Document Detail


Prognosis versus actual outcome. II. The effectiveness of clinical parameters in developing an accurate prognosis.
MedLine Citation:
PMID:  8832476     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The assignment of prognosis is one of the most important functions undertaken in clinical practice, yet there is little evidence to support the current decision-making process which is based on an outdated model of disease etiology and progression. This study evaluated 100 treated periodontal patients (2,484 teeth) under maintenance care for 5 years, with 38 of these patients followed for 8 years, to determine the relationship of assigned prognoses to the clinical criteria commonly used in the development of prognosis. The method of generalized estimating equations (GEE) for correlated data was utilized to determine the relationship of each clinical factor to the assignment of initial prognosis, improvement in prognosis at 5 years, and worsening in prognosis at 5 years. A multiple linear regression model was constructed for predicting initial prognosis based on initial clinical data. Increased probing depth, more severe furcation involvement, greater mobility, unsatisfactory crown-to-root ratio, malpositioned teeth, and teeth used as fixed abutments resulted in worse initial prognoses. The coefficients from this model were able to predict accurately the 5-year and 8-year prognoses 81% of the time. When teeth with "good" prognoses were excluded, the predictive accuracy dropped approximately 50%. Multiple logistic regression models indicated that improvement in prognoses and worsening in prognoses were both strongly associated with initial probing depth, initial furcation involvement, initial tooth malposition, and smoking when adjusted for initial prognosis. In addition, good hygiene was found to increase the probability of improvement in prognosis while initial mobility was found to decrease the likelihood of improvement in prognosis. Neither of these factors was found to be significant in worsening of prognosis. Smoking decreased the likelihood of improvement by 60% and doubled the likelihood of worsening in prognosis at 5 years. The results of this study indicate that some clinical factors used in the assignment of prognoses are clearly associated with changes in clinical condition over time. The data also demonstrated that the traditional approach for assigning prognoses is ineffective for teeth with an initial prognosis of less than good. Since most periodontally involved teeth are compromised, further work should include the development of a more effective method for assigning prognoses that is based on clear, objective clinical criteria.
Authors:
M K McGuire; M E Nunn
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of periodontology     Volume:  67     ISSN:  0022-3492     ISO Abbreviation:  J. Periodontol.     Publication Date:  1996 Jul 
Date Detail:
Created Date:  1996-11-27     Completed Date:  1996-11-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8000345     Medline TA:  J Periodontol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  658-65     Citation Subset:  D; IM    
Affiliation:
Department of Periodontics, University of Texas, Houston, USA.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Decision Making
Dental Abutments
Disease Progression
Factor Analysis, Statistical
Family Health
Furcation Defects
Humans
Likelihood Functions
Linear Models
Logistic Models
Models, Statistical*
Odds Ratio
Oral Hygiene
Periodontal Attachment Loss
Periodontal Index
Periodontitis / diagnosis*,  therapy*
Prognosis
Reproducibility of Results
Risk Factors
Sensitivity and Specificity
Smoking
Tooth Loss
Tooth Mobility
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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