Longitudinal Studies Flashcards
What were the aims of these Longitudinal Studies?
to document the immediate and long-term clinical results following several types of periodontal therapy
What are the differences in American vs European studies?
What was the first Longitudinal study?
Ramfjord et al. 1968
Ramfjord et al. 1968
32pts
SRP/occlusal adjustment
FOLLOWED BY
SubG Currettage
vs
Gingivectomy (PD_<3mm) or flap + osteoplasty/ectomy (PD>_4mm)
CAL gain after SubCR in PD>6mm
Pocket Elimination had CAL loss and greater relapse
Ramfjord et al. 1973
Follow up to 1968
4-7yr follow up
NSSD loss of CAL between SubG Curretage and Pocket Elimination surgery
PE showed a greater and better sustained pocket reduction
Ramfjord et al. 1975
CR vs PE (gingivectomy or osseous) vs MWF
NSSD between these after 5yrs
PE Not justified - does not improve long term benefit compared to MWF or CR
Which study was the first to stratify based on PD?
Knowles et al. 1979
Shallow (1-3mm), Moderate (4-6mm) and deep (7-12mm) pockets
Knowles et al. 1979
8yr follow up to Ramfjord 1975
Large PD have greater reduction than moderate PD
MWF best long term for both PD reduction and CAL
(CR vs PE vs MWF)
Hill et al. 1981
5sites/tooth - Evaluated effect of initial NSPT
Ramfjord 1987
5yr follow up to Hill et al. 1981
SRP vs CR vs PE vs MWF
1-3mm - no change in PD - CAL loss from all tx
4-6mm - PD: PE > MWF > SRP > CR
CALoss: PE > MWF > SRP
7-12mm - PE > MWF > SRP > CR
CALgain all 4
What studies investigated the importance of maintenance?
Ramfjord et al. 1982
Ramfjord et al. 1982
8yr follow up (same patients as Knowles 1979)
Looked at top and bottom 25% of patient’s PI
CAL and PD maintained over 7yr regardless of OH w/ 3mrc
Initial PDreduction and CALgain greater in patients with good OH - NSSD after 3-4yrs
Ramfjord 1987
Review
Periodic (3-4mo) maintenance is recommended for all levels of OH to prevent CAL loss over time
What did the Minnesota Longitudinal studies investigate?
SRP vs SRP + MWF at 4 and 6.5yrs
What where the results of the Michigan longitudinal studies?
Mod - Deep pockets respond better to surgical therapy with some loss of initial gains
Treatment of shallow pockets often results in CALoss
Maintenance (every 3-4mo) is important regardless of OH
What were the results of the Minnesota longitudinal studies?
Deep pockets (7mm) improved more from surgical (SRP + MWF)
Surgical had better long term stability (6.5yrs) than non-surgical (3yrs)
Molars respond less to therapy than non-molars
What were the main findings of the Nebraska Longitudinal Studies?
Supragingival Scaling (SC) had the most breakdown
Smokers had less favorable response to perio treatment
What were the main findings of the Lloma Linda Longitudinal Studies?
SRP vs Ultrasonic are similar
Home care alone does not improve pockets
Repeated SRP doesnt work
Operator variability in SRP is minimal
Better results in non-molars or molar-flat-surfaces
Who lead the Minnesota studies?
Pihlstrom
Pihlstrom 1981
Minnesota
SRP vs MWF
1-3mm, 4-6mm, 7-12mm
MWF: Increased PD reduction and CAL gain for deeper pockets
Pihlstrom 1983
Minnesota
6.5yr follow up to 1981
1-3mm: MWF had CALoss
4-6mm: PD: SRP = MWF (Less CALoss in SRP)
7-12mm: MWF stable 6.5yrs | SRP stable 3yrs | SRP MORE PD RECURRENCE
Pihlstrom 1984
Minnesota
Another 6.5yr follow up to 1981 but this is only Molars vs Non-molars
4-6mm: Molars had less CAL gain than non-molars
7mm+: NSSD in PD reduction after SRP alone - (proof of Stanbaugh 1983?)
Who lead the Nabraska longitudinal studies?
Kaldahl
Kaldahl et al. 1988
Nebraska
SC vs SRP vs MWF vs APF+OS
Split mouth - Multi-rooted - 2yr FU
PD reduction: APF+OS > MWF > SRP > SC
20% SC teeth needed re-treatment
Kaldahl et al. 1996
Nebraska
7yr follow up to 1988
PD >5mm - sustained greater reduction in APF+OS group (NSSD in others)
PD 1-4mm - CAL loss in APF group - CAL gain SRP
CS created abscess in pockets _>_7mm
Surgical and non-surgical can improve and maintain longerm
Kaldahl et al. 1996c
Nabraska
Effect of Cigarettes
another analysis: 7yr follow up to 1988
Past and Non-smokers had 2x CAL gain and PD reduction
Badersten et al. 1981/1984
Lloma Linda
Hand instrumentation vs Ultrasonic had NSSD (Single rooted ONLY)
Cercek et al. 1983
Lloma Linda
Minimal effect from OH alone (supra OR sub) - Effect from SRP
3 Phase study
Phase 1: At home OH w/Flossing (5mo)
Phase 2: CHX sub g rinsing (3mo)
Phase 3: SRP (9mo)
Badersten et al 1984b
Lloma Linda
No additional benefit to repeated SRP (single rooted)
Badersten et al. 1985d
Lloma Linda
Periodontist vs Hygienist
Operator variability is minimal
Nordland et al. 1987
Lloma Linda
Molars with FI had less CAL gain than those without or single rooted teeth
Furcation=more recurrent CAL loss
What are the Arizona studies referred to as and why?
Tucson-Michigan-Houston
Private practice: Tucson
Calibration: Michigan
2 authors: Texas
What did the Arizona studies compare? Who lead them?
SRP vs APF+OS vs MWF
Becker
Becker et al 1988
1yr follow up - 16pts - split mouth - 3mrc - Michigan O probe
SRP vs APF+OSS vs MWF
Surgery increases PD reduction (4-6mm, _>_7mm PD) but causes CAL loss (1-3mm PD)
Becker et al 2001
5yr follow up, 3mrc
SRP vs PFS+OSS vs MWF
Osseous had highest no. PD 1-3mm and greatest no. sites CAL loss _>_2mm
All treatments resulted in CAL loss 1-3mm PDs and gain in 4-6, _>_7mm PDs
w/ good maintenance - excellent results achieved with various methods
What studies make up the Arizona studies, and what is the summary of the studies?
Becker et al. 1988, 2001
Provided validity to the university studies as they had similar results - the results are applicable to private practice.
According to Becker et al 2001 - Osseous surgery has a ______ effect in reducing PD compared to MWF in patients with good maintenance in the 5 year study.
SIMILAR
What did the Washington studies investigate?
Flap curretage vs OSS
What were the Washington studies and what did they find?
Smith et al. 1980
6mo follow up - OSS greater PD reduction and maintenance but also had temporary mobility
Olsen et al. 1985
5yr follow up - OSS were stable after 5yrs compared to flap curretage. - Deeper pockets better improvement with OSS
Who lead the Swedish studies? What did they research?
Lindhe, Rosling, Heitz-Mayfield, Lang
Evaluated the effects of bone removal and then surgical vs non-surgical therapy.
What is the summary of the Swedish studies?
There is a critical probing depth that should be considered when determining treatment
Oral hygiene effects long-term results more than surgical technique
Rosling et al. 1976
APF + OSS vs MWF + OSS vs Gingivectomy
Best healing when no bone removed
Gingivectomy had residual infrabony pockets
Lindhe et al. 1982a and 1982b + Heitz-Mayfield Lang 2013
2yr follow up - split mouth
SRP vs SRP+MWF
a:
Sig PD reduction in both groups
6-12mo SRP CAL gain vs MWF CALoss
after 2yrs MWF resulted in >PD reduction and CAL gain
b:
CRITICAL PROBING DEPTHS
SRP: 2.9mm
MWF: 4.2mm
2013: 5.4mm
Lindhe et al. 1984
20% sites with poor OH lost 2mm
3% of sites with good OH lost 2mm
Low plaque (<10% PI) had more PD reduction and CAL gain
OH effects long-term results more than technique
Lindhe et al. 1985
granulation tissue is not critical for proper wound healing
Isidor et al. 1985
MWF had 0.5mm of coronal regrowth of bone in angular bony defects
Isidor et al. 1984
MWF and APF had shallower PD than SRP
SRP had slightly more CAL gain than surgical procedures
