牙龈指数与改良固相BANA试验之间的关系

本研究初步探讨了改良固相BANA试验与牙龈指数之间的关系,以便为临床牙周病活动期的诊断提供客观的辅助资料。1材料与方法1.1研究对象白求恩国际和平医院口腔科就诊患者,受试者3个月内未进行牙周治疗,未使用抗生素类药物、避孕药物,无全身系统性疾病,女性非妊娠及哺乳期,无吸烟     

改良固相BANA试验方法的建立

目的:建立一种稳定、实用的改良固相BANA试验方法。方法:利用牙龈卟啉单胞菌、福赛氏类杆菌、螺旋体等牙周炎关键致病菌均能产生胰蛋白酶样酶(Trypsin-like enzyme,TLE),可使人工合成的酶底物—苯甲酰精氨酸萘酰胺(bengoyl-DL-arginine-naphthlamide,BANA)水解的原理,并以经典的液相法为"参照标准",在国外固相法的基础上进行了适当的改良,建立了改良固相BANA试验。结果:实验发现2mmol的BANA为改良固相BNA试验最适工作浓度,在55℃水箱孵育30min,可以检测到1.95×10-6Anson以上的胰蛋白酶,并具有良好的特异性和敏感性。结论:改良固相法与液相法一样具有较好的特异性和敏感性,但固相法更简单、快捷,为临床牙周病的检测提供了客观、简便的检测方法。     

慢性牙周炎患者的龈下微生物与吸烟状况

目的　评价慢性牙周炎患者的吸烟状况与龈下牙周致病微生物的百分比。方法　 112例慢性牙周炎患者 ,根据吸烟状况分为 :①重度吸烟组 >10支 /天 (n =32 ) ;②轻度吸烟组≤ 10支 /天 (n =18) ;③戒烟者组 (n =2 4 ) ;④非吸烟组 (n =38)。观察者口内每个象限 ,选取探诊最深的 1或 2个位点 ,纸捻法取龈下菌斑 ,厌氧培养 ;并测量该位点的探诊深度 (ProbeDepth ,PD)、附着丧失 (AttachmentLoss,AL)和探诊后出血 (Bleedingofprobe ,BOP)。结果　①取样位点临床指标的均值为PD :6 .3mm、AL :6 .5mm及BOP :89% ,各组间无显著性差异。②组间菌落形成单位和龈下微生物伴放线放线杆菌 (Actinobacillusactinomycetemcomitans,A .a)、牙龈卟啉单胞菌 (Porphyromanasgingivalis,P .g)、中间普氏菌 (Prevotellaintermedia ,P .i)、核梭杆菌 (Fusobacteriumnucleatum ,F .n)和微消化球菌(Peptostreptococcusmicros,P .m)的百分比均无差异。③方差分析显示仅轻度吸烟组福赛类杆菌 (Bacteroidesforsythus,B .f)的百分比略高于其它组 (P <0 .0 4 )。结论　慢性牙周炎患者 ,探诊深度和附着丧失相似的位点 ,吸烟组、戒烟组和非吸烟组的龈下牙周致病微生物百分比 (B .f除外 )无显著差异。     

类风湿关节炎与慢性牙周炎关系研究

目的    探讨类风湿关节炎（rheumatoid arthritis,RA）与慢性牙周炎（chronic periodontitis,CP）之间的关系。方法    选择2014年1月至2015年1月于中国医科大学附属第四医院风湿免疫科确诊为RA的患者30例（RA组）和同期于中国医科大学附属第四医院体检中心进行常规体检者23例（对照组）,两组在性别及年龄上相匹配。检测两组患者的菌斑指数（plaque index,PLI）、出血指数（bleeding index,BI）、探诊深度（probing depth,PD）、附着丧失（attachment loss,AL）、缺失牙数等牙周指标,比较两组患者牙周状况、CP患病率及中、重度牙周炎的分布情况。结果    RA组患者PLI、AL、缺失牙数、CP患病率及中、重度牙周炎比例均高于对照组（均P < 0.05）,而两组BI、PD的差异无统计学意义（P > 0.05）。结论    RA患者比正常人群的牙周状况差,且其患中、重度牙周炎的比例要高于正常人群。     

慢性牙周炎活动期龈下菌斑胰蛋白酶样酶活性与龈沟出血指数的关系

目的：初步探讨慢性牙周炎活动期龈下菌斑胰蛋白酶样酶活性与龈沟出血指数之间的关系，为临床牙周病活动期的诊断提供依据。方法：记录慢性牙周炎活动期牙周袋龈沟出血指数，并采集龈下菌斑标本进行胰蛋白酶样酶检测试验。结果：不同分值的龈沟出血指数所对应的胰蛋白酶样酶检测试验A600nm检测值的差异有统计学意义，经Spearman秩相关检验r=0．718，P＜0．05。结论：龈沟出血指数与牙周袋内胰蛋白酶样酶的水平呈正相关。胰蛋白酶样酶检测试验为临床牙周病活动期的诊断提供更直观的客观参考指标。     

慢性牙周炎龈下菌斑和唾液微生物群落分析

目的:运用DGGE技术检测慢性牙周炎龈下菌斑和唾液微生物群落结构,分析其菌群之间的关系。方法:选取34名慢性牙周炎志愿者,分别采集龈下菌斑和唾液样本,采用PCR扩增细菌16Sr RNA V3区后,运用DGGE技术分析各组样本微生物群落结构。通过数字化软件Im age J将DGGE凝胶图谱转成数字信息,对所得矩阵进行主成分分析(Princ ipal ComponentAnalysis,PCA)、聚类分析(C luster Analysis)和偏最小二乘法(Partial Least Squares,PLS)分析。结果:DGGE图谱显示:龈下菌斑DGGE条带数目为11～28,,平均19;唾液DGGE条带数目为11～24,平均17;PCA结果显示:龈下菌斑与唾液比较有明显的差异;聚类分析显示:龈下菌斑、唾液形成5个明显聚类群,在同一聚类群中相似度高,在不同聚类群中相似度低,表示龈下菌斑与唾液菌群之间有显著差异;PLS结果显示:慢性牙周炎龈下菌斑与唾液菌群有显著差异。结论:DGGE是一种能直观显示微生物群落的指纹技术。通过该技术能检测牙周、唾液微生物群落的结构和组成,本结果显示,慢性牙周炎龈下菌斑与唾液微生物群落结构有明显差异。     

中老年人骨密度与慢性牙周炎的相关性研究

目的：研究中老年人骨密度降低及骨质疏松与牙周炎之间的关系。方法：选取122名进行体格检查的中老年人,女104名,男18名,进行骨密度测定及口腔检查。根据骨密度值（T值）分为观察组（T＜-1.0）与对照组（T＞-1.0）。根据附着丧失（CAL）、余留牙数目分为轻、中、重度牙周炎。运用统计学软件进行骨密度与慢性牙周炎分级间的χ2检验,并与牙周附着丧失进行相关性分析。结果：观察组较对照组,中、重度牙周炎的患病率显著增高（χ2=4.41, P＜0.05）。中老年人群的骨密度值与CAL值显著负相关（tr=-3.88,P＜0.001）,即随着骨密度降低,CAL呈增加趋势。结论：中老年人群中,骨量减少及骨质疏松与慢性牙周炎的严重程度相关;骨密度降低可能是中老年人中、重度慢性牙周炎进展的促进因素。     

侵袭性牙周炎和慢性牙周炎的龈下优势菌分析

目的 :分析侵袭性牙周炎 (aggressiveperiodontitis ,AgP)与慢性牙周炎 (chronicperiodontitis ,CP)的龈下优势菌群 ,为探讨牙周炎分类、病因和诊断提供实验依据。方法 :将中学生流调筛选 (16例 )及牙周病专科就诊(2 4例 )的AgP和CP患者 ,采集龈下菌斑样本 ,在厌氧菌基础培养基 (CDC)和选择性培养基 (TSBV)上培养分析。结果 :局限型AgP患者的伴放线放线杆菌 (Actinobacillusactinomycetemcomitans ,Aa)及兼性厌氧菌的检出率显著高于中度CP患者 (P <0 .0 5 ,P <0 .0 1) ,而广泛型AgP和重度CP患者的厌氧菌总数较局限型AgP和中度CP患者显著增加 (P <0 .0 5 )。结论 :局限型AgP和中度CP的龈下优势菌有明显差别 ,Aa是一个重要的危险因子。     

西帕依固龈液治疗慢性牙周炎的疗效观察

西帕依固龈液由没食子制成,主治牙周疾病引起的牙齿酸软,咀嚼无力,松动移位,牙龈出血等[1]。本试验通过对92例分别使用西帕依固龈液和口泰的慢性牙周炎病人的牙周状况检查,旨在了解西帕依固龈的临床疗效。     

不同程度牙周炎自然发展进程与IL-1RN基因多态性的关系

目的 了解慢性牙周炎病程的自然发展及其与IL-1RN（INTRON2）VNTR基因多态性的关系。方法对110例慢性牙周炎患者，其中轻度18例，中度34例，重度58例进行为期6个月的自然病程观察，分别在基线、6个月对全口余留牙牙周袋深度PD、临床附着丧失量AL进行检查，每个牙检查6个位点并检测其IL-1RN（INRON2）VNTR的基因多态性。结果110人平均牙周袋深度增加PD=0．23mm，平均附着丧失量增加AL=0．50mm。其中36例患者44个牙位出现了△AL≥2mm。6个月后PDAL的改变在IL-1RN（INTRON2）VNTR基因型1／1携带者与基因型1／2携带者间无明显差异（P〉0．05）。6个月后IL-1RN（INTRON2）VNTR基因型及等位基因频率在△AL≥2mm组和病情无明显改变组无统计学差异（P〉0．05），重度牙周炎组较轻中度牙周炎组更易出现快速进展（P〉0．05）。结论不同个体、不同程度其牙周病变的发展是不一样的，还不能认为IL-1RN（INTRON2）vNTR基因多态性会影响汉族人群慢性牙周炎的发展。     

Proximal attachment loss in Swedish adolescents

The present study describes periodontal conditions in 22 adolescents with proximal attachment loss greater than or equal to 2 mm (AL) and 22 matched referents without AL, all identified in a cross-sectional study of 570 16- and 18-year-old. The cases were followed for 3 years and the referents for 1 year while they were in the care of an organized dental health system. With the exception of 1 case with Morbus Hodgkin, the case and referent groups had a similar background with respect to general health and participation in the dental health program. Bleeding on probing was found at AL sites in 12 of the cases and at corresponding sites in 4 referents. 2 cases had a history of eruption disorders at the AL sites, 1 case had experienced a defective filling and 1 had a root fissure at the AL sites. At re-examinations after 1 and 3 years, 10 out of 21 earlier identified AL cases did not meet the criterion of 1 or more sites with AL greater than or equal to 2 mm. None of the cases showed progression greater than or equal to 2 mm of the lesions. In 1 case, the number of AL sites increased during the period. 4 of the cases harboured Actinobacillus actinomycetemcomitans (A.a.) at AL sites in year 1 and 3 in year 3. 8 of the cases and 4 referents had antibodies specific for A.a.-leukotoxin. The 2 most severe cases, in terms of number of sites with AL, showed bleeding at 1 or more of the AL sites, harboured A.a. at these sites and had serum titers against A.a.-leukotoxin.     

Relationship of clinical parameters to attachment loss in subsets of subjects with destructive periodontal diseases

23 subjects were followed prior to treatment for 5 to 12 months in an attempt to relate attachment loss during this period to attachment level, probing depth, gingival redness and bleeding on probing. The subjects were divided into 3 groups based on amount and distribution of prior attachment loss: minor periodontitis, predominantly molar periodontitis and generalized periodontitis. The % of sites that exhibited attachment loss during the study period in the minor periodontitis, predominantly molar periodontitis and generalized periodontitis groups, were 1.3, 8.1 and 5.4, respectively. Subjects with minor periodontitis and predominantly molar periodontitis exhibited attachment loss more frequently in molar sites, proximal sites and sites with attachment level greater than or equal to 4 mm. In subjects with generalized periodontitis, attachment loss was related to tooth surface and attachment level, but not to tooth type. The relationship between the clinical parameters and attachment loss was improved compared with previous studies by using more homogeneous subject groups, more sensitive methods of analyzing attachment change and multivariate data analysis. However, the clinical parameters could not be used as diagnostic tests to predict attachment loss at individual sites.     

The relationship between gingival crevicular fluid cathepsin B activity and periodontal attachment loss in chronic periodontitis patients: a 2-year longitudinal study

This study aims to determine whether gingival crevicular fluid (GCF) cathepsin B levels, total activity (TA) and concentration (EC) predict progressive attachment loss (AL). Seventy-five previously untreated patients with moderate periodontitis were recruited. GCF was collected from 16 molar and premolar mesiobuccal sites and probing attachment level (PAL) and probing depth (PPD) were measured with an electronic probe. Gingival, gingival bleeding and plaque indices were then scored. Prior to baseline patients were given basic periodontal treatment after which the above procedures were repeated. Carefully localized radiographs were taken of the test teeth and repeated annually. Patients were seen 3-monthly for 2 yr and the procedures were repeated. One hundred and twenty-one AL sites, 90 rapid AL (RAL) and 31 gradual AL (GAL), in 49 patients were detected. Cathepsin B levels (TA & EC) at RAL sites were significantly higher (p<0.0001) than paired control sites at the attachment loss time (ALT) and prediction time (PT). Mean levels (TA & EC) over the study period at GAL sites were significantly higher (p<0.0001) than paired control sites. Using a critical value (CV) of 7.5 μU/30 s (TA) and 30 μU /μL (EC) showed a sensitivity of 100% and specificity of 99.83% (TA) and 100% and 99.75%(EC) at both ALT & PT. Mean cathepsin B levels (TA & EC) were significantly higher (p<0.0001) at RAL and GAL sites than nonattachment loss (NAL) sites in AL patients in intrapatient comparisons and mean patient levels were significantly higher (p<0.0001) in AL patients than NAL patients in interpatient comparisons. These results indicate that GCF cathepsin B may serve as a predictor of attachment loss.     

A controlled study of relative periodontal attachment loss in people with HIV infection

OBJECTIVE: To compare the progression of periodontal destruction in people with and without HIV. METHOD: Relative attachment loss on 6 index teeth was compared between 19 people with HIV and 17 people without HIV infection over 12 and 18 month follow ups. RESULTS: The proportions of sites with 1, 2 or 3 mm of relative attachment loss were similar in the study and control groups. Mean maximum relative attachment loss was similar in both groups after 12 months but greater in the study group after 18 months. CONCLUSIONS: The data are not compelling evidence of greater periodontal destruction associated with HIV infection. Large scale cohort studies or meta-analyses would be more conclusive.     

Relation of baseline microbial parameters to future periodontal attachment loss

The relationship between the level of subgingival species at baseline and subsequent attachment loss in a subject was examined. 38 subjects (14-71 years) with prior evidence of periodontal destruction were monitored 2x for pocket depth and attachment level at 6 sites per tooth at baseline and 2 months. A subject was considered to exhibit new attachment loss if 1 or more sites increased 3 mm or more in attachment level in 2 months. Subgingival plaque samples were taken at the baseline visit from the mesial aspect of each tooth (28 sites) using Gracey curettes. Samples were dispersed, diluted and plated on Trypticase soy agar supplemented with 5% sheep blood. After 7 days of anaerobic incubation, the colonies were lifted onto nylon filters, lysed and the DNA fixed to the filters. Digoxygenin-labeled DNA probes were used to enumerate 14 subgingival species. 17 of 38 subjects (44.7%) exhibited new attachment loss in 2 months. The % of the total viable count of each species was averaged for each subject. The species enumerated and the mean % of the total cultivable microbiota averaged across the active and inactive subjects were as follows; B gingivalis 2.3, 1.2; W. recta 1.3, 0.6; B. intermedius I 2.5, 2.0; B. forsythus 1.5, 1.2; A. actinomycetemcomitans serotype a 1.1, 0.8; F. nucleatum ss vincentii 1.1, 1.0; S. intermedius 2.0, 1.9; P. micros 1.5, 1.5; B. intermedius II 1.6, 1.7; A. actinomycetemcomitans serotype b 0.4, 0.6; S. sanguis I 1.8, 2.1; S. sanguis II 2.7, 3.0; V. parvula 3.9, 4.2; C. ochracea 0.9, 1.8.(ABSTRACT TRUNCATED AT 250 WORDS)     

The relationship between attachment level loss and alveolar bone loss

Standardized radiographs and repeated periodontal probe measurements were made on 22 untreated subjects with destructive periodontal disease monitored for 1 year. Radiographs of selected sites were taken at 0, 6 and 12 months. Measurements of attachment level were made monthly. Radiographic measurements were made on 7X magnified projected images. Alveolar bone height from the CEJ was computed by multiplying the average length of the root times the measured ratio of CEJ to alveolar bone over CEJ to root tip. Each radiograph was measured twice by 2 investigators. Sites were excluded as having indistinct anatomical landmarks in which the standard deviation of the 4 measurements exceeded 0.16 mm, the measurement error for repeat determination of bone height on high quality radiographic images. A 3 sigma critical value for significant bone loss was selected as 0.48 mm. Changes in attachment level were computed for the intervals preceding and during the 6-12 month radiographic measurement period. Based on these critical values, 6.1% of the 231 radiographed sites showed significant bone loss. Similarly, 5.7% of the 1155 probed sites showed significant attachment loss. However, none of the sites with significant bone loss exhibited significant attachment loss over the same time period. In general, significant attachment loss preceded bone loss by 6 to 8 months. At 4 mm, attachment loss was found to predict subsequent bone loss with a true positive ratio of 60% and a false positive ratio of 5%, indicating a high degree of predictive discrimination. These observations indicate that attachment loss precedes radiographic evidence of crestal alveolar bone loss during periods of periodontal disease activity.     

Prediction and diagnosis of attachment loss by enhanced chemiluminescent assay of crevicular fluid alkaline phosphatase levels

The current study aimed to apply a novel enhanced chemiluminescence assay in the analysis of gingival crevicular fluid (GCF) alkaline phosphatase (ALP) levels from patients with untreated adult periodontitis. 3666 sites in 25 patients were monitored prior to and after attachment loss was detected with a Florida disc probe. Parameters assessed were, relative attachment level, probing pocket depth, occurrence of bleeding on probing (single episode), GCF volume (microliter), total ALP levels (microIU/30 s sample time) and ALP concentration (IU/l). After recruiting patients to the study, all measures were taken at baseline and 3 months later, prior to the institution of non-surgical periodontal therapy at active sites. Thresholds for determining attachment loss were calculated using a modification of the tolerance method. The mesio-buccal sites of all teeth had GCF samples collected. The size of individual patient thresholds used to define whether attachment loss had occurred, was dependent upon the discomfort felt by that patient during electronic probing, with a positive correlation existing between discomfort on probing (10 cm visual analogue scale) and threshold size (R = 0.52, p < 0.049). A total of 274 sites (7.5%) experienced attachment loss of which 39 sites had GCF samples available for analysis. Total ALP levels were significantly higher at baseline for sites that progressed to attachment loss than paired controls (p < 0.003), but all other parameters showed no differences (p > 0.1). There were significant increases in total ALP levels and GCF volumes for active sites between baseline and 3 month measures (p < 0.01), but not for control sites or test site ALP concentration (p > 0.8). The diagnostic accuracy for GCF ALP as a predictor of future attachment loss (threshold 900 microIU/30 s) was 64%, with +ve and -ve predictive values of 62% and 68%. When a threshold of 1300 microIU/30 s was selected for ALP as a marker of recent or currently active disease, diagnostic accuracy and +ve/-ve predictive values were 77% and 77%/76%, respectively. These results indicate that total GCF ALP levels may serve as a predictor of future or current disease activity.     

Relationship between CPITN and periodontal attachment loss findings in an adult population

Abstract This study investigates the relationship between CPITN findings and the prevalence and severity of periodontal attachment loss in a rural Kenyan population comprising 1131 persons aged 15–65 years. All persons were examined for calculus, gingival bleeding, pocket depths and attachment loss levels on 4 sites of each tooth present. Recordings of bleeding, calculus and pocket depths were used to compute CPITN scores based on the 10 index teeth originally proposed, and these CPITN scores were subsequently related to the attachment loss findings derived from the full-mouth assessment. In most cases, persons with a CPITN score 1 did not have attachment loss 4 mm. However, among 40+ year-old persons with CPITN score 2 over 90% had attachment loss 4 mm and over 50% of the 50+ year-olds with CPITN score 2 had attachment loss 6 mm, Less than 20% of the 15–29 year-olds with CPITN score 3 had attachment loss 6 mm, and usually the attachment loss levels ranged between 0 and 3 mm. Beyond the age of 35 years over 10% of the sextants with CPITN score 0 had attachment loss 4 mm. Below the age of 35 years more than one third of all sextants with CPITN score 3 had attachment loss levels 3 mm. Thus, the CPITN findings overestimate both prevalence and severity of periodontal attachment loss among the younger age groups and underestimate these parameters among elderly subject.