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牙周病是指发生在牙周支持组织的疾病。牙周病发展到较严重的阶段后，仅靠基础治疗不能解决全部问题，需要通过手术的方法对牙周软、硬组织进行处理，才能获得良好的疗效。牙周翻瓣术是目前应用最广泛的牙周手术方法，也是很多其他手术如骨成形术、植骨术、引导性组织再生术的基础。     

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牙周病是指发生在牙周支持组织的疾病。牙周病发展到较严重的阶段后,仅靠基础治疗不能解决全部问题,需要通过手术的方法对牙周软、硬组织进行处理,才能获得良好的疗效。本文就牙周手术治疗的概念和发展做一概述。     

半导体二极管激光及其在牙周手术治疗中的应用

近年来,激光在牙周治疗中的应用引起人们的关注。本文介绍了半导体二极管激光在牙周软、硬组织手术中的应用及其理论基础。随着激光材料和技术的不断发展,激光在牙周手术治疗中将会发挥越来越大的作用。     

牙周组织引导再生术的研究及临床应用

一、牙周组织引导性再生的概念组织引导性再生(guided tissue regeneration,GTR)是近十年来在牙周治疗的研究和临床应用中的一个热门课题.由于牙龈上皮和结缔组织的再生修复速度快于牙周膜和牙槽骨,使得牙周治疗后牙周韧带附着的再建立和牙槽骨的再修复成为困难。牙周组织引导再生术就是在牙周手术中利用具有某种特性的膜状材料,覆盖在病变牙槽骨嵴以及     

影响牙周再生手术临床效果的相关因素剖析

牙周炎可致牙周组织破坏、牙齿松动和脱落, 严重影响患者生活质量。牙周再生手术是修复牙周组织缺损的重要治疗手段, 也是目前牙周临床和基础研究的重点。全面了解影响牙周再生手术疗效的相关因素能增强临床医师的牙周治疗理念, 增加治疗效果的可预期性, 提升临床综合诊疗水平。本文阐述牙周再生的基本原则和牙周创面愈合的要点, 从患者因素、局部因素、手术因素以及再生材料选择方面全方位剖析影响牙周再生手术临床效果的各项要素, 以期对临床医师有所帮助。     

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口腔显微镜和牙周内窥镜逐步应用于临床治疗,通过它们可直视软、硬组织,有助于提高临床医生诊断和治疗疾病的能力,大大提高治疗效率。本文对口腔显微技术做一简要介绍。     

各种生长因子对牙周膜细胞分化的影响及研究进展

牙周组织再生要求牙周软组织和牙周硬组织协调一致的增殖,牙周膜细胞(perioclontal ligament cells,PDLCs)则是在牙周再生和新附着形成过程中起重要主导作用的细胞类型.     

牙周组织工程研究新进展

牙周炎是累及4种牙周支持组织的炎症性、破坏性疾病,现在包括GTR手术等传统的牙周治疗手段通常不能实现已破坏的牙周组织完全再生。近年来,大量的促进牙周再生方面的研究集中在牙周组织工程方面。本文就牙周组织工程的研究现状做一综述。     

GTR联合根尖手术治疗牙周牙髓联合病变伴重度牙槽骨缺损上颌磨牙1例

牙周牙髓联合病变涉及牙髓和牙周组织,其诊疗难度较大,预后一般不佳。本文报道1例牙周源性的牙周牙髓联合病变伴重度牙槽骨缺损的上颌第一磨牙,经根管治疗术、牙周基础治疗、引导性组织再生术(guided tissue regeneration, GTR)和同期根尖手术联合治疗,达到意向性保留患牙的目的。     

牙周外科学临床图谱

《牙周外科学临床图谱》由王勤涛编译。该书除了介绍基本的牙周外科治疗方法如翻瓣刮治术、根切除术、骨切除术和骨成形术等外，更重点突出了牙周组织再生的手术技巧，分两章详尽地介绍了引导组织再生术和引导骨再生术的基本过程和应用领域；另外还专设章节介绍了牙周组织的美容手术方法技巧，包括膜龈手术、各种组织瓣技术和牙冠延长术等。     

Periodontal health following fibrotomy of the supra-alveolar fibers

abstract — A clinical follow-up study has been carried out in order to study the periodontal health of orthodontically derotated teeth where the supra-alveolar fibers have been severed by an incision through the bottom of the marginal pocket to the border of the alveolar bone in order to reduce the tendency towards a posttreatment relapse. The material consisted of 30 rotated teeth treated orthodontically in 27 patients between the ages of 9 and 22 years. Following an average retention period of 8.3 months, the supra-alveolar fibers were severed down to the alveolar bone border. The control material consisted of untreated, banded con-tralateral teeth in the same jaw. The patients were examined for plaque, gingival health and depth of the marginal pockets. No significant difference in periodontal health could be found on comparison between, on the one hand, teeth treated with fibrotomy and, on the other hand, untreated teeth.     

Mineral status of skeleton and advanced periodontal disease

Abstract Studies of the effect of general bone loss on periodontal condition and on development of periodontal pockets suggest that there is no clear correlation between periodontal health or number of teeth and the general mineral status of the skeleton. In some reports, however, deep periodontal pockets have been correlated with good mineral status in the jawbones and skeleton. The purpose of this study of 227 healthy postmenopausal women aged 48 to 56 years was to determine whether advanced alveolar bone loss, diagnosed by panoramic radiographs, and periodontal probing depths or number of remaining teeth were correlated with the bone mineral status of the skeleton and cortical bone in the mandible. The results suggest that individuals with high mineral values in the skeleton seem to retain their teeth with deep periodontal pockets more easily than those with osteoporosis. This finding may especially motivate treatment of persons suffering from advanced periodontal disease but having good mineral status.     

牙周骨切除术和骨成形术教学训练模型的设计制作及初步应用

牙周基础性手术训练是牙周专业教学重点内容之一.本研究设计一种模拟临床病损拟实施牙周骨切除术和骨成形术的教学训练石膏模型,并制定相关的手术训练流程.该训练模型直观地模拟了临床中常见的典型牙槽骨缺损类型,研究生和进修医生在手术训练过程中可以深刻理解牙周炎导致牙槽骨骨破坏的特点,熟练掌握牙槽骨修整的过程,并学会如何通过修整形...     

Long-term effects of supportive therapy in periodontal patients treated with fibre retention osseous resective surgery. I: recurrence of pockets, bleeding on probing and tooth loss

BACKGROUND: Periodontal surgery is indicated in the treatment of persistent pockets following cause-related therapy. The aim of this study was to evaluate the long-term effect of supportive therapy in periodontal patients treated with fibre retention osseous resective surgery. METHODS: Three-hundred and four consecutive patients were identified and retrospectively examined while presenting for a supportive periodontal care (SPC) appointment (T2). All had received non-surgical periodontal treatment and osseous resective surgery as needed, to obtain no sites with probing depth (PD) >3 mm before being enrolled in the SPC programme. The mean SPC duration for the patients was 7.8+/-3.2 years while the mean interval of SPC was 3.4+/-0.8 months. RESULTS: During SPC, a total of 67 teeth had been removed (0.9%). At T2, mean full-mouth plaque scores (FMPS) was 13+/-11.3% and full-mouth bleeding scores (FMBS) was 2+/-3%. In 98.5% of the sites, PD was minimal (or=6 mm was 68 and limited to 41 patients (13.8% of sample). Initial periodontal diagnosis of severe periodontitis, smoking habits, FMBS, number of teeth at completion of active periodontal therapy (T1), number of surgically treated teeth, number of teeth with furcation involvement and number of multi-rooted teeth were associated with the number of pockets at T2. A total of 598 sites (2.1%) displayed bleeding on probing (BOP) at T2. The odds ratio of sites 4 mm or deeper to be BOP positive was 32.9 compared with sites of <3 mm depth. Gender, FMBS, FMPS, furcation involvements and overall number of pockets were associated with the number of bleeding pockets at T2. CONCLUSION: Shallow PDs achieved by treatment of the persistent pockets by fibre retention osseous resective surgery can be maintained over time. These patients displayed minimal gingival inflammation and tooth loss during SPC.     

Radiographic periodontal attachment loss as an indicator of death risk in the elderly

OBJECTIVES: Oral infections have been associated with serious systemic diseases and an increased risk of death. Our aims were to investigate whether radiographically-observed apical periodontitis lesions, carious teeth, periodontal attachment loss (horizontal bone loss, furcation lesions, number of teeth with infrabony periodontal pockets, the extent of infrabony periodontal pockets) and the sum of all these findings have any relationships with all-cause mortality within 4-year follow-up. MATERIAL AND METHODS: 292 community-dwelling elderly persons aged 76, 81 and 86 years. The number of deaths within 4 years was 54 (18.5%). In the dentate 169 subjects, of whom 32 (18.9%) deceased within 4 years, the mean number of teeth was 15.5 in men and 13.2 in women. The imaging method used was panoramic radiography supplemented by intraoral radiographs. RESULTS: 51% of the dentate subjects had infrabony pockets (mean 1.5, s.d. 2.2), and 40% had periapical periodontitis lesions (mean 1.0, s.d. 1.6). After controlling for age and gender, vertical bone loss judged as advanced infrabony pockets was associated with 4-year all-cause mortality (Odds ratio 2.2,1.0-4.7). Other associations were statistically insignificant. CONCLUSION: Periodontal attachment loss may indicate an increased risk of death in the elderly.     

Cynical hostility as a determinant of poor oral health status in an adult population

Our aim in this study was to determine whether there is an association between cynical hostility and clinically determined poor oral health, and whether this association is confounded by socioeconomic position and mediated by health behavior. The sample consisted of 4,207 dentate Finns, 30–64 yr of age. Oral health was measured in terms of numbers of missing teeth, of decayed teeth, and of teeth with periodontal pockets (≥ 4 mm). Cynical hostility was measured using the cynical distrust self-administered questionnaire. The subjects with the highest level of cynical hostility had fewer teeth, and a greater number of decayed teeth as well as teeth with deepened periodontal pockets compared to subjects with the lowest level of cynical hostility. The associations between cynical hostility and number of missing and decayed teeth were clearly confounded by level of education. Poor oral health behavior was shown to be a possible mediator between cynical hostility and number of decayed teeth, but not of missing teeth or teeth with deepened periodontal pockets. General health-related behavior did not serve as a possible mediator in any of the associations. In conclusion, cynical hostility can be considered as a risk marker for poor oral health. Interventions aimed to improve oral health should focus on psychosocial factors and on less-educated subjects.     

The relationship between periodontal conditions and perceptions of periodontal health among Pakistani immigrants in Norway

The purpose of the present study was to assess the periodontal status of Pakistani immigrants in Norway, a Third World population in an industrialized country. The findings were related to treatment needs, socio-demographic variables and cultural beliefs about periodontal health. The mean number of remaining teeth ranged from 27.7 in the 20-24-year-old age group to 25.1 in the group of 35-year-olds and older. Very few of the study population had no plaque or no subgingival calculus. Only 7.5% of the participants exhibited no bleeding at any index teeth. Age and residence in Pakistan were the strongest predictors of subgingival calculus and pocket depth. Those from the rural areas of Pakistan had deeper pockets than those from the cities. The data showed a population with high prevalences of teeth with plaque, subgingival calculus and frequent gingival bleeding, but few sites with deep pockets. A periodontal treatment need index would indicate a substantial amount of treatment time. The present study suggests that also the perceived periodontal conditions, should be taken into account when periodontal services and health education strategies are planned. The concept of periodontal illness is introduced, defined as a person's perceptions and interpretations of periodontal symptoms.     

牙周再生性手术联合正畸移动治疗垂直型骨缺损

牙周再生性手术能够使牙周炎患者的垂直型骨缺损获得最佳的治疗效果,正畸患者在牙周手术后炎症得到控制,正畸牙齿的移动也相对安全。牙周再生性手术后,可通过早期牙齿移动,使牙根在不牺牲安全性的情况下尽早进入移植部位,手术过程中使用的骨替代物或屏障膜等移植材料可能会阻碍牙齿移动,但是另一方面也会降低牙根吸收发生的概率。牙周再生性手术联合正畸治疗垂直型骨缺损能否维持长期较好的临床效果,受到牙周维护频率、正畸加力频率及大小等多方面因素的影响,术后疗效有待进一步观察和研究。     

Relationship between number of teeth and periodontal pockets

Abstract The relationship between number of teeth and the prevalence of periodontal disease is an important factor to consider when planning future needs for periodontal care. This is of particular relevance today, when the level of tooth loss is steadily reducing. The aim of the present study was to examine this relationship. Three dependent variables associated with periodontal disease were included in the analysis: 1. The probability of having pockets 4 mm or more. 2. The mean pocket depth for individuals with pockets 4 mm or more. 3. The number of pockets for individuals with pockets 4 mm or more. Age was included in the analysis as a control variable. The study population comprised 2219 individuals in the county of Trøndelag, Norway. The data were analyzed using logistic regression and multiple regression analysis. The probability of having pockets 4 mm or more increased with increasing number of teeth. The average pocket depth decreased with increasing number of teeth. There was no relationship between number of pockets and number of teeth. The increase in the probability of having pockets with a marginal increase in number of teeth was greatest for those aged 53 years and above. It is concluded that this group of people are likely to have the greatest need for periodontal care.     

引导骨再生术治疗老年重度牙周病的临床疗效

目的：观察引导骨组织再生术治疗重度牙周病的临床疗效，分析可能影响疗效的因素。方法：选择60岁以上患重度牙周病患者13例，忠牙19颗，病变位点27个，基础治疗1周后，采刖引导骨组织再生术，植入BAM骨诱导人工骨于牙周骨缺损区；术后3、6和12个月测量治疗牙各项牙周指标，分析比较临床疗效。结果：本文治疗重度牙周病患牙19颗，术后3至6个月失败5颗拔除。2组其余14颗患牙治疗后3、6和12个月检查牙龈出血指数（GBI），较术前有明融改善，2组间无明显差异。A组治疗后6和12个月检查牙周袋深度（PD）、牙齿松动度（TM）和牙槽骨高度（AH）较术前有明显改善，较B组也有明显改善。结论：重度牙周病采用引导骨组织再生术治疗能取得较好的疗效。适应征的选择，有效的基础治疗，和术设计和操作及术后护理对疗效有直接影响。