牙周炎（Periodontitis）是由牙菌斑介导的牙周支持组织的破坏性炎症性疾病。作为世界上最常见的慢性感染性疾病之一，牙周炎是一个全球流行的重大公共卫生问题，也是成人失牙的主要原因。牙周非手术治疗（Non-surgical periodontal treatment, NSPT）是牙周系统治疗的基础，其疗效受到诸多因素的影响。随着爱伤观念及微创治疗理念的提出和发展，越来越多的医师选择在局麻下实施NSPT。然而，不同局麻方式虽可有效缓解患者治疗时的疼痛不适，但其对NSPT临床疗效的影响仍缺乏强有力的理论支持。另外，牙周医师在NSPT过程中对局麻的应用仍以经验为主，关于临界值界定的研究目前尚处于空白。此外，尽管牙周治疗后的结果一般会随着时间的推移保持相对稳定，但仍有少数患者和部位会出现疾病的复发或进展，最终造成牙齿脱落。截至目前，关于中国人群NSPT后牙周炎进展甚至失牙的影响因素及其相应预测模型的研究仍十分有限。

　　综上，本课题的研究目的包括：

　　1. 基于电子化牙周信息表中的常用临床数据，评估局部注射麻醉对中国牙周炎患者NSPT短期临床疗效的影响，并确定开始实施局麻的临界探诊深度（probing depth, PD）值，为临床工作提供更准确的理论依据。

　　2. 结合临床及影像学数据，采用多水平回归模型分析中国重度牙周炎患者经NSPT后长期随访期间牙周炎进展及牙齿缺失的影响因素。

　　3. 在多水平影响因素分析的基础上，构建适合重度牙周炎人群NSPT后长期随访期间牙周炎进展及牙齿缺失的Nomogram预测模型，帮助临床医师尽早制定合理的治疗方案，并可直观地向患者展示总体及个别牙的预后，有利于医患沟通。

　　本课题为回顾性队列研究（NSPT短期疗效研究共纳入平均随访6周的3980名牙周炎患者；NSPT长期疗效研究共纳入平均随访11年的131名重度牙周炎患者），结合北京大学口腔医院牙周科电子化信息表中的临床数据以及全口根尖片中的影像学数据，采用多水平线性回归模型（因变量为PD降低值）、多水平Logistic回归模型[因变量为出血指数（bleeding index, BI）是否降低或牙周炎是否进展]和多水平Cox回归模型（因变量为失牙与否）分析评估NSPT疗效或牙周炎进展的影响因素。在多因素回归分析的基础上，构建Nomogram预测模型，并利用受试者工作特征（receiver operating characteristic, ROC）曲线、校准曲线以及决策曲线分析（decision curve analysis, DCA）对预测模型的性能、预测准确性以及净效益进行评估。

　　在上述研究的基础上，本课题得出以下结果及结论：

　　1. 本研究中局麻组在NSPT后PD、PD>=5mm百分比、探诊出血（bleeding on probing, BOP）阳性率以及BI>2百分比的降低量较非局麻组更多，且差异具有统计学意义（P<0.001）。这提示局部注射麻醉的实施对中国牙周炎患者NSPT后PD、BI等临床指标的改善有显著的积极影响。

　　2. 局麻组与非局麻组NSPT后PD降低量的差异在基线PD<7mm时为0.12-0.22mm，而当基线PD>=7mm时两者之间差异增至0.41-1.37mm，提示临床医师在6mm以上位点应实施局麻下机械治疗。

　　3. 基线PD、附着丧失（attachment loss, AL）、BOP、根分叉病变（furcation involvement, FI）、牙齿动度以及影像学骨吸收量（bone loss, BL）均与中国重度牙周炎人群下颌磨牙的牙齿脱落显著相关。就全口牙位分析而言，性别、糖尿病、吸烟状况、牙齿类型以及基线牙周状况（PD、AL、BOP、牙齿动度和BL）等临床及影像学因素与失牙显著相关。在回归分析基础上分别构建下颌磨牙及全口牙位失牙的Nomogram预测模型，曲线下面积（area under the curve, AUC）分别为0.891和0.860，提示模型预测准确性良好。校准曲线、DCA等验证结果也显示模型预测性能良好。

　　4. 本研究结果显示NSPT对牙周炎症的控制是长期有效的，且基线PD越大，治疗后PD改善越明显，深袋百分比亦由基线时的59.9%降至最后一次复诊时的40.1%，且差异具有统计学意义（P<0.0001）。

　　5. 重度吸烟状况，磨牙牙位，基线PD、AL和BL等因素与NSPT后牙周炎进展显著相关，并依此构建了相应的Nomogram预测模型。结果表明在磨牙和牙周破坏更重的位点存在更高的牙周炎复发或进展风险，提示临床医师需要更加重视这些部位的定期复查和维护。

　　本课题的创新性在于本研究整合分析了中国牙周炎人群临床及影像学数据资料，进一步分析评估NSPT疗效的影响因素及长期随访过程中牙周炎进展甚至失牙的影响因素，不仅首创了根分叉区骨吸收量的影像学测量分析方法，同时在口腔领域首次利用Nomogram构建了重度牙周炎患者NSPT后长期随访过程中牙周炎进展及失牙的预测模型。

　　上述研究结果为探索中国牙周炎人群NSPT短期及长期疗效的影响因素提供了一定的证据支持，构建的Nomogram预测模型为临床医师制定合理治疗计划提供了直观简便的新颖思路，对于未来牙周炎的个性化预后判断和治疗，均具有十分重要的临床参考价值。

　　Periodontitis is a destructive inflammatory disease of periodontal supportive tissues that is initially mediated by dental plaque. As one of the most common chronic infectious diseases in the world, periodontitis is a major public health problem and main cause of tooth loss. Non-surgical periodontal treatment (NSPT) is the basis of periodontal treatment, and the effectiveness of it may be influenced by many factors. With the proposal and development of the patient-friendly conscience, more and more people choose to perform local anesthesia (LA) during scaling and root planing (SRP) to relieve the pain and discomfort of patients. However, there is little evidence of the effects of LA on clinical outcomes of NSPT, in particular among Chinese. Besides, the application of LA by periodontists during SRP is mainly based on their experience, and the research on the definition of the threshold is still limited. In addition, although the outcome after NSPT can remain relatively stable over time, there are still a few patients and sites may experience recurrence or progression of the disease, resulting in tooth loss eventually. Up to now, there is quite limited research on the influencing factors and corresponding prediction models of periodontal progression and tooth loss after NSPT in Chinese population.

　　The purposes of the present study include:

　　To evaluate the effect of LA on short-term clinical outcomes of NSPT, and to determine the circumstances under which LA should be prescribed during SRP.

　　To analyze the influencing factors of periodontal progression and tooth loss in Chinese patients with severe periodontitis during long-term follow-up period after NSPT by multivariate regression analyses.

　　To develop suitable nomogram prediction models of periodontal progression or tooth loss after NSPT among Chinese patients with severe periodontitis by comprehensively analyzing clinical and radiographic influencing factors.

　　This is a retrospective cohort study. 3980 patients with periodontitis were enrolled in the short-term effectiveness of NSPT study, while 131 patients with severe periodontitis were selected within a mean follow-up period of 11 years in the long-term effectiveness of NSPT study. The associations of influencing factors including clinical and radiographic parameters with periodontal progression or tooth loss were assessed using multilevel linear regression, Logistic regression and Cox regression analyses. Corresponding nomogram prediction models were developed, and the validation and discriminatory ability of them were evaluated by receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA).

　　The main results and conclusions are as follows:

　　１. A significantly higher mean decrease in probing depth (PD) after NSPT was found in the LA group than in the no local anesthesia (NLA) group (0.98mm vs. 0.54mm, P<0.001). A significantly higher probability of decreases was found in the LA group in bleeding index (BI) (percentages of teeth with BI>1 and BI>2) (16.7% vs. 13.8%, P<0.001; 34.7% vs. 28.1%, P<0.001). Thus, LA improved the decrease in PD and BI after NSPT.

　　2. The difference between LA group and NLA group was 0.12mm to 0.22mm for sites with baseline PD<7mm; however, it increased to 0.41mm to 1.37mm for sites with baseline PD>=7mm, which suggesting that the clinician can perform SRP under routine LA at sites with PD>=7mm.

　　3. PD, attachment loss (AL), furcation involvement (FI), bleeding on probing (BOP), tooth mobility and radiographic bone loss (BL) were significantly associated with mandibular molar loss in Chinese patients with severe periodontitis (P<0.01). In terms of full-mouth analysis, gender, diabetes mellitus, smoking status, molar and baseline periodontal parameters (PD, AL, BOP, tooth mobility and BL etc.) were significantly associated with tooth loss. Corresponding nomogram prediction models were developed on the basis of above analyses, and the area under the curve (AUC) was 0.891 and 0.860 respectively. Calibration curve and DCA showed that the performance of models was good.

　　4. The results of the present study showed that NSPT was effective for a long time. The deeper the baseline pocket depth was, the more improvement of PD would be in the end. The percentage of deep pocket (PD>6mm) decreased from 59.9% at baseline to 40.1% at the last visit, and the difference was statistically significant (P<0.0001).

　　５. Heavy smoking status, molar, PD, AL and BL were significantly associated with the progression of periodontitis after NSPT, and a corresponding nomogram was constructed. The results showed that there was a higher risk of recurrence or progression of periodontitis in molars and periodontitis-related sites, suggesting that clinicians should pay more attention to the regular re-examination and maintenance of these sites.

　　Based on the clinical and radiographic data of Chinese patients with periodontitis, the present study further evaluated the factors influencing the short-term and long-term effectiveness of NSPT. The strength of this study lies in the innovation of the nomogram prediction models of periodontal progression and tooth loss in patients with severe periodontitis, which were not used in the field of periodontology before. In addition, this study first determined the circumstances under which local anesthesia should be prescribed during NSPT, and pioneered the method of radiographic measurement in the furcation region.

　　The above results provide certain evidence for exploring the factors influencing the effectiveness of NSPT among Chinese patients with periodontitis. The constructed nomogram prediction models can provide an effective tool and novel concept for clinicians to make personalized prognosis judgement and reasonable treatment plans.

第一章 文献综述 1
1.1 牙周非手术治疗疗效的影响因素 1
1.1.1 年龄 1
1.1.2 性别 2
1.1.3 种族及遗传因素 3
1.1.4 吸烟 4
1.1.5 全身情况 6
1.1.6 依从性 7
1.1.7 解剖因素 8
1.1.8 患牙基线牙周状况 10
1.1.9 牙齿类型 11
1.1.10 医生因素 12
1.2 失牙 13
1.2.1 失牙的危害 14
1.2.2 失牙的影响因素 15
1.3 预测模型 16
1.4 小结 17
第二章 引言 18
第三章 局麻对牙周非手术治疗短期疗效的影响 22
3.1 研究目的 22
3.2 材料和方法 22
3.2.1 研究人群 22
3.2.2 效应指标 22
3.2.3 牙周检查和治疗 24
3.2.4 统计分析 24
3.3 结果 24
3.3.1 研究人群基线特征 24
3.3.2 患者水平治疗前后临床指标的变化 24
3.3.3 局麻对牙周非手术治疗临床疗效的影响 26
3.4 讨论 32
3.5 结论 36
第四章 NSPT后下颌磨牙失牙的影响因素分析及预测模型构建 37
4.1 研究目的 37
4.2 材料和方法 37
4.2.1 研究人群 37
4.2.2 临床指标 37
4.2.3 影像学指标 39
4.2.4 统计分析 40
4.3 结果 41
4.3.1 研究人群基线特征 41
4.3.2 失牙组与非失牙组基线状况对比 41
4.3.3 NSPT后下颌磨牙缺失的单因素分析 41
4.3.4 NSPT后下颌磨牙缺失的多因素分析 45
4.3.5 NSPT后下颌磨牙存留情况的Nomogram预测模型构建与验证 45
4.3.6 NSPT后下颌磨牙存留情况Nomogram预测模型的应用示例 46
4.4 讨论 46
4.5 结论 54
第五章 NSPT后疾病进展的影响因素分析及预测模型构建 55
5.1 研究目的 55
5.2 材料和方法 55
5.2.1 研究人群 55
5.2.2 临床指标 55
5.2.3 影像学指标 56
5.2.4 统计分析 56
5.3 结果 57
5.3.1 研究人群基线特征 57
5.3.2 T0至T1期患者牙周炎分期分级的变化 57
5.3.3 失牙组与非失牙组基线状况对比 59
5.3.4 失牙组牙位分布情况 62
5.3.5 失牙组失牙原因分类情况 62
5.3.6 牙齿缺失的单因素分析 62
5.3.7 牙齿缺失的多因素分析 65
5.3.8 牙齿存留情况的Nomogram预测模型构建与验证 70
5.3.9 NSPT前后余留牙齿牙周状况变化 71
5.3.10 NSPT后余留牙齿牙周炎进展因素分析 73
5.3.11 NSPT后余留牙齿牙周炎进展Nomogram预测模型构建与验证 75
5.4 讨论 75
5.5 结论 81
第六章 结论及展望 83
参考文献 85
致谢 106
北京大学学位论文原创性声明和使用授权说明 108
学位论文答辩委员会名单 109
个人简历、在学期间发表的学术论文与研究成果 110

[1] 孟焕新. 牙周病学 [M]. 人民卫生出版社, 2008.

[2] Bratthall D, Petersen P E, Stjernsward J R, et al. Oral and Craniofacial Diseases and Disorders [M]//Nd, Jamison D T, Breman J G, et al. Disease Control Priorities in Developing Countries. Washington (DC). 2006: 723-736.

[3] Petersen P E, Ogawa H. The global burden of periodontal disease: towards integration with chronic disease prevention and control [J]. Periodontol 2000, 2012, 60(1): 15-39.

[4] Jiao J, Jing W, Si Y, et al. The prevalence and severity of periodontal disease in Mainland China: Data from the Fourth National Oral Health Survey (2015-2016) [J]. J Clin Periodontol, 2020, 48(2): 168-179.

[5] 王勤涛, 马志伟. 中国牙周病的现状、临床技术及应对策略 [J]. 口腔医学, 2018, 38(1): 1-4.

[6] 吴益华, 姜广水, 张世周, 等. 黄连水提取物药膜辅助治疗慢性牙周炎的疗效评价 [J]. 上海口腔医学, 2004, 13(4): 252-255.

[7] 徐莉, 曹采方. 牙周临床治疗Ⅲ.牙周非手术治疗的远期疗效 [J]. 中华口腔医学杂志, 2005, 40(3): 250-252.

[8] Kozlovsky A, Rapaport A, Artzi Z. Influence of operator skill level on the clinical outcome of non-surgical periodontal treatment: a retrospective study [J]. Clin Oral Investig, 2018, 22(8): 2927-2932.

[9] Shklar G. The Effects Of Aging Upon Oral Mucosa [J]. J Invest Dermatol, 1966, 47(2): 115-119.

[10] Papic M, Glickman I. Keratinization of the human gingiva in the menstrual cycle and menopause [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 1950, 3(4): 504-516.

[11] Klingsberg J, Butcher E O. Comparative histology of age changes in oral tissues of rat, hamster, and monkey [J]. J Dent Res, 1960, 39(1): 158-169.

[12] Ryan E, Toto P, Gargiulo A. Aging in human attached gingival epithelium [J]. J Dent Res, 1974, 53(1): 74-76.

[13] Wentz F M, Maier A W, Orban B. Age Changes and Sex Differences in the Clinically “Normal” Gingiva [J]. J Periodontol, 1952, 23(1): 13-24.

[14] Stahl S S, Tonna E A. H3-proline study of aging periodontal ligament matrix formation: comparison between matrices adjacent to either cemental or bone surfaces [J]. J Periodontal Res, 1977, 12(4): 318-322.

[15] Haim G, Baumg?rtel R. [Age-related changes in the periodontium (desmodont)] [J]. Dtsch Zahnarztl Z, 1968, 23(3): 340-344.

[16] Amler M H. Age factor in human alveolar bone repair [J]. J Oral Implantol, 1993, 19(2): 138-142.

[17] Severson J A, Moffett B C, Kokich V, et al. A histologic study of age changes in the adult human periodontal joint (ligament) [J]. J Periodontol, 1978, 49(4): 189-200.

[18] Coolidge E D. The thickness of the human periodontal membrane. [J]. J Am Dent Assoc, 1937, 24(8): 1260-1270.

[19] Mcdonagh A J. Periodontology, with Special Reference to Recession of the Gums [J]. J Dent Res, 1919, 1(4): 423-439.

[20] Kitchin, C P. The Prevalence of Tooth Root Exposure, and the Relation of the Extent of Such Exposure to the Degree of Abrasion in Different Age Classes [J]. J Dent Res, 1941, 20(6): 565-581.

[21] Ainamo A, Ainamo J, Poikkeus R. Continuous widening of the band of attached gingiva from 23 to 65 years of age [J]. J Periodontal Res, 1981, 16(6): 595-599.

[22] Socransky S S, Gibbons R J, Dale A C, et al. The microbiota of the gingival crevice area of man. I. Total microscopic and viable counts and counts of specific organisms [J]. Arch Oral Biol, 1963, 8(3): 275-280.

[23] Holm-Pedersen P, Agerbaek N, Theilade E. Experimental gingivitis in young and elderly individuals [J]. J Clin Periodontol, 1975, 2(1): 14-24.

[24] Church H, Dolby A E. The effect of age on the cellular immune response to dento-gingival plaque extract [J]. J Periodontal Res, 1978, 13(2): 120-126.

[25] Matsson L, Theilade J, Attstrom R. Electron microscopic study of junctional and oral gingival epithelia in the juvenile and adult beagle dog [J]. J Clin Periodontol, 1979, 6(6): 425-436.

[26] Ebersole J L, Graves C L, Gonzalez O A, et al. Aging, inflammation, immunity and periodontal disease [J]. Periodontol 2000, 2016, 72(1): 54-75.

[27] Howes E L, Harvey S C. The Age Factor in the Velocity of the Growth of Fibroblasts in the Healing Wound [J]. J Exp Med, 1932, 55(4): 577-590.

[28] Ashcroft G S, Mills S J, Ashworth J J. Ageing and wound healing [J]. Biogerontology, 2002, 3(6): 337-345.

[29] Reiker J, Van Der Velden U, Barendregt D S, et al. A cross-sectional study into the prevalence of root caries in periodontal maintenance patients [J]. J Clin Periodontol, 1999, 26(1): 26-32.

[30] Abbas F, Van Der Velden U, Hart A A. Relation between wound healing after surgery and susceptibility to periodontal disease [J]. J Clin Periodontol, 1984, 11(4): 221-229.

[31] Lindhe J, Socransky S, Nyman S, et al. Effect of age on healing following periodontal therapy [J]. J Clin Periodontol, 1985, 12(9): 774-787.

[32] Trombelli L, Rizzi A, Simonelli A, et al. Age-related treatment response following non-surgical periodontal therapy [J]. J Clin Periodontol, 2010, 37(4): 346-352.

[33] Mariotti A. Sex steroid hormones and cell dynamics in the periodontium [J]. Crit Rev Oral Biol Med, 1994, 5(1): 27-53.

[34] Parkar M, Tabona P, Newman H, et al. IL-6 expression by oral fibroblasts is regulated by androgen [J]. 1998, 10(8): 613-619.

[35] Hofbauer L C, Heufelder A E. Role of receptor activator of nuclear factor-kappaB ligand and osteoprotegerin in bone cell biology [J]. J Mol Med (Berl), 2001, 79(5-6): 243-253.

[36] Mascarenhas P, Gapski R, Al-Shammari K, et al. Influence of sex hormones on the periodontium [J]. J Clin Periodontol, 2003, 30(8): 671-681.

[37] Shiau H J, Aichelmann-Reidy M E, Reynolds M A. Influence of sex steroids on inflammation and bone metabolism [J]. Periodontol 2000, 2014, 64(1): 81-94.

[38] Kumar P S. Sex and the subgingival microbiome: do female sex steroids affect periodontal bacteria? [J]. Periodontol 2000, 2013, 61(1): 103-124.

[39] Shiau H J, Reynolds M A. Sex differences in destructive periodontal disease: exploring the biologic basis [J]. J Periodontol, 2010, 81(11): 1505-1517.

[40] Grover V, Jain A, Kapoor A, et al. The Gender Bender effect in Periodontal Immune Response [J]. Endocr Metab Immune Disord Drug Targets, 2016, 16(1): 12-20.

[41] Wang C J, Mccauley L K. Osteoporosis and Periodontitis [J]. Curr Osteoporos Rep, 2016, 14(6): 284-291.

[42] Shiau H J, Reynolds M A. Sex differences in destructive periodontal disease: a systematic review [J]. J Periodontol, 2010, 81(10): 1379-1389.

[43] Hyman J J, Reid B C. Epidemiologic risk factors for periodontal attachment loss among adults in the United States [J]. J Clin Periodontol, 2003, 30(3): 230-237.

[44] Susin C, Dalla Vecchia C F, Oppermann R V, et al. Periodontal attachment loss in an urban population of Brazilian adults: effect of demographic, behavioral, and environmental risk indicators [J]. J Periodontol, 2004, 75(7): 1033-1041.

[45] Bouchard P, Boutouyrie P, Mattout C, et al. Risk assessment for severe clinical attachment loss in an adult population [J]. J Periodontol, 2006, 77(3): 479-489.

[46] Norderyd O, Hugoson A, Grusovin G. Risk of severe periodontal disease in a Swedish adult population. A longitudinal study [J]. J Clin Periodontol, 1999, 26(9): 608-615.

[47] Massler M, Schour I, Chopra B. Occurrence of gingivitis in suburban Chicago school children [J]. J Periodontol, 1950, 21(3): 146-164.

[48] Daniell H W. Postmenopausal tooth loss. Contributions to edentulism by osteoporosis and cigarette smoking [J]. Arch Intern Med, 1983, 143(9): 1678-1682.

[49] Kornman K S, Loesche W J. Effects of estradiol and progesterone on Bacteroides melaninogenicus and Bacteroides gingivalis [J]. Infect Immun, 1982, 35(1): 256-263.

[50] Gusberti F A, Mombelli A, Lang N P, et al. Changes in subgingival microbiota during puberty. A 4-year longitudinal study [J]. J Clin Periodontol, 1990, 17(10): 685-692.

[51] Hugoson A. Gingivitis in pregnant women. A longitudinal clinical study [J]. Odontol Revy, 1971, 22(1): 65-84.

[52] Paganini-Hill A. The benefits of estrogen replacement therapy on oral health. The Leisure World cohort [J]. Arch Intern Med, 1995, 155(21): 2325-2329.

[53] Novaes A B, Jr., Novaes A B. Compliance with supportive periodontal therapy. Part 1. Risk of non-compliance in the first 5-year period [J]. J Periodontol, 1999, 70(6): 679-682.

[54] Marques M D, Teixeira-Pinto A, Da Costa-Pereira A, et al. Prevalence and determinants of periodontal disease in Portuguese adults: results from a multifactorial approach [J]. Acta Odontol Scand, 2000, 58(5): 201-206.

[55] Novaes A B, Jr., Novaes A B. Compliance with supportive periodontal therapy. Part II: Risk of non-compliance in a 10-year period [J]. Braz Dent J, 2001, 12(1): 47-50.

[56] Jonsson B, Baker S R, Lindberg P, et al. Factors influencing oral hygiene behaviour and gingival outcomes 3 and 12 months after initial periodontal treatment: an exploratory test of an extended Theory of Reasoned Action [J]. J Clin Periodontol, 2012, 39(2): 138-144.

[57] Canakci C F, Canakci V. Pain experienced by patients undergoing different periodontal therapies [J]. J Am Dent Assoc, 2007, 138(12): 1563-1573.

[58] Sumadhura C, Prasanna J S, Sindhura C, et al. Evaluation of periodontal response to nonsurgical therapy in pre- and post-menopausal women with periodontitis [J]. Indian J Dent Res, 2018, 29(3): 298-302.

[59] Bouaziz W, Davideau J L, Tenenbaum H, et al. Adiposity Measurements and Non-Surgical Periodontal Therapy Outcomes [J]. J Periodontol, 2015, 86(9): 1030-1037.

[60] Michalowicz B S, Hyman L, Hou W, et al. Factors associated with the clinical response to nonsurgical periodontal therapy in people with type 2 diabetes mellitus [J]. J Am Dent Assoc, 2014, 145(12): 1227-1239.

[61] Nieri M, Muzzi L, Cattabriga M, et al. The prognostic value of several periodontal factors measured as radiographic bone level variation: a 10-year retrospective multilevel analysis of treated and maintained periodontal patients [J]. J Periodontol, 2002, 73(12): 1485-1493.

[62] Muzzi L, Nieri M, Cattabriga M, et al. The potential prognostic value of some periodontal factors for tooth loss: a retrospective multilevel analysis on periodontal patients treated and maintained over 10 years [J]. J Periodontol, 2006, 77(12): 2084-2089.

[63] Ronderos M, Ryder M I. Risk assessment in clinical practice [J]. Periodontol 2000, 2004, 34(1): 120-135.

[64] Baker P J, Roopenian D C. Genetic susceptibility to chronic periodontal disease [J]. Microbes Infect, 2002, 4(11): 1157-1167.

[65] Laine M L, Crielaard W, Loos B G. Genetic susceptibility to periodontitis [J]. Periodontol 2000, 2012, 58(1): 37-68.

[66] Stabholz A, Soskolne W A, Shapira L. Genetic and environmental risk factors for chronic periodontitis and aggressive periodontitis [J]. Periodontol 2000, 2010, 53(1): 138-153.

[67] Butler J H. A familial pattern of juvenile periodontitis (periodontosis) [J]. J Periodontol, 1969, 40(2): 115-118.

[68] Beaty T H, Boughman J A, Yang P, et al. Genetic analysis of juvenile periodontitis in families ascertained through an affected proband [J]. Am J Hum Genet, 1987, 40(5): 443-452.

[69] Hoffman I D. Familial occurrence of juvenile periodontitis with varied treatment of one of the siblings with five-year follow-up. Case report [J]. J Periodontol, 1983, 54(1): 44-49.

[70] Vogel R I, Deasy M J. Familial occurrence of juvenile periodontitis [J]. Ann Dent, 1980, 39(2): 31-36.

[71] Melnick M, Shields E D, Bixler D. Periodontosis: a phenotypic and genetic analysis [J]. Oral Surg Oral Med Oral Pathol, 1976, 42(1): 32-41.

[72] Boughman J A, Halloran S L, Roulston D, et al. An autosomal-dominant form of juvenile periodontitis: its localization to chromosome 4 and linkage to dentinogenesis imperfecta and Gc [J]. J Craniofac Genet Dev Biol, 1986, 6(4): 341-350.

[73] Hart T C, Marazita M L, Schenkein H A, et al. Re-interpretation of the evidence for X-linked dominant inheritance of juvenile periodontitis [J]. J Periodontol, 1992, 63(3): 169-173.

[74] Vieira A R, Albandar J M. Role of genetic factors in the pathogenesis of aggressive periodontitis [J]. Periodontol 2000, 2014, 65(1): 92-106.

[75] Kornman K S, Crane A, Wang H Y, et al. The interleukin-1 genotype as a severity factor in adult periodontal disease [J]. J Clin Periodontol, 1997, 24(1): 72-77.

[76] Kinane D F, Hart T C. Genes and gene polymorphisms associated with periodontal disease [J]. Crit Rev Oral Biol Med, 2003, 14(6): 430-449.

[77] Alper S, Laws R, Lackford B, et al. Identification of innate immunity genes and pathways using a comparative genomics approach [J]. Proc Natl Acad Sci U S A, 2008, 105(19): 7016-7021.

[78] Yang I V, Wade C M, Kang H M, et al. Identification of novel genes that mediate innate immunity using inbred mice [J]. Genetics, 2009, 183(4): 1535-1544.

[79] Gunji T, Onouchi Y, Nagasawa T, et al. Functional polymorphisms of the FPR1 gene and aggressive periodontitis in Japanese [J]. Biochem Biophys Res Commun, 2007, 364(1): 7-13.

[80] Nibali L, O'dea M, Bouma G, et al. Genetic variants associated with neutrophil function in aggressive periodontitis and healthy controls [J]. J Periodontol, 2010, 81(4): 527-534.

[81] Brodzikowska A, Gorska R, Kowalski J. Interleukin-1 Genotype in Periodontitis [J]. Arch Immunol Ther Exp (Warsz), 2019, 67(6): 367-373.

[82] Hennig B J, Parkhill J M, Chapple I L, et al. Association of a vitamin D receptor gene polymorphism with localized early-onset periodontal diseases [J]. J Periodontol, 1999, 70(9): 1032-1038.

[83] Martelli F S, Mengoni A, Martelli M, et al. VDR TaqI polymorphism is associated with chronic periodontitis in Italian population [J]. Arch Oral Biol, 2011, 56(12): 1494-1498.

[84] Sun J L, Meng H X, Cao C F, et al. Relationship between vitamin D receptor gene polymorphism and periodontitis [J]. J Periodontal Res, 2002, 37(4): 263-267.

[85] 田雨, 徐莉, 孟焕新, 等. 侵袭性牙周炎维生素D受体基因多态性的FBAT分析 [J]. 北京大学学报:医学版, 2010, 42(1): 28-32.

[86] James J A, Poulton K V, Haworth S E, et al. Polymorphisms of TLR4 but not CD14 are associated with a decreased risk of aggressive periodontitis [J]. J Clin Periodontol, 2007, 34(2): 111-117.

[87] Ren X Y, Xu L, Meng H X, et al. Family-based association analysis of S100A8 genetic polymorphisms with aggressive periodontitis [J]. J Periodontal Res, 2009, 44(2): 184-192.

[88] Morton R S, Dongari-Bagtzoglou A I. Cyclooxygenase-2 is upregulated in inflamed gingival tissues [J]. J Periodontol, 2001, 72(4): 461-469.

[89] Schaefer A S, Richter G M, Nothnagel M, et al. A genome-wide association study identifies GLT6D1 as a susceptibility locus for periodontitis [J]. Hum Mol Genet, 2010, 19(3): 553-562.

[90] Gwinn M R, Sharma A, De Nardin E. Single nucleotide polymorphisms of the N-formyl peptide receptor in localized juvenile periodontitis [J]. J Periodontol, 1999, 70(10): 1194-1201.

[91] Zhang Y, Syed R, Uygar C, et al. Evaluation of human leukocyte N-formylpeptide receptor (FPR1) SNPs in aggressive periodontitis patients [J]. Genes Immun, 2003, 4(1): 22-29.

[92] Guzeldemir E, Gunhan M, Ozcelik O, et al. Interleukin-1 and tumor necrosis factor-alpha gene polymorphisms in Turkish patients with localized aggressive periodontitis [J]. J Oral Sci, 2008, 50(2): 151-159.

[93] Li Q Y, Zhao H S, Meng H X, et al. Association analysis between interleukin-1 family polymorphisms and generalized aggressive periodontitis in a Chinese population [J]. J Periodontol, 2004, 75(12): 1627-1635.

[94] Fiebig A, Jepsen S, Loos B G, et al. Polymorphisms in the interleukin-1 (IL1) gene cluster are not associated with aggressive periodontitis in a large Caucasian population [J]. Genomics, 2008, 92(5): 309-315.

[95] Hodge P J, Riggio M P, Kinane D F. Failure to detect an association with IL1 genotypes in European Caucasians with generalised early onset periodontitis [J]. J Clin Periodontol, 2001, 28(5): 430-436.

[96] Scapoli C, Borzani I, Guarnelli M E, et al. IL-1 gene cluster is not linked to aggressive periodontitis [J]. J Dent Res, 2010, 89(5): 457-461.

[97] Haber J, Wattles J, Crowley M, et al. Evidence for cigarette smoking as a major risk factor for periodontitis [J]. J Periodontol, 1993, 64(1): 16-23.

[98] Genco R J, Borgnakke W S. Risk factors for periodontal disease [J]. Periodontol 2000, 2013, 62(1): 59-94.

[99] Feldman R S, Alman J E, Chauncey H H. Periodontal disease indexes and tobacco smoking in healthy aging men [J]. Gerodontics, 1987, 3(1): 43-46.

[100] Krall E A, Garvey A J, Garcia R I. Alveolar bone loss and tooth loss in male cigar and pipe smokers [J]. J Am Dent Assoc, 1999, 130(1): 57-64.

[101] Preber H, Bergstrom J. Effect of cigarette smoking on periodontal healing following surgical therapy [J]. J Clin Periodontol, 1990, 17(5): 324-328.

[102] Helal O, Gostemeyer G, Krois J, et al. Predictors for tooth loss in periodontitis patients: Systematic review and meta-analysis [J]. J Clin Periodontol, 2019, 46(7): 699-712.

[103] Haffajee A D, Socransky S S. Relationship of cigarette smoking to attachment level profiles [J]. J Clin Periodontol, 2001, 28(4): 283-295.

[104] Axelsson P, Paulander J, Lindhe J. Relationship between smoking and dental status in 35-, 50-, 65-, and 75-year-old individuals [J]. J Clin Periodontol, 1998, 25(4): 297-305.

[105] Baljoon M, Natto S, Bergstrom J. Long-term effect of smoking on vertical periodontal bone loss [J]. J Clin Periodontol, 2005, 32(7): 789-797.

[106] Gunsolley J C, Quinn S M, Tew J, et al. The effect of smoking on individuals with minimal periodontal destruction [J]. J Periodontol, 1998, 69(2): 165-170.

[107] Montero E, Herrera D, Sanz M, et al. Development and validation of a predictive model for periodontitis using NHANES 2011-2012 data [J]. J Clin Periodontol, 2019, 46(4): 420-429.

[108] Ryder M I, Hyun W, Loomer P, et al. Alteration of gene expression profiles of peripheral mononuclear blood cells by tobacco smoke: implications for periodontal diseases [J]. Oral Microbiol Immunol, 2004, 19(1): 39-49.

[109] Ah M K, Johnson G K, Kaldahl W B, et al. The effect of smoking on the response to periodontal therapy [J]. J Clin Periodontol, 1994, 21(2): 91-97.

[110] Mooney J, Hodge P J, Kinane D F. Humoral immune response in early-onset periodontitis: influence of smoking [J]. J Periodontal Res, 2001, 36(4): 227-232.

[111] Palmer R M, Wilson R F, Hasan A S, et al. Mechanisms of action of environmental factors-tobacco smoking [J]. J Clin Periodontol, 2005, 32(Supplement S6): 180-195.

[112] Rawlinson A, Grummitt J M, Walsh T F, et al. Interleukin 1 and receptor antagonist levels in gingival crevicular fluid in heavy smokers versus non-smokers [J]. J Clin Periodontol, 2003, 30(1): 42-48.

[113] Zambon J J, Grossi S G, Machtei E E, et al. Cigarette Smoking Increases the Risk for Subgingival Infection With Periodontal Pathogens [J]. J Periodontol, 1996, 67(10S): 1050-1054.

[114] Mason M R, Preshaw P M, Nagaraja H N, et al. The subgingival microbiome of clinically healthy current and never smokers [J]. ISME J, 2015, 9(1): 268-272.

[115] Kanmaz B, Lamont G, Danaci G, et al. Microbiological and biochemical findings in relation to clinical periodontal status in active smokers, non-smokers and passive smokers [J]. Tob Induc Dis, 2019, 17(March)(20): 1-6.

[116] Pinto J R, Bosco A F, Okamoto T, et al. Effects of nicotine on the healing of extraction sockets in rats. A histological study [J]. Braz Dent J, 2002, 13(1): 3-9.

[117] Tanur E, Mcquade M J, Mcpherson J C, et al. Effects of nicotine on the strength of attachment of gingival fibroblasts to glass and non-diseased human root surfaces [J]. J Periodontol, 2000, 71(5): 717-722.

[118] Tipton D A, Dabbous M K. Effects of nicotine on proliferation and extracellular matrix production of human gingival fibroblasts in vitro [J]. J Periodontol, 1995, 66(12): 1056-1064.

[119] Labriola A, Needleman I, Moles D R. Systematic review of the effect of smoking on nonsurgical periodontal therapy [J]. Periodontol 2000, 2005, 37(1): 124-137.

[120] Chang J, Meng H W, Lalla E, et al. The impact of smoking on non-surgical periodontal therapy: A systematic review and meta-analysis [J]. J Clin Periodontol, 2021, 48(1): 60-75.

[121] Eltas A, Orbak R. Clinical effects of Nd:YAG laser applications during nonsurgical periodontal treatment in smoking and nonsmoking patients with chronic periodontitis [J]. Photomed Laser Surg, 2012, 30(7): 360-366.

[122] Hughes F J, Syed M, Koshy B, et al. Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome [J]. J Clin Periodontol, 2006, 33(9): 671-676.

[123] Wan C P, Leung W K, Wong M C, et al. Effects of smoking on healing response to non-surgical periodontal therapy: a multilevel modelling analysis [J]. J Clin Periodontol, 2009, 36(3): 229-239.

[124] Jin L, Wong K Y, Leung W K, et al. Comparison of treatment response patterns following scaling and root planing in smokers and non-smokers with untreated adult periodontitis [J]. J Clin Dent, 2000, 11(2): 35-41.

[125] Ardais R, Mario Tde G, Boligon J, et al. The effect of smoking on bleeding on probing after nonsurgical periodontal therapy: a quasi-experimental study [J]. Braz Oral Res, 2014, 28(1): 1-7.

[126] Huang C, Shi G. Smoking and microbiome in oral, airway, gut and some systemic diseases [J]. J Transl Med, 2019, 17(1): 225.

[127] 徐莉, 孟焕新, 陈智滨. 吸烟对牙周基础治疗前后龈沟液量和弹性蛋白酶水平的影响 [J]. 中华口腔医学杂志, 2003, 38(6): 405-407.

[128] Feres M, Bernal M, Matarazzo F, et al. Subgingival bacterial recolonization after scaling and root planing in smokers with chronic periodontitis [J]. Aust Dent J, 2015, 60(2): 225-232.

[129] Pucher J J, Shibley O, Dentino A R, et al. Results of limited initial periodontal therapy in smokers and non-smokers [J]. J Periodontol, 1997, 68(9): 851-856.

[130] Bostrom L, Bergstrom J, Dahlen G, et al. Smoking and subgingival microflora in periodontal disease [J]. J Clin Periodontol, 2001, 28(3): 212-219.

[131] Stoltenberg J L, Osborn J B, Pihlstrom B L, et al. Association between cigarette smoking, bacterial pathogens, and periodontal status [J]. J Periodontol, 1993, 64(12): 1225-1230.

[132] Grine G, Royer A, Terrer E, et al. Tobacco Smoking Affects the Salivary Gram-Positive Bacterial Population [J]. Front Public Health, 2019, 7(undefiend): 196-201.

[133] Grossi S G, Zambon J, Machtei E E, et al. Effects of smoking and smoking cessation on healing after mechanical periodontal therapy [J]. J Am Dent Assoc, 1997, 128(5): 599-607.

[134] Leite F R M, Nascimento G G, Baake S, et al. Impact of Smoking Cessation on Periodontitis: A Systematic Review and Meta-analysis of Prospective Longitudinal Observational and Interventional Studies [J]. Nicotine Tob Res, 2019, 21(12): 1600-1608.

[135] Chambrone L, Preshaw P M, Rosa E F, et al. Effects of smoking cessation on the outcomes of non-surgical periodontal therapy: a systematic review and individual patient data meta-analysis [J]. J Clin Periodontol, 2013, 40(6): 607-615.

[136] Kinane D F, Stathopoulou P G, Papapanou P N. Periodontal diseases [J]. Nat Rev Dis Primers, 2017, 3(undefined): 17038.

[137] 孟焕新. 牙周病与全身健康的关系 [J]. 当代医学, 2004, 7(8): 26-29.

[138] Jepsen S, Caton J G, Albandar J M, et al. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions [J]. J Clin Periodontol, 2018, 45(Suppl 20): S219-S229.

[139] Albandar J M, Susin C, Hughes F J. Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and diagnostic considerations [J]. J Clin Periodontol, 2018, 45(Suppl 20): S171-S189.

[140] Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition [J]. Diabetes Res Clin Pract, 2019, 157(2019): 107843.

[141] Grossi S G, Genco R J. Periodontal disease and diabetes mellitus: a two-way relationship [J]. Ann Periodontol, 1998, 3(1): 51-61.

[142] Kocher T, Konig J, Borgnakke W S, et al. Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge [J]. Periodontol 2000, 2018, 78(1): 59-97.

[143] Paz K, Hemi R, Leroith D, et al. A molecular basis for insulin resistance. Elevated serine/threonine phosphorylation of IRS-1 and IRS-2 inhibits their binding to the juxtamembrane region of the insulin receptor and impairs their ability to undergo insulin-induced tyrosine phosphorylation [J]. J Biol Chem, 1997, 272(47): 29911-29918.

[144] 李正阳. 牙周病与全身系统性疾病的关系 [J]. 武警医学院学报, 2012, 21(7): 576-580.

[145] Lalla E, Papapanou P N. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases [J]. Nat Rev Endocrinol, 2011, 7(12): 738-748.

[146] Christgau M, Palitzsch K D, Schmalz G, et al. Healing response to non-surgical periodontal therapy in patients with diabetes mellitus: clinical, microbiological, and immunologic results [J]. J Clin Periodontol, 1998, 25(2): 112-124.

[147] Tervonen T, Karjalainen K. Periodontal disease related to diabetic status. A pilot study of the response to periodontal therapy in type 1 diabetes [J]. J Clin Periodontol, 1997, 24(7): 505-510.

[148] Grellmann A P, Sfreddo C S, Maier J, et al. Systemic antimicrobials adjuvant to periodontal therapy in diabetic subjects: a meta-analysis [J]. J Clin Periodontol, 2016, 43(3): 250-260.

[149] Riggs B L, Melton L J, 3rd. Involutional osteoporosis [J]. N Engl J Med, 1986, 314(26): 1676-1686.

[150] 刘忠厚, 李娜, 张萌萌, 等. 中国人骨质疏松症诊断标准专家共识(第三稿 2014版) [J]. 中国骨质疏松杂志, 2014, 20(9): 1007-1010.

[151] Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis [J]. Am J Med, 1993, 94(6): 646-650.

[152] Pepelassi E, Nicopoulou-Karayianni K, Archontopoulou A D, et al. The relationship between osteoporosis and periodontitis in women aged 45-70 years [J]. Oral Dis, 2012, 18(4): 353-359.

[153] Passos J S, Vianna M I, Gomes-Filho I S, et al. Osteoporosis/osteopenia as an independent factor associated with periodontitis in postmenopausal women: a case-control study [J]. Osteoporos Int, 2013, 24(4): 1275-1283.

[154] Martinez-Maestre M A, Machuca G, Gonzalez-Cejudo C, et al. Osteoporosis, fragility fracture, and periodontal disease: a cross-sectional study in Spanish postmenopausal women [J]. Menopause, 2013, 20(1): 79-84.

[155] Juluri R, Prashanth E, Gopalakrishnan D, et al. Association of Postmenopausal Osteoporosis and Periodontal Disease: A Double-Blind Case-Control Study [J]. J Int Oral Health, 2015, 7(9): 119-123.

[156] Gomes-Filho I S, Oliveira T J, Passos J S, et al. Effect of osteoporosis on periodontal therapy among post-menopausal women [J]. Gerodontology, 2013, 30(1): 40-48.

[157] Wilder R S, Bray K S. Improving periodontal outcomes: merging clinical and behavioral science [J]. Periodontol 2000, 2016, 71(1): 65-81.

[158] Renvert S, Persson G R. Supportive periodontal therapy [J]. Periodontol 2000, 2004, 36(1): 179-195.

[159] Axelsson P, Lindhe J. The significance of maintenance care in the treatment of periodontal disease [J]. J Clin Periodontol, 1981, 8(4): 281-294.

[160] Costa F O, Cota L O, Cortelli J R, et al. Surgical and Non-Surgical Procedures Associated with Recurrence of Periodontitis in Periodontal Maintenance Therapy: 5-Year Prospective Study [J]. PLoS One, 2015, 10(10): e0140847.

[161] Costa F O, Cota L O, Lages E J, et al. Periodontal risk assessment model in a sample of regular and irregular compliers under maintenance therapy: a 3-year prospective study [J]. J Periodontol, 2012, 83(3): 292-300.

[162] Sanz-Martin I, Cha J K, Yoon S W, et al. Long-term assessment of periodontal disease progression after surgical or non-surgical treatment: a systematic review [J]. J Periodontal Implant Sci, 2019, 49(2): 60-75.

[163] Jiao J, Shi D, Cao Z Q, et al. Effectiveness of non-surgical periodontal therapy in a large Chinese population with chronic periodontitis [J]. J Clin Periodontol, 2017, 44(1): 42-50.

[164] Jiao J, Zhang L, Meng H X, et al. Clinical performance of non-surgical periodontal therapy in a large Chinese population with generalized aggressive periodontitis [J]. J Clin Periodontol, 2018, 45(10): 1184-1197.

[165] Liu Z X, Wang P L, Fang D U. [Comparative analysis of the relationship between of chronic periodontitis patients' compliance and clinical efficacy] [J]. Zhonghua Kou Qiang Yi Xue Za Zhi, 2013, 48(8): 472-476.

[166] 杜芳. 牙周支持治疗阶段患者依从性影响因素分析及对策 [J]. 上海口腔医学, 2012, 21(06): 683-686.

[167] Novaes A B, Jr., Novaes A B, Bustamanti A, et al. Supportive periodontal therapy in South America. A retrospective multi-practice study on compliance [J]. J Periodontol, 1999, 70(3): 301-306.

[168] Demetriou N, Tsami-Pandi A, Parashis A. Compliance with supportive periodontal treatment in private periodontal practice. A 14-year retrospective study [J]. J Periodontol, 1995, 66(2): 145-149.

[169] Novaes A B, Jr., De Lima F R, Novaes A B. Compliance with supportive periodontal therapy and its relation to the bleeding index [J]. J Periodontol, 1996, 67(10): 976-980.

[170] Ojima M, Hanioka T, Shizukuishi S. Survival analysis for degree of compliance with supportive periodontal therapy [J]. J Clin Periodontol, 2001, 28(12): 1091-1095.

[171] Johansson L A, Oster B, Hamp S E. Evaluation of cause-related periodontal therapy and compliance with maintenance care recommendations [J]. J Clin Periodontol, 1984, 11(10): 689-699.

[172] Shi S, Meng Y, Li W, et al. A nomogram prediction for mandibular molar survival in Chinese patients with periodontitis: A 10-year retrospective cohort study [J]. J Clin Periodontol, 2020, 47(9): 1121-1131.

[173] Konig J, Plagmann H C, Langenfeld N, et al. Retrospective comparison of clinical variables between compliant and non-compliant patients [J]. J Clin Periodontol, 2001, 28(3): 227-232.

[174] Mendoza A R, Newcomb G M, Nixon K C. Compliance with supportive periodontal therapy [J]. J Periodontol, 1991, 62(12): 731-736.

[175] Miyamoto T, Kumagai T, Jones J A, et al. Compliance as a prognostic indicator: retrospective study of 505 patients treated and maintained for 15 years [J]. J Periodontol, 2006, 77(2): 223-232.

[176] Leininger M, Tenenbaum H, Davideau J L. Modified periodontal risk assessment score: long-term predictive value of treatment outcomes. A retrospective study [J]. J Clin Periodontol, 2010, 37(5): 427-435.

[177] 孟焕新. 临床牙周病学 [M]. 北京大学医学出版社, 2014.

[178] Hou G L, Tsai C C. The morphology of root fusion in Chinese adults (I). Grades, types, location and distribution [J]. J Clin Periodontol, 1994, 21(4): 260-264.

[179] Do Vale H F, Del Peloso Ribeiro E, Bittencourt S, et al. Radiographic characteristics of furcation involvements in mandibular molars as prognostic indicators of healing after nonsurgical periodontal therapy [J]. J Am Dent Assoc, 2009, 140(4): 434-440.

[180] Hou G L, Tsai C C. Types and dimensions of root trunk correlating with diagnosis of molar furcation involvements [J]. J Clin Periodontol, 1997, 24(2): 129-135.

[181] Lu D, Meng H, Xu L, et al. Root abnormalities and nonsurgical management of generalized aggressive periodontitis [J]. J Oral Sci, 2017, 59(1): 103-110.

[182] Goh E X J, Ong M M A. Anatomical, microbiological, and genetic considerations in treatment of Chinese periodontal patients [J]. J Investig Clin Dent, 2019, 10(1): e12381.

[183] Chang P C, Chen Y W, Tu C C, et al. Association of initial mucogingival status with clinical outcome of non-surgical periodontal therapy: A retrospective analysis of 204 patients [J]. J Formos Med Assoc, 2019, 118(5): 932-938.

[184] Al-Shammari K F, Kazor C E, Wang H L. Molar root anatomy and management of furcation defects [J]. J Clin Periodontol, 2001, 28(8): 730-740.

[185] Fleischer H C, Mellonig J T, Brayer W K, et al. Scaling and root planing efficacy in multirooted teeth [J]. J Periodontol, 1989, 60(7): 402-409.

[186] Bower R C. Furcation morphology relative to periodontal treatment. Furcation entrance architecture [J]. J Periodontol, 1979, 50(1): 23-27.

[187] Chiu B M, Zee K Y, Corbet E F, et al. Periodontal implications of furcation entrance dimensions in Chinese first permanent molars [J]. J Periodontol, 1991, 62(5): 308-311.

[188] Hou G L, Chen S F, Wu Y M, et al. The topography of the furcation entrance in Chinese molars. Furcation entrance dimensions [J]. J Clin Periodontol, 1994, 21(7): 451-456.

[189] Bower R C. Furcation morphology relative to periodontal treatment. Furcation root surface anatomy [J]. J Periodontol, 1979, 50(7): 366-374.

[190] Booker B W, 3rd, Loughlin D M. A morphologic study of the mesial root surface of the adolescent maxillary first bicuspid [J]. J Periodontol, 1985, 56(11): 666-670.

[191] Zhao H, Wang H, Pan Y, et al. The relationship between root concavities in first premolars and chronic periodontitis [J]. J Periodontal Res, 2014, 49(2): 213-219.

[192] Zee K Y, Chiu M L, Holmgren C J, et al. Cervical enamel projections in Chinese first permanent molars [J]. Aust Dent J, 1991, 36(5): 356-360.

[193] Hellstrom M K, Ramberg P, Krok L, et al. The effect of supragingival plaque control on the subgingival microflora in human periodontitis [J]. J Clin Periodontol, 1996, 23(10): 934-940.

[194] Takacs V J, Lie T, Perala D G, et al. Efficacy of 5 machining instruments in scaling of molar furcations [J]. J Periodontol, 1993, 64(3): 228-236.

[195] Shi S, Meng Y, Jiao J, et al. [Tooth loss and multivariable analysis after 5-year non-surgical periodontal treatment on molars with furcation involvement]. [J]. Beijing da xue xue bao Yi xue ban, 2019, 51(5): 913-918.

[196] Loos B, Nylund K, Claffey N, et al. Clinical effects of root debridement in molar and non-molar teeth. A 2-year follow-up [J]. J Clin Periodontol, 1989, 16(8): 498-504.

[197] Ehnevid H, Jansson L E. Effects of furcation involvements on periodontal status and healing in adjacent proximal sites [J]. J Periodontol, 2001, 72(7): 871-876.

[198] Dannewitz B, Zeidler A, Husing J, et al. Loss of molars in periodontally treated patients: results 10 years and more after active periodontal therapy [J]. J Clin Periodontol, 2016, 43(1): 53-62.

[199] Xu L, Meng H X, Tian Y, et al. [Evaluation of root abnormity in patients with aggressive periodontitis] [J]. Zhonghua Kou Qiang Yi Xue Za Zhi, 2009, 44(5): 266-269.

[200] Kaldahl W B, Kalkwarf K L, Patil K D, et al. Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities [J]. J Periodontol, 1996, 67(2): 93-102.

[201] D'aiuto F, Ready D, Parkar M, et al. Relative contribution of patient-, tooth-, and site-associated variability on the clinical outcomes of subgingival debridement. I. Probing depths [J]. J Periodontol, 2005, 76(3): 398-405.

[202] Preshaw P M, Holliday R, Law H, et al. Outcomes of non-surgical periodontal treatment by dental hygienists in training: impact of site- and patient-level factors [J]. Int J Dent Hyg, 2013, 11(4): 273-279.

[203] Song J, Zhao H, Pan C, et al. Risk factors of chronic periodontitis on healing response: a multilevel modelling analysis [J]. BMC Med Inform Decis Mak, 2017, 17(1): 135.

[204] 焦剑. 牙周非手术治疗的疗效及其影响因素 [D]; 北京大学医学部, 2017.

[205] Hughes F J, Syed M, Koshy B, et al. Prognostic factors in the treatment of generalized aggressive periodontitis: I. Clinical features and initial outcome [J]. J Clin Periodontol, 2006, 33(9): 663-670.

[206] Botelho J, Machado V, Mascarenhas P, et al. Fine-tuning multilevel modeling of risk factors associated with nonsurgical periodontal treatment outcome [J]. Braz Oral Res, 2019, 33(undefined): e081.

[207] Matthews D C, Tabesh M. Detection of localized tooth-related factors that predispose to periodontal infections [J]. Periodontol 2000, 2004, 34(1): 136-150.

[208] Pihlstrom B L, Oliphant T H, Mchugh R B. Molar and nonmolar teeth compared over 6 1/2 years following two methods of periodontal therapy [J]. J Periodontol, 1984, 55(9): 499-504.

[209] Svardstrom G, Wennstrom J L. Periodontal treatment decisions for molars: an analysis of influencing factors and long-term outcome [J]. J Periodontol, 2000, 71(4): 579-585.

[210] Rosling B, Serino G, Hellstrom M K, et al. Longitudinal periodontal tissue alterations during supportive therapy. Findings from subjects with normal and high susceptibility to periodontal disease [J]. J Clin Periodontol, 2001, 28(3): 241-249.

[211] Nordland P, Garrett S, Kiger R, et al. The effect of plaque control and root debridement in molar teeth [J]. J Clin Periodontol, 1987, 14(4): 231-236.

[212] Prasad K V, Sreenivasan P K, Patil S, et al. Removal of dental plaque from different regions of the mouth after a 1-minute episode of mechanical oral hygiene [J]. Am J Dent, 2011, 24(1): 60-64.

[213] Sreenivasan P K, Devizio W, Prasad K V, et al. Regional differences within the dentition for plaque, gingivitis, and anaerobic bacteria [J]. J Clin Dent, 2010, 21(1): 13-19.

[214] Rabbani G M, Ash M M, Jr., Caffesse R G. The effectiveness of subgingival scaling and root planing in calculus removal [J]. J Periodontol, 1981, 52(3): 119-123.

[215] Tomasi C, Leyland A H, Wennstrom J L. Factors influencing the outcome of non-surgical periodontal treatment: a multilevel approach [J]. J Clin Periodontol, 2007, 34(8): 682-690.

[216] 路瑞芳, 徐莉, 孟焕新, 等. 重度广泛型侵袭性牙周炎患者非手术治疗的临床疗效观察 [J]. 中华口腔医学杂志, 2008, 43(005): 264-268.

[217] Haas A N, Silva-Boghossian C M, Colombo A P, et al. Predictors of clinical outcomes after periodontal treatment of aggressive periodontitis: 12-month randomized trial [J]. Braz Oral Res, 2016, 30(1): e41-e51.

[218] Angst P D, Piccinin F B, Oppermann R V, et al. Response of molars and non-molars to a strict supragingival control in periodontal patients [J]. Braz Oral Res, 2013, 27(1): 55-60.

[219] Brayer W K, Mellonig J T, Dunlap R M, et al. Scaling and root planing effectiveness: the effect of root surface access and operator experience [J]. J Periodontol, 1989, 60(1): 67-72.

[220] Kocher T, Ruhling A, Momsen H, et al. Effectiveness of subgingival instrumentation with power-driven instruments in the hands of experienced and inexperienced operators. A study on manikins [J]. J Clin Periodontol, 1997, 24(7): 498-504.

[221] Ruhling A, Schlemme H, Konig J, et al. Learning root debridement with curettes and power-driven instruments. Part I: a training program to increase effectivity [J]. J Clin Periodontol, 2002, 29(7): 622-629.

[222] Gartenmann S J, Hofer D, Wiedemeier D, et al. Comparative effectiveness of hand scaling by undergraduate dental students following a two-week pre-clinical training course [J]. Eur J Dent Educ, 2019, 23(1): 1-7.

[223] Michaud R M, Schoolfield J, Mellonig J T, et al. The efficacy of subgingival calculus removal with endoscopy-aided scaling and root planing: a study on multirooted teeth [J]. J Periodontol, 2007, 78(12): 2238-2245.

[224] Eaton K A, Kieser J B, Davies R M. The removal of root surface deposits [J]. J Clin Periodontol, 1985, 12(2): 141-152.

[225] Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis [J]. J Clin Periodontol, 1981, 8(1): 57-72.

[226] Lindhe J, Socransky S S, Nyman S, et al. "Critical probing depths" in periodontal therapy [J]. J Clin Periodontol, 1982, 9(4): 323-336.

[227] Rosling B G, Slots J, Webber R L, et al. Microbiological and clinical effects of topical subgingival antimicrobial treatment on human periodontal disease [J]. J Clin Periodontol, 1983, 10(5): 487-514.

[228] Muller H P, Hartmann J, Flores-De-Jacoby L. Clinical alterations in relation to the morphological composition of the subgingival microflora following scaling and root planing [J]. J Clin Periodontol, 1986, 13(9): 825-832.

[229] Greenstein G. Periodontal response to mechanical non-surgical therapy: a review [J]. J Periodontol, 1992, 63(2): 118-130.

[230] Heins P J, Karpinia K A, Maruniak J W, et al. Pain threshold values during periodontal probing: assessment of maxillary incisor and molar sites [J]. J Periodontol, 1998, 69(7): 812-818.

[231] Rams T E, Slots J. Comparison of two pressure-sensitive periodontal probes and a manual periodontal probe in shallow and deep pockets [J]. Int J Periodontics Restorative Dent, 1993, 13(6): 520-529.

[232] Guzeldemir E, Toygar H U, Cilasun U. Pain perception and anxiety during scaling in periodontally healthy subjects [J]. J Periodontol, 2008, 79(12): 2247-2255.

[233] Canakci V, Canakci C F. Pain levels in patients during periodontal probing and mechanical non-surgical therapy [J]. Clin Oral Investig, 2007, 11(4): 377-383.

[234] Chung D T, Bogle G, Bernardini M, et al. Pain experienced by patients during periodontal maintenance [J]. J Periodontol, 2003, 74(9): 1293-1301.

[235] Jeffcoat M K, Geurs N C, Magnusson I, et al. Intrapocket anesthesia for scaling and root planing: results of a double-blind multicenter trial using lidocaine prilocaine dental gel [J]. J Periodontol, 2001, 72(7): 895-900.

[236] Leung W K, Duan Y R, Dong X X, et al. Perception of Non-surgical Periodontal Treatment in Individuals Receiving or Not Receiving Local Anaesthesia [J]. Oral Health Prev Dent, 2016, 14(2): 165-175.

[237] Ashwath B, Subramoniam S, Vijayalakshmi R, et al. Anesthetic efficacy of 4% articaine and 2% lignocaine in achieving palatal anesthesia following a single buccal infiltration during periodontal therapy: A randomized double-blind split-mouth study [J]. J Anaesthesiol Clin Pharmacol, 2018, 34(1): 107-110.

[238] 孙颖, 李璐. 局部麻醉对慢性牙周炎患者龈下刮治效果及依从性的影响 [J]. 吉林医学, 2014, 35(19): 4171-4173.

[239] Kassebaum N J, Smith A G C, Bernabe E, et al. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors [J]. J Dent Res, 2017, 96(4): 380-387.

[240] Chrysanthakopoulos N A. Reasons for extraction of permanent teeth in Greece: a five-year follow-up study [J]. Int Dent J, 2011, 61(1): 19-24.

[241] Montandon A, Zuza E, Toledo B E. Prevalence and reasons for tooth loss in a sample from a dental clinic in Brazil [J]. Int J Dent, 2012: 719750.

[242] Fagundes N C F, Couto R S D, Brandao A P T, et al. Association between Tooth Loss and Stroke: A Systematic Review [J]. J Stroke Cerebrovasc Dis, 2020, 29(8): 104873.

[243] Hujoel P P, Powell L V, Kiyak H A. The effects of simple interventions on tooth mortality: findings in one trial and implications for future studies [J]. J Dent Res, 1997, 76(4): 867-874.

[244] Petersen P E, Bourgeois D, Ogawa H, et al. The global burden of oral diseases and risks to oral health [J]. Bull World Health Organ, 2005, 83(9): 661-669.

[245] Baelum V, Van Palenstein Helderman W, Hugoson A, et al. A global perspective on changes in the burden of caries and periodontitis: implications for dentistry [J]. J Oral Rehabil, 2007, 34(12): 872-906; discussion 940.

[246] Kassebaum N J, Bernabe E, Dahiya M, et al. Global Burden of Severe Tooth Loss: A Systematic Review and Meta-analysis [J]. J Dent Res, 2014, 93(7 Suppl): 20S-28S.

[247] Zimmerman B, Jenzer A C. Physiology, Tooth [M]. StatPearls. Treasure Island (FL). 2020.

[248] De Marchi R J, Hugo F N, Hilgert J B, et al. Association between number of teeth, edentulism and use of dentures with percentage body fat in south Brazilian community-dwelling older people [J]. Gerodontology, 2012, 29(2): e69-e76.

[249] Benguigui C, Bongard V, Ruidavets J B, et al. Evaluation of oral health related to body mass index [J]. Oral Dis, 2012, 18(8): 748-755.

[250] Zhu Y, Hollis J H. Associations between the number of natural teeth and metabolic syndrome in adults [J]. J Clin Periodontol, 2015, 42(2): 113-120.

[251] Geissler C A, Bates J F. The nutritional effects of tooth loss [J]. Am J Clin Nutr, 1984, 39(3): 478-489.

[252] Nascimento G G, Leite F R, Conceicao D A, et al. Is there a relationship between obesity and tooth loss and edentulism? A systematic review and meta-analysis [J]. Obes Rev, 2016, 17(7): 587-598.

[253] Fejerskov O, Escobar G, Jossing M, et al. A functional natural dentition for all--and for life? The oral healthcare system needs revision [J]. J Oral Rehabil, 2013, 40(9): 707-722.

[254] Tan H, Peres K G, Peres M A. Retention of Teeth and Oral Health-Related Quality of Life [J]. J Dent Res, 2016, 95(12): 1350-1357.

[255] Gerritsen A E, Allen P F, Witter D J, et al. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis [J]. Health Qual Life Outcomes, 2010, 8(1): 126-136.

[256] Antunes J L, Tan H, Peres K G, et al. Impact of shortened dental arches on oral health-related quality of life [J]. J Oral Rehabil, 2016, 43(3): 190-197.

[257] Tan H P, Peres K G, Peres M A. Do people with shortened dental arches have worse oral health-related quality of life than those with more natural teeth? A population-based study [J]. Community Dent Oral Epidemiol, 2015, 43(1): 33-46.

[258] Tsakos G, Watt R G, Rouxel P L, et al. Tooth loss associated with physical and cognitive decline in older adults [J]. J Am Geriatr Soc, 2015, 63(1): 91-99.

[259] Oue H, Miyamoto Y, Okada S, et al. Tooth loss induces memory impairment and neuronal cell loss in APP transgenic mice [J]. Behav Brain Res, 2013, 252(undefined): 318-325.

[260] Fang W L, Jiang M J, Gu B B, et al. Tooth loss as a risk factor for dementia: systematic review and meta-analysis of 21 observational studies [J]. BMC Psychiatry, 2018, 18(1): 345-355.

[261] Jou Y T. Dental deafferentation and brain damage: A review and a hypothesis [J]. Kaohsiung J Med Sci, 2018, 34(4): 231-237.

[262] Makiura T, Ikeda Y, Hirai T, et al. Influence of diet and occlusal support on learning memory in rats behavioral and biochemical studies [J]. Res Commun Mol Pathol Pharmacol, 2000, 107(3-4): 269-277.

[263] Rogers J. The inflammatory response in Alzheimer's disease [J]. J Periodontol, 2008, 79(8 Suppl): 1535-1543.

[264] Zheng T Z, Boyle P, Hu H F, et al. Dentition, oral hygiene, and risk of oral cancer: a case-control study in Beijing, People's Republic of China [J]. Cancer Causes Control, 1990, 1(3): 235-241.

[265] Zeng X T, Luo W, Huang W, et al. Tooth loss and head and neck cancer: a meta-analysis of observational studies [J]. PLoS One, 2013, 8(11): e79074.

[266] Chen Q L, Zeng X T, Luo Z X, et al. Tooth loss is associated with increased risk of esophageal cancer: evidence from a meta-analysis with dose-response analysis [J]. Sci Rep, 2016, 6(undefined): 18900-18906.

[267] Maisonneuve P, Amar S, Lowenfels A B. Periodontal disease, edentulism, and pancreatic cancer: a meta-analysis [J]. Ann Oncol, 2017, 28(5): 985-995.

[268] Yin X H, Wang Y D, Luo H, et al. Association between Tooth Loss and Gastric Cancer: A Meta-Analysis of Observational Studies [J]. PLoS One, 2016, 11(3): e0149653.

[269] Padilha D M, Hilgert J B, Hugo F N, et al. Number of teeth and mortality risk in the Baltimore Longitudinal Study of Aging [J]. J Gerontol A Biol Sci Med Sci, 2008, 63(7): 739-744.

[270] Peng J, Song J, Han J, et al. The relationship between tooth loss and mortality from all causes, cardiovascular diseases, and coronary heart disease in the general population: systematic review and dose-response meta-analysis of prospective cohort studies [J]. Biosci Rep, 2019, 39(1).

[271] Barros S P, Suruki R, Loewy Z G, et al. A cohort study of the impact of tooth loss and periodontal disease on respiratory events among COPD subjects: modulatory role of systemic biomarkers of inflammation [J]. PLoS One, 2013, 8(8): e68592.

[272] Hanioka T, Ojima M, Tanaka K, et al. Causal assessment of smoking and tooth loss: a systematic review of observational studies [J]. BMC Public Health, 2011, 11(1): 221-230.

[273] Lee C T, Huang H Y, Sun T C, et al. Impact of Patient Compliance on Tooth Loss during Supportive Periodontal Therapy: A Systematic Review and Meta-analysis [J]. J Dent Res, 2015, 94(6): 777-786.

[274] Nibali L, Farias B C, Vajgel A, et al. Tooth loss in aggressive periodontitis: a systematic review [J]. J Dent Res, 2013, 92(10): 868-875.

[275] Oliver R C, Brown L J. Periodontal diseases and tooth loss [J]. Periodontol 2000, 1993, 2(1): 117-127.

[276] Abdellatif H M, Burt B A. An epidemiological investigation into the relative importance of age and oral hygiene status as determinants of periodontitis [J]. J Dent Res, 1987, 66(1): 13-18.

[277] Souto M L S, Rovai E S, Villar C C, et al. Effect of smoking cessation on tooth loss: a systematic review with meta-analysis [J]. BMC Oral Health, 2019, 19(1): 245-260.

[278] Douglass C W, Gillings D, Sollecito W, et al. National trends in the prevalence and severity of the periodontal diseases [J]. J Am Dent Assoc, 1983, 107(3): 403-412.

[279] Kelly J E, Harvey C R. Basic data on dental examination findings of persons 1-74 years. United States, 1971-1974 [J]. Vital Health Stat 11, 1979, 214): 1-33.

[280] Oliver R C, Brown L J, Loe H. Variations in the prevalence and extent of periodontitis [J]. J Am Dent Assoc, 1991, 122(6): 43-48.

[281] Shi S W, Meng Y, Jiao J, et al. [Tooth loss and multivariable analysis after 5-year non-surgical periodontal treatment on molars with furcation involvement] [J]. Beijing Da Xue Xue Bao Yi Xue Ban, 2019, 51(5): 913-918.

[282] Baumer A, Pretzl B, Cosgarea R, et al. Tooth loss in aggressive periodontitis after active periodontal therapy: patient-related and tooth-related prognostic factors [J]. J Clin Periodontol, 2011, 38(7): 644-651.

[283] Nibali L, Zavattini A, Nagata K, et al. Tooth loss in molars with and without furcation involvement - a systematic review and meta-analysis [J]. J Clin Periodontol, 2016, 43(2): 156-166.

[284] Graetz C, Schutzhold S, Plaumann A, et al. Prognostic factors for the loss of molars--an 18-years retrospective cohort study [J]. J Clin Periodontol, 2015, 42(10): 943-950.

[285] Graetz C, Salzer S, Plaumann A, et al. Tooth loss in generalized aggressive periodontitis: Prognostic factors after 17 years of supportive periodontal treatment [J]. J Clin Periodontol, 2017, 44(6): 612-619.

[286] Pretzl B, Kaltschmitt J, Kim T S, et al. Tooth loss after active periodontal therapy. 2: tooth-related factors [J]. J Clin Periodontol, 2008, 35(2): 175-182.

[287] Graetz C, Schwendicke F, Kahl M, et al. Prosthetic rehabilitation of patients with history of moderate to severe periodontitis: a long-term evaluation [J]. J Clin Periodontol, 2013, 40(8): 799-806.

[288] Lulic M, Bragger U, Lang N P, et al. Ante's (1926) law revisited: a systematic review on survival rates and complications of fixed dental prostheses (FDPs) on severely reduced periodontal tissue support [J]. Clin Oral Implants Res, 2007, 18 (Suppl 3): 63-72.

[289] Wood W R, Greco G W, Mcfall W T, Jr. Tooth loss in patients with moderate periodontitis after treatment and long-term maintenance care [J]. J Periodontol, 1989, 60(9): 516-520.

[290] Ngai C, Lucas G, Busse J W. Evidence-based medicine and precision medicine: Complementary approaches to clinical decision-making [J]. Precision Clinical Medicine, 2018, 1(2): 60-64.

[291] Moons K G, Altman D G, Reitsma J B, et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration [J]. Ann Intern Med, 2015, 162(1): 55-65.

[292] Du M, Haag D, Song Y, et al. Examining Bias and Reporting in Oral Health Prediction Modeling Studies [J]. J Dent Res, 2020, 99(4): 374-387.

[293] Vougas K, Sakellaropoulos T, Kotsinas A, et al. Machine learning and data mining frameworks for predicting drug response in cancer: An overview and a novel in silico screening process based on association rule mining [J]. Pharmacol & Therapeutics, 2019, 203(undefined): 107395.

[294] Guinney J, Wang T, Laajala T D, et al. Prediction of overall survival for patients with metastatic castration-resistant prostate cancer: development of a prognostic model through a crowdsourced challenge with open clinical trial data [J]. Lancet Oncol, 2017, 18(1): 132-142.

[295] Genders T S, Steyerberg E W, Hunink M G, et al. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts [J]. BMJ, 2012, 344(jun12 1): e3485-e3485.

[296] Celli B R, Locantore N, Yates J, et al. Inflammatory biomarkers improve clinical prediction of mortality in chronic obstructive pulmonary disease [J]. Am J Respir Crit Care Med, 2012, 185(10): 1065-1072.

[297] Lamberink H J, Otte W M, Geerts A T, et al. Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis [J]. Lancet Neurol, 2017, 16(7): 523-531.

[298] Wynants L, Van Calster B, Collins G S, et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal [J]. BMJ, 2020, 369(undefined): m1328.

[299] Lee J H, Kim D H, Jeong S N, et al. Diagnosis and prediction of periodontally compromised teeth using a deep learning-based convolutional neural network algorithm [J]. J Periodontal Implant Sci, 2018, 48(2): 114-123.

[300] Yauney G, Rana A, Wong L C, et al. Automated Process Incorporating Machine Learning Segmentation and Correlation of Oral Diseases with Systemic Health [J]. Annu Int Conf IEEE Eng Med Biol Soc, 2019, 2019(undefined): 3387-3393.

[301] Krois J, Graetz C, Holtfreter B, et al. Evaluating Modeling and Validation Strategies for Tooth Loss [J]. J Dent Res, 2019, 98(10): 1088-1095.

[302] Sun H Y, Jiang H, Du M Q, et al. The Prevalence and Associated Factors of Periodontal Disease among 35 to 44-year-old Chinese Adults in the 4th National Oral Health Survey [J]. Chin J Dent Res, 2018, 21(4): 241-247.

[303] Zhao J R, Shi D, Zhang L, et al. [Analysis on types and severity of periodontitis in 34 677 patients] [J]. Zhonghua Kou Qiang Yi Xue Za Zhi, 2016, 51(1): 25-29.

[304] Drisko C H. Nonsurgical periodontal therapy [J]. Periodontol 2000, 2001, 25(1): 77-88.

[305] Preshaw P M, Alba A L, Herrera D, et al. Periodontitis and diabetes: a two-way relationship [J]. Diabetologia, 2012, 55(1): 21-31.

[306] Wilson T G, Jr. Compliance and its role in periodontal therapy [J]. Periodontol 2000, 1996, 12(1): 16-23.

[307] Armitage G C, Wu Y, Wang H Y, et al. Low prevalence of a periodontitis-associated interleukin-1 composite genotype in individuals of Chinese heritage [J]. J Periodontol, 2000, 71(2): 164-171.

[308] Kumar P S, Griffen A L, Moeschberger M L, et al. Identification of candidate periodontal pathogens and beneficial species by quantitative 16S clonal analysis [J]. J Clin Microbiol, 2005, 43(8): 3944-3955.

[309] Heft M W, Perelmuter S H, Cooper B Y, et al. Relationship between gingival inflammation and painfulness of periodontal probing [J]. J Clin Periodontol, 1991, 18(3): 213-215.

[310] Locker D, Liddell A M. Correlates of dental anxiety among older adults [J]. J Dent Res, 1991, 70(3): 198-203.

[311] Eitner S, Wichmann M, Paulsen A, et al. Dental anxiety--an epidemiological study on its clinical correlation and effects on oral health [J]. J Oral Rehabil, 2006, 33(8): 588-593.

[312] Klingberg G, Broberg A G. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors [J]. Int J Paediatr Dent, 2007, 17(6): 391-406.

[313] Wilson K E, Dorman M L, Moore P A, et al. Pain control and anxiety management for periodontal therapies [J]. Periodontol 2000, 2008, 46(1): 42-55.

[314] Van Steenberghe D, Garmyn P, Geers L, et al. Patients' experience of pain and discomfort during instrumentation in the diagnosis and non-surgical treatment of periodontitis [J]. J Periodontol, 2004, 75(11): 1465-1470.

[315] Derman S H, Lowden C E, Hellmich M, et al. Influence of intra-pocket anesthesia gel on treatment outcome in periodontal patients: a randomized controlled trial [J]. J Clin Periodontol, 2014, 41(5): 481-488.

[316] Huan-Xin M. [Current clinical status and considering of periodontology in China] [J]. Zhonghua Kou Qiang Yi Xue Za Zhi, 2008, 43(5): 257-259.

[317] Lee H J, Choi E K, Park J B, et al. Tooth Loss Predicts Myocardial Infarction, Heart Failure, Stroke, and Death [J]. J Dent Res, 2019, 98(2): 164-170.

[318] Schwendicke F, Graetz C, Stolpe M, et al. Retaining or replacing molars with furcation involvement: a cost-effectiveness comparison of different strategies [J]. J Clin Periodontol, 2014, 41(11): 1090-1097.

[319] Schwendicke F, Stolpe M, Plaumann A, et al. Cost-effectiveness of regular versus irregular supportive periodontal therapy or tooth removal [J]. J Clin Periodontol, 2016, 43(11): 940-947.

[320] Zhang H, Li W, Zhang L, et al. A nomogram prediction of peri-implantitis in treated severe periodontitis patients: A 1-5-year prospective cohort study [J]. Clin Implant Dent Relat Res, 2018, 20(6): 962-968.

[321] Armitage G C. Development of a classification system for periodontal diseases and conditions [J]. Ann Periodontol, 1999, 4(1): 1-6.

[322] Tonetti M S, Greenwell H, Kornman K S. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition [J]. J Clin Periodontol, 2018, 45(Suppl 20): S149-S161.

[323] Papapanou P N, Sanz M, Buduneli N, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions [J]. J Clin Periodontol, 2018, 45(Suppl 20): S162-S170.

[324] Mazza J E, Newman M G, Sims T N. Clinical and antimicrobial effect of stannous fluoride on periodontitis [J]. J Clin Periodontol, 1981, 8(3): 203-212.

[325] Lindhe J, Lang N P, Berglundh T, et al. Clinical periodontology and implant dentistry [M]. Sixth edition. ed. Chichester, West Sussex ; Ames, Iowa: John Wiley and Sons, Inc., 2015.

[326] Heft M W, Perelmuter S H, Cooper B Y, et al. Relationship between gingival inflammation and painfulness of periodontal probing [J]. J Clin Periodontol, 1991, 18(3): 213-215.

[327] Karadottir H, Lenoir L, Barbierato B, et al. Pain experienced by patients during periodontal maintenance treatment [J]. J Periodontol, 2002, 73(5): 536-542.

[328] Milgrom P, Coldwell S E, Getz T, et al. Four dimensions of fear of dental injections [J]. J Am Dent Assoc, 1997, 128(6): 756-766.

[329] Moore R, Brodsgaard I, Mao T K, et al. Perceived need for local anesthesia in tooth drilling among Anglo-Americans, Chinese, and Scandinavians [J]. Anesth Prog, 1998, 45(1): 22-28.

[330] Antoniazzi R P, Cargnelutti B, Freitas D N, et al. Topical intrapocket anesthesia during scaling and root planing: a randomized clinical trial [J]. Braz Dent J, 2015, 26(1): 26-32.

[331] Schirmer C, Dos Santos G O, Rost J F, et al. Factors associated with pain and analgesic consumption following non-surgical periodontal therapy under local anaesthesia and carried out by dental students [J]. J Clin Periodontol, 2018, 45(1): 68-77.

[332] Malamed S F, Gagnon S, Leblanc D. Articaine hydrochloride: a study of the safety of a new amide local anesthetic [J]. J Am Dent Assoc, 2001, 132(2): 177-185.

[333] Vree T B, Gielen M J. Clinical pharmacology and the use of articaine for local and regional anaesthesia [J]. Best Pract Res Clin Anaesthesiol, 2005, 19(2): 293-308.

[334] Derman S H, Lowden C E, Kaus P, et al. Pocket-depths-related effectiveness of an intrapocket anaesthesia gel in periodontal maintenance patients [J]. Int J Dent Hyg, 2014, 12(2): 141-144.

[335] Page R C, Kornman K S. The pathogenesis of human periodontitis: an introduction [J]. Periodontol 2000, 1997, 14(1): 9-11.

[336] Michelson D, Davenport C, Dretzke J, et al. Do evidence-based interventions work when tested in the "real world?" A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior [J]. Clin Child Fam Psychol Rev, 2013, 16(1): 18-34.

[337] Glickman I. Clinical periodontology:prevention,diagnosis and treatment of periodontal disease in the practiceof general dentistry [M]. : Saunders, 1972.

[338] Avila G, Galindo-Moreno P, Soehren S, et al. A novel decision-making process for tooth retention or extraction [J]. J Periodontol, 2009, 80(3): 476-491.

[339] Socransky S S, Haffajee A D. Periodontal microbial ecology [J]. Periodontol 2000, 2005, 38(1): 135-187.

[340] Nibali L, Sun C, Akcali A, et al. The effect of horizontal and vertical furcation involvement on molar survival: A retrospective study [J]. J Clin Periodontol, 2018, 45(3): 373-381.

[341] Salvi G E, Mischler D C, Schmidlin K, et al. Risk factors associated with the longevity of multi-rooted teeth. Long-term outcomes after active and supportive periodontal therapy [J]. J Clin Periodontol, 2014, 41(7): 701-707.

[342] Tonetti M S, Christiansen A L, Cortellini P. Vertical subclassification predicts survival of molars with class II furcation involvement during supportive periodontal care [J]. J Clin Periodontol, 2017, 44(11): 1140-1144.

[343] 齐小秋. 第三次全国口腔健康流行病学调查报告 [M]. 人民卫生出版社, 2008.

[344] Hermann P, Gera I, Borbely J, et al. Periodontal health of an adult population in Hungary: findings of a national survey [J]. J Clin Periodontol, 2009, 36(6): 449-457.

[345] Krustrup U, Erik Petersen P. Periodontal conditions in 35-44 and 65-74-year-old adults in Denmark [J]. Acta Odontol Scand, 2006, 64(2): 65-73.

[346] Huang R Y, Lin C D, Lee M S, et al. Mandibular disto-lingual root: a consideration in periodontal therapy [J]. J Periodontol, 2007, 78(8): 1485-1490.

[347] 王惠芸. 我国人牙的测量和统计 [J]. 中华口腔医学杂志, 1959, 3(2): 149-160.

[348] 方贤浩, 金昌洙, 金永哲, 等. 朝鲜族恒牙解剖测量及其意义 [J]. 解剖学杂志, 2002, 25(6): 590-592.

[349] Oginni F O. Tooth loss in a sub-urban Nigerian population: causes and pattern of mortality revisited [J]. Int Dent J, 2005, 55(1): 17-23.

[350] 王德惠, 杜华田. 三十年来拔牙原因的分析 [J]. 现代口腔医学杂志, 1992, 6(3): 174-175.

[351] Lee C Y, Chang Y Y, Shieh T Y, et al. Reasons for permanent tooth extractions in Taiwan [J]. Asia Pac J Public Health, 2015, 27(2): 2350-2357.

[352] Oliver R C, Brown L J. Periodontal diseases and tooth loss [J]. Periodontol 2000, 1993, 2: 117-127.

[353] Saminsky M, Halperin-Sternfeld M, Machtei E E, et al. Variables affecting tooth survival and changes in probing depth: a long-term follow-up of periodontitis patients [J]. J Clin Periodontol, 2015, 42(6): 513-519.

[354] Tada S, Ikebe K, Matsuda K, et al. Multifactorial risk assessment for survival of abutments of removable partial dentures based on practice-based longitudinal study [J]. J Dent, 2013, 41(12): 1175-1180.

[355] Goellner M, Berthold C, Holst S, et al. Influence of attachment and bone loss on the mobility of incisors and canine teeth [J]. Acta Odontol Scand, 2013, 71(3-4): 656-663.

[356] Nunn M E, Fan J, Su X, et al. Development of prognostic indicators using classification and regression trees for survival [J]. Periodontol 2000, 2012, 58(1): 134-142.

[357] 赵静仁, 释栋, 张立, 等. 牙周专科门诊34 677例患者的疾病种类及严重程度分析 [J]. 中华口腔医学杂志, 2016, 51(001): 25-29.

[358] Klokkevold P R, Newman M G, Takei H H, et al. Newman and Carranza's Clinical Periodontology [M]. 2018.

[359] Lindskog S, Blomlof J, Persson I, et al. Validation of an algorithm for chronic periodontitis risk assessment and prognostication: analysis of an inflammatory reactivity test and selected risk predictors [J]. J Periodontol, 2010, 81(6): 837-847.

[360] Vickers A J, Elkin E B. Decision curve analysis: a novel method for evaluating prediction models [J]. Med Decis Making, 2006, 26(6): 565-574.