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Tooth Loss During Supportive Periodontal Care (SPC): A Three Decades Retrospective Study in a University Setting
1Clinic of Conservative Dentistry and Periodontology, University Hospital Schleswig-Holstein, Kiel, Germany.
Aim:
This retrospective cohort study evaluate tooth loss and predictors during exceptionally long term supportive periodontal care (SPC), focusing on residual disease severity at SPC initiation.
Materials And Methods:
Seventy patients maintained under SPC for > 30 years were analysed using negative binomial regression (log[SPC-duration] offset) and Cox proportional hazards models (clustered by patient).
Results:
Over a mean SPC duration of 36.1 ± 3.0 [30-43] years, 63 patients lost 322 teeth (4.6 ± 4.2 per patient; 0.13 ± 0.12 per patient-year). Despite advanced baseline disease (stage III/IV: 97%), 35-year molar survival was 77% for FI 0 versus 51% for FI II-III. Tooth loss rate was significantly associated with PPD ≥ 6 mm (IRR 1.012; 95% CI 1.003-1.021; p = 0.009) and molar FI II-III (IRR 1.178; 95% CI 1.050-1.321; p = 0.005). A tooth-level Cox model confirmed elevated hazard for PPD ≥ 6 mm (HR 4.02; 95% CI 2.10-7.69) and FI II-III (HR 2.87; 95% CI 1.61-5.11). However, predictive accuracy was modest (PPV 36%-55%), indicating these markers reflect population-level risk rather than individual prognosis.
Conclusion:
Tooth loss remained low over > 30 years of SPC even for molars with advanced FI, while residual disease severity modulated this risk. Given strong survivorship bias (3.3% of eligible patients), generalisability beyond university-based specialist care is limited.
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