Abstract

Introduction: in patients suffering of chronic to severe generalized periodontitis, there are teeth at borderline, rising the question of retaining or extracting. It has been show, that teeth with qouestionable periodontal prognosis can be retained in most of the cases. Objective: to propose a proof of concept to report the survival rate, tooth loss of teeth with severe reduced attachment apparatus, and to use it to assess, for the use of a Romanian periodontal clinic, the ability of long term supportive periodontal care to modify the prognosis from hopeless to unfavorable or questionable. Methods: based on the research data on regenerative periodontal surgery issued by the team of the clinic (mainly clinical parameters as Pocket Depth, Bleeding on Probing, Clinical Attachment Level, but also tooth survival and common risk factors), full-text articles on human studies were electronically searched in PubMed and in relevant scientific journals. The query used in the advanced search offered 1,486 results. Studies were considered for inclusion if limited to patients with moderate to severe periodontitis, who underwent active periodontal therapy (APT) and followed a supportive periodontal care (SPT) program for at least 5 years. Also, they had to report data on tooth loss, diagnosis, prognosis, treatment approach, supportive periodontal treatment, treatment outcome. Results: from 18 articles selected, only 6 referred to regenerative surgical therapy. In patients treated with surgical regenerative procedures alone, the conclusions were: more than 92% of the treated teeth presented up to 15 years after regeneration with CAL in a position equal or more coronal than at baseline, when the infection-control phase of periodontal therapy was completed. The long-terms benefits of periodontal regeneration are: greater short-term CAL gain and PPD reduction, absence of tooth loss, less periodontitis progression and less need for re-intervention.

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