多学科联合治疗对成人牙周病患者切牙区牙龈乳头的重建研究

目的:评估多学科联合治疗对成人牙周病患者切牙区牙龈乳头的重建作用。方法:选择19例深覆牙合、不良冠修复致牙周病的患者接受牙周基础治疗、正畸及修复治疗,在全口洁治后获得统一基线,基础治疗后3个月、正畸治疗结束即刻、临时冠修复即刻、6个月及12个月对54颗切牙进行牙周临床检查,比较3个阶段治疗前后的差异。包括:探诊深度(PD),探诊出血(BOP),龈乳头指数(PI),龈乳头高度(PH)。进行χ²检验、非参数秩和检验及单因素方差分析。结果:牙周基础治疗3个月后,11.42%个位点的PD≥4 mm,无PD≥5 mm;95.37%的位点BOP阴性,较基线时明显改善(P<0.05);正畸治疗结束即刻,13.98%个位点的PD≥4 mm,无PD≥5 mm的位点,与牙周基础治疗后3个月的差异无统计学意义;80.56%的位点BOP阴性,与基础治疗后3个月后相比,有统计学差异;临时冠修复即刻、6个月及12个月PD及BOP均无统计学差异;在上述3个时间点PI达到Ⅲ级的龈乳头个数分别为1、8、17,龈乳头完全充盈牙间隙;PI达到Ⅱ级的龈乳头个数分别为13、16、11,差异有统计学意义;PH在3个时间点分别为(1.54±0.54) mm、(2.31±0.56)mm及(3.08±0.50) mm,差异有统计学意义。结论:多学科联合治疗有利于成人牙周病患者切牙牙龈乳头的重建,改善患者前牙区的美学。     

前牙不良冠修复所致牙周病的临床治疗评价

目的：评价牙周基础治疗及牙冠延长术治疗前牙不良冠修复所致牙周病的临床疗效。方法：选取21例前牙冠修复所致牙周病患者共208颗患牙,均采用牙周基础治疗及牙冠延长术后再行全瓷冠修复,分别于基线点、术后8周、修复后3个月分别记录探针出血（BOP）、探诊深度（PD）、患者满意度,观察临床疗效。结果：术后8周BOP、PD较基线点时有统计学差异（P〈0.05）,修复后3个月BOP、PD与冠延长术后8周相比较无统计学差异。修复后患者的满意度为91.7%。结论：牙周基础治疗及牙冠延长术有利于不良冠修复所致牙周病的治疗,且冠延长术解决了生物学宽度的问题,确保了牙周健康的长期稳定。     

Clinical effects of scaling and root planing with an adjunctive periodontal endoscope for residual pockets: a randomized controlled clinical study

目的 比较牙周内窥镜辅助龈下刮治和根面平整（SRP）与传统SRP对慢性牙周炎患者基础治疗后残留牙周袋的临床疗效。方法 将牙周基础治疗后口内每个区至少有1个位点探诊深度（PD）≥5 mm的患者纳入研究,随机分为内窥镜组和SRP组,分别对残留牙周袋位点进行内窥镜辅助SRP治疗和传统SRP治疗。在治疗前（基线）、治疗后3、6个月检查PD、探诊出血（BOP）和附着丧失（AL）,采用SPSS 20.0统计学软件对数据进行统计分析。结果 与基线相比,治疗后3、6个月内窥镜组及SRP组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）。治疗后6个月与3个月相比,内窥镜组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）,而SRP组差异无统计学意义（P>0.05）。与SRP组相比,内窥镜组治疗后3及6个月PD≥5 mm位点百分比、PD均降低,治疗后6个月AL、BOP阳性位点百分比降低（P<0.05）。结论 牙周内窥镜辅助SRP对于基础治疗后的残留牙周袋（PD≥5 mm）的临床疗效优于传统SRP,尤其具有更好的远期预后。     

慢性牙周炎牙周基础治疗前后血清超敏C反应蛋白与单核细胞趋化蛋白-1变化研究

目的    研究慢性牙周炎对血清超敏C反应蛋白（hs-CRP）和单核细胞趋化蛋白-1（MCP-1）浓度的影响。方法    选取2015—2016年于中国人民解放军陆军总医院口腔科门诊就诊的80例牙周炎患者（牙周病组）和40名无牙周炎症状的志愿者（对照组）。初诊记录探诊出血（BOP）、牙周探诊深度（PD）和临床附着丧失（CAL）情况,收集空腹静脉血,检测血清超敏C反应蛋白（hs-CRP）和单核细胞趋化蛋白-1（MCP-1）。对牙周病组进行为期3个月的牙周基础治疗,治疗结束3个月后,再次收集空腹静脉血,检测血清hs-CRP和MCP-1。结果    牙周病组与对照组基线条件无明显差异。对照组hs-CRP和MCP-1浓度为（1.48 ± 1.1）mg/L和（42.3 ± 4.9）mg/L,牙周病组分别为（3.89 ± 2.8）mg/L和（88.7 ± 5.8）mg/L,两组差异有统计学意义（P＜0.05）。牙周治疗结束3个月后,牙周病组hs-CRP和MCP-1浓度为（2.04 ± 1.5）mg/L和（64.2 ± 5.1）mg/L,与治疗前比较差异有统计学意义（P＜0.05）。结论    　慢性牙周炎可引起低滴度菌血症,造成血清炎症标志物hs-CRP和MCP-1浓度增高,有效的牙周基础治疗可降低血清hs-CRP和MCP-1。     

上颌切牙扇形移位的牙周-正畸联合治疗效果研究

目的    探讨伴上颌切牙病理性扇形移位错牙合畸形的牙周-正畸联合治疗效果。方法    选择2016年1月至2021年12月于南京大学医学院附属口腔医院正畸科就诊的经牙周-正畸联合治疗的伴有上颌切牙扇形移位的Ⅳ期/C级牙周炎患者18例，其中扇形移位的切牙31颗。回顾性分析患者正畸治疗前及正畸治疗后的出血指数（bleeding index，BI）、探诊深度（probing depth，PD）、探诊出血（bleeding on probing，BOP）位点百分比；采用锥形束CT评价扇形移位切牙的剩余牙槽骨高度（residual alveolar bone height，RBH）、切牙倾斜度及牙根吸收比的变化情况。结果    与正畸治疗前相比，正畸治疗后PD显著降低（P < 0.05）；正畸治疗后，扇形移位的切牙腭侧及近中RBH显著增加（均P < 0.05），切牙倾斜度显著减少（P < 0.001）；正畸治疗后唇侧、腭侧及远中上颌中切牙RBH的变化程度大于上颌侧切牙（均P < 0.05），上颌切牙总体牙根吸收比为0.08 ± 0.01。结论    在完善的牙周治疗基础上，正畸治疗有助于扇形移位切牙的牙周组织健康。     

牙周基础治疗对药物性牙龈增生的疗效观察

目的：评价牙周基础治疗对钙拮抗剂导致的药物性牙龈增生的治疗效果。方法：纳入钙拮抗剂导致的牙龈增生患者24例,在基线和牙周基础治疗后1个月、3个月、6个月各时点分别记录菌斑指数（plaqueindex,PLI）,出血指数（bleedingindex,BI）,探诊深度（probingdepth,PD）和牙龈增生指数（Gingivalovergrowthindex,GO）。18例患者共240个位点完成了6个月的观察。结果：在观察期间,PLI、BI、PD和GO指数持续改善（P〈0.01）,GO指数为0级的位点基线为0,治疗后6个月则上升到45.83%,GO指数为1、2、3级的位点逐渐下降,GO指数为3级的位点在治疗后6个月降为0。结论：牙周基础治疗可改善钙拮抗剂药物引起的牙龈增生的程度。     

光动力疗法辅助治疗Ⅲ期、Ⅳ期牙周炎的临床效果评价

目的: 探讨光动力疗法（photodynamic therapy,PDT）辅助龈下刮治术（subgingival scaling and root planning,SRP）在Ⅲ、Ⅳ期牙周炎治疗中的临床效果。方法: 根据2018年牙周病新分类,选择Ⅲ期和Ⅳ期牙周炎患者,经龈上洁治1周后,记录牙周探诊深度（probing depth, PD）、牙龈指数（gingival index, GI）和探诊出血（bleeding on probing,BOP）为基线。将患者分为3组,SRP组进行SRP治疗;PDT1组在SRP后即刻对口内所有PD≥5 mm的位点进行PDT;PDT2组在SRP+PDT后6周,对原位点再进行1次PDT。基线治疗后3、6个月复查,比较PD、GI和BOP阳性率的变化。采用SPSS 22.0软件包对数据进行统计学分析。结果: 共纳入30例患者、1 289个位点。SRP组、PDT1组和PDT2组各10例患者,位点数分别为476个（36.9%）、384个（29.8%）和429个（33.3%）。3组治疗后3个月、6个月复查时,PD、GI、BOP阳性率较基线均显著降低（P<0.05）; 6个月与3个月的复查结果无显著差异。PD≥5 mm的位点,PDT1组和PDT2组可以显著降低患牙的GI和BOP阳性率（P<0.05）;PD≥7 mm时,PDT2组PD显著降低（P<0.05）。结论: 对于Ⅲ、Ⅳ期牙周炎,PDT辅助SRP治疗可以获得比单纯SRP更好的临床效果。     

重度广泛型侵袭性牙周炎患者牙周序列治疗的临床研究

目的：观察重度广泛型侵袭性牙周炎（generalized aggressive periodontitis, GAgP）患者牙周序列治疗后临床指标的变化,并评价其治疗效果。方法：15例GAgP患者在龈上洁治后1个月内完成龈下刮治、根面平整及光动力治疗,刮治后4周再评估,行翻瓣及翻瓣植骨术,每3个月进行1次牙周维护,序列治疗后纵向观察12个月。在基线和维护期各时间点记录全口探诊深度（probing depth,PD）、探诊出血（bleeding on probing, BOP）和牙齿松动度,磨牙记录根分叉病变的程度。结果：在基线时患者平均PD（3．96±2．21）mm,BOP阳性位点占88．1％。序列治疗后12个月平均PD（2．36±1．28）mm,BOP阳性位点减少至8．7％,其中轻、中、重度位点治疗后PD值与治疗前比较差异有统计学意义（P〈0．05）。结论：GAgP患者经牙周序列治疗和定期牙周维护能取得良好的治疗效果。     

上颌中切牙种植修复结合软硬组织增量后的临床和影像学效果初步分析

目的    应用种植同期结合引导性骨再生（guided bone regeneration,GBR）技术及不同软组织处理方式修复缺失的单颗上颌中切牙,评价其软硬组织的增量效果。方法    纳入于2013—2014年就诊于北京大学口腔医院牙周科因单颗上颌中切牙缺失而接受种植治疗的患者6例。所有患者在种植同期行GBR,并接受不同软组织处理方式。最终修复7 ~ 24个月后,记录患者上颌前牙区牙周状况,通过影像学检查定量测量种植体唇侧骨高度及骨壁厚度,利用标准化临床照片,定量测量种植体与对照牙牙龈顶点的位置关系,以及种植体近远中龈乳头高度和充满程度,并应用粉色美学评分（pink esthetic score,PES）评价美学效果。结果    所有种植体在复查时均处于健康稳定的牙周状态。5颗种植体在复查时可观察到垂直向及水平向骨增量,种植体唇侧中央肩台根方2、4、6 mm处平均骨壁厚度分别为（1.7 ± 1.1）mm、（2.3 ± 1.1）mm、（2.2 ± 1.3）mm。种植体牙龈顶点相比对照牙（同颌对侧中切牙）平均更偏向远中（1.0 ± 0.6）mm,偏向根方（0.4 ± 0.8）mm;远中龈乳头平均高度（2.8 ± 0.5）mm和充满程度（76.9 ± 19.2）%低于近中龈乳头［（4.2 ± 0.7）mm,（89.8 ± 11.1）%］,平均PES为（11.5 ± 1.4）分。结论    对于缺牙区存在软硬组织缺损的患者,上颌中切牙种植同期结合GBR及不同软组织处理方式,可获得较为充足的骨增量效果及与对照牙相对协调的软组织形态,一定程度上改善美学效果。     

慢性牙周炎伴咬合紊乱的多学科治疗观察

目的:观察慢性牙周炎伴咬合紊乱的多学科治疗效果。方法:选取10例依从性好的慢性牙周炎伴咬合紊乱病例,采用牙周基础治疗与正畸、修复多学科联合治疗,观察1～7年,所有病例均拍摄口内像及X线牙片,分别于基线、牙周基础治疗后3个月、牙周系统治疗后1年分别记录探诊出血(BOP)、探诊深度(PD)及松动度(TM)。结果:牙周基础治疗后3个月BOP、PD较基线时有统计学差异(P<0.05),TM无明显差异(P>0.05)。基础治疗后3个月BOP、PD、TM与系统治疗后1年相比较无统计学差异(P>0.05)。结论:慢性牙周炎伴咬合紊乱病例多学科治疗有利于牙周炎的控制及疗效的维持,但患者的依从性及适应症的选择尤为重要。     

Minimally Invasive Treatment for Papillae Deficiencies in the Esthetic Zone: A Pilot Study

Background: The presence of papillary deficiencies adjacent to dental implants or teeth presents an esthetic concern for the dental team and patients. Purpose: The aim of this pilot project is to evaluate a new method for reducing or eliminating small papillary deficiencies. The use of a commercially available gel was evaluated as a possible method for enhancing deficient papillae. Materials and Methods: Eleven patients, seven females and four males, with an average age of 55.8 years (ranging from 25 to 75 years) with 14 treated sites are included in this pilot study. Patients had a minimum of one papillary deficiency in the esthetic zone. Prior to treatment photographs were either taken at a 1:1 ratio or converted to a 1:1 ratio using a commercially available program. A standardization photographic device was not used. After administration of a local anesthetic, a 23‐gauge needle was used to inject less than 0.2 mL of a commercially available and Food and Drug Administration‐approved gel of hyaluronic acid 2–3 mm apical to the coronal tip of the involved papillae. Patients were seen every three weeks and treatment was repeated up to three times. Patients were followed from 6 to 25 months after initial gel application. A computer program measured changes in pixels between initial and final treatments. A formula was derived to determine percentage change in the negative space between initial and final examinations. Results: Each site was individually evaluated. Three implant sites and one site adjacent to a tooth had 100% improvement between treatment examinations. Seven sites improved from 94 to 97%, three sites improved from 76 to 88%, and one site adjacent to an implant had 57% improvement. Conclusion: Results from this pilot study are encouraging and present evidence that small papillary deficiencies between implants and teeth can be enhanced by injection of a hyaluronic gel. Improvements were maintained for a range of 6 to 25 months.     

Orthodontic movement into infrabony defects in patients with advanced periodontal disease: a clinical and radiological study

BACKGROUND: In cases of advanced periodontal disease with a pathologic flaring of frontal teeth, a combined periodontic-orthodontic therapy may be a reliable approach in order to solve both functional and esthetic problems. The aim of the present study was to evaluate the periodontal tissue alterations following periodontal surgery and orthodontic intrusion in migrated upper central incisors with intrabony defects. METHODS: Ten patients with advanced periodontal disease and an extruded maxillary central incisor infrabony defect at its mesial aspect and probing depth (PD) > or = 6 mm were included in the present study. At baseline, PD and clinical attachment level (CAL) were measured. The vertical and horizontal dimensions of the defects were assessed on standardized radiographs. Seven to 10 days after surgery the active orthodontic treatment started using the segmented arch technique, in order to intrude and move the teeth into the defects. Maintenance therapy was performed every 2 to 3 months until the orthodontic treatment was completed. RESULTS: At the end of treatment, mean PD reduction was 4.35 mm, with a residual mean PD of 2.80 mm. Mean CAL gain was 5.50 mm. The mean radiological vertical and horizontal bone fills were, respectively, 1.35 mm and 1.40 mm. All differences were of statistical significance (P<0.001). CONCLUSION: The present study showed that the combined orthodontic and periodontic therapy performed resulted in the realignment of extruded teeth with infrabony defects, obtaining a significant probing depth reduction, clinical attachment gain, and radiological bone fill.     

Periodontal status of teeth facing extraction sites long-term after orthodontic treatment

The present study was undertaken to examine the long-term periodontal status of teeth orthodontically moved into extraction sites. Patients were examined 14 to 34 years after active orthodontic treatment involving extraction of four first premolars. Three groups were established: one with closed tooth contacts and parallel adjacent teeth, one with closed tooth contacts and tipped adjacent teeth, and one with open contacts between adjacent teeth. Within each group accumulation of plaque, gingival health status, probing pocket depth, and probing attachment level of interproximal tooth surfaces, facing extraction sites and adjacent control sites between canine and lateral incisor were compared. Significantly more probing attachment loss was found in extraction sites with open tooth contacts (P less than 0.01) and with parallel adjacent teeth and closed tooth contacts (P less than 0.05) than in control sites. However, the mean differences were less than 0.5 mm, which may not be considered clinically significant. Tipping of teeth into the extraction sites had no long-term detrimental effect on the probing attachment level. No differences in accumulation of plaque and in gingival health status were observed.     

Periodontal health of orthodontically extruded impacted teeth. A split-mouth, long-term clinical evaluation

BACKGROUND: Impaction of front teeth (often upper canines) can result in esthetic, functional, and phonetic problems, in addition to root resorption and chronic or acute infections. Most impacted front teeth can be extruded orthodontically after minor periodontal surgery. The purpose of this retrospective study was to examine the periodontal outcome of surgically exposed and orthodontically extruded impacted teeth compared with the spontaneously erupted contralateral teeth. METHODS: A total of 38 patients, who had been treated by a combined surgical and orthodontic approach (closed eruption technique by same periodontist and 2 associated orthodontists), underwent a periodontal re-examination after 4 to 10 years. Periodontal parameters (plaque and gingivitis indices, probing depth, bleeding on probing, gingival recession and width, bone level, and root resorption) of the orthodontically extruded teeth (test) were scored and compared with those of the contralateral naturally erupted teeth (control) in a masked set-up. RESULTS: No significant differences could be detected between test and control teeth, except for the gingival width, which was 1 mm larger for the spontaneously erupted teeth. CONCLUSIONS: The data indicate that orthodontic extrusion of impacted front teeth does not jeopardize their periodontal health. This procedure appears to be a satisfactory alternative to extraction and/or transplantation.     

A split-mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate

BACKGROUND: Complete unilateral cleft lip and palate (UCLP) is a hereditary or multifactorial malformation that can be corrected successfully with a combined orthodontic, surgical and restorative treatment. Such multidisciplinary treatment takes many years and demands a lot of attention to both patients' teeth and periodontium. OBJECTIVES: This split-mouth study aimed to compare the periodontal health as well as the microbial parameters between cleft and non-cleft region. MATERIAL AND METHODS: 75 patients (52 males, 23 females) between 8 and 20 years with a complete unilateral cleft lip and palate (before (n = 30), during (n = 34) and after (n = 11) the active orthodontic treatment) volunteered for this study. Four regions were defined for the split-mouth comparison: teeth neighbouring cleft (site 1), tooth in cleft (site 2), and the corresponding contra-lateral teeth, respectively, in the unaffected quadrants (sites 3 and 4). At all sites the following periodontal parameters were recorded: plaque and gingivitis indices, pocket depth, attachment loss, bleeding on probing, tooth mobility (visual and Periotest), radiographic bone loss and gingival width. In addition, three pooled subgingival plaque samples were taken (around tooth in cleft, teeth facing the cleft, and contra-lateral teeth of the latter). RESULTS: The differences between the teeth neighbouring the cleft and the corresponding contra-lateral opponents were of borderline significance (P 相似文献   

Immediate provisional restoration of an implant placed in a fresh primary maxillary canine extraction socket: a case report

This study describes a clinical case in which a primary maxillary canine with both mobility and root resorption was replaced with an immediately restored dental implant placed into the fresh extraction socket. The implant achieved high primary stability, as determined by resonance frequency analysis, and it was immediately restored with a provisional acrylic resin crown with no centric occlusion. An all-ceramic permanent crown replaced the provisonal crown four months after implant surgery. The implant was stable and no periapical radiolucencies, bleeding on probing, or pathologic probing depth were recorded after one year. The peri-implant soft tissue level appeared stable, and the interdental papillae were preserved, contributing to an optimum final esthetic result. This case supports the use of single implants for the replacement of extracted primary teeth, especially in areas where esthetics is a high priority. The immediate provisional crown maintained soft tissue contours and papillary height.     

Periodontal parameters around implants anchoring orthodontic appliances: a series of case reports

BACKGROUND: Implants replacing missing teeth provide advantages over clinical orthodontic treatment as compensation for reaction forces is no longer necessary and the lack of teeth is immediately resolved. METHODS: A total of 38 two-stage implants were inserted (16 in maxilla, 22 in mandible) in 10 partially edentulous patients with orthodontic problems. Osseointegration and marginal bone levels were assessed via intra-oral radiographs taken at the abutment stage and at the completion of the orthodontic treatment and also via probing depth, measurement of recession toward the implant/abutment (I/A) interface, and sulcus bleeding index, recorded after completion of orthodontic treatment. RESULTS: In the maxilla, the cumulative survival rate was 87.1% after 2 years; for the mandible, it remained 100%. Mean amount of bone loss was 1.6 mm for maxilla and 0.8 mm for mandible. No correlation could be found between directions of orthodontic forces and marginal bone loss. Mean percentage of bleeding sites was 38.5% and 25%, respectively, for implants in the maxilla and mandible. Attachment level was 1.2 mm (SD: 1.2) below I/A interface after completion of the orthodonic treatment. CONCLUSION: No significant marginal bone loss was present. Using implants during orthodontics can result in an easier and more predictable treatment.     

Comparison of age and sex regarding gingival and papillary recession

No studies have been published concerning the comparison between gingival and papillary recession in the maxillary esthetic zone (including incisors, canines, and premolars) regarding age and sex. This study addressed this issue. Adults (n = 250) with fully erupted permanent dentitions, healthy gingivae, and natural teeth in the maxillary esthetic area were included. Visual examinations were performed to detect papillary and gingival recession. Space evident apical to the contact area of adjacent teeth was recorded as papillary recession; a cementoenamel junction visible coronal to the buccal gingival margin was recorded as gingival recession. All sites with papillary and gingival recession were significantly associated with age; however, only some sites with gingival and papillary recession were associated with sex. Papillary recession was more severe than gingival recession in both extent and prevalence in subjects older than 30 years of age. Thus, papillary recession may be expected to be a more common esthetic dental problem.