The Prognostic Factors Of Severe Periodontitis Treated By Non-surgical Therapy

Objective: Periodontitis is a chronic inflammation in periodontal tissue caused by bacteria,the outcome of which is teeth mobility and even the teeth loss.The prosthodontic treatment for the lost teeth can lead to patients discomfort and financial burden,therefore,it's important for us to retain natural teeth for the patient.However,in clinic,the prognosis of severe periodontitis is often poor.Even if it has been treated completely,it is difficult to control the following development of inflammation.Hence,it's critically important for dentists to estimate the correct prognosis of the teeth of severe periodontitis in clinic,which is not only beneficial for us to make the rational treatment planning,but also contributes to effective communication between patients and dentists.In this study,the teeth with severe periodontitis are included,they were divided into anterior teeth,maxillary posterior region and mandibular posterior region.According to the probing depth(PD)after periodontal initial treatment,the teeth in different regions were divided into two groups: PD<5 mm and PD?5 mm.The aim of this study is to find the common prognostic factors and specific prognostic factors in different regions after periodontal initial therapy,providing evidence for the prognosis of teeth of severe periodontitis in different regions.Methods:A total of 73 patients(330 teeth)in anterior region,104 patients(362 teeth)in maxillary posterior region and 89 patients(285 teeth)were collected from Department of Periodontics,School of Stomatology,China Medical University,from September 2015 to March 2018,who were diagnosed as severe periodontitis and treated with periodontal non-surgical treatment.We recorded patients' age,gender,smoking history,diabetes history and clinical parameters of involved teeth including periodontal probing depth(PD),clinical attachment loss(CAL),sulcus bleeding index(SBI),tooth mobility(TM),plaque index(PLI),alveolar bone defect type,periodontitis type,furcation involvement(FI)for posterior teeth,crown to root ratio,occlusion trauma,pulp state and crown repair.Probing was performed with UNC-15 periodontal probe(Hu-Friedy,USA)with the power of 20-25 grams.We recorded PD and CAL of each tooth in six sites,including the mesial buccal site,the central buccal site,the distal buccal site,the mesial lingual or palatal site,the central lingual or palatal site and the distal lingual or palatal site.According to the PD values after 3 months of periodontal initial treatment,we divided these patients into two groups: PD<5 mm group and PD?5 mm group.SPSS 20.0statistical software were used for statistical data analysis.The mean PD at baseline,the maximal value of PD and the mean CAL of two groups were compared with independent sample t-test.Analysis of variance(ANOVA)was used to compare the differences of age,sex,smoking history,diabetes history,the alveolar bone defect type,periodontitis type,crown-to-root ratio,occlusal trauma,pulp state and crown prosthesis between two groups.The differences of SBI,PLI,TM,and FI of posterior teeth of two groups were compared by rank sum test.An logistic regression analysis was performed to determine the relevant factors for the prediction of teeth with poor prognosis.All tests were two-sided and parameters were statistically significant(P<0.05).Results : 1.Univariate analysis showed that in the anterior region,gender,smoking history,mean PD at baseline,the maximal value of PD,baseline SBI,baseline PLI,alveolar bone defect type and crown-root ratio were significantly different between the PD<5 mm group and PD?5 mm group(P<0.05);In maxillary posterior region,smoking history,mean PD at baseline,the maximal value of PD,mean CAL at baseline,baseline TM,baseline PLI,PLI after 3 months of periodontal initial treatment,alveolar bone defect type,periodontitis type,baseline FI,crown-to-root ratio and occlusal trauma were significantly different between PD<5 mm group and PD?5 mm group(P<0.05);In the mandibular posterior region,age,smoking history,diabetes history,mean PD at baseline,the maximal value of PD,mean CAL at baseline,baseline TM,baseline PLI,PLI after 3months of periodontal initial treatment,baseline FI,crown-to-root ratio,occlusal trauma and pulp state were significantly different between PD<5 mm group and PD?5 mm group(P<0.05).2.Logistic regression analysis suggested that the independent risk factors of prognosis in the anterior region included gender,PD at baseline,SBI,PLI and crown-to-root ratio.The prognosis factors of maxillary posterior area included smoking,mean PD at baseline,PLI in three-month follow-up,periodontitis type,FI at baseline and crown-to-root ratio.The prognosis factors of mandibular posterior area included mean PD at baseline,PLI at baseline,PLI in three-month follow-up,FI at baseline and crown-to-root ratio.Conclusion : The common prognostic factors for non-surgical treatment of severe periodontitis in the anterior region,maxillary posterior and mandibular posterior region were mean PD at baseline,PLI at baseline and crown-to-root ratio,.The specific prognostic factors in the anterior region were gender and SBI at baseline;the common prognostic factors in the posterior region were FI at baseline.Compared with the mandibular posterior teeth,the specific prognostic factors of maxillary posterior teeth were smoking and periodontitis.