牙周内窥镜与锥形束CT用于牙根纵裂诊断的比较研究

目的    比较牙周内窥镜与锥形束CT（CBCT）用于牙根纵裂（VRF）诊断中的临床价值。方法    选择邯郸市口腔医院牙周病科于2019年5月至2021年11月收治的疑似存在VRF的患者97例（患牙101颗）,均行牙周内窥镜、CBCT检查,再行外科手术治疗最终确诊。对上述2种影像学检查方法的诊断结果进行比较,评估其诊断效能。结果    97例患者101颗患牙中,行外科手术治疗最终诊断为VRF的患牙共计85颗,其中72颗为颊舌向VRF（占84.71%）,13颗为近远中向VRF（占15.29%）。牙周内窥镜与CBCT对VRF的诊断结果与金标准的一致性均较高（κ值分别为0.703和0.691,均P < 0.05）。牙周内窥镜对VRF的诊断灵敏度、特异度、准确度分别为91.76%、87.50%、91.09%,CBCT对VRF的诊断灵敏度、特异度、准确度分别为89.41%、93.75%、90.10%;牙周内窥镜对VRF的诊断效能与CBCT接近。结论    牙周内窥镜用于VRF的诊断效能较高,与CBCT检查基本一致,适用于VRF诊断。     

锥形束CT对牙根纵裂的诊断价值

目的评价锥形束CT(CBCT)对牙根纵裂(VRF)的临床诊断价值。方法对61例患者的67颗临床检查怀疑为VRF的患牙拍摄根尖X线片和CBCT,然后对所有患牙进行根尖切除、牙周翻瓣或拔除等外科手术,以确诊VRF是否存在。将根尖X线片和CBCT影像对VRF的诊断结果与外科手术结果进行比较和统计分析。结果外科手术证实62颗患牙VRF明确存在。CBCT诊断VRF的阳性检出率、灵敏度和准确度分别为83.6%、90.3%和91.0%,而根尖X线片为31.3%、33.9%和38.8%(P<0.01)。CBCT诊断颊舌向和近远中向VRF的灵敏度分别为93.2%和62.5%,高于根尖X线牙片的69.6%和12.8%(P<0.05)。结论 CBCT比根尖X线片更准确地诊断VRF。     

牙周内窥镜辅助超声龈下刮治对残留牙周袋临床疗效的评价研究

目的 评价牙周内窥镜下超声龈下刮治对牙周基础治疗后残留牙周袋的临床治疗效果.方法 收集20例慢性牙周炎患者259颗经牙周基础治疗后仍残留深牙周袋的患牙,行牙周内窥镜下超声龈下刮治,比较治疗前及治疗后3个月全口牙周探诊出血(BOP)和牙周探诊深度(PD)的变化.结果 内窥镜治疗后3个月全口平均PD值和BOP位点百分比有显著改善(P<0.001).单根牙和多根牙的平均PD均显著降低(P<0.001),PD≥5mm位点百分比显著改善(P<0.05),其中重度牙周袋位点的改善更明显(P<0.05).根分叉病变位点百分比治疗前后无明显变化.结论 残留牙周深袋经牙周内窥镜辅助超声龈下刮治后,单根牙和多根牙都有显著治疗效果,并且单根牙重度牙周袋位点改善更明显,但是多根牙II度及以上根分叉病变位点的改善有限.     

根管治疗后隐匿性牙根纵裂裂纹宽度对CBCT检出率的影响

目的:探讨裂纹宽度对使用锥形束CT(cone beam CT,CBCT)检测根管治疗后隐匿性牙根纵裂(vertical root fracture,VRF)的影响。方法:收集2016年3月~2019年3月期间26例根管治疗后怀疑隐匿性牙根纵裂患牙,所有患牙均行CBCT扫描并进行术前CBCT评价裂纹有无,所有患牙均因折裂或明显骨吸收拔除,拔除后的离体牙在显微镜下确认裂纹有无,并将拔除后的VRF患牙立即进行micro-CT扫描,使用ImageJ对micro-CT图像检测出的裂纹进行宽度测量。将VRF患牙中CBCT裂纹阳性组和阴性组的裂纹宽度使用t检验比较裂纹宽度的差异。结果:26个患牙拔除后确认24个为VRF患牙,24个患牙共有49条裂纹,CBCT术前诊断VRF患牙11颗,CBCT评价VRF牙的灵敏度为45.83%,特异度为100%,准确率为50%,micro-CT扫描VRF牙检出的准确率为100%,裂纹检出的准确率为95.92%。对micro-CT图像上检测出的裂纹使用ImageJ测量CBCT阴性组的裂纹宽度在15~99μm之间,阳性组的裂纹宽度在62~288μm之间,阳性组和阴性组之间的裂纹宽度具有显著性差异(P<0.05)。结论:根管治疗后隐匿性牙根纵裂牙在体CBCT检测的准确率相对较低,裂纹宽度是影响CBCT检测的重要因素之一。     

CBCT与DR根尖片在根折诊断中的应用比较研究

目的：对比锥形束CT（CBCT）与数字化根尖片（DR）对根折诊断的准确性,评价是根折诊断中的应用价值。方法：收集临床症状怀疑为根折,并最终确诊的患牙50颗。经由两名有临床经验的牙体牙髓科医生及一名放射科医生共同对其DR根尖片和CBCT进行阅片得出诊断结果,比较两种方法在根折诊断上的差异性和准确度。结果：50颗根折患牙,CBCT检出率100％,DR检出率20％。 CBCT与DR在根折诊断的准确性上有显著差异。结论：相对于DR,CBCT在根折诊断的准确度上有显著优势。     

锥形束CT对后牙根尖周炎骨病损的评价作用

目的:以锥形束CT(cone-beam computed tomography,CBCT)为标准,评价X线片在诊断后牙根尖周炎骨病损中的作用。方法:收集门诊同时拍摄X线片和CBCT图像的病例80例,共106颗后牙,包括前磨牙和磨牙各53颗,其中健康牙58颗,临床诊断为慢性牙髓炎11颗,诊断为慢性根尖周炎34颗(含8颗根管治疗后的患牙),根管治疗后表现正常的牙3颗。由2名有经验的医师对CBCT图像及X线片进行判读,确定根尖周指数(periapical index,PAI)分级。采用SPSS13.0软件包对所得数据进行χ2检验。结果:分别对106颗疑似患牙的CBCT图像与X线片进行判读,根尖周炎的检出率分别为59.4%和39.6%,差异有显著性(χ2=8.32,P<0.01)。X线片为二维影像,其结构重叠产生伪影,使病变范围界限不清,而CBCT三维图像则对病损范围有明确的显示,有利于疾病的诊断与治疗。另外,X线片不能表现CBCT显示的骨皮质破坏情况。结论:CBCT图像诊断根尖周炎比X线片更有临床价值,可展现X线片无法显示的细节,对疾病的破坏范围和相关结构毗邻显示更清楚,从而准确划分根尖周炎的分级,为临床正确诊断以及科学制定治疗计划提供有效的依据。     

口腔锥形束CT在下颌第二磨牙C形根管诊治中的应用

目的探讨口腔锥形束CT(cone-beam computed tomography,CBCT)在根管治疗中诊断治疗下颌第二磨牙C形根管的临床应用。方法选取初次根管治疗失败的下颌第二磨牙62颗,根尖片不能确定根管解剖形态以及可疑遗漏根管,患牙采用CBCT进行扫描三维重建。结果使用CBCT确定下颌第二磨牙中52颗为C形根管,C形根管发生率达83.87%,C形根管中28颗为C1型变异根管(53.84%),18颗为C2型变异根管(34.62%),6颗为C3型变异根管(11.54%)。52颗患牙除2颗因根管侧穿导致根管治疗失败外,其余50颗患牙通过热牙胶充填与垂直加压技术将软化的牙胶充入不规则的根管系统,达到严密充填根管,根管再治疗后患牙成功治疗的有50颗(96.15%),均无不适症状。CBCT在根管治疗中辅助定位变异根管,定位准确率较高。结论 CBCT影像精密度高,可从三维角度分析根管,在根管治疗中诊断治疗下颌第二磨牙C形根管具有临床指导意义。     

锥形束CT与数字化X线片对牙周牙髓联合病变诊断价值的对比研究

目的    评价锥形束CT（CBCT）和数字化X线片诊断牙周牙髓联合病变的准确性,以期为CBCT在牙周牙髓联合病变诊断中的应用提供依据。方法    采用简单随机化抽样法选取2015年6月至2016年12月就诊于大连市口腔医院牙周科被诊断为牙周牙髓联合病变的患者55例（患牙55颗）,分别进行CBCT和数字化X线片扫描,同时行临床探诊检查,确定附着丧失水平及釉牙骨质界至牙槽嵴顶的距离。比较3种方法对患牙牙槽骨缺损高度测量及根分叉病变诊断的差异。结果    CBCT和临床探诊均可对患牙进行近中、远中、唇（颊）侧和舌（腭）侧的牙槽骨缺损进行测量,而数字化X线牙片仅可以进行近中、远中牙槽骨缺损测量。单因素方差分析结果显示,数字化X线片、CBCT及临床探诊3种方法测量的牙周牙髓联合病变患牙近、远中牙槽骨缺损程度差异均有统计学意义（近中：F = 3.56,远中：F = 5.37;均P < 0.001）;进一步两两比较结果显示,数字化X线片与CBCT、数字化X线片与临床探诊的测量结果差异均有统计学意义（均P < 0.05）。患牙各位点［近中、远中、唇（颊）侧、舌（腭）侧）］的牙槽骨缺损高度,采用CBCT与临床探诊的测量结果差异均无统计学意义（均P > 0.05）。在诊断牙周牙髓联合病变患牙的根分叉病变发生率方面,数字化X线片与CBCT、数字化X线片与临床探诊比较,差异均有统计学意义（均P < 0.001）;而CBCT与临床探诊比较,差异无统计学意义（P > 0.05）。结论    CBCT与临床探诊在评价牙周牙髓联合病变的牙槽骨缺损程度和根分叉病变发生率方面具有一致性,均优于数字化X线片,CBCT准确性更高。     

MTA用于修补髓底及根管穿孔的临床疗效观察

目的观察采用MTA修补髓底及根管穿孔的临床效果。方法14颗髓底穿孔或根管侧穿的患牙采用根管显微镜下MTA修补,定期随访,观察治疗效果。结果复诊时14颗患牙中有13颗无不适主诉,临床检查无牙龈病变及牙周袋;1颗患牙因修补4d后疼痛加重,于外院拔除。修补前后临床检查及X线片对照显示,11颗患牙穿孔处牙槽骨无明显吸收。结论MTA是较为理想的髓底及根管穿孔的修补材料,短期临床疗效良好。     

锥形束CT在早期诊断牙根纵裂中的应用

目的:探讨锥形束CT对牙根纵裂(简称根裂)早期诊断的价值。方法:对23颗临床检查可疑为根裂且通过X线根尖片不能确诊的患牙,拍摄锥形束CT(cone-beam computed tomography,CBCT)观察是否存在根裂影像,分别记录为明确根裂、可疑或非根裂。根裂的CT诊断标准为:至少连续2个牙根断面上可见明显的低密度裂隙影或折断片明显移位。结果:CBCT显示23颗患牙中明确根裂17颗,可疑4颗,非根裂2颗。17颗明确根裂患牙均经拔除证实;4颗可疑患牙经4～6月观察后亦拔除并确诊为根裂;CT图像未见根裂表现的2颗患牙经临床证实无根裂。经拔除后确诊根裂的21颗患牙中,活髓牙10颗,已牙髓治疗的无髓牙11颗。CBCT的诊断敏感度为81%。结论:锥形束CT有助于牙根纵裂的早期诊断。     

Supportive periodontal therapy after reconstructive periodontal surgery

Clinical practice and research have established the value of supportive periodontal treatment after reconstructive periodontal surgery. The clinical procedures and the rationale for developing individualized treatments are discussed in general and for specific types of reconstructive procedures. The application of adjunctive diagnostics and chemotherapeutic agents to supplement traditional methods is described.     

Source of suspected periodontal pathogens re-emerging after periodontal treatment

Abstract To clarify the source of re-emerging periodontal pathogens after treatment, we compared the ribotypes of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia/Prevotella nigrescens group and Campylobacter rectus before and after treatment in 7 periodontitis patients and in 6 of the spouses. The patients harbored A. actinomycetemcomitans, P. gingivalis, P. intermedia/P. nigrescens group or C. rectus in their subgingival or salivary samples before treatment. The respective bacterial species were not detected 1 month after treatment, but reappeared by 6 months later. When available, 4 random colonies of each of the 4 species were isolated from both subgingival and salivary samples at each sampling occasion, the isolates were subcultured. identified and typed applying pheno- and genotypic intraspecies characterization methods. Altogether 90 strains of A. actinomycetemcomitans, P. gingivalis. P. intermedia, P. nigrescens group and C. rectus were available from 2, 3, 2 and 4 patients, respectively. The pre- and post-treatment ribotypes of A. actinomycetemcomitans-, P. gingivalis- and P. intermedia P. nigrescens group-isolates were identical in all respective patients. The pre- and post-treatment ribotypes of C. rectus were identical in 1 of 4 patients, whereas 2 patients harbored a previously not detected post-treatment ribotype and 1 patient harbored the initial and a previously not detected post-treatment ribotype. To study the possibility that periodontitis patients may acquire strains from the spouse after treatment, isolates of A. actinomycetemcomitans, P. gingivalis. P. intermedia/P. nigrescens group and C. rectus (n=95) from the patients' spouses were ribotyped and compared with those of the patients. The patient exhibited his own post-treatment ribotypes. different from those of the spouse, of A. actinomycetemcomitans and P. gingivalis in 1 couple and of P. intermedial, P. nigrescens group and C. rectus in 1 couple. In the 2 patients who harbored a previously not detected post-treatment ribotype of C. rectus. one patient shared the new ribotype with the spouse, whereas the other one did not. Although an exogenous source cannot be fully ruled out, the patient's own oral flora seems to be the main source of re-emerging periodontal pathogens after treatment.     

Survival analysis of periodontal sites before and after periodontal therapy

Periodontal diseases appear to progress with bursts of destructive activity at individual sites. One effect of treatment might be to diminish the frequency of such bursts. Survival analysis was employed to seek such effects on the periodontal sites of 16 individuals with prior evidence of destructive periodontal disease. The subjects were monitored at bi-monthly intervals and actively breaking down sites were detected using attachment level measurements and the tolerance method of analysis. When active sites were detected, control sites of equal pocket depth and attachment loss were selected and microbiological and immunological samples were taken. The subjects were treated by modified Widman flap surgery and systemically administered tetracycline. On completion of therapy, bi-monthly monitoring was reinstituted. Life tables were constructed for periodontal sites in each of the 16 subjects prior to and after therapy. A site losing more than 3 mm of attachment at any time interval was considered to have relapsed or "died". Survivor functions were calculated for each time period indicating the % of sites which survived at any time. The subjects were divided into 3 categories on the basis of post-therapy survivor functions. The annual hazard rate in 9 good treatment response subjects (group 1) was reduced from 0.10/year to 0.01/year. The hazard rate of 5 intermediate treatment response subjects (group 2A) was reduced from 0.16/year to 0.04/year and that of 2 poor treatment response subjects (group 2B) from 0.15/year to 0.07/year. Group 2A and 2B individuals were combined and differences were sought in clinical, microbiological and immunological parameters between the good and poor treatment response groups. 5 out of 7 of the poor responding individuals showed elevated humoral antibody responses to 3 or more gram-negative subgingival species tested. Many of the elevated responses in this group were to organisms which are widely distributed and return quickly after therapy such as Fusobacterium nucleatum, Eikenella corrodens, Bacteroides intermedius and Capnocytophaga sputigena. The predominant cultivable microbiota in subgingival samples taken prior to therapy from the good responding group had significantly greater proportions of Actinobacillus actinomycetemcomitans, C. ochracea and B. intermedius than the poor responding group. The latter group showed significantly elevated proportions of F. nucleatum, Peptostreptococcus micros and Streptococcus intermedius.     

Pre-treatment conceptions of periodontal disease and treatment in periodontal referrals

BACKGROUND: Patients preconceptions of periodontal therapy have not been extensively studied and are poorly understood. AIMS: To register specific anxieties and preconceptions held by patients referred for specialist periodontal treatment and to investigate the risks such patients were prepared to take of progressive periodontal problems before deciding that periodontal treatment was necessary. MATERIALS AND METHODS: 79 patients referred for specialist treatment completed a structured questionnaire. Participants completed visual analogue scales to quantify the risks which they were prepared to take of various symptoms of periodontal disease before they believed treatment was essential. RESULTS: The majority (71%) had anxieties about pending treatment with the main concern being pain. Those who had sought information prior to treatment mainly did so from close relatives. The majority of patients opted to take no or a very low (<20%) risk of any periodontal problems and, therefore, were supportive of treatment. The loss of many teeth due to periodontal disease was the least acceptable outcome followed by tooth mobility. Patients were prepared to accept a significantly higher risk of bleeding on brushing (p<0.0001) than any of the other outcomes investigated. Females recorded substantially lower risk scores than males particularly in relation to developing recession or tooth mobility in the absence of treatment. Patients who were worried about experiencing pain during treatment recorded lower risk scores than those who had no anxiety regarding pain. CONCLUSION: It is concluded that the Norwegian periodontal referrals studied were prepared to take very low risks of further periodontal symptoms despite high levels of anxiety and evidence of a lack of knowledge regarding periodontal treatment.     

Assessment of periodontal status with CPITN and conventional periodontal indices

This study compared CPITN with plaque index (PlI), gingival index (GI), papilla bleeding index (PBI), and probeable pocket depth (PPD). 52 patients were examined, mean age 43 years. Partial mouth random recording (2 upper and 1 lower or 1 upper and 2 lower sextants) was made by CPITN of 150 sextants, and at 6 sites around each tooth in each sextant for each index using a pressure-sensitive probe, with Newman tip and Williams markings, and a WHO 621 tip, probing pressure 0.25 N. Ranges of each index were compared with corresponding CPITN data. Most (71%) sextants had CPITN scores of 4, indicating periodontitis. None had CPITN scored 0 or 1. A given CPITN code was found to represent extremes of ranges for all other indices evaluated. There was no relation between CPITN and PlI or GI, nor did CPITN reflect the number of sites affected per sextant, but there was a tendency for CPITN to relate with PBI and PPD. It was concluded that CPITN may be used as a general indicator of bleeding and pocket depth, but not of plaque or gingivitis. Other indices are required to reliably assess chronic inflammatory periodontal disease status in a given mouth.