Nomogram predicting suboptimal nonsurgical therapy response in stage III or IV periodontitis using hematologic and periodontal indexes

IF 4.4 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of the American Dental Association Pub Date : 2026-09-01 Epub Date: 2026-05-14 DOI:10.1016/j.adaj.2026.02.016

Tongxuan Mu MM, Yaru Yang MM, Zhe Li MM, Weijia Zhang MM, Zihan Wang BM, Zirui Wang BM, Hong Wu PhD, Li Lin PhD, Xiaolin Tang PhD, Yaping Pan PhD, Chen Li PhD

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引用次数: 0

Abstract

Background

The authors aimed to identify risk factors for suboptimal response to nonsurgical periodontal therapy in patients with stage III or IV periodontitis and develop a predictive model to guide personalized treatment strategies.

Methods

A total of 146 patients with stage III or IV periodontitis who underwent nonsurgical periodontal treatment were retrospectively examined. Clinical and blood test data were collected. The data set was categorized into optimal (n = 92) and suboptimal (n = 54) response groups. Suboptimal responders were those with 30% or more of sites with initial probing depth of 5 mm or greater that failed to achieve a 2-mm or greater reduction or clinical health at the 6-week follow-up, and others were considered optimal. Results of logistic regression analyses identified independent risk factors, and a nomogram prediction model was constructed. Model discrimination was assessed using the area under the receiver operating characteristic curve and calibration was evaluated through the Hosmer-Lemeshow test and calibration curves. Clinical decision curve analysis was used to assess net benefit.

Results

Thick gingival phenotype, grade C periodontitis, elevated platelet to lymphocyte ratio, and mean corpuscular hemoglobin were significant risk factors for suboptimal response. The predictive model had strong discrimination (area under the receiver operating characteristic curve = 0.782) and good calibration (Hosmer-Lemeshow test, P = .532). Clinical decision analysis confirmed the usefulness of the predictive model within specific probability thresholds.

Conclusions

Gingival phenotype, periodontitis grade, platelet to lymphocyte ratio, and mean corpuscular hemoglobin are significant predictors of nonsurgical treatment outcomes in stage III and stage IV periodontitis. The proposed nomogram enables early identification of suboptimal responders.

Practical Implications

This nomogram supports personalized intervention strategies to optimize clinical outcomes and resource usage. This study was registered at the Chinese Clinical Trial Registry. The registration number is ChiCTR2400080731.

查看原文本刊更多论文

使用血液学和牙周指标预测III期或IV期牙周炎非手术治疗反应的Nomogram。

背景：作者旨在确定III期或IV期牙周炎患者非手术牙周治疗反应不佳的危险因素，并建立预测模型以指导个性化治疗策略。方法：对146例接受非手术牙周治疗的III期或IV期牙周炎患者进行回顾性分析。收集临床及血液检查资料。将数据集分为最佳（n = 92）和次优（n = 54）两组。次优应答者是指在6周的随访中，30%或更多的部位的初始探查深度为5mm或更大，未能实现2mm或更大的缩小或临床健康，而其他应答者被认为是最佳的。logistic回归分析结果确定了独立的危险因素，并建立了nomogram预测模型。采用受试者工作特征曲线下面积评价模型判别，采用Hosmer-Lemeshow检验和标定曲线评价模型标定。临床决策曲线分析用于评估净收益。结果：龈厚表型、C级牙周炎、血小板与淋巴细胞比值升高和平均红细胞血红蛋白是治疗效果不佳的重要危险因素。该预测模型具有较强的鉴别性（受试者工作特征曲线下面积= 0.782）和较好的校准性（Hosmer-Lemeshow检验，P = .532）。临床决策分析证实了该预测模型在特定概率阈值内的有效性。结论：牙龈表型、牙周炎分级、血小板与淋巴细胞比率和平均红细胞血红蛋白是III期和IV期牙周炎非手术治疗结果的重要预测因素。所提出的nomogram能够早期识别次优应答者。实际意义：该nomogram支持个性化干预策略以优化临床结果和资源利用。本研究已在中国临床试验注册中心注册。注册号为ChiCTR2400080731。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Dental Association 医学-牙科与口腔外科

CiteScore

5.30

自引率

10.30%

发文量

221

审稿时长

34 days

期刊介绍： There is not a single source or solution to help dentists in their quest for lifelong learning, improving dental practice, and dental well-being. JADA+, along with The Journal of the American Dental Association, is striving to do just that, bringing together practical content covering dentistry topics and procedures to help dentists—both general dentists and specialists—provide better patient care and improve oral health and well-being. This is a work in progress; as we add more content, covering more topics of interest, it will continue to expand, becoming an ever-more essential source of oral health knowledge.