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Lang NP, Schätzle MA et al. J Clin Periodontol 2009; 36 (Suppl. 10): 3–8

A cohort of 565 males, aged between 16 and 34 years old who 'had received state-of-the-art professional and personal dental care', were examined 7 times between 1969 and 1995. Less than 40% (n = 223) of the initial group attended the final survey. Gingival units that repeatedly showed health had 'a mean cumulative loss of attachment (LA) over 60 years life span of <2 mm', whereas those that consistently bled on probing had a mean LA of >3 mm. The authors conclude 'it has now convincingly been demonstrated that the development of periodontitis only occurs in areas of long-standing gingivitis'. The raw data is not given in this paper but it cites references for where this can be accessed. This paper also gives a contemporaneous summary of the pathogenesis of periodontal disease.