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Aim: Tooth loss prediction could improve decision-making for periodontally affected molars. We analysed the costs of removing all, none or only those molars predicted to be at-risk for extraction during supportive periodontal therapy (SPT)., Methods: This is a model-based study using a German private payer perspective. Building mainly on cost and effectiveness data from 2039 molars (301 patients) which received long-term SPT, five (exemplary) prediction/decision strategies were compared: Retaining all molars, removing molars with furcation involvement (FI) ≥ I/ ≥ II/ III, or removing all molars. Each strategy came with different proportions of molars correctly or erroneously (false positively) removed. Retaining as well as removing molars had long-term cost implications (via SPT or tooth replacement). Using Monte-Carlo microsimulations, we estimated the lifetime costs of an average population in our cohort and evaluated what accuracy a prediction method needed to have to save costs in different risk groups., Results: Removing only molars with FI III (1188 Euro) and removing no molars (1195 Euro) were significantly less costly than removing all molars (1454 Euro). Prediction methods needed to be highly specific in most populations to avoid unnecessary tooth loss and the associated high costs., Conclusions: Removing molars prior to SPT should be decided cautiously., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Cleft lip and palate incidence is high in northern Finland. This study aimed to investigate the proportion of children in need of restorative dental treatment among cleft lip and palate patients in northern Finland, as well as their need for dental treatment under general anesthesia. The records of 183 cleft lip and palate patients, treated in Oulu University Hospital from 1997 to 2013, were reviewed. Data on dental caries were analyzed in association with cleft type, considering also the presence of syndromes. The frequency of dental general anesthetic (DGA) use, and of treatments, were also analyzed. Dental treatment need was most frequently observed, in this rather limited study population, in patients with the most severe deformities, namely bilateral cleft lip and palate, of whom 60% had caries. Among the study population, 11.5% (n = 21) had a syndrome. Of those, 57.1% had dental caries at the age of 3 or 6 yr, and only four could be treated without a DGA. Dental treatment under general anesthesia was performed in 14.8% of cleft patients without a syndrome, but in 38.1% of those with a syndrome. General anaesthesia is required for the provision of dental care more often in cleft (17.5%) than in non-cleft (0.2%) patients, and especially for those with a syndrome., (© 2015 Eur J Oral Sci.)

Aim: To study outcomes of molar teeth after resective therapy performed with the intention to prolong the lifespan of teeth having one or more unsaveable roots, and without which tooth extraction would be inevitable., Material and Methods: Clinical records of 149 subjects who had undergone resective therapy were retrieved. Demography and dental history were recorded, and a recall examination was undertaken. Cox regression models were performed., Results: Of the 149 resective therapies, 132 (88.6%) were performed for periodontal reasons. Eighty-nine (59.7%) teeth subjected to resective therapies had been extracted by the time of recall (mean 10 years post-resection). The median survival period was 74 months. Factors significantly associated with shorter survival duration of teeth subjected to resective therapy were: age at resective therapy; pre-operative radiographic bone height of the remaining root(s) <50%; pre-treatment mobility II or above and not being splinted to neighbouring teeth nor incorporated as a bridge abutment., Conclusion: There was increased risk of tooth loss with increasing age at resection, grade II mobility or above, and reduced pre-operative radiographic bone heights around roots to remain. Splinting of a resected tooth to neighbouring teeth appeared to confer a protective effect towards its survival., (© 2012 John Wiley & Sons A/S.)

Aim: To study periodontal conditions, root caries, number of lost teeth and causes for tooth loss during 11-14 years after active periodontal treatment., Material and Methods: Sixty-four patients participated in the follow-up study. Reasons for tooth loss were identified through previous case books, radiographs and clinical photos. To identify factors contributing to tooth loss, a logistic multilevel regression analysis was used., Results: The number of lost teeth was 211. The main reason was periodontal disease (n = 153). Due to root caries and endodontic complications, 28 and 17 teeth, respectively, were lost. Thirteen teeth were lost for other reasons. The number of teeth (p = 0.05) and prevalence of probing pocket depths, 4-6 mm (p = 0.01) at baseline, smoking (p = 0.01) and the number of visits at dental hygienists (p = 0.03) during maintenance, significantly contributed to explain the variation in tooth loss., Conclusion: Previously treated patients at a specialist clinic for periodontology continued to lose teeth in spite of maintenance treatments at general practitioners and dental hygienists. The main reason for tooth loss was periodontal disease. Tooth loss was significantly more prevalent among smokers than non-smokers. Tooth-related risk factors were smoking, low numbers of teeth and prevalence of periodontal pockets, 4-6 mm., (© 2011 John Wiley & Sons A/S.)

Aim: The aim of this study was to determine the survival rates of questionable and hopeless teeth in patients with aggressive periodontitis (AgP) and chronic periodontitis (CP) during 15 years of supportive periodontal therapy (SPT)., Materials and Methods: Thirty-four AgP and 34 CP patients (SPT≥10 years) with bone loss of ≥50% at ≥2 teeth were consecutively recruited. Bone loss was measured on digitized radiographs and teeth were categorized as "questionable" (≥50 to <70% bone loss) or as "hopeless" (≥70%). Progression in pocket probing depths (PPD) during SPT, tooth loss and reasons for extraction were analysed., Results: In AgP patients, 262 teeth were considered as questionable and 63 as hopeless (CP: 149/51). During active periodontal therapy, 25 questionable and 26 hopeless teeth were extracted (CP: 12/16). During 15.3 ± 4.1 years of SPT of AgP 28 questionable and 15 hopeless teeth were removed (CP: 28/12). The mean tooth loss per patient during SPT in total was 0.14 (AgP) and 0.16 (CP) teeth/year. There were no significant differences in tooth loss or longitudinal progression of PPD between AgP and CP patients., Conclusions: In patients with AgP, 88.2% (209 of 237) of questionable and 59.5% (22 of 37) of hopeless teeth survived 15 years during regular SPT in a dental school department., (© 2011 John Wiley & Sons A/S.)

Unlabelled: Primary care outreach placements increasingly feature in UK undergraduate dental curricula. The profile of clinical work undertaken on placement may differ from traditional hospital-based programmes and between outreach settings. An appreciation of any differences could inform curriculum development., Objective: To compare the profiles of clinical work experienced on a traditional hospital-based programme and outreach placements in different settings., Setting: One dental hospital and eight existing primary care block placements in England., Subjects and Methods: Subjects were four cohorts of senior dental students in one UK dental school. Departmental records provided data on students' clinical experience in different settings and their achievement of placement learning objectives. Descriptive statistics for groups were compared., Main Outcome Measures: (1) Counts of patients encountered and of clinical procedures completed in the following categories: simple plastic restorations, endodontics, cast restorations, dentures, extractions and children's dentistry. (2) Student perceptions of placement learning reported via Likert scales., Results: Outreach students encountered twice as many patients and typically completed about three times as much clinical work as students in the hospital, e.g. 44 cf 16 simple plastic restorations, seven cf two endodontic procedures. There were variations in profiles by setting. For example, amalgam being more likely to be used on outreach especially in the General Dental Service; more children's dentistry in community services and more extractions in Dental Access Centres. Students reported learning outcomes generally being achieved (average 94%) although with some variation by setting., Conclusion: Dental outreach training greatly increases the quantity of students' clinical experience in everyday dentistry compared to a hospital-based programme. Placements also increase awareness of service delivery and develop clinical skills. There are appreciable variations between outreach settings possibly reflecting their purposes. Multiple contrasting outreach placements for each student might increase the uniformity of learning experiences.

Background: The Aims of this retrospective study were: (i) to describe the applicability of Fibre Retention Osseous Resective Surgery (FibReORS) to infrabony defects with different radiographic depths and (ii) to identify significant anatomical elements associated with the decision of tooth extraction or application of FibReORS in the context of a treatment approach aimed at pocket elimination., Material and Methods: Baseline radiographs with detectable infrabony defects were collected from 68 periodontal patients. Selected teeth with radiographic evidence of infrabony defects had probing depths (PD) >4 mm at revaluation following non-surgical periodontal therapy. Teeth were then surgically treated with FibReORS or extracted on the basis of the decision making of an experienced periodontist and in the context of the overall treatment plan. The total root length and the defect depth were quantified for each selected tooth using radiographic reference points., Results: A total of 324 teeth with infrabony defects were identified. Fifty-three (16%) teeth with a mean radiographic infrabony defect of 8.5+/-1.7 mm (range 6-12 mm) were extracted; 271 (84%) teeth with a mean infrabony defect of 3.0+/-1.4 mm (1-8 mm) were surgically treated, achieving PD < or =3 mm in all sites at 6-month follow-up. Surgically treated teeth showed baseline radiographic infrabony defects < or =4 mm in 86% of the cases. Logistic multilevel modelling indicated that the probability of extraction was influenced by root length (p=0.0230) and by the radiographic defect depth (p=0.0112)., Conclusion: FibReORS is applicable in the treatment of shallow to moderate bony defects and deeper defects associated with longer roots.

Background: Long-term tooth retention is the main objective of periodontal treatment. The aim of this retrospective study was to describe the prevalence and reasons of tooth extraction during active periodontal therapy (APT) and supportive periodontal care (SPC) in periodontal patients., Material and Methods: Three hundred and four periodontal patients were examined. APT consisted of non-surgical periodontal treatment and fibre retention osseous resective surgery, where needed, to obtain no sites with PD>3 mm. All patients participated in an SPC programme for 3-17 years (mean time 7.8 years)., Results: At the initial examination, 45% of the patients had moderate periodontitis and 41% severe periodontitis. During APT, 576 teeth were extracted (7.5%). The main reason for tooth extraction during APT was the presence of advanced periodontal lesions (44%). The number of tooth extractions was higher in cases with severe periodontitis. Extracted teeth showed a mean bone loss of 76% of the total root length. During SPT, a total of 67 teeth were removed (0.9%) in a subgroup of 50 patients. The clinical problems were primarily related to the incidence of root fracture (48%) and secondarily to the progression of periodontal disease (30%)., Conclusion: Prevalence of tooth extraction during APT is associated with the severity of periodontal disease. Tooth loss during supportive periodontal care may be negligible when a meticulous SPC programme is performed in patients where minimal probing depth is consequential to APT.

Background: In patients with periodontitis, a quantitative prognostic assessment is needed in order to make evidence-based decisions about retaining teeth or extracting and replacing them with a dental prosthesis., Methods: One hundred and ninety eight patients receiving active periodontal treatment in 1989 or 1990 and complying with supportive periodontal therapy (SPT) over an average of 11.8+/-2.3 years were included in the study. A generalized linear model was established and fitted via generalized estimating equations to identify predictors for tooth loss during SPT., Results: Of the 4559 teeth present at baseline, 166 (3.6%) were extracted during active treatment and 249 (5.5%) during SPT. Baseline findings of diabetes mellitus (OR=4.17), reduced alveolar bone levels (OR=1.04 for each 1% increment), increased tooth mobility (III versus 0: OR=5.52), multiple roots (OR=1.82), and non-vital pulp (OR=2.24) were significant (p<0.05) predictors for tooth loss during SPT. Based on these parameters, a prognostic model was constructed that provides estimates of tooth survival probability when periodontal therapy is rendered., Conclusion: Using a multivariate approach, a prognostic model was developed that may be of value for clinical decision making.

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 > or = 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: 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.

Background/aims: This retrospective survey was aimed at determining the prevalence of tooth extractions and the dental pathologies associated with them during both the active and maintenance phase of periodontal therapy in a periodontal population seeking comprehensive dental care., Methods: A total of 273 randomly selected subjects from the oral prophylaxis clinic of the University of Berne were included. All subjects had received comprehensive care consisting of periodontal and restorative treatment and participated in a supervised maintenance program for an average of 67+/-46 months (range 5 to 278 months). The population consisted of 39.6% current smokers and 27.8% previous smokers. 6.2% of the patients had gingivitis, 20.5% mild periodontitis, 48.4% moderate and 24.9% severe periodontitis. The average frequency of the recall visits was 4.4+/-1.5 appointments/year (range 1.7-12 appointments/year)., Results: Results indicated that 574 out of a total of 6503 teeth were extracted; 311 teeth were extracted during active therapy and 263 during the supportive periodontal care (SPC) phase of therapy. 46% of patients received tooth extractions as part of their active treatment and 41% during their participation in the secondary prevention program. In the subgroup whose treatment plan included extractions the average number was 2.5+/-1.6 teeth per patient. Likewise, the patients who received extractions during recall lost an average of 2.35+/-1.9 teeth per subject with an incidence of 0.4+/-0.37 teeth per patient per year. These data reinforce the concept that a minority of the population is responsible for the majority of tooth extractions, both during active therapy and SPC. Periodontal disease was the only pathology observed at 57% of the extracted teeth; while caries, endodontic pathology and technical problems in the absence of periodontitis were observed in 29% of cases., Conclusions: These observations indicate that the rendered treatment was effective in the long-term maintenance of the dentition of these subjects and suggest that advanced periodontal disease represented the major cause of tooth loss in this population.

Bleeding on probing and the presence of deep periodontal pockets are considered to be the best site-specific indicators for periodontal disease progression during the maintenance phase of periodontal therapy. A major emphasis of supportive periodontal care (SPC) programs, therefore, has been the control of bleeding pockets. This investigation retrospectively evaluated the changes in the prevalence of bleeding on probing, periodontal pockets, bleeding periodontal pockets and the prevalence of tooth loss in a random sample of 273 periodontal patients participating in a supportive maintenance care program at a University Clinic. During an observation period of 67+/-46 months (range 5 months to 23 years), the overall incidence of all causes of tooth mortality was 0.23+/-0.49 teeth per patient per year of observation. 56% of subjects, however, did not experience any tooth loss, while less than 10% of patients lost more than 3 teeth. Thus, participation in the SPC program was effective in preventing tooth loss in the majority of patients. During the SPC period, however, a significant increase in the prevalence of periodontal pockets, and of bleeding on probing positive periodontal pockets, in particular, was observed. At completion of active periodontal therapy, 56.4% of patients were free from bleeding pockets. This decreased to a mere 13.6% at the latest SPC evaluation. The observed increases in the number of bleeding pockets was significantly associated with: longer times since completion of active periodontal therapy, more advanced periodontal diagnosis, higher %s of bleeding sites in the dentition, cigarette smoking, lack of inclusion of periodontal surgery in the active treatment phase, tooth loss, and the response to the active phase of periodontal treatment. The data presented in the paper indicate that the observed increase in the prevalence of bleeding pockets and tooth loss was not homogeneously distributed in the studied SPC population. Rather, high risk groups of individuals could be identified. It is suggested that better knowledge of risk indicators may lead to improved and more efficient risk management efforts during periodontal maintenance care.

The aim of this study was to compare changes in periodontal status in a Swedish population over a period of 20 years. Cross-sectional studies were carried out in Jönköping County in 1973, 1983, and 1993. Individuals were randomly selected from the following age groups: 20, 30, 40, 50, 60, and 70 years. A total of 600 individuals were examined in 1973, 597 in 1983, and 584 in 1993. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. Based on clinical data and full mouth intra-oral radiographs, all individuals were classified into 5 groups according to the severity of the periodontal disease experience. Individuals were classified as having a healthy periodontium (group 1), gingivitis without signs of alveolar bone loss (group 2), moderate alveolar bone loss not exceeding 1/3 of the normal alveolar bone height (group 3), severe alveolar bone loss ranging between 1/3 and 2/3 of the normal alveolar bone height (group 4), or alveolar bone loss exceeding 2/3 of the normal bone height and angular bony defects and/or furcation defects (group 5). During these 20 years, the number of individuals in groups 1 and 2 increased from 49% in 1973 to 60% in 1993. In addition, there was a decrease in the number of individuals in group 3, the group with moderate periodontal bone loss. Groups 4 and 5 comprised 13% of the population and showed no change in general between 1983 and 1993. The individuals comprising these groups in 1993, however, had more teeth than those who comprised these groups in 1983; on the average, the individuals in disease group 4 had 4 more teeth and those in disease group 5, 2 more teeth per subject. In 1973, these 2 groups were considerably smaller, probably because of wider indications for tooth extractions and fewer possibilities for periodontal care which meant that many of these individuals had become edentulous and were not placed in a group. Individuals in groups 3, 4, and 5 were subdivided according to the number of surfaces (%) with gingivitis and periodontal pockets (> or =4 mm). In 1993, 20%, 42%. and 67% of the individuals in groups 3, 4, and 5 respectively were classified as diseased and in need of periodontal therapy with >20% bleeding sites and >10% sites with periodontal pockets > or =4 mm. In conclusion, an increase in the number of individuals with no marginal bone loss and a decrease in the number of individuals with moderate alveolar bone loss can be seen. The prevalence of individuals in the severe periodontal disease groups (4, 5) was unchanged during the last 10 years; however, the number of teeth per subject increased.

This study assesses the reliability of a self-reported health questionnaire completed by 413 subjects aged 25-74 yr in the Erie County Periodontal Disease (ECPD) Study. Specific questions on general and oral health conditions were completed by each subject during a first visit and at a follow-up examination 2 yr later, and the two compared. Results showed that the overall measure of agreement between the two visits is substantial (average kappa, kappa = 0.80). Variation by gender and age were minimal. Questions regarding allergy to medications, oral treatment, reason for tooth extraction, health symptoms and history of systemic diseases exhibited high levels of agreement (kappa ranged from 0.71-0.90). Information on vitamin and mineral intake yielded kappa = 0.63. Oral conditions scored the lowest but were still acceptable (kappa = 0.57). These findings indicate that there were no significant discrepancies in self-reported responses to the health questionnaire used in the ECPD Study. Although the information provided by the subject may not be as accurate as compared to laboratory testing, it is nevertheless a reliable source of information which can be utilized cost-effectively in research studies.

This study analysed data on periodontal reasons for tooth extractions, obtained from 52 dentists practising general dentistry in Singapore. The results revealed that, out of 2172 teeth extracted from 1276 patients, 35.8% were lost due to periodontal disease and 35.4% due to caries. Extraction due to periodontal problems increased with age, were more conspicuous in the Indian ethnic group and were frequently associated with pocketing and tooth mobility.