Distributions of Periodontal Attachment Levels

Abstract

Distributions of periodontal attachment levels at probing sites within patients have traditionally been used in clinical diagnosis and treatment planning. Progression from mild to moderate to severe disease is generally associated with increasing magnitudes of attachment loss at greater percentages of sites. Recent analyses of distributions of periodontal attachment levels have suggested three general patterns of loss defined by: (1) loss at less than about one third of all sites, (2) more widespread disease with multiple peaks and (3) normally distributed loss with virtually all sites being affected. In attempting to stimulate these three patterns using a model based on the burst theory of periodontal attachment loss, divergent assumptions about burst magnitude, frequency, and possible local immunity were required. These findings were used to support the hypothesis that distinctly different disease processes are associated with the different patterns of attachment level. In the present investigation an alternative model was developed which was theoretically consistent with the view that the three patterns reflect arbitrary stages in a continuous disease "aging" process. Simple assumptions concerning attachment loss probabilities and rates enabled the generation of attachment level distributions that matched all three patterns previously attributed to separate disease processes, depending only upon the duration of the process.

The use of rodent models to investigate host–bacteria interactions related to periodontal diseases

“…Alternatively, the relatives may move next door, representing a relatively constant mild insult that becomes problematic with time. The former is consistent with the burst model of periodontal breakdown and the latter is consistent with the slow continuous model (Socransky et al 1984, Cohen & Ralls 1988). To date, it is not known whether either or both models are accurate (Gilthorpe et al 2003).…”

Site-level progression of periodontal disease during a follow-up period

“…Another theory is presented by the burst model, in which multiple random sites show progression within a short period along with remission or repair. Other sites are free of progression throughout the individual’s life [ 32 , 46 – 48 ].…”

Unification of the "Burst" and "Linear" Theories of Periodontal Disease Progression: A Multilevel Manifestation of the Same Phenomenon

“…It has been argued that measurement error, and the possibility of different disease patterns at different sites, could produce erroneous evidence of burst progression (Ralls and Cohen, 1986;Cohen and Ralls, 1988). Yang et al (1991) advocated regression methods of analysis, though Allen and Hausmann (1995), using simulated measurements, found model-fitting assessed by the least-squares criterion unreliable.…”