Blood flow and human periodontal status

The purpose of this study was to evaluate the microcirculation in subjects with moderate gingivitis, periodontitis, and healthy gingiva. Sixty adult volunteers with clinically healthy gingiva, moderate gingivitis, and periodontitis (20 subjects each) participated in this study. The ages of the research samples ranged from 20 to 35 years. Gingival health was evaluated by using the qualitative plaque index, gingival index, gingival bleeding index, tooth mobility, probing pocket depth, clinical attachment level, and laser Doppler flowmetry (LDF) on six maxillary anterior teeth. LDF data were recorded at the facial aspect of free gingivae, interdental gingivae, attached gingivae, and alveolar mucosae on six maxillary anterior teeth, utilizing an acrylic stent to stabilize the probe. This technique was then modified to circumvent contamination by saliva and gingival exudate. When results were compared at similar sites in each patient within a trial group, there were significant differences in blood flow measurements at all the sites examined between moderate gingivitis and periodontitis when compared with measurements in healthy human gingiva. However, blood flow measurements within the same group showed significant differences at every site, at P < 0.01. Received: December 17, 2001 / Accepted: January 23, 2002     

Microcirculation of the healthy human gingiva

 The purpose of this study was to evaluate the microcirculation in healthy human gingiva. Forty-two adult volunteers with clinically healthy gingiva participated. The ages of this research sample ranged from 20 to 30 years. Periodontal conditions were evaluated and assessed by using the qualitative plaque index, gingival index, gingival bleeding index, tooth mobility, and laser Doppler flow-metry (LDF) on 12 maxillary and mandibular anterior teeth. The LDF data were recorded on the facial aspect of the free gingiva, interdental gingiva, attached gingiva, and alveolar mucosa of 12 maxillary and mandibular anterior teeth, utilizing an acrylic stent to stabilize the probe. This technique was then modified to circumvent contamination by saliva and gingival exudate. Blood flow in the maxillary anterior gingiva differed significantly from that in the mandibular anterior gingiva in interdental gingiva, attached gingiva, and alveolar mucosa, at P < 0.01. The maxillary anterior gingiva, at each point on the stent, showed significant differences in the mean LDF, at P < 0.01. For the mandibular anterior gingiva, the difference was significant only in the alveolar mucosa region. Received: November 10, 2000 / Accepted: January 23, 2002     

颈缘瓷在前牙烤瓷全冠修复中的美学效果

目的评价颈缘瓷在前牙镍铬合金烤瓷全冠修复中的临床美学效果。方法265例患者的527颗牙用金刚砂车针进行常规牙体及颈部肩台制备，用Ivoclar低温瓷粉制作具有颈缘瓷的镍铬合金烤瓷全冠。临床试戴、抛光、粘结。结果修复后随访1～4年，与具有颈缘瓷的镍铬合金烤瓷全冠相接触的牙龈未见龈缘灰线，约3％的患者有轻到中度龈炎。结论鉴于对牙龈组织的保护和牙龈及牙体美学的考虑，笔者认为在制作镍铬合金烤瓷全冠时，添加颈缘瓷是一个非常有效的修复方法。     

Gingival Condition Associated with Partial Orthodontic Treatment

A longitudinal clinical study on gingival condition was made on seventy-five patients treated with fixed orthodontic appliances in one or both dental arches. Fifty-three non-treated subjects of comparable age were included for further reference. The prevalence and severity of gingivitis about the maxillary teeth were compared for partial (i.e. banding of all maxillary teeth) and full (i.e. banding of all maxillary and mandibular teeth) orthodontic treatment. Plaque accumulation and gingival status were assessed according to the Plaque and Gingival Index systems. Gingival hyperplasia was recorded by linear measurements using pocket probes.

The results demonstrated that all patients developed generalized gingivitis during the period of active treatment. The proximal areas were invariably more affected than the buccal areas, and posterior teeth more than anterior teeth. Although the GI, PII and pocket depth values were constantly lower when treatment was limited to the maxillary teeth, the differences were small and generally not significant. Also the healing of the gingiva after removal of the appliances was more rapid when partial treatment was used. In neither orthodontic group, however, any permanent damage to the periodontal tissues could be demonstrated with the methods used.     

近红外漫反射光谱-慢性牙周炎早期诊断方法

目的:通过近红外漫反射光谱(DCS)技术测量正常、炎症状态时牙龈组织的相对血流量变化,为早期诊断慢性牙周炎提供依据.方法:随机选择30名门诊患者,应用DCS技术研发的流量仪,测量牙周治疗前、治疗后1周和1个月上前牙唇侧近、远中部位龈乳头的相对血流量,并同时做牙周探诊检查及常规临床治疗.结果:不同时期牙龈的相对血流量,健康牙龈组(129.73±10.70)高于慢性牙龈炎组(95.51 ±11.83),慢性牙龈炎组高于慢性牙周炎组(67.84±13.05).与治疗前相比,治疗后1周和1个月牙周指数均降低,牙龈相对血流量亦显著增加.牙龈指数和龈沟出血指数与相对血流量具有相关性(r=-0.902,r=-0.893).结论:DCS能无创性测量牙龈炎症不同时期牙龈组织的相对血流量变化,期望成为慢性牙周炎早期诊断方法之一.     

Laser Doppler measurement of gingival blood flow in dogs with increasing and decreasing inflammation

Dramatic changes in vessel morphology and vascularization are associated with early clinical signs of gingivitis in the dog; there is conflicting evidence of both increased and decreased blood flow in the inflamed gingiva. The blood-flow rates were compared in treated and untreated gingivitis in dogs by a new, non-invasive technique, the laser Doppler flow meter (LDF). The LDF measures blood flow in 1 mm3 of the gingival margin by back-scattered light. Four adult mongrel dogs with generalized mild gingivitis were fed a dental-plaque-inducing diet. Teeth on the left were scaled and polished at zero and four weeks and brushed six times a week during the seven-week experimental period; teeth on the right were left untreated. Test teeth were the upper canines through to the fourth premolars, and lower second premolars through to the first molars. On the facial aspect of these teeth, plaque index (PlI), gingival index (GI), and gingival crevicular fluid (GCF) were assessed at weeks zero, one, four and seven. Blood flow at the gingival margin was measured with LDF at weeks one, four and seven. Acrylic appliances were used to reposition the fibre-optic probe in the same place at each follow-up examination. In a conditional binary logistic regression model, PlI, GI and GCF were significantly related to treatment (p less than 0.01), but LDF blood flow was not (p = 0.01). Blood flow increased slightly with time on the untreated side, but there was no significant decrease in blood flow with the resolution of inflammation on the treated side. Thus microvascular changes in gingival inflammation may not quickly, if ever, be reversed.     

Changes in the gingival thickness and keratinized gingival width of maxillary and mandibular anterior teeth after orthodontic treatment

ObjectivesTo evaluate changes in the gingival thickness (GT) and keratinized gingival width (KGW) of the maxillary and mandibular central and lateral incisors and canines after fixed orthodontic treatment and their association with sagittal tooth movement (STM).Materials and MethodsIn this study of both arches, 60 periodontally healthy subjects who had completed fixed orthodontic treatment were included. Using pretreatment and posttreatment lateral cephalograms, STM of the maxillary (1-NA angle and distance, and 1-SN angle) and mandibular (1-NB angle and distance, and IMPA angle) incisors were evaluated to divide the subjects into protrusion and retrusion groups. Pretreatment and posttreatment GT was identified via transgingival probing, and KGW was calculated from the free gingival margin to the mucogingival junction.ResultsThe intragroup pretreatment and posttreatment comparison results showed a significant decrease in the GT of the maxillary and mandibular anterior teeth in the protrusion and retrusion groups and a decrease in the KGW of the maxillary lateral incisors in the protrusion group. Pearson correlation coefficient analyses for maxillary and mandibular anterior teeth revealed that the GT changes were not significantly associated with STM. However, a positive correlation existed between the KGW of tooth numbers 13 and 41 and STM.ConclusionsSTM was not significantly associated with decreased GT of the maxillary and mandibular anterior teeth, but it was positively correlated with the KGW of tooth numbers 13 and 41.     

Repeatability of ultrasonic determination of gingival thickness

The aim of the present study was to assess the degree of disagreement of ultrasonic measurements of gingival thickness at different teeth. Gingival thickness was determined in 33 volunteers with plaque-induced gingivitis. Facial/buccal gingiva was measured at the level of the gingival sulcus depth. Measurements were repeated after 2 and 4 weeks. A repeated measures, two-level (occasion, subject), variance components model revealed a within-subject variance of 0.187 mm² resulting in a repeatability coefficient of 1.20 mm. When modeling level 1 (occasion) variance as a function of tooth type, respective error terms were used for calculating 95% repeatability coefficients for different teeth. Unreliable measurements were largely confined to upper and lower second and third molars. Error terms were lowest (0.03–0.05) at upper canines and first premolars as well as lower anterior teeth and premolars, where repeatability coefficients of 0.5 to 0.6 mm could be estimated. It was concluded that performance of the device was best at certain tooth types with rather thin gingiva. The present resolution and rather high degree of disagreement may preclude, however, detection of minute increases in thickness in the micrometer range, which seem to occur during gingivitis.     

腭侧游离龈瓣修复上颌前牙区牙龈瘤切除术后缺损的临床效果评价

目的：评价腭侧游离龈瓣修复上颌前牙区牙龈瘤切除术后缺损的临床效果。方法制取腭侧游离龈瓣修复上颌前牙区牙龈瘤切除术后牙龈缺损22例。采用龈缘形态评价标准、龈乳头指数、改良出血指数等评价腭侧游离龈瓣修复前牙区牙龈瘤切除术后缺损的临床效果。结果22例患者缺损区牙龈质地、厚度与高度、牙龈乳头丰满度均取得良好的效果。结论腭侧游离龈瓣修复前牙区牙龈瘤切除术后缺损的临床效果满意。     

实验性龈炎的临床观察和龈沟液量的分析

目的　观察实验性龈炎发展过程中的临床表现及龈沟液 (GCF)量的变化 ,探讨GCF量与牙龈炎症发生和发展的关系。方法　选取 11名受试者 ,在其停止口腔卫生措施后 2 1d内 (第 0、7、14、2 1天 )和恢复口腔卫生措施 1周后 (第 2 8天 )记录临床指标的变化 ,并且测量GCF量 (每人测18颗牙 )。结果　在实验性龈炎发展过程中 ,各项临床指标 (菌斑指数、出血指数、牙龈指数、探诊深度 )和GCF量在基线时数值较低 ,停止刷牙后随着菌斑量的不断增多而逐渐上升 ,恢复刷牙后又下降到接近基线水平。GCF量与各项临床指标均为显著正相关。结论　临床指标和GCF量在基线、停止刷牙和恢复刷牙 1周后随菌斑量的改变而存在显著差异 ,反映了牙龈炎症的形成和发展过程     

The effect fo topical application of Fluorides on the gingival tissues

There have been few previous investigations of the possible local effects on the gingivae of topically applied fluoride solutions and the results obtained have been contradictory. In the present study the immediate reaction of dog gingivae to topical application of sodium fluoride in concentrations of 0.2, 1.0 and 2.0 per cent, and the reaction to long term treatment by daily application of 2.0 per cent sodium fluoride solution to clinically healthy and chronically inflamed gingivae were studied. Immediate tissue reactions were assessed from changes of microvascular structure and function (Part 1). The effect of long-term treatment was estimated from the amount of fluid in the gingival pocket (Part II). Application of sodium fluoride solutions to the crevicular epithelium in variably caused severe dysfunction of the blood vessels in chronically inflamed tissues but never of those in clinically healthy gingiva. Repeated topical applications of 2 percent NaF did not produce chronic gingivitis or aggravate an existing gingivitis.     

Dental biofilms at healthy and inflamed gingival margins

Objectives: The increased plaque formation observed in gingival inflammation is not fully understood. Receptor proteins in the dental pellicle might influence bacterial adhesion and subsequent plaque formation. The purpose of the present study was to examine proteins and microorganisms in dental biofilms, at healthy and inflamed gingival margins. Material and methods: To see whether marginal inflammation affects the composition of the pellicle and the early dental plaque, samples were taken from the gingival and incisal parts of teeth in periodontally healthy subjects, both in gingival health and during experimental gingivitis. Pellicle proteins were analysed using gel-electrophoresis, immunoblotting and image analysis. Bacteria were analysed by culturing and the PCR technique. Results: During gingivitis, the rate of plaque formation increased significantly. The semiquantitative amounts of proteins and the numbers of bacteria varied considerably between individuals and surfaces. The amount of total and individual pellicle proteins and the total numbers of bacteria were, however, increased during gingivitis and the increase in proteins was statistically significant on the incisal parts of tooth surfaces. Compared to a healthy gingiva, reduced numbers for Actinomyces spp. (incisal parts only) and streptococci and increased numbers of periodontopathogens in the 4 h dental biofilms were seen at the inflamed gingiva. Conclusion: Increased gingival crevicular fluid flow during gingivitis affects pellicle formation and increased plasma proteins in the pellicle may modify bacterial attachment and early dental plaque composition.     

牙周组织再生结合骨皮质切开术对骨性Ⅲ类错[牙合]牙龈厚度影响的数字化评估

目的通过口内扫描技术初步探索并建立一种评价软组织改变的方法,评估牙周组织再生结合骨皮质切开术对骨性Ⅲ类错[牙合]骨嵴顶冠方牙龈厚度的影响。方法纳入2018年1月至2019年3月于北京大学口腔医学院·口腔医院正畸科和口腔颌面外科转诊至牙周科、全身和牙周健康、需行正畸-正颌联合治疗的骨性Ⅲ类错[牙合]畸形患者22例,其中男性4例,女性18例,年龄(24.0±4.5)岁(19~35岁);观测前牙共112颗,其中上颌前牙46颗,下颌前牙66颗。在前牙去代偿正畸移动前行牙周组织再生结合骨皮质切开术,观察探诊深度、出血指数、角化龈宽度,比较术前及术后6个月的差异。术前与术后6个月通过口内扫描技术直接获取患者上下颌前牙区数字化模型,在分析软件中构建软组织形态测量模型,并定量分析牙冠正中测量矢状面上龈缘根方1和2 mm处牙龈厚度的变化。结果22例患者手术前后探诊深度、出血指数差异均无统计学意义(P>0.05);术后6个月角化龈宽度从术前的(4.22±1.43)mm显著增加至(5.18±2.32)mm(P<0.05)。术后6个月上颌、下颌前牙龈缘根方1和2 mm处牙龈厚度与术前相比均显著增加(P<0.05);其中上颌前牙龈缘根方1和2 mm处牙龈厚度增加量分别为(0.68±0.56)和(1.00±0.69)mm;下颌前牙龈缘根方1和2 mm处牙龈厚度增加量分别为(0.38±0.42)和(0.58±0.45)mm;且上颌牙龈厚度增加量均显著大于下颌(P<0.01)。结论基于口内扫描技术进行软组织形态变化的定量评价方法切实可行。在骨性Ⅲ类错[牙合]正畸-正颌联合治疗中牙周组织再生结合骨皮质切开术不但能增加角化龈宽度,而且可增加骨嵴顶冠方牙龈组织厚度。     

天然上前牙(根)术后龈乳头影响因素的探索

目的:明确影响术后天然牙根牙龈龈乳头的主要因素,为临床治疗提供依据。方法:需行上前牙翻瓣术的20名患者的46例上前牙龈乳头,记录术前菌斑指数、探诊深度、出血指数、龈乳头指数,记录术中乳头处龈瓣的厚度、邻面骨嵴顶至邻牙切角的距离(残根)/邻面骨嵴顶至邻接点的距离a(天然牙)、两牙根在骨嵴顶水平的近远中向距离、邻面骨嵴顶与唇侧骨嵴顶最根方的垂直距离,骨嵴顶颊舌向宽度和术后6个月修复位点恢复的邻接点与邻牙切角距离、PIS、PLI、PD、BI。单因素分析各临床指标与PIS的关系,Logistic回归分析各临床指标对PIS的影响。结果:随着邻面骨嵴顶至邻接点的距离的增加,龈乳头指数和充满率呈下降趋势,多因素分析显示,调整PD、BI、PLI后,邻面骨嵴顶至邻接点的距离是影响PIS的重要因素(OR=0.43,95%CI 0.184-0.99,P=0.047)。薄生物型的牙龈乳头体积显著小于厚生物型牙龈乳头体积(16.8±7.63 vs 27.96±9.89 mm3P<0.001)。结论:邻面骨嵴顶到邻接点的距离是影响牙龈乳头指数的主要因素,不同生物型牙龈龈乳头体积不同。     

Influence of topical application of chlorhexidine on chronic gingivitis and gingival wound healing in the dog

Abstract— The present study examines the effect of topically applied chlorhexidine gluconate on chronically inflamed gingiva and standardized gingival wounds. Five beagle dogs were fed a soft "gingivitis inducing" diet for a period of 5 months. Subsequently, a 2 % chlorhexidine solution was applied daily for 42 days to the left molars, premolars, and canines of three dogs, the corresponding teeth in the right quadrants serving as controls. The degree of gingivitis, plaque, gingival exudation, and number of crevicular leukocytes were assessed on days 0, 11, 28, 35, and 42. The healing after gingival biopsy was studied in two dogs using the same parameters on days 0, 4, 7, 14, 28, and 42. In one of the dogs chlorhexidine was applied daily to the teeth and gingiva; the other dog had saline treatment. Biopsies for histologic examination were obtained at the beginning and the end of the experiment. From these criteria, it was shown that one daily topical application of 2 % chlorhexidine gluconate to the teeth and gingiva of the dog removes plaque and resolbes a well-established chronic gingivitis. It is concluded that in the dog it is passible through topical applications of chlorhexidine to establish and maintain a plaque- and gingivitis-free dentition.     

Elevated levels of collagen cross-link residues in gingival tissues and crevicular fluid of teeth with periodontal disease

Lysylpyridinoline (LP) and hydroxylysylpyridinoline (HP) are collagen cross-link residues. Lysylpyridinoline is present in most tissues, whereas LP is present mainly in mineralized tissue. Both are elevated in tissue with increased collagen resorption. The purpose of this investigation was to assess if the concentrations of LP and HP are elevated in gingiva and gingival crevicular fluid (GCF) of teeth with advanced periodontitis (AP). We investigated human gingival biopsies of healthy teeth (n = 19) and teeth with AP (n = 43) in 49 individuals. Samples of GCF from 54 teeth with AP were collected in seven patients and compared with samples from 11 patients with experimentally induced gingivitis. Levels of LP and HP were measured by HPLC and fluorescence detection. Gingival concentrations of HP but not LP around teeth with advanced periodontitis were significantly elevated compared with teeth with healthy periodontium. While significant amounts of HP and LP were measurable in the GCF of teeth with AP, no HP and LP was identified 3 months following non-surgical periodontal therapy of the teeth or in fluid from teeth subjected to experimentally induced gingivitis. Elevated concentrations of HP and LP in GCF may serve as indicators of ongoing destruction of periodontal tissues and alveolar bone in advanced periodontitis.     

Cross-sectional study to evaluate variations in attached gingiva and gingival sulcus in the three periods of dentition

The dimensional differences of the attached gingiva and gingival sulcus in the primary, mixed and permanent dentition were studied clinically in normal gingivae of 382 children, aged 4-15 years. The depth of the gingival sulcus and the width of keratinized gingiva were also measured. Shallow gingival sulcus was observed in the primary dentition as compared to that in permanent dentition. However, in the mixed dentition deeper sulcus was observed around the newly erupted teeth. This was attributed to deeper penetration of the instrument, at the time of eruption. The widest zone of attached gingiva was observed in maxillary and mandibular incisors, decreasing gradually over the cuspids and first premolars (first primary molars), and again attached gingiva increased in second premolars (second primary molars) and first and second permanent molars. The width of attached gingiva in case of newly erupted permanent teeth (mixed dentition) was narrower in the corresponding primary teeth. This was due to an increase in the gingival sulcus depth. The attached gingiva increased in width with age. This was related to a concomitant reduction in sulcus depth.     

切牙区牙龈颜色的测量与初步分析

目的：对健康汉族成人切牙区牙龈颜色的色度值进行采集和分析,研究人体切牙区牙龈色度学分布。方法：用MINOLTACS-321便携式色差仪采集、分析127例受试者切牙区牙龈色度值,采用SAS软件进行统计学分析。结果：上颌附着龈色度值范围L＊24．25-58．88、a＊1．72-18．64、b＊0．59—10．16;上颌边缘龈色度值范围L＊23．14-59．81、a＊1．42-16．52、b＊0．56-7．99;下颌边缘龈色度值范围L＊29．94-60．12、a＊1．54-13．74、b＊1．22—9．81。上颌附着龈和边缘龈无明度上的差异,但附着龈较边缘龈的牙龈颜色要偏红偏黄许多;下颌边缘龈较上颌边缘龈则明度高,牙龈颜色偏红偏黄。结论：通过此项研究,初步确定了健康汉族成人切牙区牙龈颜色在色空间的分布范围和分布特点。     

锥形束CT法在上颌前牙区牙龈厚度评估中的应用

目的 探究锥形束CT(CBCT)法在不同牙位、不同牙龈生物型及不同牙龈退缩类型上颌前牙区牙龈厚度评估中的应用。方法 选择2018年3月至2019年7月在我院口腔科接受CBCT检查的40例患者（225颗患牙）为研究对象，测量上颌前牙区龈缘下2 mm各患牙的牙龈厚度，比较其在不同牙位、牙龈生物型、牙龈退缩类型的差异。结果 中切牙的牙龈厚度（1.56±0.32） mm>侧切牙的牙龈厚度（1.34±0.28） mm>尖牙的牙龈厚度（1.13±0.24） mm；无退缩牙龈厚度（1.42±0.38） mm>退缩牙龈厚度（1.19±0.37） mm，退缩程度越深，牙龈厚度越小，差异具有统计学意义（P<0.05）；中切牙多为厚龈型，侧切牙和尖牙多为薄龈型；大部分患者为薄龈生物型，薄龈型相比厚龈型更容易发生牙龈退缩。CBCT法测量牙龈厚度具有准确性和可重复性。结论 CBCT法在上颌前牙区不同牙位、牙龈生物型及牙龈退缩类型上评估牙龈厚度具有良好的准确性。有助于牙科医生选择牙周治疗方案、评估美学修复预后提供参考依据。     

Influence of restorative manipulations on the blood perfusion of human marginal gingiva as measured by laser Doppler flowmetry

Plaque accumulation caused by deficient fixed prosthodontics may evoke unequal degrees of gingival inflammation. Clinical investigation was performed to study the reaction of marginal gingiva during the course of routine prosthetic rehabilitation, e.g. replacement of two two-unit fixed partial dentures for aesthetic and functional reasons in a female patient. To characterize the actual state of gingival margin we recorded conventional gingivitis indices in conjunction with the employment of non-invasive laser Doppler flowmetry (LDF) for gingival perfusion measurements. Prior to the treatment procedures (control phase) the gingival indices were scored to 1 at all the five measuring points. At the end of the rehabilitation those values decreased to zero. A significant correlation was found between gingival indices and LDF readings (r=0.37, n=49, P < 0.01). Thus, our data suggest that monitoring of gingival blood perfusion by LDF may provide valuable information on the healing process of inflamed marginal gingiva.