Outcome after Partial Pulpotomy: Long-term Results of the Prospective Clinical MMP-9 Study.

PURPOSE: While the objective of partial pulpotomy is to preserve the vitality and function of the pulp tissue, the preopera-tive pulp status is the main prognostic factor for its success. To date, however, there is little data on long-term success rates. Therefore, the aim of this prospective pilot study was to assess the long-term outcome of partial pulpotomy in per-manent teeth after carious pulp exposure without signs or symptoms of irreversible pulpitis, verified clinically, radio-graphically, and via MMP-9 levels. MATERIALS AND METHODS: Patients in whom permanent teeth with extremely deep carious lesions were diagnosed as com-pletely asymptomatic (n = 8) or with signs of reversible pulpitis (n = 10) underwent non-selective caries removal followed by a blood test to assess the level of MMP-9. The teeth were thereafter partially pulpotomised, MTA-capped, and immedi-ately restored with composite resin. Follow-up examinations were performed by endodontically experienced examiners focusing on clinical and radiographic assessment. RESULTS: One patient could not be contacted and was lost to follow-up. Overall, the follow-up period ranged from 2-8 years (mean = 4.4 years). The majority of teeth remained functional and without pathology; one tooth was classified as having failed because of a vertical root fracture. There was no statistically significant difference in the groups' success rate (p = 0.3). The estimated overall survival rate was 94.1% (95% CI: 0.84-1.00) after 4 years according to the Kaplan-Meier method. CONCLUSION: Pulp vitality in permanent teeth can be preserved with high success rates by means of partial pulpotomy after carious pulp exposure in asymptomatic teeth or in teeth with reversible pulpitis.

Effect of endodontic treatment on periodontal healing of grade 3 endo-periodontal lesions without root damage in periodontally compromised patients-a retrospective pilot study.

OBJECTIVES: There is little evidence about the effect of different treatment protocols for grade 3 endo-periodontal lesions without root damage in patients with periodontitis according to the new classification of periodontal disease. The aim of this study is to evaluate the impact of endodontic treatment on the achievement of periodontal healing. MATERIALS AND METHODS: Teeth with the initial diagnosis endo-periodontal lesion without root damage grade 3, treated with a standardized endodontic treatment protocol, were included in this study. A retrospective analysis was performed to assess the impact on periodontal healing by evaluating probing pocket depth (PPD), clinical attachment gain (CAL), and periapical index score (PAI). RESULTS: Nineteen teeth and 13 patients were included. A mean reduction of 3.19 ± 3.41 mm in PPD was recorded. The mean CAL gain was 2.33± 3.75 mm. Five teeth (45.4%) showed an improvement of PAI and were classified as treatment success. CONCLUSIONS: The results failed to show a highly predictable treatment outcome for endo-periodontal lesion grade 3 without root damage in patients with periodontitis. However, endodontic therapy alone resulted in treatment success for some of the teeth, which would otherwise have had a poor prognosis. CLINICAL RELEVANCE: Endo-periodontal lesions can often be challenging for dentists in daily clinical practice. To date, there is not much evidence for practitioners to rely on. Therefore, this study aims to strengthen the evidence for the management and treatment of endo-periodontal lesions. Although the outcome is not highly predictable yet, teeth with the initial diagnosis endo-periodontal lesion without root damage grade 3 can benefit from an endodontic treatment.

Tooth-related factors for tooth loss 20 years after active periodontal therapy-A partially prospective study.

AIM: To assess factors contributing to tooth loss 20 years after active periodontal therapy (APT) on tooth level. MATERIALS AND METHODS: After an initial retrospective analysis 10 years after APT, patients were monitored for 10 more years. At clinical re-evaluation 20 years after APT, tooth-related factors (tooth type, location, bone loss, furcation involvement, abutment status) and patient-related factors (gender, smoking, adherence) were investigated. Descriptive statistical analysis and a mixed logistic regression analysis were performed with tooth loss as primary outcome variable. RESULTS: The study included 69 patients (42 female/27 male). 39 patients were non-adherent (56.5%), and 11 were active smokers (15.9%). A total of 198 out of 1611 teeth were lost. Tooth loss was significantly highest (p < .01) in molars (21.1%), multi-rooted teeth with furcation involvement (23.5%) and abutment teeth (fixed: 27.6%, removable: 36.4%). 37.6% of teeth with initial bone loss >60% were lost during 20 years. Adherent patients showed less frequent tooth loss than non-adherent patients (OR 0.371; p <  .01). CONCLUSION: Even teeth with an initial bone loss over 60% could be retained in approximately two thirds for 20 years. This should be kept in mind when assigning prognosis and establishing a treatment plan.

Twenty years later: Oral health-related quality of life and standard of treatment in patients with chronic periodontitis.

BACKGROUND: To assess oral health-related quality of life (OHRQoL) after long-term (20 years) periodontal treatment in patients with chronic periodontitis (ChP) and to compare it with the current clinical outcome and oral health status. METHODS: Twenty years after therapy, 63 patients were reexamined. The dental and periodontal status and OHRQoL using the Oral Health Impact Profile-G49 (OHIP-G49) were assessed. Descriptive statistics, correlation analysis, and tests for differences were calculated. RESULTS: Up to 75% of patients showed no probing depths > 5mm, bleeding on probing (BOP) ≤25%, no pain and satisfactory function. A comparatively low perceived oral impact of ChP was represented by an OHIP-G49 overall score of 18.89 ± 21.66. The most common reported impairment was physical pain followed by "functional limitation." A correlation between oral quality standard and the OHIP-G49 was limited to the physical pain subdomain. CONCLUSIONS: Satisfaction with oral status was perceived high by most patients treated for chronic periodontitis. A comparably high OHRQoL can be achieved and retained long-term after periodontal treatment. The objective and subjective evaluation of oral health only correlated in the subscale "physical pain."

Tooth loss in periodontally compromised patients: Results 20 years after active periodontal therapy.

AIM: To assess tooth loss in periodontally compromised patients 20 years after active periodontal therapy (APT) and to detect potential influencing factors for tooth loss on patient level. MATERIAL AND METHODS: From a total of 100 patients, who were re-evaluated ten years after APT, 70 could be re-examined 20 years ± 12 months after APT. Tooth loss during 20 years was detected and based on regression analyses the impact of patient-levelled factors was estimated. RESULTS: Of 1.639 teeth, 201 were lost (mean 2.87 teeth/patient, range 0-19 teeth, SD 3.49), resulting in a mean tooth loss rate of 0.14 teeth/patient/year during 20 years. Mean tooth loss per patient was higher during the second ten years of supportive periodontal therapy (SPT) compared to the first (1.20 vs. 1.67 teeth/patient). As influencing factors age (p < 0.001), smoking (p < 0.001), compliance to SPT (p < 0.001), marital status (p < 0.001), presence of diabetes (p < 0.001) and heart diseases (p = 0.001) could be detected. CONCLUSION: Over 20 years of follow-up, a low number of teeth were lost in mostly severely compromised periodontal patients. Smoking, non-compliance to SPT, age, living as a single and systemic diseases like diabetes or cardiovascular diseases negatively influence tooth loss on the long run.