Supportive Periodontal Treatment Research Articles

Cleansing efficacy of waist-shaped inter-dental brushes. A randomized-controlled crossover study.

ObjectiveTo compare the cleansing efficacy of waist‐shaped versus cylindric inter‐dental brushes in patients receiving supportive periodontal therapy.Materials and methodsAfter sample size estimation, 20 periodontal maintenance patients diagnosed with periodontitis stage 3 were recruited. Brushing efficacy of waist‐shaped and cylindric inter‐dental brushes was evaluated in a randomized‐controlled, examiner‐blinded, two‐period crossover study by assessment of the Turesky modification of Quigley‐Hein plaque index (T‐QHI) and the papillary bleeding index (PBI) at four sites per tooth.ResultsSeventeen probands with 1,474 tooth sites finished the study. At baseline, median of overall T‐QHI scores was 1.4 (interquartile range 1.38–1.92). After 1 month, T‐QHI for waist‐shaped inter‐dental brushes was 1.24 (1.03–1.52); in 15 individuals, T‐QHI 0 was the grade most often measured. T‐QHI for cylindric brushes was 1.71 (1.18–2.29; p = .042), with T‐QHI 0 being the grade most often measured only in seven individuals. The odds ratio for establishing plaque‐free inter‐dental sites with waist‐shaped relative to cylindric brushes was 1.8 [95% CI 1.6–1.9] (p < .001; logistic regression analysis). There were no statistically significant differences between PBI levels of waist‐shaped and cylindric brushes.ConclusionThis study has demonstrated the superiority in cleansing efficacy of waist‐shaped over cylindric inter‐dental brushes in individuals receiving supportive periodontal treatment.

Survival and maintenance efforts of adhesively attached extracted teeth in periodontitis patients

ObjectivesFor extracted teeth in periodontitis patients, adhesively attaching their crown to the adjacent teeth temporarily closes the otherwise resulting gap, allowing to postpone more comprehensive prosthetic treatment to a more appropriate time if required. This study assessed the survival and maintenance efforts of adhesively attached extracted tooth crowns (‘immediate pontics’; IPs). MethodsPatients receiving active and supportive periodontal treatment involving IPs in a university setting were retrospectively assessed. Survival and repairs of IPs were recorded. Multilevel Cox and linear regression analyses were performed to assess factors associated with survival and maintenance efforts. ResultsTwenty-seven patients (male/female: 12/15) with 34 IPs (maxilla/mandible: 13/21) were followed over mean ± SD 8.0 ± 5.0 [range: 2.0–19.3] years. At baseline 85.2% suffered from periodontitis stage II or III and 59.3% showed rapid progression (grade C). The mean (95% CI) survival time of splinting was 5.3 ± 3.8 [range: 0.1–18.0] years. Three IPs had been removed without any significant association with patient- or tooth-level factors. 35.3% of the IPs (n = 12) required a repair, with a mean of 0.5 ± 0.9 [0–3] repairs per IP (annual: 0.1 ± 0.2 [0–0.5]). The risk of repairs significantly increased with patients’ age (p = 0.018). ConclusionIPs showed moderate survival. However, to maintain IPs, frequent repairs were needed. Clinical significanceImmediately and adhesively attached crowns of extracted teeth in periodontitis patients seems like a valid, albeit temporary strategy which may allow to postpone more comprehensive prosthetic treatment if required, for example during active periodontal therapy. However, to maintain immediate pontics, frequent repairs were needed.

Adherence to supportive periodontal treatment.

Like any other chronic disease, periodontal disease can be treated, but not eradicated. Personal maintenance of periodontal health requires the continuous elimination of bacterial accumulation at the gingival level, which demands periodical professional assistance. Of upmost importance is the patient being able to actively follow the counsel of the care providers. Thus, patient compliance, adherence, and persistence are paramount for the long-term success of periodontal therapy. Unfortunately, in medicine as well as in dentistry, most studies show that, sooner rather than later, an unacceptable percentage of patients quit maintenance care. However, different studies have shown that there are behavioral techniques which may significantly improve the degree of motivation, compliance and persistence of patients with oral hygiene and supportive periodontal treatment. The right interval between maintenance visits has not been determined yet, but should be implemented according to patient needs, which do not necessarily coincide with the standard three-month interval historically accepted as adequate. Adherence to periodontal maintenance results in reduction of plaque and bleeding on probing, and potentially slowing down or halting the disease progression. Finally, based on numerous retrospective studies, patient compliance could be considered a disease-modifying factor positively affecting tooth survival. However, a lack of randomized clinical trials means this last statement is still open to question.

Evaluation of prognosis related to compliance with supportive periodontal treatment in patients with chronic periodontitis: a clinical retrospective study.

PurposeThe purpose of this study was to evaluate the prognostic effect of patient compliance with supportive periodontal treatment (PC-SPT). Chronic periodontitis patients were classified based on their compliance level, and factors affecting PC-SPT and the prognosis of PC-SPT were investigated.MethodsThis study selected 206 patients who started SPT after receiving periodontal treatment between 2010 and 2012. Patients who continued SPT through February 2016 were included. The patients were classified according to whether they exhibited complete compliance (100% of visits), excellent compliance (≥70% of visits), incomplete compliance (<70% of visits), or non-compliance (only 2 visits). Patient characteristics that could affect PC-SPT, such as age, sex, distance of the clinic from their residence, implantation, and periodontal treatment, were investigated. The number of newly decayed and extracted teeth, alveolar bone level changes around the teeth and implants, and implant removal were examined to evaluate the prognosis of PC-SPT.ResultsSex and the presence of an implant significantly affected PC-SPT. Additionally, the number of newly decayed and extracted teeth and changes in alveolar bone levels around the teeth and implants were significant prognostic factors related to PC-SPT.ConclusionsPC-SPT in chronic periodontitis patients will help maintain periodontal health and prevent further periodontal disease.

Periodontal regenerative therapy in endo-periodontal lesions: a retrospective study over 5 years.

PurposeThe aim of this study was to evaluate clinical and radiographic changes and the survival rate after periodontal surgery using deproteinized bovine bone mineral (DBBM) with 10% collagen or DBBM with a collagen membrane in endo-periodontal lesions.MethodsA total of 52 cases (41 patients) with at least 5 years of follow-up were included in this study. After scaling and root planing with or without endodontic treatment, periodontal regenerative procedures with DBBM with 10% collagen alone or DBBM with a collagen membrane were performed, yielding the DBBM + 10% collagen and DBBM + collagen membrane groups, respectively. Changes in clinical parameters including the plaque index, bleeding on probing, probing pocket depth, gingival recession, relative clinical attachment level, mobility, and radiographic bone gains were evaluated immediately before periodontal surgical procedures and at a 12-month follow-up.ResultsAt the 12-month follow-up after regenerative procedures, improvements in clinical parameters and radiographic bone gains were observed in both treatment groups. The DBBM + 10% collagen group showed greater probing pocket depth reduction (4.52±1.06 mm) than the DBBM + collagen membrane group (4.04±0.82 mm). However, there were no significant differences between the groups. Additionally, the radiographic bone gain in the DBBM + 10% collagen group (5.15±1.54 mm) was comparable to that of the DBBM + collagen membrane group (5.35±1.84 mm). The 5-year survival rate of the teeth with endo-periodontal lesions after periodontal regenerative procedures was 92.31%.ConclusionsThis study showed that regenerative procedures using DBBM with 10% collagen alone improved the clinical attachment level and radiographic bone level in endo-periodontal lesions. Successful maintenance of the results after regenerative procedures in endo-periodontal lesions can be obtained by repeated oral hygiene education within strict supportive periodontal treatment.

Long-term survival and maintenance efforts of splinted teeth in periodontitis patients

ObjectivesThis study assessed the survival and maintenance needs of splinted teeth in periodontitis patients. MethodsPatients receiving active and supportive periodontal treatment involving teeth splinting in a university setting were retrospectively assessed. Tooth and splint survival and number of splint-repairs were recorded. Multilevel Cox and generalized-mixed linear regression analyses were performed. ResultsFifty-seven patients with 227 splinted teeth (maxilla/mandible: 148/79) were followed over mean ± SD 11.0 ± 7.2 [range: 2.0–32.4]) years. Twenty-six splinted teeth were extracted during this period, the mean (95% CI) time of splint retention was 7.3 ± 5.7 (0.1–22.7). Splinted teeth did not show significantly increased risk of tooth loss compared with non-splinted teeth (HR; 95% CI: 1.30; 0.87–1.93); while age (1.07; 1.05–1.09), PPD >6 mm (4.24; 1.26–14.31), bone loss (mean HR was 5.07–15.36 depending on severity), tooth location (posterior versus anterior teeth: HR 2.08; 1.24–3.49) and the number of occlusal contact areas (mean HR was 4.38–17.34 depending on the number of antagonistic contact areas) were associated with tooth loss. 75.3% splints required repair, with a mean of 2.6 ± 1.9 [1.0–8.0] repairs per splint during the mean observation time (0.4 ± 0.6 [0.0–3.5] repairs per splint/year). ConclusionSplinting did not significantly increase the risk of tooth loss; splinted teeth showed long-term survival. To maintain splints, frequent repairs were needed. Clinical significanceSplinted teeth were not at significantly higher risk of tooth loss than non-splinted teeth. While splinting does not improve the prognosis of periodontally affected teeth, it can assist their retention by reducing their mobility.

A two-piece dental implant comprising a replaceable thin titanium sleeve may be a new approach to re-osseointegration following peri-implant disease

Bacteria initiated peri-implantitis can lead to bone destruction around a dental implant, modifying its surface and preventing re-osseointegration. Consequently, all available methods for treating periimplantitis have disappointing long-term results. Implant failure will lead to loss of the prosthetic reconstruction as well. A fresh new implant surface enables re-osseointegration. Our hypothesis is that a fresh new surface replacing a contaminated implant surface may be a new treatment approach for peri-implantitis and may allow re-osseointegration. A new two-piece dental implant, having a replaceable thin titanium sleeve may be designed. The replacement of a contaminated sleeve by a fresh new sleeve will solve the peri-implant disease by removing the contaminated surface, enabling re-osseointegration and ensuring long-term stability of the implant without endangering the prosthetic reconstruction. This minimally-invasive therapy is expected to be conducted in a simple manner, by every practicing dentist, during supportive periodontal treatment, thereby facilitating the treatment of peri-implantitis.

Clinical performance of non-surgical periodontal therapy in a large Chinese population with generalized aggressive periodontitis.

This study aimed to evaluate clinical performance of non-surgical periodontal treatment (NSPT) and its influential factors in a large Chinese population with generalized aggressive periodontitis (GAgP). Longitudinal periodontal examination data of 1,004 GAgP patients (numbers of patients with observation periods 6weeks~, 3months~, 6months~, 1year~, 3years~ and >5years were 203, 310, 193, 205, 70 and 23, respectively) were extracted from a hospital-based electronic periodontal charting record system and analysed by multilevel analysis. Mean probing depth (PD) and attachment loss (AL) reductions at patient level were 1.17mm and 1.07mm, respectively. Multilevel analysis demonstrated PD reductions after maintenance were mainly influenced by frequency of supportive periodontal treatment (FSPT), gender, adjunctive systemic use of antibiotics, baseline mobility, tooth type and baseline PD and bleeding index reductions were mainly influenced by FSPT, adjunctive systemic use of antibiotics, baseline AL, baseline mobility, tooth type and baseline PD. The clinical performance of NSPT on patients with GAgP was proved in the large Chinese population. Outcomes of NSPT were mainly influenced by FSPT, adjunctive systemic use of antibiotics, baseline mobility, tooth type and baseline PD.

PR675: Comparison of clinical parameters between implants and control teeth during supportive periodontal treatment

PR675: Comparison of clinical parameters between implants and control teeth during supportive periodontal treatment

O086: Subjective evaluation of different piezo‐electric ultrasonic devices in supportive periodontal treatment by patients and dental hygiene students

O086: Subjective evaluation of different piezo‐electric ultrasonic devices in supportive periodontal treatment by patients and dental hygiene students

PD059: Patient comfort during supportive periodontal treatment of implants using air polish devices ‐ a clinical study

PD059: Patient comfort during supportive periodontal treatment of implants using air polish devices ‐ a clinical study

Validation of multivariable models for predicting tooth loss in periodontitis patients.

A large number of multivariable models which associate independent variables with the outcome tooth loss exist. Directly or indirectly, these make predictions as to the relative risk of tooth loss. We aimed to validate six of these prediction models. We applied each model, if needed after adaptions, in a cohort of 301 compliant periodontitis patients who had been under supportive periodontal treatment (SPT) in a university setting over 21.7±5.6years. The models employed a range of tooth-level and patient-level parameters. Model accuracy, that is, the ability to rightly predict tooth loss during SPT using baseline parameters, was investigated by the area under the receiver-operating-characteristics curve (AUC). Most models showed low accuracy (AUC ranged between 0.52 and 0.67). The classification model from Avila etal. (2009) Journal of Periodontology, 80, 476-491, expressing the risk of tooth loss in five grades, was most accurate (mean AUC: 0.67, 95%CI: 0.65/0.69). When applying this model, the risk of false-positively predicting tooth loss was high, except when the highest grade (i.e. a tooth being considered as having a hopeless prognosis) was used. In this case, the specificity was 84% and the sensitivity 46%. Predicting tooth loss in this specific cohort of periodontitis patients was only limitedly possible.

Non-Surgical Periodontal Therapy Impact on Progression of Chronic Periodontitis and Prevention of Further Tooth Loss

Objective: Prevention of tooth loss and maintaining favorable periodontal status are the ultimate goals of periodontal therapy. The aim of this study was to evaluate the effectiveness of non-surgical periodontal therapy and supportive periodontal care in arresting the progression of chronic periodontitis and in preventing tooth loss. Materials and methods: Periodontal charts, self-reported medical history, and two interleukin-1 (IL-1) polymorphism genotypes of 100 patients were obtained from the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository after screening 4,825 subjects. We used tooth loss (TL) and clinical attachment loss (CAL) as outcomes of disease affection in our analysis. In our study, we have included third molars, teeth lost during active periodontal treatment (APT), and those lost during the supportive periodontal program. All subjects had at least 12 months of follow-up. Fisher’s exact test was used to investigate the association between tooth loss and different risk factors. Paired t-test was conducted to detect the difference in means of CAL at baseline and at final assessment. Results: There were 59 patients (36 males and 23 females with an average age of 52 years) that lost at least one tooth during supportive periodontal care. Tooth mortality rate declined by more than half in patients who enrolled in a supportive periodontal program for six years compared to those who dropped out after one year (0.52 vs. 3.4 teeth/patient/year, respectively). Increased risk of tooth loss was found to be associated with diabetes (p=0.01), as well as high blood pressure (p<0.0001). We did not find an association between tooth loss and polymorphisms in interleukin IL-1α/IL-1β (rs1800587, p=0.36 and rs1143634, p=0.51, respectively). During the first and the second year of supportive periodontal treatment, the clinical attachment loss decreased by 0.36 mm and 0.34 mm, respectively (p=0.025 and p=0.0697), when compared to baseline measurements. Moreover, a slight increase in CAL was found in the group of patients who attended regular periodontal maintenance program for six years (p=0.037, difference of 0.38 mm in comparison to the baseline measurement). Conclusion: Our findings suggested that supportive periodontal therapy is effective for the long-term preservation of teeth and the stability of periodontal tissue in patients with advanced chronic periodontitis.

Compliance with Supportive Periodontal Treatment in Patients with Dental Implants.

The need for dental implants is increasing, and supportive periodontal treatment can achieve long-term success and prevent peri-implantitis. Contributing factors to noncompliance with long-term scheduled supportive periodontal treatment remain unclear. To investigate whether demographic and clinical characteristics are associated with noncompliance, the authors analyzed data for patients who had received dental implants. The authors recruited patients participating in a supportive periodontal treatment program after receiving permanent prostheses on implants placed from 2005 to 2013. Demographic data and dental treatment histories were collected. Compliance was defined as a record of participation in a standard supportive periodontal treatment program for at least 1 year. The chi-square test, log-rank test, Kaplan-Meier survival curve, and Cox proportional hazards model were used for statistical analysis. The study included 120 patients (259 implants, 60% compliance). The two groups (compliant and noncompliant) differed significantly in frequency distributions for sex (P = .0017), educational level (P = .0325), and histories of substance use (P = .0016), periodontitis (P = .0005), and root planing or flap surgery (P = .0002). The Kaplan-Meier survival curves and log-rank test showed that increases in cumulative continuation rates were significantly associated with male sex (P = .0025); body mass index ≥ 24 kg/m² (P = .0093); and a history of periodontitis (P < .0001), root planing or flap surgery (P < .0001), and substance use (P = .0026). Multivariate Cox proportional hazards model for supportive periodontal treatment noncompliance showed significantly higher compliance in patients who had received root planing or flap surgery (hazard ratio = 0.26, 95% confidence interval = 0.12 to 0.53, P = .0002). These results suggest that in patients who received a permanent prosthesis on implant placement, root planing or flap surgery was the crucial factor in determining compliance with supportive periodontal treatment. However, well-designed large-scale studies with a larger sample size are needed to confirm the findings of this study.

Supportive periodontal treatment: Pocket depth changes and tooth loss.

The purpose of this retrospective study was to determine the results of 10years of supportive periodontal treatment(SPT) following active periodontal therapy(APT). Probing pocket depth(PPD), bleeding on probing(BOP), tooth loss(TL)and the effects of two patient-related factors, smoking and gender were evaluated. This retrospective study examined patients who underwent APT and SPT for adult periodontitis. Analyses were conducted using site-, tooth- and patient-level information. Mean values were calculated, and parametric and nonparametric analyses were conducted as appropriate to assess the results of APT and SPT. There was a significant improvement in BOP and PPD after APT. After 10years, 9.3% of the patients adhered to the SPT protocol. The improvement in BOP and PPD was maintained, with no additional improvement in the clinical parameters at the 10-year follow-up. Furthermore, differences between non-smokers and smokers were found. After the 10-year follow-up, smokers had a significantly higher percentage of sites with a PPD of 4mm or higher; the mean PPD was also significantly higher in smokers. A significant difference was also found between males and females during SPT for the percentage of sites with BOP and the percentage of sites with a PPD≥6mm. A minority of patients(18.5%) did not lose teeth, and it was found that molars are the teeth most likely to be lost. The mean number of teeth lost was 2.6 during 10-year follow-up. This study indicates that with regard to bleeding on probing and probing pocket depth, patients receiving supportive periodontal treatment maintain their periodontal condition. However, in this group of adherent maintenance patients, tooth loss was most prevalent for molar teeth.

Long-Term Stability After Regenerative Treatment of Infrabony Defects: A Retrospective Case Series.

This study aims to evaluate long-term stability of attachment achieved in infrabony defects (IBDs) by regenerative treatment. All patients who had received regenerative treatment for at least one IBD between 2004 and 2010 were screened for this retrospective case series. If complete examinations (plaque/gingival index, probing depth [PD], vertical clinical attachment level [CAL-V]) were available for patients at baseline and 12 months after surgery, they were invited for reexamination 60 ± 12 months after surgery. Reexamination involved testing for interleukin (IL)-1 polymorphism and counting number of supportive periodontal treatment (SPT) visits. Forty-one patients (24 males and 17 females; age, median: 62.0 years, lower/upper quartile: 49.8/68.3 years; six smokers, and 9 IL-1 positive) were included for analysis, each contributing one IBD. Regenerative therapy resulted in significant attachment gain after 1 (median: -3 mm, lower/upper quartile: -1.5/-4 mm; P <0.001) and 5 (median: -3 mm, lower/upper quartile: -1.9/4.5 mm; P <0.001) years. The study failed to detect median change of CAL-V from 1 to 5 years after surgery (median: 0 mm; lower/upper quartile: -1/1.5 mm; P = 0.84). Multiple regression analysis identified that number of SPT visits is correlated with CAL-V gain from 1 to 5 years after surgery. IL-1 polymorphism and percentage of sites with PD >6 mm at 5-year reexamination are correlated with CAL-V loss from 1 to 5 years after surgery. CAL-V achieved by regenerative therapy in IBDs may have retained stability over 5 years. Frequent SPT is associated with stability. IL-1 polymorphism and generalized reinfection are associated with less stability.

Langerhans Cell Histiocytosis Mimicking Aggressive Periodontitis. A Multidisciplinary Approach During an 8‐Year Follow‐Up Period

Introduction: Aggressive periodontitis (AgP), according to the diagnostic criteria set by the American Academy of Periodontology, is an infrequent periodontal disease. However, certain cases originally diagnosed as AgP due to young age and the involvement of first molars, when not responding to therapy, can diagnostically involve more severe systemic conditions such as the rare disorder Langerhans cell histiocytosis (LCH).Case Presentation: A 25‐year‐old white male, with no known systemic diseases, was referred to the Postgraduate Clinic of the Department of Periodontology and Implant Biology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece. Clinical and radiographic examination and comparison with a previous evaluation revealed a rapidly progressive lesion involving the molar region in all quadrants, although the patient had been treated by a periodontist during the last 2 years. Molars were extracted and biopsies taken, which demonstrated morphologic and immunohistochemical characteristics leading to the diagnosis of LCH. The patient was referred to a hematology clinic, where he received a comprehensive examination and chemotherapy. The patient did not further comply with his proposed medical treatment and therefore 2 years later appeared with a progressing lesion in the molar area. He was re‐treated by further extractions and closure of a sinus perforation. He was persuaded to continue the treatment plan and received supportive periodontal treatment every 3 months. Regular medical and periodontal checkups show that his condition remains stable during the last 5 years.Conclusion: Periodontists should be aware of rare systemic conditions mimicking AgP and immediately refer the patient accordingly.

Cost-effectiveness of regular versus irregular supportive periodontal therapy or tooth removal.

Regular SPT (supportive periodontal treatment) retains teeth longer than irregular SPT but this regimen is not necessarily cheaper; extraction and replacement of teeth was usually the most expensive.

Long-Term Results of Peri-implant Conditions in Periodontally Compromised Patients Following Lateral Bone Augmentation.

The aim of this retrospective study was to compare long-term (≥ 5 years) outcomes of implants placed in patients treated for chronic periodontitis versus those placed in periodontally healthy patients. In both groups, the implants were placed in alveolar ridges that were laterally augmented with autogenous bone block grafts using a split bone block technique. Two hundred ninety-two patients were screened in the course of supportive periodontal treatment examinations. Nonsmoking patients without any severe systemic diseases who had adhered to regular supportive periodontal treatment for a minimum of 5 years after undergoing autogenous lateral grafting (using the split bone block technique), implant placement, and prosthetic reconstructions were classified into two groups based on their presurgical status: periodontally healthy patients (PHP) and periodontally compromised patients (PCP). Clinical outcomes for 77 patients, 38 PHP and 39 PCP, were examined. All had been successfully treated for severe lateral atrophy and received a total of 241 endosseous implants between 2002 and 2008. At the final examination, mean bleeding on probing was 7.08% ± 7.27% in PHP and 14.49% ± 18.14% in PCP, a statistically significant difference. Significantly higher Plaque Index and more recession were associated with a narrow (< 2 mm) width of keratinized mucosa. Implants in alveolar ridges laterally augmented using a split bone block technique revealed similar clinical peri-implant conditions in both PHP and PCP. Using autogenous bone block grafts without biomaterials resulted in long-term peri-implant tissue stability.

Endodontic status and retention of molars in periodontally treated patients: results after 10 or more years of supportive periodontal therapy.

To assess the influence of endodontic status on retention of molars in patients under supportive periodontal treatment (SPT). A total of 136 subjects with 1015 molars at baseline were examined retrospectively, including 188 endodontically treated molars in 90 patients. Multilevel Cox regression analysis identified factors contributing to loss of molars. Root canal treatments contributed significantly to loss of molars during on average 13.2years of SPT (Hazard ratio: 2.98, 95% CI: 1.74-5.1, p<0.001). Endodontic treatment was more frequently present in first molars (p<0.001) and in the maxilla (p=0.01). In endodontically treated molars, degree III furcation involvement could be detected more often compared to molars without root canal treatment (p<0.001). Among the root canal-treated molars, several patient and tooth-related factors showed an impact on tooth retention, but only molars with a periapical index of 4 and 5 (labelled "diseased") were significantly more often lost. The retention of molars in periodontally compromised patients after periodontal treatment is influenced by periodontal as well as endodontal factors. On a long-term basis, it is feasible to retain these teeth via active periodontal treatment and SPT for more than 10years.