Association between signs of trauma from occlusion and periodontitis

The purpose of this study was to evaluate the association between signs of trauma from occlusion, severity of periodontitis and radiographic record of bone support. The maxillary first molars of 300 individuals were independently evaluated by two examiners for signs of trauma from occlusion, pattern or occlusal contacts and severity of periodontitis. Each site was also evaluated radiographically by an independent third examiner. The results indicated that: teeth with either bidigital mobility, functional mobility, a widened periodontal ligament space or the presence of radiographically visible calculus had a deeper probing depth, more loss of clinical attachment and less radiographic osseous support than teeth without these findings, teeth with occlusal contacts in centric relation, working, nonworking or protrusive positions did not exhibit any greater severity of periodontitis than teeth without these contacts, teeth with both functional mobility and radiographically widened periodontal ligament space had deeper probing depth, more clinical attachment loss and less radiographic osseous support than teeth without these findings and given equal clinical attachment levels, teeth with evidence of functional mobility and a widened periodontal ligament space had less radiographic osseous support than teeth without these findings.     

树脂粘接剂粘固铸造金属板治疗牙周炎所致后删的临床评价

目的 评价树脂粘接剂固定铸造金属板治疗牙周炎所致后牙松动的临床效果.方法 选择30例因牙周炎导致后牙松动患者,经严格牙周病的综合治疗,后牙中有一颗或一颗以上松动度仍在Ⅱ度以上,应用树脂粘接剂加铸造金属板进行粘接固定,观察固定后一年牙周探诊深度（probing depth,PD）、附着丧失（attachment loss,AL）和根尖X线片的变化,随访时间最短12个月,最长24个月.结果 30例患者中仅1例发生夹板脱落,1例菌斑控制不良,显效12例、有效16例、无效2例,有效率为93.33％.一年后实验牙的PD、AL均无明显改变（P＞0.05）.结论 该方法能有效地进行牙周炎松动后牙的固定,有一定的临床应用前景.     

The association of occlusal contacts with the presence of increased periodontal probing depth

Aim: This study evaluates relationships in humans between various occlusal contacts and the presence of deeper probing depths, reduced width of keratinized tissue, and less than favourable initial prognosis. Materials and Methods: The tooth level relationship between various occlusal contacts and pocket probing depths, width of keratinized gingiva, and prognosis at the time of initial examination was evaluated (multivariate model) in a group of patients (85 patients, 2219 teeth) with active periodontal disease. Results: The following were noted to be associated with significantly deeper pocket probing depths: premature contacts in centric relation (0.89 mm, p<0.0001), posterior protrusive contacts (0.51 mm, p<0.0001), balancing contacts (1.01 mm, p<0.0001), combined working and balancing contacts (1.13 mm, p<0.0001), and the length of slide between centric relation and centric occlusion. Protrusive contacts on anterior teeth were significantly associated with shallower probing depths (?0.18 mm, p=0.0076) and a wider zone of keratinized tissue (0.16 mm, p=0.0065). Balancing contacts with and without working contacts and centric prematurities were all associated with an increased incidence of a less than “Good” prognosis Conclusions: Multiple types of occlusal contacts were shown to be associated with deeper probing depths and the increased assignment of a less than “Good” initial prognosis.     

牙周炎患者牙合创伤研究进展

由于微生物感染,牙周炎患者的牙周组织被破坏,形成牙周袋,出现附着丧失和牙槽骨吸收,引起咬合不适、创伤甚至松动移位。同时,牙合创伤是牙周炎的局部促进因素,过大的牙合力使牙周组织发生改变,加重牙周组织的破坏。在牙周炎患者中,牙周组织破坏与牙合创伤经常相互作用、互为影响。文章就牙周炎患者牙合创伤的相关研究进展做一综述。     

Bio-Oss联合Bio-Gide治疗牙周炎垂直型骨吸收的临床疗效观察

目的评价异种骨移植物Bio-Oss联合Bio-Gide治疗牙周骨下袋的临床疗效。方法选择28例全身健康的慢性牙周炎患者,经基础治疗6周以上,牙周袋深度超过5mm的垂直型骨吸收患牙40牙位,随机平分为2组。引导组织再生GTR组20个牙位,在翻瓣术同时植入Bio-Oss和Bio-Gide。对照组20个牙位仅行翻瓣术;术后3、6、12个月回访,检查探诊出血指数、菌斑指数、牙周探诊深度、临床附着丧失、牙龈退缩和牙松动度,及X线检查比较2组骨缺损修复情况。结果 GTR组术后3、6、12个月牙周探诊深度、临床附着丧失、探诊出血指数均比术前及对照组明显改善（P〈0.01）;术后6、12个月牙松动度比术前及对照组明显减轻;术后3、6、12月菌斑指数比术前轻度降低（P〈0.05）。对照组术后3、6、12个月牙周探诊深度和探诊出血指数较术前减少,临床附着丧失和菌斑指数较术前轻度降低,牙松动度和龈退缩与术前差异无显著性。结论 Bio-Oss联合Bio-Gide能明显减轻牙周袋深度和减少牙周附着丧失,可促进牙周形成新附着和新骨。     

利用Florida探针评价牙周炎非手术治疗的疗效

目的利用Florida探针评价牙周炎的非手术治疗的疗效。方法选择100例牙周炎患者为研究对象,进行牙周非手术治疗,采用Florida探针检测患者在治疗前和治疗结束后1个月时的探诊深度（PD）和附着丧失（AL）。检测位点为患者所有天然牙的近中颊、颊正中、远中颊和舌正中4个位点。将全口牙分成前牙组、前磨牙组、后牙组和所有牙组4组,比较4组间、4个位点间以及PD<5 mm和PD≥5 mm的位点间治疗前后PD和AL的变化。结果前牙组、前磨牙组、后牙组和所有牙组治疗后PD和AL与治疗前相比均有明显改善（P<0.05）,PD明显下降,且有牙周附着再获得;其中前牙的改善较磨牙和前磨牙更明显。PD<5mm和PD≥5mm的牙周位点间PD的恢复有统计学差异（P<0.05）,治疗后明显好转;而AL在治疗前后无统计学差异（P>0.05）。4个位点间改善程度的比较无统计学差异（P>0.05）。结论Florida探针能够较准确、客观地评价牙周状况。牙周非手术治疗对牙周炎具有良好的治疗效果,前牙疗效更为明显,同一牙齿不同位点的疗效基本一致。     

Occlusal contacts of the natural teeth

The areas of contact between the mandibular and maxillary teeth are critical in helping control the occlusion. They affect the amount and direction of force against the teeth and the periodontium. In addition, they determine how efficiently the forces are expended. The significant aspects of the occlusal contacts of the posterior teeth are: the mandibular position and excursion at the time of their occurrence and their location, size, distribution, and, possibly, number.If the occlusal forces produce unfavorable occlusal contacts and if the periodontal structures are susceptible, trauma from occlusion will occur. This can result in advanced bone loss and excessive mobility of the teeth.The occlusion is most favorable when the contacts are small and arranged symmetrically and when the forces are directed in a vertical direction, along the long axis of the tooth.     

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提要：牙齿松动是牙周病主要的临床症状之一。如何治疗松动牙、防止牙周炎进行性加重、尽可能地保存牙齿、促进牙周组织的重建再生,是牙周科医生致力于解决的主要问题。经牙周基础治疗、去除危险因素、消除牙周组织炎症并建立平衡牙合后,多数患牙的松动度可不同程度减轻。而松动度较大的患牙经牙周治疗也很难恢复正常,并影响咀嚼功能,产生继发性牙合创伤,使得牙周组织破坏、吸收加剧。对动度较大的松动牙进行固定,消除其创伤,减轻牙合力负担,使之行使正常咬合功能,牙周膜接受功能性刺激,从而促进牙周组织的修复和愈合。因此,松牙固定是牙周治疗的必要措施。牙周炎的松牙固定是将单根或多根患牙与健康牙通过夹板连接成一个稳固的“多根牙”,建立起一个新的咀嚼单位。本文对牙周病的松动牙固定、各类牙周夹板在临床上的使用及夹板固定技术做一介绍。     

Upper anterior tooth mobility. Selected associations in untreated periodontitis

The relationship between buccolingual tooth mobility (TM) and other clinical parameters was studied in 124 upper anterior teeth in 21 patients with untreated periodontitis. Periapical long-cone radiographs were available for 74 teeth in the same population. TM was measured with Mühlemann's macroperiodontometer. Probing depths, attachment levels and bleeding were measured with a constant force probe. Bone levels were estimated from radiographs. Presence of occlusal contact was noted in the intercuspal position and excursive movements of the mandible. Attachment levels showed the highest correlation with TM, and radiographically estimated bone support was the next highest. Results varied according to tooth type: the attachment level of the lateral incisors showed the highest correlation with TM, while probing depths and proximal bone support showed lower associations with TM in all cases. In this population, no association was detected between the presence of occlusal contact and TM, or between inflammation and TM. Multiple and partial correlation analysis indicated that probing attachment level was the most important correlate of tooth mobility.     

盐酸二甲胺四环素辅助治疗慢性牙周炎的短期临床疗效观察

目的 观察盐酸二甲胺四环素(MINO)辅助治疗慢性牙周炎的临床效果.方法 将78例患者200颗患牙采用自身对照随机分为MINO试验组和对照组,观察用药结束后1周、 4周MINO组与对照组牙周袋深度(PD)、附着水平(AL)、探诊出血(BOP)的变化.结果 用药结束后1周、4周,两组PD、AL和BOP阳性率较基线时都有显著下降; 1周时试验组PD、AL和BOP阳性率虽然都低于对照组,但两组比较差异均无统计学意义(P＞0.05);而4周时两组PD、AL和BOP阳性率比较则差异有统计学意义(P＜0.05).结论 盐酸二甲胺四环素对慢性牙周炎有明显的辅助治疗效果,是临床上一种值得推广的局部治疗药物.     

不同程度慢性牙周炎患者病情的二年自然进展

目的　观察不同程度慢性牙周炎的自然进展规律。方法　纵向观察 16 9例轻、中、重度慢性牙周炎患者在 2年中的疾病自然进展 ,检查除第三磨牙外的全口牙 ,每颗牙 6个位点 ,以探诊深度、附着丧失为指标 ,两次检查之间附着丧失加重≥ 3mm的牙位定为活动性进展。结果　活动性发生率依基线时疾病的轻、中、重程度而逐渐增高 ,按位点活动性的发生率分别为 0 14 %、0 39%及0 73% ,按个体活动性的发生率分别为 15 5 6 %、2 9 89%及 4 3 2 4 % ,差异有统计学意义。结论　重度牙周炎患者是牙周破坏活动性进展的高危人群。     

Impact of increased occlusal contact, interleukin-1 genotype, and periodontitis severity on gingival crevicular fluid IL-1beta levels

BACKGROUND: The study of occlusal therapy in humans with periodontitis is problematic due to potential irreversible bone loss in control subjects. The hypothesis of this pilot investigation was that increased interocclusal contact initiated by short-term occlusal splint disuse would increase tooth mobility and the bone-resorptive cytokine interleukin (IL)-1beta in gingival crevicular fluid (GCF), comparable to IL-1-positive genotype and increased periodontitis severity. METHODS: Nineteen non-smoking chronic periodontitis patients using nocturnal occlusal splints and undergoing periodontal maintenance in a private practice were evaluated at five time points: 24 hours after continuous splint use; 1, 2, and 3 days after no occlusal splint use; and 14 days after resumption of customary nighttime splint use. Subjects were evaluated to confirm that the plaque index and gingival index were < or = 1.0, and to categorize past periodontitis (moderate or severe) and IL-1 genotype (1A +4845 plus IL-1B +3954). Test sites on two anterior teeth vulnerable to occlusal trauma were sampled for mobility, GCF IL-1beta, and IL-1 receptor antagonist (ra). RESULTS: Tooth mobility remained low during the 3-day period when patients were not wearing their occlusal appliance. GCF IL-1beta decreased after not wearing the appliances (P = 0.016), especially at 48 hours. At this time, genotype-positive subjects had higher levels of GCF IL-1beta/IL-1ra than genotype-negative subjects (P = 0.045), and patients who had experienced severe periodontitis had higher IL-1beta levels than moderate periodontitis subjects (P = 0.004). CONCLUSIONS: These findings suggest that short-term discontinuation of occlusal splint therapy in non-smoking periodontitis patients undergoing periodontal maintenance does not result in potential signs of early occlusal trauma (increasing mobility or GCF IL-1beta). Longer-term studies may be needed to determine appropriate therapy applications for periodontitis-susceptible patients with definable occlusal discrepancies and/or parafunction.     

Tooth mobility measurements following two methods of eliminating nonworking side occlusal interferences

Abstract The objective of this study was to compare tooth mobility following two methods of eliminating nonworking side interference (NWSI). The first method involved the complete elimination of any tooth contact on the NWS. The second method involved the reduction of the NWSI to a level which was harmonious with the occlusion on the working side. Thirty-three clinically healthy individuals having nonworking side interferences and no pathological signs of occlusal trauma, participated in the study. After 1 month of intensive training in oral hygiene, the volunteers were divided into three groups of 11 each. The first two groups were experimental and the third group received no occlusal adjustment to serve as a control. In the first group tooth mobility measurements and periapical x-ray films of teeth with nonworking interferences were taken. Occlusal interferences were then totally eliminated by selective tooth grinding. Two months later mobility and x-ray recordings of same teeth were repeated. In the second group the same procedure was performed, but nonworking side interferences were adjusted to harmonious contacts with occlusion on the working side. Tooth mobility was measured in hundredths of a millimeter, using the microperiodontometer designed by Mühlemann (1954). Data were subjected to statistical analysis and the following conclusions were drawn:

• 1 Tooth mobility was significantly (P < 0.001) reduced after complete elimination of nonworking side interferences, as well as after adjusting the nonworking side interferences to harmonious contacts with occlusion on the working side (P < 0.01).
• 2 The reduction in mobility was significantly (P < 0.001) greater when occlusal interferences were completely eliminated than when harmonious contacts were achieved.
• 3 There were no detectable radiographic changes, either in the interproximal alveolar bone level or periodontal ligament spaces, 2 months following occlusal adjustment.

     

Periodontal status of teeth facing extraction sites long-term after orthodontic treatment

The present study was undertaken to examine the long-term periodontal status of teeth orthodontically moved into extraction sites. Patients were examined 14 to 34 years after active orthodontic treatment involving extraction of four first premolars. Three groups were established: one with closed tooth contacts and parallel adjacent teeth, one with closed tooth contacts and tipped adjacent teeth, and one with open contacts between adjacent teeth. Within each group accumulation of plaque, gingival health status, probing pocket depth, and probing attachment level of interproximal tooth surfaces, facing extraction sites and adjacent control sites between canine and lateral incisor were compared. Significantly more probing attachment loss was found in extraction sites with open tooth contacts (P less than 0.01) and with parallel adjacent teeth and closed tooth contacts (P less than 0.05) than in control sites. However, the mean differences were less than 0.5 mm, which may not be considered clinically significant. Tipping of teeth into the extraction sites had no long-term detrimental effect on the probing attachment level. No differences in accumulation of plaque and in gingival health status were observed.     

2-year observation of attachment loss in a rural Chinese population

BACKGROUND: Risk indicators for periodontitis seem to vary with study population. The purpose of this study was to determine whether risk indicators of additional attachment loss differ between generations of Chinese villagers in a rural area of China over a 2-year period. METHODS: The study population consisted of 310 subjects aged 15 to 44. In each subject, 2 quadrants from either the upper or lower jaw were randomly selected and 6 sites on each tooth were examined. Clinical parameters included plaque scoring system (PSS), calculus index (CI), probing depth (PD), attachment level (AL), and sulcus bleeding index (SBI). The second examination was done 2 years after the first. RESULTS: In the 15- to 24-year-old age group, mean PSS, CI, and SBI were significantly higher in subjects with additional attachment loss > or =3 mm (AL+) than in those without attachment loss (AL-). In the 25- to 34-year-old age group, mean PD was significantly higher in AL+ than in AL-, and mean PD and AL were significantly higher in AL+ than in AL- in the 35- to 44-year-old age group. Although the number of subjects with AL+ increased with age, the mean number of sites with AL+ per subject did not differ by generation. In addition, smokers tended to exhibit attachment loss more often than non-smokers. CONCLUSIONS: The present results suggest that the clinical parameters associated with attachment loss differ between generations and that gingival inflammation is likely associated with the onset of periodontitis more strongly than progression of periodontitis, whereas PD and/or AL are associated with the progression of periodontitis.     

Update on Prevalence of Periodontitis in Adults in the United States: NHANES 2009 to 2012

Background: This report describes prevalence, severity, and extent of periodontitis in the US adult population using combined data from the 2009 to 2010 and 2011 to 2012 cycles of the National Health and Nutrition Examination Survey (NHANES). Methods: Estimates were derived for dentate adults, aged ≥30 years, from the US civilian non‐institutionalized population. Periodontitis was defined by combinations of clinical attachment loss (AL) and periodontal probing depth (PD) from six sites per tooth on all teeth, except third molars, using standard surveillance case definitions. For the first time in NHANES history, sufficient numbers of non‐Hispanic Asians were sampled in 2011 to 2012 to provide reliable estimates of their periodontitis prevalence. Results: In 2009 to 2012, 46% of US adults, representing 64.7 million people, had periodontitis, with 8.9% having severe periodontitis. Overall, 3.8% of all periodontal sites (10.6% of all teeth) had PD ≥4 mm, and 19.3% of sites (37.4% teeth) had AL ≥3 mm. Periodontitis prevalence was positively associated with increasing age and was higher among males. Periodontitis prevalence was highest in Hispanics (63.5%) and non‐Hispanic blacks (59.1%), followed by non‐Hispanic Asian Americans (50.0%), and lowest in non‐Hispanic whites (40.8%). Prevalence varied two‐fold between the lowest and highest levels of socioeconomic status, whether defined by poverty or education. Conclusions: This study confirms a high prevalence of periodontitis in US adults aged ≥30 years, with almost fifty‐percent affected. The prevalence was greater in non‐Hispanic Asians than non‐Hispanic whites, although lower than other minorities. The distribution provides valuable information for population‐based action to prevent or manage periodontitis in US adults.     

Transalveolar screws and the incidence of dental damage: a prospective study

The incidence of screw/tooth contact in the placement of transalveolar screws was prospectively studied. The clinical significance of such contact when it occurred was assessed. Patients with fractures of the mandible requiring intra- or post-operative control of their occlusion with transalveolar screws were entered into the study. Following screw removal, contact was assessed radiographically and all teeth adjacent to screws were tested for vitality. Any contacts were judged to be minor if less than 50% of the diameter of the screw hole impinged on a tooth root or major if this was more than 50%. Fifty-four male and one female patients completed the study. There were 232 screws placed in these patients adjacent to 440 teeth. Twenty-six screws (11.2%) had major contacts and 37 (15.9%) had minor contacts. Seventeen teeth tested as non-vital with electronic pulp testing but of these only 6 showed any impingement by screws. Two screws were associated with complications in two patients. Screw/tooth contact does occur using transalveolar screws, however, the incidence of clinically significant damage appears to be very low.     

The influence of dynamic occlusal interferences on probing depth and attachment level: results of the Study of Health in Pomerania (SHIP)

BACKGROUND: The purpose of this study was to investigate potential associations between dynamic occlusal interferences and signs of periodontal disease in posterior teeth based on dental and medical measurements obtained from a population-based sample in the cross-sectional epidemiological study entitled, "Study of Health in Pomerania" (SHIP). METHODS: Medical history and dental and sociodemographic parameters of 2,980 representatively selected dentate subjects, 20 to 79 years of age, were collected. The analysis was performed on posterior teeth only using a mixed linear model that considers the clustered structure of the data. The model also was adjusted with respect to known risk factors for periodontal disease. RESULTS: The presence of non-working side contacts only was significantly related to probing depth (P<0.0001) and attachment loss (P=0.001). The presence of non-working side contacts and working side contacts on the same tooth was significantly related to increased probing depth (P=0.004) but not attachment level. The effect magnitude was a mean increase of 0.13 mm for probing depth and 0.14 mm in attachment loss. Known risk factors for periodontal disease that also showed significant associations with probing depth and attachment loss included male gender, age, smoking, education, and plaque score. Other factors significantly related to probing depth and/or attachment loss were tilted teeth, restored occlusal surfaces versus sound surfaces, elongated teeth, and tooth type (molar versus premolar). CONCLUSION: The effect of non-working contacts on periodontal disease status was discernible, but weak in terms of magnitude and specificity.     

引导骨再生术和引导组织再生术治疗牙周根分叉病变的临床研究

目的探讨多孔矿化骨(Bio-oss)与双层胶原膜(Bio-gide)对牙周根分叉病变骨缺损治疗的临床效果和骨引导作用。方法45例Ⅱ~Ⅲ度根分叉病变患牙随机分为3组,分别为:①植入Bio-oss组(GBR);②植入Bio-oss后覆盖Bio-gide组(GTR)和③对照组,即根分叉区行翻瓣术组(OFD)。在术前和术后3、6和12个月观察牙龈指数(GI)、牙周袋深度(PD)、附着丧失(AL)、牙松动度(TM),X线片观察牙槽骨的变化。结果术后3个月时,3组GI、PD、AL较术前均减少(P<0.01),GBR组或GTR组PD和AL比OFD组降低,X线片见GBR组或GTR组骨高度和骨密度轻度增加。术后6、12个月时,GBR组或GTR组PD、AL与OFD比差异有显著性,TM较术前减轻,GTR组的PD、AL比GBR组减少,松动度较GBR组轻度减轻,各组GI无明显差异,X线片见GBR组或GTR组骨高度比术前明显增加,GTR组比GBR组骨高度轻度增高。结论Bio-oss和Bio-gide能有效修复根分叉病变的牙周骨缺损,改善临床指标,促进骨再生及牙周新附着形成,两者合用效果更好,其作用可维持1年以上。