Diabetes as a prognostic factor in periodontitis

Background + Aims

• Periodontal breakdown can lead to further damage in nearby tissues if not treated adequately. Extracting a hopeless or non-essential adjacent tooth can enhance the survival of molars that have undergone periodontal treatment.
• Research suggests that the long-term retention of periodontally compromised teeth may be achievable without harming adjacent teeth. Regular maintenance is essential for improving the outlook of these teeth, though it can increase costs for patients. However, replacing teeth lost due to periodontal disease represents a significant financial burden.
• Dentists must evaluate the prognosis of compromised teeth to effectively communicate with patients and develop suitable treatment plans. Previous studies have highlighted that molars are at a greater risk of loss compared to other teeth, and their response to treatment is often less favourable due to their unique anatomical morphology and location.
• The primary goal of this systematic review is to assess the survival rates of molars during periodontal maintenance in patients who are periodontally compromised, as well as to identify the risk factors associated with molar loss.

Materials + Methods

• 41 studies published between 1978 and 2023 (5584 patients, 29,908 molars retained at the beginning of maintenance therapy, mean follow-up duration of 14.7 years) were included. The adapted NOS assessment revealed that 10, 24 and 7 studies had low, moderate, and high risk of bias, respectively.
• The pooled survival rate of the molars during maintenance therapy was 82%. The average loss of molars was 0.05 per patient per year among the patients receiving long-term periodontal maintenance (PM) therapy.
• Significant patient-related risk factors include older age, lack of compliance, smoking, bruxism, diabetes and lack of private insurance.
• Significant tooth-related risk factors include maxillary location, increased probing pocket depth, furcation involvement, higher mobility and lack of pulpal vitality.
• The studies were divided into three subgroups according to the average follow-up duration: <10 years, <15 years and >15 years. No significant differences were observed among the subgroups.
• Analysed periodontal interventions include resective surgery, tunnelling surgery, regenerative surgery, open flap debridement and non-surgical treatment. The molars that underwent regenerative treatment had the highest survival rate (97%). In contrast, the molars that underwent resection procedures were prone to loss (71%).
• A subgroup analysis was performed to determine the effect of the inclusion or exclusion of the third molar on the results. In terms of molar loss due to periodontal reasons during SPC, analysis of 17 studies revealed no significant differences between the two subgroups.

Results

• 41 studies published between 1978 and 2023 (5584 patients, 29,908 molars retained at the beginning of maintenance therapy, mean follow-up duration of 14.7 years) were included. The adapted NOS assessment revealed that 10, 24 and 7 studies had low, moderate, and high risk of bias, respectively.
• The pooled survival rate of the molars during maintenance therapy was 82%. The average loss of molars was 0.05 per patient per year among the patients receiving long-term periodontal maintenance (PM) therapy.
• Significant patient-related risk factors include older age, lack of compliance, smoking, bruxism, diabetes and lack of private insurance.
• Significant tooth-related risk factors include maxillary location, increased probing pocket depth, furcation involvement, higher mobility and lack of pulpal vitality.
• The studies were divided into three subgroups according to the average follow-up duration: <10 years, <15 years and >15 years. No significant differences were observed among the subgroups.
• Analysed periodontal interventions include resective surgery, tunnelling surgery, regenerative surgery, open flap debridement and non-surgical treatment. The molars that underwent regenerative treatment had the highest survival rate (97%). In contrast, the molars that underwent resection procedures were prone to loss (71%).
• A subgroup analysis was performed to determine the effect of the inclusion or exclusion of the third molar on the results. In terms of molar loss due to periodontal reasons during SPC, analysis of 17 studies revealed no significant differences between the two subgroups.

Limitations