二次牙周龈下刮治与牙周翻瓣术短期临床疗效比较

目的比较二次牙周龈下刮治和根面平整（scaling and root planning,SRP）与牙周翻瓣术治疗慢性牙周炎的短期临床疗效。方法选取牙周基础治疗3个月后牙周探诊深度为5～7mm的前牙或前磨牙共52颗作为研究对象,随机分为2组,二次SRP组行龈下刮治和根面平整术,翻瓣组进行改良Widman翻瓣术。分别在治疗前、治疗后3个月和6个月,检查记录探诊出血（bleeding on probing,BOP）、探诊深度（probing depth,PD）、牙龈退缩（gingival recession,GR）及临床附着水平（clinical attachment level,CAL）,并比较分析。结果二次SRP组和翻瓣组患牙的BOP阳性率、PD、GR、CAL治疗前分别为91.30%、（5.60±0.99）mm、（0.37±0.49）mm、（5.98±1.17）mm和92.13%、（5.87±1.02）mm、（0.30±0.47）mm、（6.03±1.30）mm,治疗后6个月分别为17.39%、（2.87±0.78）mm、（2.00±0.62）mm、（5.07±1.01）mm和11.23%、（2.53±0.51）mm、（2.36±0.68）mm、（4.89±0.84）mm,2组治疗后6个月各项指标与治疗前比较差异均有统计学意义（P〈0.01）。治疗后6个月2组间BOP阳性率、PD及CAL比较差异无统计学意义（P〉0.05）,但翻瓣组GR明显高于二次SRP组（P〈0.05）。结论对于前牙或前磨牙,二次SRP与牙周翻瓣术可达到相同的治疗效果,翻瓣术后牙龈退缩较二次牙周龈下刮治和根面平整后明显。     

翻瓣刮治术治疗慢性牙周炎的临床疗效观察

目的观察翻瓣刮治术治疗慢性牙周炎的临床疗效。方法选择经牙周基础治疗3个月后的重度慢性牙周炎患者15例、46颗患牙,进行翻瓣刮治术,分别在治疗前、术后6个月、术后3年记录菌斑指数(PLI)、出血指数(BI)、牙周探诊深度(PD)、临床附着水平(CAL),拍摄X线片观察牙槽骨变化情况。结果翻瓣刮治术后BI、PD、CAL均较治疗前有明显改善,且3年随访显示疗效稳定,垂直型骨缺损区可获得新骨形成。结论翻瓣刮治术治疗重度慢性牙周炎患牙可以取得较好的临床效果。     

两种骨移植材料治疗牙周骨内缺损的3年临床回顾性观察

目的：评价牙周翻瓣刮治术联合移植生物活性玻璃（PerioGlas）或多孔无机骨（Bio-Oss）,治疗患重度牙周炎前牙的三年临床效果。方法：回顾19例前牙有深牙周袋,存在牙周骨内缺损的慢性牙周炎患者,在行牙周翻瓣刮治术后分别移植PerioGlas或Bio-Oss,记录术前,术后1年,术后3年的临床牙周指数和检查牙周X线片表现。结果：两组病例术后1年和术后3年与基线比较牙周探诊深度（PD）和临床附着丧失（CAL）显著降低,牙龈退缩水平（GR）略有增加。PerioGlas组术后1年PD减少4.94 mm;CAL减少3.94 mm;GR增加1.00 mm。Bio-Oss组术后1年PD减少5.15 mm;CAL减少3.95 mm。GR增加1.10 mm。各组病例术后1年和3年的PD、GR、CAL比较差异均无统计学意义。术后3年PerioGlas组和Bio-Oss组间各项牙周指数PD、GR、CAL比较差异无统计学意义。结论：牙周翻瓣刮治联合骨移植术治疗前牙重度牙周骨内缺损,显著改善临床牙周状态,使牙周骨内缺损再生,3年后临床效果稳定。两种骨移植材料Bio-Oss和PerioGlas均可以引导牙周骨再生,显著改善临床牙周...     

单独龈下超声刮治与结合人工刮治两种方法的临床效果比较

目的 比较单独应用龈下超声刮治与结合人工刮治两种治疗方式的临床效果.方法 选取36例慢性牙周病患者,采用半口对照的方法将患牙分为对照组(左半口)和实验组(右半口),先对所有患牙进行龈上洁治术,一周后对照组实行龈下超声刮治术,实验组实行龈下超声刮治结合人工刮治术.治疗前后1个月、3个月分别检查受试牙,并记录各项临床指标( BOP、PD、CAL).结果 在治疗结束后1个月和3个月,两组各项牙周临床指标均有明显改善(P＜0.05),实验组的改善优于对照组,且有显著性差异(P＜0.05).结论 龈下超声刮治后使用人工刮治,可以获得一个更加平整的根面,取得良好的临床效果.     

2种超声器械龈下刮治的效果评价及扫描电镜观察

目的：比较0dontogain和Prophy Max超声治疗仪在牙周龈下刮治治疗中的效果,并对刮治后的牙根进行扫描电镜观察.方法：选取20例慢性牙周病患者,采用半口对照,随机分为A组（0dontogain组）和B组（Prophy Max组）,每组6个患牙.按照分组,分别对受试牙进行超声龈下刮治术.在龈下刮治术前,术后1个月、2个月分别检查观察牙的各项临床指标（BOP、PD、CAL）,同时记录2组的操作时间.选择10个离体单根牙,随机分为A组和B组,分别用Odontogain和Prophv Max超声仪进行刮治,记录每颗牙的操作时间,并对刮治后的离体牙根作扫描电镜观察.实验结果采用SAS6.12软件包进行分析.结果：A组和B组在龈下刮治术后1个月和2个月,各项牙周临床指标均有明显改善（P＜0.01）,A组的改善稍优于B组,但无显著性差异（P＞0.05）.在临床及离体牙的操作时间上,A组明显优于B组（P＜0.01）.扫描电镜显示,离体牙经刮治后,2组的牙根邻面均较光滑,且A组残留的牙石较少.结论：2种超声治疗仪在牙周治疗中都能达到较好的治疗效果,Odontogain超声治疗仪更快捷、高效.     

牙周内窥镜辅助超声龈下刮治对残留牙周袋临床疗效的评价研究

目的 评价牙周内窥镜下超声龈下刮治对牙周基础治疗后残留牙周袋的临床治疗效果.方法 收集20例慢性牙周炎患者259颗经牙周基础治疗后仍残留深牙周袋的患牙,行牙周内窥镜下超声龈下刮治,比较治疗前及治疗后3个月全口牙周探诊出血(BOP)和牙周探诊深度(PD)的变化.结果 内窥镜治疗后3个月全口平均PD值和BOP位点百分比有显著改善(P<0.001).单根牙和多根牙的平均PD均显著降低(P<0.001),PD≥5mm位点百分比显著改善(P<0.05),其中重度牙周袋位点的改善更明显(P<0.05).根分叉病变位点百分比治疗前后无明显变化.结论 残留牙周深袋经牙周内窥镜辅助超声龈下刮治后,单根牙和多根牙都有显著治疗效果,并且单根牙重度牙周袋位点改善更明显,但是多根牙II度及以上根分叉病变位点的改善有限.     

超声和手工龈下刮治对龈下微生物影响的研究

目的 :比较Perioproline超声龈下刮治和手工龈下刮治对龈下微生物的影响 ,评价Periopro line超声龈下刮治系统的临床疗效和工作效率。方法 :选取慢性成人牙周炎患者 7名 ,共 2 0个左右基本对称牙被纳入研究 ,随机分入实验组 (超声组 )和对照组 (手工组 )。记录治疗时间和治疗前、治疗后 0d、7d和 14d的PD ,BOP值 ,及采集龈下菌斑样本培养鉴定 ,观察比较总菌落形成单位 (CFU)和牙周可疑致病菌检出率及检出量的变化。结果 :两组在治疗后PD、BOP值及龈下菌斑总量 (CFU)和牙周可疑致病菌数量及检出率均显著下降 (P <0 .0 5) ;治疗前后各时段组间均无明显差别 ;超声组的治疗时间明显少于手工组 (P <0 .0 5)。结论 :Perioproline超声龈下刮治和手工龈下刮治均可有效减少龈下微生物的量 ,改善患牙的牙周临床状况 ,且两者间无差异 ,但Perioproline超声龈下刮治明显较手工刮治节省时间     

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。     

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目的评价牙周基础治疗对侵袭性牙周炎（AgP）患者的疗效。方法选择2011年2月至2012年7月南京大学医学院附属口腔医院牙周科就诊的AgP患者58例,进行全口牙周基础治疗。于治疗后1、3、6个月复查,检查患者口中所有天然牙的牙周探诊深度（PD）、附着丧失（CAL）、探诊出血（BOP）、牙龈退缩（GR）,记录松动度。结果治疗后1个月大体观察牙龈组织炎症明显好转,牙龈色泽、形态在多数牙位恢复正常。治疗后3个月PD、CAL与治疗前相比降低,差异有统计学意义（均P〈0．05）;GR增加、松动度好转,但差异无统计学意义（均P〉0．05）。治疗后6个月PD、CAL与治疗前相比降低,GR较治疗前增加,差异均有统计学意义（均P〈0．05）;松动度好转,但差异无统计学意义（P〉0．05）。治疗后6个月与治疗后3个月相比,各项临床指标差异均无统计学意义（均P〉0．05）。治疗后3、6个月,≥3．5mm牙周袋和BOP所占比例与治疗前相比明显下降,差异均有统计学意义（均P〈0．05）。结论基础治疗是治疗AgP的有效手段,中短期疗效可靠。     

Vector治疗仪在慢性牙周炎非手术治疗中的疗效观察

目的：比较Vector治疗仪与Hu—Friedy刮治器在慢性牙周炎非手术治疗中的疗效。方法：临床随机选择68例慢性牙周炎患者,随机分成Vector治疗仪组及Hu—Friedy刮治器组,在基点及治疗6个月后,分别记录：牙周探针出血（BOP）,牙周探诊深度（PD）,临床附着丧失（CAL）。结果：在基点及6个月,各临床参数两组间无统计学差异。结论：Vector治疗仪与传统的手工刮治器在慢性牙周炎非手术治疗短期疗效相似。     

Variation in periodontal referral in 2 regions in theUK

This study investigated the periodontal referral patterns of general dental practitioners (GDPs) in Northern Ireland (NI) and North West England (NWE). A questionnaire dealing with periodontal referral was sent to all 520 GDPs registered in NI and to 274 GDPs in NWE. A usable return was made by 355 (68%) in NI and 189 (70%) in NWE. The NI dentists made significantly more periodontal referrals (median 5, range 0-80) in the year preceding the survey than those in NWE (median 2, range 0-50), p<0.001. Distance was the only factor significantly related to the referral rate in both regions with those who practised more than 25 miles from a specialist referring significantly fewer patients in both regions. In NI, there was a trend towards increased periodontal referral by GDPs who had attended more postgraduate courses; however, in NWE, this was not the case. The GDPs in NWE were significantly less likely than those in NI to refer patients with medical conditions. It is concluded that there is considerable variation in periodontal referral both within and between the 2 regions studied. It is further concluded that in many cases, non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in these regions (NI and NWE) in relation to periodontal referral. Much of the variance in referral in North West England, as in Northern Ireland, remains unexplained.     

Trends in socioeconomic disparities in oral health in Brazil and Sweden

Celeste RK, Nadanovsky P, Fritzell J. Trends in socioeconomic disparities in oral health in Brazil and Sweden. Community Dent Oral Epidemiol 2011; 39: 204–212. © 2010 John Wiley & Sons A/S Abstract – Objectives: To describe the dynamics of trends in socioeconomic disparities in oral health in Brazil and Sweden among adults, to assess whether trends follow expected patterns according to the inverse equity hypothesis. Methods: In Sweden, we obtained nationally representative data for the years 1968, 1974, 1981, 1991 and 2000, and in Brazil, for 16 state capitals in 1986 and in 2002. Trends in the prevalence of ‘edentulism’ and of ‘teeth in good conditions’ were described in two groups aged 35–44 with lower and higher economic standards, respectively. Results: There was an annual decline in disparities in ‘edentulism’ of 0.4 percentage points (pp) (95% CI = 0.2–0.7) in Brazil and 0.7pp (95% CI = 0.5–0.9) in Sweden, as a result of improvements in both income groups. Concerning ‘teeth in good conditions’, in Brazil, there was improvement only in the higher income group and absolute disparities have increased (0.5pp annually), while in Sweden, there was a nonsignificant decrease (0.3pp annually) with improvements in both groups. Since 1991 in Sweden and in 2002 in Brazil, our measures of socioeconomic disparities in ‘edentulism’ were not statistically significant. Trends did not differ by sex or dental visit. Conclusions: Despite improvements in both income groups and a decrease in disparities in ‘edentulism’, the poorer group in Brazil has seen no improvement in ‘teeth in good conditions’ and disparities have increased. It appears that Brazil and Sweden reflect different stages of trend for ‘teeth in good conditions’ and the same stages for ‘edentulism’, represented by the inverse equity hypothesis.     

Fluorosis in relation to fluoride levels in water in central Nigeria

Abstract– Objectives : This study was conducted to examine the prevalence of dental fluorosis in relation to fluoride levels in water among children aged 12–15 years in the states of Plateau and Bauchi, Nigeria. Methods : Children ( N =203) were examined using WHO criteria. The children were from two schools and permanent residents of the communities in which the schools are located (Tilden Fulani and Kanadap). Intra-examiner reliability for determining fluorosis scores was 80%. Results : Fluoride levels in the water ranged from 0.0–0.4 mg/L. Prevalence of dental fluorosis in the sample was 51%. Forty-one percent had very mild fluorosis, 7% had mild fluorosis and 3% had moderate to severe fluorosis. The lowest DMFT was observed in the school where the fluoride level of the water ranged between 0.0 and 0.4 mg/L, and in the group with very mild fluorosis. Conclusion : Fluoride levels in water for central Nigeria were appropriate for oral health. In the areas where the children were permanent residents, factors other than the fluoride levels of the water contributed to the severity of dental fluorosis.     

Trends in endodontic claims in Italy

According to the scant data available in the literature, endodontic claims are common among dental professional liability cases and the second most common type of claim. This study aimed to describe the characteristics of endodontic claims in Italy and the most frequently disputed errors, and the discussion below includes consideration of ethical and medico‐legal aspects thereof. We retrospectively analysed 120 technical reports written on cases of professional malpractice in endodontics in the last 5 years. The complainant patients were males in 22.5% of the cases, while females made up the remaining 77.5%. In the dentist sample, male operators were more often involved in litigation cases (80%) than female operators. The most frequently claimed technical errors were: lack of a complete filling of root canal/s (71.7%), the perforation of tooth structure (12.7%), extrusion of sealing materials beyond the apex of the tooth (9.6%) and the fracture of an endodontic instrument (5.9%). In 1.7% of cases it was found that the expert did not make any errors performing the endodontic therapy. In only very few cases (2.7%) no therapy was considered necessary, while the most common therapeutic solution involved in endodontic misconduct was tooth extraction (53.0%). In many cases the dentist preferred to extract the endodontically undertreated tooth and substitute it prosthetically rather than trying to re‐treat it. The discrepancy between the total number of cases examined and those that eventually go to court leads us to believe that the majority of endodontic malpractice cases are resolved in out‐of‐court settlements.     

Human Herpesviridae in acute necrotizing ulcerative gingivitis in children in Nigeria

Herpesviruses have been implicated in the pathogenesis of human periodontitis. The present study investigated whether herpeasviruses are present in the lesions of acute necrotizing ulcerative gingivitis. Sixty-two Nigerian children, aged 3–14 years, were studied. Twenty-two children had acute necrotizing ulcerative gingivitis and were also malnourished, 20 exhibited no acute necrotizing ulcerative gingivitis but were malnourished, and 20 were free of acute necrotizing ulcerative gingivitis and in a good nutritional state. Polymerase chain reaction methods were used to determine the presence of human cytomegalovirus (HCMV), Epstein-Barr virus type 1 and type 2 (EBV-1, EBV-2), herpes simplex virus (HSV), human herpes virus 6 (HHV-6), human papilloma virus and human immunodeficiency virus type 1 in crevicular fluid specimens collected by paper points. Of the 22 acute necrotizing ulcerative gingivitis patients, 15 (68%) revealed viral infection and 8 (36%) viral coinfection. Thirteen (59%) acute necrotizing ulcerative gingivitis patients demonstrated HCMV, 6 (27%) EBV-1, 5 (23%) HSV and 1 (5%) HHV-6. Only 2 (10%) subjects from each group not affected by acute necrotizing ulcerative gingivitis showed viral presence, and no control subject revealed viral coinfection. These findings suggest that HCMV and possibly other herpesviruses contribute to the onset and/or progression of acute necrotizing ulcerative gingivitis in malnourished Nigerian children.     

Changes in caries prevalence in Japan

In Japan, the mean DMFT at 12 years of age increased from 2.8 in 1957 to 5.9 in 1975. From the 1981 survey (DMFT=5.43), conversely, the mean DMFT decreased and reached 3.64 in 1993. The increase in caries prevalence can, without doubt, be explained by an increment of sugar consumption, since the intake of sugar increased after World War II and exceeded 18.25 kg/year (50 g/day) in 1965 and reached a maximum value (29.3 kg/year) in 1973 in Japan. On the other hand, the reason why the DMFT has decreased since 1981 is not clear. In many industrialized countries, a caries reduction has been achieved with acceptable fluoride exposure, although sugar consumption was still at a high level. However, fluoride usage was still limited during the last 2 decades in Japan. There is no community where fluoridated drinking water has been supplied since 1972. Fluoride tablet use was also discontinued for children in the 1970s. Fluoride mouthrinsing programs were available for only 19r of school children in 1992. Moreover, the market share of fluoridated dentifrices stayed at 10% until 1986 and became 30% only in 1988. An excellent correlation (r=0.91; P 0.01) is observed between the DMFT in 12-year-olds and per capita sugar consumption per year between 1957 and 1987 in Japan.     

Advances in local anesthesia in dentistry

Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia.     

Localization of SOST/sclerostin in cementocytes in vivo and in mineralizing periodontal ligament cells in vitro

Jäger A, Götz W, Lossdörfer S, Rath‐Deschner B. Localization of SOST/sclerostin in cementocytes in vivo and in mineralizing periodontal ligament cells in vitro. J Periodont Res 2009; doi: 10.1111/j.1600‐0765.2009.01227.x. © 2009 John Wiley & Sons A/S Background and Objective: Cementum and bone are rather similar hard tissues, and osteocytes and cementocytes, together with their canalicular network, share many morphological and cell biological characteristics. However, there is no clear evidence that cementocytes have a function in tissue homeostasis of cementum comparable to that of osteocytes in bone. Recent studies have established an important role for the secreted glycoprotein sclerostin, the product of the SOST gene, as an osteocyte‐derived signal to control bone remodelling. In this study, we investigated the expression of sclerostin in cementocytes in vivo as well as the expression of SOST and sclerostin in periodontal ligament cell cultures following induction of mineralization. Material and Method: Immunolocalization of sclerostin was performed in decalcified histological sections of mouse and human teeth and alveolar bone. Additionally, periodontal ligament cells from human donors were cultured in osteogenic conditions, namely in the presence of dexamethasone, ascorbic acid and β‐glycerophosphate, for up to 3 wk. The induction of calcified nodules was visualized by von Kossa stain. SOST mRNA was detected by real‐time PCR, and the presence of sclerostin was verified using immunohistochemistry and western blots. Results: Expression of sclerostin was demonstrated in osteocytes of mouse and human alveolar bone. Distinct immunolocalization in the cementocytes was shown. In periodontal ligament cultures, following mineralization treatment, increasing levels of SOST mRNA as well as of sclerostin protein could be verified. Conclusion: The identification of SOST/sclerostin in cementocytes and mineralizing periodontal ligament cells adds to our understanding of the biology of the periodontium, but the functional meaning of these findings can only be unravelled after additional in vitro and in vivo studies.