1100 JADA, Vol. 140 http://jada.ada.org September 2009 T he rate of tooth loss is rel- atively high for people with periodontitis who have not received perio- dontal treatment. 1-5 Perio- dontal treatment and maintenance care can reduce tooth loss signifi- cantly. 2,3,6-12 Lovdal and colleagues 13 reported that undergoing scaling and root planing at regular inter- vals reduced tooth mortality at five years not only for patients with plaque-free dentitions, but also for patients with inadequate plaque control. Ramfjord and colleagues 14-16 followed 104 patients with moderate-to-advanced periodontitis for seven years after they completed periodontal therapy and found that only 1.15 percent of teeth were lost owing to progression of periodon- titis. Lindhe and Nyman 17,18 studied 61 patients with severe periodon- titis who underwent periodontal surgery and were able to maintain excellent oral hygiene for 14 years. At five years, none of the patients’ 1,330 teeth were lost. At 14 years, 30 teeth were lost; one-half were extracted owing to caries, endodon- tic defects or both. The tooth loss rate at 14 years was 2.3 percent. Investigators in other studies Dr. Tsami is an associate professor, Department of Periodontics, School of Dentistry, University of Athens, Greece. Address reprint requests to Dr. Tsami at 45 Michalacopoulou St., Athens, 115 28 GR, Greece, e-mail “atsami@dent.uoa.gr”. Dr. Pepelassi is an assistant professor, Department of Periodontics, School of Dentistry, University of Athens, Greece. Dr. Kodovazenitis is a periodontist, Department of Periodontics, School of Dentistry, University of Athens, Greece. Dr. Komboli is an associate professor, Department of Periodontics, School of Dentistry, University of Athens, Greece. Parameters affecting tooth loss during periodontal maintenance in a Greek population Alexandra Tsami, DDS, PhD; Eudoxie Pepelassi, DDS, MSc, PhD; George Kodovazenitis, DDS, MSc, MPH, PhD; Mado Komboli, DDS, PhD Background. Investigators have evaluated predictive parameters of tooth loss during the maintenance phase (MP). The authors conducted a retrospective study to evaluate the rate of tooth loss and to explore the parameters that affect tooth loss during MP in a Greek population. Methods. A periodontist administered periodontal treatment and main- tenance care to 280 participants with severe periodontitis for a mean period ± standard deviation of 10.84 ± 2.13 years. The periodontist recorded the following parameters for each participant: oral hygiene index level, simplified gingival index level, clinical attachment level, probing depth measurements, initial tooth prognosis, smoking status, tooth loss during active periodontal treatment and MP, and compliance with suggested maintenance visits. Results. The authors found that total tooth loss during active treatment (n = 1,427) was greater than during MP (n = 918) and was associated with the initial tooth prognosis, tooth type group, participants’ compliance with suggested maintenance visits, smoking status and acceptability of the quality of tooth restorations. Most of the teeth extracted during mainte- nance had an initial guarded prognosis (n = 612). Participants whose com- pliance was erratic had a greater risk of undergoing tooth extraction than did participants whose compliance was complete. Conclusions. Participants’ initial tooth prognosis, tooth type, compli- ance with suggested maintenance visits and smoking status affected tooth loss during MP. Initial guarded prognosis and erratic compliance increased the risk of undergoing tooth extraction during maintenance. Clinical Implications. Determining predictive parameters for disease progression and tooth loss provides critical information to clinicians so that they can develop and implement rational treatment planning. Key Words. Tooth loss; periodontal maintenance; tooth prognosis; patient compliance; smoking; tooth type. JADA 2009;140(9):1100-1107. ABSTRACT CLINICAL P R A C T I C E Copyright © 2009 American Dental Association. All rights reserved. Reprinted by permission.