产黑色素拟杆菌群与牙周病发病关系的临床研究——牙龈拟杆菌与成年人牙周炎

本文从临床筛选了46例成年人牙周炎患者牙周袋内标本和其中12例同一口腔内非牙周炎区龈沟内标本，以及进行了以局部治疗为主的19例综合治疗后同一牙周袋内标本，进行了厌氧菌检查，分离鉴定产黑色素拟杆菌群，又重点进行了牙龈拟杆菌的鉴定，分析了它们与成年人牙周炎的发病, 及与各种牙周状态的关系，并实验证明清除牙周袋内菌斑及局部病灶的疗法是最重要的牙周治疗手段。     

牙髓源性牙周牙髓联合病变牙周袋内牙龈卟啉单胞菌定量PCR检测

目的 比较牙髓源性牙周牙髓联合病变与重度慢性牙周炎患牙牙周袋内牙龈卟啉单胞菌的数量差异,为临床诊断牙髓源性牙周牙髓联合病变提供科学依据.方法 采集牙髓源性牙周牙髓联合病变、重度慢性牙周炎牙周袋内的龈下菌斑及正常人群龈沟液标本,应用实时定量PCR法检测牙龈卟啉单胞菌(Porphyromonas gingivalis,Pg)数量.结果 3组标本中Pg检出率差异无统计学意义;Pg数量差异有统计学意义.牙髓源性牙周牙髓联合病变中Pg数量显著性低于重度慢性牙周炎患牙(P<0.01),与正常人群Pg数量差异无统计学意义.结论 牙髓源性牙周牙髓联合病变中Pg数量低于重度慢性牙周炎患牙,与正常人龈沟液内的水平一致,Pg数量有可能作为鉴别牙髓源性与牙周源性牙周牙髓联合病变的指标.     

重度牙周炎病例牙周牙髓联合治疗与单纯牙周治疗的临床对比研究

目的：本研究比较了重度牙周炎病例牙周牙髓联合治疗法与单纯牙周治疗法治疗效果的差异，旨在探讨牙髓状态对牙周治疗效果的影响。方法：半年随访重度牙周炎病例14例，共计试验牙20颗，随机进入实验组(牙周牙髓联合治疗组)12颗，对照组(单纯牙周治疗组)8颗。于治疗后3个月、6个月通过牙周袋探诊深度(probing pocket depth，PDD)、相对附着水平(relative attachment level，RAL)，影像学指标釉牙骨质界到骨缺陷底的距离(cementum enamal junction to bottom of born，defects，CEJ-BD)，釉牙骨质界到牙槽嵴顶的距离(cementum enamal junctioa to alveolar crest，CEJ-AC)及计算机辅助骨密度影像分析值(computer assisted densitometric image analysis，CADIA)对比两组治疗效果的差异。结果：观察期内临床指标PPD、RAL及CEI-AC未出现显著性差异，而CEJ-BD及CADIA于治疗后3个月，6个月出现显著性差异。结论：重度牙周炎病例选择牙周牙髓联合治疗法较单纯牙周治疗法更有利于牙周骨组织的再生。     

盐酸四环素在牙周牙髓联合病变中的近期疗效观察

目的：评价盐酸四环素（TC）在牙周牙髓联合病变中根管消毒和牙周炎基础治疗的临床效果。方法：选取62例患牙周牙髓联合病变的上颌第一磨牙，牙周袋探诊深度≥4mm，随机分为两组，实验组（TC组）：TC根管消毒和牙周局部TC冲洗；对照组（FC组）；甲醛甲酚（FC）根管消毒和局部用生理盐水冲洗，临床观察牙周袋深度，牙周附着丧失的变化。结果：TC组临床指标改善优于FC组（P＜0．05）。结论：TC用于牙周牙髓联合病的根管消毒和牙周的基础治疗有效。     

产黑色素拟杆菌群与牙周病发病关系的临床研究——牙龈拟杆菌与成年人牙周炎

本文从临床筛选了46例成年人牙周炎患者牙周袋内标本和其中12例同一口腔内非牙周炎区龈沟内标本,以及进行了以局部治疗为主的19例综合治疗后同一牙周袋内标本,进行了厌氧菌检查,分离鉴定产黑色素拟杆菌群,又重点进行了牙龈拟杆菌的鉴定。分析了它们与成年人牙周炎的发病关系,以及与各种牙周状态的关系。并实验证明清除牙周袋内菌斑及局部病灶的疗法是最重要的牙周治疗手段。     

成人牙周炎活跃期与非活跃期牙周袋内微生物系构成的研究

就成人牙周炎活跃期与非活跃期牙周袋非附着菌斑进行厌氧培养、分离和鉴定．结果发现，厌氧菌，尤其是Ｇ－厌氧杆菌活跃期明显高于非活跃期；Ｇ＋兼性厌氧菌则非活跃期明显高于活跃期，提示成人牙周炎由活跃期向非活跃期发展，其细菌构成由Ｇ－厌氧杆菌检出率为主转向以Ｇ＋兼性厌氧菌为主     

创伤松动牙牙周牙髓联合治疗疗效观察

目的：对2～3度松动创伤性牙周炎进行牙周牙髓联合治疗,进行疗效观察。方法：70例创伤引起的2～3度松动的86颗患牙经过调,牙周夹板固定,根管治疗及牙周基础治疗后,经1～3年观察,复查X线片,检查牙周情况及松动度。结果：2～3度松动牙经牙髓牙周联合治疗后,患牙的牙周袋及松动度均得到不同程度改善。结论：牙周牙髓联合治疗对创伤引起的2～3度松动牙治疗效果较好。     

不同牙周状态下牙周袋内挥发性硫化物水平的比较

目的：检测牙周健康者、慢性龈炎和慢性牙周炎患牙牙周袋内挥发性硫化物水平,为牙周炎的早期诊断提供客观指标.方法：选择牙周健康者、慢性龈炎及慢性牙周炎患者3组,治疗前记录牙周各项临床指标,并用金刚牙科探针记录颊侧近远中牙周袋内挥发性硫化物（VSC）水平.结果：3组中慢性牙周炎组牙周袋内VSC水平与牙周健康组牙周袋内VSC水平及慢性龈炎组牙周袋内VSC水平比较均有显著差异（P＜0.05）,牙周健康组牙周袋内VSC水平与慢性龈炎组牙周袋内VSC水平比较无显著性差异（P＞0.05）.VSC与临床指标PLI（P＜0.01,r=0.593）、PD（P＜0.01,r=0.720）、BI（P＜0.01,r=0.662） 、AL（P＜0.01,r=0.746）均相关.结论：牙周袋内VSC可能是反映牙周组织状况的一项较为客观的指标.     

伴有牙髓症状的急性牙周炎的诊治体会

探讨治疗急性牙周炎伴有亚急性牙髓炎的最佳治疗方法。方法　对伴有牙髓症状的 5 5例牙周病患者的 86颗患牙进行治疗 ,其中 5 5颗行牙周系统治疗 ,31颗患牙行牙周牙髓联合治疗。结果　两种治疗方法的有效率 ,经 χ2 检验P >0 .0 5 ,显示两种治疗方法效果无差异。结论　一些急性牙周炎患牙尽管牙髓刺激症状明显 ,但经牙周系统治疗 ,症状是能够控制的 ,不要轻易做牙髓治疗。     

补肾合剂对大鼠牙周袋菌群的影响

目的研究中药补肾合剂对牙周炎大鼠牙周袋菌群的影响并探讨其作用机制.方法选用10月龄SD大鼠80只,雌雄各半.随机分为3组:正常对照组16只,牙周炎造膜对照组40只,中药治疗组24只.分别于造膜完成后、中药治疗前、中药治疗结束后处死实验大鼠.处死实验大鼠前在全麻下,用无菌刮匙和棉签去除龈上菌斑后,用两根无菌纸尖分别置于大鼠左上第一磨牙的近中颊侧和远中颊侧龈下10s来采集龈下菌斑标本.采集龈沟内细菌进行细菌培养鉴定.同时观察各阶段大鼠的生活状态.结果牙周炎模型建立后,牙周微生态发生变化,需氧及兼性厌氧菌减少,产黑色素等致病性厌氧菌增加.中药治疗后,牙周厌氧性致病菌明显减少,需氧和/或兼性厌氧菌明显减少.结论补肾合剂可使牙周局部有益菌增加,产黑色素等厌氧致病菌减少,达到治疗牙周炎的目的.     

牙周洁治对人牙周炎袋底微生物和龈沟液量的影响

目的:探讨牙周洁治对人牙周炎袋底微生物和龈沟液量的影响,为研究牙周洁治机制提供依据。方法:选60例牙周炎患者,随机分为2组,每组30例,洁治组作牙周洁治,对照组用常规漱口液漱口,分别在治疗前、治疗后1周和治疗后1月用刚果红负性染色法观察袋底微生物的变化,并测定牙周探诊深度(PD)、龈指数(GI)和龈沟液量(GCF)的变化。结果:洁治组在洁治后1周时牙周袋底的球菌比率明显增加,杆菌和螺旋体比率及PD和GCF明显降低;对照组GI轻度降低,但PD和GCF以及袋底的球菌、杆菌、螺旋体比率无明显变化;洁治组和对照组的球菌、杆菌和螺旋体比率及PD、GI和GCF均有显著性差异。洁治后1月时PD、GI和GCF量及袋底的微生物比率与洁治1周时无显著性差异。结论:牙周洁治对人牙周炎袋底微生物有明显的改善作用,可通过减少袋底致病菌比率和降低PD以减轻牙周炎症和减少龈沟液的分泌。     

The microbial flora from root canals and periodontal pockets of non-vital teeth associated with advanced periodontitis

Microflora from root canals and periodontal pockets of periodontally affected teeth were compared in order to elucidate the as yet unknown relationship between pulpal and periodontal disease. Caries-free teeth affected with advanced periodontitis and diagnosed as clinically dead by electric pulp testing were selected. The root canals and periodontal pockets were sampled, and the bacterial flora examined by both culture and interference microscopy. The results indicated that the aerobe/anaerobe ratio in the periodontal pocket was 0.23, while it was 0.0022 in the root canal, the large predominance of obligate anaerobes reflecting the anaerobic environment found in the root canal. Morphological classification obtained from interference microscopy showed similar proportions of morphotypes in the two sites. Results of anaerobic culture demonstrated a significantly higher rate of detection of facultative Streptococcus bacteria in the periodontal pocket than in the root canal. The predominant bacterial species common to both regions were Streptococcus, Peptostreptococcus, Eubacterium, Bacteroides, and Fusobacterium for obligate anaerobes. As for facultative anaerobes, Actinomyces and Streptococcus were detected predominantly in the periodontal pocket. The occurrence of micro-organisms common to both sites in this study suggests that the periodontal pocket may be a possible source of root canal infections.     

Progression and stagnation of periodontal disease

Local factors may contribute to acute exacerbations of the periodontal disease, however, their pathological basis is systemically established. The more bacteria and bacterial products get into the periodontal tissue the more serious is destruction. Host's resistance controls composition of the subepithelial bacterial flora. Under condition of defective phagocyte function bacteria, otherwise occurring rarely in the pocket, multiply quickly and penetrate the periodontal pocket epithelium. Specific immune defence can stop them only in the subepithelial conjunctive tissue causing its destruction. Juvenile periodontitis goes with defects of granulocyte function and an aggressive pocket flora. These patients need antibiotics taken systematically, removing of the infected pocket epithelium and regular recalls. Care of patients with adult periodontitis is limited to good oral hygiene.     

Toll样受体4在牙髓根尖周疾病及牙周病中的作用

牙髓根尖周疾病及牙周病是以革兰阴性厌氧菌感染为主的混合感染,脂多糖(LPS)是所有革兰阴性厌氧菌细胞膜的组成成分,是主要的毒力因子.Toll样受体4作为重要的脂多糖结合受体,由于其独特的生物学特性,近年来成为研究热点.本文从Toll样受体4的结构特点、表达分布、致病机制、临床意义等方面作一综述.     

Real-time polymerase chain reaction quantification of human cytomegalovirus and Epstein-Barr virus in periodontal pockets and the adjacent gingiva of periodontitis lesions

BACKGROUND: Genomic sequences of human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV), two herpesviruses, can frequently be detected in periodontal pockets of progressive periodontitis lesions, but the prevalence and load of the two viruses in gingival tissue are unknown. This study determined levels of HCMV and EBV DNA in the periodontal pocket and in the adjacent gingiva of periodontitis lesions using a real-time polymerase chain reaction (PCR) assay. MATERIAL AND METHODS: A total of 20 systemically healthy periodontitis patients participated in the study. Nine patients below 35 years of age were tentatively diagnosed as having aggressive (early onset) periodontitis, and 11 patients 36-56 years of age as having chronic (adult) periodontitis. Clinical parameters were evaluated using established methods. Using periodontal curettes, specimens were harvested from 6-10 mm periodontal pockets and from the adjacent inflamed periodontal pocket wall. A 5'-nuclease (TaqMan) real-time PCR assay was used to identify and quantify genomic copies of periodontal HCMV and EBV. RESULTS: HCMV DNA was detected in 78% of subgingival and 33% of gingival tissue samples from aggressive periodontitis lesions, but only in 46% of subgingival and 9% of gingival tissue samples from chronic periodontitis lesions. In aggressive periodontitis, HCMV subgingival and gingival tissue counts were positively correlated with periodontal pocket depth and probing attachment loss at sample sites (p6 mm, but none of 14 patients having mean pocket depth at sample teeth相似文献   

牙周袋内硫化物与牙周状况的相关性研究

目的探讨牙周袋内硫化物（VSCS）与牙周状况的相关性。方法选择慢性牙周炎患者14例,慢性牙龈炎患者15例,对全口牙齿进行探诊深度及出血指数的检查,并用硫化物检测仪对牙周袋内VSCS进行测定。结果牙周袋内VSCS水平与探诊深度具有正相关性（P〈0.05）;牙周炎组VSCS阳性牙位率和阳性位点率与牙龈炎组具有非常显著性差异（P〈0.005）。结论牙周袋内VSCS测定可作为评价牙周状况的辅助指标之一。     

Microbiological findings of infected root canals and adjacent periodontal pockets in teeth with advanced periodontitis

The purpose of the present study was to examine the flora from the root canals and periodontal pockets of teeth with advanced periodontal disease in order to compare the predominant cultivable microflora from the canals with those found in the adjacent periodontal pockets. Three samples were collected from each of sixteen patients, one from the root canal and two from the adjacent periodontal pocket in two different sites. Criteria for inclusion in the survey were pocket depth of greater than or equal to 7 mm, intact clinical crowns, and lack of periapical lesions. The study has demonstrated that the microorganisms present in the root canals of caries-free teeth with advanced periodontitis generally resembled those found in the adjacent periodontal pockets. The similarity in the recovery of organisms in the current study suggests that the pocket could be the source of the root canal infections. Further investigation is needed to clarify whether such factors as duration of periodontitis and age of the patient play a role in pulpal pathosis and whether the presence of specific bacterial species is also a factor in the etiology and pathogenesis of pulp disease.     

The localization of periodontal-disease-associated bacteria in human periodontal pockets.

Some Gram-negative anaerobes are associated with the incidence and progression of periodontal disease. In periodontal pockets, however, the localization of those bacteria is unknown. We investigated the localization of 5 bacterial species in human periodontal pockets. Fifteen teeth with a part of periodontal pockets from 10 adult periodontitis patients were obtained, and the localization of bacteria was examined immunohistochemically. Positive reactions with anti-Prevotella nigrescens antibody were located at the epithelium-associated plaque area in the middle pocket zones. In the middle and deep pocket zones, Fusobacterium nucleatum and Treponema denticola were especially localized in the unattached plaque area, but Eikenella corrodens was observed in the tooth-attached plaque area. Actinobacillus actinomycetemcomitans, detected in 2 of 15 samples examined, was found in the unattached plaque area, in the middle pocket zone. The present findings indicated that the 5 bacterial species examined localized at distinct regions in human periodontal pockets.     

Periodontal abscess: etiology, diagnosis and treatment

The periodontal abscess is an acute destructive process in the periodontium resulting in localized collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp. The prevalence of periodontal abscess is relatively high and it affects the prognosis of the tooth. Periodontal abscesses can develop on the base of persisting periodontitis but can also occur in the absence of periodontitis. The cause of the development of periodontal abscess originating from chronic periodontitis is the marginal closure of a periodontal pocket, or the pocket lumen might be too tight to drain the increased suppuration due to changes in the composition of subgingival microflora, alteration of bacterial virulence or host defenses. Diagnosis of a periodontal abscess is based on medical and dental history as well as oral examination (pocket depth, swelling, suppuration, mobility, sensibility of the tooth). The most prevalent group of bacteria: P. gingivalis, P. intermedia, B. forsythus, F. nucleatum and P. micros. Previous studies have suggested that the complete therapy of the periodontitis patients with acute periodontal abscess has to do in two stages: the first stage is the management of acute lesions, then the second stage is the appropriate comprehensive treatment of the original and/or residual lesions. The management of acute lesions includes establishing drainage via pocket lumen, subgingival scaling and root planing, curettage of the lining pocket epithelia and seriously inflamed connective tissue, compressing pocket wall to underlying tooth and periodontal support, and maintaining tissue contact. Some authors recommend the incision or to establish drainage and irrigation, or a flap surgery, or even extraction of hopeless teeth. We recommend the use of systemic antibiotics as a preventive measure of systemic disease or in case of systemic symptoms.     

Longitudinal stability of serum immunoglobulin G responses to periodontal bacteria

BACKGROUND: The value of seroepidemiology in the study of periodontal infections has not been adequately explored. This study examined serum immunoglobulin (IgG) responses to periodontal bacteria in patients with periodontitis and periodontitis-free individuals over a 30-month period. METHODS: Eighty-nine patients with chronic periodontitis and 42 control subjects with no deep periodontal pockets and no or minimal attachment loss (30-72 years old, 43% men) were included. Patients were examined at baseline, after completed periodontal therapy 4 months post-baseline, and at 30 months, and controls, at baseline and 30 months. IgG antibodies to 19 periodontal species were determined by checkerboard immunoblotting. RESULTS: On average, patients displayed at baseline up to 800-fold higher titers than controls to all but three species. Over the 30-month period, titers remained stable at low levels in controls. In patients, periodontal conditions improved from a baseline mean probing depth of 3.6 mm, bleeding on probing of 62% and an average of 21.5 pockets of=6 mm/person, to 2.5 mm mean pocket depth, 30% bleeding on probing, and 1.2 deep pockets, at 30 months. Over time, antibody titers showed a modest decline in patients, but remained significantly elevated at 30 months in comparison with controls. Antibody-level changes over time were not significantly different between subjects that did and did not receive adjunctive systemic antibiotics. CONCLUSIONS: Conspicuous differences in IgG titers to periodontal bacteria exist between periodontitis patients and periodontally healthy controls. Despite successful periodontal therapy, titers remained elevated over a 30-month period, suggesting that serology may mark the history of past periodontal infection.