Periodontal treatment molars longevity

Periodontal treatment of molars – Treat it or pull it?

The Journal of Periodontology recently published an article following over 800 molars that had periodontal treatment done with post-treatment time ranging from 15 to 40 years (average of 24 years). They created a scoring system based on age, probing depth, mobility, furcation involvement, molar type, and smoking and tracked how long these teeth lasted if treated.  They wanted to do diabetes as well but lacked enough patients with the disease to be statistically significant.  Here are the results in graph form.

 

‘‘What type of periodontal treatment was rendered?’’ All non-mobile molars were treated. This could account for the low percentage (3.9%) of molars extracted during active treatment.  Molars with PD exceeding the depth of effective scaling and root planing (SRP) (5 mm), were treated with osseous surgery with an emphasis on thorough SRP. Later in the study, when freeze-dried bone allograft became available, osseous graft material was placed in craters; even later, strips of polyglactin 910 tightweave woven mesh were placed.

 

Results

“Within the parameters of this study, it is proposed that a more accurate periodontal prognosis can be determined provided the following criteria are met by the patient: 1) complete the recommended periodontal therapy; 2) follow the  recommended maintenance regimen; 3) practice adequate daily plaque removal; and 4) refrain from smoking.”

The present study finds that smoking (HR = 3.38), PD (HR = 1.33), and mobility (HR = 1.45) were the most significant prognostic factors.

 

Results from similar studies

Smoking, diabetes, age, sex, tooth mobility, severity of furcation, non-vital pulp, and parafuncitonal habit without bite guard all were strong indicators in survival of treated molars.

Interestingly, to me anyway, is that based on a meta-analysis bleeding on probing (BOP) was found to be a poor forecaster of disease activity and was not a reliable indicator of the demise of teeth. However, the absence of BOP is an excellent predictor of no future AL.