Success rates in periodontal treatment as related to choice of evaluation criteria

Abstract

Background, aims: The aim of the present investigation was to determine the success rates of treatment of 36 patients with moderate to advanced periodontal disease as related to different clinical and radiographic criteria. Method: The treatment comprised oral hygiene education, subgingival scaling and root planing, and when judged indicated, periodontal surgery. An “evaluation criteria staircase” comprising 5 levels was introduced to be utilized for evaluation of the treatment results in 4 proximal sites (1 in each quadrant) which were followed for 3 years. The highest level of the staircase (level 1) is the most challenging and comprises the traditonal criteria for “perfect” periodontal health, while the lower levels are gradually less demanding. Results: At the follow‐up examination 3 years after active treatment, 52.1% of the experimental sites fulfilled the criteria for successful treatment according to level 1. On the lowest level (level 5) which only required no further loss of alveolar bone for treatment to be considered “successful”, the number of such treated sites reached 95.1%. The present data showed that even if level 5 was accepted as the evaluation criterion for “success”, resulting in very few failed sites (4.9%), these sites may demand considerable extra clinical time and costs for retreatment because of their distribution among many individuals (13.2%). This clinical time increases substantially if higher levels of success are desired. From a cost‐benefit point of view, it is therefore of utmost importance that not only patient compliance but also disease resistance and the value of the affected tooth for the dentition are taken into consideration when the indications for retreatment are weighed. This is especially important since many sites were found to be non‐progressive for a long time, even though they did not exhibit perfect periodontal health. Conclusions: It is suggested that the “evaluation criteria staircase” presented in this paper might be a helpful clinical instrument for decision‐making in individually designed and site‐related retreatments of patients with periodontal disease.

Success of non‐surgical periodontal therapy in adult periodontitis patients: A retrospective analysis

“…Success rates at site level are higher than the overall success rate due to the fact that many subjects exhibited a mixture of both diseased and healthy sites . The results of a clinical study with a follow‐up of 36 months after active therapy show that based on a construction of clinical parameters to define success 26% of the individuals exhibited “perfect” periodontal health and were considered to be successfully treated . In the light of this, the success rate of 39% in the present study could also be seen as an acceptable success.…”

“…Based on our definition, the success rate in the present study was 39%, which implies that in 61% the goal was not reached. Of course, the effect of treatment may improve further if a period of maintenance is offered or that additional periodontal therapy such as flap surgery is provided. However, the overall success of 39% from clinical perspective could be considered disappointing.…”

“…Other researchers have also pointed out that if a satisfactory treatment result is obtained the number of successfully treated individuals is much lower than the successfully treated sites. Success rates at site level are higher than the overall success rate due to the fact that many subjects exhibited a mixture of both diseased and healthy sites . The results of a clinical study with a follow‐up of 36 months after active therapy show that based on a construction of clinical parameters to define success 26% of the individuals exhibited “perfect” periodontal health and were considered to be successfully treated .…”

Success of supportive periodontal therapy in periodontitis patients — A retrospective analysis

“… 7 An important focus area during SPT is supragingival plaque control, as this has proven to maintain the obtained stable periodontal condition. 8 , 9 As periodontitis is a multifactorial disease, the interaction between different factors contributing to individual susceptibility for developing the disease may influence patients’ response to periodontal therapy and their stability during SPT. 3 , 10 Even after the completion of periodontal therapy with the most optimal results, life‐long supportive care to prevent the recurrence of periodontitis is recommended.…”

“…To ensure long‐term stability of the periodontium after APT, patients are entered into a supportive periodontal therapy (SPT) programme to reduce the possibility of reinfection and further development of periodontitis 7 . An important focus area during SPT is supragingival plaque control, as this has proven to maintain the obtained stable periodontal condition 8,9 . As periodontitis is a multifactorial disease, the interaction between different factors contributing to individual susceptibility for developing the disease may influence patients’ response to periodontal therapy and their stability during SPT 3,10 .…”