Use of antimicrobial agents during supportive periodontal therapy

Individual susceptibility to periodontal breakdown involves an interplay of genes, periodontal pathogens and other modulating factors. Anti-infective treatment, which includes oral hygiene measures, mechanical debridement, pharmacologic intervention and surgery, has been shown to be effective in arresting the progression of periodontal disease. Nevertheless, due to the chronic nature of the disease, susceptible individuals who are not maintained in a supervised recall program subsequent to the active treatment phase, show signs of recurrent destruction. Supportive periodontal therapy (SPT) is an integral part of periodontal treatment for patients with history of periodontitis, and is needed to prevent recurrence of disease in susceptible individuals. To prevent re-infection with periodontal pathogens, SPT includes elimination of dental plaque and bacteria from the oral cavity, thereby preventing the recurrence of pathogens into the gingival area. For individuals at risk of developing periodontitis, SPT should combine self-performed and professional anti-infective therapy, using mechanical and pharmacological means. The existing evidence suggests that the adjunctive use of antimicrobial pharmacologic therapy during SPT may enhance the results of mechanical debridement. The use of antimicrobials varies between patients, and is dependent on risk assessment and longitudinal monitoring of the clinical status of the periodontium.     

Efficacy of bone-fill favoring treatment on juvenile periodontitis

In this study we evaluated the effect of bone-fill favoring mechanical treatment on the marginal bone level and periodontal pockets of juvenile periodontitis patients. A total of 10 patients (3 men and 7 women) 13–29 yr of age were treated until no gingivitis or periodontal pockets were present. The intensive therapy (3–8 wk) included scaling, curettage and modified Widman flaps. The maintenance therapy comprised 4 recall visits during the first year after therapy and 2–5 visits per year thereafter. The efficacy of the therapy was evaluated by radiologic measurements of bony defects (%) 12 and 16–65 months after the treatment. The results showed a significant improvement both 1 yr after treatment and at the end of the study. The bone loss was 10.1% less than prior to the treatment and no sites with new bone loss were found after therapy in any of the patients. The bulk of healing took place during the first year after the active therapy, while some further improvement was detected thereafter. Our results show that non-resective mechanical treatment allows excellent healing and regeneration of JP lesions. Our findings also suggest that an adequate follow-up period is needed before definite conclusions can be drawn about the efficacy of the treatment procedures used.     

Comparison of salivary levels of mucin and amylase and their relation with clinical parameters obtained from patients with aggressive and chronic periodontal disease

Objective

Salivary mucin and amylase levels are increased in patients with chronic periodontitis (CP). Due to the fact that aggressive periodontitis (AgP) not only differs from chronic periodontitis in terms of its clinical manifestation, the aim of this study was to compare salivary mucin and amylase levels and their relation to the clinical parameters of patients with aggressive periodontitis with that of patients with chronic periodontitis.

Material and Methods

Eighty subjects were divided into two groups: 20 patients with AgP and their 20 matched controls and 20 patients with CP and their 20 matched controls, based on clinical attachment loss (CAL), probing pocket depth (PPD) and bleeding on probing (BOP). Whole unstimulated saliva was obtained and mucin, amylase and protein were determined by colorimetric methods. Pearson’s correlation analysis was used to determine the relationship between salivary mucin, amylase and protein levels and the clinical parameters.

Results

Salivary mucin, amylase and protein levels were increased in patients with AgP and CP but there were no differences between them or between control groups. Pearson’s correlation analysis, determined in the entire subjects studied, showed a positive and significant correlation of mucin, amylase and proteins with CAL and PPD and a negative correlation with the flow rate. When Pearson’s correlation analysis was carried out in each group separately, Fisher’s z transformation showed no significant difference between both groups.

Conclusion

Comparison of the salivary levels of mucin, amylase and protein and their relationship with clinical parameters of AgP patients with that of CP patients revealed no differences between both groups.     

侵袭性牙周炎和慢性牙周炎的龈下优势菌分析

目的 :分析侵袭性牙周炎 (aggressiveperiodontitis ,AgP)与慢性牙周炎 (chronicperiodontitis ,CP)的龈下优势菌群 ,为探讨牙周炎分类、病因和诊断提供实验依据。方法 :将中学生流调筛选 (16例 )及牙周病专科就诊(2 4例 )的AgP和CP患者 ,采集龈下菌斑样本 ,在厌氧菌基础培养基 (CDC)和选择性培养基 (TSBV)上培养分析。结果 :局限型AgP患者的伴放线放线杆菌 (Actinobacillusactinomycetemcomitans ,Aa)及兼性厌氧菌的检出率显著高于中度CP患者 (P <0 .0 5 ,P <0 .0 1) ,而广泛型AgP和重度CP患者的厌氧菌总数较局限型AgP和中度CP患者显著增加 (P <0 .0 5 )。结论 :局限型AgP和中度CP的龈下优势菌有明显差别 ,Aa是一个重要的危险因子。     

Effect of non-surgical treatment on chronic and aggressive periodontitis: clinical, immunologic, and microbiologic findings

Background: Our goal was to examine differences in clinical, microbiologic, and immunologic responses to non‐surgical mechanical therapy in patients with generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP). Methods: Twenty patients with GCP and 14 patients with GAgP were evaluated. Clinical data, gingival crevicular fluid (GCF), and subgingival plaque samples were collected at baseline and 3 months after non‐surgical periodontal treatment. Levels of 40 subgingival species were measured using checkerboard DNA‐DNA hybridization. GCF interleukin (IL)‐1β, ‐4, and ‐8 and interferon‐γ (IFN‐γ) were analyzed using a multiplexed bead immunoassay, and elastase activity was measured using an enzymatic assay. The significance of changes with time was examined using the Wilcoxon rank sum test. Changes in clinical, microbiologic, and immunologic parameters after therapy were compared between groups using the Mann‐Whitney U test. Results: After periodontal therapy, we found significant improvements for all clinical parameters in both groups. We also observed significant reductions in elastase activity in shallow and deep sites from the GAgP group and in deep sites from the GCP group. Microbiologic data showed significant reductions in proportions of orange and red complexes and an increase in proportions of Actinomyces species in both clinical groups. When the clinical, microbiologic, and immunologic responses after therapy were compared between groups, only minor differences were found. Conclusion: This study fails to show any significant differences between severe forms of GCP and GAgP in response to non‐surgical periodontal treatment.     

侵袭性牙周炎与慢性牙周炎病变位点中人巨细胞病毒的定量检测

目的 应用实时荧光定量PCR方法 检测侵袭性牙周炎(AgP)及慢性牙周炎(CP)患者龈下样本中人巨细胞病毒(HCMV)的DNA载量,探讨HCMV感染与牙周炎之间的关系.方法 选择18例AgP患者、24例CP患者及15例牙周健康对照者,收集龈下样本114例.构建含有HCMV高保守片段的重组质粒,制备标准品DNA模板,建立...     

Individual Composition of Human Leukocyte Antigens and Periodontopathogens in the Background of Periodontitis

Background : Human leukocyte antigens (HLAs) are a basic precondition to induce the immune response to pathogens. Therefore, this study evaluates associations among periodontitis, five key periodontopathic bacteria, and HLAs to test their impact together with additional risk factors in multivariate analyses. Methods: Eighty‐five patients with generalized aggressive periodontitis (GAgP) and 71 patients with generalized chronic periodontitis (CP) were compared to 88 periodontitis‐free controls. HLA Class I and II typing was performed by polymerase chain reaction (PCR) with sequence‐specific primers. Subgingival plaque specimens were detected by PCR with sequence‐specific oligonucleotides. Risk‐factor analyses were performed with respect to the cofactors age, sex, smoking, and plaque level by logistic regression. Results: In the total patient group (GAgP + CP), the adjusted odds ratio (OR) of periodontitis was decreased in cases who were carriers of HLA‐B*57 (OR = 0.259, 95% confidence interval [CI] = 0.086 to 0.782), HLA‐DQB1*08 (OR = 0.404, 95% CI = 0.187 to 0.871), or the combination HLA‐DRB1*04;DRB4*;DQB1*0302 (OR = 0.407, 95% CI = 0.185 to 0.895). Moreover, individuals who expressed HLA‐DRB1*04 (OR = 0.36, 95% CI = 0.148 to 0.886) or HLA‐DRB1*04;DRB4*;DQB1*0302 (OR = 0.29, 95% CI = 0.092 to 0.884) had a decreased colonization risk with Aggregatibacter actinomycetemcomitans. Conclusions: Certain HLA markers were negatively associated to the manifestation of a generalized periodontitis and/or the individual colonization of A. actinomycetemcomitans. The underlying mechanisms have to be investigated in future studies.     

A retrospective radiographic study of alveolar bone loss in the primary dentition in patients with localized juvenile periodontitis

Lately, it has been questioned whether localized juvenile periodontitis (LJP) is restricted to the permanent dentition, or if it sometimes might have a prepubertal onset, involving the primary dentition. To clarify this question, 17 patients with LJP, together with 17 non-LJP matched controls, were retrospectively examined for radiographic signs of alveolar bone destruction in their primary dentitions. All LJP subjects but one showed localized marginal bone loss, whereas no bone loss was observed among the controls. The results suggest that at least some cases of LJP start in the primary dentition prior to the involvement of the permanent teeth.     

Occurrence of Bacteroides gingivalis, Bacteroides intermedius and Actinobacillus actinomycetemcomitans in severe periodontitis in relation to age and treatment history

A total of 242 subjects including 138 untreated severe periodontitis patients and 104 patients with refractory periodontal disease, previously treated for severe periodontitis, were examined for the occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius. Pooled subgingival samples of representative periodontal lesions were used for anaerobic cultivation on blood agar and for the enumeration of A. actinomycetemcomitans on selective TSBV medium. 97% of the untreated patients were infected with one or more of the test micro-organisms. In this patient group, the occurrence of A. actinomycetemcomitans, B. gingivalis and B. intermedius was 54%, 48% and 63%, respectively. The prevalence of A. actinomycetemcomitans positive patients appeared to be age related and decreased with increasing age. Likewise, the number of patients solely infected with A. actinomycetemcomitans decreased with increasing age. The prevalence of B. gingivalis infected patients appeared to increase with increasing age. These phenomena were not observed in the refractory periodontitis patients. The occurrence of A. actinomycetemcomitans, B. gingivalis and B. intermedius in the refractory periodontitis group was 55%, 27% and 59%, respectively. A statistical significant difference in the prevalence of B. gingivalis was found between the untreated and the refractory periodontitis patients. In both patient groups, the relative proportion of A. actinomycetemcomitans was significantly higher in subjects with this bacterium as the sole indicator micro-organism than in patients who, besides being infected with A. actinomycetemcomitans, were also infected with black-pigmented Bacteroides species. Furthermore, in comparison with untreated patients, unsuccessfully treated patients solely infected with A. actinomycetemcomitans had on average a lower number but also a higher mean % of this bacterium.(ABSTRACT TRUNCATED AT 250 WORDS)     

β-防御素基因在牙龈组织中的表达

目的:检测人β-防御素(HBD-1,-2,-3)基因在牙周炎病变和健康牙龈组织中的表达。方法:应用反转录多聚合酶链反应(RT-PCR)技术检测健康牙龈(HC组,11例)、慢性牙周炎(CP组,12例)和侵袭性牙周炎(AgP组,9例)牙龈组织中HBD-1、HBD-2和HBD-3mRNA表达水平。结果:HBD-1,-2,-3在所有牙龈组织样本中均有mRNA表达;HBD-3mRNA在HC组、CP组、AgP组的表达水平分别为0.53±0.12,0.30±0.17和0.40±0.17,3组间差异有统计学意义(P<0.01),健康牙龈中HBD-3mRNA表达相对强度明显高于慢性牙周炎组;HBD-2和HBD-3基因的mRNA表达水平呈正相关(P<0.01,r=0.48)。结论:牙龈上皮表达的β-防御素(HBD-1,-2,-3),尤其是HBD-3在健康牙龈组织较高水平的mRNA表达,提示其在牙周宿主免疫防御反应中可能发挥重要作用。     

炎性病变累及下颌神经管的病因及多学科治疗策略

下颌后牙区尤其是下颌第一磨牙根尖到下颌神经管上缘的距离多数仅为1 ~ 4 mm。因此，当下颌后牙区罹患重度牙周炎和（或）根尖周炎时，炎症有可能扩散累及邻近的下颌神经管，引起相应区域的神经感觉异常。此类病例罕见，病情复杂，相应的治疗往往需要多学科医生参与共同完成。笔者根据自己的临床体会结合文献报道就其病因机制及多学科治疗策略做一梳理。     

悬突对牙周状态及龈下菌斑的影响

目的：从微生态学角度探讨悬突引起牙周炎的机制，揭示悬突对牙周组织的危害性。方法：检测568个有悬突牙及568个对照牙的G1和PD，采集龈下菌斑以刚果红染色，测其龋下菌群的细菌组成。结果：悬突牙组的GI、PD明显高于对照组，其螺旋体、杆菌及球菌较对照牙组有显著性差异。结论：悬突改变牙周微生态环境，使龋下菌群细菌组成发生变化；临床治疗中要加强悬突的防治。     

Bacterial penetration of pocket soft tissues in chronic adult and juvenile periodontitis cases

This study investigates bacterial invasion of the soft tissue walls of deep pockets from cases with adult (AP) and juvenile periodontitis (JP). Transmission electron microscopy was used to examine pocket soft tissue walls removed from extracted teeth from 5 patients with AP and 2 patients with JP. Bacteria were sparse throughout the epithelium and connective tissue, regardless of the level of tissue breakdown. However many inflammatory cells were seen, and these did appear to be located in regions of marked collagen loss. Accumulations of large numbers of bacteria were extremely rare and found only on the epithelial surface or in artefactual spaces within the deeper tissues. The findings indicate that the tissue destruction associated with periodontitis is not directly related to bacterial invasion. The sparse organisms within the pocket tissues probably result from passive entry rather than an invasive action. Under these circumstances, it would seem reasonable to suggest that bacterial metabolic products rather than the micro-organisms themselves penetrate the tissues in periodontitis.     

Clinical and Immunoinflammatory Evaluation of One‐Stage Full‐Mouth Ultrasonic Debridement as a Therapeutic Approach for Smokers With Generalized Aggressive Periodontitis: A Short‐Term Follow‐Up Study

Background: This study aims to evaluate the effect of one‐stage full‐mouth ultrasonic debridement (OSFMUD) on clinical and immunoinflammatory parameters in smokers with generalized aggressive periodontitis (GAgP). Methods: Fourteen smoking and 14 non‐smoking patients with GAgP were selected. After initial supragingival therapy, patients were treated by OSFMUD. Full‐mouth parameters evaluated were: 1) plaque index (PI); 2) bleeding scores (BS); 3) probing depth (PD); and 4) clinical attachment level (CAL). Clinical evaluation was performed, and gingival crevicular fluid (GCF) was collected for selected sites (ss) at baseline and 1, 3, and 6 months. GCF was analyzed via enzyme‐linked immunosorbent assay for: 1) receptor activator of nuclear factor‐κ B ligand (RANKL); 2) osteoprotegerin (OPG); 3) interleukin (IL)‐6; and 4) tumor necrosis factor (TNF)‐α, whereas secreted osteoclastogenic factor of activated T‐cells (SOFAT) was evaluated by Western blotting. Results: Significant reduction (P <0.05) was observed between baseline and 6 months for: 1) PI; 2) BS; and 3) PD, with no difference between smoking and non‐smoking patients (P >0.05). Regarding CAL, only non‐smoking patients showed a significant decrease (P <0.05). Significant reduction (P <0.05) was observed in both groups for: 1) PIss; 2) PDss; 3) bleeding on probing; and 4) relative CAL. Smoking and non‐smoking patients presented significantly decreased levels of IL‐6 and TNF‐α over time (P <0.05); however, no difference was observed between groups (P >0.05). RANKL was significantly different (P <0.05) only for non‐smokers at 6 months, whereas OPG was not significant (P >0.05). SOFAT expression was significantly lower (P <0.05) after OSFMUD for non‐smokers only. Conclusion: Considering the clinical and immunoinflammatory parameters evaluated in this short‐term follow‐up study, it can be concluded that OSFMUD can be used as an alternative treatment for smokers with GAgP.