A Novel Evidence-Based Periodontal Prognosis Model
Abstract
Objective
Patients
with periodontal disease and the dental professionals responsible for
their care want to know which teeth are expected to respond favorably to
periodontal treatment and which teeth are likely to be lost in the
short and long term. A number of different periodontal prognosis systems
have been previously proposed but do not consider important
patient-level factors, such as smoking and diabetic control, in the
calculation of the expected outcome and often use subjective measures
that introduce potential inaccuracies. The aim of this report is to
translate the best available evidence on periodontal prognosis into a
clinical model to facilitate decision-making and improve patient
outcomes.
Methods
Criteria
for an ideal prognostic system were proposed and used to assess the
previously reported models. With an emphasis on the inclusion of
patient-level modifiers (PLMs) and the exclusive use of objective
parameters, a new evidence-based model was developed.
Results
This
report proposes a new tooth-level prognosis model that uses 9
evidence-based quantifiable parameters to provide a prognosis of secure,
doubtful, poor, or irrational to treat. Six tooth-level risk predictors
(bone loss:age, pocket depth, furcation involvement, infrabony defects,
anatomical factors, and mobility) and 3 PLMs (smoking, diabetes, and
bleeding on probing) are used to determine the expected course of
disease with specific reference to the suitability of the tooth for
future dental treatment.
Conclusions
PLMs
must be considered when determining the prognosis of a tooth with
periodontal disease. The model proposed in this report is based on the
best available evidence for factors affecting tooth survival and has
been designed to be as simple and objective as possible to facilitate
its adoption in clinical practice. It will be retrospectively and
prospectively validated to determine its ability to accurately predict
the course of disease.
Comments