The effect of occlusal discrepancies on periodontitis. II. Relationship of occlusal treatment to the progression of periodontal disease

Background: A causal relationship between occlusal discrepancies and periodontal disease has been postulated in the past. However, minimal data are available concerning the effect of treatment of occlusal discrepancies on periodontitis. Methods: The records from a private practice limited to periodontics were reviewed to find patients who had complete periodontal examination records, including occlusal analysis, that were recorded at least 1 year apart. Patients who fit these criteria were divided into a group that had none of the recommended treatment (untreated n = 30), those who had only nonsurgical treatment (partially treated n = 18), and a control group that had completed all recommended treatment (surgically treated n = 41). The data for each tooth of each patient, including occlusal status, were placed in a database and analyzed using the generalized estimating equations method. Results: Worsening in overall clinical condition, as measured by worsening in prognosis, indicated that teeth with no initial occlusal discrepancies and teeth with treated initial occlusal discrepancies were only about 60% as likely to worsen in overall clinical condition over time compared to teeth with untreated occlusal discrepancies. Teeth with untreated occlusal discrepancies were also shown to have a significantly greater increase in probing depth per year than either teeth without initial occlusal discrepancies or teeth with treated initial occlusal discrepancies (P <0.001). In addition, teeth with untreated occlusal discrepancies had a significant increase in probing depth per year (P <0.001), whereas teeth without initial occlusal discrepancies and teeth with treated initial occlusal discrepancies had no significant increase in probing depth per year (P >0.05). Conclusions: This study provides strong evidence of an association between untreated occlusal discrepancies and the progression of periodontal disease. In addition, this study shows that occlusal treatment significantly reduces the progression of periodontal disease over time and can be an important adjunct therapy in the comprehensive treatment of periodontal disease.