated with severe disease progression. Furthermore, female gender and differences in income level appeared in the multivariate analysis to be related with severe bone loss, with odds ratios of 3.19 (CI: 1.02-9.97) and 8.46 (CI: 1.97-36.37), respectively.

Risk of severe periodontal disease in a Swedish adult population. A cross-sectional study.

In this study, potential risk factors for severe periodontal disease were identified in a cross-sectional sample from the county of Jonkoping, Sweden. 547 adults 20-70 years of age were categorised clinically and radiographically by level of periodontal disease experience. These levels were used to divide the sample into groups--individuals without any reduction in periodontal bone level (60%) and those with severe periodontal bone loss (13%)--which were then used in univariate and multivariate logistic regression analyses as dependent variable. Demographic, socio-economic, general health, smoking habits, clinical, and dental care variables were used in the different regression analyses. In the univariate model, age (20-70 years) was found to be correlated with more severe periodontal disease experience (odds ratio: 1.13; 95% CI: 1.10-1.17). The association with periodontal disease was more pronounced for the older age groups (50, 60, and 70 years). A negative financial situation was also related to severe periodontal bone loss when regressed univariately (odds ratio 2.20 [95%: 1.04-4.68]). Moderate-heavy smoking (> or =10 cigarettes/day) appeared to be associated with severe periodontal destruction with an odds ratio of 9.78 (95% CI: 3.62-36.42). Of the clinical variables in the univariate model, higher mean levels of supragingival dental plaque and the presence of subgingival calculus were related to more severe periodontal disease with odds ratios of 1.02 (95%: 1.01-1.03) and 2.96 (95%: 1.50-5.88), respectively. When the same variables were regressed multivariately, age (continuous) (odds ratio 1.17 [95% CI: 1.12-1.22]), moderate-heavy smoking (odds ratio 11.84 [95% CI: 4.19-33.50]), and higher mean levels of plaque (odds ratio 1.02 [95% CI: 1.00-1.03]) remained significant. Light smoking (1-9 cigarettes/day) was not significantly associated with severe periodontal disease in the 2 regression models. The present study demonstrated that smoking, greater age, and higher mean levels of plaque are potential risk factors for severe periodontal disease in this specific population.

Treatment of interproximal angular defects by guided tissue regeneration: 1 year follow‐up

SUMMARY The periodontal regeneration of interproximal bone defects of the posterior teeth produced by guided tissue regeneration (GTR), with expanded Polytetrafluoroethylene barrier membranes and conventional therapy, was clinically evaluated in 20 intrabony periodontal defects in 10 patients. The material included the presence of at least two proximal angular lesions for the same patient, probing pocket depth ≥ 6 mm, bone defect depth ≥ 3 mm, and 2‐wall defects with crestal involvement relative to the tooth circumference ranging from 90 to 270°. Healing was clinically evaluated by surgical re‐entry of GTR‐treated sites (10 sites) and debridement only sites (10 sites) 1 year after initial surgery following a strict plaque control regimen. A significant correlation was observed between probing depth reduction, attachment gain and defect depth (test sites); there was increased bone fill in GTR‐treated lesions of 2.95 ± 1.3 mm corresponding to a 69.4% improvement compared to control sites, and 1–3 ± 1.0 mm corresponding to a 32% improvement (P &lt; 0.0039). The results demonstrated that bone regeneration is highly reliable, as compared to conventional therapy, in cases of severe periodontal bone loss from posterior teeth provided that the principles of GTR are applied.