Tooth loss during long-term periodontal maintenance


While periodontal disease is very common treatment can be clinically effective. However, long term periodontal maintenance care based on patient and tooth related factors may be required. Periodontal disease is an important cause of tooth loss and the impact of periodontal maintenance on tooth loss may be influenced by smoking, diabetes, age and gender.

The aim of this review was to evaluate the risk factors/predictors of tooth loss in patients with periodontitis having periodontal therapy and long-term periodontal maintenance.


Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Medline/PubMed, Google Scholar and Web of Science databases. Studies of periodontitis patients who underwent active periodontal therapy (APT) and followed a regular periodontal maintenance programme with a minimum follow up of 5 years follow-up were considered. Two reviewers independently extracted data and assessed risk of bias using an adapted version of the Newcastle–Ottawa Scale (NOS). Random effects meta-analyses of number of tooth loss per patient per year were conducted.


  • 33 studies (3 prospective, and 30 retrospective cohorts) were included.
  • The studies were conducted in 16 different countries across Europe, Asia and America.
  • 12 studies were considered to be at low risk of bias, 20 at moderate risk and one at high risk.
  • No difference in the rate of tooth loss per patients per year (TLPPY) was seen in the prospective and retrospective studies.
    • Prospective studies TLPPY = 0.18 (95%CI; 0.11 to 0.26)
    • Retrospective studies TLPPY = 0.12 (95%CI; 0.10 to 0.14)
  • 27 studies reported that a total of 75,776 teeth were present after periodontal treatment with 6640 (8.8%) lost during subsequent periodontal maintenance.
  • 16 studies reported that of a total of 53,995 teeth present after periodontal treatment 4067 teeth (7.5%) were lost, 2,720 of these were because of periodontal reasons.


The authors concluded: –

Most patients undergoing periodontal maintenance (PM) did not experience tooth loss. Long- term results suggest an average loss of 0.1–0.2 teeth per patient per year during active periodontal treatment. Also, there were relevant patient-related (age, gender, active smoking, compliance regarding PM) and tooth-related factors (tooth type, tooth location, baseline PPD, presence of furcation involvement and baseline mobility) towards tooth loss during PM.


This new review presents and update of an earlier review by Chambrone et al 2010 which had included 13 retrospective studies. The reviewers have searched a good range of databases including 20 additional studies. Although, the majority of the studies are still of a retrospective design which is more prone to bias than prospective studies the analysis presented indicated no statistically significant difference in the tooth loss per patient per year between pro- and retrospective designs.  In addition to the 2010 review by Chambrone a 2019 review by Helal et al (Dental Elf – 1st Jul 2019) also estimated a mean average tooth loss of 0.12 teeth per annum.  While there are differences between the reviews the estimate for tooth loss is consistent. However, the findings relate to a group of compliant patients participating in long term periodontal maintenance treatment, so the findings are not applicable to a general population.  While discussed no detailed analysis of patient factors related to tooth loss is presented including the 3 factors significantly associated with tooth loss. compliance, diabetes and smoking noted in the Helal et al review. Future studies of this topic should be prospective, use the new periodontal classification and collect data on systemic and other relevant conditions, habits and common outcome measures


Primary Paper

Carvalho R, Botelho J, Machado V, Mascarenhas P, Alcoforado G, Mendes JJ, Chambrone L. Predictors of tooth loss during long-term periodontal maintenance: An updated systematic review. J Clin Periodontol. 2021 May 17. doi: 10.1111/jcpe.13488. Epub ahead of print. PMID: 33998031.

Other references

Chambrone L, Chambrone D, Lima LA, Chambrone LA. Predictors of tooth loss during long-term periodontal maintenance: a systematic review of observational studies. J Clin Periodontol. 2010 Jul;37(7):675-84. doi: 10.1111/j.1600-051X.2010.01587.x. Epub 2010 May 26. PMID: 20528960.

Dental Elf – 1st Jul 2019

Tooth loss predictors in periodontal patients





Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+