Aim The aim of this study was to investigate patient‐ and tooth‐level factors that may predict tooth loss and periodontitis progression in patients who have undergone at least 5 years of periodontal maintenance. Materials and Methods In this retrospective cohort study, 135 patients were examined after active periodontal therapy (APT) and periodontal maintenance for 5.09–8.65 years (mean 6.16 ± 0.74 years). Regression models were applied to identify risk factors associated with tooth loss and disease progression. Results Stage IV periodontitis (incidence rate ratio [IRR] = 4.61; 95% confidence interval, CI [2.97–7.18], p < .001), the presence of ≥5 sites with probing pocket depth (PPD) ≥5 mm at the end of APT (IRR = 2.04; 95% CI [1.32–3.20], p < .01), and residual PPD ≥7 mm at the end of APT (odds ratio [OR] = 3.01; 95% CI [1.14–7.94], p < .05) were risk factors for tooth loss. Residual PPDs of 5 mm (OR = 2.02; 95% CI [1.20–3.40], p < .01) and 6 mm (OR = 2.41; 95% CI [1.22–4.76], p < .05) at the end of APT were risk factors for disease progression. Above 3 mm, each 1 mm increase in maximum PPD/clinical attachment loss was associated with an increased risk of tooth loss and disease progression. Conclusions Stage IV periodontitis is associated with an increased risk of tooth loss. Teeth with PPD ≥5 mm at the end of APT are at risk of periodontitis progression or tooth loss.

Patients with rapidly progressing periodontitis may require extractions of teeth with poor periodontal prognosis. Although replacement with a dental implant is a popular choice, teeth autotransplantation remains a viable option. Herein, we report a case of a 23-year-old patient with rapidly progressing periodontitis resulting in severe clinical attachment loss on the left maxillary first molar, which required extraction. The tooth was replaced by tooth autotransplantation of the unerupted immature left mandibular third molar, which was delivered carefully without compromising the periodontal ligament. Cone beam computed tomography and three-dimensional printing of the third molar donor tooth significantly aided the tooth autotransplantation procedure. Recovery was uneventful. At the 1-year follow-up, healthy periodontal parameters and radiographic features were noted, and the autotransplanted tooth remained vital. This case showed that tooth autotransplantation is a viable option for replacing tooth loss due to rapidly progressing periodontitis.