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Nomogram predicting suboptimal nonsurgical therapy response in stage III or IV periodontitis using hematologic and
Tongxuan Mu1, Yaru Yang1, Zhe Li1
1Department of Periodontology, School and Hospital of Stomatology, China Medical University, Shenyang, China.
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.
