RT-qPCR检测CPC对中重度慢性牙周炎患者口内环境中红色复合体的影响

目的:利用RT-qPCR检测CPC对中重度慢性牙周炎患者口内环境中红色复合体构成比的影响。方法:临床选择40例中重度慢性牙周炎患者,随机分成CPC(试验)组、溶媒(对照)组,牙周基础治疗后分别使用该药品含漱+袋内冲洗。记录患者基线和用药4周后的临床指标;采集龈下菌斑、龈沟液和唾液样本,BANA试验检测胰蛋白酶样酶含量,RT-qPCR检测P.gingivalis、T.forsythia、T.denticola在总菌量中的构成比。结果:治疗后:1)试验组AL、BOP、PLI显著改善(P<0.01),对照组仅AL改善(P<0.01);2)两组龈下菌斑和龈沟液样本中胰蛋白酶样酶含量均显著下降(P<0.05);3)两组P.gingivalis构成比均显著下降(P<0.01),T.forsythia在试验组构成比显著下降(P<0.01),而T.denticola治疗前后无变化;4)P.gingivalis、T.forsythia、T.denticola两两之间构成比均显著相关(P<0.01)。结论:CPC可抑制牙菌斑形成,改善患者的临床症状,并对龈下菌斑中的P.gingivalis有一定的抑制作用,临床上可用于辅助治疗中重度慢性牙周炎。     

龈下刮治和根面平整术联合Nd: YAG激光治疗慢性牙周炎的疗效评价

目的 研究龈下刮治和根面平整术（SRP）联合Nd: YAG激光治疗对慢性牙周炎患者的疗效。方法 选择口内有4颗及以上牙齿,探诊深度为4~8 mm的慢性牙周炎患者,研究位点为分布在口内4个不同象限的互不毗邻的单根牙。随机分成4组:对照组（不治疗）、SRP组（单纯SRP）、SRP+L组（SRP后行激光治疗）、L+SRP组（激光治疗后行SRP）。观测时间点为基线（临床处理前）和临床处理后1周、1个月、3个月,比较不同组在不同观测点牙周临床指标和龈下菌群中红色复合体（包括牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体）的组成变化。结果 牙周临床指标:SRP、SRP+L、L+SRP组的各项临床指标变化均优于对照组;3个治疗组组间比较,探诊出血、探诊深度和临床附着丧失量之间无明显差异（P>0.05）,但在3个月时,L+SRP和SRP+L组的菌斑指数百分比下降较SRP组明显（P<0.05）。微生物检测结果:SRP、SRP+L、L+SRP组龈下菌斑中牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体百分比均较基线下降,3个治疗组间也存在一定差异（P<0.05）,但在不同观测时间点的差异不完全相同。结论 慢性牙周炎治疗中,Nd: YAG激光联合SRP治疗较单纯SRP治疗未见明显优势,且Nd: YAG激光和SRP的治疗先后对临床效果也无明显影响;但激光联合SRP治疗可能较单纯SRP更有利于局部菌斑的控制。     

牙龈卟啉单胞菌与龈沟液中白细胞介素8关系的研究

目的:探讨龈沟液(GCF)中白细胞介素8(IL -8)在慢性牙周炎病程中的变化、IL- 8与牙周临床检测指标以及同龈下菌斑中细菌含量的相关关系。方法: 5名非牙周炎患者的10颗牙周健康牙和30名慢性牙周炎(CP)患者的70颗牙(其中10颗为健康牙, 60颗为牙周炎患牙)纳入本研究。采集观察牙的GCF样本、龈下菌斑样本,同时记录所有牙的牙龈指数(GI)、牙周袋探诊深度(PPD)、临床附着丧失水平(CAL)。用ELISA法检测样本中IL -8的水平,用厌氧菌培养技术培养菌斑标本,用PCR法检测菌斑中的牙龈卟啉单胞菌(Pg),结果:慢性牙周炎组的GCF中IL -8的总量高于临床牙周健康组,而IL -8的质量浓度在各组中无差异。GCF中IL- 8浓度与GI、PPD、CAL无相关关系,而IL -8的总量与GI、PPD、CAL呈正相关关系。龈下菌斑中Pg的检出量与GCF中IL- 8的含量间未发现有相关关系。结论:慢性牙周炎患者龈沟液中IL- -8量增加与龈沟液分泌增加有关而与牙龈卟啉单胞菌检出CFU无关。     

半导体激光辅助重度慢性牙周炎牙周非手术治疗的临床研究

目的: 评估半导体激光在辅助重度慢性牙周炎的牙周非手术治疗中发挥的作用。方法: 20例重度慢性牙周炎患者基线时进行牙周各项检查,包括探诊深度(probing depth, PD)、临床附着水平(Clinical attachment level, CAL)、出血指数(bleeding index, BI)、松动度(tooth mobility, MOB)。将患者的牙列分为左右两侧,右侧患牙为对照组,仅采用牙周非手术治疗;左侧患牙为实验组,先行牙周非手术治疗,再选取检查时重度慢性牙周炎的患牙,进行半导体激光的牙周袋消毒。治疗后8周对患者进行同样的牙周检查,比较牙周指标恢复情况。结果: 8周复查时两组的PD、CAL及BI均较基线时明显降低(P＜0.05);实验组PD和CAL的改善程度比对照组更明显(P＜0.05),治疗后的MOB无明显改善(P＞0.05)。结论: 半导体激光在辅助重度慢性牙周炎牙周非手术治疗时可以增加其疗效,能有效增加附着水平,它可能是对当前牙周非手术治疗方案的有效补充。     

种植义齿排龈后种植体周围软组织损伤愈后的动物实验研究

目的 通过观察比格犬种植义齿排龈后牙龈指数、龈沟液量和龈沟液中炎症细胞因子肿瘤坏死因子-α（TNF-α）等指标的变化,探讨排龈所致种植义齿周围软组织损伤愈后情况。方法 拔除8只比格犬左侧下颌第四前磨牙（n=8）,严格控制口腔菌斑,2个月后行骨水平种植体植入,3个月后行全冠粘接固位。全冠粘接前使用排龈线排龈5 min,排龈前和排龈后1、3、7、14、28、56 d,分别记录种植体的牙龈指数,测量龈沟液量并用酶联免疫吸附试验检测龈沟液中TNF-α的变化。 结果 种植体牙龈指数、龈沟液量、TNF-α在排龈后第1、3、7天均大于排龈前和排龈后第14、28、56天（P<0.05）,第14、28、56天恢复至排龈前水平,差异无统计学意义（P>0.05）。结论 保持良好口腔卫生的情况下,骨水平种植义齿周围软组织排龈线造成的排龈损伤是可逆性损伤,牙龈指数、龈沟液量、TNF-α在第14天恢复至排龈前水平。     

基于高通量测序技术研究慢性牙周炎患者龈下刮治和根面平整术治疗前后龈下菌群的变化

目的 采用基于16S核糖体DNA(rDNA)的高通量测序技术,分析10例慢性牙周炎患者接受龈下刮治和根面平整术(SRP)治疗前后龈下菌斑多样性及相对丰度的变化,探讨应用微生物群落的构成变化作为牙周炎诊断及预后评估指标的可行性.方法 选择2014年3—9月在首都医科大学附属北京口腔医院牙周科就诊的10例慢性牙周炎患者作为研究对象,在SRP治疗前及治疗后3个月分别在研究对象的同一位点采集龈下菌斑样本,提取样本基因组DNA,采用Illumina Miseq平台测序,分析各组样本从门到种各水平的菌群分布及相对丰度.结果 在门水平上,共检测到16个菌门,有8个门的细菌在牙周龈下菌斑菌群结构中占主要地位(99%);在属水平上,共检测到128个不同菌属,SRP治疗后3个月坦纳菌属(Tannerella)的相对丰度较治疗前明显降低(P<0.05),纤毛菌属(Leptotrichia)和链球菌属(Streptococcus)的相对丰度较治疗前明显上升(P<0.05);在种水平上,6种牙周可疑致病菌被检出,SRP治疗后3个月福赛坦纳菌(Tannerella forsythia)和中间普氏菌(Prevotella intermedia)的相对丰度较治疗前明显减少(P<0.05).结论 慢性牙周炎患者龈下菌群具多样性,SRP治疗前后,牙周可疑致病菌的相对丰度降低,而有益菌的相对丰度升高,SRP治疗可以明显改变龈下菌群构成.     

不同牙周状态下龈沟液中瘦素水平的比较

目的:检测牙周健康者、慢性龈炎和慢性牙周炎患牙龈沟液中瘦素水平,为牙周炎的早期诊断提供客观指标。方法:选择牙周健康者、慢性龈炎和慢性牙周炎患者3组,治疗前记录牙周各项临床指标,并用Whatman^ 1号滤纸收集颊侧近远中牙周袋内GCF采用ELISA检测瘦素含量;同时收集血清进行瘦素水平的检测。结果:3组中慢性牙周炎组龈沟液中瘦素水平与牙周健康者龈沟液中瘦素水平比较有显著差异(P<0.05),慢性牙周炎组龈沟液中瘦素水平与慢性龈炎龈沟液中瘦素水平及慢性龈炎组龈沟液中瘦素水平与牙周健康者龈沟液中瘦素水平比较均无显著差异;牙周健康者、慢性龈炎和慢性牙周炎患者血液中瘦素水平比较均有显著差异(P<0.05)。血中的瘦素与临床指标PLI (P<0.01,r=0.593)、PD(P<0.05,r=0.920)、BI(P<0.05,r=0.862)、AL(P<0.05,r=0.846)均相关;龈沟液中的瘦素与临床指标PLI(P<0.01,r=0.813)、PD(P<0.05,r=0.962))、BI(P<0.05,r=0.720、AL(P<0.05,r=0.946)均相关。结论:龈沟液中瘦素水平可能是反映牙周组织状况的一项较为客观的指标。     

Nd∶YAP激光辅助牙周基础治疗对Ⅲ期B/C级牙周炎患者龈沟液中HIF-1α、ICAM-1水平的影响

目的:探究Nd∶YAP激光辅助牙周基础治疗对Ⅲ期B/C级牙周炎的疗效及龈沟液中低氧诱导因子-1α(HIF-1α)、细胞间黏附分子-1(ICAM-1)水平的变化。方法:采用分口实验,在26例Ⅲ期B/C级牙周炎患者的对照组行牙周基础治疗,实验组在基础治疗后辅助使用Nd∶YAP激光。在治疗前、治疗后6周及3月记录PD、BOP,并用纸尖法收集龈沟液,使用ELISA试剂盒检测龈沟液中HIF-1α、ICAM-1的水平。结果:与基线相比,治疗后6周及3月时两组的PD、BOP(%)及龈沟液中HIF-1α、ICAM-1水平均显著降低(P<0.05),实验组治疗后6周的PD、BOP(%)及治疗后3月的PD、ICAM-1浓度显著低于对照组(P<0.05)。结论:Nd∶YAP激光辅助牙周基础治疗在短期内对Ⅲ期B/C级牙周炎患者安全有效,能降低PD、BOP(%)及龈沟液中ICAM-1水平。     

改良骨皮质切开术对下前牙牙周组织和基骨宽度影响的临床研究

目的:研究改良骨皮质切开术前术后下前牙牙周组织和基骨宽度的变化,评估其手术的安全性,为临床提供参考。方法:选取轻中度安氏Ⅲ类错牙合的健康成人,进行下前牙改良骨皮质切开术辅助正畸治疗,并对下前牙正畸矫治前后的各项牙周指数和基骨宽度进行比较。结果:下前牙正畸矫治前后探诊深度、出血指数、牙龈萎缩各项指标均无统计学差异;正畸治疗后角化龈宽度(5.8±2.4) mm大于术前(5.2±1.9) mm(P=0.041);下前牙根尖区基骨厚度治疗后(6.04±4.57) mm比治疗前(5.32±3.87) mm增厚(P=0.024),但其中下前牙根尖区唇侧基骨厚度治疗后(2.27±1.72) mm,比治疗前(2.88±2.35) mm减小(P=0.014),舌侧基骨厚度治疗后(3.97±3.49) mm则比治疗前(2.54±2.06) mm增大(P=0.040);下颌B点基骨厚度治疗后(7.17±5.21) mm比治疗前(6.47±3.99) mm增厚(P=0.042)。结论:改良骨皮质切开术辅助正畸治疗矫治中度安氏Ⅲ类错牙合,对其下前牙牙周组织是安全的,甚至能刺激下前牙基骨的增生。     

光动力疗法对慢性牙周炎患者龈沟液IL-1β和MMP-8含量的影响

目的:光动力疗法(photodynamic therapy,PDT)具有抗微生物作用,在牙周病等感染性疾病的治疗中受到关注.该实验通过检测治疗前、后患者龈沟液IL-1β和MMP-8的含量变化,评价PeriowaveTM光敏抑菌系统治疗慢性牙周炎的临床效果.方法:58例慢性牙周炎患者,随机分为A组[龈下刮治和根面平整(SRP) 1次PDT]、B组(SRP 2次PDT)和C组(SRP),PDT治疗选用PeriowaveTM光敏抑菌系统(675nm的二极管激光和0.01%亚甲蓝).治疗时以0.01%亚甲蓝作为光敏剂,二极管激光用140mW的功率照射60s.用酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)检测治疗前、后龈沟液中IL-Iβ和MMP-8的含量.采用SAS6.12软件包进行统计学分析.结果:治疗后6周时,A、B、C 3组龈沟液IL-1β和MMP-8的含量与治疗前的基线相比,均显著降低,但组间无显著差异;治疗后12周,A、B 2组IL-1β及B组MMP-8含量变化与C组比较有显著差异(P＜0.05).结论:SRP和SRP与PDT联合治疗在控制炎症的同时,能有效降低患者龈沟液中IL-1β和MMP-8的含量,但控制炎症的效果维持时间更长.因此.PDT可作为治疗慢性牙周炎的一种新方法.     

The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation

OBJECTIVES: The aim of this split-mouth, double-blind controlled clinical trial was to study the effects of irradiation with low-level lasers as an adjunctive treatment of inflamed gingival tissue. MATERIALS AND METHODS: Seventeen patients with moderate periodontitis were included. After clinical examination, all teeth were scaled and root planed (SRP). One week after SRP, we took samples of gingival crevicular fluid (GCF) and subgingival plaque. The laser therapy was started 1 week later and continued once a week for 6 weeks. One side of the upper jaw was treated with active laser and the other with a placebo. The test side was treated with two low-level lasers having wavelengths of 635 and 830 nm. The patients then underwent another clinical examination with sampling of GCF and plaque. The GCF samples were analysed for elastase activity, interleukin-1beta (IL-1beta) and metalloproteinase-8 (MMP-8). We examined the subgingival plaque for 12 bacteria using DNA probes. RESULTS: The clinical variables i.e. probing pocket depth, plaque and gingival indices were reduced more on the laser side than on the placebo one (p<0.01). The decrease in GCF volume was also greater on the laser side, 0, 12 microl, than on the placebo side, 0.05 microl (p=0.01). The total amount of MMP-8 increased on the placebo side but was slightly lower on the laser side (p=0.052). Elastase activity, IL-1beta concentration and the microbiological analyses showed no significant differences between the laser and placebo sides. CONCLUSION: Additional treatment with low-level lasers reduced periodontal gingival inflammation.     

Comparison of Nd:YAG laser versus scaling and root planing in periodontal therapy

BACKGROUND: The Nd:YAG laser has recently been used in the treatment of periodontal disease. However, although a clinical reduction of probing depth and gingival inflammation to this new approach has been reported, it has not been fully evaluated. Interleukin-1 beta (IL- 1beta), a potent stimulator of bone resorption, has been identified in gingival crevicular fluid (GCF), which is closely associated with periodontal destruction. The aim of this study was to compare the effects of Nd:YAG laser treatment versus scaling/root planing (SRP) treatment on crevicular IL-1beta levels in 52 sampled sites obtained from 8 periodontitis patients. METHODS: One or 2 periodontitis-affected sites with a 4 to 6 mm probing depth and horizontal bone loss from 3 adjacent single-root teeth in each of 4 separate quadrants were selected from patients for clinical documentation and IL-1beta assay. Sampling site(s) from each diseased quadrant was randomly assigned to one of the following groups: 1) subgingival laser treatment (20 pps, 150 mJ) only; 2) SRP only; 3) laser treatment first, followed by SRP 6 weeks later; or 4) SRP first, followed by laser therapy 6 weeks later. The GCF was collected and the amount of IL-1beta was assayed by enzyme-linked immunosorbent assay (ELISA). Clinical parameters and GCF were measured at baseline and biweekly after therapy for 12 weeks. RESULTS: An obvious clinical improvement (marked decrease in the number of diseased sites with gingival index > or =2) and reduction of crevicular IL- 1beta were found in all groups. The level of IL- 1beta was significantly lower in the SRP group (P = 0.035) than in the laser therapy group for the duration of the 12 weeks. The laser combined SRP therapy group showed a further reduction of IL- 1beta (6 to 12 weeks after treatment) than either laser therapy alone or SRP combined laser therapy. CONCLUSIONS: Our data suggest that laser therapy appeared to be less effective than traditional SRP treatment. Of the 4 treatment modalities, inclusion of SRP was found to have a superior IL- 1beta response, when compared to other therapies without it. In addition, no additional benefit was found when laser treatment was used secondary to traditional SRP therapy.     

阿奇霉素辅助Ⅲ/Ⅳ期牙周炎患者非手术治疗的临床疗效及其对唾液微生物群落的影响

目的 评价全身应用阿奇霉素辅助治疗对Ⅲ/Ⅳ期牙周炎患者非手术治疗的临床疗效及其对唾液微生物群落的影响。方法 纳入40例Ⅲ/Ⅳ期牙周炎患者作为研究对象,随机分为常规非手术治疗组(SRP组)和阿奇霉素辅助非手术治疗组(AZI组)。在基线、SRP后第3天和第6周3个时点进行临床检查和唾液采集。通过临床检查分析两组患者临床治疗效果;通过16S rRNA测序分析唾液微生物组,确定各分类单元丰富度、多样性和相对丰度的差异。结果 与基线相比,两组患者治疗后所有临床指数均显著改善(P<0.001)。与SRP组相比,在治疗后第3天和第6周,AZI组的临床附着丧失(clinical attachment loss, CAL)和探诊出血(bleeding on probing, BOP)的改善更显著(P<0.05),但探诊深度(probing depth, PD)的改善仅在治疗后第6周时更明显(P<0.05)。位点水平分层统计结果显示,AZI组治疗后位点水平牙周指标优于SRP组。AZI组治疗后所有α多样性指数均显著降低(P<0.05),而SRP组仅Sobs指数治疗后第3天有短暂降低。...     

牙周微创非手术治疗对薄龈生物型牙周炎患者上前牙区的疗效评价

目的 探讨薄龈生物型牙周炎患者上前牙区患牙实施牙周微创非手术治疗(minimally invasivenon-surgical therapy, MINST)的临床必要性。方法 选取2020年5月至2021年9月在南京医科大学附属口腔医院牙周科就诊的Ⅲ期/Ⅳ期薄龈生物型牙周炎患者18例,随机分成2组,针对上前牙,一组患者行牙周微创非手术治疗(MINST组),另一组行传统龈下刮治和根面平整术(subgingival scaling and root planing, SRP)(SRP组)。比较基线、术后3个月和术后6个月时患者的探诊深度(probing depth, PD)、临床附着丧失(clinical attachment loss, CAL)、牙龈退缩(gingival recession, GR)和探诊出血(bleeding on probing, BOP)阳性率指标变化及差异。术后即刻和术后1周记录受试者疼痛/不适的视觉模拟评分(visual analog scale, VAS),术后6个月记录受试者对治疗结果的VAS评分并进行美学效果的满意度调查。结果 无论基线位点的PD如何...     

Relationship of changes in interleukin-8 levels and granulocyte elastase activity in gingival crevicular fluid to subgingival periodontopathogens following non-surgical periodontal therapy in subjects with chronic periodontitis

OBJECTIVES: To determine the effect of scaling and root planing (SRP) on the interrelations of subgingival periodontopathogens and both interleukin-8 (IL-8) and granulocyte elastase activity in gingival crevicular fluid (GCF), and to assess their relations to the short-term treatment response in management of chronic periodontitis. MATERIAL AND METHODS: GCF and subgingival plaque were collected from 16 subjects with untreated chronic periodontitis at baseline and 4 weeks after SRP. IL-8 levels were determined by ELISA. Granulocyte elastase activity was analyzed with a specific substrate, pGluProVal-pNA, and the maximal rate of elastase activity (MR-EA) was calculated. 5 DNA-probes were used to detect the presence of A. actinomycetemcomitans (A. a.), B. forsythus (B.f.), P. gingivalis (P.g.), P. intermedia (P.i.), and T. denticola (T.d.), with a sensitivity = 103 cells/paper point. RESULTS: IL-8 and MR-EA levels in GCF decreased significantly after SRP (p < 0.001) with a corresponding reduction of total count of the species. Of the sites with probing depth (PD) >/= 5.0 mm and co-infection by B.f., P.g., P.i. & T.d. at baseline, the sites without persistent co-infection of these species after SRP exhibited a significant reduction of IL-8 levels (p < 0.02), MR-EA levels (p < 0.02) and PD (p < 0.01). No such change was found in the sites where such a co-infection persisted. Moreover, reduction of IL-8 levels in those pocket sites was accompanied by a concomitant reduction of MR-EA (p < 0.02) and PD (p < 0.01), while no significant change in MR-EA levels and PD was noted in those pocket sites that exhibited an increase of IL-8 levels after SRP. At baseline, the former group of sites showed significantly higher IL-8 levels than the latter group of sites (p < 0.02). CONCLUSIONS: IL-8-related granulocyte elastase activity was related to the change in infection patterns of the target periodontopathogens following scaling and root planing. Varying initial IL-8 levels in GCF and a corresponding shifting change of granulocyte elastase activity in GCF may characterize the different short-term treatment responses.     

Effects of Nd:YAG and CO2 laser treatment and ultrasonic scaling on periodontal pockets of chronic periodontitis patients

BACKGROUND: The aim of the present study was to compare the effectiveness of Nd:YAG and CO2 laser treatment to that of ultrasonic scaling used as monotherapies by examining clinical parameters, subgingival microflora, and interleukin-1 beta (IL-1beta) in gingival crevicular fluid (GCF). METHODS: Eighteen patients, each of whom had 2 or more sites with probing depth measuring > 5 mm, were included this clinical trial. The 41 sites were randomly assigned treatment with either Nd:YAG laser alone (n = 14, 100 mj, 20 pps, 2.0 W, 120 seconds), CO2 laser alone (n = 13, 2.0 W, 120 seconds), or ultrasonic scaling alone (n = 14, maximum power, 120 seconds). At baseline and at 1, 4, and 12 weeks, clinical measurements (plaque index, PI; gingival index, GI; probing depth, PD; clinical attachment level, CAL; and bleeding on probing, BOP) were performed and subgingival plaque and GCF sampled. A quantitative analysis of Porphyromonas gingivalis was carried out using real-time polymerase chain reaction (PCR) procedures. The amounts of IL-1beta were estimated by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Decreased inflammation and PD were observed in all 3 groups after treatment. A microbiological analysis indicated significant decreases in P. gingivalis in the Nd:YAG and scaling groups at 1, 4, and 12 weeks compared to baseline (P < 0.05). The amount of GCF significantly decreased in the Nd:YAG and scaling groups at 12 weeks. The amount of IL-1beta increased in the CO2 group from baseline to 1 week (P < 0.05). The Nd:YAG group tended to show a decrease in IL-1beta from 1 to 12 weeks, although these data were not statistically significant. CONCLUSIONS: Our data suggest that Nd:YAG laser and ultrasonic scaling treatments showed significant improvements regarding the clinical parameters and subgingival microflora compared to the baseline, but no significant difference was observed between the 3 groups.