牙周疾病对全身健康的影响之一：牙周疾病对心血管疾病和糖尿病的影响

牙周疾病是严重危害人类口腔健康的两大口腔疾病之一，其发病率高，是造成我国成人牙齿丧失的首位原因。牙周疾病是由菌斑微生物所引起的牙齿周围支持组织的慢性感染性疾病，包括牙龈炎和牙周炎。牙周疾病都表现出牙龈的炎症，牙周炎时还有深层牙周组织的病变，轻到中度牙周炎患者往往无明显症状，重度牙周炎患者才出现脓肿、不适、牙齿松动和移位等症状，在检查时会发现牙周的炎症和破坏表现，如牙龈红肿、易出血，探诊时可发现有牙周袋形成、牙周附着丧失，X线片上可显示患牙的牙槽骨吸收，牙槽骨高度降低，重度患者会有牙的松动或脱落，从而造成咀嚼等功能的丧失。     

牙周干预治疗对慢性阻塞性肺疾病患者BODE指数的影响

目的比较慢性阻塞性肺疾病伴慢性牙周炎患者在进行牙周干预治疗前、后,多因素分级系统BODE指数分级人数分布的变化,探讨牙周干预疗对慢性阻塞性肺疾病预后的改善作用。方法选择87名中、重度慢性阻塞性肺疾病伴牙周炎患者,分为干预组43例,对照组44例;干预组进行牙周干预治疗,对照组仅进行口腔卫生宣教;2组分别记录基线及受试1年后出血指数、牙周附着丧失及BODE指数分级情况。结果干预组牙周治疗后出血指数、牙周附着丧失与基线及对照组比差异均有统计学意义（均P〈0.05）。干预组牙周干预治疗后BODE分级人数分布与治疗前及对照组比差异均有统计学意义（均P〈0.05）。结论牙周干预治疗可促进患者的口腔卫生及牙周健康状况,可改善中、重度慢性阻塞性肺疾病伴牙周炎患者的预后,牙周干预治疗对慢性阻塞性肺疾病具有积极作用。     

社区退休人员牙周健康状况调查及影响因素分析

目的 了解社区退休人员的牙周健康状况及影响因素,为社区医院制定针对本社区老年人的口腔预防、保健和治疗计划提供参考.方法 采用随机抽样的方法,选择240位在社区医院进行年度健康体检的退休人员作为调查对象进行问卷调查和全口牙周检查,并进行统计学分析.结果 所有调查对象都有不同程度的牙周附着丧失,全口平均附着丧失为(2.17±1.28) mm,全口平均探诊深度为(2.36±0.42) mm.刷牙习惯的不同显著影响探诊深度(P＜0.05).性别、年龄和吸烟习惯对附着丧失有显著影响(P＜0.05).结论 以牙周附着丧失为标准,所有调查对象均有牙周组织疾病;刷牙习惯和吸烟习惯是影响牙周健康的因素.     

牙周炎患者治疗后的维持期处理

对于牙周炎患者来说,如果细菌的作用未能得到控制,那么就有牙周附着继续丧失的危险。目前,尚无针对性的牙周治疗方法可以使得治疗后的疾病部位不遗留任何可导致复发的因素;并且尚未找到一种方法可以提高患者对这些细菌的免疫力。因此,只有彻底控制菌斑才能最大限度地防止牙周疾病的复发。然而许多年来,尽管作者等人进行了很多尝试,但依旧没有能够长期地彻底控制牙周炎患者的菌斑。控制菌斑始终贯穿于牙周疾病的预防、治疗后的愈合及牙周健康的维持过程中,虽然三者的菌斑控制方案     

伴类风湿关节炎的广泛型侵袭性牙周炎牙周系统治疗一例

广泛型侵袭性牙周炎(generalized aggressiveperiodontitis,GAgP)是一组发生于年轻人群,病变累及全口大多数牙齿,有严重而快速的牙周附着丧失和牙槽骨破坏的牙周疾病,发病率较低.同时伴有类风湿关节炎(rheumatoidarthritis,RA)的GAgP少有报道.笔者于1994年接诊一例伴BA的CAgP患者,经过15年的牙周系统治疗,疗效满意,现报告如下.     

慢性牙周炎和慢性肾病相关关系的 研究进展

慢性牙周炎不仅可以导致牙周支持组织的破坏和丧失,还与多种全身系统性疾病如高血压、糖尿病等有关.慢性肾病是一种破坏肾功能的威胁人类健康的常见的全身性疾病.近年来大量研究显示,慢性牙周炎与慢性肾病可能具有相关关系,通过治疗牙周炎有可能改善肾功能.本文就慢性牙周炎与慢性肾病相关性的流行病学调查研究、牙周治疗对慢性肾病的影响以...     

侵袭性牙周炎的治疗研究进展

侵袭性牙周炎（aggressive periodontitis,AgP）是牙周炎的一个亚类,以牙周附着快速丧失、牙槽骨迅速吸收为主要特征,发病年龄较轻,常有全身背景,是严重危害人类健康的牙周疾病。由于其治疗结果不可预测以及治疗效果不稳定,AgP的治疗方法一直在积极的探索中。本文对近年来AgP的治疗进展作一综述。     

江西省老年人牙周健康状况抽样调查分析

目的：了解江西省老年人牙周健康状况及相关影响因素,为开展老年人口腔预防保健工作提供基线资料。方法：采用多阶段、分层、等容量、随机抽样的方法,调查江西省65-74岁城乡共792名老年人的牙周疾病状况。结果：江西省老年人的牙龈出血检出率、牙周袋检出率和附着丧失≥4 mm的检出率分别为93.9%、81.0%和91.7%。人均有牙龈出血、牙石、牙周袋、附着丧失≥4 mm的检出牙数分别为13.27颗、17.68颗、4.88颗、6.65颗。饮食习惯和使用牙线、牙签与牙龈出血率、牙石检出率相关。结论：牙周疾病是江西省老年人的常见多发病,应加强牙周病的防治工作,努力改善老年人的口腔健康状况,以期提高其生命质量。     

牙周炎患者种植治疗的临床策略

牙周疾病是导致我国成人牙齿丧失的首要原因,缺失牙的患者往往伴有牙周疾病。如果牙周炎患者在种植前未控制牙周感染,余牙尤其是种植区邻牙牙周袋内的致病菌会迅速定植在种植体上,可导致种植体周围组织的感染,影响骨结合,或发生种植体周围炎,继而导致种植失败。另外,目前尚无证据表明天然牙被种植体取代后,宿主对微生物感染的反应会发生改变,因此牙周炎易感患者如感染控制不当,其种植体和天然牙发生骨丧失的危险性是相似的。种植治疗前要进行全面的牙周检查和危险因素评估以制定合理的牙周和种植治疗计划。如患者伴有牙周炎症,在种植手术前须先行牙周治疗,控制牙周感染,消除牙周炎症。余留牙的探诊深度(PD)≤5mm,牙龈探诊后出血(BOP)<25%,方能开始种植阶段的治疗。牙周炎患者的种植区多存在软、硬组织缺陷,在植入种植体的同期也需进行一些牙周手术治疗,从而有利于种植修复治疗或获得好的美学效果。教会患者进行口腔卫生维护的方法,如刷牙、使用牙线或牙间隙刷等,特别要注意保持种植基台周围的清洁。告知患者要定期复查(修复后早期2-3个月复查一次,以后适当延长间隔期每年至少2次)。医师在复查时发现问题及时处理,并进行专业牙周维护和种植体周的清洁维护。     

2型糖尿病患者牙周指标与糖化血红蛋白关系的研究

目的 :研究 2型糖尿病患者牙周指标与糖化血红蛋白间的相关关系。方法 :随机选择 3 0例 2型糖尿病伴牙周炎患者于牙周基础治疗前检测其体重 ,菌斑指数 ,牙龈指数 ,探诊出血指数 ,探诊深度 ,附着丧失 ,糖化血红蛋白值。结果 :糖化血红蛋白与附着丧失、年龄的密切相关。结论 :糖化血红蛋白是影响牙周破坏的重要指标。     

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在口腔诸多的科研领域,都需要制作牙及牙周组织联合切片进行观察和研究。牙及牙周组织结构复杂,不同于一般组织。牙釉质、牙本质、牙骨质和牙槽骨内含有大量的无机盐成分,主要以磷酸钙和碳酸钙的羟基磷灰石晶体     

Soft Tissue Attachment to Titanium Implants Coated with Growth Factors

Background: Enhancing the connective tissue seal around dental implants may be an important factor in implant survival. Purpose: The objective of the study was to investigate the effect of implant surface modification with either platelet‐derived growth factor (PDGF) or enamel matrix derivative (EMD) on connective tissue attachment to titanium implants. Materials and Methods: Eighteen implants (Branemark® Mk III Groovy NP (3.3 mmØ × 10 mm, Nobel Biocare) were implanted subcutaneously into 12 rats. Six implants each were coated with either PDGF or EMD immediately prior to implantation and six implants were left uncoated. Implants were retrieved at 4 and 8 weeks and assessed histologically to compare the soft tissue adaptation to the implant surfaces. Results: Ingrowth by soft connective tissue into the threads of all implants was noted at 4 and 8 weeks. Coating with growth factors did not alter the orientation of fibroblasts and collagen fibers. The depth of connective tissue penetration into the implant grooves was significantly greater for the implants coated with PDGF at 4 weeks. The thickness of the connective tissue in growth was significantly less for the implants coated with PDGF at 8 weeks. Conclusion: Coating of the implant surface with rhPDGF‐BB or EMD can increase the speed and quantity of soft tissue healing around the implant surface.     

骨形成蛋白促进牙周组织再生的动物实验研究

目的将骨形成蛋白（ｂｏｎｅｍｏｒｐｈｏｇｅｎｅｔｉｃｐｒｏｔｅｉｎ，ＢＭＰ）联合应用于牙周引导组织再生（ｇｕｉｄｅｄｔｉｓｓｕｅｒｅｇｅｎｅｒａｔｉｏｎ，ＧＴＲ）技术中，观察和比较其对牙周组织再生修复的影响和意义。方法制备狗下颌后牙区人工骨缺损，于清创后分组置入引导膜材料和ＢＭＰ，以常规翻瓣术为对照；分不同时期取材做组织学观察和评价。结果实验组较对照组新生组织量多，而以复合ＢＭＰ组效果最为显著；膜材料在早期有一定抑制结合上皮根向迁移的作用。结论利用外源性ＢＭＰ的主动生物诱导活性，可望应用于临床促进牙周硬组织成分的新生修复。     

Begg技术第三期治疗前后牙颌面硬软组织的变化

本文对３２例拔除第一双尖牙、采用Ｂｅｇｇ技术矫正的ＡｎｇｌｅⅡ类１分类患者，比较分析Ｂｅｇｇ技术第三期治疗前后其面部硬软组织的变化。结果显示：Ｂｅｇｇ技术第三期治疗对上齿槽座点和切牙均可产生有效的移动，而对软组织外观甚微。提示了面部硬软组织对治疗反应的另一侧面－非同步性。文中探讨了Ｂｅｇｇ技术在第三期治疗中所起的作用。     

Influence of supracrestal tissue attachment thickness on radiographic bone level around dental implants: A systematic review and meta‐analysis

The present systematic review and meta‐analysis was carried out to determine the extent to which supracrestal tissue attachment (STA) thickness affects marginal bone loss (MBL) around dental implants. An electronic search was conducted in PubMed (MEDLINE), EMBASE, and complementary sources covering the period up to June 2018. The studies were meta‐analyzed based on implant position with respect to the alveolar bone crest (crestal/supracrestal). The MBL values were categorized according to STA width (thick/thin). Of the 1062 eligible titles, nine articles were included in the review. The implants were positioned crestal or supracrestal with respect to the alveolar ridge. The difference between (thin/thick) STA was statistically significant among analytical subsets in terms of lesser MBL (crestal‐positioned: weighted mean difference [WMD] = 0.52, 95% CI [0.03‐1.01]; P = 0.036; supracrestal‐positioned: WMD = 1.26; 95% CI [1.12‐1.39]; P = 0.00; pooled analysis: WMD = 0.73; 95% CI [0.033‐1.13]; P < 0.01). Implant positioning and patient age showed statistical significance in the meta‐regression analysis. The heterogeneity explained by age was R² = 39.8%. Despite its limitations, the present study demonstrates that implants with thin STA result in greater MBL. There is moderate certainty of the evidence for a large effect of MBL prevention “in favor” of a thick STA environment in crestal‐positioned implants and the pooled analysis, but lesser certainty when only supracrestal‐positioned implants are considered. No trials studying this topic in subcrestal‐positioned implants were found.     

Long‐Term Results Comparing Xenogeneic Collagen Matrix and Autogenous Connective Tissue Grafts With Coronally Advanced Flaps for Treatment of Dehiscence‐Type Recession Defects

Background: Although connective tissue grafts with coronally advanced flaps (CTG + CAF) have been deemed the gold standard for recession defect treatment, to provide adequate recession coverage, the periodontal profession continues to pursue lower‐morbidity, patient‐preferred substitutes that are more convenient and of unlimited supply. Methods: Using a randomized, controlled, and masked contralateral comparison of matched‐pair, within‐patient recession defects, collagen matrix (CMX) + CAF therapy was compared with CTG + CAF at 6 months and 5 years. The primary efficacy endpoint was percentage of root coverage (RC). Secondary efficacy parameters included width of keratinized tissue (KTw), probing depth (PD), clinical attachment level (CAL), clinician rating of color and texture compared with surrounding tissues, and patient esthetic satisfaction. Results: Seventeen patients were available for the 5‐year recall. Mean RC between 6 months and 5 years changed from 89.5% to 77.6% for CMX + CAF test sites and 97.5% to 95.5% for CTG + CAF control sites. KTw averaged >3 mm for both test and control sites at 5 years. PD was equivalent at all time points. The 6‐month to 5‐year changes for RC, KTw, and PD were not significantly different between therapies. CAL change from 6 months to 5 years was greater for CTG + CAF (0.26 mm) than CMX + CAF (?0.21 mm). Tissue color match to surrounding tissues remained similar for both therapies throughout the study. There was a difference in tissue texture at both 6 months and 5 years, with CMX + CAF sites tending to be “equally firm” and CTG + CAF sites “more firm.” Patient satisfaction was high, with no statistical difference in satisfaction between therapies at any time point. Conclusion: When balanced with patient‐reported satisfaction, clinical rankings of esthetics, and control and historical RC results reported by other investigators, CMX + CAF appears to present a viable and long‐term alternative to traditional CTG + CAF therapy.     

A retrospective study of trauma-associated oral and maxillofacial lesions in a population from southern Taiwan

Objective

The aim of this retrospective analysis was to determine the age, gender, frequency and distribution of trauma-associated hard tissue and soft tissue lesions of the oral and maxillofacial region in a population from southern Taiwan.

Patients and Methods

Approximately 10% of the 27,995 biopsy records of patients with history of trauma resulting in lesions who were treated at our institution between 1991 and 2006 were examined for this study.

Results

In the included records, there were 2,762 soft tissue and 26 hard tissue lesions. Mucocele was the most frequent trauma-associated soft tissue lesion (955 cases). The youngest patients were those who presented with mucocele (mean age = 27.3 years), while the oldest patients were those with peripheral giant cell granuloma (58 years). The lower lip was the most frequent site of occurrence of mucocele (676, 64.5%) and was also the predominant site of occurrence of all soft tissue lesions (815, 29.5%), followed by the buccal mucosa (654, 23.4%) and the tongue (392, 14.2%). Trauma-associated hard tissue lesions included only osteoradionecrosis (24 cases) and traumatic bone cysts (2 cases).

Conclusion

As little data of this nature have been reported from populations of Asian developing countries, the findings of this retrospective analysis is valuable for epidemiological documentation of type of traumatic oral lesions as well as for informing the professionals and the layman about the importance of this category of oral lesions.     

A Technique to Replicate Soft Tissues Around Fixed Restoration Pontics on Working Casts

When missing maxillary incisors are replaced, the patient's primary concern is usually esthetics. Depending on the patient's smile line and the display of the incisors, the esthetic zone may extend to the entire clinical crown and include the surrounding soft tissue. For these patients, the appearance and form of the soft tissue at the base of the pontics is as critical as the esthetics of the incisal edges of the restoration. A technique is presented to precisely transfer the soft tissue morphology of the pontic area to the working cast. This modified master cast allows the laboratory technician to fabricate restorations that will harmonize precisely with the soft tissues of the patient.     

微球在牙体组织再生领域应用的研究进展

随着组织工程技术和再生学科的发展,失去的牙体组织再生成为可能.微球作为组织工程中常用的载体形式,适用于小且形状不规则的牙体组织再生,同时还可利用微球的靶向性和缓释控释来运输各种生长因子、药物等到达指定区域.本文就微球在牙体组织再生领域应用的研究现状进行综述.