Outcome of treatment in subjects with different severity of periodontal disease. A longitudinal evaluation

Abstract

The overall aim of the present thesis was to describe the early and more long-term outcome of different modalities of periodontal treatment in subjects with varying severity of periodontal disease. Based on the periodontal attachment and bone level measurements made at a Baseline examination, two groups of subjects were identified: one group with a low prevalence of severe periodontal disease "Normal Group"(NG); one group with high susceptibility to periodontal disease "High Susceptible Group"(HSG). The NG received non-surgical therapy alone, while the HSG received either non-surgical or surgical therapy, or systemic administration of metronidazole and amoxicillin as an adjunct to scaling and root planing. Following treatment, the subjects of both groups were included in a professionally supervised maintenance care program (SPT) and were followed for periods ranging between 2 and 12 years. From the findings made in the present series of studies it was concluded that:1) non-surgical periodontal therapy followed by SPT including regularly (every 3 months) repeated oral hygiene instruction and subgingival debridement, markedly retarded the rate of disease progression in HSG. In some susceptible subjects (about 20%) however, recurrence of disease occurred during SPT;2) in NG, attachment loss and recession of the gingival margin at buccal sites was a common finding during SPT. Sites with recession at Baseline were susceptible to additional apical displacement of the gingival margin. Furthermore, loss of periodontal tissue support at approximal surfaces was associated with buccal soft tissue recession;3) in patients with advanced periodontitis and high prevalence of sites with deep pockets, surgical therapy was more effective than non-surgical scaling and root planing in reducing pocket depth;4) the use of systemic metronidazole and amoxicilln in combination with scaling and root planing, seemed to improve the outcome of therapy and arrest progressive periodontitis for a at least two years. Following the two year interval, however, recurrence of disease was frequently observed