Four types of periodontal treatment compared over two years

Results of various modalities of periodontal therapy were studied in 90 subjects (mean age 45 years) with moderate to severe periodontitis. Initial measurements of pocket depth and clinical attachment levels were compared with measurements obtained after the initial hygienic phase of the treatment and measurements of the same areas 1 and 2 years after four different types of periodontal treatment had been applied on a randomized basis to each of the four quadrants of the dentition. These treatments were: (1) surgical pocket elimination or reduction, (2) modified Widman flap surgery. (3) subgingival curettage, (4) scaling and root planing only. The patients were recalled for prophylaxis every 3 months, and rescored annually. One-way analysis of variance and Scheffe's method were used to test the hypothesis of equal treatment effects. The results were analyzed both with initial pocket depth as the baseline and with pocket depth at the hygienic phase as the baseline using a grouping of pockets 1 to 3 mm, 4 to 6 mm, and greater than or equal to 7 mm. For the 1 to 3 mm pockets there was a slight reduction in depth at the hygienic phase, with only minor changes after the various modalities of treatment over 2 years. However, significant losses of attachment after all modalities of periodontal therapy, including scaling alone, were observed at both the 1-year an 2-year intervals. For pockets 4 to 6 mm deep, the main reduction in pocket depth occurred at the hygienic phase, but the pockets also were reduced by further treatment, most by pocket elimination and modified Widman surgery. However, this reduction in pocket depth after surgery had no beneficial influence on maintenance of the attachment level, which actually was maintained best by scaling alone. For deep pockets greater than or equal to 7 mm, significant reduction in pocket depth occurred both at the hygienic phase and 1 to 2 years after treatment, with the greatest initial reduction after pocket elimination surgery. However, again there was no significant difference in attachment results among the four methods.     

The effect of non-surgical treatment on periodontal pockets in smokers and non-smokers

Abstract. Changes in probing pocket depth following non-surgical periodontal treatment were investigated in 75 patients, 40 of whom were heavy smokers. Pockets with an initial probing depth of 4–6 mm were studied. The treatment consisted of patient instruction and motivation and debridement of plaque and calculus by hand instrumentation. The treatment was completed within 5 months and probing depth was recorded prior to and 1 month following the completion of therapy. Plaque index was reduced to a minimum in both smokers (P1I = 0.2) and non-smokers (P1I = 0.1) following treatment. An average reduction in probing pocket depth of 1.1 mm in smokers and 1.2 mm in non-smokers was observed. The reduction attained was less in smokers than in non-smokers for all regions of the dentition investigated. The greatest difference between groups was observed for the maxillary anterior region.     

Comparison of platelet pellet and bioactive glass in periodontal regenerative therapy

OBJECTIVE: In recent years, platelet-rich plasma combined with graft materials has been used for periodontal regeneration. The individual role of blood products with guided tissue regeneration in periodontal regenerative therapy is unclear and needs to be elucidated. The purpose of this study was to compare the clinical and radiological effectiveness of platelet pellet/guided tissue regeneration (PP/GTR) and bioactive glass/GTR (BG/GTR) treatments in patients with periodontal disease. MATERIAL AND METHODS: Using a split mouth design, 15 chronic periodontitis patients with pocket depths > or = 6 mm following periodontal initial therapy were randomly assigned to treatment with a combination of PP/GTR or BG/GTR in contralateral dentition areas. An absorbable membrane of polylactic acid was used GTR. The criteria for the comparative study were preoperative and postoperative 6 months pocket depth, clinical attachment level, and radiological alveolar bone level. RESULTS: Both treatment modalities resulted in significant pocket depth reduction and gain in clinical attachment and alveolar bone level compared to the preoperative values (p < 0.01). Reduction in pocket depth, gain in clinical attachment and alveolar bone level were 4(3-6), 4.1+/-0.7, 4.9+/-1.4 mm in the PP/GTR group and 4(3-7), 4.1+/-1.2, 5.9+/-1.7 mm in the BG/GTR group, respectively. The differences between the two groups were not statistically significant (p > 0.05). CONCLUSIONS: Within the limits of this study, it was concluded that PP may be effective as a bioactive glass graft material and used as a graft material for treating intrabony defects. PP thus appears to be a suitable alternative in the regenerative treatment of intrabony periodontal defects.     

Periodontal diseases in adult Kenyans

This study comprised 1131 persons who constitute a stratified random sample of the entire population aged 15-65 years in Machakos District, Kenya. Each person was examined for tooth mobility, plaque, calculus, gingival bleeding, loss of attachment and pocket depth on the mesial, buccal, distal and lingual surface of each tooth. The oral hygiene was poor with plaque on 75-95% and calculus on 10-85% of the surfaces depending on age. Irrespective of age, pockets greater than or equal to 4 mm was seen on less than 20% of the surfaces, whereas 10-85% of the surfaces had loss of attachment greater than or equal to 1 mm. The proportion of surfaces per individual with loss of attachment greater than or equal to 4 mm or greater than or equal to 7 mm, and pocket depths greater than or equal to 4 mm or greater than or equal to 7 mm, respectively, showed a pronounced skewed distribution, indicating that in each age group, a subfraction of individuals is responsible for a substantial proportion of the total periodontal breakdown. The individual teeth within the dentition also showed a marked variation in the severity of periodontal breakdown. Our findings provide additional evidence that destructive periodontal disease should not be perceived as an inevitable consequence of gingivitis which ultimately leads to considerable tooth loss. A more specific characterization of the features of periodontal breakdown in those individuals who seem particularly susceptible is therefore warranted.     

Periodontal tissue alterations following Emdogain treatment of periodontal sites with angular bone defects. A series of case reports

The aim of the present study was to assess the predictability of probing attachment gain and probing pocket depth reduction following Emdogain treatment at sites with deep angular bone defects. MATERIAL AND METHODS: 108 consecutively-treated periodontal patients (mean age 55.8 years) were included. Each subject exhibited at least 1 deep interproximal intrabony defect that could be identified as an experimental site based on the inclusion criteria: (i) probing pocket depth > or = 5 mm, (ii) probing attachment loss > or = 6 mm, (iii) radiographic evidence of an interproximal bone defect with a > or = 3 mm intrabony component. A total of 145 defects met the criteria for inclusion. All subjects received non-surgical periodontal therapy. This included subgingival instrumentation in all parts of the dentition. At least 6 months after the completion of this treatment, a baseline examination was performed to characterise the experimental site. Reconstructive therapy was subsequently performed. Full-thickness periodontal flaps were elevated, and the root surface scaled and planed. No bone recontouring was performed. A gel containing 24% EDTA was applied on the exposed root and was kept in place for 2 min. A preparation of enamel matrix proteins was applied to the root surface and adjacent defect space. The flaps were replaced and closed with sutures. The experimental sites were re-examined 12 months after reconstructive surgery. RESULTS: The re-examination demonstrated that a treatment including the application of enamel matrix proteins at periodontal sites with angular defects resulted in a mean probing attachment level gain of 4.6 mm and a probing pocket depth reduction of 5.2 mm. 87% of all sites treated exhibited a probing attachment gain of > 2 mm. One site suffered probing attachment loss. The radiographic assessments revealed that the bone defect had been reduced in depth by 2.9 mm on average. The reduction in defect size corresponded to an average bone fill of 69% of the original defect. In 43% of the defects, the bone fill amounted to > or = 80%. CONCLUSION: The overall probing pocket depth reduction, probing attachment level gain, and soft tissue recession, that results following Emdogain therapy, is similar to the corresponding outcome variables following GTR.     

4 modalities of periodontal treatment compared over 5 years

The purpose of the present study was to assess in a clinical trial over 5 years the results following 4 different modalities of periodontal therapy (pocket elimination or reduction surgery, modified Widman flap surgery, subgingival curettage, and scaling and rool planing). 90 patients were treated. The treatment methods were applied on a random basis to each of the 4 quadrants of the dentition. The patients were given professional tooth cleaning and oral hygiene instructions every 3 months. Pocket depth and attachment levels were scored once a year. 72 patients completed the 5 years of observation. Both patient means for pocket depth and attachment level as well as % distribution of sites with loss of attachment greater than or equal to 2 mm and greater than or equal to 3 mm were compared. For 1-3 mm probing depth, scaling and root planing, as well as subgingival curettage led to significantly less attachment loss than pocket elimination and modified Widman flap surgery. For 4-6 mm pockets, scaling and root planing and curettage had better attachment results than pocket elimination surgery. For the 7-12 mm pockets, there was no statistically significant difference among the results following the various procedures.     

Comparison of platelet pellet and bioactive glass in periodontal regenerative therapy

Objective. In recent years, platelet-rich plasma combined with graft materials has been used for periodontal regeneration. The individual role of blood products with guided tissue regeneration in periodontal regenerative therapy is unclear and needs to be elucidated. The purpose of this study was to compare the clinical and radiological effectiveness of platelet pellet/guided tissue regeneration (PP/GTR) and bioactive glass/GTR (BG/GTR) treatments in patients with periodontal disease.

Material and methods. Using a split mouth design, 15 chronic periodontitis patients with pocket depths?≥?6 mm following periodontal initial therapy were randomly assigned to treatment with a combination of PP/GTR or BG/GTR in contralateral dentition areas. An absorbable membrane of polylactic acid was used GTR. The criteria for the comparative study were preoperative and postoperative 6 months pocket depth, clinical attachment level, and radiological alveolar bone level.

Results. Both treatment modalities resulted in significant pocket depth reduction and gain in clinical attachment and alveolar bone level compared to the preoperative values (p<0.01). Reduction in pocket depth, gain in clinical attachment and alveolar bone level were 4(3–6), 4.1±0.7, 4.9±1.4 mm in the PP/GTR group and 4(3–7), 4.1±1.2, 5.9±1.7 mm in the BG/GTR group, respectively. The differences between the two groups were not statistically significant (p>0.05).

Conclusions. Within the limits of this study, it was concluded that PP may be effective as a bioactive glass graft material and used as a graft material for treating intrabony defects. PP thus appears to be a suitable alternative in the regenerative treatment of intrabony periodontal defects.     

Reproducibility of pocket depth and attachment level measurements when using a flexible splint

Abstract Pocket depth, attachment level and bone level assessments were carried out using flexible splints to produce readily identifiable reference points and to standardize the probing spot and the direction of probe insertion. The pocket depth and attachment level measurements were carried out twice at intervals of 3 weeks, both before and 3 months after periodontal treatment. The level of alveolar bone was measured by transgingival probing (“sounding”) and again following elevation of a mucoperiosteal flap. The measurements were made with a periodontal probe to the nearest higher millimeter. Complete agreement was found between the first and second measurements of pocket depths and attachment level for approximately 60% of the examined surfaces, both before and after periodontal treatment. A deviation of 1 mm or less was found for approximately 95% of the surfaces, and the difference between the first and second measurement never exceeded 3 mm. When transgingival probing measurements were compared to the measurements of the periodontal bone level assessed after elevation of a mucoperiosteal flap, complete agreement was found for 60% of the surfaces, and a deviation of 1 mm or less was found for 90% of the surfaces. No discrepancy exceeding 3 mm was observed. The results of this study indicate that readily identifiable reference points can be produced by flexible splints in assessments of pocket depth, attachment level and bone level alterations in studies on the effect of periodontal treatment.     

The periodontal condition of regular dental attenders in Northern Ireland

The aim of this study was to assess the prevalence and severity of periodontal destruction in regular dental attenders in Northern Ireland. 132 individuals aged between 20 and 49 years who had recently had a course of routine treatment in the General Dental Service completed a questionnaire and had a periodontal examination. Measurements of plaque, subgingival calculus, bleeding, probing pocket depth and periodontal attachment level were made at 4 proximal sites per tooth. Plaque was present at an average of 17%, subgingival calculus at 13%, and bleeding on probing at 34% of interproximal surfaces examined. The mean probing pocket depth was 2.7 mm and the mean probing attachment level was 1.0 mm. Incipient periodontal destruction was common with all subjects having at least 1 pocket of greater than or equal to 3 mm and 90% having at least 1 site with greater than or equal to 2 mm attachment loss. Only 24 (18%) of those examined had deep pocketing or severe loss of periodontal attachment (greater than or equal to 6 mm). The extent of deep pocketing and severe attachment loss was low at only 0.2% and 0.6%, respectively, of the sites examined. It was concluded that gingivitis and incipient periodontitis were prevalent and extensive in the regular dental attenders investigated, but that severe periodontal destruction was uncommon.     

Design of clinical trials of traditional therapies of periodontitis

The present paper on the design of clinical trials of periodontal therapy first addresses the issue of the etiology of periodontal disease. It is suggested that most if not all forms of destructive periodontal disease are caused by microorganisms and that there are different forms of disease with different microbial etiologies. The progressive nature of destructive periodontal disease is subsequently discussed and it is emphasized that, in a given patient, periodontal sites which show signs of inflammation and attachment loss may not over a period of several months and years show further sign of attachment loss. The present methods of assessing periodontal disease do not allow us to discriminate between potentially active and inactive sites in untreated patients. The significance and variability of indicators of periodontal disease such as bleeding on probing, probing pocket depth and probing attachment level measurements are discussed. The errors inherent in the various measurements are analyzed and suggestions are presented describing how alterations in any of the above parameters could be identified and presented in a clinical trial. Of concern for the statistical analysis of clinical data of periodontal disease is the definition of the "experimental unit". For a number of years, the "experimental unit" in periodontal trials was the patient. It is clear, however, that different sites within the same individual show different patterns of disease progression and lesion morphology and often respond differently to periodontal therapy. Statistical analyses must consequently be designed which recognize differences in site-to-site infection and lesion morphology within a common host. Until such analyses are available, the investigator should be wary of pooling data within the same individual, since such pooling may obscure meaningful alternatives which may take place in individual periodontal sites. Some goals of periodontal therapy are subsequently identified. 4 goals are discussed more in detail, namely: to establish conditions which will allow the patient to maintain a dentition without further breakdown of the periodontium; to reduce pocket depth to establish an anatomy in the dentogingival region which with proper maintainance care will prevent the re-establishment of the subgingival infection; to gain attachment as a result of treatment; to assess the effect of a certain chemotherapeutic agent on periodontal disease.     

Comparison of results following three modalities of periodontal therapy related to tooth type and initial pocket depth

Abstract Results following three modalities of periodontal therapy (subgingival curettage, modified Widman flap surgery, and pocket elimination or reduction surgery) in 78 patients over 8 years were compared for variations in pocket depth and clinical attachment level related to tooth types (maxillary molars, mandibular molars, maxillary biscupids, mandibular biscupids, maxillary anterior teeth, mandibular anterior teeth). The analysis was based on a classification of three severity groups according to initial crevice or pocket depth (Class I, 1–3 mm; Class II, 4–6 mm; and Class III, 7–12 mm) and with patient's means of measurements being the experimental units for the statistical analysis. Reduction in pocket depth and gain of clinical attachment for pockets 4 mm or deeper occurred following all three methods of treatment, and was well sustained over 8 years. No one modality of treatment was consistently superior to any of the other two with regards to sustained reduction of pocket depth and gain of clinical attachment. Surgical pocket elimination or reduction did not enhance the prognosis for maintenance of periodontal support in either moderate or advanced periodontal lesions anywhere in the mouth compared with more conservative modalities of treatment. In spite of prophylaxis and instruction in home care every 3 months, there was a slight progressive loss of attachment over time in areas of shallow crevices (1–3 mm).     

The identification of periodontal attachment loss from clinical measurements

Clinical readings of pocket depth and loss of periodontal attachment were recorded on the approximal sites of 21 teeth scheduled for extraction. Corresponding laboratory measurements of pocket depth and loss of periodontal attachment were made on the teeth after extraction. Clinical measurements were within 1mm of their corresponding laboratory values on 95% of occasions. Clinical readings of loss of periodontal attachment of 0 or 1mm showed poor agreement with corresponding laboratory measurements. It was concluded that the presence of loss of periodontal attachment can only be reliably identified where a clinical reading of 2mm or greater is recorded.     

Periodontal probing: What does it mean?

Abstract The periodontal probe has been and continues to be used as an important diagnostic instrument by the dental profession. The measurements recorded with the probe have generally been considered to represent a reasonably accurate estimate of sulcus or pocket depth. Recent reports on the histopathology of the periodontal lesion and the histological features of a healing lesion, together with histological studies on the relationship of the probe to periodontal tissues, have shed some new light on periodontal probing. It is now apparent that probing depth measured from the gingival margin seldom corresponds to sulcus or pocket depth. The discrepancy is least in the absence of inflammatory changes and increases with increasing degrees of inflammation. In the presence of periodontitis the probe tip passes through the inflamed tissues to stop at the level of the most coronal intact dento-gingival fibers, approximately 0.3–0.5 mm apical to the apical termination of the junctional epithelium. Decreased probing depth measurements following periodontal therapy may be due in part to decreased penetrability of the gingival tissues by the probe. Following treatment aimed at obtaining new attachment in periodontal defects, wider variations may occur between the location of the probe tip and the most coronal dento-gingival fibers than in the case of untreated sites. This is due in part to the formation of a so-called “long” junctional epithelium. In the absence of inflammation this epithelium may not be penetrable during ordinary probing, but could account for a rapid increase in probing depth measurements when inflammatory changes allow the probe to traverse the epithelium and/or the adjacent infiltrated connective tissue. In view of the difficulty inherent in relating periodontal probing measurements to actual sulcus or pocket depth, the interpretation of periodontal probing in the practice of periodontics may need reappraisal.     

GTR with bioresorbable membranes in the treatment of intrabony defects: a clinical and histologic study

The aim of the present study was to evaluate clinically and histologically the treatment of intrabony periodontal defects with a bioresorbable membrane barrier. Fifty-two intrabony periodontal defects were treated according to the principles of guided tissue regeneration (GTR) with a bioresorbable membrane. Results were evaluated by assessing probing pocket depth, recession of the gingival margin, and clinical attachment level at baseline and at 1 and 2 years after therapy. Bone level changes were evaluated radiographically. The postoperative phase was uneventful in all cases. There was a mean probing pocket depth reduction from 8.4 to 3.6 mm, a mean increase of gingival margin recession from 1.5 to 3.0 mm, and a mean clinical attachment level change from 9.9 to 6.5 mm. Mean attachment gain was 3.4 mm. Two teeth scheduled for extraction were also treated with the same bioresorbable membrane. The histologic analysis 6 months after treatment revealed the formation of new connective tissue attachment and new alveolar bone in both cases. Based on the histologic findings it can be concluded that the clinical improvements following GTR with this type of bioresorbable membrane may represent, at least in part, true periodontal regeneration.     

Tooth mobility and periodontal therapy

Abstract. Data collected as part of an 8–year longitudinal study on periodontal therapy involving 82 patients and 1974 teeth were analyzed to determine if tooth mobility influenced the results of treatment.
For each patient, pocket depth, attachment level and tooth mobility were scored clinically at the initial appointment, and once a year for 8 years following periodontal therapy. The treatment consisted of scaling, oral hygiene instruction, occlusal adjustment, periodontal surgery (curettage, modified Widman or pocket elimination), followed by recall prophylaxes every 3 months. Tooth mobility data on a scale of 0–3 were related to changes in attachment levels for three grades of severity of periodontal disease, based on initial pocket depth (1–3 mm, 4–6 mm, and 7+ mm). Mean patient attachment changes were calculated from teeth in the same severity category for each patient. The data were analyzed by one-way analysis of variance and Scheffe's multiple comparison procedure to test the hypothesis of equal effects of tooth mobility on the results of the treatment for the three severity groups over 8 years.
The results indicate that there is a statistically significant relationship between original tooth mobility and the change in level of attachment following treatment. Pockets of clinically mobile teeth do not respond as well to periodontal treatment as do those of firm teeth exhibiting the same initial disease severity.     

Short-term effects of initial, nonsurgical periodontal treatment (hygienic phase)

Abstract Longitudinal studies have reported the effect of various modalities of periodontal surgery on pocket depth and attachment levels related to pretreatment measurements. However, possible changes in these measurements as a result of scaling, oral hygiene improvements and occlusal adjustment during the hygienic phase were not considered. The purpose of the present study was to examine the short-term effect of treatment of the hygienic phase in 90 patients with some pockets extending 4 mm or more apically to the CEJ. Pretreatment pocket depths and attachment levels related to the CEJ were measured by a thin probe in five sites at all 2,355 teeth in the sample. Scaling, root planing, instruction in oral hygiene and occlusal adjustment were completed during four to six sessions for each patient. Four weeks after completion of the hygienic phase, all variables were recorded. Mean measurements for pocket depths 1–3 mm, 4–6 mm. and ≥ 7 mm prior to treatment were compared to their posttreatment scores. Pocket depth decreased significantly for pockets extending 4 mm or more apically to the FGM. For pockets 4–6 mm there was a mean difference in pocket depth of 0.%± 0.47 mm (P < .0001) between pretreatment and post-treatment observations. For pockets 7 mm or greater the mean difference was 2.22 ± 1.35 mm (P < .0001). Reduction in depth of pocket and improvement in attachment levels were related to the initial level of severity. Pocket reduction was in part due to the improvement in attachment levels. This study has demonstrated that the clinical severity of periodontitis is reduced significantly 1 month following the hygienic phase of periodontal therapy, and that need for surgical pocket treatment cannot be assessed properly until completion of the hygienic phase of treatment.     

Community periodontal index of treatment needs and prevalence of periodontal conditions

BACKGROUND/AIMS: In 1977, the World Health Organization (WHO) proposed a new index, the community periodontal index of treatment needs (CPITN) to evaluate the periodontal treatment needs of populations. The aim of this study is to compare different approaches of recording and presenting the CPITN. METHODS: A sample of 2110 subjects aged 35-44 years were examined between September 1994 and July 1995, throughout the province of Quebec, Canada. For each tooth (3rd molars excluded), the presence of bleeding and calculus, the level of epithelial attachment, and the depth of periodontal pockets were measured. Periodontal pocket depths were measured from the edge of the free gingiva, at 2 sites (mesiovestibular and vestibular), as well as all around the tooth. RESULTS: Only 8.5% of adults had at least one tooth with a 6 mm or deeper periodontal pocket when probing on 2 sites, whereas if probing is done all around the tooth, this percentage is 2.5x higher (21.4%). The partial recording of pocket depths (10 index teeth recommended by WHO, or 2 quadrants chosen at random) resulted in an underestimation of the prevalence of subjects with at least one tooth with a periodontal pocket (CPITN score 3 and 4). Among subjects with at least one tooth with a 6 mm or deeper periodontal pocket, 12% were not detected with the 10 index teeth recording, and 25% go undetected with the measure on 2 quadrants. Finally, using the % of subjects with periodontal pockets overestimates the prevalence of deep pockets compared with using sextants. Indeed, close to 30.0% of sextants have no treatment needs, whereas only 5.2% of subjects are in this category. Similarly, 7.7% of sextants have at least one tooth with a 6 mm or deeper periodontal pocket, yet there are 3x more subjects in this category (21.4%).     

Periodontal status of secondary crowded mandibular incisors

The present study was undertaken to examine whether secondary crowded mandibular incisors experience more periodontal breakdown than aligned lower incisors long-term after orthodontic treatment. Patients from 19 to 35 years after active treatment were selected. 2 groups were established: 1 with crowded mandibular incisors and 1 with aligned incisors. The groups were matched according to age, time after treatment, gender and periodontal disease classification. A separate group with crowded and aligned incisors within the same individual was established. Accumulation of plaque, gingival inflammation, probing pocket depth and probing attachment level were registered at 6 locations around each incisor. Among the patients studied, the oral hygiene level was high. In both groups, the loss of connective tissue attachment was largely due to periodontal pocket formation in interproximal areas and gingival retraction in buccal and lingual areas. A small but statistically significant difference in probing attachment level was found between crowded and aligned interproximal areas within the same individual (P less than 0.05). No differences in accumulation of plaque or in gingival inflammation were found. No differences were found for any of the dependent variables between the groups with crowded and aligned incisors.     

吸烟对牙周基础治疗效果影响的研究

目的评价吸烟与非吸烟慢性牙周炎患者牙周基础治疗1个月后的疗效差异。方法选择36例慢性牙周炎患者,吸烟组20例,非吸烟组16例,基线时两组牙周炎病情相似。从牙列的4个象限选取探诊深度在5～9mm范围的位点1～2个,吸烟组108个位点,非吸烟组88个位点,观察这些位点在牙周基础治疗前、治疗后1个月临床指标的变化,包括菌斑指数(PLI),牙龈出血指数(BI),牙周袋探诊深度(PPD)和附着丧失(AL);在作临床观察的同时,对治疗前后龈沟液白介素(IL)-1β进行检测。结果治疗前(基线时)两组PLI、BI、PPD、AL以及IL-1β差异不显著,牙周基础治疗1个月后,两组的各项指标均有明显的改善,但吸烟组改善程度明显低于非吸烟组(P<0.05)。结论慢性牙周炎患者,吸烟者牙周基础治疗的效果差于