Progression and treatment of chronic adult periodontitis

Background: The periodontal status of 41 medically healthy adults with untr eated chronic periodontitis was monitored before and after scaling and root planing (SRP). Methods: During a 6-month pretreatment phase, clinical measurements, digita l subtraction radiography (DSR) analysis of alveolar bone, and measurement of gingival crevicular fluid (GCF) prostaglandin E-2 (PGE(2)) levels were u ndertaken. SRP was provided during a I-month treatment phase. Clinical, rad iographic, and bio chemical analyses were repeated in a 6-month post-treatm ent healing period. Results: Pretreatment: no clinically significant changes in mean plaque ind ices (PI), probing depths (PD), bleeding on probing (BOP), or relative clin ical attachment levels (CAL) were detected (P >0.05), DSR revealed small bu t statistically significant bone height (0.04 mm) and mass (0.97 mg) loss ( P <0.001). GCF PGE2 levels gradually increased from 38.8 ng/ml at month 1 t o 79.4 ng/ml at month 6. Post-treatment: statistically and clinically signi ficant reductions were observed in mean PI, BOP, and PD (P <0.05). A statis tically significant reduction in CAL was noted (P <0.05). The trend towards progressive bone loss was halted and reversed, and a statistically signifi cant decrease in GCF PGE, concentrations was detected (P <0.001). Smokers, non-smokers, and ex-smokers did not differ significantly in PI, BOP, GAL, r adiographic, or biochemical parameters at any time. Mean PD was significant ly greater in current smokers than in non-smokers and ex-smokers (P <0.005) . PD reduced comparably in all 3 smoking subgroups following treatment (P < 0.01). Conclusions: Conventional clinical measurements failed to identify disease progression over a 6-month period. Significant improvements were observed i n clinical parameters after SRP, and a trend towards progressive bone loss was halted and reversed. Regular and frequent maintenance visits are import ant following treatment to maintain improvements in clinical parameters. Sm okers had deeper probing depths than non- and ex-smokers, but pockets were reduced significantly and comparably in all 3 smoking subgroups following e fficacious treatment.