定期回診和牙周統合治療在牙周臨床狀況與回診率之分析研究

Analysis of the Periodontal Status and the Compliance Rates when Patients Received Regular Recall and Comprehensive Periodontal Treatment Project.

賴昭翰(Chao-Han Lai)

指導教授 ： 呂炫堃

臺北醫學大學/口腔醫學院/牙醫學系碩博士班/碩士(2014年)

https://doi.org/10.6831/TMU.2014.00079

摘要

背景:自從台灣健保署推行了｢牙周病統合照護計畫｣(Comprehensive
Periodontal Treatment Project，CPTP)，在病患接受治療的意願提升下，更希望維護病人長期的牙周健康。然而，目前仍未有牙周統合治療計畫的相關研究，証實牙周病統合照護計畫治療後的成果。台北醫學大學附設醫院牙周病科設立了明信片回診制度(postcard recall system，PRS)，幾年施行下來，對於病患回診狀況也多所關心。
目的:(1)在本院明信片回診制度建立後，追縱比較定期回診的牙周病患，和過去未定期回診牙周病人的牙周狀況。(2)比較牙周病統合照護計畫和傳統牙周病治療的病人，治療後臨床結果是否有差異。(3)明信片回診制度建立後，回診率改變的狀況。(4)在牙周病回診維護期間，探討可能的相關危險因子，對牙周病復發及牙齒喪失的影響。
材料與方法:此研究是利用回溯性的方式，總共納入病患 381 位，其中 161 位為回診追縱病人，另外 220 位為電子病歷查詢病人，所有病人來自於台北醫學大學附設醫院牙周病專科門診中心，時間為 2006 年 1 月到 2013 年 12 月期間，經標準程序篩選，納入全口中度到重度牙周炎的病患。回診追縱病人按條件分成有定期回診 (compliance, n=94)和沒有定期回診(non-compliance, n=67)，定期回診病人又可分接受牙周傳統治療(CPT, n=48)或牙周統合照護計畫(CPTP, n=46)的病患，測量其在初診(T1)，第一次回診(T2)，和最近一次回診(T3)的牙周狀況，分別比較兩組在臨床參數:牙周探測深度(PPD)，探測出血點(BOP)，牙菌斑控制指數(PCR)，牙齒喪失數(TL)的差異。另外用電子病歷隨機挑選牙周病患 220 位，針對2010 以前沒有 PRS，和 2010之後有 PRS 的病人，各 110 位病人，計算其 6個月回診的狀況。最後就回診追縱病人，採用邏輯斯迴歸(logistic regression)分析來探討相關因子對牙周病復發及牙齒喪失的影響。
結果:161 位回診追縱病人，接受過完整的牙周治療，在平均追縱 3.8 年後，有定期回診(n=94)相較於沒定期回診(n=67)的組別，在臨床參數上有顯著的改善。而有接受 CPTP(n=46)相較於 CPT(n=48)的病人，有較多淺的 PPD 分佈，較少的 BOP，較低的 PCR，及較少的 TL。220 位經電子病歷查詢的病人，在 PRS 建立之後，定期回診的比率從 27%提升到 72%。年齡，抽菸，PPD≥7mm，PCR≥30%和牙周復發有顯著相關性，而年齡，糖尿病，BOP≥30%，追縱時間之長久和牙齒喪失有顯著相關性。
結論:根據本教學醫院的評估，參與牙周統合照護計畫，且遵守每 6 個月明信片回診制度，可以得到最理想且穩定的牙周健康，進一步控制了相關危險因子對牙周復發及牙齒喪失的影響。

關鍵字

牙周統合照護計畫 ； 牙周維護 ； 維護性牙周治療 ； 定期回診 ； 危險因子

並列摘要

Aim: Comprehensive Periodontal Treatment Project（CPTP）has been executed since 2010 in order to help people with periodontitis in Taiwan. However,there was still no strong evidence to show the longitudinal outcome of CPTP. Postcard recall system (PRS) was created to remind patients of coming back for supportive periodontal therapy (SPT). The compliance rates with SPT should be determined.
The objective of this study includes (1) Comparison of the treatment outcomes between compliant patients and non-compliant patients. (2) Analysis of the treatment outcomes between people participating in CPTP as well as those receiving conventional periodontal therapy (CPT). (3) Examination of the effect of PRS on the compliance rates with SPT. (4) Investigation of the influence of predictive factors for the periodontal recurrence and tooth loss during the observational period.
Material and methods: 381 patients who received periodontal therapy from Taipei Medical University Hospital were collected in this retrospective study. 161 patients were recalled for the investigation of periodontal status; while the other 220 patients were checked by their electronic charts for the degree of compliance with SPT. Recalled patients were grouped into compliance (n=94) and non-compliance (n=67). Patients in compliance under PRS and those in non-compliance without PRS were assessed and compared. Compliant patients were also grouped into CPT (n=46) and CPTP (n=48). Patients in CPT were compared with those in CPTP by periodontal parameters. The parameters that
included probing pocket depth (PPD), bleeding on probing (BOP), plaque control record (PCR) and tooth loss (TL) were collected during the following period. In addition, 110 patients treated before 2010 as well as 110 patients
treated after 2010 were randomly selected for the assessment of the compliance rates. Descriptive statistics and logistic regression analysis were performed to
analyze the predictive factors associated with periodontal recurrence and tooth loss.
Results: 161 recalled subjects who completed periodontal therapy were followed for 3.8 years. When patients in compliance (n=94) compared with those in non-compliance(n=67), they had better improvement in periodontal status. Patients receiving CPTP (n=46), as compared with those receiving CPT (n=48), had a better tendency of shallower PPD, less BOP, lower level of PCR and fewer TL. The compliance rates increased from 27% to 72% by the establishment of PRS after 2010. Age, Smoking, PPD≥7mm and PCR≥30% were found to be associated with periodontal recurrence; while age, the existence of diabetes, BOP≥30% and time elapsed since treatment were related to tooth loss.
Conclusion: This study confirmed that patients had the most optimal and stable periodontal health when they received CPTP under the supervision of PRS. The compliance with SPT might control predictive factors for recurrence of
periodontal disease and tooth loss.

並列關鍵字

Comprehensive periodontal treatment project ； periodontal maintenance ； supportive periodontal therapy ； compliance ； risk factors

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