Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
Department of Periodontics, University of Louisville School of Dentistry, Louisville, KY, USA.
J Clin Periodontol. 2021 May;48(5):648-658. doi: 10.1111/jcpe.13430. Epub 2021 Mar 19.
To assess the ability of two-way interactions between baseline stage, grade and extent to predict tooth loss due to periodontitis (TLP) over a long-term follow-up period.
Patients treated for periodontal disease with a complete medical history, baseline periodontal chart, full mouth radiographs and a minimum of ≥10 years follow-up were recruited. Supportive periodontal therapy (SPT) visits were recorded during the entire follow-up period. Patients were categorized according to their stage, grade and extent. The absolute survival at 10-, 20-, and 30-year follow-up was calculated for TLP. Kaplan-Meier survival curves were plotted at the tooth-level and multilevel Cox regression frailty models were constructed in order to assess the association among predictive variables and TLP by taking into account the hierarchical patient-teeth structure.
442 patients (11,125 teeth) with a mean follow-up of 23 years met the inclusion criteria and were included in this study. The most prevalent diagnosis at baseline was stage III grade B (30.3%), followed by stage II grade B (23.5%). Among the parameters analysed, stage and grade were found to be the best predictors of TLP. Statistically significant differences were observed for extent only in patients with severe disease (stage IV or grade C). The multilevel Cox regression analysis demonstrated that patients with higher concomitant baseline staging and grading developed greater TLP over the follow-up period.
Higher concomitant staging and grading corresponded to greater risk for TLP and generalized extent only became a significant predictor in patients with stage IV or grade C disease.
评估基线分期、分级和范围的双向交互作用在长期随访期间预测因牙周炎导致的牙齿丧失（TLP）的能力。
招募了患有牙周病并具有完整病史、基线牙周图表、全口 X 光片和至少≥10 年随访记录的患者。在整个随访期间记录了支持性牙周治疗（SPT）就诊情况。根据患者的分期、分级和范围进行分类。计算了 TLP 在 10、20 和 30 年随访时的绝对生存率。绘制了 Kaplan-Meier 生存曲线，并构建了多水平 Cox 回归脆弱性模型，以评估预测变量与 TLP 之间的关联，同时考虑到患者-牙齿的分层结构。
符合纳入标准并纳入本研究的 442 名患者（11125 颗牙齿）的平均随访时间为 23 年。基线时最常见的诊断是 III 期 B 级（30.3%），其次是 II 期 B 级（23.5%）。在分析的参数中，仅在患有严重疾病（IV 期或 C 级）的患者中，分期和分级被发现是 TLP 的最佳预测指标。多水平 Cox 回归分析表明，基线分期和分级较高的患者在随访期间发生更大的 TLP。
较高的同期分期和分级与更大的 TLP 风险相关，只有在患有 IV 期或 C 级疾病的患者中，广泛的程度才成为一个重要的预测指标。
