Association of Clinical Risk Factors With Treatment Outcomes

Abstract

A patient's decision to accept treatment recommended by his dental health care provider will be strongly influenced by the quality of the information he is given. Estimates of prognosis and treatment predictability must be based on the evidence available from the literature and the practitioners' own experience. Thorough, accurate, and relevant clinical and adjunctive diagnostic data will be a major influence in the development of the patient's individualized treatment strategy. Some clinical findings such as severity of disease for age, deepening pockets accompanied by loss of clinical attachment, frequent bleeding on probing, and bone loss can be considered as risk and prognosis factors. "Hard" data implicating specific clinical or diagnostic findings as risk factors or markers are difficult to find because there are few randomized longitudinal trials available. A new approach which attempts to focus on reducing the risk of undesirable outcomes while improving the probability of successful outcomes following treatment has been referred to as the Treatment Predictability Model. A key feature of this approach is the focus on individual patient circumstances and preferences through the use of decision analysis techniques. A large scale, long-term project utilizing a practice-based research network (PBRN) provided some descriptive information about factors that could distinguish between responders and nonresponder patients undergoing treatment for advanced periodontitis. Bacterial colonization, level of post-treatment plaque control, and smoking were major predictive variables in this group of periodontitis patients. The predictive treatment approach may be one way to develop evidence that will improve the predictability of outcomes for individual patients.

Retention of Hopeless Teeth: The Effect on the Adjacent Proximal Bone Following Periodontal Surgery

“…Grossi et al 25,26 found that heavy smokers had greater odd ratios for attachment and alveolar bone loss compared to non‐smokers. It was shown that smoking affected the response of non‐surgical and surgical periodontal treatment 27‐29 . The exclusion of smokers from the present study might have resulted in greater bone gain postoperatively.…”

A Systematic Review of Clinical Efficacy of Adjunctive Antibiotics in the Treatment of Smokers With Periodontitis

“…Different factors were proposed to explain non‐responsiveness, 6,7 with one being the subgingival persistence of putative pathogens following mechanical therapy 8 . Smokers are a therapeutically challenging subpopulation of patients with periodontitis who may not respond to periodontal therapy as favorably as non‐smokers 9‐14 …”

Locally delivered minocycline microspheres for the treatment of periodontitis in smokers

“…Not only are smokers at higher risk for destructive periodontitis, but they also respond less favorably to conventional or mechanical interventions as compared to nonsmokers. The majority of longitudinal cohort studies indicate that smokers exhibit smaller probing pocket depth reductions and smaller clinical attachment level gains following nonsurgical scaling and root planing (SRP) (Preber & Bergström 1986, Newman et al 1994, Grossi et al 1995b, Preber et al 1995, Haffajee et al 1997). Smokers also exhibit poorer long‐term responses in maintenance therapy (McGuire & Nunn 1996).…”