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北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (1): 70-77. doi: 10.19723/j.issn.1671-167X.2023.01.010

• 论著 • 上一篇    下一篇

重度牙周炎患者4年自然进展失牙的多因素分析

温静1,欧阳翔英1,*(),裴喜燕2,邱善湧1,刘健如1,刘文逸1,曹采方1   

  1. 1. 北京大学口腔医学院·口腔医院牙周科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，国家药品监督管理局口腔生物材料重点实验室，北京 100081
    2. 北京大学口腔医学院·口腔医院第一门诊部，北京 100034
  • 收稿日期:2020-10-09 出版日期:2023-02-18 发布日期:2023-01-31
  • 通讯作者: 欧阳翔英 E-mail:kqouyangxy@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(82071118);国家自然科学基金(81991500);国家自然科学基金(81991502);国家自然科学基金(81870772)

Multivariable analysis of tooth loss in subjects with severe periodontitis over 4-year natural progression

Jing WEN1,Xiang-ying OUYANG1,*(),Xi-yan PEI2,Shan-yong QIU1,Jian-ru LIU1,Wen-yi LIU1,Cai-fang CAO1   

  1. 1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
    2. First Clinical Division, Peking University School and Hospital of Stomatology, Beijing 100034, China
  • Received:2020-10-09 Online:2023-02-18 Published:2023-01-31
  • Contact: Xiang-ying OUYANG E-mail:kqouyangxy@bjmu.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(82071118);the National Natural Science Foundation of China(81991500);the National Natural Science Foundation of China(81991502);the National Natural Science Foundation of China(81870772)

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摘要：

目的: 评估中国农村重度牙周炎患者4年自然进展不同失牙数人群的基线特征，分析影响失牙数量的相关因素。方法: 纳入15~44岁的217名重度牙周炎患者，通过问卷调查、临床检查和影像学检查，分析其4年自然进展失牙情况，计算磨牙缺失数、有牙周膜增宽(widened periodontal ligament space, WPDL)的牙数、有根尖病变的牙数等牙周疾病和龋病相关的基线指标，比较不同失牙数人群的基线特征，并进一步分析影响不同失牙数的相关因素。结果: 在4年自然进展后，失牙共103颗，年人均失牙(0.12±0.38)颗。其中，无失牙组有174人，失牙1~2颗组有34人，失牙≥3颗组有9人。磨牙缺失最多，尖牙缺失最少。与新发失牙数显著呈正相关的基线指标包括骨吸收＞50%的牙数、骨吸收＞65%的牙数、探诊深度(probing depth, PD)≥5 mm的牙数百分数、PD≥7 mm的牙数百分数、临床附着丧失≥5 mm的牙数百分数、有骨下袋的牙数、有WPDL的牙数和有根尖周病变的牙数。多元有序Logistic回归分析结果显示，骨吸收＞50%的牙数(OR=1.550)、基线磨牙缺失数(OR=1.774)、有WPDL的牙数(1~2颗：OR=1.415；≥3颗：OR=13.105)、有根尖周病变的牙数(1~2颗：OR=4.393；≥3颗：OR=9.526)和龋/残根的牙数(OR=3.028)显著增加了新发失牙和多颗新发失牙的风险。结论: 在4年自然进展后，中国农村中青年的重度牙周炎患者失牙和多颗失牙风险与骨吸收＞50%的牙数、基线磨牙缺失数、有WPDL的牙数、有根尖周病变的牙数和龋/残根的牙数显著相关。

关键词: 牙周炎, 自然进展, 失牙, 齿数

Abstract:

Objective: To evaluate the characteristics of severe periodontitis with various number of tooth loss during 4-year natural progression, and to analyze the factors related to higher rate of tooth loss. Methods: A total of 217 patients aged 15 to 44 years with severe periodontitis were included, who participated in a 4-year natural progression research. Data obtained from questionnaire survey, clinical examination and radiographic measurement. Tooth loss during 4-year natural progression was evaluated. The baseline periodontal disease related and caries related factors were calculated, including number of teeth with bone loss > 50%, number of missing molars, number of teeth with widened periodontal ligament space (WPDL), number of teeth with periapical lesions and etc. Characteristics of populations with various number of tooth loss and the related factors that affected higher rate of tooth loss were analyzed. Results: In 4 years of natural progression, 103 teeth were lost, and annual tooth loss per person was 0.12±0.38. Nine patients lost 3 or more teeth. Thirty-four patients lost 1 or 2 teeth, and 174 patients were absent of tooth loss. Molars were mostly frequent to lose, and canines presented a minimum loss. The number of teeth with WPDL, with periapical lesions, with intrabony defects, with probing depth (PD)≥7 mm, with PD≥5 mm, with clinical attachment loss≥5 mm, with bone loss > 50% and with bone loss > 65% were positively correlated to number of tooth loss. Results from orderly multivariate Logistic regression showd that the number of teeth with bone loss > 50% OR=1.550), baseline number of molars lost (OR=1.774), number of teeth with WPDL (1 to 2: OR=1.415; ≥3: OR=13.105), number of teeth with periapical lesions (1 to 2: OR=4.393; ≥3: OR=9.526) and number of teeth with caries/residual roots (OR=3.028) were significant risk factors related to higher likelihood of tooth loss and multiple tooth loss. Conclusion: In 4 years of natural progression, the number of teeth with bone loss > 50%, baseline number of missing molars, number of teeth with WPDL, baseline number of teeth with periapical lesions and number of teeth with caries/residual roots were significantly related to higher risk of tooth loss and multiple tooth loss among Chinese young and middle-aged patients with severe periodontitis in rural areas.

Key words: Periodontitis, Natural progression, Tooth loss, Number of teeth

中图分类号: 

  • R781.4

图1

4年自然进展中的失牙牙位"

表1

不同失牙数人群的基线特征"

Characteristics TL=0(n=174) TL=1-2(n=34) TL≥3(n=9) P
Age/years☆ 33.13±7.50 36.41±5.05 35.67±6.00 0.033
Gender, n(%)☆ 0.007
    Female 87 (50.0) 20 (58.8) 0 (0.0)
    Male 87 (50.0) 14 (41.2) 9 (100.0)
Smoking dosage# 7.28±15.12 8.10±12.78 12.79±9.03 0.029
Smoking years 5.82±8.73 5.18±7.95 13.44±7.49 0.014
Number of baseline missing molars☆ 0.27±0.70 1.53±1.89 1.78±1.05 ＜0.001
Number of teeth with WPDL* 0.28±0.67 1.15±1.64 2.89±3.41 ＜0.001
Number of teeth with PD≥7 mm/%* 1.00±5.30 5.00±13.8 15.00±20.40 0.002
Number of teeth with PD≥5 mm/%* 16.00±20.70 28.00±32.3 44.00±34.40 0.022
Mean CAL/mm# 2.16±0.96 2.49±1.15 4.25±2.01 0.003
CALmax/mm# 2.90±1.61 3.08±2.11 6.13±3.27 0.015
Number of teeth with CAL≥5 mm/%* 18.70±24.49 29.62±32.31 64.44±34.88 ＜0.001
Number of teeth with CAL≥3 mm/% 66.54±32.75 74.29±26.65 89.00±19.74 0.090
Mean PD/mm# 2.73±0.46 3.00±0.66 3.42±0.67 0.002
PDmax/mm# 5.18±1.21 5.63±1.41 6.44±1.67 0.004
Number of teeth with IBD☆ 0.50±0.98 1.26±1.99 2.00±1.73 0.003
Number of teeth with BL＞65%* 0.06±0.48 0.21±0.48 3.56±4.85 ＜0.001
Number of teeth with BL＞50%* 0.75±2.01 2.06±3.22 9.78±7.38 ＜0.001
Number of teeth with caries/residual roots☆ 0.56±1.03 1.68±1.77 2.00±2.29 ＜0.001
Number of teeth with periapical lesions* 0.28±0.63 1.24±1.37 2.33±2.00 ＜0.001

表2

不同失牙数的单因素分析"

Variables TL=0
(n=174)		 TL=1-2
(n=34)		 TL≥3
(n=9)		 P OR 95%CI
Age/years 33.13±7.50 36.41±5.05 35.67±6.00 0.013 1.069 1.014-1.127
Gender, n(%) 0.491 1.264 0.649-2.462
    Female 87 (50.0) 20 (58.9) 0 (0.0)
    Male 87 (50.0) 14 (41.1) 9 (100.0)
Smoking index, n(%) 0.055 2.081 0.985-4.402
    Slight 143 (82.2) 25 (73.5) 5 (55.6)
    Moderate/Severe 31 (17.8) 9 (26.5) 4 (44.4)
Number of teeth with BL＞50% 0.75±2.01 2.06±3.22 9.78±7.38 ＜0.001 1.344 1.208-1.496
Number of baseline missing molars 0.27±0.70 1.53±1.89 1.78±1.05 ＜0.001 1.986 1.540-2.560
Number of teeth with WPDL, n(%)
    0 140 (80.5) 16 (47.0) 3 (33.3)
    1-2 30 (17.2) 14 (41.2) 1 (11.1) 0.002 25.585 1.590-7.622
    ≥3 4 (12.3) 4 (11.8) 5 (55.6) ＜0.001 3.483 7.776-84.268
Number of teeth with periapical lesions, n(%)
    0 133 (76.4) 9 (26.5) 3 (33.3)
    1-2 33 (19.0) 22 (64.7) 1 (11.1) ＜0.001 7.265 3.290-16.039
    ≥3 3 (4.6) 3 (8.8) 5 (55.6) ＜0.001 59.086 15.165-230.212
Number of teeth with caries/residual roots, n(%)
    0 120 (69.0) 10 (29.4) 3 (33.3)
    ≥1 54 (31.0) 24 (70.6) 6 (66.7) ＜0.001 5.023 2.440-10.350
Number of teeth with IBD, n(%)
    0 123 (70.7) 20 (58.9) 3 (33.3)
    ≥1 51 (29.3) 14 (41.1) 6 (66.7) 0.023 2.188 1.112-4.306

表3

不同失牙数的有序多元Logistic回归分析"

Variables TL=0
(n=174)		 TL=1-2
(n=34)		 TL≥3
(n=9)		 B SE Wald P OR 95%CI
Age/years 33.13±7.50 36.41±5.05 35.67±6.00 0.012 0.035 0.113 0.737 1.012 0.922-1.059
Gender, n(%) 0.110 0.540 0.042 0.839 1.116 0.311-2.581
    Female 87 (50.0) 20 (58.9) 0 (0.0)
    Male 87 (50.0) 14 (41.1) 9 (100.0)
Smoking index, n(%) 0.536 0.639 0.705 0.401 1.709 0.489-5.977
    Slight 143 (82.2) 25 (73.5) 5 (55.6)
    Moderate/Severe 31 (17.8) 9 (26.5) 4 (44.4)
Number of teeth with BL＞50% 0.75±2.01 2.06±3.22 9.78±7.38 0.438 0.245 3.199 0.044 1.550 1.043-2.507
Number of baseline missing molars 0.27±0.70 1.53±1.89 1.78±1.05 0.573 0.161 12.600 0.000 1.774 1.293-2.433
Number of teeth with WPDL, n(%)
    0 140 (80.5) 16 (47.0) 3 (33.3)
    1-2 30 (17.2) 14 (41.2) 1 (11.1) 0.347 0.518 0.449 0.503 1.415 0.513-3.904
    ≥3 4 (12.3) 4 (11.8) 5 (55.6) 2.573 0.824 9.750 0.002 13.105 2.606-65.891
Number of teeth with periapical lesions, n(%)
    0 133 (76.4) 9 (26.5) 3 (33.3)
    1-2 33 (19.0) 22 (64.7) 1 (11.1) 1.480 0.475 9.714 0.002 4.393 1.732-11.145
    ≥3 3 (4.6) 3 (8.8) 5 (55.6) 2.254 0.801 7.909 0.005 9.526 1.980-45.787
Number of teeth with caries/residual roots, n(%)
    0 120 (69.0) 10 (29.4) 3 (33.3)
    ≥1 54 (31.0) 24 (70.6) 6 (66.7) 1.108 0.484 5.253 0.022 3.028 1.175-7.815
Number of teeth with IBD, n(%)
    0 123 (70.7) 20 (58.9) 3 (33.3)
    ≥1 51 (29.3) 14 (41.1) 6 (66.7) 0.140 0.484 0.083 0.773 1.150 0.337-2.248
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ISSN 1671-167X
CN 11-4691/R
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