Journal of dentistry · 2026
Long-term outcomes of regenerative periodontal therapy and orthodontic treatment: 20-year results from a prospective study.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Roccuzzo Andrea, Li Yuan, Salvi Giovanni E, Stähli Alexandra, Imber Jean-Claude, Roccuzzo Mario
Аннотация
OBJECTIVES: To evaluate the 20-year clinical outcomes of periodontal regenerative and orthodontic treatment for severely periodontally compromised teeth.
METHODS: In this prospective study, 48 patients with Stage IV periodontitis, each with at least one non-molar tooth (n = 48 test teeth) exhibiting pathologic migration and an associated intrabony defect characterized by probing depth (PD) of ≥ 7 mm, were consecutively included. The treatment protocol comprised: 1) supra/sub-gingival instrumentation (Step Ⅰ-Ⅱ); 2) periodontal regenerative surgery using enamel matrix derivative (EMD) alone or combined with a bone graft and membrane (Step Ⅲ); 3) orthodontic treatment initiated 8-12 months post-surgery to correct malposition (Step R); and 4) tailored supportive periodontal care (SPC) (Step Ⅳ). Clinical parameters were recorded at baseline (T0), 10-year (T10), and 20-year (T20) follow-up visits.
RESULTS: Thirty-three patients (drop-out rate: 31.2%; n = 29 test teeth) completed the 20-year follow-up. The T20 estimated tooth survival was 89.1% (CI: 79.4-99.9%), while complication-free probability was 86.3% (CI: 75.7-98.3%). Overall, five test teeth experienced complications (1 pulp necrosis, 2 root fractures, 2 periodontal disease recurrence) and four were extracted during the 20-year period. All periodontal parameters significantly improved from T0 to T20: full-mouth plaque scores decreased from 48.8% to 14.6% (34.2 ± 19.3%; 95% CI: 27.3, 41.0; p < 0.001), and full-mouth bleeding scores dropped from 55.5% to 10.2% (45.4 ± 18.5%; 95% CI: 38.8, 51.9; p < 0.001). The number of sites with PD ≥ 7 mm was reduced from 25.8 to 0.9 (24.9 ± 17.0; 95% CI: 18.9, 30.9; p < 0.001). At the test tooth level, mean PD decreased from 6.3 mm to 3.0 mm (3.1 ± 1.4 mm; 95% CI: 2.6, 3.7; p < 0.001). Treatment success (i.e., tooth survival + PD ≤ 4 mm) was observed in 81.8 % of cases.
CONCLUSIONS: The 20-year results demonstrate that orthodontic treatment subsequent to periodontal regeneration is a predictable strategy for long-term tooth preservation, provided it is integrated into a stringent and tailored supportive care program. This interdisciplinary approach does not compromise the benefits of regeneration and offers a viable alternative to tooth extraction.
CLINICAL SIGNIFICANCE: This study revealed that the combination of peridoontal regeneration and orthodontic therapy can successfully preserve natural teeth in severe periodontitis cases over two decades, highlighting the critical role of a tailored SPC program.
METHODS: In this prospective study, 48 patients with Stage IV periodontitis, each with at least one non-molar tooth (n = 48 test teeth) exhibiting pathologic migration and an associated intrabony defect characterized by probing depth (PD) of ≥ 7 mm, were consecutively included. The treatment protocol comprised: 1) supra/sub-gingival instrumentation (Step Ⅰ-Ⅱ); 2) periodontal regenerative surgery using enamel matrix derivative (EMD) alone or combined with a bone graft and membrane (Step Ⅲ); 3) orthodontic treatment initiated 8-12 months post-surgery to correct malposition (Step R); and 4) tailored supportive periodontal care (SPC) (Step Ⅳ). Clinical parameters were recorded at baseline (T0), 10-year (T10), and 20-year (T20) follow-up visits.
RESULTS: Thirty-three patients (drop-out rate: 31.2%; n = 29 test teeth) completed the 20-year follow-up. The T20 estimated tooth survival was 89.1% (CI: 79.4-99.9%), while complication-free probability was 86.3% (CI: 75.7-98.3%). Overall, five test teeth experienced complications (1 pulp necrosis, 2 root fractures, 2 periodontal disease recurrence) and four were extracted during the 20-year period. All periodontal parameters significantly improved from T0 to T20: full-mouth plaque scores decreased from 48.8% to 14.6% (34.2 ± 19.3%; 95% CI: 27.3, 41.0; p < 0.001), and full-mouth bleeding scores dropped from 55.5% to 10.2% (45.4 ± 18.5%; 95% CI: 38.8, 51.9; p < 0.001). The number of sites with PD ≥ 7 mm was reduced from 25.8 to 0.9 (24.9 ± 17.0; 95% CI: 18.9, 30.9; p < 0.001). At the test tooth level, mean PD decreased from 6.3 mm to 3.0 mm (3.1 ± 1.4 mm; 95% CI: 2.6, 3.7; p < 0.001). Treatment success (i.e., tooth survival + PD ≤ 4 mm) was observed in 81.8 % of cases.
CONCLUSIONS: The 20-year results demonstrate that orthodontic treatment subsequent to periodontal regeneration is a predictable strategy for long-term tooth preservation, provided it is integrated into a stringent and tailored supportive care program. This interdisciplinary approach does not compromise the benefits of regeneration and offers a viable alternative to tooth extraction.
CLINICAL SIGNIFICANCE: This study revealed that the combination of peridoontal regeneration and orthodontic therapy can successfully preserve natural teeth in severe periodontitis cases over two decades, highlighting the critical role of a tailored SPC program.