Four modalities of periodontal treatment compared over five years.

The purpose of the study was to compare, over 5 yr, the results following four conventionally used modalities of treatment for moderate-to-advanced periodontitis. Ninety subjects (53 females and 37 males), age 24 to 68 yr (mean 45) were selected for the study from persons seeking dental care or who were referred for periodontal treatment at The University of Michigan School of Dentistry. To be included, the subjects had to have at least 20 treatable teeth, and some periodontal pockets extending at least 4.0 mm or more apically to the cementoenamel junction. Plaque, gingivitis, calculus, depth of pockets, clinical loss of attachment from the cementoenamel junction and tooth mobility were scored. For the present paper, only pocket depth and attachment level scores were considered. All of the patients then had scaling, root planing and instruction in oral hygiene by a dental hygienist for a total of 5 to 8 h over about 4 wk. A periodontist checked the completeness of calculus removal and did occlusal adjustment if he considered it to be indicated. A rescoring was done 4 wk after completion of the scaling and root planing. Then four types of periodontal treatment were provided by a periodontist. Each quadrant of the patient's dentition was assigned randomly to one of four treatment types: (1) surgical pocket elimination or reduction, including bone surgery, (2) modified Widman flap surgery, (3) subgingival curettage following scaling and root planing, and (4) scaling and root planing only. The teeth were polished once a week for 3 to 4 wk after the periodontal treatment. Then the patients were placed on recall prophylaxis and topical fluoride every 3 months, and scored annually prior to prophylaxis. If, at the time of the routine prophylaxis, pocket exudate could be expressed by moving a ball burnisher against the surface of the gingiva and/or overt bleeding resulted from pocket probing, the patient was rescheduled in 2 to 3 wk for examination and possible retreatment by a periodontist. Data for pocket depth and attachment level were arranged on the basis of the initial measurements in groups of 1-3 mm depth, 4-6 mm and >7 mm depth. One-way analysis of variance was used to test the hypothesis of equal treatment effects in the three levels of pocket depth at the end of the hygienic phase and at each yearly interval following treatment. The test was performed on patient means for changes in pocket depth and attachment level. If the hypothesis of equal treatment effect was rejected at the 0.05 level of significance using ANOVA, Scheffe's method for multiple comparisons was used to determine which of the pairs of treatment differed. Percentage distribution of sites with loss of >2 mm and >3 mm for the various groups also were compared. The measurements for the teeth that were lost were included until the teeth were lost. Seventy-two of the original 90 patients completed the 5-yr study.