Response to letter to the editor, 'tooth loss in aggressive periodontitis: A systematic review'

摘要

In a comment to our systematic review on tooth loss in aggressive periodontitis (AgP) (Nibali et al, 2013), S. Ramachandra highlighted the importance of early diagnosis in AgP (Ramachandra, 2013). Since the time.of disease onset is hardly ever detectable in retrospect, disease severity appears the only measurable 'disease staging' index. We reported that more teeth initially deemed 'hopeless' had to be extracted during supportive periodontal therapy compared with teeth with secure or questionable prognosis in one of the reviewed AgP longitudinal studies (Graetz et al, 2011). The effect of tooth prognostic factors on tooth survival in periodontitis cases has been previously documented, although subject factors probably play an even more important prognostic role (McGuire and Nunn, 1996; Matuliene et al, 2010). Unfortunately, although average clinical and radiographic parameters are usually reported in AgP studies, rarely are categorical variables indicating severity or 'diagnosis staging' reported and analyzed in relation to tooth loss. In fact, the article by Graetz and co-workers was the only reviewed article (Nibali et al, 2013) to associate measures of diagnosis staging, expressed as severity of initial bone loss, with tooth loss (Graetz et al., 2011). Therefore, meta-analysis for this variable was not feasible. It does not help that, for AgP, there are no mild-moderate-severe criteria as for chronic periodontitis, perhaps in the assumption that all cases are 'severe' by definition (Lang et al, 1999). Therefore, initial tooth prognosis (McGuire, 1991) or, more objectively, radiographic bone loss (Graetz et al., 2011)could be used and reported in future studies on AgP as a criterion for diagnosis staging.