Predictors of long-term outcomes in patients undergoing periodontal maintenance

Abstract

Aim: This retrospective study aimed to characterize the baseline status of patients following periodontal maintenance, analysing the association between the long-term outcome of these patients, smoking, bruxism, and the main clinical and radiographic variables.

Material and methods: A sample of 174 patients with moderate to severe periodontitis was refined into homogeneous subsamples according to smoking and bruxism and the rate of tooth loss due to periodontal disease (TLPD): 0, 1-2, and >2 teeth. The association and the distribution (χ² test) of the variables within the subsamples were analysed.

Results: Smoking and bruxism were significantly associated with higher TLPD rates. Vertical and circumferential bone defects (p < .0001), and abfractions (p < .0001) were associated with bruxism and particularly with bruxism and TLPD >2. Furcation defects (p = .0002), fewer radio-opaque subgingival calculus (χ² p < .0001), a lower mean Gingival index (χ² p = .027), and increased mean recessions >1.5 mm (χ² p = .0026) were associated with smoking and higher TLPD rates. The mean baseline mobility, abfractions, and recessions characterized two basic types of TLPD.

Conclusions: Smoking, bruxism, and routine clinical and radiological parameters can be used to characterize the baseline status of patients with worse outcomes.

Keywords: abfractions; bruxism; periodontal disease; periodontal prognosis; tooth loss.

Figure 1

(a–d) are cases of TLPD 0 in non‐bruxists, (a and b) present a wider periodontium in a 26 year follow‐up in a non‐smoker (a) and a 20 year follow‐up in a smoker (b). (c‐d) present a narrower periodontium with developing gingival recessions in non‐smoking patients after 20 (c) and 23 years (d). (e and f) are TLPD 0 cases (after 20 and 22 years) of mild eccentric bruxism progressing to moderate bruxism (protruvise grinding) in a non‐smoking patient (e) and in a smoking patient with abfractions grade (f). (g, h, and i) (after 20, 22 and 25 years, respectively) depict moderate eccentric bruxism progressing to severe bruxism in a non‐smoking patients with TLPD 0 (g), TLPD 1–2 teeth (h) and TLPD >2 teeth (i). These three patients as well as the remaining cases of eccentric bruxism developed recession exclusively in the area of abfractions. Besides, these lesions developed to a lesser extent.(j, k, and l) (after 28, 20 and 26 years, respectively) are cases of mild to moderate centric bruxism with attrition mostly grade 0 and 1 progressing to severe centric bruxism with attrition grades 0–2 and abfractions grades 2–4. TLPD was (j), 1–2 teeth (k) and >2 teeth (l)