Diagnostic predictability of scores Noel Claffey, Karin Nylund,

Robert Kiger, Steve Garrett and

Jan Egelberg

of plaque, bleeding, suppuration School of Dentistry, Loma Linda University,

Loma Linda CA, USA; Dublin Dental Hospital,
Trinity Coilege, Dublin, Ireland; Postgraduate
Dental Education Center, Örebro County

and probing depth for probing Council, Örebro, Sweden . ;

attachment loss
Jyears of observation following initial periodontal therapy

Claffey N, Nylund K, Kiger R, Garrett S and Egelberg J: Diagnostic predictability

of scores of plaque, bleeding, suppuration and probing depth for probing attachment
loss. 3^ years of observation following initial periodontal therapy. J Clin Periodontol
1990; 17: 108-114.

Abstract. Recordings of supragingival plaque, bleeding, suppuration and prob-

ing depth were obtained for 42 months following initial periodontal therapy.
Scores accumulated after various time intervals during monitoring were studied
for their predictive value in reveahng probing attachment loss as determined by
regression analysis during the 0-42 month period. Accumulated plaque scores
demonstrated low predictability. Accumulated bleeding scores showed modest
predictive values. Suppuration on probing was not a frequent finding during
the observation interval and also had modest predictive power. Increase in prob-
ing depth compared to baseline and deep residual probing depth had modest
predictability after 3 and 12 months, but showed increasing accuracy in reveahng
probing attachment loss over later time intervals. After a few years of maintenance, Key words: diagnostic predictability; clinical
increase in probing depth, particularly if combined with high frequency of bleed- criteria; réévaluation; initial periodontal
therapy; prognosis.
ing on probing, showed the highest predictive value for probing attachment
loss of the scores examined. Accepted for publication 2 March 1989

In a companion paper to this report,
the diagnostic value of scores of supra-
gingival plaque, bleeding, suppuration
and probing depth to predict probing
attachment loss was determined in pa-
tients monitored for 5 years after non-
surgical periodontal therapy. Modest
predictive values were observed for
plaque, bleeding and suppuration. Dee-
pened probing depth, on the other hand,
showed high diagnostic predictabihty,
at least during the final years of the 5-
year observation interval (Badersten et
al. 1989).
However, the companion report did
not include observations on molar teeth.
The low plaque and bleeding scores
found, may have resulted in little pro-
gressive disease, thereby limiting the
usefulness of the data in determining
the diagnostic predictability of clinical
signs. The present report determines the
predictive value of the same clinical
signs to reveal probing attachment loss
in another group of subjects monitored
for 42 months following initial perio-
dontal therapy. In these individuals,
plaque and bleeding scores were not re-
duced to the same extent and molar
teeth were included.
Material and Metiiods
Subjects
17 patients, 5 female and 12 male, 32-65
years of age participated. The patients
had received no periodontal treatment
within the preceding 5 years and showed
generahzed periodontitis characterized
by bleeding on probing, loss of perio-
dontal attachment, and subgingival cal-
culus. All patients but 1 had at least 2
molars with clinically detectable fur-
cation involvement.
All available teeth in the patients
were included in the study, except for
third molars and teeth with periodontal
pockets extending to the apex of the
roots. A total of 2121 sites were moni-
tored.
Initial therapy
Following baseline examination, all pa-
tients were instructed in oral hygiene
including a sulcular brushing technique
and interdental cleaning with dental
floss and/or interdental brushes. Re-
inforcement and reinstruction were pro-
vided a variable number of times, based
on individual needs, for the first 6
months of the study. Subsequently, re-
inforcement was provided only at some
of the recording visits every 3rd month.
An initial, single episode of crown
and root debridement was provided
using 2 separate appointments; 1 for
each half of the dentition. All instru-
mentation was performed under local
anesthesia using ultrasonic instruments
(Dentsply®-Cavitron®, Model 200, with

TFI-10 tips, Cavitron Ultrasonics Inc,
Long Island, NY, USA) or various hand
instruments. 2 operators participated,
using an average time of active instru-
mentation amounting to 3.2 min/tooth
for non-molar teeth and 6.7 min/tooth
for molars.
Maintenance
The maintenance therapy varied among
the 17 subjects, 4 subjects received no
subgingival instrumentation through-
out the entire 42 months following the
initial debridement (subject nos, 2, 3, 7
and 8), These individuals were provided
with oral hygiene reinforcement and
tooth polishing with rubber cup and
abrasive paste only at the recording
visits. The remaining 13 individuals, in
addition to supragingival plaque con-
trol, received isolated root debridement
of deep and/or bleeding sites at most
recording visits during the period be-
tween 12-27 months. Prior to 12
months and between 30-42 months, no
subgingival debridement was per-
formed. The variability of the mainte-
nance therapy was explained by the fact
that the 17 patients were participating
in studies with varying protocols.
Measurement
Clinical records were obtained at base-
line and at every 3rd month throughout
the 42-month study. 3 examiners were
utilized (authors SG, RK and KN),
Examiners SG and RK recorded 6 and
7 subjects, respectively, during the first
half of the 42 month observation inter-
val. Subsequently, these examiners were
substituted with examiner KN, but not
until calibration tests had demonstrated
a comparable reproducibility of probing
measurements between all 3 examiners.
4 subjects were recorded by examiner
KN throughout the 42 months.
Measurements were taken from 6
sites around each non-molar tooth:
mesiobuccal, midbuccal, distobuccal,
distolingual, midlingual and mesiolin-
gual. In maxillary molars, 8 sites were
measured: mesiobuccal, midbuccal of
mesial and distal roots, buccal fur-
cation, distobuccal, distolingual fur-
cation, midlingual of palatal root and
mesiolingual furcation. In mandibular
molars, 10 sites were measured: mesio-
buccal, midbuccal of mesial and distal
roots, buccal furcation, distobuccal, di-
stolingual, midlingual of mesial and dis-
tal roots, lingual furcation and mesiolin-
Prediction of probing attachment loss
gual. Records of dental plaque, bleeding
on probing, probing depth and probing
attachment level were obtained as fol-
lows.
Dental plaque. Presence or absence of
dental plaque was scored after rinsing
with a disclosing solution (Erythrosine
2%, Oral Health Products, Tulsa, OK,
USA), Plaque present along the gingival
margin that could be easily removed
with the tip of a periodontal probe was
recorded.
Bleeding and suppuration on probing.
Sites with bleeding and/or suppuration
on probing were recorded during the
course of measurements of probing
depth and probing attachment level (see
below).
Probing depth and probing attachment
level. Measurements of probing depth
and probing attachment level were
made using an electronic, pressure-sen-
sitive probe (Electronic Periodontal
Probe, Model 200 A, Vine Valley Re-
search, Middlesex, NY, USA) with a
probing force of 0,50 N. A probe tip
having 1 mm increments and a 0,4 mm
diameter was used. Measurements were
made to the nearest 0.5 mm, A vacuum-
adapted soft acrylic onlay (Scheu-Den-
tal, Iserlohn, West Germany) was used
to provide reference points for the prob-
ing attachment measurements. For
proximal surfaces, the placement of the
probe was guided by the interdental in-
dentations of the thin onlay and the
probe was directed apically toward the
midproximal aspect of the root surface.
Mid-bucca! and midlingual sites were
measured by placing the probe at these
locations and directing it longitudinally
along the root surface. For furcation
sites, the probe was angled into the mid-
furcal areas and after 2 or 3 repeated
probings, the deepest point was located
and recorded.
Calculation ot piaque, bleeding and
suppuration frequencies.
Accumulated frequencies of the pres-
ence of supragingival plaque, bleeding
and suppuration upon probing at each
individual site were calculated during
the following intervals: 3-12, 3-24, 3-36
and 3-42 months. For plaque and bleed-
ing, these frequencies were calculated as
a % of positive scores of all examina-
tions performed during the interval. For
suppuration, the number of examin-
ations with a positive score during the
interval was added.
109
Identification of sites with probing
attachment ioss
The recordings at 3-month intervals
during the 42-month study provided a
series of 15 probing attachment level
measurements for each site. These meas-
urements were subjected to linear analy-
sis of regression (Goodson et al. 1982,
Haffajee et al, 1983, Badersten et al.
1985), The slope of the regression line
for each of these sites was calculated
together with the projected probing at-
tachment loss during the 42-month in-
terval (Av), The probability for each
slope being different from a horizontal
line was determined using 13 degrees of
freedom. A minimum Ar of 1,5 mm and
a probability of/)<0,05 were required
to classify a site as showing probing
attachment loss.
Determination of diagnostic predictability
The reliability of scores for plaque,
bleeding, suppuration and probing
depth in identifying sites with probing
attachment loss was evaluated from cal-
culations of diagnostic predictability ra-
tios (%) as follows:
Probing attachment
Investigated loss
score presence absence
positive a b
negative c d
diagnostic a
predictability a+b
Thus, diagnostic predictability gives the
proportion of sites with positive scores
that shows loss of probing attachment.
Only sites with initial probing depth
^4.0 mm were included {N=l\36). If
the sum of a + h was less than 10, calcu-
lations were not performed due to the
uncertainty associated with such a small
number of sites. If the sum was between
10-19, this was indicated by using
parentheses for the predictability score
in the data presentation.
Longitudinal analyses
Mean scores for plaque, bleeding, prob-
ing depth, probing attachment level and
gingival recession were calculated for
sites of various initial depths ( ^ 3.5 mm,
4.0-6,5 mm and ^7.0 mm) at each ob-
servation interval throughout the 0-42
month period. Patient means were cal-
culated for each variable, followed by
110 Claffey et al.

PLAOUE computation of group means. The end

SCORE points (0 and 42 months) v^^ere statisti-
cally compared using the Student i-test
for paired observations {N= 17). These
90 longitudinal analyses were performed
80- for the purpose of describing the aver-
IPD < 3.5
70 -
age outcome of therapy for the partic-
IPD 4.0-6.5
ipating subjects.
60 - IPD > 7.0
50
40 -
•••.X Results
30-
Longitudinal observations
20-
10 - Mean scores of supragingival plaque,
bleeding upon probing, probing depth,
3 6 9 12 15 18 21 24 27 30 33 36 39 42 probing attachment level change and
MONTHS gingival recession during the 42-month
observation period are presented in
Fig. 1. Mean supragingival plaque scores (%) at various intervals during the 42-month
observation period for sites of various initial probing depth (IPD) (mm), * denotes statistically Figs. 1 ^ . For sites initially 4.0-6.5 mm
significant difference (/?^0.05) for comparison between 0 and 42 months. deep, the plaque scores remained
around 30% and the bleeding scores
around 35% during most of the study
BLEEDING period. For sites initially ^7.0 mm, the
SCORE corresponding numbers were 35% for
the plaque scores and 50% for the
100-1 bleeding scores. Probing depths re-
IPD < 3.5
90- mained stable during the 3-42 month
iPD 4.0-6.5
80 period. A gradual loss of probing at-
IPD > 7.0
70 tachment took place for sites initially
60
^3.5 mm, together with a tendency
towards relapse of initial attachment
50
gains for sites initially 4.0-6.5 and ^7.0
40
mm. Some gingival recession was ob-
30 served for sites of all initial depth during
i20 the observation period.

3 6 9 12 15 18 21 24 27 30 33 36 39 42 Frequency of sites with probing attachment

MONTHS loss

Fig. 2. Mean bleeding upon probing scores (%) at various intervals during the 42-month On the average, the subjects showed
observation period for sites of various initial probing depth (IPD) (mm), * denotes statistically 10% sites with probing attachment loss
significant difference (p^Q.05) for comparison between 0 and 42 months. during the 0-42 month period. Attach-
ment loss was more frequent for sites
initially ^7.0 mm (16%) and for fur-
PROBING cation sites (22%) than for other sub-
DEPTH groups of sites. Among the participating
mm 17 subjects, the frequency of sites with
9 IPD < 3.5 probing attachment loss ranged from
IPD 4.0-6.5 1% t o 2 1 % (Table 1),
7 IPD >: 7.0
6 Diagnostic predictability
5
The diagnostic predictability of various
4
_x clinical scores at progressive time points
3 _x during the study to identify sites with
2 probing attachment loss observed after
1 • 42 months is presented in Tables 2-9.
The results showed that all the investi-
3 6 9 12 15 18 21 24 27 30 33 36 39 42 gated scores, except perhaps plaque
MONTHS scores, were associated with probing at-
Fig. 3. Mean probing depths (mm) at various intervals during the 42-month observation tachment loss. This association was
period for sites of various initial probing depth (IPD) (mm). * denotes statistically significant demonstrated by improved diagnostic
difference (p^0.05) for comparisons between 0 and 42 months. predictabihty along with increased fre-
 Prediction of probing attachment loss 111

quency or magnitude of the various PROBING ATTACHMENT iPD S 3.5

scores. Also, the diagnostic predictabil- LEVEL CHANGE
mm IPD 4.0-6.5
ity improved as time priogressed.
iPD > 7.0
For plaque scores, the diagnostic pre- 1 •
dictability was low and showed no or
little increase with heightened plaque
frequency or with lengthened obser-
vation interval (Table 2).
Bleeding frequency 5 Ï 7 5 % reached a
diagnostic predictability of 4 1 % after GINGIVAL RECESSION
mm
42 months. This means that 4 1 % of the
sites that bled upon probing at 75% or
more of the examinations between 3-42
months had undergone probing attach-
ment loss during 0 ^ 2 months (Table 3). 3 6 9 12 15 18 21 Ik 27 30 33 36 39 42
Suppuration on probing reached a di-
MONTHS
agnostic predictability of 40% to 50%.
However, suppuration was not a fre- Fig. 4. Mean probing attachment level change and mean gingival recession (mm) at various
quent finding. Few sites demonstrated intervals during the 42-month observation period for sites of various initial probing depth
suppuration more than 3 times during (IPD) (mm). * denotes statistically significant difference (/7<O.O5) for comparison between 0
the entire 3 ^ 2 month period (Table 4). and 42 months.
Diagnostic predictability of residual
probing depth ^7.0 mm increased from
24% at 3 months to 50% at 42 months.
In other words, 24% of the sites with
this probing depth at 3 months were
found to have lost probing attachment Table 1. Frequency (%) of sites with probing attachment loss J; 1.5 mm during 0-42 months
at 42 months. 50% of the sites with for sites of different initial probing depth, for sites of different surface location, and for all
residual depth 5:7.0 mm at 42 months sites for each of the subjects under study
had undergone probing attachment loss Initial probing depth Surface location All
(Table 5). When residual probing depth Subject <3.5 4.0-6.5 >7.0 buccal lingual proximal furcation sites
was combined with a bleeding frequency 1 3 0 0 4 4 0 0 1
^ 7 5 % , or with suppuration at one or 2 3 2 4 0 0 4 0 7
more of the examinations, the predicta- 3 3 0 17 22 0 3 -* 6
bility was enhanced at later intervals 4 4 2 23 3 3 6 10 6
(Tables 6, 7). 5 10 0 6 0 19 4 13 6
An increase in probing depth ^5^1.0 6 10 3 0 22 6 2 13 7
7 11 6 0 6 6 8 20 8
mm compared to baseline showed a pre- 2
8 6 50 0 5 8 100 8
dictability after 24 months of 45%. Af- 3 3 23 5 10 7 14 8
9
ter 36 and 42 months, predictability was 10 14 6 0 13 21 7 0 9
increased to 61"/o and 68 "/o. respectively 11 15 4 14 25 11 5 10 10
(Table 8). When an increace in probing 12 20 6 0 13 13 17 0 13
depth was combined with a bleeding fre- 13 12 19 13 5 24 15 25 16
quency > 7 5 % . there was a general im- 14 32 11 0 27 21 14 25 18
provement in predictability scores. For 15 13 16 43 22 24 13 40 19
example, an increase > 1 mm together 16 8 28 43 5 14 24 33 20
17 24 13 27 14 14 22 38 21
with a bleeding frequency ^ 7 5 % yield-
ed predictability scores after 36 and 42 mean 11 7 16 11 II 9 22 10
months of 82% and 87%i, respectively S.D. ±8 ±7 ±17 ±10 ±8 ±7 ±25 ±6
(Table 9). * no sites available.
Combinations of increase in probing
depth with either deep initial or deep
residual probing depths led to a slight
Table 2. Diagnostic predictability (%) of accumulated plaque frequency scorci of increasing
improvement in predictability scores magnitude during various observation intervals for probing attachment loss at 42 months:
compared to those resulting from the (example for interpretation: if plaque was present at > 7 5 % of the 8 examinations during
use of increase in probing depth alone. 3-24 months, 15% of sites demonstrated probing attachment loss during the 0 ^ 2 months
When increase in probing depth was time period)
combined with bleeding frequency Observation interval (months)
^ 7 5 % , the addition of deep initial or Plaque frequency (%) 3-12 3-24 3-36
deep residual probing depth did not en-
hance the predictability. 12 12 11 11
5:50 13 13 12 12
Calculations of diagnostic predicta- 13 15 13 15
bility were performed for a multitude
112 Claffey et al.

Table 3. Diagnostic predictability (%) of accumulated bleeding frequency scores of increasing of different combinations of the clinical
magnitude during various observation intervals for probing attachment loss 0-42 months signs. For some of these combinations,
Observation interval (months) the number of available sites was insuf-
Bleeding frequency (%) 3-12 3-24 3-36 3^2 ficient for interpretation. This was es-
11 12 13
pecially true for combinations with sup-
- , A i ••••

13 14 17 19 puration on probing. For other combi-

15 21 31 41 nations, e.g., those with plaque scores,
no improvement of predictability was
observed.

Table 4. Diagnostic predictability (%) of accumulated suppuration frequency (no, of examin-

ations with suppuration) during various observation intervals for probing attachment loss Discussion
0-42 months
A comparison of the longitudinal obser-
Observation interval (months) vations in this group of subjects to those
Suppuration frequency 3-12 3-24 3-36 3-42 of the subjects in a companion study
26 28 34 (Badersten et al. 1989) shows that the
(50) (42) 41 present group had higher plaque and
* Less than 10 sites available for calculation. bleeding scores during the maintenance
( ) 10-19 sites available for calculation. interval than the other group. Probing
attachment loss in the other group was
most frequent for sites initially <3.5
mm and infrequent for sites initially
Table 5. Diagnostic predictability (%) of residual probing depth of different magnitude at
^ 7.0 mm. In the present group, attach-
various observation intervals for probing attachment loss 0-42 months
ment loss was more frequent for sites
Residual probing depth Observation interval (months) initially ^7.0 mm than for either sub-
(mm) 3 12 24 36 42 group of shallower sites. The present
>4.0 15 16 14 18 18 group included furcation sites in molars,
>5,0 20 22 24 27 28 which had the highest incidence of prob-
^6.0 26 26 32 36 37 ing attachment loss among all sub-
^7,0 24 26 38 45 50 groups of sites. These circumstances
^8.0 20 26 39 63 61 give the overall impression that the pres-
^9,0 (29) 21 35 72 80 ent group of subjects responded less fa-
( ) 10-19 sites available for calculation. vorably to treatment and showed more
evidence of inflammatory periodontal
disease during the maintenance interval
than the other group. From this point
Table 6. Diagnoslic predictability (%) oï residual probing depth -\- bleeding frequency '^75% of view, the present group of subjects
after various observation intervals for probing attachment loss 0 ^ 2 months
may be more suitable for the study of
Observation interval (months) diagnostic predictability of clinical
Residual probing depth (mm) 12 24 36 42 signs, since more areas with relapse of
^4,0 22 26 41 43 disease may be included.
29 35 50 51
30 42 56 62 In the study by Badersten et al.
31 48 61 67 (1989), probing attachment loss was de-
37 (50) 70 73 termined by a combination of linear re-
(27) * (75) (82) gression analysis and end-point analy-
sis. In the present report, linear re-
* Less than 10 sites available for calculation,
( ) 10-19 sites available for calculation.
gression analysis alone was used, since
duphcate initial and final recordings
needed for a useful end-point analysis
were not available. During the analyses
Table 7. Diagnostic predictability of residual probing depth + suppuration frequency ^ 1 after of the data by Badersten et al. (1989),
various observati(Jn intervals for probing attachment loss 0 ^ 2 months it was found that the diagnostic pre-
Observation interval (months) dictabilities of the various clinical signs
Residual probing depth (mm) 12 24 36 42 showed little change, whether they were
calculated against probing attachment
^4,0 * 28 30 39
* 30 35 42 loss determined by linear regression
* 33 44 48 analysis, by end-point analysis, or by a
* (50) 62 63 combination of the methods. A com-
* * (86) 74 parison of diagnostic predictabilities be-
+ * (100) (88) tween the 2 studies is therefore probably
not hampered by this difference in
* Less than 10 sites available for calculation.
( ) 10-19 sites a'vailable for calculation. methods.
 Prediction of probing attachment loss 113

A comparison of diagnostic predicta- Table 8. Diagnostic predictability (%) of inerease in probing depth of different magnitudes
bility of various clinical signs from the between various observation intervals for probing attachment loss 0 ^ 2 months
2 studies is shown in Table 10. It should Increase in probing depth Observation interval (months)
be kept in mind that attachment loss (mm) 0-3 0-12 0-24 0-36 0^2
was determined between 0-60 months 22 28 2X 37 39
JsO.O
by Badersten et al. (1989) and between >0,5 22 36 42 55 56
0 ^ 2 months In the present study. 5=1.0 8 29 45 61 68
Plaque and bleeding frequencies seem >1,5 <6) (21) 45 72 73
to have modest predictive power in both >2.0 (17) (53) 76 82
studies. There may be limited reasons * Less than 10 sites available for calculation.
to expect that frequent occurrence of ( ) 10-19 sites available for calculation.
supragingival plaque should be associ-
ated with attachment loss in the ma-
jority of sites in patients on mainten-
Table 9. Diagnostic predictability (%) of increase In probing depth + bleeding frequeney > 75%
ance. The results seem to support this
of different magnitudes between various observation intervals for probing attachment loss
notion. Frequent bleeding on probing, 0-42 months
on the other hand, could possibly have
been expected to show higher predicta- Observation interval (months)
Increase in probing depth (mm) 12 24 36 42
bility. However, it is possible that the
modest predictive value of bleeding is 50.0 33 (50) 70 11
related to the dichotomous type of score 50.5 39 * 74 (88)
that was used (bleeding/no bleeding). 5 1.0 25 (82) (87)
5 1.5 (30) * (85) (86)
Minimal bleeding may often have oc-
5 2.0 * * (82) (90)
curred after probing of many sites, thus
giving high bleeding frequency to sites * Less than 10 sites available for calculation.
with limited inflammation, A scoring ( ) 10-19 sites available for calculation.
system selecting sites with marked
bleeding only, might have improved the
predictive power of bleeding upon
probing. Table 10. Diagnostic predictability of selected clinical signs after 12, 24 and 36 months for
probing attachment loss at the end of the maintenance period in the study by Badersten et
In both studies, residual probing al. (1989) (60 months) and in the present study (42 months)
depths had a modest predictive value at
12 months, but had increased power at Badersten ct al. (1989) Claffey et al. (1989)
(months) (months)
later yearly intervals. Increase in prob-
Clinical sign 12 24 36 12 24 36
ing depth compared to baseline (prior
to therapy) seemed to be the criterion plaque frequency 5 75% 7 13 28 13 15 13
with best predictive value, particularly bleeding frequency 5 75% 13 14 23 15 21 31
residual probing depth 5 6.0 mm 12 16 28 26 32 36
if combined with bleeding frequencies
residual probing depth 5 7.0 mm 20 26 37 26 38 45
^ 7 5 % . No other combinations of clin- residual probing depth 5 7.0 mm-l-
ical signs were observed in either of bleeding frequency 5 75% * * * 31 48 61
these studies yielding higher predictive residual probing depth 5 7.0 mm-l-
values. suppuration frequency 5 1 * * * * (50) 62
The high predictive power of an in- increase in probing depth 5 1.0 mm * 39 * 29 45 61
crease in probing depth or a deep re- increase in probing depth 5 10 mm +
bleeding frequency 5 75% (82)
sidual probing depth at a later interval,
such as 36 months, could be considered * Less than 10 siles available for calculation.
to be "a finding of the obvious": Attach- ( ) 10-19 sites available for calculation.
ment loss as a result of periodontal dis-
ease is often associated with increased
probing depth. For clinical purposes,
however, these observations may be of
some affirmative value in the recog-
nition of recurrent periodontal destruc- these patients for conclusive evaluation. are to reach meaningful diagnostic
tion for patients on maintenance Furthermore, longitudinal records of values.
therapy. .scores reflecting the inflammatory sta-
The results of these 2 studies should tus of the periodontal tissues are useful
not be interpreted as indications of the in the management of inflammation,
Acknowledgement
lack of usefulness of bleeding scores which may be a worthwhile therapeutic
alone and suppuration scores alone for goal in itself. Sincere thanks are due to Norman Me-
monitoring purposes. As discussed It would seem from the results of this dina, MSPH, School of Dentistry,
above, the bleeding scores used may study, that longer observation intervals Loma Linda University, Loma Linda,
have limitations. Suppuration on prob- than those used traditionally may be CA, USA, for calculations of data.
ing did not occur often enough among needed if commonly used clinical signs
114 Claffey el al.
Zusammenfassung
Diagnostische Vorhersagharkeit des Attach-
mentverlustes durch Meßwerte der Plaque,
Blutung, Pusentleerung und Sondierungstiefe.
3\ Jahre der Beobachtung nach initialer Paro-
don ialhehandlung
Befunde über supragingivale Plaque, Blu-
tung, Pusentleerung und Sondierungstiefe
wurden während 42 Monaten nach initialer
Parodontalbehandlung erhoben. Die Werte,
die nach verschiedenen Zeitintervallen wäh-
rend des Beobachtungszeitraums gesammelt
wurden, hat man bezüglich ihres Vorhersage-
wertes für den Attachmentverlust, der an
Hand der Regressionsanalyse während der
0-42 Monatsperiode bestimmt wurde, stu-
diert. Die gesammelten Blutungswerte zeig-
ten einen geringen Vorhersagewert. Pusent-
leerung auf Sondierung war nicht häufig
während des Beobachtungsintervals und hat-
te auch geringen Vorhersagewert. Die Zunah-
me der Sondierungstiefe im Vergleich zur
Ausgangsuntersuchung und tief gebliebene
Sondierungstiefe hatten nach 3 und 12 Mona-
ten geringen Vorhersagewert, zeigten aber zu-
nehmende Genauigkeit bei der Angabe von
Attachmentverlust während späterer Zeitin-
tervalle. Nach einigen Jahren der Erhaltungs-
therapie ließ von den untersuchten Werten
die Zunahme an Sondierungstiefe, besonders
in Kombination mit einer häufigen Sondie-
rungsblutung den höchsten Vorhersagewert
für den Attachmentverlust erkennen.
Résumé
Valeur de prévision diagnostique des scores de
la plaque, du saignement, de la suppuration et
de la profondeur des poches à ¡égard de la
perte d'attache au sondage. Observation sur
31 ans après traiiement parodontal initial
Après un traitement parodontal initial, des
enregistrements de la plaque sus-gingivale,
du saignement, de la suppuration et de la
profondeur de sondage ont été pratiqués pen-
dant 42 mois. On a. par une analyse de régres-
sion, étudié la valeur de prédiction, à l'égard
de la perte d'attache au sondage, des valeurs
ainsi accumulées après divers intervalles au
cours des 42 mois de la période d'observa-
tion. Les valeurs accumulées pour les scores
de la plaque possédaient une faible valeur de
prédiction. Les valeurs accumulées pour les
scores du saignement avaient une mode.ste
valeur de prédiction. Une suppuration lors
du sondage était rare pendant la période
d'observation et possédait également une mo-
deste valeur de prédiction. L'augmentation
de la profondeur de sondage par rapport à
l'examen initial et l'existence de fortes pro-
fondeurs résiduelles avaient une modeste va-
leur de prédiction après 3 mois et 12 mois,
mais possédaient lors des périodes plus tardi-
ves une précision croissante en ce qui concer-
nait la perte d'attache au sondage. Après
quelques années de maintenance, l'augmenta-
tion de la profondeur de sondage, surtout
lorsqu'elle était associée à une fréquence éle-
vée du saignement provoqué par sondage,
présentait pour la perte d'attache au sondage
la valeur de prédiction la plus élevée parmi
les scores considérés.
References
Badersten, A., Nilvèus, R. & Egelberg. J.
(1985) Effect of nonsurgical periodontal
therapy. V. Patterns of probing attachment
loss in nonresponding sites. Journal of
Clinical Periodontology 12, 270-282.
Badersten, A., Nilvéus, R. & Egelberg, J.
(1990) Scores of plaque, bleeding, suppu-
ration and probing depth to predict prob-
ing attachment loss. 5 years of observation
following nonsurgical periodontal therapy.
Journal of Clinical Periodontologv 17, in
press.
Goodson, J. M., Tanner. A. C. R., Haffajee.
A. D., Sornberger, G. C. & Socransky, S.
S. (1982) Patterns of progression and re-
gression of advanced destructive perio-
dontal disease. Journal of Clinical Peri-
odontology 9, 472^81.
Haffajee, A. D., Socransky, S. S. & Goodson.
J. M. (1983) Comparison of different data
analyses for detecting changes in attach-
ment level. Journal of Clinical Periodonio-
logy 10, 298-310.
Address:
Jan Egelbcrg
Postgraduate Denial Education Center
Örebro Couniv Council
Box 1126
S-701 11 Örebro
Sweden
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