A 5-year prospective validation of the Miller–McEntire Periodontal Prognostic Index

Abstract

Background: This 5-year prospective survival analysis study aimed to examine the prognostic validity of a periodontal prognostic score specific for diseased molars: Miller–McEntire Periodontal Prognostic Index (MMPPI). Materials and Methods: One thousand and twenty-three molars were evaluated from 129 patients. The MMPPI scoring factors included age, smoking, diabetes, probing depth, mobility, molar type, and furcation involvement. MMPPI was computed as the sum of scores for all seven prognostic factors. Appropriate periodontal treatment and supportive periodontal therapy were provided. All patients were evaluated at baseline and annually posttreatment up to 5 years. Hazard risk ratios (HR) were computed for each prognostic factor, MMPPI scores assigned. The MMPPI score were then analyzed using Kaplan-Meier survival analyses. Results: A total of 31/1023 (0.3%) molars were extracted over the 5-year follow-up duration. Significant and positive hazard risk ratio (HR = 1.9) was noted for the total MMPPI score, validating its prognostic value for molar survival at 5 years prospectively. Kaplan–Meier survival analysis showed a significantly lower probability of molar survival with increasing MMPPI scores, where total score >8 showed worse survival probability over time. The hazard risk ratio was significant for individual prognostic factors: mobility (HR = 1.63), smoking (HR = 1.61), diabetes mellitus (DM) (HR = 1.4), molar type (1.97), and furcation involvement (2.22). Conclusions: The findings of the current study demonstrate significant prognostic validity of MMPPI scores for molar loss for 5 years, and a score >8 showed markedly worse molar survival probability in a well-maintained, university-based, prospective cohort. Mobility, smoking, DM, molar type, and furcation were component factors that were significant individual predictors.

Ten-year prognostic outcomes of molar survival using the Miller-Mcentire Periodontal Prognostic Index – A longitudinal prospective study

“…The inclusion criteria in this study were moderate to chronic periodontitis patients and the exclusion criteria in this study that may impact the periodontal prognosis were patients with restorations and molar prosthesis, root canal-treated molars, and any patients with systemic disease. [ 2 4 5 ]…”

“…MMPPI scores were the total of these 7 scores. [ 2 4 5 ] Surgical intervention after nonsurgical periodontal therapy (scaling and root planning with adjunctive local drug delivery application with metronidazole gel) was considered for patients with residual pockets that included open flap debridement with minimal osseous recontouring to facilitate adaptation of the flap. Periodontal regenerative therapy was done with angular bone defects and craters that were placed with an osseous graft material and over this graft material, a resorbable collagen membrane was placed beneath the flap for not only preventing loss of graft material but at the same time, enhancing regeneration by clot stabilization.…”

“…Moreover, it revealed that each unit increase in MMPPI score translated to a 1.9-fold increase in the risk of molar loss over a 5-year period. [ 2 ] This data suggested the potential for a shift toward more precise and proactive clinical decision-making in molar preservation.…”

“…The Miller-McEntire Periodontal Prognostic Index (MMPPI)[ 1 ] is a predictive tool designed to aid in assessing molar tooth survival, and we have earlier reported its prognostic value over a 5-year horizon. [ 2 ] Later, the authors modified and externally validated the MMPPI, which was then named the periodontal risk score (PRS). The PRS, based on a combination of clinical and demographic factors, demonstrated remarkable value in predicting tooth mortality and guiding clinical decision-making.…”

“…In addition, it offers an opportunity to refine and validate the MMPPI/PRS’s predictive thresholds, ultimately providing clinicians with precise guidance for treatment planning. [ 2 3 ] As the MMPPI components are amenable to rapid clinical recording, its large-scale application could potentially enable early interventions and personalized treatment plans that may mitigate the loss of molars and the associated oral health consequences. With minimal clinical experience, the PRS with its 7 associated components can easily be rescored with minimal chair time by qualified dental auxiliaries and the dentist.…”