Periodontitis stage and grade modifies the benefit of regular supportive periodontal care in terms of need for retreatment and mean cumulative cost

Muhammad H A Saleh; Ann Decker; Andrea Ravidà; Hom-Lay Wang; Maurizio Tonetti

doi:10.1111/jcpe.13909

Periodontitis stage and grade modifies the benefit of regular supportive periodontal care in terms of need for retreatment and mean cumulative cost

J Clin Periodontol. 2024 Feb;51(2):167-176. doi: 10.1111/jcpe.13909. Epub 2023 Dec 12.

Authors

Muhammad H A Saleh¹, Ann Decker¹, Andrea Ravidà², Hom-Lay Wang¹, Maurizio Tonetti^{3

4}

Affiliations

¹ Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.
² Department of Periodontics, University of Pittsburgh School of Dentistry, Pittsburgh, Pennsylvania, USA.
³ Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, National Clinical Research Center of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ European Research Group on Periodontology, Genoa, Italy.

PMID: 38084661
DOI: 10.1111/jcpe.13909

Abstract

Aim: This study aimed to characterize the periodontal breakdown during supportive periodontal care (SPC) and to quantify the corresponding cost-effectiveness of periodontal therapy.

Materials and methods: Data were obtained from charts of patients who received active periodontal therapy (APT) with a minimum follow-up of ≥10 years. Analysis was done to identify factors associated with the incidence of additional sub-gingival instrumentation (SGI) and/or surgery (SUR) during SPC and mean cumulative cost of recurrence was calculated. All relevant data were collected.

Results: In all, 442 patients were included. Over the follow-up period, 62% of Stage I and II patients and 72% of Stage III and IV patients required further treatment following the APT; 56.5% of SGI patients and 78.6% of SUR patients received a second intervention. SUR patients received more SUR during the follow-up period (p = .035). Stage III and IV patients received more SUR during SPC than Stage I and II patients (p = .001). Grade C patients received more SUR during the follow-up period (p < .05). During the 5-year period preceding retreatment, the mean SPC visits were lower for patients who did not require retreatment (p < .001). Risk factors such as regularity of maintenance, smoking and diabetes were related to a higher chance of receiving SUR during the follow-up period (p < .05). The mean cumulative costs indicated less recurrence cost for compliers in Stage III and IV or Grade B and C but not for those in Stage I and II or Grade A.

Conclusions: The risk of relapse in the maintenance population may be correlated with higher stage and grade, patient compliance, modifiable risk factors and the nature of the treatment provided during APT. The total cost of treatment of recurrences was lower for compliers in Stage III/IV and Grade B/C compared with erratic compliers with the same severity and risk.

Keywords: cost analysis; long-term results; periodontitis; risk factors; surgery.

MeSH terms

Humans
Periodontitis* / therapy
Retreatment
Risk Factors
Smoking