Effect of single-visit full-mouth non-surgical therapy and risk factor analysis on long-term periodontal treatment outcomes: aretrospective study

Abstract

Objectives: This study aimed to evaluate the long-term effectiveness of single-visit full-mouth non-surgical therapy in managing patients with progressive periodontitis during supportive periodontal therapy (SPT), with tooth loss due to periodontitis (TLP) as the primary outcome. Secondary objectives included assessing changes in probing depth (PD) and identifying risk factors associated with TLP.

Materials and methods: A retrospective analysis was conducted using patient records from the University of Michigan School of Dentistry. Included were 283 patients (mean age: 53.2 years) with periodontal breakdown during SPT (PiKS) who underwent single-visit full-mouth ultrasonic instrumentation. The primary outcome was TLP over a mean follow-up of 19.4 years. Secondary outcomes included changes in PD (≥ 5 mm and ≥ 6 mm) and identification of risk factors for tooth loss. Statistical analyses used multilevel binary logistic regression with generalized estimating equations (GEE) and linear regression models.

Results: Among 283 patients (mean age: 53.2 years), the mean TLP was 0.9 teeth per patient over a mean follow-up of 19.4 years. Factors significantly associated with TLP included diabetes (OR = 2.41; p = 0.013), current smoking (OR = 2.13; p = 0.025), higher periodontitis Grades B and C (OR = 3.31; p = 0.001), and Stages III-IV (OR = 8.67; p = 0.001). Baseline pocket depths (PD) ≥ 5 mm (OR = 1.13; p = 0.002) and ≥ 6 mm (OR = 1.29; p = 0.001) were also associated with higher TLP. Each additional annual SPT visit reduced the TLP risk by half (OR = 0.50; p = 0.003). PD ≥ 5 mm showed minimal increase change (0.16; p = 0.02), while depths ≥ 6 mm actually decreased (-0.10; p = 0.01).

Conclusion: Single-visit full-mouth non-surgical therapy is effective for long-term management of PiKS, with low tooth loss rates. Diabetes, smoking, advanced periodontitis stage/grade, and deeper baseline pockets are key predictors of TLP. Frequent SPT visits significantly mitigate tooth loss risk.

Clinical relevance: During (SPT) appointments, prevalent practice involves the full-mouth instrumentation of persistent periodontal pockets to disrupt microbial populations and consequently reduce the inflammatory response responsible for disease progression. This study investigates the efficacy of single-visit full-mouth instrumentation as a potential alternative to standard practices in controlling periodontal disease during SPT, which have potential benefits for patients, including reduced treatment time, improved adherence to maintenance therapy, and comprehensive management of periodontal disease. By minimizing the number of visits, this approach may enhance patient compliance while reducing the risk of reinfection from untreated sites between sessions, ultimately contributing to better long-term periodontal stability. Factors such as deeper baseline probing depths and crucial risk elements for TLP-including diabetes, smoking, and advanced stages (III-IV) and grades (B and C) of periodontitis, can play a role in TLP. Additionally, this study provides valuable insights into the customization of more intensive interventions for patients at higher risk. Our findings highlight the importance of frequent SPT visits, with each additional annual visit halving the risk of TLP. The observed reduction in PD of ≥ 6 mm following treatment indicates the significant potential of comprehensive debridement for enhancing long-term periodontal stability. This evidence supports the implementation of tailored, intensive SPT schedules, particularly for patients identified as having higher risks, thereby contributing to improved clinical outcomes in periodontal disease management.

Keywords: Periodontitis; Smoking; Supportive periodontal therapy; Tooth loss.

Fig. 1

Distribution and stratification of smoking status in the study cohort. The chart illustrates the proportion of non-smokers (71.0%), current smokers (< 10 cigarettes/day: 15.2%; >10 cigarettes/day: 2.1%), and former smokers (< 10 cigarettes/day: 9.9%; >10 cigarettes/day: 1.8%) among participants at baseline

Fig. 2

Depicts the annual rate of tooth loss categorized by the model against the three most relevant factors, along with the annual rate of SPT visits