Development of a prognostic tool: based on risk factors for tooth loss after active periodontal therapy

Prognostic factors affecting probing depth reduction following non‑surgical periodontal therapy in patients with periodontitis: A linear mixed‑effects model analysis

The present study aimed to elucidate the prognostic factors affecting the probing depth (PD) reduction following the non-surgical periodontal treatment of patients with periodontitis using a linear mixed-effects model. A retrospective analysis was performed on 455 patients who met the specific inclusion criteria. Data were gathered from 3-month re-evaluation records in the electronic periodontal charting system at the Department of Periodontology, School and Hospital of Stomatology at Tianjin Medical University between December 2021 and January 2022. Descriptive statistics were used to assess the changes in PD and certain baseline characteristics of the patients. A three-level nested random-effects mixed-effect model (patient/tooth/site) was used to evaluate the prognostic factors for PD reduction. Variance decomposition was conducted to analyze PD reduction across different nested levels. P<0.05 was considered to indicate a statistically significant difference. The overall mean PD reductions at the patient level for all sites were 0.88 mm. Patients diagnosed with Grade C periodontitis exhibited a greater PD reduction compared with those with Grade B periodontitis (0.96 vs. 0.76 mm; P<0.001). The multivariable coefficient for patients with Grade C periodontitis was 0.20 (95% confidence interval, 0.08-0.33; P<0.001). Random-effects analysis demonstrated that the variability in PD reduction was 59.4, 39.1 and 73.8% at the patient, tooth and site levels, respectively. Grade C periodontitis had the most substantial importance on the effect of PD reduction following NSPT. This reduction in PD could primarily be explained at both the site and patient levels.

Factors Influencing Tooth Sensitivity: Insights From the Hospital Universiti Sains Malaysia Using Bootstrap-Enhanced Ordinal Regression

Introduction Tooth sensitivity, or dentin hypersensitivity (DH), is characterized by sharp, sudden pain in response to stimuli such as cold, heat, sweet, or acidic foods and drinks. In Malaysia, there is limited understanding of the epidemiological aspects of tooth sensitivity, necessitating focused research. The condition results from the exposure of dentinal tubules transmitting stimuli to nerves within the pulp, with contributing factors including gingival recession, enamel erosion, and periodontal disease. This study aims to investigate the factors associated with tooth sensitivity among patients at the Hospital Universiti Sains Malaysia (USM) using advanced statistical methods. Methods This study employed a computational research design to develop an ordinal regression and bootstrap methodology using the RStudio software (Posit PBC, Boston, MA) to analyze secondary data from the Hospital Universiti Sains Malaysia. Six variables were analyzed: tooth wear severity, patient's age, gender, smoking status, alcohol status, and type of toothbrush. The study was conducted in three phases: 1) the development of an ordinal regression model, 2) the development of algorithms for ordinal regression and bootstrap method, and 3) validation using tooth sensitivity data. Results The analysis revealed that the replication with 1000 samples provided the most precise estimates with small standard errors (SE) and consistently significant effects across variables. Tooth sensitivity was influenced by age, toothpaste type, toothbrush type, and brushing frequency. Conclusion The study highlights the importance of considering multiple variables such as age, toothpaste type, toothbrush type, and brushing frequency in understanding tooth sensitivity. The combined ordinal regression and bootstrap technique significantly improved the model's accuracy, providing valuable insights for dental health professionals. These findings underscore the need for specific guidelines on oral hygiene practices to manage and reduce the risk of tooth sensitivity.

Systematic Review of Prognosis Models in Predicting Tooth Loss in Periodontitis

This study reviews and appraises the methodological and reporting quality of prediction models for tooth loss in periodontitis patients, including the use of regression and machine learning models. Studies involving prediction modeling for tooth loss in periodontitis patients were screened. A search was performed in MEDLINE via PubMed, Embase, and CENTRAL up to 12 February 2022, with citation chasing. Studies exploring model development or external validation studies for models assessing tooth loss in periodontitis patients for clinical use at any time point, with all prediction horizons in English, were considered. Studies were excluded if models were not developed for use in periodontitis patients, were not developed or validated on any data set, predicted outcomes other than tooth loss, or were prognostic factor studies. The CHARMS checklist was used for data extraction, TRIPOD to assess reporting quality, and PROBAST to assess the risk of bias. In total, 4,661 records were screened, and 45 studies were included. Only 26 studies reported any kind of performance measure. The median C-statistic reported was 0.671 (range, 0.57-0.97). All studies were at a high risk of bias due to inappropriate handling of missing data (96%), inappropriate evaluation of model performance (92%), and lack of accounting for model overfitting in evaluating model performance (68%). Many models predicting tooth loss in periodontitis are available, but studies evaluating these models are at a high risk of bias. Model performance measures are likely to be overly optimistic and might not be replicated in clinical use. While this review is unable to recommend any model for clinical practice, it has collated the existing models and their model performance at external validation and their associated sample sizes, which would be helpful to identify promising models for future external validation studies.

Vital root resection with radicular retrograde partial pulpotomy in furcation-involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects

AIM

Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro).

SUMMARY

Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6-10 mm) preoperatively and 2.62 ± 0.42 mm (3-4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing.

KEY LEARNING POINTS

In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.

Probing pocket depth reduction after non-surgical periodontal therapy: Tooth-related factors

BACKGROUND

To investigate tooth-related factors that influence the reduction of probing pocket depths (PPD) after non-surgical periodontal therapy (NST).

METHODS

Seven hundred forty-six patients with a total of 16,825 teeth were included and retrospectively analyzed. PPD reduction after NST was correlated with the tooth-related factors; tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration; using logistic multilevel regression for statistical analysis.

RESULTS

NST was able to reduce probing depth overall stratified probing depths (1.20 ± 1.51 mm, p ≤ 0.001). The reduction was significantly higher at teeth with higher probing depths at baseline. At pockets with PPD ≥ 6 mm, PPD remains high after NST. Tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration are significantly and independently associated with the rate of pocket closure.

CONCLUSIONS

The tooth-related factors: tooth type, number of roots, furcation involvement, vitality, mobility, and type of restoration had a significant and clinically relevant influence on phase I and II therapy. Considering these factors in advance may enhance the prediction of sites not responding adequately and the potential need for additional treatment, such as re-instrumentation or periodontal surgery, to ultimately achieve the therapy end points.