Modelling changes in clinical attachment loss to classify periodontal disease progression

Abstract

AimThe goal of this study was to identify progressing periodontal sites by applying linear mixed models (LMM) to longitudinal measurements of clinical attachment loss (CAL).MethodsNinety‐three periodontally healthy and 236 periodontitis subjects had their CAL measured bi‐monthly for 12 months. The proportions of sites demonstrating increases in CAL from baseline above specified thresholds were calculated for each visit. The proportions of sites reversing from the progressing state were also computed. LMM were fitted for each tooth site and the predicted CAL levels used to categorize sites regarding progression or regression. The threshold for progression was established based on the model‐estimated error in predictions.ResultsOver 12 months, 21.2%, 2.8% and 0.3% of sites progressed, according to thresholds of 1, 2 and 3 mm of CAL increase. However, on average, 42.0%, 64.4% and 77.7% of progressing sites for the different thresholds reversed in subsequent visits. Conversely, 97.1%, 76.9% and 23.1% of sites classified as progressing using LMM had observed CAL increases above 1, 2 and 3 mm after 12 months, whereas mean rates of reversal were 10.6%, 30.2% and 53.0% respectively.Conclusion LMM accounted for several sources of error in longitudinal CAL measurement, providing an improved method for classifying progressing sites.

Patterns of periodontal disease progression based on linear mixed models of clinical attachment loss

“…The findings reported here were based on the largest cohort of subjects to be monitored for periodontal disease progression without therapy thus far. We used LMM of repeated measures of CAL to compensate for the high variability in this clinical parameter and achieve a more accurate diagnosis of disease progression (Teles et al., ). In the current study, we demonstrated that certain patterns of periodontal disease progression previously reported were also identifiable using this novel approach.…”

“…The data were obtained as part of a prospective multicentre clinical study on biomarkers of periodontal disease progression (Teles et al., ). Participants were recruited between January 2012 and December 2014 at four clinical centres in the United States: The Forsyth Institute (Cambridge, MA), New York University College of Dentistry (New York, NY), the University at Buffalo, State University of New York (Buffalo, NY) and Southern Illinois University School of Dental Medicine (Alton, IL).…”

“…Sites were then classified as progressing based on the predictions from the first series of LMM using the threshold established from the second series. We grouped sites based on changes in pCAL (ΔpCAL) into: (i) regressing sites (ΔpCAL < −2Q 75 ); (ii) stable sites (−2Q 75 ≤ ΔpCAL ≤2Q 75 ); (iii) intermediate sites (2Q 75 < ΔpCAL < 4Q 75 ); and (iv) progressing sites (ΔpCAL ≥ 4Q 75 ) (see Teles et al., for additional details).…”

Influence of Periodontal Disease on Changes of Glycated Hemoglobin Levels in Patients With Type 2 Diabetes Mellitus: A Retrospective Cohort Study

“…Establishment of appropriate criteria to define periodontal disease progression is more controversial than for definition of periodontal disease status at a certin time point. In this study, a threshold of 2 mm was applied, as it is widely used in the literature for longitudinal studies 35 , 36 . Using this criterion for periodontal progression, a significant increase was observed in levels of HbA1c after an average of 3 years in patients showing progression of periodontal disease, even after adjusting for HbA1c levels and sex.…”

Characterization of macrophage polarization in periodontal disease

“…Over the past decades, different disease progression models for periodontitis have been described addressing bacterial biofilm as the primary aetiology (Jeffcoat & Reddy, ; Socransky, Haffajee, Goodson, & Lindhe, ; Teles et al, ). However, limited evidence on the transition from established to advanced stages of periodontitis is available.…”