Flemmig T F
Westfalian Wilhelm University, Münster, Germany.
Ann Periodontol. 1999 Dec;4(1):32-8. doi: 10.1902/annals.1999.4.1.32.
The purpose of this review was to assess the scientific and clinical bases for the proposed classification of periodontitis. The clinical and histopathological signs and the etiology of periodontitis were described. Cross-sectional studies were analyzed to determine when onset of periodontitis most frequently occurs in adults. In addition, the progression rates of periodontitis have been assessed from longitudinal studies. No clinical, histopathological, or microbiological features could be identified that would characterize different disease entities of chronic periodontitis. The prevalence, extent, and severity of periodontitis were found to increase continually with higher age and there was no age when onset of disease would most likely occur. The rate of periodontitis progression varies largely between patients and there is no natural threshold for distinguishing various rates of disease progression. The incidence of periodontitis unresponsive to treatment depends on pretreatment progression rate, extent and severity of disease, tooth type, smoking, high levels of putative periodontal pathogens, a deficient immune response, and the type of therapy provided. There is no scientific basis for the classification "adult periodontitis" and "refractory adult periodontitis." Extensive clinical examinations are required for the diagnosis of "rapidly progressive adult periodontitis." It appears unrealistic that these examinations can be performed routinely in clinical practice. Therefore, the classification proposed by the Organizing Committee to define adult, rapidly progressive, and refractory periodontitis as specific disease entities was replaced with a simplified classification of periodontitis based on the scientific data available.
本综述的目的是评估所提出的牙周炎分类的科学和临床依据。描述了牙周炎的临床和组织病理学体征以及病因。分析横断面研究以确定牙周炎在成年人中最常发病的时间。此外，已从纵向研究中评估了牙周炎的进展速度。未发现可用于表征慢性牙周炎不同疾病实体的临床、组织病理学或微生物学特征。发现牙周炎的患病率、范围和严重程度随年龄增长而持续增加，且没有最可能发病的年龄。牙周炎的进展速度在患者之间差异很大，并且没有区分不同疾病进展速度的自然阈值。对治疗无反应的牙周炎的发生率取决于治疗前的进展速度、疾病的范围和严重程度、牙齿类型、吸烟、假定的牙周病原体水平高、免疫反应不足以及所提供的治疗类型。“成人牙周炎”和“难治性成人牙周炎”的分类没有科学依据。诊断“快速进展性成人牙周炎”需要进行广泛的临床检查。在临床实践中常规进行这些检查似乎不现实。因此，根据现有科学数据，用一种简化的牙周炎分类取代了组委会提出的将成人、快速进展性和难治性牙周炎定义为特定疾病实体的分类。
