Tonetti M S, Muller-Campanile V, Lang N P
Department of Periodontology and Fixed Prosthodontics, University of Berne, Switzerland.
J Clin Periodontol. 1998 Dec;25(12):1008-16. doi: 10.1111/j.1600-051x.1998.tb02406.x.
Bleeding on probing and the presence of deep periodontal pockets are considered to be the best site-specific indicators for periodontal disease progression during the maintenance phase of periodontal therapy. A major emphasis of supportive periodontal care (SPC) programs, therefore, has been the control of bleeding pockets. This investigation retrospectively evaluated the changes in the prevalence of bleeding on probing, periodontal pockets, bleeding periodontal pockets and the prevalence of tooth loss in a random sample of 273 periodontal patients participating in a supportive maintenance care program at a University Clinic. During an observation period of 67+/-46 months (range 5 months to 23 years), the overall incidence of all causes of tooth mortality was 0.23+/-0.49 teeth per patient per year of observation. 56% of subjects, however, did not experience any tooth loss, while less than 10% of patients lost more than 3 teeth. Thus, participation in the SPC program was effective in preventing tooth loss in the majority of patients. During the SPC period, however, a significant increase in the prevalence of periodontal pockets, and of bleeding on probing positive periodontal pockets, in particular, was observed. At completion of active periodontal therapy, 56.4% of patients were free from bleeding pockets. This decreased to a mere 13.6% at the latest SPC evaluation. The observed increases in the number of bleeding pockets was significantly associated with: longer times since completion of active periodontal therapy, more advanced periodontal diagnosis, higher %s of bleeding sites in the dentition, cigarette smoking, lack of inclusion of periodontal surgery in the active treatment phase, tooth loss, and the response to the active phase of periodontal treatment. The data presented in the paper indicate that the observed increase in the prevalence of bleeding pockets and tooth loss was not homogeneously distributed in the studied SPC population. Rather, high risk groups of individuals could be identified. It is suggested that better knowledge of risk indicators may lead to improved and more efficient risk management efforts during periodontal maintenance care.
探诊出血和深牙周袋的存在被认为是牙周治疗维护阶段牙周疾病进展的最佳部位特异性指标。因此，支持性牙周护理（SPC）计划的一个主要重点一直是控制出血性牙周袋。本研究回顾性评估了在大学诊所参加支持性维护护理计划的273名牙周病患者的随机样本中，探诊出血、牙周袋、出血性牙周袋的患病率变化以及牙齿缺失的患病率。在67±46个月（范围为5个月至23年）的观察期内，所有导致牙齿丧失的病因的总体发病率为每位患者每年观察期0.23±0.49颗牙。然而，56%的受试者没有牙齿丧失，而不到10%的患者牙齿丧失超过3颗。因此，参与SPC计划在大多数患者中有效地预防了牙齿丧失。然而，在SPC期间，观察到牙周袋的患病率显著增加，尤其是探诊阳性牙周袋的出血患病率显著增加。在积极牙周治疗结束时，56.4%的患者没有出血性牙周袋。在最近的SPC评估中，这一比例降至仅13.6%。观察到的出血性牙周袋数量增加与以下因素显著相关：积极牙周治疗完成后的时间更长、牙周诊断更严重、牙列中出血部位的百分比更高、吸烟、在积极治疗阶段未包括牙周手术、牙齿丧失以及对牙周治疗积极阶段的反应。本文提供的数据表明，观察到的出血性牙周袋患病率和牙齿丧失的增加在研究的SPC人群中分布并不均匀。相反，可以识别出高危个体群体。建议更好地了解风险指标可能会在牙周维护护理期间改进并提高风险管理效率。
