Aggressive periodontitis: 5-year follow-up of treatment.
BACKGROUND
The hypothesis that in subjects with aggressive periodontitis, a long-term stability of periodontal health can be achieved following comprehensive mechanical/surgical and systemic antimicrobial therapy was tested in this prospective study.


METHODS
Thirteen patients (36.9+/-7.4 years) with aggressive periodontitis were monitored before and up to 5 years following periodontal therapy. Clinical attachment levels (CAL) were assessed pretherapy, and at 3 months following completion of active periodontal therapy supplemented by amoxicillin plus metronidazole. All subjects were subsequently enrolled in a maintenance program and provided with supportive periodontal therapy with 3 to 4 appointments annually. Reexaminations were performed after 6 months and 1, 2, 3, 4, and 5 years. The data were analyzed using the method of generalized estimating equations (GEE) for CAL changes from baseline to the 3-month visit, and from completion of periodontal therapy to each annual visit up to the 5-year follow-up reappointment.


RESULTS
During the 5-year study, all subjects strongly benefited from periodontal treatment. Between baseline and the 3-month reexamination, the CAL levels revealed a significant decrease of 2.23 mm (95% confidence interval [CI]: 1.77 to 2.69 mm; P < or =0.001). At the 5-year maintenance visit, the CAL changes ranged from -0.04 to +0.29 mm with no further statistically significant periodontal breakdown (P >0.05). Five years after surgery, 3.2% of the treated sites demonstrated a further CAL gain > or =3 mm. A stabilization (CAL -2 to +2 mm) occurred in 94.6% of the cases. The number of periodontal sites experiencing a breakdown varied from 5.3% at 6 months to 2.2% at 5 years.


CONCLUSIONS
In aggressive periodontitis, comprehensive mechanical/surgical and antimicrobial therapy is an appropriate treatment regimen for long-term stabilization of periodontal health. In this study, periodontal disease progression was successfully arrested in 95% of the initially compromised lesions, while 2% to 5% experienced discrete or recurrent episodes of loss of periodontal support.
Buchmann
Rainer
R
Department of Periodontology and Oral Biology, Goldman School of Dental Medicine, Boston University, MA, USA. rainer_buchmann@yahoo.de
Nunn
Martha E
ME
Van Dyke
Thomas E
TE
Lange
Dieter E
DE
D000328:Adult; D016976:Aggregatibacter actinomycetemcomitans / Q000302:isolation & purification; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003773:Dental Plaque / Q000382:microbiology; D012534:Dental Scaling; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000473:pathology; D010518:Periodontitis / Q000188:drug therapy* / Q000601:surgery*; D012008:Recurrence; D018709:Statistics, Nonparametric; D013357:Subgingival Curettage; D013524:Surgical Flaps; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D008795:Metronidazole; D000658:Amoxicillin