Frequency, cost, and time to re-treatment after active periodontal therapy.

Abstract

Background: Supportive periodontal therapy (SPT) reduces the probability of infection reoccurrence further disease progression. Despite that, several patient/tooth related variables have been linked to tooth loss during SPT. This longitudinal study examines the correlation between periodontal staging, grading, initial therapy, and frequency, cost, and time-to-re-treatment following active periodontal therapy (APT).

Methods: Patients who received scaling and root planing (SRP) or surgery (SUR) were included. Demographics, annual SPT visits, and medical history were collected. Radiographic bone loss (RBL), probing depths (PD), and clinical attachment loss were collected at six sites/tooth. A simple binary logistic regression model assessed the probability of re-treatment. Multiple models were constructed while adjusting for confounding factors: sex, age, number of SPT visits, and baseline data.

Results: Three hundred patients underwent SRP, and 142 underwent SUR as their APT. 191 patients (63.7%) required a second intervention over 24 ± 8.2-year follow-up. The second intervention type was correlated with the first (p = 0.035). The likelihood of a second intervention was higher in SUR patients (p < 0.001). Significant differences in time to first intervention based on stage (p = 0.019) and compliance (p < 0.001). Similar patterns were observed for time-to-recurrence based on stage (p = 0.03) and compliance (p = 0.017) but not grade (p = 0.144). Mean teeth "free of intervention time" was 16.3 years before the first additional therapy. However, SSD was found between stages (p = 0.028) and grades (p = 0.043) for SUR interventions, but not for SRP.

Conclusion: In this long-term study, higher stage patients and those who had surgical treatments received more frequent retreatments. The first intervention affected the likelihood and type of the second intervention. 12.4% of patients were responsible for 64% of the entire retreatment spending.

Plain language summary: Patients with more severe periodontitis who initially underwent surgery needed more frequent therapy. Patients who had surgery as their intervention during active periodontal therapy were more prone to have surgery as their additional therapy during follow-up.