Ravidà Andrea, Saleh Muhammad H A, Ghassib Iya H, Qazi Musa, Kumar Purnima S, Wang Hom-Lay, Eke Paul I, Borgnakke Wenche S
Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.
Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA.
Periodontol 2000. 2024 Jul 25. doi: 10.1111/prd.12585.
The study aims were (1) to explore whether "periodontal treatment" consisting of surgical therapy (flap, resective, or regenerative) or scaling and root planing treatment with long-term periodontal maintenance treatment, is cost-effective in terms of preventing periodontitis-attributable tooth extraction and replacement by implant-supported crowns ("extraction/replacement"); (2) to assess the effect of cigarette smoking on this cost-effectiveness. Data for this observational retrospective study were collected from dental charts of patients who had received periodontal therapy and at least annual follow-up visits for >10 years were analyzed by linear regression generalized estimating equations and generalized linear models. Among 399 adults (199 males, 200 females), those with the least mean annual treatment cost experienced the greatest mean annual costs for extraction/replacement, indicating general cost-effectiveness. Cigarette smoking adversely impacted this cost-effectiveness, with current heavy smokers experiencing no cost-effectiveness. Former smokers with Grade C periodontitis benefitted most, whereas smoking did not influence cost-effectiveness for Grade B periodontitis. Assessed by mean annual costs of "extraction/replacement," periodontal treatment was cost-effective, which decreased in a dose-response manner by former and current smoking intensity. Cigarette smoking should be factored into treatment planning and cost-effective analyses of periodontal treatment. Smoking cessation should be encouraged.
（1）探讨由手术治疗（翻瓣术、切除术或再生术）或龈下刮治术及根面平整术并长期进行牙周维护治疗所组成的“牙周治疗”，在预防因牙周炎导致的牙齿拔除及种植支持冠修复（“拔牙/修复”）方面是否具有成本效益；（2）评估吸烟对这种成本效益的影响。这项观察性回顾性研究的数据收集自接受过牙周治疗的患者的牙科病历，并通过线性回归广义估计方程和广义线性模型对至少进行了10年的年度随访数据进行分析。在399名成年人（199名男性，200名女性）中，平均年度治疗成本最低的患者，其拔牙/修复的平均年度成本最高，这表明总体具有成本效益。吸烟对这种成本效益有不利影响，目前的重度吸烟者没有成本效益。患有C级牙周炎的既往吸烟者受益最大，而吸烟对B级牙周炎的成本效益没有影响。以“拔牙/修复”的平均年度成本评估，牙周治疗具有成本效益，且随着既往和当前吸烟强度呈剂量反应关系下降。在牙周治疗的治疗计划和成本效益分析中应考虑吸烟因素。应鼓励戒烟。
