Vertical subclassification predicts survival of molars with class II furcation involvement during supportive periodontal care.

BACKGROUND: Furcation involvement is a major predictor of tooth survival. Focus has so far been on the predictive value of the horizontal component of furcation involvement. Residual periodontal support on each of the roots is likely to play a major role on retention of the furcated molar. Aim of this clinical audit study was to preliminarily assess the impact of vertical subclassification on tooth retention. METHODS: Tooth retention of class II furcated molars in 200 consecutive patients compliant with periodontal supportive care for a minimum of 10 years was retrospectively evaluated in a single practice. Randomly selected furcated molars were retrospectively diagnosed in terms of vertical subclassification (residual periodontal support on the most compromised root), and time to tooth extraction/loss was determined in clinical records. Kaplan-Meier survival curves were constructed. RESULTS: Ten-year survival of molar with class II furcation involvement was 52.5%. Survival was 91% for subclass A, 67% for subclass B and 23% for subclass C. Mean years of survival were 9.5-10.1, 8.5-9.3 and 6-7.3 for subclasses A, B and C, respectively. Tests of equality of the survival distributions showed highly significant differences in all portions of the curve (p < .001). Stratified analyses by smoking showed significant differences for the two groups (p < .001). Hazard rates for tooth extraction/loss were 4.2 and 14.7 for subclasses B and C, respectively. CONCLUSIONS: Residual periodontal support assessed as vertical subclassification of furcation involvement seems to be a good predictor of survival of molar with class II horizontal furcation. This has implication for prognosis, treatment planning and development of effective molar retention strategies.

[Observation of bone morphology in furcation defects of mandibular molars using cone beam computed tomography].

OBJECTIVE: To observe mesial-distal bone morphology in classes II and III furcation involvements (FI) of mandibular molars using cone beam computed tomography (CBCT), to develop a classification system of mesial-distal bone morphology of furcation defects and to observe the intrabony defects on CBCT images. METHODS: Based on the existing CBCT data, the mandibular molars with horizontal bone defects in furcation area were observed. One hundred and seventeen sites of 81 mandibular molars with class II or class III FIclassified on CBCT images were included. The classification system of mesial-distal bone morphology of furcation defects was developed. According to the location of the line drawn from mesial to distal alveolar bone crest (AC-line) of the tooth and bone level under furcation fornix, the bone morphology was classified into three types, including concave type, flat type and protruding type. The concave type was divided into two subtypes according to the location of AC-line and furcation fornix (Fx), which were subtype 1(AC-line coronal or equal to Fx)and subtype 2 (AC-line apical to Fx).The frequency of each type was calculated and analyzed. The intrabony defects was observed on sagittal CBCT images. RESULTS: In the 117 sites with FI, the flat type appeared with the highest rate (64.10%) and the protruding type appeared with the lowest rate (6.84%). The rates of subtype 1 and subtype 2 of concave type were 13.68% and 15.38%, respectively. The rate of subtype1 which was supposed to be beneficial for bone regeneration was 8.96% in class II FI and 20.00% in class III FI. Thirtyone intrabony defects were found among the 117 FI, 29 of which appeared in proximal aspect of the tooth and the left 2 appeared in furcation area. The highest frequency of the intrabony defects was found in subtype 1 of concave type. CONCLUSION: The classification of mesial-distal bone morphology on CBCT images may be helpful for clinicians to make accurate treatment plan before surgery and could be used in future studies to understand the influence of bone morphology on regenerative therapy for furcation defects.

Effects of EMD liquid (Osteogain) on periodontal healing in class III furcation defects in monkeys.

AIM: To evaluate the effect of a novel liquid carrier system of enamel matrix derivative (Osteogain) soaked on an absorbable collagen sponge (ACS) upon periodontal wound healing/regeneration in furcation defects in monkeys. MATERIALS AND METHODS: The stability of the conventional enamel matrix derivative (Emdogain) and Osteogain adsorbed onto ACS was evaluated by ELISA. Chronic class III furcation defects were created at teeth 36, 37, 46, 47 in three monkeys (Macaca fascicularis). The 12 defects were assigned to one of the following treatments: (1) open flap debridement (OFD) + ACS, (2) OFD+Emdogain/ACS, (3) OFD+Osteogain/ACS, and (4) OFD alone. At 16 weeks following reconstructive surgery, the animals were killed for histological evaluation. RESULTS: A 20-60% significantly higher amount of total adsorbed amelogenin was found for ACS-loaded Osteogain when compared to Emdogain. The histomorphometric analysis revealed that both approaches (OFD + Emdogain/ACS and OFD + Osteogain/ACS) resulted in higher amounts of connective tissue attachment and bone formation compared to treatment with OFD + ACS and OFD alone. Furthermore, OFD + Osteogain/ACS group showed higher new attachment formation, cementum, and new bone area. CONCLUSIONS: Within their limits, the present data indicate that Osteogain possesses favourable physicochemical properties facilitating adsorption of amelogenin on ACS and may additionally enhance periodontal wound healing/regeneration when compared to Emdogain.

Assessing Maxillary Molar Furcation Involvement by Cone Beam Computed Tomography.

OBJECTIVE: To evaluate the reproducibility of four parameters for quantitatively assessing maxillary molar furcation involvement (FI) by cone beam computed tomography (CBCT). METHODS: Thirty-nine sites with degree II FI, classified by probing of 21 maxillary molars, were investigated. Degrees of FI in these sites were assessed based on CBCT data. In these samples, four parameters for quantitatively assessing FI in CBCT images were measured. The parameters included horizontal bone loss at furcation entrance level (HBL), maximum HBL (HBL-max), maximum vertical bone loss (VBL-max) and root trunk length (RT). The reproducibility of the measurements was evaluated. RESULTS: Amongst the 39 degree II FI classified by probing, only 17.9% were confirmed by CBCT. The other 46.2% were 'through and through' defects, 15.4% were fused roots and 20.5% were degree I FI in the CBCT image. The intraobserver repeatability for all four parameters was high, with intraclass correlation coefficients (ICC) of 0.960 for HBL, 0.992 for HBL-max, 0.987 for VBL-max and 0.983 for RT. The ICCs for two observers was also high (ICCs: 0.873 to 0.947). The parameters and related methods of measurements proposed in the study showed high reproducibility. CBCT images provided more details in assessing maxillary molar FI. CONCLUSION: The parameters and related methods of measurements developed in this study showed high reproducibility. CBCT images provide more details in assessing maxillary molar FI.

A Novel Surgical Approach for Treatment of Class II Furcation Defects Using Marginal Periosteal Membrane.

OBJECTIVES: This study was designed to describe and evaluate the use of a vascularized marginal periosteal barrier membrane (MPM) harvested by a semilunar incision, alone or combined with a bone graft, in treatment of class II furcation defects in mandibular molars, compared to open flap debridement (OFD). METHODS: Thirty class II furcation defects in mandibular molars were randomly assigned into three equal groups: Group I included OFD, Group II included defects treated with MPM, and Group III consisted of defects treated with MPM after applying demineralized freeze-dried bone allograft (DFDBA). At baseline and 6-month follow-up, vertical probing depth (VPD), clinical attachment level (CAL) measurements, along with a radiographic measurement of bone height (BH), were obtained for each defect. Transmission electron microscopy (TEM) was used for further evaluation of the histological changes associated with gingival samples related to each line of treatment. RESULTS: Both Groups II and III reflected significant favorable outcomes in all the assessed parameters compared to OFD. A non-significant difference was found between both groups regarding VPD, while significant improvement in CAL and BH were detected in Group III (p ≤ 0.05). Favorable histological findings were also noticed in the test groups, with more improvement in Group III. CONCLUSION: Placement of a vascularized MPM as a barrier membrane, using a semilunar incision, demonstrated a significant improvement in both clinical and histological outcomes of class II furcation defects in lower molars. When it was combined with DFDBA, a meaningful difference was found with regard to early wound healing and gain in CAL and BH.

Consecutive Case Series Using a Composite Allograft Containing Mesenchymal Cells with an Amnion-Chorion Barrier to Treat Mandibular Class III/IV Furcations.

This retrospective case series describes a layered regenerative approach for five Class III and one borderline Class IV furcation, involving treatment consisting of root management that included conditioning with tetracycline solution followed by the topical application of recombinant platelet-derived growth factor BB. A composite allograft with mesenchymal stem cells was subsequently placed into the furcation and covered by a barrier derived from human amnion-chorion with flaps advanced to completely cover the site. Three furcations, including the one diagnosed as Class IV, had complete closure, two were converted to Class I, and in one instance, there was no improvement. This regenerative algorithm for mandibular Class III furcations may present the potential to save these teeth by altering the prognosis, which has traditionally been poor to hopeless, resulting in many of these teeth routinely being extracted.

Periodontal regeneration - furcation defects: a systematic review from the AAP Regeneration Workshop.

BACKGROUND: The aim of this review is to present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy to provide clinical guidelines for the therapeutic management of furcation defects and to identify priorities for future research that may advance the understanding of periodontal regenerative medicine. METHODS: A comprehensive search based on predetermined eligibility criteria was conducted to identify human original studies and systematic reviews on the topic of periodontal regeneration of furcation defects. Two reviewers independently screened the title and abstract of the entries yielded from the initial search. Subsequently, both reviewers read the full-text version of potentially eligible studies, made a final article selection, and extracted the data of the selected studies considering specific clinical scenarios. The clinical scenarios contemplated in this review included the following: 1) facial and interproximal Class I defects in maxillary molars; 2) facial and lingual Class I defects in mandibular molars; 3) facial and interproximal Class II furcation defects in maxillary molars; 4) facial and lingual Class II furcation defects in mandibular molars; 5) Class III furcation defects in maxillary molars; 6) Class III furcation defects in mandibular molars; and 7) Class I, II, or III furcation defects in maxillary premolars. Endpoints of interest included different clinical, radiographic, microbiologic, histologic, and patient-reported outcomes. RESULTS: The initial search yielded a total of 1,500 entries. The final selection consisted of 150 articles, of which six were systematic reviews, 109 were clinical trials, 27 were case series, and eight were case reports. A summary of the main findings of previously published systematic reviews and the available evidence relative to the indication of regenerative approaches for the treatment of furcation defects compared with conventional surgical therapy are presented. Given the marked methodologic heterogeneity and the wide variety of materials and techniques applied in the selected clinical trials, the conduction of a meta-analysis was not viable. CONCLUSIONS: On the basis of the reviewed evidence, the following conclusions can be drawn. 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial or interproximal and mandibular facial or lingual Class II furcation defects. 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the evidence is limited to one case report. 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in maxillary molars is limited to clinical case reports. 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy. 5) Future research efforts should be primarily directed toward the conduction of clinical trials to test novel regenerative approaches that place emphasis primarily on patient-reported outcomes and also on histologic demonstration of periodontal regeneration. Investigators should also focus on understanding the influence that local, systemic, and technical factors may have on the outcomes of regenerative therapy in furcation defects.

Periodontal regeneration - furcation defects: a consensus report from the AAP Regeneration Workshop.

BACKGROUND: Treatment of furcation defects is a core component of periodontal therapy. The goal of this consensus report is to critically appraise the evidence and to subsequently present interpretive conclusions regarding the effectiveness of regenerative therapy for the treatment of furcation defects and recommendations for future research in this area. METHODS: A systematic review was conducted before the consensus meeting. This review aims to evaluate and present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy. During the meeting, the outcomes of the systematic review, as well as other pertinent sources of evidence, were discussed by a committee of nine members. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group agreed on a comprehensive summary of the evidence and also formulated recommendations for the treatment of furcation defects via regenerative therapies and the conduction of future studies. RESULTS: Histologic proof of periodontal regeneration after the application of a combined regenerative therapy for the treatment of maxillary facial, mesial, distal, and mandibular facial or lingual Class II furcation defects has been demonstrated in several studies. Evidence of histologic periodontal regeneration in mandibular Class III defects is limited to one case report. Favorable outcomes after regenerative therapy for maxillary Class III furcation defects are limited to clinical case reports. In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although generally Class I furcation defects may be treated predictably with non-regenerative therapies. There is a paucity of data regarding quantifiable patient-reported outcomes after surgical treatment of furcation defects. CONCLUSIONS: Based on the available evidence, it was concluded that regenerative therapy is a viable option to achieve predictable outcomes for the treatment of furcation defects in certain clinical scenarios. Future research should test the efficacy of novel regenerative approaches that have the potential to enhance the effectiveness of therapy in clinical scenarios associated historically with less predictable outcomes. Additionally, future studies should place emphasis on histologic demonstration of periodontal regeneration in humans and also include validated patient-reported outcomes. CLINICAL RECOMMENDATIONS: Based on the prevailing evidence, the following clinical recommendations could be offered. 1) Periodontal regeneration has been established as a viable therapeutic option for the treatment of various furcation defects, among which Class II defects represent a highly predictable scenario. Hence, regenerative periodontal therapy should be considered before resective therapy or extraction; 2) The application of a combined therapeutic approach (i.e., barrier, bone replacement graft with or without biologics) appears to offer an advantage over monotherapeutic algorithms; 3) To achieve predictable regenerative outcomes in the treatment of furcation defects, adverse systemic and local factors should be evaluated and controlled when possible; 4) Stringent postoperative care and subsequent supportive periodontal therapy are essential to achieve sustainable long-term regenerative outcomes.

Clinical performance of access flap in the treatment of class II furcation defects. A systematic review and meta-analysis of randomized clinical trials.

OBJECTIVES: To systematically review the performance of access flap (OFD) in the treatment of class II furcation defects (FD). METHODS: RCTs evaluating surgical treatment of class II FD with OFD, minimum 6 months follow-up were identified. Screening, data extraction, and quality assessment were conducted independently by three reviewers. The primary outcomes were tooth survival and change in the horizontal clinical attachment level (HCAL). Changes in vertical clinical attachment level (VCAL), reduction of pocket probing depth (PPD), recession increase (REC), horizontal (HBL), and vertical bone level (VBL) were also collected. RESULTS: The search identified 1571 studies out of which 11 articles met the inclusion criteria. Data analysis was performed on 199 patients and 251 FD. Tooth survival was seldom reported. Altogether with inflammatory amelioration, the weighted mean differences were for HCAL 0.96 mm [CI: (0.60, 1.32), p < 0.001], 0.55 mm [CI: (0.00, 1.10), p = 0.05] for VCAL gain. PPD reduction over 6 months was 1.38 mm [CI: (0.91, 1.85), p < 0.01]. Potential risk of bias was identified. CONCLUSIONS: Teeth with mandibular class II furcation involvement treated with OFD show significant clinical improvements 6 months after surgery. Nevertheless, in order to better understand the magnitude of these changes and their clinical relevance, prospective long-term trials are needed.

Enamel matrix protein derivative plus synthetic bone substitute for the treatment of mandibular Class II furcation defects: a case series.

OBJECTIVES: The aim of this study is to report on the treatment of mandibular Class II furcation defects with enamel matrix protein derivative (EMD) combined with a ßTCP/HA (ß-tricalcium phosphate/hydroxyapatite) alloplastic material. METHOD AND MATERIALS: Thirteen patients were selected. All patients were nonsmokers, systemically healthy, and diagnosed with chronic periodontitis; had not taken medications known to interfere with periodontal tissue health and healing; presented one Class II mandibular furcation defect with horizontal probing equal to or greater than 4 mm at buccal site. The clinical parameters evaluated were probing depth (PD), relative gingival margin position (RGMP), relative vertical clinical attachment level (RVCAL), and relative horizontal clinical attachment level (RHCAL). A paired Student t test was used to detect differences between the baseline and 6-month measurements, with the level of significance of .05. RESULTS: After 6 months, the treatment produced a statistically significant reduction in PD and a significant gain in RVCAL and RHCAL, but no observable change in RGMP. RVCAL ranged from 13.77 (± 1.31) at baseline to 12.15 (± 1.29) after 6 months, with a mean change of -1.62 ± 1.00 mm (P < .05). RHCAL ranged from 5.54 (± 0.75) to 2.92 (± 0.92), with a mean change of -2.62 ± 0.63 mm (P < .05). After 6 months, 76.92% of the patients improved their diagnosis to Class I furcation defects while 23.08% remained as Class II. CONCLUSION: The present study has shown that positive clinical results may be expected from the combined treatment of Class II furcation defects with EMD and ßTCP/HA, especially considering the gain of horizontal attachment level. Despite this result, controlled clinical studies are needed to confirm our outcomes.

Furcation Measurements: Realities and Limitations.

Furcation involvement is a common sequela of severe chronic periodontal disease. Its effective management has a profound influence on the outcome of periodontal therapy. For the efficient clinical management of furcation defects, it is necessary to have a reliable diagnostic tool that can accurately measure and quantify the furcation defect. This article addresses the various diagnostic methods available and assesses their limitations. Further, it also highlights some new frontiers in the field of furcation diagnosis and measurements.

Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.

This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ≥6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient.

Treatment outcome of mineral trioxide aggregate: repair of root perforations-long-term results.

INTRODUCTION: This historical cohort study follows on a previously reported trial, with the aim of assessing the outcome for teeth with root perforations managed by the orthograde placement of mineral trioxide aggregate (MTA) and identifying potential outcome factors for such treatment with a larger sample size and longer follow-up periods than in the first phase of the project. METHODS: The treatment outcomes of 64 root perforations repaired between 2000 and 2012 with MTA were investigated. The root perforations were located in different areas of the root. Calibrated examiners assessed clinical and radiographic outcomes by using standardized follow-up protocols 12-107 months after treatment (median, 27.5 months). Preoperative, intraoperative, and postoperative information was evaluated. The outcomes were dichotomized as healed or diseased. RESULTS: Of the 64 teeth examined (85% recall rate), 86% were healed. The univariate analyses (χ(2) tests) identified 2 potential prognostic factors, experience of the treatment providers (odds ratio, 2.14; 95% confidence interval, 0.39-11.74; P < .01) and placement of a post after treatment (odds ratio, 0.06; 95% confidence interval, 0.01-0.27; P < .01). In the multivariate stepwise logistic Cox regression, none of the potential prognostic factors displayed a significant effect on the outcome at the 5% level. CONCLUSIONS: MTA appears to have good long-term sealing ability for root perforations regardless of the location. The results of this historical cohort study confirm the results of the first phase of this project.

Evaluation of periodontitis and bone loss in patients undergoing hemodialysis.

BACKGROUND: Chronic kidney disease has been a worldwide public health challenge and also a risk factor for oral health. The objectives of this study are to investigate the periodontal status in Chinese patients undergoing hemodialysis (HD) and assess periodontal bone loss (BL) using cone-beam computerized tomography (CBCT). METHODS: The patients in the HD and control groups received periodontal and CBCT examinations in the same period. Age, sex, and HD details were obtained from a hospital database. Periodontal status was evaluated using the community periodontal index (CPI) and clinical attachment loss (AL). Periodontal BL was measured by the distance from the cemento-enamel junction to the alveolar crest using CBCT. The distance between the furcation upper and lower boundaries was considered the furcation defect. RESULTS: One hundred two patients undergoing HD and 204 control patients were enrolled. As for the demographic data and number of remaining teeth for each patient, there was no significant difference between HD and control groups. The CPI and AL showed statistical differences (P <0.001). The results of periodontal BL indicated that the patients undergoing HD had significantly more BL at their mandibular first premolars and first molars than did patients in the control group (P <0.01) at every site except the disto-buccal one (P <0.05). As for the furcation defects, the distance for the patients undergoing HD was nearly double that of the patients in the control group (P <0.001). CONCLUSION: Compared with the generally healthy population, periodontitis and periodontal BL were significantly more severe in the Chinese patients undergoing HD.

Periodontal pathogens and associated factors in aggressive periodontitis: results 5-17 years after active periodontal therapy.

OBJECTIVES: To assess the association between presence of periodontal pathogens and recurrence of disease in patients with aggressive periodontitis (AgP) after active periodontal therapy (APT) and further influencing factors. MATERIAL & METHODS: Microbiological samples were taken from 73 patients with AgP 5-17 years after APT at 292 sites (deepest site per quadrant). Real-time polymerase chain reactions were used to detect the periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. Uni- and multivariate analyses evaluated the associations between pathogens and recurrence of disease, smoking and adjunctive antibiotic therapy. RESULTS: At re-examination A. actinomycetemcomitans could be detected in six patients (8.2%), P. gingivalis in 24 (32.9%), T. forsythia in 31 (42.5%) and T. denticola in 35 (48.0%). Increased levels of T. forsythia and T. denticola at re-examination were significantly associated with recurrence of disease in multivariate analyses (OR: 12.72, p < 0.001; OR 5.55, p = 0.002 respectively). Furthermore, high counts of T. denticola were found in patients with increased percentage of sites with clinical attachment levels (CAL) ≥ 6 mm compared to those with low counts (13.8% versus 3.2%, p = 0.005). CONCLUSION: In patients with recurrence of disease T. forsythia and T. denticola were detected more frequently and in higher counts. Furthermore, T. denticola was found more frequently in patients with increased CAL.

Periodontal probing versus radiographs for the diagnosis of furcation involvement.

BACKGROUND: Decisions in periodontal therapy for multirooted teeth are essentially based on accurate diagnosis of the furcation involvement (FI). Furcation probing (FP) is still the basic diagnostic measure, although the assessment may be difficult. The aim of this study is to evaluate the validity of FP and radiographic assessment of FI compared with visual assessment during open flap surgery (OFS). METHODS: In this retrospective clinical cohort study, 215 participants with periodontal disease and at least one molar treated with OFS were enrolled, and a total of 834 molars were assigned for FI by FP and in radiographs analyzed by an experienced (EE) and less experienced examiner (LE). For the investigation, 143 panoramic radiographs (OPGs) and 77 intra-oral radiographs (I-Os) were evaluated. RESULTS: The Class of FI by FP was confirmed in 56%, whereas 15% were overestimated and 29% underestimated. FI Class 0 and I had been detected with high probability (74% and 54%, respectively). Of all FI Class III, 57% were detected correctly by radiographs and 32% by FP. FP and OFS revealed a weighted κ-coefficient (κw) = 0.588; radiographs and OFS had κw = 0.542 (OPG κw = 0.555 and I-O κw = 0.521). The interrater reliability for radiographs was dependent on the experience of the examiner (EE κw = 0.618; LE κw = 0.426). CONCLUSIONS: Experience in analyzing conventional radiographs increases the potential of correct diagnosis of advanced FI. The reliability of FP compared with radiographic assessment depends on the anatomy and location of the tooth. Both diagnostic tools should be used in cases of suspected FI.

An evidenced-based scoring index to determine the periodontal prognosis on molars.

BACKGROUND: This retrospective study evaluates and assigns scores to six prognostic factors and derives a quantitative scoring index used to determine the periodontal prognosis on molar teeth. METHODS: Data were gathered on 816 molars in 102 patients with moderate-to-severe periodontitis. The six factors evaluated (age, probing depth, mobility, furcation involvement, smoking, and molar type) were assigned a numeric score based on statistical analysis. The sum of the scores for all factors was used to determine the prognosis score for each molar. Only patients with all first and second molars at the initial examination qualified for the study. All patients were evaluated a minimum of 15 years after treatment. RESULTS: The post-treatment time ranged from 15 to 40 years and averaged 24 years. When the study was completed, 639 molars survived (78%), and, of those surviving molars, 588 survived and were periodontally healthy (92%). In molars with lower scores (scores 1-3), the 15-year survival rates ranged from 98% to 96%. In molars with middle scores (scores 4-6), the 15-year survival rates ranged from 95% to 90%, and, for molars with higher scores (scores 7-10), the survival rates ranged from 86% to 67%. CONCLUSION: The present results indicate that the periodontal prognosis of molars diagnosed with moderate-to-severe periodontitis can be calculated using an evidence-based scoring index.

Tooth loss in individuals under periodontal maintenance therapy: 5-year prospective study.

BACKGROUND AND OBJECTIVE: Tooth loss (TL), one of the most visible results of the evolution of periodontitis, causes physiological and psychological impacts on a patient's life. This prospective study aimed to evaluate the incidence, underlying reasons and influence of risk predictors for the occurrence of TL in a program of periodontal maintenance therapy (PMT) over 5 years. METHODS: The sample comprised 212 individuals diagnosed with chronic moderate-severe periodontitis, who had finished active periodontal treatment, were incorporated in a PMT program. Individuals were divided in to two groups: 96 regular compliers (RC) and 116 irregular compliers (IC). Full-mouth periodontal examination was performed. Social, demographic, behavioral and biological variables of interest were collected at all PMT visits. The effect of risk predictors and confounders for TL, as well as the underlying reasons of TL, were assessed by univariate and multivariate analysis. RESULTS: TL was significantly lower among RC (0.12 teeth lost/year) in comparison to IC (0.36 teeth lost/year; p < 0.01). Individuals that were > 55 years old, males and smokers lost significantly more teeth in both groups (with IC > RC). The number of teeth lost due to periodontal reasons was significantly higher than TL for other reasons in both groups (p < 0.01). The final linear and logistic model for TL included: male gender, smoking, probing depth 4-6 mm in up to 10% of sites and irregular compliance. CONCLUSION: IC individuals undergoing PMT presented higher rates of TL when compared to RC individuals. Findings demonstrated the influence of irregular compliance and the importance of monitoring other risk predictors for TL such as smoking, male gender and severity of probing depth during PMT.

The accuracy of cone-beam computed tomography in assessing maxillary molar furcation involvement.

AIM: The aim of this study was to investigate the accuracy of cone-beam computed tomography (CBCT) in assessing maxillary molar furcation involvement (FI). MATERIALS AND METHODS: Fifteen patients with generalized chronic periodontitis after initial therapy were recruited. CBCT was performed in maxillary molars with probing pocket depths of ≥6 mm and advanced FI, and CBCT images were analysed. Furcation surgery was performed in 20 maxillary molars. Lastly, intra-surgical FI assessments were compared with CBCT-based data. RESULTS: Intra-surgical findings confirmed 82.4% of the CBCT data, with a weighted kappa of 0.917. The agreement between both assessments was the highest in buccal furcation entrances, followed by distopalatal and mesiopalatal furcation entrances. Of the four parameters tested of detailed root anatomy and furcation morphology, the mean length of the root trunk and the width of the furcation entrance revealed by CBCT were consistent with their respective intra-surgical values (p > 0.05). Horizontal bone loss and vertical bone loss were underestimated by CBCT relative to their respective intra-surgical classifications (p ≤ 0.05). CONCLUSIONS: Cone-beam computed tomography images demonstrate a high accuracy in assessing the loss of periodontal tissue of the FI and root morphologies in maxillary molars.

Periodontal conditions in patients with Marfan syndrome - a multicenter case control study.

BACKGROUND: Marfan syndrome (MFS) is a disorder of the connective tissues. Alterations of the elastic fibers may manifest in different tissues especially in the skeletal, cardiovascular and ocular system. Oral manifestations like orthodontic or skeletal anomalies and fragility of the temporomandibular joint have been well described by various authors. However, no data are available regarding a possible periodontal involvement of MFS. Hence, the aim of the present study was to investigate for the first time if MFS may increase the susceptibility to periodontitis. METHODS: A comprehensive periodontal examination including documentation of probing pocket depth, gingival recession, clinical attachment level, and bleeding on probing was conducted in all patients. In addition, dental conditions were assessed by determining the Index for Decayed, Missing and Filled Teeth (DMFT) and a self-administered questionnaire was filled out by patients. For statistical analysis, the unpaired t-Test was applied (level of significance: p < 0.05). Both groups were matched concerning well known periodontal risk factors like age, gender and smoking habits. RESULTS: 82 participants, 51 patients with MFS (30 female and 21 male, mean age: 40.20 ± 15.35 years) and 31 sound controls (17 female and 14 male, mean age: 40.29 ± 13.94 years), were examined. All assessed periodontal and dental parameters were not significantly different between groups. CONCLUSIONS: Based on our data, patients with MFS did not reveal a higher prevalence of periodontitis compared to the control group. However, Marfan patients showed a tendency to more inflammation signs, which can be explained by the crowded teeth. Therefore, a regular professional cleaning of the teeth is recommendable (i.e., 6 months intervals) in order to reduce the bacterial biofilm in the oral cavity and thus resulting in a decreased risk of systemic diseases, specifically endocarditis.