Compliance as a Prognostic Indicator II: Outcome of 11545 Teeth

Objectives: Emerging evidence demonstrates that the relationship of patient compliance to overall tooth prognosis remains controversial. In this study, we evaluate the impact of patient compliance related to the tooth prognosis by using individual tooth based data.

Methods: This retrospective study evaluates the impact of compliance (complete vs. erratic) on two common periodontal clinical parameters, including alveolar bone loss level and tooth loss for 459 subjects and 11,545 teeth in a long term period of observation (15 to 25 years) and maintenance therapy (at least 10 years). Compliance was defined in two ways for all analyses by Miyamoto's classification. Change in the clinical variables was dichotomized into bone loss versus no bone loss according to Shei score, and tooth loss versus no tooth loss. The effects of both definitions of compliance were then evaluated and analyzed for each tooth of each patient in a series of generalized estimating equations regression models with adjustment for potential confounders.

Results: The analysis of the dichotomous change in clinical parameters over time demonstrated that complete compliers tended to show reduction in bone loss compared to the erratic complier for both definitions of compliance (p<0.001). In contrast, under both definitions for compliance, there was no significant difference with regard to the incidence of tooth loss (definition1; p =.383 and definition2; p =.853).

Conclusion: Based on these results, complete compliers under both definitions demonstrated a reduction in the progression of bone loss when compared to erratic compliers; however, with regard to tooth loss, there was no significant difference between those groups. The results seem to indicate that 1), periodontal health status can be improved for complete compliers when compared to erratic compliers 2), the decision for tooth extraction made by the dentists at maintenance visits results in greater tooth loss. Supported by NIH R03DE016924.