Periodontal treatment decisions for molars: An analysis of influencing factors and long-term outcome

Background: The purpose of this retrospective study was 1) to analyze facto rs influencing the treatment decision for periodontitis-affected molars and 2) to evaluate the long-term outcome of the decision. The treatment altern atives included in the analysis were maintenance of the tooth with only non -surgically/surgically performed scaling/root planing with or without furca tion plasty, root separation/resection, and tooth extraction. Methods: Data collected from a total of 1,313 first and second molars in 22 2 patients (mean age 45 years; range 14 to 73 years), referred for periodon tal treatment, were analyzed with respect to treatment decisions for furcat ion-involved teeth. The patients had been examined with respect to oral hyg iene status, gingival conditions, probing depth, furcation involvement, and radiographic bone height before and after active periodontal treatment. Fr equencies, mean values and standard deviations were calculated for the vari ous variables assessed. Multiple regression models were formulated in order to analyze the influence of various variables on treatment decisions. One- hundred and sixty (72%) of the patients agreed to participate in a follow-u p examination to determine the clinical and radiographic status of the mola rs 8 to 12 years after the active phase of treatment for evaluation of the long-term outcome of the treatment decision. Results: Twenty-eight percent of the molars were extracted and 4% were root separated/resected. Factors found to significantly influence the decision of tooth extraction were tooth mobility, tooth position, lack of occlusal a ntagonism, degree of furcation involvement, and remaining bone support. Of the factors analyzed with respect to root separation/resection, molar posit ion and degree of furcation involvement showed the strongest influence on t he treatment decision. The 8- to 12-year follow-up examination revealed tha t 96% of the molars subjected to non-resective therapy were still in functi on. The corresponding figure for root separated/resected molars was 89%. Lo ss of radiographic bone support during the 10-year follow-up period was 0.1 to 0.6 mm for the various molars with the highest value for maxillary seco nd molars. Conclusions: A conservative approach to the treatment of molars with even d eep furcation invasions may show a high long-term success rate, provided ma intenance care is offered.