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??Objective    This study compared circulating high-sensitivity C-reactive protein??hs-CRP??and monocyte chemoattractantprotein-1??MCP-1??in control individuals and patients with periodontal disease and observed whether non-surgical periodontal therapy affected inflammatory disease markers after 3 months. Methods    40 controls and 80 patients with periodontal disease were selected.Periodontal parameters included probing depth??bleeding on probing??clinical attachment level?? as well as the following inflammatory markers??high-sensitivity C-reactive protein ??hs-CRP??and monocyte chemoattractant protein??MCP??-1. Results    There were no differences in the hematologic parameters of the patients in the control and periodontal disease groups. Hs-CRP and MCP-1 concentrations were higher in theperiodontal disease group at baseline compared to the controls??P = 0.005 and P = 0.003??respectively??. A decrease in circulating hs-CRP and MCP-1 concentrations was observed 3 months after therapy??P = 0.009 and P = 0.007??respectively??. Conclusion    In apparently otherwise healthy patients??periodontal disease is associated with increased circulating concentrations of hs-CRP andMCP-1??which decreased 3 months after non-surgical periodontal therapy.     

IL-6−174 genotype associated with the extent of periodontal disease in type 1 diabetic subjects

Aim: The aim of this study was to investigate whether genetic polymorphism in certain cytokine and receptor molecule genes and diabetic status associate with the extent of periodontal disease in type 1 diabetes mellitus (DM).
Material and Methods: Eighty patients with type 1 DM participated. Visible plaque, bleeding on probing (BOP), probing pocket depth (PD) and attachment level (AL) were examined clinically and glycosylated haemoglobin (HbA1c) levels were used to assess the glycemic control of DM. CD-14, IL-6, TNF- α , IL-10, IL-1 α , IL-1 β and TLR-4 gene polymorphisms were studied using the polymerase chain reaction (PCR).
Results: The 3-year HbA1c was good (<7.5%) in 16%, acceptable (7.5–8.5%) in 36% and poor (>8.5%) in 48% of the subjects. IL-6⁻¹⁷⁴ genotype and 3-year GHbA1c associated significantly with BOP and PD4 mm, subjects with the GG genotype of the IL-6⁻¹⁷⁴ exhibiting more severe periodontal disease than those with the GC/CC genotype. After stratification by IL-6 genotype, associations between the extent of periodontal disease and 3-year HbA1c levels remained significant in subjects carrying the GC/CC but not the GG genotype.
Conclusions: In addition to the HbA1c level, the IL-6⁻¹⁷⁴ genotype is a significant susceptibility factor for periodontal disease among type 1 diabetics.     

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。     

The effect of periodontal therapy on serum TNF-α and HbA1c levels in type 2 diabetic patients

Background:  To determine the effect of non-surgical periodontal therapy on serum TNF-α and HbA1c levels in poorly and well-controlled type 2 diabetic patients.
Methods:  In total, 45 patients were enrolled in the study; 30 patients with type 2 diabetes mellitus with periodontitis (15 with poorly controlled diabetes, HbA1c ≥ 7%, group 1A and 15 with well-controlled diabetes, HbA1c < 7%, group 1B) and 15 patients that were systemically healthy with periodontitis (group 2). The plaque index, gingival index, probing depth, clinical attachment loss, gingival bleeding index, HbA1c value, and circulating TNF-α concentration were measured at baseline and three months after the non-surgical periodontal therapy.
Results:  All periodontal parameters and serum TNF-α levels were significantly decreased three months after the non-surgical periodontal therapy compared to the baseline values in all groups. The HbA1c values were significantly decreased only in well-controlled diabetic patients. We found no significant differences in the periodontal parameters or TNF-α levels at baseline and after three months between the two groups.
Conclusions:  Although non-surgical periodontal therapy eliminates local/systemic infection and inflammation via decreases in TNF-α, it is insufficient for significantly reducing HbA1c levels without strict glycaemic control in poorly controlled diabetic patients in a short time period.     

Healing response to non-surgical periodontal therapy in patients with diabetes mellitus: clinical, microbiological, and immunologic results

Abstract. The aim of the present study was to monitor clinical, microbiological, medical, and immunological effects of non-surgical periodontal therapy in diabetics Lind healthy controls. 20 IDDM (insulin dependent. n = l) or NIDDM (non-insulin dependent. n = 13) diabetic patients (median duration 11.5 years, range of HbA_1C: 4.4–10.6%) with moderate to advanced periodontal disease and 20 matched healthy control patients, were subjected to supragingival pretreatment and subsequent subgingival therapy Periodontal examinations (API. PBI, BOP. PPD, PAL), microbiological examinations (culture), medical routine examinations, and immunological examinations (oxidative burst response of PMNs to TNF-α and FMLP) were performed at baseline, 2 weeks after supragingival, and 4 months after subgingival therapy. 4 months after completion of non-surgical therapy, the following compared to baseline significant ( p ≤0.05) changes (Δ) of clinical parameters (median) were found in diabetic patients versus control patients: JAPI (30.4% versus 36.3%), ΔPBI (22.9% versus 24.2%), ΔBOP (39.5% versus 46.9%). The median % per patient of pockets with PPD≥4 mm decreased from 41.9% to 28.3% in diabetics, and from 41.6% to 31.8% in controls. Microbiologically. similar reductions of periopathogenic bacteria were found in diabetics and controls. Neither periodontal data nor the oxidative burst response of PMNs showed any significant difference ( p >0.05) between diabetics and control patients. In this study, periodontal therapy had no significant influence on medical data of diabetics. In conclusion, this study indicates that metabolically well-controlled diabetics might respond to non-surgical periodontal therapy as well as healthy control patients.     

The effect of non-surgical periodontal therapy on peroxidase activity in diabetic patients: a case-control pilot study

Objective: To evaluate the effect of periodontal therapy on clinical parameters as well as on total salivary peroxidase (TSP) activity and myeloperoxidase (MPO) activity in the gingival crevicular fluid (GCF) of patients with type 2 diabetes mellitus (DM2) and of systemically healthy individuals.
Material and Methods: Twenty DM2 subjects with inadequate metabolic control (test group) and 20 systemically healthy individuals (control group), both groups with chronic periodontitis, were enrolled. Periodontal clinical parameters, namely periodontal probing depth (PD), clinical attachment level (CAL), visible plaque index (VPI), bleeding on probing (BOP), gingival bleeding index (GBI) and presence of suppuration (SUP), as well as TSP activity and GCF MPO activity, were assessed before and 3 months after non-surgical periodontal therapy.
Results: At baseline and 3 months post-treatment, the test group presented a higher percentage of sites with VPI and BOP ( p <0.01). MPO activity in the GCF presented lower values ( p <0.05) for the test group at both baseline and the post-treatment period. The periodontal treatment resulted in a significant improvement of most clinical and enzymatic parameters for both groups ( p <0.05).
Conclusions: In both groups, the periodontal therapy was effective in improving most clinical parameters and in reducing salivary and GCF enzymatic activity. The diabetic individuals presented lower MPO activity in the GCF.     

Role of serum cytokines tumour necrosis factor-α and interleukin-6 in the association between body weight and periodontal infection

Aim: To study the role of serum cytokines tumour necrosis factor α (TNF- α ) and interleukin 6 (IL-6) as potential mediators in the association between body weight and periodontal infection among an adult population.
Material and Methods: This study was based on a subpopulation of the Health 2000 Health Examination Survey, which included dentate non-diabetic, non-rheumatic subjects, aged between 45 and 64 years, who had never smoked and whose serum levels of TNF- α and IL-6 were analysed and whose periodontal status was clinically determined (effective n =425). The number of teeth with periodontal pockets of 4 mm or more and the number of teeth with periodontal pockets of 6 mm or more were used as outcome variables. Relative risks and 95% confidence intervals were estimated using Poisson regression models.
Results: Serum IL-6, but not TNF- α associated with teeth with deepened periodontal pockets. Multivariate models showed that IL-6, but not TNF- α , could mediate the effect of body weight on periodontium.
Conclusion: In this population of non-diabetic and non-rheumatic subjects, who had never smoked, serum IL-6 was associated with periodontal infection. The results suggest that serum IL-6 could be one mediating factor that connects body weight and periodontal infection.     

牙周治疗对血清IFN-γ及IL-4水平的影响

目的:探讨牙周基础治疗对牙周炎患者血清干扰素-γ(IFN-γ)及白细胞介素-4(IL-4)水平的影响。方法:检测慢性牙周炎患者牙周基础治疗前和治疗后4～6周内,牙龈探诊深度、出血指数;采用双抗体夹心ELISA法,通过绘制标准曲线求出标本中IFN-γ和IL-4的浓度,对检测结果进行t检验。结果:慢性牙周炎患者血清IFN-γ、IL-4显著高于对照组(P<0.01);慢性牙周炎患者经牙周基础治疗后,其探诊深度、出血指数、血清IFN-γ浓度均显著降低(P<0.01),血清IL-4浓度无显著变化(P>0.05)。结论:IFN-γ、IL-4与牙周组织炎症的发病有关,控制牙龈炎症可降低血清IFN-γ水平,但IL-4浓度不因牙龈炎症的控制而下降。     

Periodontal debridement as a therapeutic approach for severe chronic periodontitis: a clinical, microbiological and immunological study

Aim: To clinically, microbiologically and immunologically characterize periodontal debridement as a therapeutic approach for severe chronic periodontitis.
Material and Methods: Twenty-five patients presenting at least eight teeth with a probing pocket depth (PPD) of 5 mm and bleeding on probing (BOP) were selected and randomly assigned to quadrant-wise scaling and root planing or one session of full-mouth periodontal debridement. The following clinical outcomes were assessed: plaque index, BOP, position of gingival margin, relative attachment level (RAL) and PPD. Real-time PCR was used for quantitative analysis of Aggregatibacter actinomycetemcomitans , Porphyromonas gingivalis and Tannerella forsythia . The enzyme-linked immunosorbent assay permitted the detection of IL-1 β , prostaglandin E₂, INF- γ and IL-10 in gingival crevicular fluid (GCF). All the parameters were evaluated at baseline, and at 3 and 6 months after treatment.
Results: Both the groups had similar means of PPD reduction and attachment gain over time. Besides a significant reduction in the bacterial level after treatment in both groups, microbiological analysis failed to demonstrate significant differences between them. Finally, no difference was observed between groups with respect to the levels of inflammatory mediators in GCF.
Conclusion: Periodontal debridement resulted in a similar clinical, microbiological and immunological outcome when compared with standard scaling and root planing and therefore may be a viable approach to deal with severe chronic periodontitis.     

Non-surgical periodontal therapy with and without subgingival minocycline administration in patients with poorly controlled type II diabetes: a randomized controlled clinical trial

The aim of this study was to evaluate changes in clinical parameters and levels of inflammatory biomarkers in plasma in periodontal patients with poorly controlled type 2 diabetes mellitus (T2DM) after non-surgical periodontal therapy. Twenty-eight poorly controlled T2DM patients were randomly assigned to treatment with scaling and root planning (SRP) and SRP + subgingival minocycline administration. Clinical parameters, including the probing depth (PD), bleeding on probing (BOP), plaque score (PS), clinical attachment level (CAL), and plasma interleukin (IL)-6, soluble receptor of advanced glycation end products (sRAGE), chronic reactive protein (CRP), and hemoglobin A1c (HbA1c) were measured before and after a 6-month treatment period. Significant changes in PD, BOP, PS, and CAL were found in both groups. The latent growth curve model showed an overall reduction in the log HbA1c level in the SRP group (−0.082, p = 0.033). Small changes in the log sRAGE level and log CRP level in plasma were found in both groups. IL-6 in the plasma increased in the SRP group, but slightly decreased in the SRP+minocycline group (0.469 pg/ml, p = 0.172). Non-surgical periodontal therapy with or without subgingival minocycline application may achieve significant periodontal improvement and moderate improvement in HbA1c, but had no significant effect on plasma levels of IL-6, CRP, or sRAGE in patients with poorly controlled T2DM. For patients with both periodontal diseases and diabetes, non-surgical periodontal treatments may be helpful in their diabetic control.     

The role of obesity as a modifying factor in patients undergoing non-surgical periodontal therapy

Background: Earlier studies have shown an association between obesity and periodontitis, which is mediated by cytokine production. The aim of this study is to assess the role of obesity as a modifying factor on periodontal clinical parameters and on circulating proinflammatory cytokine levels in subjects undergoing non‐surgical periodontal treatment. Methods: Twenty‐seven obese subjects and 25 normal‐weight subjects were enrolled in this study. Subjects in both groups had generalized chronic periodontitis. The periodontal parameters measured before and 3 months after non‐surgical periodontal therapy were: visible plaque index, bleeding gingival index, bleeding on probing, probing depth, and clinical attachment level. In addition, subjects underwent anthropometric measurements and serum analyses of fasting glucose, glycated hemoglobin, interleukin‐1β, interleukin‐6, tumor necrosis factor‐α, and interferon‐γ. Results: Periodontal therapy significantly decreased visible plaque index, bleeding gingival index, bleeding on probing, probing depth of 4 to 6 mm, probing depth ≥7 mm, clinical attachment level of 4 to 6 mm, and clinical attachment level ≥7 mm in both groups (P ≤0.05). Circulating proinflammatory cytokines significantly decreased in obese and normal‐weight subjects after periodontal treatment (P ≤0.05). However, interleukin‐6 and tumor necrosis factor‐α levels remained higher in obese subjects 3 months after treatment (P ≤0.05). Conclusion: Obesity does not seem to play a negative role by interfering in the improvement of the periodontal clinical response or decreasing circulating proinflammatory cytokine levels after periodontal treatment.     

牙周基础治疗对2型糖尿病伴慢性牙周炎患者龈沟液丝氨酸蛋白酶抑制剂和肿瘤坏死因子-α水平的影响

目的 观察牙周基础治疗对2型糖尿病伴发或不伴发慢性牙周炎患者龈沟液(gingival crevicular flu-id,GCF)丝氨酸蛋白酶抑制剂(vaspin)和肿瘤坏死因子-α(TNF-α)水平的影响.方法 本研究包含60个研究对象,分为4组:15例2型糖尿病伴发慢性牙周炎患者为DM-CP组;15例慢性牙周炎不伴发2型糖尿病患者为CP组;15例牙周健康的2型糖尿病患者为DM组;15例牙周及全身系统均健康的个体为CTRL组.治疗前与牙周基础治疗8周后取样GCF并检测牙周临床指标.通过ELISA法检测GCF样本中vaspin和TNF-α的水平.结果 治疗前慢性牙周炎组GCF中vaspin和TNF-α水平显著高于牙周健康组(P<0.05),治疗后慢性牙周炎组GCF中vaspin和TNF-α水平显著降低(P<0.05).各组vaspin总量与TNF-α总量、糖化血红蛋白水平、牙龈指数以及探诊深度在统计学上存在正相关关系(P<0.05).结论 牙周基础治疗能明显降低慢性牙周炎患者GCF中vaspin和TNF-α的水平.提示GCF中vaspin和TNF-α可作为糖尿病、牙周炎诊断及其预后的炎性标志物.     

牙周治疗对非胰岛素依赖型糖尿病患者的短期影响

目的　研究非胰岛素依赖型糖尿病牙周病患者牙周常规非手术治疗后 ,牙周状况及糖代谢的改变。方法　选择非胰岛素依赖型糖尿病患者 2 5例 ,进行牙周非手术治疗 ,比较治疗前及治疗后 4周、8周牙周状况 (探诊出血 ,牙周袋深度 )和糖化血红蛋白的水平。结果　患者治疗后 ,牙周探诊出血、探诊深度明显减轻。重度牙周炎患者治疗后 4周、8周糖化血红蛋白的水平降至 9.0 1± 0 .85 %和 8.84± 1.5 2 % ,与治疗前相比差异有显著性。轻中度牙周炎组治疗后 4周糖化血红蛋白略有下降 ,8周时与治疗前相比差异无显著性。结论　非胰岛素依赖型糖尿病患者牙周炎症控制短期内使糖代谢水平得到一定改善 ,但远期影响尚不肯定 ,有待进一步研究     

Bisphosphonate therapy improves the outcome of conventional periodontal treatment: results of a 12-month, randomized, placebo-controlled study

BACKGROUND: Bone loss in periodontitis results from inflammatory reactions that stimulate osteoclastic bone resorption. Bisphosphonates inhibit bone resorption and increase bone mass. This study evaluated the effect of bisphosphonate therapy as an adjunct to non-surgical periodontal treatment in patients with moderate to severe chronic periodontitis. METHODS: Patients were randomized (2:1) to one of two bisphosphonate therapies or placebo for 1 year. All patients received non-surgical periodontal treatment (scaling, root planing) and periodontal maintenance therapy every 3 months. Clinical assessments at baseline and 6 and 12 months included clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP). Periodontal bone mass was assessed by dental radiographs at baseline and 12 months using fractal analysis and digital subtraction radiography (DSR). RESULTS: Seventy patients were randomized, 43 to the bisphosphonate group and 27 to the placebo group. Bisphosphonate therapy significantly improved CAL, PD, and BOP relative to the placebo group during the 6- to 12-month period (CAL, P = 0.0002; PD, P = 0.0156; BOP, P = 0.0079). There was no difference in the change in periodontal bone mass between the bisphosphonate and placebo groups as measured by fractal analysis and DSR. CONCLUSION: These data suggest that bisphosphonate treatment improves the clinical outcome of non-surgical periodontal therapy and may be an appropriate adjunctive treatment to preserve periodontal bone mass.     

Effect of non-surgical periodontal therapy on C-telopeptide pyridinoline cross-links (ICTP) and interleukin-1 levels

BACKGROUND: Biochemical markers harvested from gingival crevicular fluid (GCF) may be useful to identify and predict periodontal disease progression and to monitor the response to treatment. C-telopeptide pyridinoline cross-links (ICTP), a host-derived breakdown product specific for bone, and interleukin-1beta (IL-1), a potent bone-resorptive cytokine, have been associated with periodontal tissue destruction. The aim of this study was to examine the effect of non-surgical periodontal therapy on GCF levels of ICTP and IL-1. METHODS: Twenty-five chronic periodontitis subjects were monitored at 8 sites per subject at baseline prior to scaling and root planing and 1, 3, and 6 months after therapy. Four shallow (probing depths < 4 mm) and 4 deep (probing depths > or = 5 mm) sites were monitored for both marker levels and clinical parameters. GCF was collected for 30 seconds on paper strips, and levels of ICTP and IL-1 were determined using radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) techniques, respectively. Clinical measurements included probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). RESULTS: Deep sites exhibited significantly (P<0.001) higher ICTP and IL-1 levels compared to shallow sites at all time intervals. ICTP demonstrated a stronger association to clinical parameters than IL-1 including a modest correlation (r = 0.40, P<0.001) between ICTP and attachment loss. Significant improvements in PD, CAL, and BOP were observed at 1, 3, and 6 months in all sites (P<0.01). However, non-surgical mechanical therapy did not significantly reduce ICTP and IL-1 levels over the 6-month period. Further examination of subjects based on smoking status revealed that ICTP levels were significantly reduced at 3 and 6 months and IL-1 levels reduced at 3 months among non-smokers only. CONCLUSIONS: A single episode of non-surgical mechanical therapy did not significantly reduce biochemical markers associated with bone resorption in patients exhibiting chronic periodontitis. Future longitudinal studies are warranted to specifically evaluate the relationship between C-telopeptide pyridinoline cross-links and periodontal disease progression.     

Periodontal Inflammatory Conditions Among Smokers and Never‐Smokers With and Without Type 2 Diabetes Mellitus

Background : There is a dearth of studies regarding the influence of cigarette smoking on periodontal inflammatory conditions among patients with type 2 diabetes mellitus (T2DM). The aim of the present study is to assess periodontal inflammatory conditions among smokers and never‐smokers with and without T2DM. Methods: One hundred individuals (50 patients with T2DM [25 smokers and 25 never‐smokers] and 50 controls [25 smokers and 25 never‐smokers]) were included. Information regarding age, sex, duration and daily frequency of smoking, duration and treatment of diabetes, and oral hygiene was recorded using a questionnaire. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL], and marginal bone loss [MBL]) were measured. Hemoglobin A1c (HbA1c) levels were also recorded. Results: Mean age, monthly income status, and education levels were comparable among smokers and never‐smokers with and without T2DM. Mean HbA1c levels were significantly higher among patients with T2DM (8.2% ± 0.1%) compared with controls (4.4% ± 0.3%) (P <0.05). Smokers in the control group were smoking significantly greater numbers of cigarettes (15.5 ± 2.5 cigarettes daily) compared with smokers with T2DM (6.2 ± 2.1 cigarettes daily) (P <0.05). Periodontal parameters were comparable among smokers and never‐smokers with T2DM. Among controls, periodontal parameters (PI [P <0.05], AL [P <0.05], PD ≥4 mm [P <0.05], and MBL [P <0.05]) were significantly higher in smokers than never‐smokers. Never‐smokers with T2DM had worse periodontal status than smokers and never‐smokers in the control group (P <0.05). Conclusions: Periodontal inflammatory conditions are comparable among smokers and never‐smokers with T2DM. Among controls, periodontal inflammation is worse among smokers than never‐smokers.     

The relationship between periodontal condition and serum levels of resistin and adiponectin in elderly Japanese

Background and Objective:  Diabetes and periodontitis are associated with each other. Adipokines, specifically adiponectin and resistin, are secreted from adipocytes and are thought to cause insulin resistance in rodents. Additionally, adiponectin and resistin may play a role in inflammation and immune responses. The aim of this study was to clarify the relationship between serum levels of adipokines and periodontal conditions in elderly Japanese people with and without periodontitis.
Material and Methods:  A total of 158 Japanese men and women (76 years old) with or without periodontitis were selected for the study. Serum adiponectin, resistin, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations were compared between subjects with and without periodontitis.
Results:  Serum resistin levels and total leukocyte counts in subjects with periodontitis were higher than in control subjects. No significant differences were observed in adiponectin, IL-6 and TNF-α levels between subjects with and without periodontitis. Logistic regression analysis showed that periodontitis with at least one tooth that displayed a probing pocket depth of ≥6 mm was significantly associated with higher serum resistin levels (odds ratio, 2.0; 95% confidence interval, 1.0–4.0). When excluding periodontitis subjects with ≤10% of bleeding on probing and excluding control subjects with >10% bleeding on probing, differences between groups and odds ratio increased. Serum adiponectin tended to decrease in patients with periodontitis, albeit not significantly.
Conclusion:  Increased serum resistin levels were significantly associated with periodontal condition, especially when considering bleeding on probing, in elderly Japanese people. There was also a trend, though non-significant, toward decreased levels of adiponectin in subjects with periodontitis.     

牙周炎症对牙龈组织巨噬细胞胞外诱捕网形成的影响

目的:探讨牙周炎症对牙龈组织中巨噬细胞胞外诱捕网(METs)形成的影响。方法:纳入基础治疗后,需进行牙周翻瓣手术的牙周炎患者29例,以牙周健康的牙冠延长术患者20例作为对照。术前记录菌斑指数(PLI)、牙龈指数(GI)、探诊深度(PD)、临床附着丧失(CAL)等牙周临床指标,收集龈沟液(GCF)样本,术中收集牙周炎患者牙周破坏最严重部位的牙龈组织及牙冠延长术患者的健康牙龈组织。采用激光共聚焦显微镜观察牙龈组织中METs的形成情况,采用ELISA技术检测GCF中TNF-α和IL-9表达水平,分析两组样本METs形成水平与各牙周临床指标、GCF中TNF-α、IL-9水平的相关性。结果:牙周炎组METs形成分数,PLI、GI、PD、CAL等牙周临床指标,以及TNF-α、IL-9水平均显著高于正常对照组(P<0.05)。METs形成分数与PD、CAL正相关(P<0.05)。结论:牙周炎症破坏可以促进牙龈组织中METs的形成。     

牙周基础治疗对Ⅱ型糖尿病伴牙周炎病人糖基化终产物的影响

目的:观察牙周基础治疗对Ⅱ型糖尿病伴慢性牙周炎病人牙周组织和血清中糖基化终产物(advanced glycation end of products,AGEs)变化的长期影响。方法:诊断为Ⅱ型糖尿病并伴有中等程度以上牙周炎的病人30例,分为进行牙周基础治疗的干预组15例(DM1组),未进行牙周基础治疗的未干预组15例(DM2组);分别在初诊和每次复诊治疗前记录2组的探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、空腹血精、AGEs指标。结果:经牙周基础治疗后,DM1组牙周临床指标均有明显改善;2组AGEs水平有不同程度升高(P<0.05);DM1组第21个月AGFs水平显著低于DM2组,有统计学意义(P<0.05)。结论:牙周基础治疗对Ⅱ型糖尿病伴慢性牙周炎病人的PD、AL、血糖水平、AGEs水平有显著的改善(P<0.05),并且有助于长期稳定。     

Periodontitis and atherogenesis: causal association or simple coincidence?

OBJECTIVES: The aim of this study was to assess the systemic effects of treating severe widespread periodontitis in a population of otherwise healthy individuals by examining treatment associated changes in markers of inflammation that are also implicated in cardiovascular atherosclerotic diseases. The potential impact of specific polymorphisms in cytokine genes known to influence both periodontitis and cardiovascular diseases was also examined. MATERIALS AND METHODS: A convenience sample of patients affected with severe generalised periodontitis was enrolled into a prospective single blind longitudinal intervention trial with a 6 months follow-up. Serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels were assessed by high-sensitivity assays. Serological and clinical periodontal parameters were evaluated at baseline, 2 and 6 months after completion of non-surgical periodontal therapy. Results: In the 94 subjects that completed this pilot trial improvements in all clinical periodontal parameters were achieved. These were accompanied with significant reductions in serum IL-6 and CRP concentrations. In a multivariate model, serum CRP levels were significantly associated with the outcome of periodontal treatment after correcting for potential covariates (age, body mass index, gender, smoking) and polymorphisms in the IL-6 (-174 C/G) and IL-1A (-889) genes. A median decrease in serum CRP of 0.5 mg/l (95% CI 0.4-0.7 mg/l) was observed 6 months after completion of periodontal therapy in this population. Subjects with above average response to periodontal therapy (<30 residual pockets and <30% of sites bleeding on probing) accounted for the observed improvement in serum CRP. CONCLUSIONS: Control of periodontitis, achieved with non-surgical periodontal therapy, significantly decreased serum mediators and markers of acute phase response. The significance of the serum response was associated with the half of the population that responded better to non-surgical periodontal therapy. The results of this pilot study indicate that severe generalised periodontitis causes systemic inflammation. This is consistent with a causative role of periodontitis in atherogenesis.