Clinical, microbiological, and immunological studies following initial preparation in adult periodontitis

This study investigated the clinical, microbiological and immunological changes induced in adult periodontitis by initial preparation. Microflora in periodontal lesions was mainly examined by cultural methods, and serum IgG antibody levels were measured by an enzyme linked immunosorbent assay. Black-pigmented gram negative anaerobes, especially Porphyromonas (Bacteroides) gingivalis, was predominant in periodontal pockets with adult destructive periodontitis. Significantly elevated serum IgG antibody levels to P. gingivalis was found in high frequency, and these serum IgG antibody levels correlated with the presence of P. gingivalis in periodontal pockets, not with other bacteria tested. Total-CFU was significantly reduced and clinical conditions were improved after supragingival plaque control, but the microflora themselves showed few changes. Although reduction of total-CFU and changes in microflora were observed following scaling and root planing, it was found to be difficult to completely eliminate periodontopathic bacteria from periodontal pockets. Although serum IgG antibody levels to P. gingivalis was significantly reduced following initial preparation, the levels were still elevated from those of the controls. It was found that the presence of P. gingivalis was correlated with clinical conditions, including bleeding on probing and residual pocket depth following initial preparation.     

Clinical and microbiological effects of initial periodontal therapy in conjunction with amoxicillin and clavulanic acid in patients with adult periodontitis

The aim of the present study was to investigate the clinical and microbiological effects of initial periodontal therapy in conjunction with systemic amoxicillin plus clavulanic acid in adult periodontitis patients using a double-blind, parallel-group, and placebo-controlled protocol. 21 patients with a clinical diagnosis of generalised adult periodontitis were recruited. Clinical measurements and microbiological assessments were carried out at baseline, 3, and 12 months post-treatment. Approximately 6 weeks after initial periodontal treatment (3-6 h), patients were randomly assigned to receive coded study medication of 500 mg amoxicillin plus 125 mg clavulanic acid (Augmentin) or placebo, every 8 h for 10 days. Patients returned for follow-up visits 3, 6, 9, and 12 months after completion of the medication. The mean plaque index (PI) at baseline was 1.1 for placebo group and 0.9 for the test group. At 3 months, the PI had dropped to 0.3 in both groups, and was maintained during the rest of the study. The changes in bleeding on probing (BOP) and gingival index (GI) in the course of the study were similar in both groups. The mean whole mouth probing pocket depth (PPD) in the placebo group was 3.8 mm at baseline and 3.9 mm in the test group. A mean reduction of 1.0 mm in the placebo group and 0.9 mm in the test group was observed during the first 3 months. No further reduction in PPD was noticed during the study period in either group. There was no statistically significant difference in the PPD reduction between the 2 groups. The change in clinical attachment level (CAL) from baseline to 3 months amounted to 0.5 mm in both groups. Between 3 and 12 months, the CAL changed in neither group. In both groups, treatment resulted in a decrease in the number of spirochetes and motile rods in positive patients, but no significant differences between either group were noted in any of the dark field microscopy observations. At baseline, 1 patient in the placebo group and 2 patients in the test group were culture positive for Actinobacillus actinomycetemcomitans (Aa). After therapy, Aa was not detectable in the placebo group and 1 patient remained positive in the test group. In the placebo group, the number of patients positive for Porphyromonas gingivalis (Pg) decreased from 7 to 2 after therapy. In the test group, the 4 patients positive for Pg at baseline remained positive after therapy. In both groups, all subjects were positive for Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn) at baseline. At 12 months, all subjects had detectable subgingival Fn. 9 out of the 11 placebo and 8 of the 10 test patients remained positive for Pi. There were no differences in detection frequency of Peptostreptococcus micros (Pm) and Bacteroides forsythus (Bf) in both groups between baseline, 3, and 12 months post-treatment. The findings demonstrated that, in comparison to placebo, systemic amoxicillin plus clavulanic acid provided no additional clinical and microbiological effects in the treatment of adult periodontitis patients.     

Clinical and microbiological associations in chronic periodontitis

Chronic Periodontitis is the most prevalent form of periodontal disease. The subgingival microflora has been associated with the onset and progression of the disease. The aim of this work was to establish associations and correlations between clinical indicators and subgingival plaque microbiological data in patients diagnosed with moderate or severe Periodontitis. One hundred sites with a probing depth of > or = 5 mm were selected. Plaque Index (PI), Gingival Index (GI), Bleeding on Probing (BP), Probing Depth (PD) and Clinical Attachment Level (CAL) were measured. The subgingival plaque microbiological assay comprised cultures in selective and non-selective media and identification tests for Porphyromonas gingivalis (Pg), Prevotella intermedia/nigrescens (Pi/n), Actinobacillus actinomycetemcomitans (Aa), Fusobacterium (F) and Peptostreptococcus micros (Pm). Dark field microscopy was used to analyze the relative proportions of Treponema to the total microbial morphotypes. Small Treponeina (ST), Medium Treponema (MT), Large Treponema (LT) and Total Treponema (TT) were determined. Our results showed associations and a correlation between PD and AL, r = 0.62 (p<.0001); PD and Pg X2 = 15.22, r = 0.39 (p<.001); AL and Pg X2 = 10.72, r = 0.32 (p<.001). A negative correlation was observed between Pg and Pi/n X2 = 12.65, r = -0.35 (p<.001); BP and F X2 = 8.93; GI and F X2 = 8.92. The present results reveal associations and correlations between some clinical indicators and subgingival plaque microorganisms in patients diagnosed with Chronic Periodontitis.     

Histological and microbiological aspects of ligature-induced periodontitis in beagle dogs

Abstract This study was designed to investigate, using 6 beagle dogs, the levels of selected putative pathogens in healthy sites, in gingivitis sites, and in sites with histologically confirmed attachment loss. Levels of attachment loss increased with increasing periods of ligation and reached a maximum of 0.15 mm at 57 days. Both histological attachment level and histological pocket depth were found to vary significantly with health/disease status (P<0.0001). Higher numbers of total colony-forming units were seen for ligated sites than for healthy and gingivitis sites. Levels of Purphyromonas gingivalis and Prevotella intermedia also changed significantly with health/disease status (p<0.001). These organisms showed their greatest increases at the time of the most intense attachment loss. Higher levels of Fusobaeterium nucleatum were seen in the gingivitis sites than in healthy or Heated sites. Low levels of Campylobacter rectus and Capnocytophaga spp. were detected throughout. The morphometric microbiological analysis revealed unexpectedly high %s of motile rods, while spirochetes were found in very low %s. The total number of bacterial cells detected using phase contrast microscopy was not found to vary significantly. None of the morphotypes were demonstrated as showing significant changes with health/disease status.     

Systemic antibiotics in the management of chronic periodontitis

Multiple research studies have investigated the use of systemic antibiotics as adjunctive treatments in the management of chronic periodontitis. However, the great heterogeneity of study designs and variable outcomes that have been reported have led to confusion among the profession as to whether or not there is any clinical benefit of using systemic antibiotics. In this review, the potential advantages and disadvantages of using systemic antibiotics are considered together with outcomes from published clinical studies. Few published studies are of adequate quality to be considered in systematic reviews, and the outcomes are very varied. Drawing definitive conclusions is difficult, but given the lack of reliable data available, systemic antibiotics cannot be indicated as adjuncts in the treatment of chronic periodontitis.     

伴糖尿病的慢性牙周炎牙周基础治疗疗效观察二例

牙周炎和糖尿病(diabetes mellitus)都是严重危害人类健康的常见病,许多研究已经证实两者可以相互影响.目前,非手术治疗仍是牙周炎最基础、最有效的治疗方法.以控制菌斑为主的牙周基础治疗对伴有糖尿病的牙周炎患者能否取得同样的疗效,目前尚无明确结论.笔者在临床中曾收治两例伴糖尿病的慢性牙周炎患者,现报道如下,以期对牙周基础治疗对伴糖尿病的牙周炎患者牙周炎症及代谢改善的作用进行探讨.     

基础治疗对慢性牙周炎临床疗效和龈下牙周致病菌的影响

目的:评价牙周基础治疗对慢性牙周炎临床疗效及龈下牙周致病菌的影响.方法:纳入慢性牙周炎患者 120例,在牙周基础治疗前和治疗后1个月时检查牙周探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、菌斑指数(plaque index,PLI)和牙龈指数(gingival index,GI).采用实时荧光定量聚合酶链反应法(real-time PCR)检测基础治疗前和治疗后6周时龈下菌斑中牙龈卟啉单胞菌(P.g)和伴放线放线杆菌(A.a)比例的变化.采用SAS6.12软件包对所得数据进行t检验.结果:各项指数在治疗前、后比较差异有统计学意义(P＜0.05).治疗后P.g占总菌的比例与基线相比有显著性差异(P＜0.05),治疗后A.a占总菌的比例与基线相比,无显著差异(P＞0.05).结论:基础治疗可以有效治疗慢性牙周炎,并能降低致病菌P.g的比例.     

Clinical and microbiological evaluation of therapy for juvenile periodontitis

Eight patients (mean age 15.6 yrs) with severe molar-incisor bone loss and pocket formation characteristic of juvenile periodontitis were entered into a clinical protocol of three sequential stages: scaling and root planing (S/RP); S/RP concurrent with systemic tetracycline therapy (1 gm/day for 28 days); periodontal surgery concurrent with systemic tetracycline therapy. Clinical and microbiological examinations were scheduled at baseline, at 1 to 2 months after Stage I, at 1 to 2 months after completion of tetracycline therapy in Stages II and III, and during recall. A decision to progress to the next stage or to place the patient on a 3-month recall was based solely on clinical findings (suppuration, bleeding upon probing and pocket depth) at the deepest site in each patient. Paperpoint subgingival plaque samples from representative affected sites were analyzed for percentage of total cultivable microflora composed of black-pigmented Bacteroides species (BPB), surface translocating bacteria (STB) and Actinobacillus actinomycetemcomitans (Aa). At baseline, all sites bled to probing, seven of eight sites showed suppuration, and deepest pocket depths averaged 8.0 mm. STB were detected in one and BPB in four sites, respectively, and all sites demonstrated Aa, which constituted approximately 40% of the total cultivable flora. S/RP alone had essentially no effect on either clinical or microbiological findings, and all patients progressed to Stage II. Five went on to Stage III. S/RP with tetracycline was clinically and microbiologically more effective at sites in which Aa was predominant. Surgery was required in all sites containing high levels of both BPB and Aa. These results suggest that microbiological diagnosis may be useful in selecting and monitoring treatment for juvenile periodontitis.     

Endothelial dysfunction in patients with chronic periodontitis and its improvement after initial periodontal therapy

BACKGROUND: Recent epidemiological data suggested that there is a relationship between periodontal health and atherosclerotic coronary heart disease. Although hypothetical models were proposed, the exact mechanism of this association has not been clarified. The aim of this study is to investigate whether there is an endothelial dysfunction in patients with chronic periodontitis and, if present, whether recovery is possible with therapy. METHODS: The study groups consisted of 28 patients (mean age: 45.5 +/- 8.6 years) with chronic periodontitis and without any atherosclerotic vascular disease, and 26 healthy controls (mean age: 43.7 +/- 6.8 years). Cardiovascular risk factors were investigated in both groups. Brachial artery responses to reactive hyperemia (endothelium-dependent dilatation [EDD]) and sublingual nitroglycerin (endothelium-independent dilatation [EID]) were measured using high-resolution vascular ultrasound in both groups. Measurements were taken before and after initial periodontal therapy in the periodontal patients. RESULTS: There was no significant difference between the groups with regard to cardiovascular risk factors. In the baseline measurements, EDD and EID were significantly impaired in patients with chronic periodontitis when compared with the controls (8.4% +/- 4.0% versus 19.4% +/- 8.1%, P<0.0001; 13.3% +/- 6.3% versus 29.5% +/- 10.0%, P<0.0001 for EDD and EID, respectively). After non-surgical periodontal therapy, EDD and EID improved significantly (from 8.4% +/- 4.0% to 17.7% +/- 5.7%, P<0.0001; and from 13.3% +/- 6.3% to 24.9% +/- 7.3%, P<0.0001 for FMD and EID, respectively). The EDD and EID changes in the controls were insignificant. CONCLUSION: This study showed that endothelial functions were impaired in patients with chronic periodontitis and that they improve following initial periodontal therapy.     

Clinical and microbiological evaluation of the effectiveness of the Nd:Yap laser for the initial treatment of adult periodontitis. A randomized controlled study

BACKGROUND: Enhancement of the results obtained by scaling and planing is most often sought by using antimicrobial therapies. Laser beams have been shown to be bactericidal and could possibly target pathogens more effectively and with fewer compliance problems than antiseptic solutions. METHODS: Thirty subjects 20-60 years old presenting periodontal pockets at least 5 mm deep in each quadrant received initial periodontal treatment. The study had a split-mouth design. The control side (SRP) only received scaling and planing, and the test side (SRP+laser) was treated by both SRP and Nd:Yap (yttrium aluminum perovskite doped with neodym) laser. Clinical conditions were evaluated at day 0 and day 90 using the plaque index, gingival index, bleeding on probing, pocket probing depth, and clinical attachment level. Microbial sampling was also performed on days 0 and 90, and the presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and Treponema denticola was analysed by polymerase chain reaction in a commercial laboratory. Post-operative pain or discomfort was measured by the patient using a linear visual scale. Pearson's chi-squared test was used to compare bacterial presence. RESULTS: There was no statistically significant difference concerning clinical data between test and control groups at baseline. Both treatments enhanced the clinical situation compared to baseline; however, results were not significantly different between the two groups. T. forsythensis was the organism most numerous in both groups. Though initial treatment diminished the numbers of all the pathogens it did not do so statistically significantly. Differences between test and control groups were very small and bore no significance. Evaluation of the post-operative pain did not reveal any differences between the groups. CONCLUSIONS: Scaling and root planing was effective in reducing levels of plaque, inflammation, and bleeding upon probing. No additional advantage was achieved by using the Nd:Yap laser.     

Effects of metronidazole plus amoxicillin as the only therapy on the microbiological and clinical parameters of untreated chronic periodontitis

AIM: To determine the effect of metronidazole plus amoxicillin (M+A) as the sole therapy, on the subgingival microbiota of chronic periodontitis. MATERIAL AND METHODS: Twenty-two patients with untreated chronic periodontitis were randomly assigned to a group that received M+A for 7 days, or to a group receiving scaling and root planing (SRP) and two placebos. Clinical measurements including sites with plaque, bleeding on probing (BOP), probing depth (PD) and attachment level (AL) were made at baseline, 3, 6, 9 and 12 months. Subgingival plaque samples were taken from all teeth at baseline 3, 6, 9 and 12 months for the counts of 40 subgingival species using checkerboard DNA-DNA hybridization. RESULTS: Mean PD was reduced from 2.80+/-0.45 at baseline to 1.95+/-0.05 at 12 months (P<0.001) and from 2.39+/-0.41 to 1.95+/-0.10 (P<0.001) in the M+A- and SRP-treated patients, respectively. Corresponding values for relative mean AL were 10.07+/-1.30-9.77+/-0.34 (P<0.001) and 9.94+/-0.28-9.77+/-0.26 (P<0.001). Percentage of sites exhibiting BOP were 40.6+/-18.3-14.0+/-1.4 (P<0.001), and 38.5+/-5.1-19.0+/-2.8 (P<0.001) in the M+A and SRP groups, respectively. Mean total DNA probe counts and counts of the majority of the 40 test species were significantly reduced over time in both groups, with no significant differences detected at any time point between groups. At 12 months many of the species were still present at significantly lowered levels compared with their baseline counts in both groups. CONCLUSIONS: Changes in clinical and microbiological parameters were similar after receiving systemically administered M+A as the sole therapy or after receiving SRP only.     

Microbiological evaluation of initial preparation for adult periodontitis patients

The microbial flora from 46 adult periodontitis lesions of 23 patients and 18 sites in 9 healthy persons were examined and levels of serum IgG antibody to gram negative periodontal disease-associated bacteria were measured by enzyme-linked immunosorbent assay. Plaque samples and serum samples were taken 40-50 days after initial preparation consisting of scaling and root planing. To evaluate the effects of the therapy on 10 patients with adult periodontitis, changes in clinical parameters were compared with alterations of the microbial flora and serum IgG antibody levels. Black-pigmented Bacteroides species, mainly Bacteroides gingivalis, were found to be predominant in periodontitis lesions. A significant relationship was found between the prevalence of B. gingivalis and elevated titers of serum IgG antibody against the microorganism. No relationships between Bacteroides intermedius, Actinobacillus actinomycetemcomitans and elevated titers of serum IgG antibody to them were detected. The fact that there was no marked reduction of serum IgG antibody to B. gingivalis after initial preparation suggests that a more extended, longitudinal study is required. Although brushing resulted in a significant reduction of the number of total cultivable organisms in samples from periodontal pockets, no significant proportional changes in gram-negative bacteria in the lesional flora were found. Initial preparation was not effective in eliminating gram-negative bacteria from deep periodontal pockets. However, the microbiological shifts, especially the reduction in the proportion and frequency of detection of B. gingivalis in periodontal pockets, was paralleled by significant improvement in the clinical parameters.     

伴冠心病牙周炎患者牙周基础治疗的临床疗效观察

目的 观察伴有冠状动脉粥样硬化性心脏病(以下简称冠心病)的牙周炎患者牙周基础治疗后临床指标的变化,并评价其治疗效果.方法 32例伴有冠心病的牙周炎患者,在1个月内完成口腔卫生指导、洁治、刮治和根面平整术,治疗后6周复查,进行牙周维护,在治疗前和治疗后3个月时记录全口牙周情况:菌斑指数(plaque index,PLI)、探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、牙龈出血指数(bleeding index,BI),并进行血清超敏C-反应蛋白(high-sensitivity C-reactive,hs-CRP)、总胆固醇、甘油三酯、高密度脂蛋白胆固醇(high-density lipoprotein,HDL)、低密度脂蛋白胆固醇(low-density lipoprotein,LDL)及血糖的检测.结果 牙周治疗后3个月患者的临床指标显著改善,平均PD由(3.95±0.15)mm减少至(2.93±0.21)mm,平均AL由(3.08±0.43)mm降至(2.43±0.37)mm,PD≥5 mm的位点百分比由(22.37±6.88)%降至(3.00±1.80)%,差异均有统计学意义(P＜0.01).牙周治疗后3个月患者的hs-CRP水平显著降低,由(2.71±2.69)mg/L降至(1.99±2.14)mg/L,差异有统计学意义(P＜0.01);总胆固醇,甘油三酯、HDL、LDL及血糖的测定值与治疗前相比差异均无统计学意义(P＞0.05).结论 在本研究范围内,对于伴有冠心病的牙周炎患者,牙周基础治疗取得良好的治疗效果,患者的牙周临床指标改善,血清hs-CRP水平降低.     

Progression and treatment of chronic adult periodontitis.

BACKGROUND: The periodontal status of 41 medically healthy adults with untreated chronic periodontitis was monitored before and after scaling and root planing (SRP). METHODS: During a 6-month pretreatment phase, clinical measurements, digital subtraction radiography (DSR) analysis of alveolar bone, and measurement of gingival crevicular fluid (GCF) prostaglandin E2 (PGE2) levels were undertaken. SRP was provided during a 1-month treatment phase. Clinical, radiographic, and biochemical analyses were repeated in a 6-month post-treatment healing period. RESULTS: Pretreatment: no clinically significant changes in mean plaque indices (PI), probing depths (PD), bleeding on probing (BOP), or relative clinical attachment levels (CAL) were detected (P>0.05). DSR revealed small but statistically significant bone height (0.04 mm) and mass (0.97 mg) loss (P<0.001). GCF PGE2 levels gradually increased from 38.8 ng/ml at month 1 to 79.4 ng/ml at month 6. Post-treatment: statistically and clinically significant reductions were observed in mean PI, BOP, and PD (P<0.05). A statistically significant reduction in CAL was noted (P<0.05). The trend towards progressive bone loss was halted and reversed, and a statistically significant decrease in GCF PGE2 concentrations was detected (P<0.001). Smokers, non-smokers, and ex-smokers did not differ significantly in PI, BOP, CAL, radiographic, or biochemical parameters at any time. Mean PD was significantly greater in current smokers than in non- and ex-smokers (P<0.005). PD reduced comparably in all 3 smoking subgroups following treatment (P<0.01). CONCLUSIONS: Conventional clinical measurements failed to identify disease progression over a 6-month period. Significant improvements were observed in clinical parameters after SRP, and a trend towards progressive bone loss was halted and reversed. Regular and frequent maintenance visits are important following treatment to maintain improvements in clinical parameters. Smokers had deeper probing depths than non- and ex-smokers, but pockets were reduced significantly and comparably in all 3 smoking subgroups following efficacious treatment.     

慢性牙周炎合并冠心病患者牙周基础治疗对细胞因子水平的影响

目的研究牙周基础治疗对重度慢性牙周炎合并冠心病患者牙周临床指标、外周血细胞因子和C反应蛋白水平的影响。方法筛选重度慢性牙周炎合并稳定型冠心病患者32例,采用非手术牙周基础治疗方法,治疗前及治疗后4周测量牙周探诊深度（probingdepth,PD）、附着丧失（attachment loss,AL）和探诊出血指数（bleed—ing压计index,BI）,许采集外周静脉血,采用放射免疫法和免疫比浊分析法分别检测白细胞介索-1β（interleukin-1β,1L-1β）、门细胞介素-2（interleukin-2,IL-2）、白细胞介素-6（interleukin-6,IL-6）、肿瘤坏死因子-α（tumor necrosis fac—for-α,TNF—α）和C反应蛋白（C—reactive pmtein,CRP）含量。结果牙周基础治疗4周后,PD由（5．35±0．97）mm减至（2.72±0．65）mm,AL由（5．83±1．12）mm减至（3．24±0．79）mm,BI由3．45±0．83降至0．80±0．77,差砰均有统计学意义（P〈0．05）。外周血IL-1β、IL-2和IL-6水平均有所下降,TNF—α及CRP水平均数略有升高,其中IL-1β由（0．184±0．045）ng/mL降至（0．145±0．039）ng／mL,TNF—α由（1．082±0．206）ng/mL升高至（1．182±0．154）ng/mL,治疗前后IL-1β及TNF-α水平的差异有统计学意义（P〈0．05）.结论 重度慢性牙周炎合并冠心病的患者,牙周基础治疗可显著改善牙周临床指标,降低外周血IL-1β水平,升高TNF-α水平,     

A systematic review of the effects of full-mouth debridement with and without antiseptics in patients with chronic periodontitis

Objectives: To assess the clinical and microbiological effects of full-mouth debridement with (FMD) and without the use of antiseptics [full-mouth scaling and root planing (FMSRP)] in comparison with conventional staged debridement (CSD) in patients with chronic periodontitis after at least 6 months.
Material and Methods: The search in MEDLINE (PubMed), covering a period of 1975 to October 2007, and hand searching yielded 207 titles. Forty-two abstracts and 17 full-text articles were screened for inclusion.
Results: Twelve articles allowed a direct comparison of FMD with CSD, FMSRP with CSD and FMD with FMSRP. Probing pocket depth reductions were significantly greater (0.2 mm) with FMD and FMSRP compared with CSD. Moreover, a modest reduction in BOP (9%) favoured FMD. Likewise, clinical attachment levels were improved by 0.2–0.4 mm in favour of FMD and FMSRP, respectively. In all comparisons, single-rooted teeth and deep pockets benefitted slightly from FMD and FMSRP. Limited differences in the changes of the subgingival microbiota were noted between the treatment modalities.
Conclusions: Despite the significant differences of modest magnitude, FMD or FMSRP do not provide clinically relevant advantages over CSD. Hence, all three treatment modalities may be recommended for debridement in the initial treatment of patients with chronic periodontitis.