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Background: Guided tissue regeneration (GTR) is a common treatment modality for correcting vertical or bony defects in furcations. Multiple materials are used in GTR with allografts and xenografts being the most widely used. Each material has distinctive properties affecting the regenerative potential. A new bone graft combination of xenogeneic/allogeneic may improve the outcome of GTR by providing space maintenance (Xenograft) and osteoinductive potential (Allograft). The aim of this case report is to evaluate the efficacy of the new combined xenogeneic/allogeneic material based on clinical and radiographic outcomes., Methods: A 34-year-old healthy male presented with vertical bone loss interproximally between #'s 9 and 10. Clinical exam revealed 8 mm probing depth without mobility. The radiographic exam revealed a wide and deep vertical bony defect of 30%-50% bone loss. The defect was treated using a layering technique with xenogeneic/allogeneic bone graft and collagen membrane., Results: The 6- and 12-month follow-ups revealed a significant reduction in probing depths and radiographic bone fill., Conclusions: GTR using a layering technique of xenogeneic/allogeneic bone graft and collagen membrane showed proper correction of a deep and wide vertical bony defect. The 12-month follow-up revealed healthy periodontium with normal probing depths and bone level., (© 2023 American Academy of Periodontology.)

Introduction: Tooth autotransplantation is a viable surgical treatment option for patients with missing permanent teeth. Premolars are generally used for autotransplantation but often require extensive modifications. This case report evaluates the use of supernumerary tooth as an alternative option for premolar autotransplantation. This report shows successful supernumerary tooth autotransplantation with 6-year follow-up., Methods: A 13-year-old male with non-contributory medical history was referred for a missing maxillary left central incisor (#9) and presence of a supernumerary tooth. The clinical and radiographic examination revealed presence of supernumerary tooth with similar dimensions to a central incisor. The treatment plan included autotransplantation of the supernumerary tooth to replace the missing central incisor (short-term) and future implant replacement of the autotransplanted tooth when jaw growth ceases (long-term). The patient and parents consented to treatment. A 3-D tooth replica was constructed based on CBCT analyses. Site #9 was prepared using split ridge technique to create a socket to house the 3-D replica. Upon achieving proper socket form, the supernumerary tooth was extracted and autotransplanted in the prepared socket. The supernumerary tooth was splinted, and the bite opened posteriorly using composite to eliminate any occlusal interferences., Results: The patient was followed up clinically and radiographically. The autotransplanted supernumerary tooth integrated well within the newly created socket and remained functional at the 6-year follow-up., Conclusions: The current case presents successful management of supernumerary tooth autotransplantation with 6-year follow-up. The results show stable periodontium with satisfactory functional and aesthetic results., (Copyright © 2022 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Background: Immediate implant placement (IIP) into fresh extraction socket is a favorable treatment option. If successfully managed, it reduces the overall treatment time, and increases patient's satisfaction. Surgical and restorative factors affect IIP success rates. In this systematic review we evaluate the effect of guided bone regeneration (GBR) at the time of IIP on crestal bone level (CBL) changes after at least 12-months of functional loading., Methods: Reviewers conducted an independent search of the National Center for Biotechnology Information PubMed, Medline, and the Cochrane Collaboration Library from 1966 to January 2017 following the inclusion criteria. A hand search of bibliographies of reviews and clinical trials related to IIP was also performed. This study looked into CBL changes around IIP primarily and further extracted the data to conduct three meta-analysis of "IIP using GBR versus IIP without GBR", "IIP using bone graft alone versus IIP using bone graft with membrane" and "IIP using GBR versus conventional implant placement" which were further subdivided to provide more detailed information for each. Four reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms., Results: The electronic search identified 714 potential studies and the hand search retrieved 55 studies. Crestal bone level (CBL) changes were determined in three meta-analyses. The results revealed a mean difference in CBL changes of 0.175 ± 0.180 mm  in favor of IIP without GBR when compared with implant with GBR. However, IIP with bone graft and membrane showed better results when compared with IIP with bone graft alone [CBL changes of 0.532 ± 0.572 mm]. CBL preservation was noted in IIP with GBR versus conventional implant placement [CBL changes of - 0.001 ± 0.049 mm]., Conclusions: Meta-analyses showed minimal difference in CBL around IIP with bone graft versus without bone graft and with IIP with GBR compared with conventional implant placement. However, IIP with bone graft and membrane reported better CBL preservation compared with IIP with bone graft alone. Nonetheless, these results should be interpreted with caution because of moderate heterogeneity between studies., (© 2019 American Academy of Periodontology.)

Cannabis, also known as marijuana, is one of the most commonly used substances for medical and recreational purposes globally. With the trend of global legalization of medical use of cannabis and even the recreational use, the prevalence of recreational use of cannabis has increased markedly over the past few years. Correspondingly, the potential health concerns related to cannabis consumption have also increased. Therefore, it is necessary for oral healthcare providers to understand the effects of cannabis use on oral health. This review briefly summarizes the components of cannabis, biologic activities on tissues, and mechanisms of action in human cells and tissues. Oral tissue expression of cannabinoid receptors and the potential association of cannabis to oral diseases are also examined. The goals of this review are to (1) elaborate the basic biology and physiology of cannabis in human oral tissues, and (2) provide a better understanding the effects of its use and abuse on oral health. Due to insufficient information, more well-designed studies should be conducted. It is urgent to include cannabis usage into dental patient health records., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Introduction: Implants that lack keratinized tissue (KT) have been associated with increased plaque accumulation, gingival inflammation or hue of metal showing through the tissue. Free gingival grafts (FGGs) are a predictable treatment for minimal or lack of KT. FGGs can increase the zone of KT around teeth and implants alike. Despite predictability of FGGs, stabilizing the graft around implants can be challenging, but is critical for success. Little information is available regarding ways to stabilize FGGs around implants. Acrylic or composite stents are a viable option for obtaining graft stability and support during the healing process., Case Presentation: This case report highlights the practicality of using acrylic or composite stents for FGG stabilization with successful outcomes. Two patients presented with dental implants, with minimal or lack of KT requiring soft tissue augmentation. FGGs were harvested from the palate and fitted around implant carriers allowing stabilization and adequate suturing. Custom-made acrylic or composite stabilization stents were fabricated to fit around implant carriers, which were screwed into the implant platform, and hollowed out internally to provide space for the graft. Postoperative visits showed healthy, stable zones of KT in both cases., Conclusion: The customized acrylic or composite stents allowed stabilization of the FGGs with successful outcome., (© 2019 American Academy of Periodontology.)

Introduction: Gingival recession (GR) is an unhealthy root exposure that could result in sensitivity, abrasion, root caries and higher chance of plaque collection. The prevalence of GR is higher on the facial surfaces but could also affect the lingual tooth surfaces. Despite the etiology and location of GR, treatment is warranted to improve the long-term periodontal stability around the affected teeth. This case report describes the use of partly deepithelialized free gingival graft (PE-FGG) to augment lingual GR post orthodontic treatment., Case Presentation: The current report evaluates the results of PG-FGG to correct lingual recession in a 21-year-old female. The patient presented with 5 mm lingual recession on a previously orthodontically rotated tooth (#21). The recession was treated using a PE-FGG to increase keratinized gingiva (KG) and reduce root exposure. Follow-up at 24 months showed adequate root coverage and KG., Conclusion: The use of PE-FGG can be used to enhance KG for lingual recession with adequate root coverage., (© 2019 American Academy of Periodontology.)

This is the first study to our knowledge to report a novel mutation in the interferon regulatory factor 8 gene (IRF8 G388S ) associated with multiple idiopathic tooth root resorption, a form of periodontal disease. The IRF8 G388S variant in the highly conserved C-terminal motif is predicted to alter the protein structure, likely impairing IRF8 function. Functional assays demonstrated that the IRF8 G388S mutant promoted osteoclastogenesis and failed to inhibit NFATc1-dependent transcriptional activation when compared with IRF8 WT control. Further, similar to subjects with heterozygous IRF8 G388S mutation, Irf8 +/- mice exhibited increased osteoclast activity in the mandibular alveolar bone surrounding molar teeth. Immunohistochemistry illustrated increased NFATc1 expression in the dentoalveolar region of Irf8 -/- and Irf8 +/- mice when compared with Irf8 +/+ controls. Genomewide analyses revealed that IRF8 constitutively bound to regulatory regions of several thousand genes in osteoclast precursors, and genetic aberration of IRF8 significantly enhanced many osteoclast-specific transcripts. Collectively, this study delineates the critical role of IRF8 in defining osteoclast lineage and osteoclast transcriptional program, which may help in better understanding of various osteoclast-mediated disorders, including periodontal disease. © 2019 American Society for Bone and Mineral Research., (© 2019 American Society for Bone and Mineral Research.)

Background: Immediate implant placement (IIP) is predictable but can lead to esthetic challenges, including midfacial recession (MFR) and papillary height (PH) loss. The aim of this systematic review is to examine the effect of IIP on MFR and PH after at least 12 months of functional loading., Methods: Literature review of the Cochrane and MEDLINE electronic databases and hand search up to January 2016 identified eligible studies. Four reviewers independently assessed data quality and methodology., Results: A total of 106 articles satisfied the inclusion criteria. Twelve studies qualified for three meta-analyses. MFR was slightly less in conventional implant placement (CIP) than in IIP, but the result was not statistically significant (mean difference [MD] -0.064 mm; P = 0.687). Similarly, there was better PH maintenance in CIPs, with statistical significance for distal PH (DPH) only (cumulative PH: MD -0.396, P = 0.010; DPH: MD -0.765, P <0.001; mesial PH [MPH]: MD -0.285, P = 0.256). MFR was slightly less in IIP with thick versus thin biotypes, but not statistically significantly different (MD -0.373, P = 0.243). Pooled data showed statistically significantly less MFR and better PH maintenance in IIP with thick biotype (MFR: MD -0.478, P <0.001; cumulative PH: MD -0.287, P <0.001; MPH: MD -0.288, P <0.001; DPH: MD -0.310, P <0.001). Non-significantly less MFR (MD 0.253, P = 0.384) and significantly better PH maintenance were found in IIP with immediate provisionalization versus conventional restoration (MD -0.519, P = 0.028)., Conclusions: IIP in thick biotype and with immediate provisionalization had less MFR and better PH than IIP in thin biotype or with delayed restoration. However, these findings should be interpreted with caution due to high heterogeneity, which was calculated using comprehensive meta-analysis statistical software that took into account sample size and different treatment groups, and limited qualified studies.

Background: Multiple idiopathic cervical root resorption (MICRR) is a rare entity distinct from pathologic root resorption that occurs as a result of several local and systemic factors., Methods: This report describes a familial pattern of MICRR, including a recently identified case and a 30-year follow-up on previously described cases., Results: The previously reported father (aged 95 years) and son (aged 64 years), and the recently affected daughter (aged 61 years) recounted non-contributory medical history. The resorptive lesions were asymptomatic, unassociated with any predisposing factors, and first identified during the fourth to sixth decades of life. All tooth types were affected, with posterior teeth being affected earlier and with greater frequency; however, distal root surfaces were never affected. The resorptive lesions were progressive in nature, with additional teeth becoming involved as the condition was followed over time. In many instances, surrounding alveolar bone extended into the existing resorptive defects, but without clinical evidence of ankylosis. Gingival tissues, periodontal probing, and tooth mobility were within normal limits. Microcomputed tomography of extracted teeth demonstrated that the lesions were more extensive than clinically evident and rarely invaded the pulp chamber. Histologically, many resorptive lesions were noted along the cementum surface, with evidence of isolated cemental repair. Management of MICRR focused on restoring damaged root surfaces and extracting teeth with extensive root resorption., Conclusions: MICRR is a challenging entity with unknown etiology and a lack of well-established preventive and management strategies. The familial pattern noted in this report necessitates future studies to investigate the role of genetic components in MICRR development.

Background: Immediate implant placement (IIP) is a successful treatment and has the advantages of reducing time and increasing patient satisfaction. However, achieving predictable esthetic results with IIP presents a challenge because of naturally occurring bone loss postextraction. Therefore, the focused question of this systematic review is: What is the effect of IIP on crestal bone level (CBL) changes after at least 12 months of functional loading?, Methods: Extensive literature review of the Cochrane and MEDLINE electronic databases and a manual search up to November 2012 identified eligible studies. Two reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms., Results: Electronic and manual searches identified 648 relevant publications. A total of 57 articles satisfied the inclusion criteria. Sixteen studies had test and control groups; therefore, meta-analyses could be performed. The results demonstrated better CBL preservation around IIP compared with implant placement in healed/native bone at 12 months [CBL difference of -0.242 (95% confidence interval [CI], -0.403 to -0.080; P = 0.003)]. Similarly, platform switching around IIP showed better results compared with non-platform switching (CBL difference of -0.770 [95% CI, -1.153 to -0.387; P <0.001]). There was no difference in mean CBL changes with regard to one-stage or two-stage IIP protocol (-0.017 [95% CI, -0.249 to 0.216; P = 0.85]) or the use of immediate or delayed immediate implant loading (0.002 [95% CI, -0.269 to 0.272; P = 0.99])., Conclusions: Meta-analyses showed less CBL loss around IIP compared with implant placement in healed bone. Platform-switched implants showed greater crestal bone preservation than non-platform-switched implants. There was no significant difference in CBL with one- versus two-stage placement or use of immediate versus delayed IIP loading. Although there were statistically significant differences favoring IIP, the small differences may not be clinically relevant. Although IIP showed favorable outcomes for CBL changes, these results should be interpreted with caution because of high heterogeneity among studies.

This report describes the use of the combination of 2 technologies (Cone-beam computed tomography and Optical 3-dimensional scan) to maximize accuracy of implant placement in an area where previous implants failed and had to be removed. This report also stresses the increased efficiency of combining technologies to fabricate stereolithographic surgical guide which, when used intraoperatively, can improve precision of placement.

Selection Criteria: For inclusion in this systematic review, studies had to be randomized clinical trials (RCTs) or controlled trials in healthy human subjects comparing the effects of essential-oil mouthwash (EOMW) with chlorhexidine (CHX) on plaque and calculus accumulation, tooth staining, and gingival inflammation. Included studies could be either short-term (< 4 weeks' duration) or long-term (> 4 weeks' duration). Studies were required to include a specific formulation of EOMW (Listerine, Johnson and Johnson). They reportedly selected this standard formula of EOMW because it was representative of essential oil-based mouthwashes and because it has the American Dental Association seal of approval. Conversely, there were no restrictions on the concentration of CHX used in studies. The CHX concentration in studies varied from 0.1% to 0.2%. Studies could include no brushing (de novo model) or brushing in conjunction with EOMW or CHX. The authors identified 390 unique articles from electronic database searches. Twenty-five of these articles were selected for full review. Seven articles were excluded because they did not meet the inclusion criteria. Hand searching the reference list of selected manuscripts resulted in the addition of one article. The final systematic review included 19 articles, with a total of 826 subjects who completed all trials. The systematic review included short-term studies lasting less than 4 weeks and long-term studies of 4 or more weeks' duration. Six of these trials were included in the 7 separate meta-analyses performed, yielding a total of 315 participants. The age of subjects in the trials ranged from 16 to 62 years. The study by Axelsson and Lindhe was included twice in the metaanalysis of plaque index, gingival index, and stain index because CHX was used in 0.1% and 0.2% concentrations. The studies by Haffajee et al and Charles et al were each used in meta-analyses for both plaque index and gingival index. Three separate meta-analyses included assessments for plaque index, whereas 2 involved gingival index and 2 assessed tooth staining index., Key Study Factor: The effects of EOMW or CHX used as a monotherapy (alone) or in conjunction with self-performed daily oral hygiene on periodontal health, was measured by assessments for plaque index or calculus index, staining index, gingival bleeding index, or gingival index., Main Outcome Measure: The primary outcomes of this systematic review and meta-analysis were differences in mean plaque index, calculus index, and tooth staining index, gingival index, and gingival bleeding after daily use of either chlorhexidine gluconate or essential oil mouthwash for < 4 or > 4 weeks., Main Results: Nineteen randomized or controlled clinical trials were included in this systematic review. In 5 of the 7 studies of plaque index, CHX was found to be significantly better than EOMW at reducing plaque accumulation. Stain development was assessed in 5 long-term brushing trials. CHX was significantly associated with more staining than EOMW in the systematic review. The calculus index was significantly greater among CHX users versus EOMW users. Of the 5 studies that measured gingivitis levels, 4 provided statistical data that could be used in the systematic review. Two of these investigations showed significantly lower gingival inflammation with CHX. Bleeding indices were assessed in 5 short-term and 4 long-term studies. Only one of the short-term studies showed a significant difference, whereas 3 of 4 long-term studies showed no difference between CHX and EOMW. Meta-analyses were included for plaque index, gingival index, and tooth staining index. In 2 of 3 meta-analyses of plaque index trials, CHX was shown to be significantly more effective than EOMW at reducing plaque. One of the significant meta-analyses involved plaque regrowth over 4 days (< 4 weeks) of no oral hygiene measures. The overall weighted mean difference (WMD) for the plaque index (Turesky modification of the Quigley and Hein plaque index was 0.46 (95% confidence interval (CI) = 0.09, 0.84). The other meta-analysis was a comparison of 6-week and 6-month trials (> 4 weeks) in which either daily EOMW or CHX supplemented normal oral hygiene measures. This long-term study of plaque accumulation showed significantly less plaque with CHX than with EOMW. The WMD for the long-term plaque control studies was smaller than for the short-term studies (0.19; 95% CI = 0.08, 0.30). No significant differences were found in meta-analyses for gingival inflammation (gingival index) or stain accumulation (stain index). Significant heterogeneity was identified in 1 of 2 of the meta-analyses for both gingival index and stain index., Conclusions: The authors concluded that CHX was significantly better at reducing plaque accumulation than EOMW in short-and long-term studies. Staining and calculus accumulation were greater among CHX users compared to EOMW. CHX and EOMW were not different with respect to long-term control of gingival inflammation. They suggested that EOMW might be a reliable alternative to CHX for controlling gingival inflammation in cases where a dental professional deems that anti-inflammatory oral care is beneficial. However, they concluded that CHX remains the first choice when plaque control is the focus of therapy., (Copyright © 2012. Published by Mosby, Inc. All rights reserved.)

Article Title and Bibliographic Information: Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: a systematic review. Van Leeuwen MPC, Slot DE, Van der Weijden GA. J Periodontol 2011 Feb;82(2):174-94. Epub 2010 Nov 2., Reviewer: Anthony L. Neely, DDS, MDentSc, PhD., Purpose/question: To determine whether essential oil mouthwash is comparable to chlorhexidine gluconate with respect to reducing plaque and gingival inflammation and promoting calculus accumulation and extrinsic staining., Source of Funding: Some support came from the Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam. TYPE OF STUDY DESIGN: Systematic review with meta-analysis of data., Level of Evidence: Level 1: Good-quality, patient-oriented evidence., Strength of Recommendation Grade: Grade B: Inconsistent or limited-quality patient-oriented evidence., (Copyright © 2011. Published by Mosby, Inc.)

Background: Predictable regeneration of lost periodontal tissues in furcations is difficult to achieve. This paper investigates the efficacy of different treatment modalities for Class II molar furcations., Methods: Publications in English were searched using PubMed, Medline, and Cochrane Library databases combined with hand searching from January 1, 1966 to October 1, 2007. The search included randomized controlled human trials in molar Class II furcations with over 6 months of surgical reentry follow-up. Changes in vertical probing depths, vertical attachment levels, and vertical and horizontal bone levels were compared., Results: The search identified 801 articles of which 34 of 108 randomized clinical trials met the criteria. Thirteen trials had test and control arms allowing three meta-analyses: 1) five comparing non-resorbable versus resorbable membranes, 2) five comparing non-resorbable membranes versus open flap debridement and 3) three comparing resorbable membranes versus open flap debridement. There was significant improvement for resorbable versus non-resorbable membranes mainly in vertical bone fill (0.77 ± 0.33 mm; [95% CI; 0.13, 1.41]). Non-resorbable membranes showed significant improvement in vertical probing reduction (0.75 ± 0.31 mm; [95% CI; 0.14, 1.35]), attachment gain (1.41 ± 0.46 mm; [95% CI; 0.50, 2.31]), horizontal bone fill (1.16 ± 0.29 mm; [95% CI; 0.59, 1.73]), and vertical bone fill (0.58 ± 0.11 mm; [95% CI; 0.35, 0.80]) over open flap debridement. Resorbable membranes showed significant improvement in vertical probing reduction (0.73 ± 0.16 mm; [95% CI; 0.42, 1.05]), attachment gain (0.88 ± 0.16 mm; [95% CI; 0.55, 1.20]), horizontal bone fill (0.98 ± 0.12 mm; [95% CI; 0.74, 1.21]) and vertical bone fill (0.78 ± 0.19 mm; [95% CI; 0.42, 1.15]) over open flap debridement., Conclusions: Guided tissue regeneration with the use of resorbable membranes was superior to non-resorbable membranes in vertical bone fill. Both types of membranes were more effective than open flap debridement in reducing vertical probing depths and gaining vertical attachment levels and in gaining vertical and horizontal bone.

Objective: To examine the relationship between periodontal diagnosis and prognosis and survival of prosthodontic abutments over time., Method and Materials: The study consisted of 70 randomly selected patients with either fixed or removable partial dentures delivered by dental students. Age, gender, ethnicity, pertinent medical history, smoking status, procedure performed, abutment tooth number, year of prosthesis delivery, year of most recent periodontal examination, year of tooth loss, periodontal diagnosis and prognosis, date of prosthesis delivery, and most recent periodontal examination were extracted from dental charts. Statistical analyses included chi-square, Kaplan-Meier, and Cox proportional hazards models., Results: A total of 16 of 226 abutment teeth (7.1%) were lost. A total of 88.6% of subjects lost no abutment teeth during the study, while 15.7% lost at least 1 tooth. Analysis showed a cumulative 13.8-year survival rate of 66.0% (SE = +/- 0.10). Tooth-specific periodontal prognosis was a significant predictor of tooth loss. The data showed a 3.05-fold increased risk for tooth loss with removable partial denture abutments compared to fixed partial denture abutments. Abutment teeth with an initial specific prognosis of "good" had a 9.3-fold lower risk of loss than teeth with any other specific prognosis., Conclusions: Teeth with a periodontal prognosis other than good and those used as removable partial denture abutments had an increased risk of tooth loss. Periodontal diagnosis, overall prognosis (prognosis for the entire dentition), gender, ethnicity, smoking status, and diabetes were not significantly associated with abutment tooth loss over time.

Implant placement in fresh extraction sockets in conjunction with appropriate guided bone regeneration is well documented. The decision to extract teeth and replace them with immediate implants is determined by many factors, which ultimately affect the total treatment plan. The goal of this article is to review some of the important clinical considerations when selecting patients for immediate implant placement, and to discuss the advantages and disadvantages of this mode of therapy.

Background: The etiology of idiopathic cervical root resorption has not been elucidated clearly. However, the process has been linked to trauma, intracanal bleaching, and partial-thickness connective tissue grafts., Methods: This study describes a familial pattern of multiple idiopathic cervical root resorption in a father and son., Results: The father was a healthy 63-year-old white male who presented with the first resorption lesion in 1983. Twenty-seven additional lesions were identified on 16 teeth over 22 years. Five teeth were lost as a result of extensive resorption. The son was a healthy 43-year-old when a resorption lesion was identified in 1993. A lesion identified on another tooth 12 years later resulted in extraction., Conclusions: Close relatives of those affected by multiple idiopathic cervical root resorption should be examined carefully for cervical resorption. This study also showed that early treatment can prevent or delay the need for extraction.

Aim: No long-term studies have reported on risk factors for tooth loss in subjects without home or professional dental care. The purpose of this report is to identify potential risk factors for tooth loss among male Sri Lankan tea labourers who participated in a 20-year investigation of the natural history of periodontal disease., Material and Methods: Data for this report were obtained from the 455 subjects who participated in multiple examinations over the 20-year period from 1970 to 1990. Analyses included data from interim examinations in 1971, 1973, 1977, 1982 and 1985. Oral health assessments included the following: (1) attachment levels in millimetres on all mesial and mesio-buccal surfaces, excluding third molars; (2) plaque index; (3) gingival index; (4) calculus index; (5) caries index; and (6) missing teeth. Other variables included age, history of smoking and betel nut use. Statistical analyses included descriptive statistics and multivariate repeated-measures modelling with generalized estimating equations., Results: Tooth loss was significantly dependent upon interactions between the mean attachment loss and betel nut use (Z=3.40; p=0.0007) and history of missing teeth (Z=-3.70; p=0.0002). The effect of attachment loss on tooth loss was increased in the presence of betel nut and diminished when teeth were already missing at baseline., Conclusion: History of missing teeth, betel nut use and increasing attachment loss were significant predictors of tooth loss over time. Betel nut use increased the effect of attachment loss on loss of teeth, while history of missing teeth diminished the effect of attachment loss on tooth loss.