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 Aug;48(8):1008-1018. doi: 10.1111/jcpe.13489. Epub 2021 Jun 1.
To assess whether maintenance variables have a differential effect on tooth loss due to periodontitis (TLP) based on staging and grading.
Patients treated for periodontitis for a minimum of ≥10 years follow-up were included and categorized according to their stage and grade at baseline. Impact of number, regularity, and pattern of supportive periodontal therapy visits (SPT) on TLP was explored by dividing teeth into test (5 year time periods prior to TLP events) and control groups (random 5 year periods without tooth loss).
The regularity of maintenance visits, but not the overall quantity, had a significant impact on risk of TLP and showed higher importance as staging and grading increased (larger impact for stages III/IV and grade C). The minimum threshold of visits below which the risk of TLP was equivalent to that of the control group was one visit every 7.4 months for stages I-II, 6.7 months for stage III-IV, 7.2 months for grade B and 6.7 months for grade C. This frequency should be increased for former and current smokers, diabetics and elderly patients. Stage III and IV patients who skip more than 1 year of maintenance in a 5 year period have an increased risk of TLP (OR = 2.55) compared to those only miss 1 year. A similar trend was noted for grade C patients, but not for stages I/II or grades A/B.
Lack of SPT regularity and missing multiple years of maintenance had a larger influence on risk of TLP for higher-level staging and grading.
评估维持治疗变量是否会根据牙周炎的分期和分级对牙周炎导致的失牙（TLP）产生不同的影响。
纳入至少接受≥10 年随访治疗的牙周炎患者，并根据基线时的分期和分级进行分类。通过将牙齿分为测试组（TLP 事件前 5 年时间段）和对照组（无失牙的随机 5 年时间段），探讨维持性牙周治疗就诊的次数、规律性和模式对 TLP 的影响。
维持性就诊的规律性，而不是就诊总数，对 TLP 的风险有显著影响，且随着分期和分级的增加，其重要性也随之增加（对于 III/IV 期和 C 级，影响更大）。就诊次数低于此值时，TLP 的风险与对照组相当，对于 I-II 期为每 7.4 个月一次，对于 III-IV 期为每 6.7 个月一次，对于 B 级为每 7.2 个月一次，对于 C 级为每 6.7 个月一次。对于曾经吸烟者、糖尿病患者和老年患者，应增加该频率。与仅错过 1 年的患者相比，在 5 年内错过 1 年以上维持治疗的 III/IV 期患者发生 TLP 的风险增加（OR=2.55）。对于 C 级患者也存在类似的趋势，但对于 I/II 期或 A/B 级患者则没有。
缺乏 SPT 规律性和错过多年的维持治疗对较高分级和分期的 TLP 风险有更大的影响。
