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Loss of molars in periodontally treated patients: a retrospective analysis five years or more after active periodontal treatment.

OBJECTIVES: Evaluation of tooth loss in molars and prognostic factors for molar survival. MATERIAL AND METHODS: Five hundred and five molars in 71 patients (mean age 46 years; 40 females) were evaluated. The following inclusion criteria were required: periodontal therapy of at least one molar, at least 5 years of supportive periodontal therapy, and baseline assessment of furcation involvement (FI). RESULTS: At baseline 200 of 505 molars exhibited no FI, 116 degree I, 122 degree II, and 67 degree III FI. Twenty-seven molars did not receive periodontal treatment; 127 molars were subjected to non-surgical therapy, and 227 to flap surgery. Tunnel preparation was performed on 14 molars, root resection on 20, regenerative therapy on 57 teeth, and 33 molars were extracted. During the average follow-up period of 107 months 38 molars were lost additionally. Molars with degree III FI had the highest mortality. A multi-level proportional hazard model revealed smoking, baseline bone loss, number of molars left, and degree III FI as risk factors influencing the retention time of molars. CONCLUSION: Overall periodontal therapy results in a good prognosis of molars. Degree III FI leads to a significant deterioration of prognosis. Beyond FI smoking, baseline bone loss, and number of molars left influence molar survival.

Adolescent↗

Orthodontic movement after periodontal regeneration of class II furcation: a pilot study in dogs.

PURPOSE: The effect of orthodontic movement on the periodontal tissues of maxillary second pre-molars, after regenerative treatment for class II furcations, was evaluated in four mongrel dogs. MATERIAL AND METHODS: Class II furcation lesions were created. After 75 days they were treated with bovine bone mineral matrix and guided tissue regeneration with absorbable membrane. After 2 months of daily plaque control, each of the dog's furcation pre-molars was randomly assigned to a test or control group. Orthodontic appliances were placed on both sides of the maxilla using third pre-molars and canines as anchorages. In the test group, bodily orthodontic movement of the second pre-molars was performed in the mesial direction for 3 months while control pre-molars remained unmoved. The dogs were sacrificed for histometric and histologic analyses. RESULTS: There were no statistically significant differences between the two groups in total bone and biomaterial areas or linear extension of periodontal regeneration on the radicular surfaces. In the test group, however, there was a tendency to a greater quantity of bone and a lesser quantity of biomaterial. CONCLUSION: The orthodontic movement was not pre-judicial to the results obtained with the regenerative periodontal treatment.

Animals↗

Prognostic factors in the treatment of generalized aggressive periodontitis: I. Clinical features and initial outcome.

AIMS: The aims of this study were to investigate prognostic factors for initial response to non-surgical periodontal treatment for generalized aggressive periodontitis. METHODS: Seventy-nine patients with generalized aggressive periodontitis were included in this prospective follow-up intervention study. Patients' clinical and demographic parameters were collected at baseline and 10 weeks following a standard course of treatment (four visits of non-surgical root surface debridement together with OHI as required). The relationship between clinical variables and treatment outcome were analysed at site-specific level by chi(2) analysis and for patient-specific variables by logistic regression. RESULTS: In general, there was a good response to the treatment provided. In deep sites the mean pocket depth reduction was 2.11+/-2.01 mm. Site-specific analysis showed that the presence of plaque had a small but significant predictive effect on outcome (odds ratio 1.4). Sites on teeth with grade II/III mobility showed a significantly reduced response to treatment. Twenty-five patients were classified as "non-responders". Current smoking was strongly associated with non-responding patients (odds ratio 3.8) in a logistic regression model; plaque, baseline bleeding and initial pocket depth were not significantly associated with treatment outcomes. CONCLUSIONS: Overall, the results emphasize the importance of smoking as a negative prognostic factor, and suggest that treatment outcomes may be determined by a wide range of different determinants requiring further study.

Adult↗

Restraint stress enhances alveolar bone loss in an experimental rat model.

BACKGROUND AND OBJECTIVE: The purpose of the present study was to examine the effects of restraint stress on periodontal breakdown resulting from Porphyromonas gingivalis-challenged periodontitis in rats. MATERIAL AND METHODS: To examine the influence of restraint stress on periodontal breakdown, rats were orally challenged with the periodontal pathogen P. gingivalis. Twenty male, specific pathogen-free (SPF) 3-wk-old, Sprague-Dawley rats were divided into four groups: group A (controls), group B (exposed to restraint stress for 12 h/d for 22 d), group C (orally challenged with P. gingivalis), and group D (exposed to restraint stress for 12 h/d for 22 d and orally challenged with P. gingivalis). After 22 d, all animals were killed. The distance from the alveolar bone crest to the cemento-enamel junction was determined, concentrations of adrenocorticotropic hormone were measured as stress markers, and atrophy of the thymus and spleen were assessed. In addition, the furcation area of the maxillary molars was examined histologically, while gingival cytokine gene expression was assessed by mRNA using reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: In the restrained group, all stress markers were elevated, and the thymus and spleen were atrophied. Combined restraint stress and oral challenge with P. gingivalis resulted in significantly higher bone loss, and osteoclasts were observed. RT-PCR analysis revealed low cytokine gene expression in the restrained groups. CONCLUSION: These results suggest that the presence of restraint stress significantly enhances the progression of P. gingivalis-challenged periodontitis in rats.

Alveolar Bone Loss↗

Periodontal disease and tooth loss.

Numerous epidemiological studies have shown that caries is the main reason for tooth loss. More recent epidemiological data seem to show an increasing trend of tooth loss due to periodontal reasons rather than caries. In considering the issue of periodontal disease and tooth loss the following observations were made. The presence of initial attachment loss, bone height and the habit of smoking significantly increase the risk of tooth mortality. There is a strong correlation between smoking, the severity of periodontal disease and tooth mortality. Cross-sectional population surveys of tooth loss reported lower anterior teeth to be the most frequently extracted due to periodontal reasons, followed by upper anteriors and upper second molars. However, in long term maintenance studies, molars were lost most frequently. Periodontal reasons for tooth loss were mainly mobility followed by furcation involvement. Periodontal surgery did not significantly enhance tooth retention in high risk groups. Ethnic differences observed were not significant and would need further investigations to address variables such as cultural differences, health habits, diet and socio-economic status. In conclusion, periodontal tooth mortality was found to be associated with the loss of periodontal attachment and risk groups with advanced periodontitis contributing to major tooth loss in a minority of the population.

Alveolar Bone Loss↗

Sealing effectiveness of materials used in furcation perforation in vitro.

OBJECTIVES: In this study the sealing ability of various materials used to repair furcation perforations was evaluated. DESIGN: Ninety human molars were endodontically treated and a perforation was made in the pulp chamber floor using a round bur. The teeth were inserted into a moistened flower sponge and perforation sites were sealed with one of the following materials: Mineral Trioxide Aggregate (ProRootM), Super-EBA, Vitremer, Hemarcol together with Super-EBA, Hemarcol together with Vitremer, Tricalcium phosphate together with AH26, Cavit W and amalgam. After eight months, the sealing effectiveness of the materials was evaluated in a double-blinded trial under a video-microscope by detecting the penetration of silver nitrate solution (50%w/w) in longitudinal tooth sections. RESULTS: Perforation sites filled with Hemarcol together with Vitremer or with MTA exhibited statistically less silver stain penetration while Cavit W or Tricalcium phosphate together with AH26 sealer failed to effectively seal the perforation sites. CONCLUSIONS: MTA alone or Vitremer in combination with a collagen sponge can be used effectively in the treatment of perforations in a furcation area.

Aluminum Compounds↗