Assessment of periodontitis grade in epidemiological studies using interdental attachment loss instead of radiographic bone loss

Winkler, P; Dannewitz, Bettina; Nickles, Katrin; Petsos, Hari; Eickholz, Peter

doi:10.1111/jcpe.13679

Cited by 2 publications

(3 citation statements)

References 24 publications

(71 reference statements)

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“…In the absence of direct evidence of progression based on longitudinal CAL or BL measurements, or in the absence of any radiographic examination, indirect evidence of progression can be inferred (Winkler et al, 2022) by considering relative CAL as a percentage of the root length based on root length data provided by two studies (Salonen et al, 1991; Schumacher & Gente, 1995). While this seems to be an appealing method, grade assignment using CAL and standard root length data showed only fair to good/moderate agreement with the one based on relative BL data (kappa values ranged between 0.359 and 0.427) (Winkler et al, 2022). Thus, assessment of grade based on cross‐sectional CAL data in the absence of radiographs has apparent shortcomings.…”

Section: Discussionmentioning

confidence: 99%

“…Considering that radiographic BL data are commonly unavailable in epidemiological surveys, relative CAL as a percentage of the root length can be estimated using the following formula: relative CAL (%) = 100 Â CAL (mm)/root length (mm). Root length data can be retrieved from two studies as suggested by Winkler et al (2022): standard root lengths of a German cohort were reported for all teeth without distinction between sexes (Schumacher & Gente, 1995), see also Appendix Table 1. Sex-specific root lengths from mesial and distal sites of all teeth (excluding third molars) were reported for 732 randomly selected Swedish males and females (Salonen et al, 1991), see also Appendix Table 2 Under the following link, information and syntax for various statistical programs implementing the ACES framework to epidemiological survey data will be provided: https://github.com/ACESperiodontitis.…”

Section: Assessment Of Gradementioning

confidence: 99%

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ACES: A new framework for the application of the 2018 periodontal status classification scheme to epidemiological survey data

Holtfreter,

Kuhr,

Borof

et al. 2024

J Clinic Periodontology

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AimTo propose a framework for consistently applying the 2018 periodontal status classification scheme to epidemiological surveys (Application of the 2018 periodontal status Classification to Epidemiological Survey data, ACES).Proposed FrameworkWe specified data requirements and workflows for either completed or planned epidemiological surveys, utilizing commonly collected measures of periodontal status (clinical attachment levels [CAL], probing depths, bleeding on probing), as well as additional necessary variables for the implementation of the 2018 periodontal status classification (tooth loss due to periodontitis and complexity factors). Following detailed instructions and flowcharts, survey participants are classified as having periodontal health, gingivitis or periodontitis. Rates of edentulism must also be reported. In cases of periodontitis, instructions on how to compute the stage and extent are provided. Assessment of grade can be derived from CAL measurements (or from radiographic alveolar bone loss data) in relation to root length and the participant's age.ConclusionsACES is a framework to be used in epidemiological studies of periodontal status that (i) have been completed, and in which stage and grade according to the 2018 classification are inferred retroactively, or (ii) are being planned. Consistent use of the proposed comprehensive approach will facilitate the comparability of periodontitis prevalence estimates across studies.

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Section: Discussionmentioning

confidence: 99%

Section: Assessment Of Gradementioning

confidence: 99%

ACES: A new framework for the application of the 2018 periodontal status classification scheme to epidemiological survey data

Holtfreter,

Kuhr,

Borof

et al. 2024

J Clinic Periodontology

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“…Sample size calculation was done based on previous data as reported by Winkler et al [ 24 ] under the assumption of an expected kappa value of 0.4, a minimum acceptable kappa of 0.7 and a proportion of outcome (i.e. periodontal grade C according to radiographic bone loss) indicating a minimum sample size of 66 individuals to reach a power (1-β) of 0.9.…”

Section: Methodsmentioning

confidence: 99%

Periodontal grading—estimation of responsiveness to therapy and progression of disease

Bumm,

Ern,

Folwaczny

et al. 2024

Clin Oral Invest

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Objective To investigate the capability of periodontal grading to estimate the progression of periodontal disease and the responsiveness to therapy. Materials and methods Eighty-four patients who underwent non-surgical therapy (NST) were included. Direct and indirect evidence of progression were determined according to the current classification. Responsiveness to therapy was examined using mean pocket probing depths reduction (PPDRed), reduction of bleeding on probing (BOPRed), and the rate of pocket closure (%PC) after six months. Results Statistical analysis revealed no agreement between direct and indirect evidence in grading periodontitis (κ = 0.070). The actual rate of progression as determined by longitudinal data was underestimated in 13% (n = 11), overestimated in 51% (n = 43) and correctly estimated in 30% (n = 36) by indirect evidence. No significant differences in responsiveness to therapy were observed in patients graded according to direct evidence. Using indirect evidence, patients assigned grade C showed more PPDRed but less BOPRed and lower %PC compared to grade B. Conclusion The present data indicate that indirect evidence may lead to inaccuracies compared to direct evidence regarding the estimation of periodontal progression. However, indirect evidence seems to be more suitable in the estimation of responsiveness to therapy than direct evidence, helping to identify cases that are more likely to require additional therapies such as re-instrumentation or periodontal surgery. Clinical relevance Regarding the estimation of disease progression and responsiveness to periodontal therapy, accuracy and reliability of both direct and indirect evidence are limited when grading periodontitis.

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Assessment of periodontitis grade in epidemiological studies using interdental attachment loss instead of radiographic bone loss

Abstract: Aim: Comparison of grading according to radiographic bone loss (BL) or according to interdental clinical attachment loss (CAL).

Cited by 2 publications

References 24 publications

ACES: A new framework for the application of the 2018 periodontal status classification scheme to epidemiological survey data

ACES: A new framework for the application of the 2018 periodontal status classification scheme to epidemiological survey data

Periodontal grading—estimation of responsiveness to therapy and progression of disease

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