Supportive care after active periodontal treatment

Abstract This review concerns the most significant questions regarding supportive (maintenance) care after active periodontal treatment: the effectiveness and ideal frequency of maintenance appointments, the adecuacy of the supportive therapy according to patient needs, the possible alternatives to currently accepted protocols, and the relative value of personal oral hygiene in the overall context of supportive care. Periodontal diseases are infections with a high potential for recurrence, progressive loss of attachment and eventually, tooth loss. Current therapies for periodontal diseases are highly predictable in arresting disease activity. Supportive periodontal care has been shown to be very effective in maintaining support when adapted to each particular case. Nevertheless, current maintenance therapies may be unsuccessful in preventing further loss of attachment in a small number of sites for some patients. Tests aiming at bacterial identification and the subgingival application of antimicrobials may be helpful in the management of such cases, however the practical value in a specific setting is not known. There is growing evidence of the fundamental role of personal oral hygiene in supportive periodontal care. In cases with rapid and severe periodontal destruction and where local and/or systemic risk factors are present, personal oral hygiene becomes a key factor in the long-term preservation of periodontal support.     

Periodontal inflammation and attachment loss: a critical problem for biological studies

BACKGROUND: In biological studies of periodontitis, there has been long-standing confusion between the ubiquitous phenomena of inflammation and the essential criterion of attachment loss. This is partly attributable to inadequate methods of clinical measurement, but seems also to be a consequence of an unproven and usually unstated assumption that the same biological processes underlie both inflammation and attachment loss. Developments in unidimensional clinical probing methods have helped in studies of periodontal treatment. However, such methods are intrinsically unsuitable in studies of periodontal diseases, and may have given them a false sense of security. The confusion has been compounded by inappropriate use of statistical techniques in an attempt to solve problems which do not arise from mathematical models but are intrinsic to measurement methods.
OBJECTIVE: This paper is a clinician's attempt to state the current difficulties and suggest some ways forward, including the development of three-dimensional measurement, non-invasive probing, and several objectives for biochemical, microbiological and immunolog-ical research.     

Does the adjunctive use of statins provide additional benefits to nonsurgical periodontal treatment? A systematic review and meta‐analysis

Adjunctive therapeutic agents may be used to improve the response to nonsurgical periodontal therapy. Local delivery of statins (simvastatin, artovastatin and rosuvastatin) is a promising adjunct to scaling and root planing (SRP). Thus, the aim of this review is to evaluate if adjunctive local delivery of statins is more effective than SRP alone. Randomized clinical trials that presented a test group evaluating local delivery of statins as adjuncts in healthy, diabetic and smoking patients were included. Medline and the Cochrane library database were searched up to November 2016. Random effects meta‐analyses were conducted for pocket depth change and clinical attachment gain. One hundred and twenty‐five studies potentially related to the aim of this review were screened, but only 10 were included. The majority of the trials reported additional clinical benefits in the groups that were treated with adjunctive local delivery of statins. Pooled calculations showed that local delivery of statins resulted in additional reduction of pocket depth and clinical attachment gain in healthy people, smokers and diabetic patients. Local statins may offer additional clinical benefits to SRP, even in smokers and diabetics.     

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随着牙周临床不断发展,每一位从事牙周疾病治疗的医生都面临着临床技能和专业知识方面的巨大挑战.本文就开展牙周手术治疗所需的基本知识和条件做一简单论述,希望对致力于开展和正在开展牙周临床治疗的青年医生实施牙周手术有所裨益.     

Periodontal conditions in adolescents, 15–19 years of age: an overview ot CPITN data in the WHO Global Oral Data Bank

Results of 61 CPITN surveys in 39 countries for the age group 15-19 yr, stored in the WHO Global Oral Data Bank as of 1 July 1987, are assembled in an overview showing percentages of persons according to the highest score for each person and the mean numbers of sextants affected per person. The most frequently observed condition was score 2 (calculus with or without bleeding), although some shallow pocketing of 4 or 5 mm was present in most populations surveyed. It should thus be emphasized that the major thrust of activities in periodontal care should be in health promotion and education, leading to improved oral hygiene.     

激光在牙周治疗中的应用

[摘要]本文就目前牙周治疗中常见的几种激光作一介绍。文献回顾显示激光可以清除97%以上的牙周致病菌,能够有效去除病变牙骨质,并且对牙周组织和根面损伤较小,同时,激光可以减少治疗中的疼痛。在今后的牙周治疗具有广泛的应用前景。 [关键词]激光;牙周致病菌;牙周治疗;牙周手术     

Putative stem cells in regenerating human periodontium

Background and Objective:  Human postnatal stem cells have been identified in periodontal ligament, with the potential to regenerate the periodontium in vivo . However, it is unclear if periodontal ligament stem cells are present in regenerating periodontal tissues. The aim of this study was to identify and localize putative stem cells in block biopsies and explant cultures of regenerating human periodontal tissues.
Material and Methods:  Guided tissue regeneration was carried out on the molars of three human volunteers. After 6 wk, the teeth with the surrounding regenerating tissues and bone were surgically removed and processed for immunohistochemistry. The mesenchymal stem cell-associated markers STRO-1, CD146 and CD44 were used to identify putative stem cells. Cell cultures established from regenerating tissue explants were analysed by flow cytometry to assess the expression of these markers. Mineralization, calcium concentration and adipogenic potential of regenerating tissue cells were assessed and compared with periodontal ligament stem cells, bone marrow stromal stem cells and gingival fibroblasts.
Results:  STRO-1⁺, CD44⁺ and CD146⁺ cells were identified in the regenerating tissues. They were found mainly in the paravascular and extravascular regions. Flow cytometry revealed that cultured regenerating tissue cells expressed all three mesenchymal stem cell associated markers. The regenerating tissue cells were able to form mineral deposits and lipid-containing adipocytes. However, the level of mineralization in these cells was lower than that of periodontal ligament stem cells and bone marrow stromal stem cells.
Conclusion:  Cells with characteristics of putative mesenchymal stem cells were found in regenerating periodontal tissues, implying their involvement in periodontal regeneration.     

Periodontal conditions in Europe

The aim of the present overview is to evaluate the periodontal conditions in European populations. Study was made of a number of extensive surveys of periodontal diseases carried out in a number of European countries, primarily North West Europe. These surveys often provide considerable detail. However, international comparisons are difficult to perform because of the different methods applied. Therefore, the latest overviews of results of periodontal surveys, based on the CPITN method and stored in the WHO Global Oral Data Bank, are given for the age groups 15-19 years and 35-44 years. Based on this approach, the conclusions are as follows. Trends and prevalences in periodontal health and disease in Europe are clear, at least up to the age of 60 year. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before age 50 and certainly not a major cause of edentulousness before age 60. For a large majority, in most of the populations observed, the progress of periodontal destruction seems to be compatible with the retention of a natural, functioning dentition into older age. However, the periodontal problem might still be of considerable magnitude and importance as bleeding on probing is widely encountered in the younger age groups. Furthermore, 5-15% of populations affected by a serious, irreversible condition at age 40 years is high, compared with most other diseases.     

Bacterial invasion and persistence: critical events in the pathogenesis of periodontitis?

Periodontitis is chronic inflammation of the periodontium caused by the host's inflammatory response to plaque biofilm, which destroys tooth‐supporting soft and hard tissues. Periodontitis is a complex disease that involves interactions among three main features – microbial challenge, the host immune response, and environmental and genetic risk factors – in its pathogenesis. Although periodontitis has been regarded as the result of hyperimmune or hyperinflammatory responses to plaque bacteria, recent studies indicate that periodontal pathogens are rather poor activators and/or suppressors of the host immune response. This raises the question of how periodontal pathogens cause inflammation. To resolve this issue, in the present review we propose that bacterial invasion into gingival tissue is a key event in the initiation of periodontitis and that the persistence of these bacteria within host tissue results in chronic inflammation. In support of this hypothesis, we present the ways in which microbial, environmental and genetic risk factors contribute to bacterial invasion. It is hoped that the current model will instigate active discussion and new research to complete the puzzle of this complex disease process.     

Periodontal maintenance in a specialist periodontal clinic and in general dental practice

OBJECTIVES: To monitor the efficacy of periodontal maintenance whether conducted in a specialist periodontology clinic or in the practice of the referring general dentist. MATERIALS AND METHODS: Thirty-five subjects with a diagnosis of moderate-severe chronic periodontitis who were referred to the specialist clinic received periodontal non-surgical therapy. Following a 6-month healing phase, subjects were randomly allocated to one of two groups: A (n=18, periodontal maintenance provided within the specialist clinic) or B (n=17, periodontal maintenance provided by the referring general dentist in accordance with written instructions provided by the specialist). All subjects were examined at months 0 (corresponding to 6 months post-completion of non-surgical therapy), 6 and 12. Full-mouth plaque index (PI), % bleeding on probing (%BOP) and probing depth (PD) measurements were recorded. PDs were also recorded at eight test sites which, prior to non-surgical therapy, exhibited PD 5-8 mm, BOP and radiographic alveolar bone loss. Standardized radiographs were exposed at test sites at months 0 and 12, and bone changes assessed using digital subtraction radiography (DSR). RESULTS: As a result of the non-surgical therapy, statistically significant improvements in all clinical parameters were recorded. In the maintenance period, mean PI increased significantly from months 0 to 12 (p<0.05), but this increase did not differ significantly between groups A and B (p>0.05). No other clinical parameters changed significantly in the maintenance phase of the study. Reductions in %BOP, mouth mean PD and mean test sites PD achieved by the non-surgical therapy were maintained and did not differ significantly whether subjects were allocated to group A or group B (p>0.05). Current smokers had significantly deeper PD than non-smokers and former smokers at all time points (p<0.05), although otherwise, smoking status did not affect the outcomes of the study. DSR analysis identified statistically non-significant, slight, alveolar bone loss in both groups between months 0 and 12. CONCLUSION: In the short term, periodontal maintenance can be provided in general dental practice with the same expected outcomes compared with maintenance that is provided in a specialist clinic, providing that general dentists are given specific instructions regarding the maintenance regimen. A strong emphasis on effective plaque control is necessary.     

Can we successfully maintain risk patients?

The most fundamental premise in the current view of periodontal disease is that not all individuals are at equal risk for disease and disease progression. Studies reveal that about 5-20% of the population is at risk for severe disease progression. The purpose of this paper is to define at-risk patients, review risk factors and indicators of disease progression, and outline an evidence-based strategy that includes both self-care and professional care for maintaining periodontal health. Risk factors/risk indicators considered include history of previous disease, increased pocket depth and loss of clinical attachment, frequency of dental care, specific bacterial pathogens, and systemic/environmental host factors such as smoking, diabetes mellitus, genetics, and stress. Because host factors may have more influence on disease progression than periodontal pathogens, personal and professional maintenance care must include the role of the host in periodontal disease progression. By examining the evidence surrounding these complex issues, dentists and dental hygienists are able to determine the extent to which evidence supports available approaches to maintain periodontal health and control disease progression.     

A multicenter clinical trial of PerioGardTM in distinguishing between diseased and healthy periodontal sites

Abstract We designed and performed a multicenter clinical trial to determine the relationship between measurements of the level of the enzyme aspartate amino-transferase (AST) in gingival crevicular fluid (GCF) to other measures used to detect periodontal disease and monitor outcome of treatment, including pocket depth and gingival inflammation. 32 periodontitis patients were enrolled at the University of Washington, Seattle, 30 at the University of Florida, Gainesville, and 34 at the University of Illinois, Chicago. 10 periodontally normal control subjects were enrolled at each location. 8 diseased and 4 healthy sites were designated for study in each patient and 8 healthy sites designated in each control subject. Measures of disease included pocket depth, severity of gingival inflammation, and GCF volume. AST levels were measured using the PerioGard^TM test kit. Clinical measurements were made and GCF samples harvested and tested 2X before and 2X after therapy consisting of scaling and root planing under local anesthetic. Specific design and other issues are discussed, including selection of patients and control subjects, sample size, selection of experimental test sites, methods for assessment of diseased and therapeutic improvement, harvesting of GCF, and selection of appropriate biostatistical methods for data analysis. Demographics of the patient populations at the 3 locations are reported. As expected, therapy induced only negligible changes in the measures of disease at healthy sites in control subjects, and relatively minor improvement in healthy sites in patients. In contrast, statistically significant improvement relative to pre-treatment baseline status in all 3 measures of disease was observed for diseased sites at all 3 study locations with all p-values less than 0.0002. The magnitude of improvement was comparable to that reported previously by others. The % of PerioGard-positive sites decreased significantly between the screening baseline and both post-treatment visits for patients at all 3 locations, with p values of 0.0001 to < 0.0008.     

From manual periodontal probing to digital 3‐D imaging to endoscopic capillaroscopy: Recent advances in periodontal disease diagnosis

Deepened periodontal pockets exert a significant pathological burden on the host and its immune system, particularly in a patient with generalized moderate to severe periodontitis. This burden is extensive and longitudinal, occurring over decades of disease development. Considerable diagnostic and prognostic successes in this regard have come from efforts to measure the depths of the pockets and their contents, including level of inflammatory mediators, cellular exudates and microbes; however, the current standard of care for measuring these pockets, periodontal probing, is an analog technology in a digital age. Measurements obtained by probing are variable, operator dependent and influenced by site‐specific factors. Despite these limitations, manual probing is still the standard of care for periodontal diagnostics globally. However, it is becoming increasingly clear that this technology needs to be updated to be compatible with the digital technologies currently being used to image other orofacial structures, such as maxillary sinuses, alveolar bone, nerve foramina and endodontic canals in 3 dimensions. This review aims to summarize the existing technology, as well as new imaging strategies that could be utilized for accurate evaluation of periodontal pocket dimensions.     

Periodontal conditions in adults, 35–44 years of age: an overview of CPITN data in the WHO Global Oral Data Bank

Results of 28 CPITN surveys in 24 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 July 1986 are assembled in an overview presenting: percentages of persons according to the highest score for each person, the estimated national percentages of edentulousness and the mean numbers of sextants affected per person. It is concluded that for a large majority in most of the populations observed, the progress of periodontal disease has been slow and seems to be compatible with retention of a natural dentition until at least the age of 50.     

Periodontal conditions in 35–44-year-old factory workers in Shanghai

Abstract A periodontal survey applying CPITN was carried out in almost 500 male and female factory workers, 35–44 yr of age, in Shanghai, P.R. China. Calculus and shallow pockets were most frequent. Deep pockets of 6 mm and over were seldom found. The mean number of missing teeth was only 2.7 (out of 32). Problems associated with third molars seem to provide the largest immediate oral health problem     

Periodontal disease activity: a development strategy for its investigation by means of accurate 3-dimensional clinical measurement

Abstract The central problem in all previous approaches to clinical assessment of periodontal disease activity is the use of unidimensional measurement, which implies a number of unjustifiable assumptions. In addition, the use of unidimensional probing measurement has established that there are several distinct problems of validity and reliability in currently available techniques. The present paper begins with an analysis of these matters, leading to an approach to accurate clinical measurement of periodontitis in 3 dimensions, with the possibility of future development of a valid system for assessing the nature of disease activity.     

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.     

脱乙酰壳多糖支架在牙周组织工程中的应用

脱乙酰壳多糖生物材料尽管具有良好的生物相容性,但其作为牙周组织工程支架材料时也有自身的局限和不足。本文就牙周组织工程、脱乙酰壳多糖、脱乙酰壳多糖牙周组织工程支架等研究进展作一综述。     

Antibiotics in periodontal therapy: advantages and disadvantages*

Abstract. Antibiotic treatment of periodontitis aims at eradicating or controlling specific pathogens. Prime candidates for antibiotic therapy are patients with recently diagnosed active periodontitis or a history of recurrent disease who fail to stabilize following mechanical/surgical therapy. Since a variety of microbes with differing antimicrobial susceptibility profiles may cause periodontitis, selection of antimicrobial agents should be based on proper microbial diagnosis and sensitivity testing, as well as consideration of the patient's medical status. The risk of treating chemotherapeutically solely on the basis of clinical features, radiographic findings or a limited microbiological analysis, is failure to control the pathogens or overgrowth of new pathogens. A review of published papers reveals that appropriate systemic antibiotic therapy may enhance healing in patients with recent or high risk of periodontal breakdown. Systemic antibiotic therapy seems more predictable than topical administration in eradicating periodontal pathogens from deep periodontal pockets. Several promising antimicrobial agents for periodontitis treatment need testing in placebo-controlled, double-blind, randomized clinical trials.     

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牙周手术治疗主要是为了消除牙周袋,建立生理性的软、硬组织形态,促进牙周组织修复和再生,建立新的牙周附着关系,恢复美观和功能需要.现代牙周手术往往包含软、硬组织的再生手术,而手术的成功,必须依赖实施规范的牙周外科操作,才能提高手术成功率.随着各种新技术和新材料用于牙周手术治疗,牙周手术的结果才会实现组织再生.