Validation of a multivariate prediction rule for history of periodontitis in a separate population.

AIM: Validation of a previously derived prediction rule for periodontitis in an external population sample. MATERIALS AND METHODS: Age, smoking and self-reported tooth mobility were used in logistic models to predict moderate and severe periodontitis as diagnosed from panoramic radiographs of 246 patients attending private practices in Germany. Coefficients derived from these models were used to predict periodontitis in a representative population-based sample of 3297 residents of the region of Pomerania, Germany. RESULTS: In the full derivation sample, the predictive power of the logistic model as measured by the c-statistic was 0.82 and 0.84 for moderate and severe periodontitis, respectively. In the validation set, these models yielded c-statistics of 0.82 for both moderate and severe periodontitis. Lower c-statistics were obtained among subjects aged 40 years and older in the derivation set (c=0.74 and 0.77), and the performance was poorer in the validation set with c-statistics of 0.69 and 0.72, respectively. CONCLUSIONS: A prediction rule based on age, smoking and self-reported tooth mobility can yield a moderately useful external validity. Validity may be dependent on specific population characteristics, and derivation of a prediction rule based on a clinical subsample of the target population with a larger set of predictors may provide better results in an application.

The accuracy of individual self-reported items to determine periodontal disease history.

The objective of this study was to evaluate the validity of self-reported periodontal disease and symptoms to predict periodontal disease history in a German population. We analysed data from 246 patients who answered a self-administered questionnaire on self-perceived periodontal disease and self-reported symptoms of periodontal disease. Actual periodontal status was assessed from panoramic radiographs and periodontal disease was defined as > or = 3 teeth with radiographic alveolar bone loss (ABL) > 5 mm (prevalence 39%). Sensitivity (SN) and specificity (SP) of self-reported items for diagnosis of periodontal disease history were calculated. The diagnostic accuracy of any individual item was generally low. For example, self-perceived periodontal disease had SN of 49% and SP of 67%. All self-reported items had low sensitivity, while self-reported professionally diagnosed bone loss, tooth loss caused by periodontal disease and mobility had SP > 90%. In conclusion, we did not identify a single individual question that can assess periodontal disease from self-reporting with satisfactory validity. Future studies will evaluate whether multivariate prediction rules using information from several self-reported variables are a valid means to ascertain periodontal disease history.

Periapical and periodontal healing after osseous grafting and guided tissue regeneration treatment of apicomarginal defects in periradicular surgery: results after 12 months.

OBJECTIVE: The aim of the present study was to evaluate the periapical and periodontal healing of apicomarginal defects 12 months after periradicular surgery and guided tissue regeneration in a series of consecutively treated patients. STUDY DESIGN: Patients with apicomarginal defects who were referred for periradicular surgery were included. Apicomarginal defects were grafted with Bio-Oss bone mineral and covered with a Bio-Gide membrane. Periodontal probing depths (PPDs) and relative attachment levels were measured preoperatively and 12 months postoperatively with a manual force-controlled probe. Periapical healing was assessed clinically and radiographically. RESULTS: Of the 23 defects in 22 patients for whom follow-up data were available, 19 were considered clinically and radiographically successful, 2 were doubtful, and 2 were failures. Overall, the baseline median PPD decreased from 9.0 mm to 3.0 mm, corresponding to a median relative attachment level gain of 2.8 mm. In the case of periodontic-endodontic lesions, the median baseline PPD decreased from 9.8 mm to 4.0 mm, corresponding to a median relative attachment level gain of 4.2 mm. Defects that involved a proximal root surface had a significantly higher residual PPD than did defects not involving a proximal root surface. CONCLUSIONS: Guided tissue regeneration treatment of apicomarginal defects yields good results in terms of periapical and periodontal healing after 12 months and should be considered as an adjunct to periradicular surgery in such cases.

Apicomarginal defects in periradicular surgery: classification and diagnostic aspects.

The prognosis of periradicular surgery is affected by the amount and location of bone loss. Apicomarginal defects are localized bony defects encompassing the total root length, and periradicular surgery on these teeth is associated with a lower success rate. This paper reviews the etiology, pathogenesis, and morphology of apicomarginal defects as encountered in periradicular surgery on the basis of a series of 24 consecutively treated patients. Periodontal data were recorded before surgery in all patients, and apicomarginal defects were diagnosed after flap reflection or, if applicable, apicoectomy. On the basis of the findings in these cases and on theoretic considerations, a classification system for apicomarginal defects with potential therapeutic and prognostic implications is presented and several criteria for differential diagnosis are discussed.