Diabetes as a prognostic factor in periodontitis

Background + Aims

• Tooth loss (TL), a significant outcome of periodontitis, affects patients physiologically and psychologically. Periodontal therapy and patient compliance during supportive periodontal care (SPC) are crucial in reducing TL risk.
• Studies highlight patient- and tooth-related factors influencing TL, including periodontal bone loss, tooth mobility, furcation involvement (FI), tooth type, and vitality, with FI identified as a major predictor of molar survival.
• Molars with FI are particularly prone to further attachment loss and have double the risk of being lost during SPC.
• This study aimed to evaluate the impact of FI on molar longevity and factors influencing molar loss during SPC.

Materials + Methods

• The study analysed data from 222 patients diagnosed with stage II-IV periodontitis who underwent SPC for at least 10 years in a private dental clinic.
• Clinical parameters, including probing depth, clinical attachment level, and furcation involvement (FI), were recorded at baseline (T1) and after 10 years (T2).
• The study assessed molar loss (ML) as the primary outcome and identified contributing tooth- and patient-related factors, including FI degree, compliance, smoking, diabetes, and socio-economic factors.
• Treatment included non-surgical and surgical interventions, such as resective surgery for FI II, root amputation, hemisection or tunnelling procedures for FI – III.
• Tooth vitality was assessed using sensitivity tests and radiographic assessments.
• Compliance was evaluated based on SPC attendance.
• Statistical analyses, including multilevel Cox regression and mediation analysis, were used to identify, respectively, the independent risk factors and assess the role of compliance in the relationship between FI and molar survival.

Results

• Loss of molar teeth was analysed amongst 222 patients with stage II-IV periodontitis undergoing 12.4 years of SPC.
• Of 5,315 teeth present at baseline (T1), 542 teeth were lost by follow-up (T2), including 235 molars (43.2% of all teeth lost).
• The molar survival rate during SPC was 82.3%, with loss of molars strongly associated with furcation involvement (FI). Molars with FI = III exhibited the highest relative risk (RR = 19.7) for loss compared to FI = 0.
• Periodontal parameters, including probing depth and bleeding on probing, significantly worsened over time.
• Compliance with SPC mitigated the risk of ML, with non-compliers exhibiting a hazard ratio (HR) of 2.42.
• Patient-related factors significantly associated with ML included age >50 years (HR = 1.41), male gender (HR = 1.21), diabetes (HR = 3.12), and smoking (HR = 3.73).
• Tooth-related factors such as FI = II (HR = 2.63), FI = III (HR = 5.23), probing depths ≥5 mm (HR = 3.78), and non-vitality (HR = 2.88) were strongly predictive of ML.
• The mediation analysis demonstrated a significant role of compliance in mitigating molar loss risk associated with FI, with compliance explaining 89.5% of the mediation effect.

Limitations