Background: Clinical wisdom often suggests that retention of periodontally hopeless teeth may accelerate the destruction of the adjacent periodontium. The purpose of this study was to examine the effect of retaining hopeless teeth on the adjacent alveolar bone following periodontal surgery.Methods: A retrospective study was conducted based on intraoral radiographs. Teeth were considered hopeless if they had lost ≥70% bone height at either of the proximal surfaces. The minimal follow‐up period after surgery was 24 months. All subjects completed periodontal therapy, including scaling and root planing (SRP), and periodontal surgery at these sites. Ninety‐three subjects with 110 hopeless teeth were included in this study. Cases were sorted into two groups: retained, which included 57 hopeless teeth (50 subjects) that were maintained; and extracted, which included 53 hopeless teeth (43 subjects) that were removed at surgery. All radiographs were digitized, and measurements of radiographic bone distance (RBD) were made using computerized software.Results: Mean follow‐up was 4.40 ± 0.23 years. For the retained hopeless teeth, there was a mean bone gain of 0.82 mm from baseline (7.18 ± 0.35 mm) to the final examination (6.45 ± 0.41 mm; P = 0.0061). Likewise, the postoperative percentage of RBD of the retained hopeless teeth showed a statistically significant improvement from baseline (57.46% ± 1.5%) to the final examination (52.32% ± 2.03%; P = 0.0032). Teeth adjacent to a hopeless tooth had a slight radiographic bone gain postoperatively, which was greater in the extracted group. However, it was significant only for the distal neighboring teeth (1.50% versus 11.36%, respectively; P = 0.0119).Conclusion: Long‐term preservation of hopeless teeth following periodontal surgery is an attainable goal with no detrimental effect on the adjacent proximal teeth.

Mechanical periodontal therapy is widely used for a variety of periodontal conditions. While the clinical efficacy of this treatment has been validated, the radiographic response has not been studied in depth. The purpose of the present study was to examine the clinical and radiographic response to mechanical periodontal therapy, and assess the factors associated with these changes. One hundred and eight patients, with established periodontitis, received oral hygiene instruction and mechanical periodontal therapy for a period of 4 to 5 weeks. Scheduled maintenance visits were performed at 3, 6, 9, and 15 months. Probing depth (PD) and attachment level (AL) measurements were performed at baseline, and at 3 and 15 months. Intraoral radiographs were taken at baseline and 12 to 15 months postsurgery using a Rinn alignment system. Alveolar eresiai height (ACH) measurements were performed on a pair of digitized images of the previously taken radiographs. An overall mean of patients' changes for PD, AL, and ACH was initially computed. Active sites (gainers and losers) were determined using a threshold method, and expressed as patient's percentage of active sites (number of active sites of the total sites measured in each patient). Mean overall probing reduction and AL gain was 0.5 mm and 0.44 mm, respectively. Of all sites measured, 16.6% exhibited AL gain, while only 6.2% of all sites exhibited AL loss. Mean overall change in ACH was −0.07 mm, of which 11.8% of all sites exhibited ACH gain, while 15.1% exhibited loss beyond the threshold. Non‐smokers presented no change in bone loss, while smokers continued to lose bone at an annual rate of 0.17 mm. despite treatment (P <0.005). Likewise, the average percent of sites per patients showing attachment gain beyond the threshold were much greater in non‐smokers (13.9%) compared to 9.0% in smokers (P <0.01). Mean probing reduction was 50% greater among non‐smokers (0.6 mm) when compared to smokers (0.4 mm), which was also statistically significant (P <0.05). A positive and significant correlation was established between the percentage of sites with AL gain and sites with ACH gain (Rho = 0.40; P = 0.0001). It is suggested that monitoring sites for AL and ACH gain expressed as changes beyond a selective threshold is an important outcome variable in treatment studies. J Periodontol 1998;69:590–595.