Chronology of an interdental periodontal lesion

Abstract A case in which intermittent and spontaneous periodontal breakdown and repair has occurred on two different occasions in the same interproximal site over a period of 18 years is described. The possible etiology of the lesions is discussed in terms of current concepts of localized bacterial selectivity. Also reviewed is the potential for repair in two-walled infrabony defects.     

牙周牙髓联合病变治疗探讨

目的:探讨慢性牙周炎及其引起的牙髓根尖周病变治疗方法.方法:将118位病人的166个患牙进行牙髓活力测试、评价.根据临床症状进行牙周基础治疗和根管治疗术,随访6个月,观察疗效.结果:前磨牙冷诊阳性率77.55%,电活力阳性率85.71%,开髓后发现有67.34%牙髓部分或全部坏死;磨牙冷诊阳性率75.22%,电活力阳性率72.57%,开髓后发现有56.63%牙髓部分或全部坏死.根管治疗术6个月后复查所有患牙症状明显改善,咬合功能基本恢复正常,松动度、探诊深度都有明显改善(P<0.05).结论:牙髓状态应根据病史和症状进行综合判断.慢性牙周炎引起的牙髓刺激症状经过牙周基础治疗以及脱敏或楔形缺损充填治疗症状明显减轻者,可不做牙髓处理.经上述治疗后症状仍未消失,应行根管治疗术.如有牙髓坏死,并由此加重骨破坏者,应尽早进行根管治疗术.     

比较非手术治疗对重度慢性牙周炎磨牙不同部位牙周病变的疗效

目的:根据磨牙中重度慢性牙周炎发生不同部位病变比较非手术治疗的疗效。方法:根据单个磨牙深牙周袋发生的部位(颊侧或舌/腭侧)将收集的上、下颌磨牙各分为两组(上颌I组、上颌II组、下颌I组、下颌II组),观察各组治疗前后牙周指标的变化,比较疗效差异。结果:4组病例治疗后6周各项牙周指标均较基线有明显改善,差异有显著性(P<0.01)。上颌两组间及下颌两组间比较,可见6周时上颌II组的PD、BI、CAL均高于上颌I组,差异有显著性(P<0.01);下颌II组的PD、BI、CAL高于下颌I组,差异有显著性(P<0.01)。结论:发生在磨牙的牙周炎症无论是上颌还是下颌,颊侧病变的预后均好于舌/腭侧,差异有显著性。     

Effect of long-term methotrexate-induced neutropenia on experimental periodontal lesion in rats

The effects of long-term methotrexate (MTX)-induced neutropenia on the periodontal lesion in rats were investigated histologically, histometrically and bacteriologically. A nylon thread was inserted into the interdental gingiva between the 1st and 2nd right maxillary molars of the animals 3 weeks before an application of MTX. The animals were then divided into Groups A and B. Group B were injected intraperitoneally with 1.0 mg/kg of MTX 3 times per week for 9 weeks. Group A received saline as a control. Five animals were killed at the 1st, 3rd, 5th, 7th, and 9th week. In Group A, the neutrophils did not decrease during these 9 weeks. In Group B, however, the neutrophils decreased during the 3rd to 9th week. Whereas the experimental side of Group A showed only moderate alveolar bone resorption between the 7th and 9th week, [in Group B] a marked alveolar bone resorption occurred in Group B occurred in the same period. Alveolar bone loss in the experimental side of Group B was significantly greater (p < 0.01) than in Group A in the 7th to 9th weeks. The percentage of gram-negative rods increased in both control and experimental sides of Group B at the 9th week. The results of the present study indicate that neutropenia is induced by a long-term application of MTX in rats and that alveolar bone destruction increases as time goes by in the area where a nylon thread was inserted.     

Conversion of a stable T-cell lesion to a progressive B-cell lesion in the pathogenesis of chronic inflammatory periodontal disease: an hypothesis

Changes in the host's immunological response or, alternatively, changes in the oral microflora have been implicated as possible mechanisms by which a stable lesion of chronic inflammatory periodontal disease may become a progressive lesion leading to tissue destruction and tooth loss. It has recently been established that the progressive lesion in humans can be unequivocally considered as a B-cell response. Circumstantial evidence exists which suggests that the stable lesion is in fact a T-cell-mediated mechanism. An hypothesis is presented to explain the change from a stable to a progressive state in terms of a shift from a predominantly T-cell lesion to one involving large numbers of B-cells. Mechanisms of this shift in cell populations are considered together with a discussion of possible means of preventing such a shift.     

牙周来源的牙周牙髓联合病变和牙周牙髓共存病变患牙牙周治疗时机的系统评价

目的 评估牙周来源的牙周牙髓联合病变以及真正联合病变（牙周病变和牙髓病变共存）患牙的牙周治疗时机,从而指导临床治疗。方法 在PubMed、EMbase、Cochrane、Web of Science、CNKI、CBM、万方数据库中搜索1980年至2017年3月间关于牙周牙髓联合病变治疗的相关文章,并对其进行分析。结果 最终纳入2篇随机对照研究、2篇前瞻性病例系列研究和8篇病例报告。所有研究病例均采用根管治疗和牙周非手术治疗或牙周手术治疗,且根管治疗是综合治疗的第一步;观察指标包括牙周探诊深度及附着丧失等。结论 对于牙周来源的牙周牙髓联合病变和真正的联合病变患牙,牙髓治疗和牙周非手术治疗间可能不需要观察期,但此结论还需大样本前瞻性随机对照临床研究来验证。     

Ultrastructure of the periodontal lesion in a case of Papillon-Lefèvre syndronne (PLS)

Abstract In this study, 11 permanent teeth and their associated soft tissues from an 11-year-old boy with PLS were examined. Plaque, cementum and periodontal tissues were examitied by scanning (SEM) and transmission electron microscopy (TEM), Except for depressed lymphocyte transformation, there were no abnormal haematological data. Local findings included abnormally thin cementum, extensive destruction of the periodontal ligament were still attached to the root, and severe inflammation of the soft tissues. Few bacteria were found in any of the soft tissue layers. The apical border plaque was restricted to gram- cocci and rods. The features observed in this case of PLS may indicate primary defects of cementum or ligament attachment, or disruption of fibroblast and cementoblast function due to the rapid advance of the disease process. Lack of bacterial invasion in the pocket soft tissue casts doubt on its involvement in the present case of severe periodontitis. The restricted range of morphotypes observed suggests a limited range of associated organisms. Further research is required to clarify the rôle of the host response and to identify the organisms involved.     

胃癌前病变患者口腔中龋病及牙周病主要致病菌的分布研究

目的 本研究旨在评价和分析胃癌前病变患者口腔中龋病和牙周病主要致病菌的分布,探索胃癌患者口腔感染性疾病主要致病菌与健康人群的差异,为口腔疾病与胃癌的相关性的机制研究提供线索.方法 按病理诊断结果,将研究对象分为胃癌前病变组和对照组.提取唾液和牙菌斑样本DNA,进行实时定量PCR,所得数据用χ2检验比较不同细菌的分布情况,Mann-Whitney非参数检验比较不同组别细菌的DNA水平的差异.结果 病例和对照组的唾液中的变异链球菌(Streptococcus mutans,Sm)和远缘链球菌(Streptococcus sobrinus,Sb)2种龋病相关主要致病菌,无论是检出率还是DNA水平均没有显著性差异.病例和对照组的唾液和牙菌斑中牙周病主要病原菌牙密螺旋体(Treponema denticola,Td)、伴放线放线杆菌(Actinobacillus actinomycetemcomitans,Aa)和福赛斯坦纳菌(Tannerella forsythensis,Tf)的DNA水平均高于对照组,Aa在两组中差异具有统计学意义(P<0.05).唾液样本中Pg的DNA水平在两组间则颇为相近,病例组稍低于对照组.牙菌斑样本中的Pg则是病例组略高于对照组,差异不具有统计学意义.结论 胃癌前病变患者口腔中被测的龋病主要致病菌与未见差异,而牙周主要致病菌的含量与健康对照人群有所不同.伴放线放线杆菌可能在胃癌与牙周病相关性中发挥作用.     

Studies of a periodontal tissue lesion in the rat, untreated or treated with chlorhexidine digluconate

Abstract The studies currently reported farmed part of an enquiry whose overall objective was to identify a suitable animal model upon which initial screening of compounds and formulations with prophylactic and/or therapeutic potential in periodontitis could be carried out, An earlier study (Rovin et al. 1966) reported that periodontal inflammation could be produced in the conventional laboratory rat by application of a ligature to the molar teeth. The present paper describes the pathological and histopathological changes in the periodontium following application of ligatures to the molar teeth of young rats, and the tissue responses observed after topical application of chlorhexidine digluconate. Plaque formed rapidly and an acute periodontitis was induced; application of increasing concentrations of chlorhexidine digluconate gave a progressive diminution in the severity of the lesions. The major bacterial components of the plaque were actinomycetes and streptococci.     

Clinical course of chronic periodontitis. II. Incidence, characteristics and time of occurrence of the initial periodontal lesion

AIM: The purpose of this study was to assess the initiation and progression of periodontal disease during adult life. MATERIALS AND METHODS: In a 26-year longitudinal investigation of the initiation and progression of chronic periodontitis that started in 1969 and included 565 men of Norwegian middle class, 223 who had participated in some, but not all, intermediate examinations presented at the last survey in 1995. Fifty-four individuals were available for examination in all seven surveys. RESULTS: Covering the age range from 16 to 60 years, the study showed that at 16 years of age, 5% of the participants had initial loss of periodontal attachment (ILA > or = 2 mm) at one or more sites. Both the subject incidence and the site incidence increased with time, and by 32 years of age, all individuals had one or more sites with loss of attachment. As age progressed, new lesions affected sites, so that as these men approached 60 years of age approximately 50% of all available sites had ILA. An assessment of the intraoral distribution of the first periodontal lesion showed that, regardless of age, molars and bicuspids were most often affected. At and before the age of 40 years, the majority of ILA was found in buccal surfaces in the form of gingival recession. By 50 years, however, a greater proportion of sites presented with attachment loss attributed to pocket formation or a combination of pocket formation and gingival recession. As individuals neared 60 years of age, approximately half of the interproximal areas in posterior teeth had these lesions. CONCLUSION: This investigation has shown that, in a well-maintained population who practises oral home care and has regular check-ups, the incidence of incipient periodontal destruction increases with age, the highest rate occurs between 50 and 60 years, and gingival recession is the predominant lesion before 40 years, while periodontal pocketing is the principal mode of destruction between 50 and 60 years of age.     

A comparison of T4:T8 lymphocyte ratio in the periodontal lesion of healthy and HIV-positive patients.

Previous reports describe a characteristic, rapidly progressive, periodontitis that is unique to patients who are seropositive for HIV antibody (Western blot +). The purpose of this study was to compare the T4 and T8 lymphocyte subpopulations in the peripheral blood and periodontal lesions of these HIV patients with those of healthy controls. T-cell subsets in peripheral blood were quantified by flow cytometry. The values from this analysis were used to calculate the peripheral T4:T8 lymphocyte ratio for each patient. Gingival tissue (papilla) was obtained from 8 HIV+ patients and from 6 healthy HIV- control patients during routine gingival surgery. The T-cell subpopulations in the gingival tissue were determined using serial cryostat sections that were labeled with monoclonal antibodies for T4 and T8 cells and developed using an avidin-biotin-peroxidase system. Six sections were taken from each of the 14 tissue specimens (one per patient). The sections were examined at 450 x and the mean number of T4 and T8 cells calculated for each section. These mean values were then used to determine the T4:T8 lymphocyte ratio for each tissue specimen. The peripheral blood analysis revealed a mean serum T4:T8 ratio of (2.07 +/- 0.455) for the controls and (0.58 +/- 0.26) for the HIV patients. The significantly lower T4:T8 ratio in HIV patients is consistent with their diagnosis. Although the results indicated that the mean T4:T8 lymphocyte ratio in the gingiva of controls was highly variable (2.70 +/- 1.344), the gingiva of HIV patients consistently exhibited a complete absence of T-cells.(ABSTRACT TRUNCATED AT 250 WORDS)     

Microbial colonization of the periodontal pocket and its significance for periodontal therapy

The aim of this paper was to evaluate strategies for periodontal therapy from the perspective of periodontal disease being a consequence of microbial colonization of the periodontal pocket environment. In classic bacterial infections the diversity of the microbiota decreases as the disease develops. In most cases of periodontitis, however, the diversity of the flora increases. Most incriminating bacteria are thought to harm tissues significantly only if present in high numbers over prolonged periods of time. Clinical trials have repeatedly demonstrated that scaling and root planing, a procedure that aims to remove subgingival bacterial deposits by scraping on the tooth surface within the periodontal pocket, is effective. At present, for the therapy of any form of periodontal disease, there exists no protocol with proven superiority, in terms of efficiency or effectiveness, over scaling and root planing plus systemic amoxicillin and metronidazole. Some exponents advocate rationing these drugs for patients with a specific microbial profile. However, the evidence for any benefit of bacteriology‐assisted clinical protocols is unsatisfactory. Treated sites are subject to recolonization with a microbiota similar to that present before therapy. The degree and speed of recolonization depends on the treatment protocol, the distribution patterns of periodontal microorganisms elsewhere in the oral cavity and the quality of the patient's oral hygiene. To limit the use of antibiotics and to avoid accumulation of harmful effects by repeated therapy, further efforts must be made to optimize procedures addressing the microbial colonization and recolonization of the periodontal pocket.