Periodontal treatment decisions for molars: an analysis of influencing factors and long-term outcome.
BACKGROUND
The purpose of this retrospective study was 1) to analyze factors influencing the treatment decision for periodontitis-affected molars and 2) to evaluate the long-term outcome of the decision. The treatment alternatives included in the analysis were maintenance of the tooth with only non-surgically/surgically performed scaling/root planing with or without furcation plasty, root separation/resection, and tooth extraction.


METHODS
Data collected from a total of 1,313 first and second molars in 222 patients (mean age 45 years; range 14 to 73 years), referred for periodontal treatment, were analyzed with respect to treatment decisions for furcation-involved teeth. The patients had been examined with respect to oral hygiene status, gingival conditions, probing depth, furcation involvement, and radiographic bone height before and after active periodontal treatment. Frequencies, mean values and standard deviations were calculated for the various variables assessed. Multiple regression models were formulated in order to analyze the influence of various variables on treatment decisions. One-hundred and sixty (72%) of the patients agreed to participate in a follow-up examination to determine the clinical and radiographic status of the molars 8 to 12 years after the active phase of treatment for evaluation of the long-term outcome of the treatment decision.


RESULTS
Twenty-eight percent of the molars were extracted and 4% were root separated/resected. Factors found to significantly influence the decision of tooth extraction were tooth mobility, tooth position, lack of occlusal antagonism, degree of furcation involvement, and remaining bone support. Of the factors analyzed with respect to root separation/resection, molar position and degree of furcation involvement showed the strongest influence on the treatment decision. The 8- to 12-year follow-up examination revealed that 96% of the molars subjected to non-resective therapy were still in function. The corresponding figure for root separated/resected molars was 89%. Loss of radiographic bone support during the 10-year follow-up period was 0.1 to 0.6 mm for the various molars with the highest value for maxillary second molars.


CONCLUSIONS
A conservative approach to the treatment of molars with even deep furcation invasions may show a high long-term success rate, provided maintenance care is offered.
Svärdström
G
G
Department of Periodontology, Faculty of Odontology, Göteborg University, Sweden.
Wennström
J L
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000145:classification; D003657:Decision Making; D003766:Dental Occlusion; D012534:Dental Scaling; D005500:Follow-Up Studies; D017823:Furcation Defects / Q000145:classification / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008334:Mandible; D008437:Maxilla; D008875:Middle Aged; D008963:Molar / Q000601:surgery; D008964:Molar, Third / Q000601:surgery; D009911:Oral Hygiene Index; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D010518:Periodontitis / Q000145:classification / Q000601:surgery / Q000628:therapy*; D012044:Regression Analysis; D012189:Retrospective Studies; D016745:Root Planing; D014081:Tooth Extraction; D014086:Tooth Mobility / Q000145:classification; D014092:Tooth Root / Q000601:surgery; D016896:Treatment Outcome