Papapanou P N
Department of Periodontology, Faculty of Odontology, Gothenburg University, Sweden.
Swed Dent J Suppl. 1989;66:1-45.
The main objective of this series of investigations was to develop a model to assess periodontal treatment priorities based on the amount of remaining alveolar bone support. To obtain proper data to generate this model, a cross-sectional and a longitudinal investigation of periodontal disease were undertaken. On radiographs from 531 subjects aged 25-75 years, assessments of alveolar bone level (ABL), i.e. the distance between the cementoenamel junction and the most coronal level of the alveolar bone support, were performed at the approximal surfaces of all present teeth A small proportion of the sample (11%) showed advanced alveolar bone loss (mean ABL greater than or equal to 6 mm). An ABL of greater than or equal to 6 mm was found in 13% of the tooth sites examined. The severity of alveolar bone loss was more pronounced in the maxilla than in the mandible. Incisors showed the highest and molars the lowest frequency of advanced alveolar bone loss. The assessments of ABL were repeated on radiographs taken 10 years later from 194 of the subjects. An average longitudinal tooth loss of 3.8 teeth/subject was noted. Differences in alveolar bone height were calculated. It was observed that 7% of the subjects and 10% of the tooth sites had experienced advanced additional loss of alveolar bone. The mean annual alveolar bone loss varied between 0.07-0.14 mm in ages between 25 and 65 years. 70 year old subjects showed the most pronounced rate of additional bone loss (0.28 mm/year). A subsequent clinical examination revealed an overall high degree of agreement between the radiographic and the probing attachment level determinations. In 92% of the tooth sites with measurable ABL and probing attachment loss the difference between the two assessments was within 2 mm. However, the agreement became poorer with increasing severity of periodontal tissue breakdown. The data on the longitudinal alveolar bone level changes generated age- and tooth type specific "critical" bone loss limits. These described amounts of bone loss beyond which therapeutic intervention must be performed in order to secure proper function of the teeth throughout life. A random sample of 192 industrial employees was examined radiographically and clinically. When traditional criteria were employed to assess the periodontal treatment needs, 100% of the subjects and 70% of the approximal tooth sites examined required therapy. Bleeding on probing together with the described alveolar bone loss limits identified the 40% of the subjects and the 2.5% of the tooth sites which should be given priority with respect to periodontal therapy.
这一系列调查的主要目的是开发一种模型，以便根据剩余牙槽骨支持量来评估牙周治疗的优先级。为了获取生成该模型的适当数据，开展了一项牙周疾病的横断面和纵向调查。在531名年龄在25至75岁的受试者的X光片上，对所有现存牙齿邻面的牙槽骨水平（ABL）进行了评估，即牙骨质釉质界与牙槽骨支持最冠方水平之间的距离。一小部分样本（11%）显示有严重的牙槽骨丧失（平均ABL大于或等于6毫米）。在所检查的牙位中，13%发现ABL大于或等于6毫米。上颌牙槽骨丧失的严重程度比下颌更明显。切牙出现严重牙槽骨丧失的频率最高，磨牙最低。对194名受试者10年后拍摄的X光片再次进行ABL评估。观察到平均每位受试者纵向牙齿丧失3.8颗。计算牙槽骨高度的差异。观察到7%的受试者和10%的牙位经历了严重的额外牙槽骨丧失。25至65岁年龄段的平均每年牙槽骨丧失在0.07至0.14毫米之间。70岁的受试者额外骨丧失率最为明显（0.28毫米/年）。随后的临床检查显示，X光片和探诊附着水平测定之间总体一致性较高。在92%可测量ABL和探诊附着丧失的牙位中，两种评估之间的差异在2毫米以内。然而，随着牙周组织破坏程度的增加，一致性变差。纵向牙槽骨水平变化的数据生成了年龄和牙型特定的“临界”骨丧失限度。这些描述的骨丧失量超过此限度就必须进行治疗干预，以确保牙齿在整个生命过程中的正常功能。对192名产业员工的随机样本进行了X光片和临床检查。当采用传统标准评估牙周治疗需求时，100%的受试者和70%所检查的邻面牙位需要治疗。探诊出血加上所描述的牙槽骨丧失限度确定了40%的受试者和2.5%的牙位应在牙周治疗中给予优先考虑。
