A Long-Term Survey of Tooth Loss in 600 Treated Periodontal Patients
TL;DR: Patients in a private periodontal practice were reexamined an average of 22 years after their active treatment and the patterns of tooth loss were observed and tooth retention seemed more closely related to the case type than the surgery performed.
Abstract: 1. Six hundred patients in a private periodontal practice were reexamined an average of 22 years after their active treatment and the patterns of tooth loss were observed. 2. During the post-treatment period, 300 patients had lost no teeth from periodontal disease, 199 had lost one to three teeth, 76 had lost 4 to 9 teeth and 25 had lost 10 to 23 teeth. 3. Of 2,139 teeth that originally had been considered of questionable prognosis, 666 were lost. Of these, 394 were lost by one sixth of the patients and only 272 by the other five-sixths. 4. Of 1,464 teeth which originally had furcation involvements, 460 were lost, 240 of them by one-sixth of the patients who deteriorated most. 5. The mortality of teeth which were treated with periodontal surgery was compared with that of teeth which did not have surgery. Tooth retention seemed more closely related to the case type than the surgery performed. 6. In general, periodontal disease is bilaterally symmetrical and there is a predictable order of likelihood of tooth loss according to position in the arch.
Citations
More filters
TL;DR: The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis.
Abstract: Background Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. Methods Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. Results The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier. Conclusions The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.
1,366 citations
TL;DR: The present study reported on the 30-year outcome of preventive dental treatment in a group of carefully monitored subjects who on a regular basis were encouraged, but also enjoyed and recognized the benefit of, maintaining a high standard of oral hygiene.
Abstract: Background: The biofilm that forms and remains on tooth surfaces is the main etiological factor in caries and periodontal disease. Prevention of caries and periodontal disease must be based on means that counteract this bacterial plaque.
Objective: To monitor the incidence of tooth loss, caries and attachment loss during a 30-year period in a group of adults who maintained a carefully managed plaque control program. In addition, a comparison was made regarding the oral health status of individuals who, in 1972 and 2002, were 51–65 years old.
Material and Methods: In 1971 and 1972, more than 550 subjects were recruited. Three hundred and seventy-five subjects formed a test group and 180 a control group. After 6 years of monitoring, the control group was discontinued but the participants in the test group was maintained in the preventive program and was finally re-examined after 30 years. The following variables were studied at Baseline and after 3, 6, 15 and 30 years: plaque, caries, probing pocket depth, probing attachment level and CPITN. Each patient was given a detailed case presentation and education in self-diagnosis. Once every 2 months during the first 2 years, once every 3–12 months during years 3–30, the participants received, on an individual need basis, additional education in self-diagnosis and self-care focused on proper plaque control measures, including the use of toothbrushes and interdental cleaning devices (brush, dental tape, toothpick). The prophylactic sessions that were handled by a dental hygienist also included (i) plaque disclosure and (ii) professional mechanical tooth cleaning including the use of a fluoride-containing dentifrice/paste.
Results: Few teeth were lost during the 30 years of maintenance; 0.4–1.8 in different age cohorts. The main reason for tooth loss was root fracture; only 21 teeth were lost because of progressive periodontitis or caries. The mean number of new caries lesions was 1.2, 1.7 and 2.1 in the three groups. About 80% of the lesions were classified as recurrent caries. Most sites, buccal sites being the exception, exhibited no sign of attachment loss. Further, on approximal surfaces there was some gain of attachment between 1972 and 2002 in all age groups.
Conclusion: The present study reported on the 30-year outcome of preventive dental treatment in a group of carefully monitored subjects who on a regular basis were encouraged, but also enjoyed and recognized the benefit of, maintaining a high standard of oral hygiene. The incidence of caries and periodontal disease as well as tooth mortality in this subject sample was very small. Since all preventive and treatment efforts during the 30 years were delivered in one private dental office, caution must be exercised when comparisons are made with longitudinal studies that present oral disease data from randomly selected subject samples.
816 citations
Cites result from "A Long-Term Survey of Tooth Loss in..."
...This finding is in agreement with data from other longitudinal studies (e.g. Hirschfeld & Wasserman 1978, Hunt et al. 1985)....
[...]
538 citations
TL;DR: periodontal disease appears to be bilaterally symmetrical and tooth loss response emulated this pattern with greatest loss of maxillary second molars and least loss of mandibular cuspids.
Abstract: A population of 100 patients with periodontal disease who had been treated and maintained for 15 years or longer was studied for tooth loss. The patients averaged 43.8 years of age and consisted of 59 females and 41 males. Patients were examined and their dental records were reviewed. On the basis of response to therapy and tooth loss, the patients were classified as Well-Maintained (77), Downhill (15), or Extreme Downhill (8). At the completion of initial treatment, 2,627 teeth were present. Of this number, during the maintenance period, 259 teeth (9.8%) were lost due to periodontal disease, while 40 teeth (1.5%) were lost due to other causes. Evaluation was made as to patterns of tooth loss, loss of questionable teeth, loss of teeth with furcations, surgical vs. nonsurgical therapy, and presence of fixed or removable prostheses. Considerable variation occurred between response groups. Periodontal disease appears to be bilaterally symmetrical and tooth loss response emulated this pattern with greatest loss of maxillary second molars and least loss of mandibular cuspids.
524 citations
References
More filters
TL;DR: There is sufficient evidence that microorganisms play a primary role in the etiology of most forms of human periodontal disease, and the question is no longer whether organisms cause periodontals but rather are specific organisms responsible for specific disease forms.
Abstract: T H E R E IS A B U N D A N T evidence to implicate microorga nisms as the primary etiologic agents of various forms of periodontal disease (for reviews see 1 6 ) Particularly convincing were the demonstrations by Loe and co workers that removal of dental plaque by rigorous plaque control procedures 7 , 8 or antiseptic agents 9 , 1 0 could prevent or reverse clinical gingivitis in human volunteers More recently, Lindhe and Nyman 1 1 and Rosling et a l 1 2 demonstrated that progress of destruc tive periodontitis could be halted and partially reversed by surgical procedures when accompanied by twice monthly professional tooth cleaning These studies in dicated that suppression of the total microbiota could be effective in controlling both gingivitis and destruc tive periodontitis in humans What the studies did not and could not indicate is whether all or only segments of the microbiota were responsible for the observed clinical response The success of antibiotic therapy in controlling the acute phase of acute necrotizing ulcera tive gingivit is 1 3 1 7 indicates the etiologic role of micro organisms in this form of human periodontal disease Since only some of the species resident in bacterial plaque are sensitive to a given antibiotic, it is clear that only a finite segment of the microbiota is responsible for this disease It would seem that there is sufficient evidence that microorganisms play a primary role in the etiology of most forms of human periodontal disease The question is no longer whether organisms cause periodontal dis eases but rather are specific organisms responsible for specific disease forms?
625 citations
TL;DR: It is demonstrated that it is possible to treat periodontal disease successfully, even in advanced stages, in patients willing to maintain plaque-free dentition.
Abstract: The present clinical study was initiated in 1969 to test the hypothesis that microbial plaque is the cause of periodontal disease and that hence even advanced cases of periodontitis can be cured in patients willing to exercise optimal plaque control. The material consisted of 75 patients with severe destruction of the periodontal tissues. The patients were selected for the study because of their ability to maintain plaque-free dentition. Following an initial examination, a preliminary treatment plan was presented to the patients. This plan included detailed instructions in plaque control measures, scaling, root planning and emergency dental care, including endodontic therapy and extractions. Three to six months after the termination of the so-called presurgical treatment, surgical elimination of pathologically deepened pockets was performed. The patients were recalled every 3 to 6 months after the end of the treatment. At these reexaminations the following parameters were assessed: Plaque Index, Gingival Index, Pocket Depths, Marginal alveolar bone topography and height. The results demonstrate that it is possible to treat periodontal disease successfully, even in advanced stages, in patients willing to maintain plaque-free dentition.
484 citations
TL;DR: In this paper, the combined effect of subgingival scaling and controlled oral hygiene on the incidence of Gingivitis was investigated, and the results showed that the scaling and hygienic conditions were associated with a higher incidence of gingivitis.
Abstract: (1961). Combined Effect of Subgingival Scaling and Controlled Oral Hygiene on the Incidence of Gingivitis. Acta Odontologica Scandinavica: Vol. 19, No. 3-4, pp. 537-555.
240 citations
215 citations
TL;DR: Three methods for treatment of periodontal pockets (subgingival curettage, modified Widman flap surgery, and pocket elimination) were applied as a clinical trial to 82 patients, and the most favorable results regarding gain or maintenance of attachment levels and reduction of pocket depth were observed interproximally.
Abstract: Three methods for treatment of periodontal pockets (subgingival curettage, modified Widman flap surgery, and pocket elimination) were applied as a clinical trial to 82 patients. Follow up results over one to five years after the initial treatment are reported. The variations in attachment levels and pocket depth were analyzed statistically as related to methods of treatment and yearly time intervals following the initial treatment. The most favorable results regarding gain or maintenance of attachment levels and reduction of pocket depth were observed interproximally. Subgingival curettage provided the greatest gain in attachment level up to three years postoperatively, but after four to five years there was no significant difference in results following the three methods. The most significant loss of attachment and return of pocket depth occurred on the buccal aspects of the teeth, and the results were not significantly different for the three methods except at the first year of follow up when the attachment level was maintained best after curettage.
170 citations