Resumen de Compliance as a Prognostic Indicator: Retrospective Study of 505 Patients Treated and Maintained for 15 Years
Martha E. Nunn, Takanari Miyamoto, Takashi Kumagai, Judith A. Jones, Thomas E. Van Dyke
Compliance as a Prognostic Indicator: Retrospective Study of 505 Patients Treated and Maintained for 15 Years Takanari Miyamoto,*† Takashi Kumagai,‡ Judith A. Jones,*§ Thomas E. Van Dyke,‖ and Martha E. Nunn§ *Department of General Dentistry, Goldman School of Dental Medicine, Boston University, Boston, MA.
†Department of Dental Public Health, School of Dentistry at Matsudo, Nihon University, Matsudo, Chiba, Japan.
‡Private practice, Yamagata, Japan.
§Department of Health Policy and Health Services Research, Goldman School of Dental Medicine, Boston University.
‖Department of Periodontology and Oral Biology, Goldman School of Dental Medicine, Boston University.
Correspondence: Dr. Martha E. Nunn, Department of Health Policy and Health Services Research, Goldman School of Dental Medicine, Boston University, 715 Albany, 560, Boston, MA 02118. E-mail: nunn@bu.edu.
Background: The relationship of patient compliance to overall tooth prognosis remains controversial. There are little data, often conflicting, that pertain to tooth loss as a function of patient compliance.
Methods: This retrospective study evaluates the impact of compliance (complete versus erratic) on common periodontal clinical variables, such as probing depth, bleeding index, plaque index, and tooth loss for 505 patients in a long-term period of observation (15 to 23 years) and maintenance therapy (at least 10 years). Compliance was defined in two ways for all analyses. Under the definition for compliance 1, patients who missed <30% of all prescribed maintenance visits were classified as complete compliers. Under the definition for compliance 2, patients who never went 2 years without a maintenance visit were classified as complete compliers. Change in clinical variables was dichotomized into reduction in plaque index versus no reduction, reduction in bleeding on probing versus no reduction, reduction in the percentage of periodontal pockets >3 mm versus no reduction, no increase in decayed, missing, or filled teeth (DMFT) versus increase, and no tooth loss versus tooth loss. The effects of both definitions of compliance were then evaluated in a series of multiple logistic regression models with adjustment for potential confounders.
Results: The analysis of the dichotomous change in clinical parameters over time revealed that complete compliers tended to show reduction in bleeding on probing and reduction in plaque index compared to erratic compliers for both definitions of compliance. In contrast, complete compliers under compliance 2 were less likely to have a reduction in the percentage of periodontal pockets >3 mm compared to erratic compliers, whereas complete compliers under compliance 1 had about the same likelihood of demonstrating a reduction in periodontal pockets compared to erratic compliers under this classification scheme. Under both definitions for compliance, complete compliers were more likely to exhibit tooth loss than erratic compliers, with the greatest tooth loss exhibited by complete compliers under the definition for compliance 1.
Conclusions: Based on these results, complete compliers under both definitions tended to show a reduction in plaque and bleeding on probing over time. However, change in periodontal pockets and DMFT over time varied according to the definition of compliance that was used. In addition, the results seem to indicate that the decision for tooth extraction made by dental health professionals at maintenance visits may result in greater tooth loss.
KEYWORDS: Compliance, maintenance, prognosis Cited by Ewa M. Czochrowska and Marco Rosa. (2015) The orthodontic/periodontal interface. Seminars in Orthodontics 21, 3-14.
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