Subject: Smoking
Effect of Periodontal Therapy in Smokers and Non-Smokers With
Advanced Periodontal Disease: Results After Maintenance Therapy
for a
Minimum of 5 Years
George H. Papantonopoulos
Abstract
Background: Longitudinal clinical studies show smoking is a risk
factor for periodontal disease progression. It has also been documented
that smoking impairs healing after periodontal therapy. However,
the longitudinal effect of smoking on treatment results in patients
who undergo long-term maintenance therapy has not been extensively
investigated. This study clinically and radiographically compared
smoking and non-smoking patients who had been treated for advanced
periodontal disease and who received maintenance therapy for a
minimum of 5 years.
Methods: Twenty-nine patients were selected over a 6-month period
when they presented for a regularly scheduled visit in a private
office. Patients were selected on the basis of initially having
lost 50% of bone support on 50% of their teeth; had received follow-up
therapy for at least 5 years; were compliant at 75% of the appointments;
and had plaque scores <20% in 75% of the visits. All patients
had received non-surgical and surgical therapy as required for
pocket elimination. Fourteen were active smokers during the entire
maintenance period. Clinical measurements of probing depths and
presence of plaque and gingivitis and a new set of standardized
radiographs were taken.
Results: Smokers had higher mean radiographic bone loss values
prior to treatment (7.52 + 1.39 versus 6.65 +
1.39) and at the final examination (7.32 + 1.42 versus 6.29 +
1.29) mean radiographic bone loss as well as initial, immediate
post-therapy, and final percent of pockets greater than 6mm (1.42% +
1.87% versus 0.60% + 1.11%). Differences were not statistically
significant. Over 5 to 8 years, seven sites in four non-smokers
and 11 sites in six smokers exhibited radiographic bone loss at
or greater than 2mm. One tooth in a non-smoker and three
teeth in two smokers were lost. In a logistic regression analysis,
smoking increased the odds ratio 10.7 times of having 1
site with bone loss at or more than 2 mm.
Conclusion: The present study on a small group of patients treated
for advanced periodontal disease and well maintained over 5 to
8 years showed no statistically significant differences between
smokers and non-smokers in clinical probing depth and radiographic
bone loss measurements.
[J Periodontol 2004;75:839-843.]
