Lundgren D, Asklöw B, Thorstensson H, Härefeldt A M
Department of Periodontology, Institute for Postgraduate Dental Education, Jönköping, Sweden.
J Clin Periodontol. 2001 Jan;28(1):23-30. doi: 10.1034/j.1600-051x.2001.280104.x.
BACKGROUND, AIMS: The aim of the present investigation was to determine the success rates of treatment of 36 patients with moderate to advanced periodontal disease as related to different clinical and radiographic criteria.
The treatment comprised oral hygiene education, subgingival scaling and root planing, and when judged indicated, periodontal surgery. An "evaluation criteria staircase" comprising 5 levels was introduced to be utilized for evaluation of the treatment results in 4 proximal sites (1 in each quadrant) which were followed for 3 years. The highest level of the staircase (level 1) is the most challenging and comprises the traditonal criteria for "perfect" periodontal health, while the lower levels are gradually less demanding.
At the follow-up examination 3 years after active treatment, 52.1% of the experimental sites fulfilled the criteria for successful treatment according to level 1. On the lowest level (level 5) which only required no further loss of alveolar bone for treatment to be considered "successful", the number of such treated sites reached 95.1%. The present data showed that even if level 5 was accepted as the evaluation criterion for "success", resulting in very few failed sites (4.9%), these sites may demand considerable extra clinical time and costs for retreatment because of their distribution among many individuals (13.2%). This clinical time increases substantially if higher levels of success are desired. From a cost-benefit point of view, it is therefore of utmost importance that not only patient compliance but also disease resistance and the value of the affected tooth for the dentition are taken into consideration when the indications for retreatment are weighed. This is especially important since many sites were found to be non-progressive for a long time, even though they did not exhibit perfect periodontal health.
It is suggested that the "evaluation criteria staircase" presented in this paper might be a helpful clinical instrument for decision-making in individually designed and site-related retreatments of patients with periodontal disease.
背景、目的：本研究旨在确定36例中重度牙周病患者根据不同临床和影像学标准进行治疗的成功率。
治疗包括口腔卫生教育、龈下刮治和根面平整，必要时进行牙周手术。引入一个包含5个级别的“评估标准阶梯”，用于评估4个邻面部位（每个象限1个）的治疗结果，随访3年。阶梯的最高级别（1级）最具挑战性，包含“完美”牙周健康的传统标准，而较低级别要求逐渐降低。
在积极治疗3年后的随访检查中，52.1%的试验部位符合1级成功治疗标准。在最低级别（5级），仅要求牙槽骨无进一步丧失即可视为治疗“成功”，达到该标准的治疗部位比例为95.1%。目前的数据表明，即使将5级作为“成功”的评估标准，导致失败的部位很少（4.9%），但由于这些部位分布在许多个体中（13.2%），重新治疗可能需要大量额外的临床时间和成本。如果期望更高的成功水平，临床时间会大幅增加。因此，从成本效益的角度来看，在权衡重新治疗的适应证时，不仅要考虑患者的依从性，还要考虑疾病的抵抗力以及患牙对牙列的价值，这一点至关重要。这一点尤为重要，因为许多部位虽然未表现出完美的牙周健康，但长期处于非进展性状态。
建议本文提出的“评估标准阶梯”可能是一种有用的临床工具，有助于在为牙周病患者进行个体化设计和与部位相关的再治疗时进行决策。
