MAINTENANCE THERAPY IN YOUNG-ADULTS WITH SEVERE GENERALIZED PERIODONTITIS

THE PURPOSE OF THIS STUDY WAS TO EVALUATE one year of maintenance ther apy in young adults with severe periodontitis (SP) who had previously received periodontal therapy consisting of root planing and scaling fo llowed by open flap debridement. Subjects were evaluated with clinical and microbiological measurements at 3, 6, 9, and 12 months following the completion of active therapy. Subjects were included in the study if they completed a minimum of two evaluation appointments. Monitoring of these subjects during the maintenance phase was analyzed by three methods. First, changes in mean attachment level and mean probing dept h were calculated at 3-month intervals to determine if the subjects co ntinued to lose or gain attachment and/or had periodontal pockets of i ncreasing or decreasing depth. Second, the frequency of periodontal br eakdown was determined and compared to breakdown rates of subjects in other patient populations. Third, future changes in attachment level w ere related to the presence or absence of two putative periodontal pat hogens, Actinobacillus actinomycetemcomitans and Porphyromonas gingiva lis in subgingival plaque. Mean attachment level remained constant in 13 subjects who completed one year of maintenance therapy. However, me an probing depth increased at a yearly rate of 0.19 mm and in periodon tally-involved sites pocket depth increased at a yearly rate of 0,65 m m both of which were statistically significantly different from O (P<. 05). The frequency of periodontal breakdown in this study was higher t han reported in other similar studies of different periodontitis patie nt populations. The reminder of the data in the study was from 21 subj ects who had completed at least two recall appointments. In these subj ects sites infected with A. actinomycetemcomitans and P. gingivalis ex hibited significantly greater probing depth than non-infected sites. A t 11 different sites in 6 subjects, P. gingivalis was detected in 16 s amples and those sites had average additional attachment losses of 0.7 2 mm after 3 months. This additional attachment loss was significantly greater (P <.05) than that at sites having no detectable P. gingivali s, which experienced little or no additional loss in attachment level (average = 0.0007 mm). A. actinomycetemcomitans was detected in 35 sam ples from 29 different sites in 12 subjects; however, no additional at tachment loss was found 3 months later. These results indicate that P. gingivalis, but not A. actinomycetemcomitans, may be predictive of fu ture attachment loss in young adults with severe generalized periodont itis and that the frequency of periodontal breakdown may be higher in SP patients than that in other patient populations. Consequently, micr obiological monitoring of patients for P. gingivalis and more frequent clinical monitoring of SP patients may be appropriate during maintena nce therapy.