Diabetes as a prognostic factor in periodontitis

Background + Aims

• Periodontitis is a chronic condition that damages gums and bones, leading to tooth loss. It is a major oral health issue globally and can severely affect the quality of life.
• Managing periodontitis involves regular professional cleaning and supportive care to preserve teeth over the long term.
• Molar teeth, due to their complex structure, are particularly vulnerable to periodontitis-related damage.
• Patient-related factors such as smoking, diabetes, and age, as well as tooth-specific issues like bone loss and furcation involvement, influence molar survival.
• This study aimed to assess factors contributing to molar loss over a 10-year period following active periodontal therapy (APT) and to understand how these factors impact long-term outcomes.

Materials + Methods

• A retrospective cohort study involving 136 patients with 1,015 molars was conducted.
• Patients underwent APT between 1990 and 2002, followed by regular supportive periodontal therapy (SPT) over a mean duration of 13.2 years.
• Inclusion required:
  • ≥10 years of SPT
  • Radiographic evidence of bone loss
  • Molar involvement
  • Recording of smoking habits and systemic conditions such as diabetes
• APT included professional cleaning, scaling, root planing, and, if needed, surgical treatments. SPT involved routine monitoring, cleaning, and re-treatment of at-risk sites.
• Furcation involvement (FI) and bone loss were assessed clinically and radiographically.
• Multilevel statistical analysis identified risk factors influencing molar survival.
• The primary outcome was molar loss.

Results

• Of 1,015 molars, 50 were lost during APT, and 154 were lost during SPT. This equates to 0.09 molar losses per year.
• Risk Factors:
  • Molar loss was significantly associated with:
    • Severe furcation involvement (HR: 4.68)
    • Advanced bone loss (>60%) (HR: 3.74)
    • Residual deep pockets after therapy (HR: 1.43)
    • Endodontic treatment (HR: 2.98)
    • Patient factors such as age, smoking, and diabetes (HR: 5.25 for diabetes).
  • Women and smokers had a higher risk of molar loss.
• Despite risk factors, most molars with severe furcation or bone loss survived over 10 years with appropriate therapy.
• Regular SPT and thorough initial therapy were critical to preserving teeth, even in high-risk cases.

Limitations