An Evidenced-Based Scoring Index to Determine the Periodontal Prognosis on Molars

• Autores: P.A. Niklaus
• Localización: Journal of periodontology, ISSN 0022-3492, Nº. 2, 2014, págs. 214-225
• Idioma: inglés
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• Resumen

  • Background: This retrospective study evaluates and assigns scores to six prognostic factors and derives a quantitative scoring index used to determine the periodontal prognosis on molar teeth.

    Methods: Data were gathered on 816 molars in 102 patients with moderate-to-severe periodontitis. The six factors evaluated (age, probing depth, mobility, furcation involvement, smoking, and molar type) were assigned a numeric score based on statistical analysis. The sum of the scores for all factors was used to determine the prognosis score for each molar. Only patients with all first and second molars at the initial examination qualified for the study. All patients were evaluated a minimum of 15 years after treatment.

    Results: The post-treatment time ranged from 15 to 40 years and averaged 24 years. When the study was completed, 639 molars survived (78%), and, of those surviving molars, 588 survived and were periodontally healthy (92%). In molars with lower scores (scores 1-3), the 15-year survival rates ranged from 98% to 96%. In molars with middle scores (scores 4-6), the 15-year survival rates ranged from 95% to 90%, and, for molars with higher scores (scores 7-10), the survival rates ranged from 86% to 67%.

    Conclusion: The present results indicate that the periodontal prognosis of molars diagnosed with moderate-to-severe periodontitis can be calculated using an evidence-based scoring index.

    Determining prognosis is one of the most important functions undertaken in clinical practice. In medicine, determining treatment and prognosis is often assisted by quantitative methods, including combinations of algorithms, decision trees, and/or clinical balance sheets.1,2 Although there are many systems for determining prognosis in periodontal disease,3-8 there is a need for an objective, evidenced-based scoring index that will provide a prognosis score for each individual tooth.9,10 Such a scoring index would be beneficial because determining an accurate prognosis for periodontally involved teeth is crucial to the development of an appropriate treatment plan.11 One clinician described assigning periodontal prognosis as an �art based on a science.�12 Another stated �that a coin toss would be an easier and more accurate way for a clinician to assign a prognosis under traditional guidelines.�13,14 Periodontal disease is multifactorial and includes both risk factors (factors that cause disease) and prognostic factors (factors that focus on disease outcome once disease is present).15-17 Abundant evidence exists in the periodontal literature regarding the association between prognostic factors and tooth loss in periodontally maintained patients.6,13,18-28 Although some prognostic factors can be altered by treatment, others cannot. Prognostic factors can be categorized as follows: 1) those that can be controlled by the patient (daily plaque removal, smoking cessation, compliance with wearing occlusal guards, compliance with the recommended preventive maintenance schedule); 2) those affected by periodontal treatment (probing depth [PD], mobility, furcation involvement, trauma from occlusion, bruxism, other parafunctional habits); 3) those associated with systemic disease (diabetes mellitus [DM], immunologic disorders, hypothyroidism); and 4) those that are uncontrollable (poor root form, poor crown/root ratio, tooth type, age, genetics).29 Traditionally, prognosis of periodontally involved teeth has been evaluated using the terms �good,� �fair,� �poor,� �questionable,� and �hopeless.�7,14 Additionally, �short-term� and �long-term� have been used to signify the future. These arbitrary terms do not offer clinicians a reliable method for assigning prognosis. McGuire and Nunn13 concluded that the ability to predict tooth survival accurately is the ultimate test for any index devised to determine prognosis. The current concept of assigning periodontal prognosis is often based on clinical opinion. The clinician typically considers many factors, including disease severity. Although clinical experience, therapeutic skill, and patient compliance can influence prognosis, an objective way of determining prognosis is needed. The purpose of this study is to develop and test a practical, evidence-based scoring index to objectively determine the prognosis of periodontally involved molars. This study has four significant features: 1) the use of a long-term cohort study; 2) scoring all molars at the initial examination, even those planned for extraction; 3) scoring molars only, the most difficult teeth to treat and maintain; and 4) evaluation of the periodontal health of the surviving molars. The scoring index must be simple to score as well as easily understood by both the dentist and patient. It should be designed so a dental assistant can calculate the score from examination data. Ultimately, software could be developed that would calculate the score electronically.