The Potential Prognostic Value of Some Periodontal Factors for Tooth Loss: A Retrospective Multilevel Analysis on Periodontal Patients Treated and Maintained Over 10 Years

Background: The great challenge in clinical periodontology is assigning a prognosis to a periodontally affected patient. Many different factors can affect the long‐term maintenance of periodontally compromised teeth. The main questions usually considered by the periodontist are: 1) Will a tooth lose more bone in the future? 2) Will the tooth itself be lost in the future? The purpose of this retrospective study was to evaluate the value of some clinical, genetic, and radiographic variables in predicting tooth loss in periodontal patients (aged 40 to 60 years) treated and maintained for 10 years. Methods: Sixty consecutive non‐smoking patients (aged 46.77 ± 4.96 years) with moderate to severe chronic periodontitis (CP) were treated with scaling and root planing (SRP). Some patients also underwent additional surgical treatments. All patients were maintained in the same private practice for 10 years. The frequency of recall appointments was 3.4 ± 1.0 months. At baseline (T0) and 10 years later (T2) the following clinical variables were evaluated: the number of teeth, probing depths (PD), tooth mobility (TM), and presence of prosthetic restorations (PR). In addition, radiographic measurements were taken of the mesial and distal distances from the cemento‐enamel junction (CEJ) to the bottom of the defect (BD), to the bone crest (BC), and to the root apex (RA). At T2, a genetic test to determine the IL‐1 genotype and genetic susceptibility for severe periodontal disease was performed for all 60 patients, and they were classified as IL‐1 genotype positive (G+) or negative (G−) according to the test results. Tooth loss was used as the outcome variable. Different predictor variables were then tested using a two‐level statistical model (patient and tooth levels). At the patient level, these were: age, gender, mean bone loss (mean CEJ‐BD)T0, the interleukin‐1 (IL‐1) genotype, the interaction between mean bone loss, and IL‐1 genotype (mean CEJ‐BDT0 × IL‐1 genotype). At the tooth level, the variables were: TMT0, prosthetic restorations (PR)T0, molar teeth (MT)T0, the infrabony component of the defect (BC‐BD)T0, PDT0, bone level (CEJ‐BD)T0, and residual supporting bone (BD‐RA)T0. Results: Among the considered predictor variables, the following were significantly associated with the outcome variable: 1) MTT0 (P