牙周炎伴发糖尿病的临床治疗

对牙周炎伴发糖尿病６８例病人的治疗进行观察，实验组牙周炎及糖尿病同时治疗，而对照组仅治疗牙周炎，观察３０天。结果为实验组中牙周炎显效３４例，占９１．９％，对照组牙周炎显效１１例，占２９．７％．ｘ＾２＝３２．８〉７．８８，Ｐ〈０．００５。结果表明，对于牙周炎伴发糖尿病病人，在治疗牙周炎的同时，治疗糖尿病，可以明显提高牙周炎的疗效。     

盐酸米诺环素治疗慢性牙周炎的疗效观察

目的：观察盐酸米诺环素(派丽奥软膏)治疗慢性牙周炎的疗效。方法 60例慢性牙周炎患者随机分为治疗组和对照组，每组各30例。全部病例均经全口洁治、刮治，治疗组局部用派丽奥软膏，对照组口服甲硝唑，局部涂布碘甘油。结果：治疗组显效ll例，有效19例，有效率占100％；对照组显效5例，有效20例，有效率占83．33％。结论：局部应用派丽奥软膏辅助治疗慢性牙周炎，可获得较理想的临床效果。     

复方环丙沙星糊剂局部治疗牙周炎的临床疗效

目的：观察局部应用复方环丙沙星糊剂治疗牙周炎的临床疗效。方法：取适量复方环丙沙星糊剂置于牙周袋内，另设口服环丙沙星＋甲硝唑为对照组进行对比研究。结果：局部应用复方环丙沙星治疗成人牙周炎的疗效显效率为92．31％，优于对照组（64．00％），两组不良反应比较，试验组为0．00％，对照组为40．00％，试验组明显优于对照组，结论：局部应用复方环丙沙星糊剂治疗牙周炎疗效显著，药物配制方便，无不良反应，前景广阔。     

碳酸氢钠和氟化钠混合液治疗牙本质过敏症的临床研究

目的：观察碳酸氢钠和氟化钠混合液治疗牙本质症过敏的疗效。方法：实验组使用1mol/L浓度的碳酸氢钠和0．12mol/L浓度的氟化钠混合液；对照组用0．48mol/L浓度的氟化钠溶液，记录第3次治疗后的疗效及实验组3个月后的随访结果。结果：实验组，显效54例（90．00％），有效4例（6．67％），无效2例（3．33％），总有效58例（96．67％）。对照组，显效24例（40．00％），有效33例（55．00％），无效3例（5．00％），总有效57例（95．00％）。两组总有效率无显著差异（P＞0．05），显效率有显著差异（P＜0．05）。3个月后实验组疗效；显效47例（88．68％），有效4例（7．55％），无效2例（3．77％），总有效51例（96．23％）。结论：1mol/L浓度的碳酸氢钠和0．12mol/L浓度的氟化钠混合液是一种高效、作用持久、使用安全的牙本质脱敏剂。     

补肾健脾活血中药治疗2型糖尿病伴慢性牙周炎的短期效果观察

目的探讨补肾健脾活血中药治疗2型糖尿病伴慢性牙周炎的短期疗效。方法68例2型糖尿病伴中重度慢性牙周炎患者，随机分为试验组36例、对照组32例。两组均给予牙周基础治疗，在此基础上试验组口服补肾健脾活血中药3个月。治疗前后测定菌斑指数、龈沟出血指数、牙周袋探诊深度、附着丧失等牙周临床指标及糖化m红蛋白（hemoglobin A1c，HbA1c）水平。结果治疗后龈沟出血指数、探诊深度、HbA1c3项指标，试验组分别为0．49±0．41、（3．21±0．33）mm、6．64％4-0．54％，对照组分别为1．57±0．34、（3．91±0．49）mm、7．01％±0．47％，试验组改善程度明显优于对照组，差异有统计学意义（P〈0．05）。结论在规范的牙周基础治疗后，补肾健脾活血中药可明显提高2型糖尿病伴慢性牙周炎的治疗效果。     

替硝唑局部控释给药治疗牙周炎的应用研究

目的：观察替硝唑局部控释给药治疗牙周炎的临床疗效。方法：应用替硝唑棒缓释剂治疗45例成人牙周炎患者,并以口服替硝片剂为对照组,进行对比研究,检测了治疗前后牙周炎的各项指数以及病变部位厌氧菌的变化。结果：替硝唑棒治疗成人牙周炎的疗效显效率为93．33％,优于对照组73．33％。替硝唑局部给药对口腔厌氧菌的杀灭效果较口服替硝唑强,用药后无任何毒副作用。结论：替硝唑局部控释给药治疗牙周炎疗效显著,前景广阔。     

2型糖尿病伴慢性牙周炎牙周基础治疗的疗效观察

目的观察牙周基础治疗对2型糖尿病伴慢性牙周炎患者在临床指标及血糖控制方面的影响。方法选取52例2型糖尿病伴慢性牙周炎患者并随机分为2组。实验组行牙周基础治疗和药物治疗，对照组仅给予药物治疗。治疗前后分别记录患者各项临床指标和糖化血红蛋白水平。结果治疗后16周实验组菌斑指数（PLI）及出血指数显著减少，且PLI与对照组差异有统计学意义（P〈0.001）：两组患者其他各项临床指标和糖化血红蛋白水平在治疗后有一定改善，但差异无统计学意义。结论牙周基础治疗有利于2型糖尿病伴慢性牙周炎患者减轻牙周炎症及在一定程度上改善代谢状况。     

草珊瑚口腔膏治疗牙周炎临床疗效分析

目的：观察草珊瑚口腔膏治疗牙周炎临床疗效，方法：将100名牙周炎患者，随机分为实验组和对照组各50例，观察用草珊瑚口腔膏治疗前后临床症状，菌斑指数（PLI），牙龈指数（GI），龈沟出血指数（SBI）的变化。结果：2组用草珊瑚膏之前牙周各项指数的平均值无显著性差异（P＞0．05），用草珊瑚7天后有显著性差异（P＜0．01），结论：草珊瑚口腔膏治疗牙周炎有效、安全。     

牙周基础治疗对宁夏地区回、汉人群2型糖尿病伴慢性牙周炎患者糖、脂代谢的影响

目的：通过对宁夏地区回、汉人群2型糖尿病伴发慢性牙周炎患者进行牙周基础治疗,观察其糖、脂代谢水平的变化。方法：选取120例2型糖尿病伴发慢性牙周炎患者（回族60例,汉族60例）,分为病例组和对照组。检查各患者的口腔专科临床指标;静脉生化指标和脂代谢指标。病例组进行牙周基础治疗和常规糖尿病药物治疗,对照组给予单纯的常规糖尿病药物治疗。结果：病例组在牙周基础治疗前后,牙周探诊深度、糖化血红蛋白、甘油三酯和总胆固醇有下降趋势,差异具有统计学意义（P〈O．05）,而附着丧失和空腹血糖有一定程度的变化,但无显著性差异。对照组的各指标治疗前后的差异均无统计学差异。回、汉人群之间,各指标的差异性无显著性。病例组和对照组相比,牙周探诊深度和糖化血红蛋白的差异具有统计学意义（P〈0．01）,而附着丧失、空腹血糖、甘油三酯和．ca,胆固醇的差异无显著性。结论：牙周基础治疗可有效缓解宁夏地区2型糖尿病伴慢性牙周炎患者的牙周炎症,降低牙周袋深度;可在一定程度上改善患者HbAlc水平;对患者脂代谢无显著影响。     

替硝唑治疗成人牙周炎的疗效评价

为进一步观察替硝唑的临床疗效，作者应用替硝唑治疗５２例成人牙周炎患者，并以甲硝唑为对照，检测了治疗前后病变部位厌氧菌的变化。结果表明，替硝唑治疗成人牙周炎的疗效（显效率７３．１％）优于甲硝唑（４３．５％）。替硝唑对口腔厌氧菌的杀灭效果较甲硝唑好，特别对牙周炎的常见致病菌——牙龈类杆菌和产黑色素类杆菌的杀灭效果明显优于甲硝唑。     

MTA应用于显微根尖手术治疗慢性根尖周炎的效果观察

目的 观察三氧化矿物凝聚体(mineral trioxide aggregate,MTA)应用于显微根尖手术治疗慢性根尖周炎的效果.方法 无法行常规根管再治疗的慢性根尖周炎患者64例91颗患牙,随机分为观察组和对照组.观察组患者32例48颗,行显微根尖手术,应用MTA进行倒充填治疗.对照组患者32例43颗,行传统外科根尖手术联合银汞合金充填治疗.术后每隔3个月定期复诊,随访12个月,通过临床和X线检查评估根尖周病损愈合情况,进行疗效判定.结果 观察组痊愈27颗,改善17颗,成功率91.67%(44/48);对照组痊愈19颗,改善12颗,成功率72.09%(31/43).观察组治疗成功率明显高于对照组(x2=5.997,P=0.014).结论 MTA应用于显微根尖手术治疗慢性根尖周炎效果满意.     

Heightened gingival inflammation and attachment loss in type 2 diabetics with hyperlipidemia

BACKGROUND: Our previous studies in diabetic (DB) rats suggest that hyperlipidemia may cause a dysregulation of the cellular and local cytokine response to periodontitis (AP). The objective of the present study was to determine if diabetes has a similar dysregulatory effect on the gingival response to AP in humans. METHODS: Peripheral blood, as well as gingival tissue (GT) and gingival crevicular fluid (GCF), was obtained from a total of 35 patients who were categorized into the following groups based on level of diabetic (type 2) control and presence or absence of adult periodontitis (AP): group 1, systemically and periodontally healthy (n = 6); group 2, systemically healthy with adult periodontitis (n = 7); group 3, well-controlled diabetes and periodontally healthy (n = 6); group 4, well-controlled diabetes with adult periodontitis (n = 5); group 5, poorly controlled diabetes and periodontally healthy (n = 5); group 6, poorly controlled diabetes and adult periodontitis (n = 6). All subjects were given a thorough periodontal examination, including probing depths (PD), clinical attachment levels (CAL), gingival index (GI), plaque index (PI), and vertical bitewing radiographs. Blood studies included levels of glycated hemoglobin (HbA1c), triglycerides (TG), cholesterol (CHL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL). The levels of interleukin-1 beta (IL-1beta) in GCF and GT, interleukin-6 (IL-6), and platelet-derived growth factor AB (PDGF-AB) in GT from patients in each experimental group were analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Our results indicate that all clinical indices except PI were significantly elevated in the poorly controlled and well-controlled diabetics, compared to systemically healthy patients, but only in the subjects without preexisiting AP (Tukey's multiple comparisons, P <0.05). Pairwise linear regression analysis revealed significant (P <0.01) positive associations between periodontal inflammation (PD, CAL, PI, GI) and levels of GCF IL-1beta, GT IL- 1beta GT IL-6, but not GT PDGF; moreover, GT IL-6 levels were significantly associated (P<0.05) with GT IL-1beta. As TG levels increased in the non-AP patients (group 1 < group 3 < group 5), there was a trend, not significant, for increased GCF IL-1beta levels and increased gingival inflammation. Interestingly, periodontitis resulted in increased PDGF-AB levels in the gingiva of systemically healthy and well-controlled diabetes patients, but this increase was obtunded in poorly controlled diabetes patients. CONCLUSIONS: This confirms our earlier work in the diabetic rat model. These studies indicate that decreased metabolic control in type 2 diabetics results in increased serum triglycerides and has a negative influence on all clinical measures of periodontal health, particularly in patients without preexisting periodontitis. Levels of the cytokine IL- 1beta showed a trend for increasing as diabetic control diminished. In contrast, levels of the growth factor PDGF, which normally increase in periodontitis, decreased in poorly controlled diabetics with periodontitis. These studies suggest a possible dysregulation of the normal cytokine/growth factor signaling axis in poorly controlled type 2 diabetics that may contribute to periodontal breakdown/diminished repair.     

Effects of low-dose doxycycline and bisphosphonate clodronate on alveolar bone loss and gingival levels of matrix metalloproteinase-9 and interleukin-1β in rats with diabetes: a histomorphometric and immunohistochemical study

Background: Bisphosphonates (BPs) and low‐dose doxycycline (LDD) have been shown to inhibit bone resorption and to improve the levels of proinflammatory mediators and destructive enzymes in gingival tissues, respectively. The purpose of this study is to evaluate the effect of mono and combined BP clodronate and LDD therapies in reducing gingival levels of matrix metalloproteinase‐9 (MMP‐9), interleukin‐1β (IL‐1β), and alveolar bone loss in rats with diabetes. Methods: Fifty adult Wistar rats were divided into five study groups as follows: 1) group 1 = diabetes control; 2) group 2 = diabetes + periodontitis; 3) group 3 = diabetes + periodontitis + LDD; 4) group 4 = diabetes + periodontitis + clodronate; and 5) group 5 = diabetes + periodontitis + LDD + clodronate. LDD and clodronate were given as a single agent or as combination therapy during the 7 days of the post‐experimental periodontitis period. On day 7, the rats were sacrificed, the mobility of the tooth was recorded, and block biopsies were removed. The gingival tissues were analyzed histologically and immunohistochemically for expression of MMP‐9 and IL‐1β. Alveolar bone loss was evaluated morphometrically under a light microscope. Data analysis was performed statistically by Kruskal‐Wallis and post hoc Tukey and Spearman correlation tests. Results: Alveolar bone loss was significantly greater in groups 2 through 5 than group 1 (P <0.05) but was not significantly different among groups 2 through 5 (P >0.05). Animals with periodontitis (group 2) expressed significantly higher levels of MMP‐9 and IL‐1β compared with those without periodontitis (group 1) (P <0.05). MMP‐9 expression was significantly lower in group 3 than groups 1, 2, and 5 (P <0.05). IL‐1β expression was significantly lower in the groups 1, 3, 4, and 5 than 2 (P <0.01) but was not significantly different among groups 1, 3, 4, and 5. Positive correlations were found between alveolar bone loss and density of inflammation (ρ = 0.319, P = 0.021) and between MMP‐9 and IL‐1β (ρ = 0.418, P = 0.002), respectively. Conclusion: Our findings suggest that ligature‐induced periodontitis in animals with diabetes results in significantly higher levels of MMP‐9 and IL‐1β expression in gingiva. The use of mono and combined clodronate and LDD administrations may significantly reduce levels of MMP‐9 and IL‐1β expression. However, drug administration did not affect alveolar bone levels during the study period.     

黄芩苷对大鼠实验性牙周炎的保护效应及作用机制研究

目的 观察黄芩苷对丝线结扎诱导的大鼠牙周组织炎性破坏的保护作用,并探讨这一作用是否与牙龈组织中基质金属蛋白酶(matrix metalloproteinases,MMP)表达水平的改变有关.方法 将SD大鼠按随机数字表法分为3组,每组9只.用丝线结扎方法建立牙周炎模型,建模第7天处死动物.用药组(B200组)每天灌胃给予黄芩苷200 mg/kg;阴性对照组(L组)每天灌胃药物媒介0.5%羧甲基纤维素钠;空白对照组(C组)不予牙周炎诱导.评价牙槽骨吸收和胶原纤维的面积分数.免疫组化方法检测牙龈组织中MMP-1、MMP-2和MMP-9的表达.结果 B200组的骨吸收值[(0.93±0.04)mm]显著低于L组[(1.03±0.07)mm,P=0.009)];B200组的胶原纤维面积分数[(48.13±18.69)%]显著高于L组[(31.08±14.85)%,P=0.047];与L组相比,应用黄芩苷显著下调了MMP-1(P=0.023)及MMP-9(P=0.042)的水平,并降低了MMP-2的表达(P=0.099).结论 黄芩苷能够减少丝线结扎诱导的大鼠牙周炎的组织破坏,这一作用可能与其抑制MMP-1、MMP-2和MMP-9的表达有关.     

Serum leveis of inflammatory markers in type 2 diabetes patients with chronic periodontitis

Diabetes has been associated with periodontitis, but the mechanisms through which periodontal diseases affect the metabolic control remain unclear.

Objective

This study aimed to evaluate serum leveis of inflammatory markers, IL-8, IL-6 and monocyte chemoattractant protein 1 (MCP-1), in type 2 diabetic patients in the presence of chronic periodontitis.

Material and Methods

Forty two individuals were enrolled in this study and assigned to one of five groups: diabetes mellitus with inadequate glycemic control and periodontitis (DMI+P, n = 10), diabetes mellitus with adequate glycemic control and periodontitis (DMA+P, n = 10), diabetes mellitus without periodontitis (DM, n = 10), periodontitis without diabetes (P, n=6), and neither diabetes nor periodontitis (H, n = 6). Periodontal clinical examination included visible plaque index (PL), gingival bleeding index (GB), probing depth (PD), attachment level (AL) and bleeding on probing (BP). Glycemic control was evaluated by serum concentration of glycated hemoglobin (HbAlc). Inflammatory serum markers IL-8, IL-6 and (MCP-1) were measured by ELISA.

Results

DMI+P and DMA+P groups presented higher PD (p=0.025) and AL (p=0.003) values when compared to the P group. There were no significant differences among groups for IL-6, IL-8 and MCP-1 serum levels.

Conclusions

Although periodontitis was more severe in diabetic patients, the serum levels of the investigated inflammatory markers did not differ among the groups.     

牙周健康指数与胰岛素抵抗的相关性探讨

目的：评价糖尿病患者牙周健康指数对胰岛素抵抗的影响。方法：将24例伴有牙周炎的血糖控制不良的2型糖尿病（T2DM）患者随机分成两组,实验组在接受糖尿病规范化治疗的同时进行牙周非手术治疗,对照组只接受糖尿病规范化治疗,不予以牙周病治疗,测量并比较牙周治疗前、治疗后1、3、6、12月龈沟出血指数（SBI）、牙周探诊深度（PD）、牙周附着水平（AL）、空腹血糖（FPG）、空腹血浆胰岛素（FINS）,计算胰岛素抵抗指数（（HOMA—IR）,对HOMA—IR与上述指标行相关分析和多元线性逐步回归分析。结果：实验组牙周健康指数明显优于对照组（P〈0．05）,且胰岛素抵抗指数低于对照组（P〈0．05）;牙周健康指数SBI、PD、AL与胰岛素抵抗指数呈显著正相关（分别rs=O．877,r=0．925,r=0．933）,多元线性逐步回归分析显示HOMA—IR与PD、AL呈正相关。结论：控制2型糖尿病伴有牙周炎患者的牙周健康指数,有益于改善胰岛素抵抗。     

Increased titre and avidity of IgG antibodies to Porphyromonas gingivalis whole cells and a cell surface protein in subjects with adult periodontitis

The titre and avidity of IgG antibodies to Porphyromonas gingivalis whole cells and a 47 kDa cell surface protein were determined in scrum samples taken from 20 subjects with adult periodontitis and 20 controls, matched for age, gender, ethnic origin and oral hygiene status. Antibody litres were measured by ELISA and antibody avidity was determined by a chaotrope-dissociation ELISA. Avidity was defined as the molarity of chaotrope required to reduce absorbance by 50% (ID₅₀). The mean IgG antibody log titre to whole cells (8. 29 vs. 6. 92; p<0.01) and to the 47 kDa antigen (7. 61 vs. 6. 77; p<0.05) were higher in cases than in controls. Mean IgG antibody avidity to whole cells (4. 59 vs. 2. 47; p<0.001) and to the surface protein (2. 54 vs. 1. 67; p<0.001) were also higher in cases than in controls. In cases, IgG antibody titre was highly correlated with avidity for both whole cells (r=0.878; p= <0.001) and the 47 kDa protein (r=0.683; p<0.001). There was a weaker positive correlation between the titre and the avidity of antibody to whole cells (r=0.591; p<0.01) in the control population but antibody titre and avidity for the 47 kDa sonicate antigen were not correlated in the controls (r=0.104). We conclude that many patients with adult periodontitis have effective humoral immunity to P. gingivalis. However, in up to half the patients with adult periodontitis, antibody titres and avidities were low and similar to control values, indicating either susceptibility due to poor host response or that disease is not associated with this particular pathogen.     

Conventional and advanced implant treatment in the type II diabetic patient: surgical protocol and long-term clinical results

PURPOSE: To investigate the effect of type-2 diabetes on implant survival and complication rate. MATERIALS AND METHODS: Prospective study enrolling type-2 diabetic patients suffering from edentulism, having a mean perioperative HbA1c level of 7.2%, and compliant with a maintenance program. All the patients underwent dental and periodontal examinations and had laboratory testing for HbA1c, fasting plasma glucose, blood lipids, and microalbuminuria. Nondiabetic patients matched for implant treatment indication served as controls. The influence of clinical diabetes-related factors and periodontal parameters (Plaque Index, bleeding on probing, probing depth) on implant survival were assessed via univariate then multivariate methods. RESULTS: Forty-five diabetic patients, followed for 1 to 12 years, mean age 64.7 years, received 255 implants: 143 following a classical protocol and 112 in cases of sinus floor elevation, immediate loading, and guided bone regeneration. Forty-five nondiabetic control patients received 244 implants: 142 following a classical protocol and 102 in cases of advanced surgery. Implant survival following conventional or advanced implant therapy was not statistically different between the well-controlled (HbA1c < 7%, P = .33) and the fairly well-controlled group (HbA1c 7% to 9%, P = .37). The overall survival rate for the diabetic group was 97.2% (control 98.8%) and was not significantly different for age, gender, diabetes duration, smoking, or type of hypoglycemic therapy. The mean peri-implant bone loss was 0.41 +/- 0.58 mm (control, 0.49 +/- 0.64 mm). PI and BOP fairly correlated with postoperative complications. HbA1c was the only multivariate independent factor affecting the complication rate (P = .04). No statistically significant difference was found for patients (P = .81) or for implants (P = .66) for the advanced surgery cases or the conventional approach in diabetic patients compared to nondiabetic patients.     

牙周非手术治疗对2型糖尿病伴牙周炎患者糖化血红蛋白A1c和血清可溶性细胞间黏附分子-1的影响

目的 探讨牙周非手术治疗对2型糖尿病伴慢性牙周炎（DMCP）患者牙周状况、糖代谢及血清可溶性细胞间黏附分子-1（sICAM-1）的影响。方法 选择诊断为2型糖尿病伴慢性牙周炎的患者,按糖化血红蛋白A1c （ GHbA1c ）控制水平分为血糖控制良好组（GHbA1c＜7.00％,DMCP1组,30例）和血糖控制较差组（GHbA1c≥7.00％,DMCP2组,30例）;选择不伴有系统性疾病的慢性牙周炎患者（CP组,30例）为对照组。所有患者均进行牙周非手术治疗,分析治疗前（基线）及治疗后1、3个月时探诊深度（PD）、临床附着丧失（CAL）、菌斑指数（PLI）、龈沟出血指数（SBI）、探诊出血（BOP）、空腹血糖（FPG）、GHbA1c及血清sICAM-1水平的变化。结果 治疗后1、3个月时,3组PD、SBI、PLI、BOP阳性率、血清sICAM-1水平比基线时均明显降低（P＜0.05）,CP组和DMCP1组CAL比基线时亦均明显降低（P＜0.05）,但DMCP2组CAL无明显变化（P＞0.05）。治疗后3个月时,DMCP2组GHbA1c水平与基线时比较平均降低1.12%,差异有统计学意义（P＜0.05）,但CP组和DMCP1组在整个观察期间GHbA1c水平与基线时比较差异均无统计学意义（P＞0.05）。结论 牙周非手术治疗可降低2型糖尿病伴牙周炎患者的牙周炎症程度及血清sICAM-1的水平,并可改善血糖控制良好者的牙周附着水平;该治疗还可以降低血糖控制较差者的GHbA1c水平。     

光动力疗法对伴糖尿病根尖周炎患者的根管治疗效果

目的 观察光动力疗法对伴糖尿病根尖周炎患者的根管治疗疗效。方法 随机选择180例伴有糖尿病的根尖周炎患者，随机平均分为试验组和对照组，每组90例，对照组常规进行根管预备消毒，试验组行根管预备消毒+光动力辅助根管消毒。使用视觉量表法（VAS）评价根管预备术后3天局部疼痛状况，2年后根据患者临床症状、临床检查和X线检查情况统计根管治疗的成功率。结果 根管预备后3天，试验组疼痛反应轻于对照组，具有统计学差异(P<0.05)。根管治疗后2年，试验组成功率（93.33%）大于对照组（83.33%），具有统计学差异(P<0.05)。结论 对伴有糖尿病的根尖周炎患者，使用光动力疗法对其根管进行消毒，可减轻根管预备后急性疼痛症状，提高根管治疗的成功率。