Microbial and clinical measurements of periodontal pockets during sequential periods of non-treatment, mechanical debridement and metronidazole therapy

Microbial and clinical parameters were studied in 11 subjects with chronic inflammatory periodontitis. 2 periodontal pockets per subject were studied longitudinally. The microbial parameters included counts of different subgingival micro-organisms by dark field microscopy, counts of the total colony forming units (c.f.u.) on anaerobic blood agar, the facultative anaerobic counts and counts of black-pigmented Bacteroides, Fusobacterium and E. corrodens. The clinical parameters were probing pocket depth, bleeding after probing and crevicular fluid production. Clinical and microbial observations were compared during 3 consecutive periods of non-treatment, debridement and metronidazole therapy. The experimental sites were debrided by deep scaling while no debridement was carried out at the control sites. The effect of this treatment was studied over a period of 3 months. Then, at the experimental sites, a 2nd session of debridement was followed by administration of metronidazole. The effect of metronidazole alone and combined with mechanical debridement was studied during a subsequent 3-month period. The disease activity did not correlate with the microbial parameters and was evident in the presence as well as in the absence of black-pigmented Bacteroides. A single session of subgingival debridement resulted in significant reductions in probing depth, spirochetes, motile organisms, black-pigmented Bacteroides and E. corrodens. Repopulation of the subgingival sites was observed. However, the composition of the subgingival microbiota remained significantly changed during the 3 months after debridement. The re-isolation of the same Bacteroides-species and the same B. gingivalis type after treatment indicated an outgrowth of micro-organisms remaining at these sites.(ABSTRACT TRUNCATED AT 250 WORDS)     

高压氧结合龈上下洁治治疗牙周炎的疗效观察

目的：探讨高压氧(HBO)结合龈上下洁治对牙周炎的治疗效果。方法：将牙周炎患者随机分为3组：龈上下洁治治疗组、HBO治疗组、HBO结合龈上下洁治治疗组，比较3种疗法治疗前后牙周炎各临床参数及龈沟液中天冬氨酸转氨酶(GCF—AST)水平的变化。结果：3种疗法对牙周炎均有不同程度的疗效，以HBO结合龈上下洁治对牙周炎的治疗效果最好。结论：HBO结合龈上下洁治对牙周炎有协同治疗作用。     

A Systematic Review and Meta-analysis of Clinical,Immunological, and Microbiological Shift in Periodontitis After Nonsurgical Periodontal Therapy With Adjunctive Use of Probiotics

ObjectivesThere is a lack of evidence regarding long-term effects of probiotics as adjuncts to nonsurgical periodontal therapy (NSPT) in the management of periodontitis. Therefore, this systematic review aimed to evaluate the clinical, microbiological, and immunological outcomes of probiotics applied as an adjunct to NSPT with at least 3 months of follow-up.MethodsElectronic searches of 5 databases were performed. Clinical trials that compared the adjunctive use of probiotics in NSPT with NSPT alone, reporting clinical or immunological or microbiological outcomes, were selected. The primary clinical outcome variables were clinical attachment level (CAL) and probing pocket depth (PPD). Meta-analyses were conducted to evaluate the efficacy of probiotics over different longitudinal intervals.ResultsTen randomized controlled trials were included, and high heterogeneity in methods was noted. Meta-analysis revealed CAL gain, and PPD reduction in the probiotics group was significant at 3 months and 12 months, but no significant difference was noted at 6 months and 9 months. There was no significant difference in periodontal pathogen levels between groups at 3 months. Immunological data were not sufficient for quantitative analysis. Ancillary sensitivity analysis indicated a subset of studies with severe mean baseline PPD (≥5 mm) at baseline showed significant and more CAL gain and PPD reduction at 3 months, with probiotics administration of 2-4 weeks.ConclusionHeterogenous evidence implied a long-term clinical benefit of probiotics as an adjunct to NSPT. Outcomes may be impacted by baseline disease severity. Limited microbiological and immunological data precluded any conclusive findings. Current evidence is insufficient to formulate clinical recommendations.     

牙周炎致错位前牙正畸治疗后牙根吸收的临床研究

目的：观察牙周炎导致的唇向散开前牙经正畸治疗后牙根吸收情况,并与牙周健康的正畸患者进行比较。方法：选择安氏Ⅰ或Ⅱ1前牙散在间隙的成人牙周炎患者和牙周健康的成人正畸患者各12例,均无需拔牙,采用MBT直丝弓固定矫治,应用Nemoceph头影测量软件测量矫治前后前牙的牙冠与牙根比值,并作配对t检验,判断其牙根吸收程度。结果：矫治后两组均有轻度牙根吸收（P〈0.05）,牙周炎组牙根吸收程度较牙周健康组大,但二组间差别无统计学意义。结论：牙周炎患者和牙周健康患者正畸治疗后牙根均有一定程度吸收,但是可接受的。牙周炎患者通过正畸关闭前牙散在间隙并不会加重牙根吸收。     

Treatment of peri-implantitis by local delivery of tetracycline. Clinical, microbiological and radiological results

The purpose of this study was to investigate the clinical, microbiological and radiological effects of peri-implantitis therapy by local delivery of tetracycline. In 25 partially edentulous patients, 30 implants with radiographic evidence of circumferential bone loss, and peri-implant probing depths > or =5 mm were treated with polymeric tetracycline HCl-containing fibers. Clinical and microbial parameters were recorded at baseline, and 1, 3, 6, and 12 months (M) after treatment. Standardized radiographs were obtained at baseline, M3, and one year after treatment. Two patients were discontinued from the study after 180 days because of persisting active peri-implantitis with pus formation. The remaining subjects showed a significant decrease of mean peri-implant probing depth from 6.0 to 4.1 mm (M1, P<0.001), which was maintained over 12 months. In comparison to baseline, the bleeding tendency was significantly reduced after one month, and thereafter (P<0.001). No significant recession of the mucosal margin was noted. The radiologically determined distance from the shoulder of the implant to the bottom of the bony defect decreased slightly, but not significantly, from 5.2 to 4.9 mm. At M1, M3 and M6, mean total anaerobic cultivable bacterial counts were significantly lower than at baseline (P<0.001). A significant decrease in frequency of detection was noted for Prevotella intermedia/nigrescens, Fusobacterium sp., Bacteroides forsythus, and Campylobacter rectus (P<0.01). Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Eikenella corrodens had very low baseline frequencies that could not be significantly suppressed further. In conclusion, therapy of peri-implantitis by local delivery of tetracycline had a positive effect on clinical and microbiological parameters.     

根面平整术治疗单纯性牙周炎临床和细菌学研究

目的 通过治疗,将牙周袋内含有大量内毒素的病变牙骨质刮除,使新附着产生。方法 用根面平整术和龈上洁治术治疗牙周炎,并追踪观察一年。结果 龈上洁治术（对照组）有效率为43%。根面平整术（治疗组）有效率为79%。结论 根面平整术在牙周基础治疗中具有重要作用。     

牙周炎患者牙周袋内硫化物水平与牙周临床指标的相关分析

目的评价牙周炎患者牙周袋内硫化物（pS）与口气挥发性硫化物（VSC）及牙周临床指标的相关性。方法全口洁治后1周，对20例慢性牙周炎伴口臭的患者龈下刮治和根面平整（SRP）前后用Halimeter检测口气中VSC，用金刚探针检测pS，并对牙周袋内pS及菌斑指数、出血指数、探诊深度、临床附着水平纵向观察6个月。结果口内pS〉0的位点数（r=0．592，P〈0．001）和ps值（r=0．506，P〈0．001）与口气VSC均呈显著正相关；治疗后6周、3个月、6个月，pS与出血指数呈低度相关，r值分别为0．183、0．411、0．350（P〈0．05）；SRP后6周，pS及各临床指标较基线水平显著改善（P〈0．001），并在第3、6个月时进一步改善或保持稳定。结论pS值可以特异性地反映牙周袋内硫化物的水平，可作为牙周疗效判断的客观指标，反映和监测维护期的牙周组织炎症状况。     

粘结夹板对于前牙重度牙周炎的疗效观察

目的:评价复合树脂粘结牙周夹板对重度牙周炎所致松动前牙的治疗效果。方法:临床完成36例尼龙丝增强复合树脂牙周夹板制作,以USPHS标准和牙周检查指数评价牙周夹板的1~3年随访结果。结果:牙周夹板修复后1年,PD、AL指数显著降低,90%修复体3年后仍保持完好。结论:粘结夹板是保存重度牙周炎松动患牙的一种可靠、有效的方式。     

可摘式牙周夹板修复治疗牙周炎的临床效果分析

目的：评价可摘式牙周夹板对牙周炎伴牙列缺损患者的修复效果。方法：选取40例,随机分为2组,每组20例。两组患者行牙周基础治疗后,分别采用可摘式牙周夹板修复和可摘局部义齿修复,观察并记录不同时段各相关牙周指数。结果：可摘式牙周夹板组修复后24个月时菌斑指数（ plaque index,PLI）和出血指数（ bleeding in-dex,BI）较修复前增加（P＜0.05）;但修复后12个月和24个月时牙周探诊深度（periodontal probing depth,PD）较修复前下降,差异均有统计学意义（P＜0.05）。可摘局部义齿修复组修复后12个月和24个月时均出现PLI、BI和PD较修复前明显增加（P＜0.05）。结论：可摘式牙周夹板可改善牙周炎伴有牙列缺损患者的牙周状况,其修复疗效优于可摘局部义齿。     

Expression of HMGB1 and HMGN2 in gingival tissues, GCF and PICF of periodontitis patients and peri-implantitis

Background and objective

High mobility group chromosomal protein B1 (HMGB1) and N2 (HMGN2), two members of high mobility group (HMG) family, play important role in inflammation. The purpose of this study was to investigate the expression of HMGB1 and HMGN2 in periodontistis.

Materials and methods

The expression of HMGB1 and HMGN2 mRNA in gingival tissues and gingival crevicular fluid (GCF) in chronic periodontitis (CP), generalised aggressive periodontitis (G-AgP) patients and healthy subjects was detected by real-time PCR. The protein level of HMGB1 and HMGN2 in peri-implant crevicular fluid (PICF), peri-implant crevicular fluid of peri-implantitis (PI-PICF) and normal patients was determined by Western blotting. Furthermore, IL-1β, IL-6, IL-8, TNF-α and HMGB1 levels in GCF, PI-PICF and healthy-PICF samples from different groups were determined by ELISA.

Results

HMGN2 expression was increased in inflamed gingival tissues and GCF from CP and G-ApG groups compared to control group. HMGB1 expression was the highest in the gingival tissues and GCF from CP patients and was accompanied by increased concentrations of IL-1β, IL-6, IL-8 proinflammaory cytokines.

Conclusion

To our knowledge, this is the first study reporting that the expression of HMGB1 and HMGN2 was increased in the gingival tissues and GCF in CP and G-AgP and the PICF in PICF. Our data suggest that HMGB1 may be a potential target for the therapy of periodontitis and PI.     

牙周洁治和刮治对牙龈微循环的作用研究

目的探讨牙周洁治和刮治对牙龈血流量(GBF)、血流速度(BCV)和血浓度(BC)等微循环指标和牙周临床指标的影响。方法选慢性牙周炎(CP)患者20例、侵袭性牙周炎(AgP)和牙龈炎(G)患者各10例,选健康人(H)10例作为对照,用激光多普勒血流仪测定牙周洁刮治前后患者的GBF、BCV和BC及牙龈指数(GI)、菌斑指数(PLI)、牙周探诊深度(PD)、附着丧失(AL)的变化,并与健康组比较。结果治疗后1周时CP组、AgP组和G组患者GBF和BCV较治疗前均明显增加,BC较治疗前明显降低,CP组患者GBF,BCV和BC值与AgP组有非常显著性差异(P<0.01);治疗后CP组,AgP组和G组GI和PLI明显降低,CP组和G组PD和CP组的AL明显降低,AgP组PD和AL轻度降低;治疗后1个月时各组GBF,BCV和BC和牙周临床指标与治疗后1周时无显著性差异。结论牙周洁治和刮治对牙龈微循环指标有明显改善作用,其临床治疗作用与牙龈微循环改善密切相关。     

牙周治疗在牙周-牙髓联合病变中的应用效果评价

目的 评价牙周治疗在牙周-牙髓联合病变中的疗效。方法 选择109例牙周-牙髓病变患者（120颗患牙）,所有患牙均经完善的根管治疗,分为A、B 2组。A组为牙周治疗组（60颗患牙）,根管治疗完成2周后行牙周基础治疗;6周后仍有5 mm以上牙周袋且探诊后出血者,进行翻瓣术治疗。B组为非牙周治疗组（60颗患牙）,单纯行根管治疗和龈上洁治术。术后3、6、12、24个月进行随访,观察2组患者牙周探诊深度（PD）、牙槽骨吸收程度、牙松动度（TM）等的变化。采用SPSS 22.0软件包对数据进行统计学分析。结果 A组术前、术后2年PD分别为（5.966±1.877）mm、（5.133±1.935)mm,牙周探诊深度减轻,有统计学差异。B组术前、术后2年PD分别为（5.533±1.856）mm、( 6.167±1.927)mm,牙周探诊深度显著增加。2组术前TM无统计学差异（P>0.05）。术后2年,A组TM显著低于B组（P<0.05）。X线表现,A组术后2年牙槽骨吸收较术前无显著变化（P>0.05）;B组术后2年,牙槽骨吸收较术前显著减轻（P<0.05）。结论 根管治疗结合牙周治疗用于牙周-牙髓联合病变能取得较好的疗效,值得推广应用。     

Risk assessment for clinical attachment loss of periodontal tissue in Korean adults

PURPOSE

The purpose of this study was to assess the prevalence and extent of clinical attachment loss of periodontal tissue and to find out variables related to clinical attachment loss (CAL) in Korean adults older than 40 years of age.

MATERIALS AND METHODS

Data were collected from 2,519 subjects who were part of a cohort study conducted in Ansan city by Korea University Medical School for Korean Genome project. Age, sex, smoking, drinking, fast glucose, blood pressure, obesity and total cholesterol levels were examined. The oral examination included probing pocket depth, gingival recession and CAL of Ramford''s teeth. The severity of periodontitis was classified based on the mean value of CAL. The relationship between each risk factor and the severity of CAL was independently estimated using the chi-square test, the test or one-way ANOVA. Multiple regression analysis was used to determine the significance of each factor in the periodontal disease.

RESULTS

The prevalences of clinical attachment between 1 and 3 mm, between 3 and < 5 mm, and ≥ 5 mm were 80.27%, 16.75% and < 1%, respectively. Although the univariate analysis showed age, gender, smoking, fasting glucose, blood pressure and total cholesterol levels were significantly related to the severity of CAL, multiple regression analysis indicated that age (P < .0001), gender (P < .0001) and smoking (P < .05) were only significantly related.

CONCLUSION

Older age, male gender and smoking were significant risk factor for the increase of CAL, and these may be useful indicators of periodontitis high-risk groups.     

氯己定联合机械清创对种植体周围炎的治疗效果及对患者SF-36评分的影响

目的：研究氯己定联合机械清创对种植体周围炎的治疗效果及对患者SF-36评分的影响。方法：选取2015年1月—2019年1月浙江省人民医院收治的种植体周围炎患者100例,按照随机数字表法随机分为对照组和联合组各50例。2组患者均采用机械清创术进行治疗,联合组在机械清创术后使用氯己定漱口液含漱。对2组患者治疗前、后菌斑生物膜不同层面平均活性、改良菌斑指数（modified plaque index,mPLI）、探诊后出血指数（bleeding on probing,BOP）、改良龈沟出血指数（modification sulcus bleeding index,mSBI）、探诊深度（probing depth,PPD）、临床附着水平（clinical attachment level,AL）进行评价,并使用SF-36评分量表、VAS视觉疼痛评分法对2组患者生活质量、疼痛程度进行评价,评定治疗效果及统计并发症发生情况。采用SPSS 20.0软件包对数据进行统计学分析。结果：治疗前2组患者菌斑生物膜不同层面平均活性、mPLI、mSBI、AL、PPD、BOP、VAS、SF-36评分比较,无显著差异（P>0.05）;治疗后联合组患者菌斑生物膜不同层面平均活性、mPLI、mSBI、AL、PPD、BOP、VAS评分均低于对照组,SF-36评分高于对照组,治疗总有效率显著高于对照组（P<0.05）。联合组患者治疗过程中并发症发生率显著低于对照组（P<0.05）。结论：氯己定联合机械清创对种植体周围炎患者进行治疗,效果显著,可有效抑制菌斑生物膜活性,抑制菌斑形成,减轻患者疼痛,提高生活质量。     

The relationship of initial clinical parameters to the long-term response in 112 cases of periodontal disease

The purpose of the present study was to determine whether any of the clinical parameters recorded during an initial periodontal examination would relate to the course of periodontal cases maintained for long periods of time. Based on available documentation, cases which had a downhill course were assembled from a population previously studied. In addition, long-term cases currently under maintenance care were drawn from our private practice. On average, the patients had been under care for 23 years. The study population was heavily weighted toward downhill cases to better compare these cases with those usually found in periodontal practice. Positive statistical correlations were found between the amount of subgingival calculus and the degree of gingival inflammation at initial examination. Disease severity initially was positively correlated to long-term course of disease. The amount of subgingival calculus did not relate to the long-term result. There was a strong correlation between inflammatory gingival hyperplasia initially and good long-term maintenance. The results suggest that, in combination, initial characteristics of periodontal cases coupled with long-term results of treatment may aid in further subclassifying the periodontal diseases.     

椅旁健康教育对慢性牙周炎患者维护期口腔卫生状况的影响

目的探讨椅旁健康教育对慢性牙周炎患者维护期口腔卫生状况的影响。方法 120例慢性牙周炎患者随机分为实验组和对照组,均给予洁治、龈下刮治和根面平整,实验组同时给予全面的口腔健康教育。于基线、基线后1、3、6个月检查Quigley-Hein菌斑指数。采用两组完全随机化设计资料均数的t检验分析所得数据。结果基线、基线后1个月时,两组间菌斑指数差异无统计学意义（t0=1.543,P0=0.1227;t1=1.925,P1=0.063）;基线后3、6个月时,实验组菌斑指数显著低于对照组（t3=19.153,P3=0.001;t6=25.265,P6=0.001）。结论实施全面的口腔健康教育可以显著改善牙周炎患者的口腔卫生状况。     

牙周炎患者种植义齿修复5年回顾性研究

目的比较牙周炎与牙周健康患者牙列缺损行种植修复后的疗效差异。方法采用回顾性分析的研究方法。牙列缺损患者44例,共植入种植体80颗,慢性牙周炎患者病情稳定后植入种植体40颗（牙周炎组）,牙周健康者植入种植体40颗（牙周健康组）,计算2组修复后5年种植体的存留率,测量种植体周骨吸收量,对2组的种植体存留率比较采用卡方检验,对2组种植体周骨吸收量的比较采用配对t检验。结果牙周炎组及牙周健康组种植体5年存留率分别为95.0%、97.5%,差异无统计学意义（χ2=0.346,P〉0.05）。牙周炎组及牙周健康组种植体周骨吸收量分别为（2.34±0.72）mm、（1.76±0.68）mm,差异有统计学意义（t=3.7,P〈0.05）。结论牙周炎患者种植修复边缘骨吸收显著增加,为种植修复的危险因素之一。