Saleh Muhammad H A, Dukka Himabindu, Troiano Giuseppe, Ravidà Andrea, Qazi Musa, Wang Hom-Lay, Greenwell Henry
Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.
Department of Periodontics, University of Louisville School of Dentistry, Louisville, Kentucky, USA.
J Periodontol. 2022 Jan;93(1):57-68. doi: 10.1002/JPER.20-0662. Epub 2021 May 24.
Clinicians predominantly use personal judgment for risk assessment. Periodontal risk assessment tools (PRATs) provide an effective and logical system to stratify patients based on their individual treatment needs. This retrospective longitudinal study aimed to validate the association of different risk categories of four PRATs (Staging and grading; Periodontal Risk Assessment (PRA); Periodontal Risk Calculator; and PerioRisk) with periodontal related tooth loss (TLP), and to compare their prognostic performance.
Data on medical history, smoking status, and clinical periodontal parameters were retrieved from patients who received surgical and non-surgical periodontal treatment. A comparison of the rate of TLP and non-periodontal related tooth loss (TLO) within the risk tool classes were performed by means of Kruskal-Wallis test followed by post-hoc comparison with the Bonferroni test. Both univariate and multivariate Cox Proportional hazard regression models were built to analyze the prognostic significance for each single risk assessment tool class on TLP.
A total of 167 patients with 4321 teeth followed up for a mean period of 26 years were assigned to four PRATs. PerioRisk class 5 had a hazard ratio of 18.43, Stage 4 had a hazard ratio of 7.99, and PRA class 3 had a hazard ratio of 6.13 compared with class/stage I. With respect to prognostic performance, PerioRisk tool demonstrated the best discrimination and model fit followed by PRA.
All PRATs displayed very good predictive capability of TLP. PerioRisk showed the best discrimination and model fit, followed by PRA.
临床医生主要依靠个人判断进行风险评估。牙周风险评估工具（PRATs）提供了一个有效且合理的系统，可根据患者的个体治疗需求对其进行分层。这项回顾性纵向研究旨在验证四种PRATs（分期与分级；牙周风险评估（PRA）；牙周风险计算器；以及PerioRisk）的不同风险类别与牙周相关牙齿缺失（TLP）之间的关联，并比较它们的预后性能。
从接受手术和非手术牙周治疗的患者中获取病史、吸烟状况和临床牙周参数数据。通过Kruskal-Wallis检验比较风险工具类别内的TLP和非牙周相关牙齿缺失（TLO）发生率，随后采用Bonferroni检验进行事后比较。构建单变量和多变量Cox比例风险回归模型，以分析每个单一风险评估工具类别对TLP的预后意义。
共有167名患者的4321颗牙齿接受了平均26年的随访，并被分配到四种PRATs中。与I类/分期相比，PerioRisk 5级的风险比为18.43，4期的风险比为7.99，PRA 3级的风险比为6.13。在预后性能方面，PerioRisk工具表现出最佳的区分度和模型拟合度，其次是PRA。
所有PRATs对TLP均显示出非常好的预测能力。PerioRisk表现出最佳的区分度和模型拟合度，其次是PRA。
