Diabetes as a prognostic factor in periodontitis

Background + Aims

• Supportive periodontal care (SPC) is critical for maintaining periodontal stability and preventing recurrence of periodontitis. Personalising treatment plans is increasingly essential due to varying chronic illnesses and patient capacities. Periodontal breakdown during SPC often necessitates additional active therapy, highlighting the need for robust risk assessment tools.
• Staging/grading criteria from the 2017 World Workshop on diagnosing periodontitis may help predict post-treatment breakdown, particularly in severe cases (Stage III/IV, Grade C).
• Regular SPC visits significantly reduce the risk of tooth loss in high-risk patients, though associated costs may not decrease.
• Few studies have explored the relationship between periodontitis stage/grade, SPC compliance, and the need for further treatment. It has been hypothesised that disease severity correlates with the need for additional surgical or non-surgical interventions, which may influence cost-effectiveness by preventing tooth loss and other complications.
• This study aimed to evaluate the incidence of retreatment during SPC, identify contributing factors to instability, and calculate mean cumulative costs by stage, grade, and compliance.

Materials + Methods

• This retrospective study analysed periodontal patients treated at the University of Michigan School of Dentistry with a minimum follow-up of 10 years. Data from physical and electronic records included demographic details, medical histories (smoking and diabetes status), baseline periodontal charting, and radiographs. Exclusions applied to incomplete records, external treatment, or missing smoking/diabetes details.
• Patients were staged and graded using 2017 World Workshop case definitions.
• Follow-up data spanned from the first SPC visit after active therapy to the last documented SPC visit. SPC visits included reassessment of risk factors, oral hygiene reinforcement, and removal of supra- and sub-gingival plaque when needed. Maintenance compliance was evaluated through the number, regularity, and frequency of SPC visits. Patients were categorised into two groups: those requiring additional sub-gingival instrumentation or surgery during SPC and those who did not.
• Cost analysis considered treatment and maintenance costs in 2022 USD, including SPC sessions, SGI, SUR, and tooth replacement with implants.
• Statistical analyses identified factors associated with additional subgingival instrumentation/ surgery using logistic regression and survival analyses.
• Outcomes measured included the incidence, timing, and cost-effectiveness of additional interventions during SPC.

Results

• The study included 442 patients (mean age 47.5 years) with a follow-up of 22.7 years.
• 56.6% of patients adhered to SPC protocols, while 43.4% were erratic compliers.
• Approximately 38% of Stage I-II and 28% of Stage III-IV patients required no further treatment after active periodontal therapy (APT).
• 42% of Grade A, 32% of Grade B, and 28% of Grade C did not require further treatment in SPC.
• Stage III-IV and Grade C patients received more surgery during SPC.
• Multiple binary logistic regression models revealed that higher staging and grading did not increase the probability of subgingival instrumentation during SPC, but the total number of SPC visits during the follow-up period did.
• Multiple binary logistic regression models demonstrated that patients with stage IV periodontitis had an increased probability of having SUR during the follow-up period.
• Risk factors such as smoking and diabetes were associated with an increased risk of receiving surgery during the follow-up period.
• Stage III-IV and Grade C patients exhibited greater cumulative costs compared to less severe cases.

Limitations