The predictability of periodontal treatment as measured by tooth loss: a retrospective study.

OBJECTIVE: This study evaluated the predictability of periodontal treatment as measured by tooth loss in 114 patients. METHOD AND MATERIALS: The patients were selected for the study if they had been treated for moderate-to-advanced periodontitis and had received continuous periodontal maintenance every 3 to 6 months for 5 years or longer. The patients averaged 53 years of age, were equally divided by gender, and were maintained an average of 12.5 years. Patients were retrospectively assigned, according to the number of teeth lost following active periodontal treatment, to the well-maintained group (96 patients, 0 to 3 teeth lost), downhill group (15 patients, 4 to 9 teeth lost), or extreme downhill (three patients, 10 to 23 teeth lost) group. Teeth were retrospectively assigned a questionable or hopeless prognosis. RESULTS: Of the 2,899 teeth present during maintenance care, 378 had a questionable prognosis because of furcation involvement, and 63 (16.7%) of these teeth were lost. Of the 529 nonfurcated teeth that had a questionable prognosis, 68 (12.9%) were lost during the maintenance phase of treatment. Ninety-six teeth were given a hopeless prognosis, and 32 (33.3%) of these teeth were lost. Surgical treatment of teeth with questionable or hopeless prognosis did not improve the retention of these teeth in the downhill and extreme downhill groups. CONCLUSION: The prognosis of a periodontally compromised tooth in individual patients in difficult to predict accurately. A hopeless prognosis is more accurate than a questionable prognosis in predicting tooth loss in these patients.

Tooth loss due to periodontal abscess: a retrospective study.

This retrospective study focused on the frequency of tooth loss due to periodontal abscess among 42 patients who were treated by a single clinician over a 5- to 29-year period. A total of 114 patients were selected from the active periodontal recall schedule of a single periodontist at The University of Iowa College of Dentistry. The criteria for inclusion in the study included having a history of moderate to advanced periodontitis, being on 3 to 6 month recall periodontal maintenance care, and completion of active periodontal therapy prior to October 1987. Other parameters evaluated were age; gender; number of teeth present and missing at the initial, reevaluation, and last periodontal recall visit; initial periodontal prognosis; furcation involvement; non-surgical and surgical periodontal therapy; and reasons for tooth loss. Patients were grouped according to the number of teeth lost following active periodontal treatment into well-maintained (0 to 3), downhill (4 to 9), and extreme downhill (10 to 23) groups. Forty-two of the 114 patients were identified as having one or more periodontal abscesses. A total of 109 teeth were affected by periodontal abscess of which 49 (45%) teeth were lost and 60 (55%) were successfully maintained over an average of 12.5 years (5 to 29 years). More furcated teeth were lost than nonfurcated teeth and teeth given a hopeless prognosis were lost more consistently than those given a questionable prognosis in all groups. The frequency of periodontal abscess and tooth loss per patient was greater in the downhill and extreme downhill response groups than the well-maintained group. This suggests that teeth with a history of periodontal abscess can be treated and maintained for several years.

The effectiveness of periodontal treatment as measured by tooth loss.

In a retrospective study, the authors evaluated the effectiveness of periodontal treatment in preventing tooth loss in patients with moderate to advanced periodontitis. Patients had received maintenance therapy for an average of 12.5 years. Of the 2,899 teeth present after active treatment, 152 were lost to periodontal disease and 68 were lost to other causes during maintenance therapy. The authors evaluated causes and patterns of tooth loss after surgical vs. nonsurgical treatment. Surgery did not significantly improve tooth retention in the high-risk patients. This study and other retrospective studies suggest that tooth loss may be related more to the type of periodontal disease present than to the treatment rendered.

Risk factors for various levels of periodontal disease and treatment needs in Iowa.

A cross-sectional study of the non-institutionalized population of the State of Iowa was completed in 1980. Persons were interviewed by telephone and a follow-up dental examination was conducted in the home. Periodontal treatment needs were measured using the WHO-621 Index of Periodontal Treatment Needs which has been modified and is now known as the Community Periodontal Index of Treatment Needs. Findings were consistent with other recent studies, which have shown a relatively high proportion of gingival bleeding and calculus. Although moderate pocket formation (3-6 mm) occurs in approximately 30% of the adult population, complex treatment needs (pockets 6 mm or greater) occurred in only 1.3% of the population. While sex did not significantly affect the distribution of periodontal needs; age, recency of visit to the dentist and income are possible risk factors for serious periodontal disease.

Examination of topographical gingival anatomy by a filter imprint technique.

The Millipore filter imprint technique was applied to oral cytology using modification of the Papanicolaou and Shorr stains. This technique has the major advantage of demonstrating on each imprint the topographic relationship between cellular zones and also allows for repeated sampling of superficial changes in the same area without tissue. This method provides a wide variety of cytological information about gingival anatomy and demonstrates a number of regions of differing cellular composition.

An examination of the cytology of uninflammed and inflammed gingiva using a filter imprint technique.

Filter imprint cytologic specimens were obtained from the gingiva of 41 male dental students following clinical assessment of gingival health using a modification of the Loe gingival index. Nineteen of the specimens were from inflamed, and 22 from uninflamed gingiva. The imprints were fixed and stained by a modification of the Papanicolaou method and macroscopic and microscopic examinations showed that: 1. With increasing severity of clinically detectable gingival inflammation,, there appears to be an increase in the width of the bands of inflammatory cells and epithelial cells adjacent to the gingival margin. 2. An inverse relationship is found between keratinization and inflammation in that the percentages of anucleated epithelial cells was reduced at the gingival margin and significantly reduced midway in the attached gingiva of the inflamed groups. 3. No changes associated with inflammation were noted in cell cytology at the mucogingival junction.