Site-level progression of periodontal disease during a follow-up period

Yoshiaki Nomura, Toshiya Morozumi, Taneaki Nakagawa, Tsutomu Sugaya, Masamitsu Kawanami, Fumihiko Suzuki, Keiso Takahashi, Yuzo Abe, Soh Sato, Asako Makino-Oi, Atsushi Saito, Satomi Takano, Masato Minabe, Yohei Nakayama, Yorimasa Ogata, Hiroaki Kobayashi, Yuichi Izumi, Naoyuki Sugano, Koichi Ito, Satoshi SekinoYukihiro Numabe, Chie Fukaya, Nobuo Yoshinari, Mitsuo Fukuda, Toshihide Noguchi, Tomoo Kono, Makoto Umeda, Osamu Fujise, Fusanori Nishimura, Atsutoshi Yoshimura, Yoshitaka Hara, Toshiaki Nakamura, Kazuyuki Noguchi, Erika Kakuta, Nobuhiro Hanada, Shogo Takashiba, Yasuharu Amitani, Hiromasa Yoshie

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


Periodontal disease is assessed and its progression is determined via observations on a site-by-site basis. Periodontal data are complex and structured in multiple levels; thus, applying a summary statistical approach (i.e., the mean) for site-level evaluations results in loss of information. Previous studies have shown the availability of mixed effects modeling. However, clinically beneficial information on the progression of periodontal disease during the follow-up period is not available. We conducted a multicenter prospective cohort study. Using mixed effects modeling, we analyzed 18,834 sites distributed on 3,139 teeth in 124 patients, and data were collected 5 times over a 24-month follow-up period. The change in the clinical attachment level (CAL) was used as the outcome variable. The CAL at baseline was an important determinant of the CAL changes, which varied widely according to the tooth surface. The salivary levels of periodontal pathogens, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, were affected by CAL progression. “Linear”- and “burst”-type patterns of CAL progression occurred simultaneously within the same patient. More than half of the teeth that presented burst-type progression sites also presented linear-type progression sites, and most of the progressions were of the linear type. Maxillary premolars and anterior teeth tended to show burst-type progression. The parameters identified in this study may guide practitioners in determining the type and extent of treatment needed at the site and patient levels. In addition, these results show that prior hypotheses concerning "burst" and "linear" theories are not valid.

Original languageEnglish
Article numbere0188670
JournalPloS one
Issue number12
Publication statusPublished - Dec 2017

All Science Journal Classification (ASJC) codes

  • General


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