Long-term Evaluation of Periodontal Therapy: I. Response to 4 Therapeutic ModalitiesWayne B. Kaldahl, Journal periodontal 1996; 67:93-102

Introduction

• Several short term longitudinal trials with a various clinical parameters shown a relative small number of periodontal disease.• Previous studies compared only 2 or more

therapeutics for > 5 years.• The aim of this study is looking for the

effective of 4 modalities of periodontal treatment and seven year of supportive periodontal treatment.

Materials and Methods

•Selected sample: 82 individuals 30f & 52m

•Mean age =43.5 year.•With moderate periodontitis•Sample dropped out for some reason was

recorded in Table 1

Table-1Exam completed Number

completingNumber exiting and reason

Post-therapy (year)1234567

8278757573736951

03 moved; non compliance3 moved01 died; 1 non compliance1 moved2 moved; 1 non compliance18 dismissed; study termination

Materials and Methods conts

• Randomized split mouth designated to receive 4 types of periodontal therapy1. Coronal scaling (CS)2. Coronal scaling and subgingival root

planning (RP)3. Coronal scaling and subgingival root

planning with Modified Widman surgery (MW)

4. Coronal scaling and subgingival root planning followed by flap with osseous resection surgery (FO)

Material and Method conts

•3 following phases were performed1. Non-surgical 2. Surgical 3. Supportive (SPT) NS Phase

1. Instruction OHI2. Scaling and

polishing3. Design to

receive different treatment

Surgical Phase

•Decision of tooth extracted or root amputated if1. CAL extended to or past the apex2. Non periodontal reasons (RCT failure,

Cracked tooth; non-restorability)3. In FO quadrant to allow for establishment

of a positive osseous artchitecture.

Data collection• Supraginvial plaque: when plaque accumulating

on probe tip during pocket exam.• Gingival Suppuration: non clear exudates in

gingival crevice following lateral pressure at GM• BOP: 0.35 mm diameter probe with 25 grams,

positive bleeding within 30 s following insertion. • PD: located in bleeding area by using 50 grams

pressure. Measuring from GM.• GR: measuring from CEJ or restorative margin-

GM• CAL: calculated the sum of PD and GR.

Periodontal Breakdown sites

• CS treated site > 3mm CAL than baseline considers as unstable.• RP; MW; FO treated site > 3mmCAL than

baseline considers as unstable.• All unstable sites were retreated by RP,

but if it still has > 1mm of CAL at the area have to be treated by specialist.• Data obtained from subsequently

extracted teeth or from patient existing the study during SPT.

ResultType of Treatment

Phase PD Mean

RP, MW, FO I 1-4mm P<00.5

Phase I

PD 73% of time + 1mm 95% of time

CAL 68% of time + 1mm 94% + 2mm 100%

Results

•No significant different between 1-4mm PD in second year of SPT.

•Mean PD reduction at all examination by CS, RP, MW, FO = p<0.05

•After Phase II during year II SPT FO<MW<RP showed PD reduction, but CR showed inverse PD reduction.

Results• PD 1-4mm– During 1st 2year of SPT: FO> MW, RP increase

• CAL 1-4mm– FO no changed– MW and RP showed loss in 1st year SPT later stabilized. ▫ CR and RP showed increase of CAL in phase II▫ Loss of CAL= FO>MW>RP>CS

• CAL 5-6 mm– Gain CAL by RP and MW during SPT– Gain attachment is greater in RP; MW > CR; FO in 1st 2 year

SPT• CAL > 7mm– Gain CAL by FO; RP and MW– Gain attachment is greater in RP; MW > CR; FO in 7 year SPT– FO>MW>RP>CS.

• GR through out SPT– FO>MW>RP>CS

Prevalence of Gingival Inflammatory Indices•Bleeding: CS; RP; MW; FO reduce

bleeding ▫CS showed bleeding occurred through in

2nd year SPT.•Suppuration: CS>RP>MW>FO•Plaque: Phase I and II decrease of plaque

Disscusion

•Mean reducing PD MW>RP•MW + citric acid root treatment no

advantages in long term PD reduction.•MW better gain CAL than curette in >

7mm.•RP better gain CAL than MW in 4-6mm•FO showed greater PD reduction.•Ostectomy didn’t produce positive osseou

architecture.

Disccusion

•Principle flap and ostectomy surgery are good for crown lengthening procedure, which minimized the pocket recurrence.

•FO showed reduction of adjacent tooth attachment.

•FO=MW=RP gaining CA without ostectomy.

•Amount of plaque accumulation at site treated by FO=MW=RP.

Disscusion

•CS treated showed reducing PD, gain CAL, gain GR, decrease bleeding and suppuration.

•Small clinical changed in 5-6 mm PD.•Following up 7years therapy showed with

no different of improving clinical parameters in both non-surgical and surgical.