OBJECTIVES Long-term outcomes of conservative periodontal and prosthetic treatment of patients with moderate to severe periodontitis were to be evaluated. Groups of younger (YG) and middle-aged patients (MG) were to be compared regarding survival of fixed and removable dental prostheses (FDP, RDP) inserted after active periodontal therapy (APT). In addition, functional-occlusal status over more than 10 years of supportive periodontal therapy (SPT) was analysed. METHODS The present multi-case-series retrospectively analysed data of 68 patients (34 YG and 34 MG) who had received APT and regular SPT ≥10 years. Tooth loss, occlusal status and survival and complications of prosthetics were evaluated descriptively and comparatively (t-test). RESULTS There was no statistical difference between YG and MG concerning tooth loss/year (p > 0.05). Functional-occlusal status was retained during SPT in 75% and 69% of YG and MG. Restorations inserted after APT showed high survival for both age groups (100%). Mean survival time until the last SPT visit was 15.2 and 11.6 years for FDP and RDP in YG, and 12.5 and 13.1 years in MG. CONCLUSIONS Prosthetic restorations in both younger and middle-aged patients with severe periodontitis showed high survival, if pre-prosthetic APT and regular SPT had been performed.

BACKGROUND:Residual probing depth (PD) after subgingival scaling can be treated with repeated scaling or periodontal surgery. Ambiguous results about the additional clinical benefit of a second scaling procedure exist. Therefore, we performed a prospective study comparing the clinical results of repeated subgingival scaling versus periodontal surgery in 30- to 40-year-old subjects with generalized advanced periodontitis.METHODS:Twenty-six subjects (mean age, 37 +/- 3 years) were treated after an initial examination (t(1)), initial subgingival scaling, and baseline examination (t(2)) with a randomly assigned second subgingival scaling (test) and periodontal surgery (control) in a split-mouth design. The final examination (t(3)) took place 6 months postoperatively. Intraindividual comparisons of mean PD and clinical attachment level (CAL) were analyzed.RESULTS:PD was reduced from 4.1 +/- 0.2 mm initially (t(1)) to 3.1 +/- 0.1 mm at baseline (t(2)), and to 2.9 +/- 0.1 mm at the end of the study (t(3)) for the test sites; and from 4.5 +/- 0.2 mm (t(1)) to 3.5 +/- 0.1 mm (t(2)), and 3.1 +/- 0.1 mm (t(3)) for the control sites. The total PD decrease from t(1) to t(3) was significant (P <0.001) for both therapies. PD reduction from t(2) to t(3) was only significant (P <0.001) for control sites, resulting in a significant (P = 0.010) difference between test and control at the final examination. CAL increased 0.2 +/- 0.1 mm (t(2)) plus 0.3 +/- 0.1 mm (t(3)) for the test sites and 0.2 +/- 0.1 mm (t(2)) plus 0.2 +/- 0.1 mm (t(3)) for the control sites. Total CAL gain was statistically significant for the test and control sites. CAL gain from t(2) to t(3) was only significant (P = 0.022) for the test sites.CONCLUSIONS:Both treatments reduced PD and increased CAL. A second subgingival scaling resulted in significant additional CAL gain and reduced the need for surgery.

The aim of this retrospective study was to evaluate the influence of interleukin (IL)-1 genotype on the clinical parameters pocket probing depth and tooth loss in periodontally treated and regularly maintained patients. Only data from non-smokers were included.Patient mean data on pocket probing depth (PPD) and tooth loss from 53 Caucasian patients treated for generalized chronic periodontitis and maintained for an average of 15.5 years at the university of Kiel were analysed. All patients were genotyped and subjects with at least one copy of the variant allele 2 at positions IL-1A-889 and IL-1B +3954 were classified IL-1 genotype positive.12 patients (22.6%) were IL-1 genotype positive. IL-1 genotype positive/negative patients were on average 46-3/45.8 years old with a mean of 23.8/23.9 teeth, resp., at baseline (TO). A total of 86 teeth were lost initially, resulting in an average of 21.5/22.5 teeth after active treatment (T1). The corresponding values after 13 years of supportive periodontal care (T2) were 20.7/21.6 teeth. Corresponding mean PPD values for IL-1 genotype positive/negative patients decreased from 4.7 mm/5.3 mm (To) to 2.9 mm/2.9 MM (T1) and increased slightly to 3.3 mm/3.4 mm at T2. Intergroup differences of PPD and tooth loss were not significant.Regarding pocket probing depth and tooth loss, there were no significant differences related to IL-1 genotype.

AIM:Benchmarking is a means of setting goals or targets. On an oral health level, it denotes retaining more teeth and/or improving the quality of life. The goal of this pilot investigation was to assess whether the data generated by a population-based study (SHIP 0) can be used as a benchmark data set to characterize different practice profiles.MATERIAL AND METHODS:The data collected in the population-based study SHIP (n=4310) in eastern Germany were used to generate nomograms of tooth loss, attachment loss, and probing depth. The nomograms included twelve 5-year age strata (20-79 years) presented as quartiles, and additional percentiles of the dental parameters for each age group. Cross-sectional data from a conventional dental office (n=186) and from a periodontology unit (n=130, Greifswald) in the study region as well as longitudinal data set of a another periodontology unit (n=135, Kiel) were utilized in order to verify whether the given practice profile was accurately reflected by the nomogram.RESULTS:In terms of tooth loss, the data from the conventional dental office agree with the median from the nomogram. For attachment loss and probing depth, some age groups yielded slight but not uniform deviations from the median. Cross-sectional data from the periodontology unit Greifswald showed attachment loss higher than the median in younger but not in older age groups. The probing depth was uniformly less than the median and tended toward the 25th percentile with increasing age. The longitudinal data of the Unit of Periodontology in Kiel showed a pronounced trend towards higher percentiles of residual teeth, meaning that the patients retained more teeth.CONCLUSION:The profile of the Pomeranian dental office does not deviate noticeably from the population-based nomograms. The higher attachment loss of the Unit of Periodontology in Greifswald in younger age strata clearly reflects their selection because of periodontal disease; the combination of higher attachment loss and decreased probing depth may reflect the success of the treatment. The tendency of attachment loss towards the median with increasing age may indicate that the Unit of Periodontology in Greifswald does not fulfill its function as a special care unit in the older subjects. The longitudinal data set of the Unit of Periodontology in Kiel impressively reflects the potential of population-based data sets as a means for benchmarking. Thus, nomograms can help to determine the practice profile, potentially yielding benefits for the dentist, health insurance company, or--as in the case of the special care unit--public health research.

The influence of systematic dummy-head training with Periopolishe (PP, group A) and Gracey instruments (GRA, group B) on the effectiveness of root debridement was evaluated by Rühling et al., 2002 (9). Their results indicate that independent of the instrument used, untrained operators were only able to debride root surfaces at low levels of effectiveness. It was possible to increase effectiveness to a high level through systematic training in both groups. The aim of the present study was to assess the role of operator motivation and self-assessment on scaling effectiveness. Before baseline, operators were asked to answer a questionnaire rating the expectation of the instrument performance. Four groups of inexperienced operators (n = 11 each) received 10 weeks dummy-head training. In groups A (GRA) and B (PP), training was combined with a motivational programme. Groups C (GRA) and D (PP) received the same training, but no additional motivational programme. In a dummy-head, 10 test teeth were debrided and operators were asked to estimate their effectiveness of debridement at each test day. Effectiveness was calculated as percentage of debrided root area on 10 test teeth at different time points with an image analysis programme (NIH Image) and ANOVA. Two groups were compared using the Mann-Whitney U-test (unpaired) and the Wilcoxon signed ranks test (paired). Motivated groups (A and B) reached about 25% higher debridement results (p < 0.001) and were able to estimate their effectiveness more precisely compared to groups C and D. In the low motivation groups (C and D), overestimation of more than 20% was evident (p < 0.001). The questionnaires revealed underestimation of the GRA instruments and overestimation of PP instruments. Operator motivation and self-assessment greatly influence learning of effective root debridement.

Background/aims: This retrospective study determined the treatment outcomes of 142 compliant periodontal patients observed for at least 10 years at the University of Kiel. All patients had been treated for moderate to advanced periodontitis and regularly received supportive periodontal therapy (SPT).Methods: Patient- and tooth-related variables [tooth loss and pocket probing depth (PPD)] were analysed.Results: Of a total of 3353 teeth, 167 were extracted during active treatment and 99 during SPT, mainly for periodontal reasons. Forty-five per cent of the patients did not lose any teeth during 11.7 years of observation. Thirty-seven per cent underwent extractions during active treatment or SPT, 18% both during active periodontal therapy and SPT. Mean tooth loss per patient was 0.07 teeth/year during SPT. Mobility, furcation involvement, smoking, and prescription antibiotics had a negative impact on prognosis. Intraindividual differences in PPD were significant between single- and multirooted teeth with initial PPD greater than or equal to 4 mm at baseline, following active treatment and at the end of SPT, and between firm and mobile teeth at baseline. Interindividual differences in mean PPD were only significant between smokers and non-smokers at the end of the observation period.Conclusions: Long-term maintenance of our patients was effective. Periodontal disease represented the major cause of tooth loss in a minority of the population.

BACKGROUND/AIMS:In a dummy-head trial, we assessed how effectively untrained operators were able to learn scaling with curettes and power-driven instruments.METHODS:Two untrained operator groups (n = 11 each) received six 2-h lessons during a 10-week period following a training program. Subgingival scaling was performed with curettes (GRA) and a power-driven system (PP). At 6 test days each subject had to instrument 10 test teeth. The percentage of debrided area was assessed with an image analysis program. Learning success was measured as a percentage of debrided root area and scaling time. Furthermore, the effectivity was related to difficulty in anatomical situations and access to root surfaces. Statistical analysis was carried out with SPSS.RESULTS:At baseline, effectivity was 63.1% (GRA) vs. 52.3% (PP). Between weeks 9 and 11, operators reached a plateau for group GRA at 84.7% and group PP at 81.3%. Scaling time did not differ between the two groups. Debridement of teeth with complex root shapes that were hard to access was less effective with the power-driven system.CONCLUSION:Independent of the instrument used, untrained operators were only able to debride root surfaces at low levels of efficacy. With systematical training, effective scaling with the power- driven system was as easy to learn as with hand instruments. On root surfaces with complicated shape and anatomy or difficult accessibility, the power-driven system works significantly less effectively.

Background: The aim of this retrospective study was to evaluate if patients with moderate to advanced periodontitis had comparable periodontal conditions at baseline and during supportive periodontal therapy (SPT) whether they were compliant or not.Method: Patient-related variables were compared: age, tooth mobility, furcation involvement, number of teeth, pocket probing depth, plaque index. Compliant patients (n = 142) received complete periodontal treatment and were followed over at least 10 years (group A). Non-compliant patients either discontinued supportive periodontal therapy (n = 42, group B) or dropped out before or during periodontal surgery (n = 44, group C).Results: At baseline, there were no significant differences between the 3 groups except for mobility. During SPT, mean pocket probing depth and plaque index differed significantly.Conclusion: These results indicate that non-compliant patients compared to compliant patients had similar periodontal conditions at baseline, but responded less favourably to periodontal surgery and maintenance.

BACKGROUND Recently, we have developed teflon-coated sonic scaler inserts which remove plaque without removing tooth substance; they polish subgingivally. In a preclinical test, we showed that these modified inserts remove plaque nearly as effectively as do conventional sonic scaler inserts. The present investigation was intended as a proof-of-principle of subgingival polishing. The aim was to study the effect of subgingival polishing on the resolution of gingival inflammation in comparison to conventional scaling. MATERIAL AND METHODS In 10 patients with moderate to advanced periodontal disease, who had at least 2 single-rooted teeth with a probing depth of >6 mm in each quadrant, all single-rooted teeth were subjected to one treatment regimen consisting of 2 instrumentation episodes (1st/2nd treatment): curette/curette, curette/teflon-coated sonic scaler, teflon-coated sonic scaler/teflon-coated sonic scaler, and an untreated control. The second treatment session was performed 3 months after the first instrumentation, and the final registration 3 months after the second instrumentation. Clinical measurements included probing depth, change of clinical attachment level, bleeding upon probing, and plaque scores. RESULTS Probing depth, attachment level, and bleeding scores were reduced in the 3 instrumentation groups versus the control group in the 1st period; in the 2nd period, no further change occurred. Subgingival polishing with teflon-coated sonic scaler inserts was slightly less effective than conventional scaling. CONCLUSION Subgingival polishing with teflon-coated sonic scaler inserts seems to be nearly as effective as conventional scaling. Thus, it may be the instrumentation of choice for maintenance treatment of residual pockets.

BACKGROUND, AIMS The aim of this retrospective study was to assess the effect of regular supportive periodontal treatment on disease progression in patients with moderate to advanced periodontitis. METHOD We compared radiographic change of interdental bone level and number of teeth at 2 time points in 3 patient groups (mean age 46 years): group A, periodontally untreated patients (n= 14) who dropped out during initial therapy; group B, non-compliant patients (n=26), who discontinued supportive periodontal therapy after ca. 2 years of maintenance; group C, compliant patients (n=27), who regularly attended the maintenance program for 7 years. Periodontal treatment was performed as scaling and root planing or flap surgery in groups B and C. All 3 groups were re-examined ca. 7 years after the initial examination. RESULTS Patients in group A lost 3.8 teeth (0.5 teeth/year), those in group B 3.2 (0.4 teeth/year), and in group C, patients lost 2.0 teeth (0.2 teeth/year). About half of the patients lost no teeth (group A 43%, B 42%, C 55%), and only 17 subjects lost more than 3. At the 2nd examination, an increase in interdental bone was found only in group C (+0.13 mm), while groups A and B lost 0.57 mm and 0.31 mm of alveolar bone level, respectively (p<0.05 group C versus A and B). CONCLUSIONS Systematic periodontal treatment stops interdental bone loss and decreases the rate of tooth loss in most cases. Periodontal surgery without regular follow-up care cannot prevent further periodontal destruction, but it can delay it.