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Treatment outcome of the graduate periodontics clinic at the University of British Columbia : short term and long term results

University of British Columbia

The active treatment and maintenance for 100 periodontal patients (2,512 teeth) in the graduate periodontics clinic at the University of British Columbia was surveyed. All patients were in maintenance for at least 2 years and had an average duration of maintenance of 5.2 years. A subgroup of patients that were maintained for an average of 11 years was also investigated (19 patients). Patients and teeth were evaluated separately in order to determine the effectiveness of our treatment and maintenance program in terms of probing depth (PD) reduction, attachment level (AL) changes and tooth loss. Pockets were further divided into moderate (4-6 mm) and deep (Si7 mm), while teeth were grouped into molars and nonmolars. Additionally, prognosis of individual teeth and their long-term survivability were investigated. It was found that PD improved significantly during active therapy for all pockets, i.e. 2.1 mm in deep pockets and 0.7 mm in moderate pockets. This improvement continued for the duration of maintenance. Attachment levels improved during initial treatment but slightly deteriorated during maintenance. However, clinically all attachment levels were stable for the duration of our study. Smokers showed similar initial attachment gain and probing depth improvement with nonsmokers. During maintenance though, both AL and PD measurements were better for nonsmokers. Smoking didn't result in significantly greater tooth loss compared to nonsmoking patients in our study. Furthermore, if a patient was assigned in the severe periodontitis group it was likely that he/she would show a better response in PD reduction (1.38 mm vs. 0.34 mm; p<0.01) and attachment gain (0.64 mm vs. -0.48 mm; pO.Ol) compared to moderate periodontitis patients. Pretreatment prognosis and its association with tooth survivability was also studied and the results indicate that although at 5 years the prognoses of "good" and "fair" seem to overlap, by the 11 -year mark they are well separated in terms of percentage of survivability. At 5 years the percent of surviving "good" teeth is 99.4% and that of "fair" teeth is 95.6%. However, at 11 years these numbers change to 99.1% and 89.3% respectively. Notably, the "poor" teeth still have a 79% chance of surviving for 5 years. This number was similar even when evaluating the "poor" molars, alone which showed a 77%) survivability. With molars though we also showed a direct association between survivability and the clinical parameters of increased mobility and furcation involvement. These results seem to indicate that the effectiveness of the UBC graduate periodontics clinic in maintaining its patients is comparable with other studies. Tooth loss appears to be well controlled even for smokers. However, it is likely that a more aggressive smoking cessation protocol would be advantageous to our patients especially during maintenance. When assigning a prognosis we found our criteria to be reasonable and well founded. Our suggestion of using only 4 categories of prognoses instead of the usual 5, was proven to be valid and well supported at 11 years but not at 5 years. It seems that perhaps this modified prognosis assignment (with 4 categories) that we implemented may be more reasonable and effective in terms of communication with patients and with other colleagues.

Thesis/Dissertation

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2009-10-29

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http://hdl.handle.net/2429/14358

Dental Science

University of British Columbia

UBCV

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