基于高通量测序技术研究慢性牙周炎患者龈下刮治和根面平整术治疗前后龈下菌群的变化

目的 采用基于16S核糖体DNA(rDNA)的高通量测序技术,分析10例慢性牙周炎患者接受龈下刮治和根面平整术(SRP)治疗前后龈下菌斑多样性及相对丰度的变化,探讨应用微生物群落的构成变化作为牙周炎诊断及预后评估指标的可行性.方法 选择2014年3—9月在首都医科大学附属北京口腔医院牙周科就诊的10例慢性牙周炎患者作为研究对象,在SRP治疗前及治疗后3个月分别在研究对象的同一位点采集龈下菌斑样本,提取样本基因组DNA,采用Illumina Miseq平台测序,分析各组样本从门到种各水平的菌群分布及相对丰度.结果 在门水平上,共检测到16个菌门,有8个门的细菌在牙周龈下菌斑菌群结构中占主要地位(99%);在属水平上,共检测到128个不同菌属,SRP治疗后3个月坦纳菌属(Tannerella)的相对丰度较治疗前明显降低(P<0.05),纤毛菌属(Leptotrichia)和链球菌属(Streptococcus)的相对丰度较治疗前明显上升(P<0.05);在种水平上,6种牙周可疑致病菌被检出,SRP治疗后3个月福赛坦纳菌(Tannerella forsythia)和中间普氏菌(Prevotella intermedia)的相对丰度较治疗前明显减少(P<0.05).结论 慢性牙周炎患者龈下菌群具多样性,SRP治疗前后,牙周可疑致病菌的相对丰度降低,而有益菌的相对丰度升高,SRP治疗可以明显改变龈下菌群构成.     

Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients

OBJECTIVES: To compare the effects of scaling and root planing (SRP) on clinical and microbiological parameters at selected sites in smoker and non-smoker chronic and generalized aggressive periodontitis patients. MATERIALS AND METHODS: Clinical parameters including probing depth (PD), relative attachment level (RAL), and bleeding upon probing (BOP), and subgingival plaque samples were taken from four sites in 28 chronic periodontitis (CP) and 17 generalized aggressive periodontitis (GAgP) patients before and after SRP. Polymerase chain reaction assays were used to determine the presence of A. actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Prevotella intermedia and Treponema denticola. RESULTS: Both CP and GAgP non-smokers had significantly greater reduction in pocket depth (1.0+/-1.3 mm in CP smokers versus 1.7+/-1.4 mm in non-smokers, p=0.007 and 1.3+/-1.0 in GAgP smokers versus 2.4+/-1.2 mm in GAgP non-smokers, p<0.001) than respective non-smokers, with a significant decrease in Tannerella forsythensis in CP sites (smokers 25% increase and non-smokers 36.3% decrease, p<0.001) and Prevotella intermedia at GAgP sites (smokers 25% reduction versus 46.9% in non-smokers, p=0.028). CONCLUSION: SRP was effective in reducing clinical parameters in both groups. The inferior improvement in PD following therapy for smokers may reflect the systemic effects of smoking on the host response and the healing process. The lesser reduction in microflora and greater post-therapy prevalence of organisms may reflect the deeper pockets seen in smokers and poorer clearance of the organisms. These detrimental consequences for smokers appear consistent in both aggressive and CP.     

Clinical and microbiological features of subjects with adult periodontitis who responded poorly to scaling and root planing

Abstract In a previous report, it was shown that scaling and root planing (SRP) decreased mean pocket depth and attachment level in subjects with adult periodontitis, as well as the levels and prevalence of Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola. However, a subset of subjects in that study exhibited mean loss of attachment following SRP. The purpose of the present investigation was to seek clinical and microbiological differences between subjects who responded well or poorly to SRP. 57 subjects with adult periodontitis were treated by full-mouth SRP under local anaesthetic. Clinical assessments of plaque, redness, suppuration, BOP, pocket depth and attachment level were made at 6 sites per tooth prior to and 3 months post-SRP. Attachment level measurements were repeated at each visit and differences in means between visits used to assess change. 18 subjects showed mean attachment loss 3 months post-SRP (poor response group), while 39 showed mean attachment level gain (good response group). The prevalence and levels of 40 subgingival taxa in subgingival plaque samples from the mesiobuccal site of each tooth (maximum 28 sites) in each subject prior to and 3 months post-SRP were assessed using checkerboard DNA-DNA hybridization. The prevalence of each species was computed for each subject and averaged across subjects in the 2 treatment-response groups at each visit. Differences between groups were sought using the Mann-Whitney test. There were no statistically significant differences between the 2 response groups in any clinical parameter prior to therapy. Subjects in the good response group showed more attachment level gain at sites with baseline pocket depths of < 4 mm, 4–6 and > 6 mm than poor response subjects. Of 40 species evaluated. A. naeslundii genospecies 2 (A. viscosus), T. denticola, C. gracilis and C. rectus were significantly higher and more prevalent pre-therapy in the good response subjects. Mean attachment level change post SRP could be predicted using multiple linear regression with A. naeslundii genospecies 2 (A. viscosus) and T. denticola as the predictor variables (r²=0.373, p < 0.00001). Sites that gained ≥ 2 mm of attachment post therapy showed a significant decrease in the counts of P. gingivalis (7.5±3.5 to 0.2±0.2×10⁵), T. denticola (8.2±3.5 to 1.8±1.1×10⁵) and B. forsythus (11.1 ± 5.7 to 0.3±0.2×10⁵). The data of the present investigation indicate that SRP is most effective in subjects and sites with high levels of the subgingival species that this therapy affects.     

光动力疗法联合龈下刮治术治疗慢性牙周炎疗效观察

目的 观察光动力疗法联合龈下刮治和根面平整术治疗慢性牙周炎的临床效果.方法 选择中、重度慢性牙周炎患者30例,随机分为3组,每组10人.A组:单纯龈下刮治和根面平整术治疗;B组:龈下刮治和根面平整术治疗后即刻行光动力疗法;C组:龈下刮治和根面平整术治疗后1周行光动力疗法.治疗前、龈下刮治和根面平整术治疗后6周、12周时分别记录牙周袋探诊深度及探诊出血的阳性牙位点,并进行统计学分析.结果 龈下刮治和根面平整术后6周和12周结果显示,3组牙周袋探诊深度和探诊出血情况较术前均有改善(P＜0.05).B组和C组的牙周袋探诊深度和探诊出血情况改善效果均优于A组(P＜0.05);B组与C组间差异无统计学意义(P＞0.05).结论 对中、重度慢性牙周炎患者应用光动力疗法联合龈下刮治和根面平整术治疗,较单独使用龈下刮治和根面平整术治疗效果更佳.光动力疗法可作为新的辅助治疗手段用于牙周病的治疗.     

Clinical and microbiologic effects of single-dose metronidazole or scaling and root planing in treatment of adult periodontitis

Sites affected with adult periodontitis were observed for 3 months to compare their clinical and microbiologic responses to a single 2 g dose of metronidazole, scaling and root planing, or no treatment. 2 sites with probing depths greater than or equal to 5 mm in each of 18 female subjects (6 in each treatment group) were evaluated clinically (plaque and bleeding indices, probing depth, attachment loss) and microbiologically (%s of cocci, motile rods, non-motile rods and spirochetes, and of obligate anaerobic colony-forming units, black-pigmented Bacteroides, Fusobacterium and Actinobacillus actinomycetemcomitans in subgingival plaque). No significant differences in these variables existed between the 3 groups at baseline. The no-treatment (control) group showed no substantial clinical or microbiologic changes during the study. After 1 month, scaling and root planing had effected significant clinical improvement and significant shifts in the subgingival flora to a pattern more consistent with periodontal health; these changes were still evident at 3 months. In contrast, 1 month after metronidazole, there was some clinical improvement and a significant increase in cocci and a decrease in motile rods, but at 3 months these changes were no longer evident. The results show that the benefits of scaling and root planing are sustained for at least 3 months. However, the benefits of a single 2 g dose of metronidazole are both few and transient, indicating that this regimen, while effective against anaerobic infections in other organ systems, is not clinically or microbiologically effective in the treatment of adult periodontitis.     

A novel approach to the use of subgingival controlled-release chlorhexidine delivery in chronic periodontitis: a randomized clinical trial

Background: We aimed to analyze clinical, microbiologic, and serologic effects of chlorhexidine (CHX) chips used as a subgingival controlled‐release delivery device before and immediately after scaling and root planing (SRP). Methods: Twenty‐four patients presenting with ≥12 teeth with probing depth (PD) ≥5 mm and bleeding on probing were assigned in test or control groups. After prophylaxis, CHX chips (test) or placebo chips (control) were placed in pockets with PD ≥5 mm. Ten days later, SRP was performed in all teeth with PD ≥4 mm in a single appointment. Immediately after SRP, new chips were inserted in all pockets with PD ≥5 mm. Parameters were assessed at baseline; beginning of SRP; and 1, 3, and 6 months after treatment. Subgingival samples were obtained at baseline; beginning of SRP; and at 1 month after treatment. Periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola were analyzed. Serum levels of high sensitive C‐reactive and lipopolysaccharide‐binding proteins were measured. The changes of the parameters between and within the groups were tested by Mann‐Whitney U test (P <0.05). Results: All clinical and serologic parameters improved in both groups over time. There was a significant difference in clinical attachment level (CAL) gain from baseline to 6 months between groups (1.17 mm in the test group versus 0.79 mm in the placebo group) (P <0.05). The treatment with CHX chips showed a greater reduction of the microorganisms of the “red complex” after 1 month (P = 0.02). Conclusion: The use of CHX chips before and immediately after SRP improved CAL and reduced the subgingival microorganisms of the red complex in the treatment of chronic periodontitis.     

Effectiveness of systemic amoxicillin/metronidazole as adjunctive therapy to scaling and root planing in the treatment of chronic periodontitis: a systematic review and meta-analysis

Background: The combination of Amoxicillin and metronidazole (AMX/MET) as an adjunctive treatment to scaling root planing (SRP) has been proposed for the treatment of chronic periodontitis; however, its effectiveness and clinical safety remain to be defined. The purpose of the present meta-analysis is to assess the effectiveness of SRP + AMX/MET compared to SRP alone. Methods: An electronic search of eight databases from their earliest records through October 8, 2011 and a hand search of international dental journals for the last 15 years were conducted. Gain in clinical attachment level (CAL), reduction in probing depth (PD), secondary outcomes, and adverse events were analyzed. A random-effect model was used to pool the extracted data. The weighted mean difference (WMD) with 95% confidence interval (CI) was calculated for continuous outcomes; heterogeneity was assessed with the Cochrane χ(2) and I(2) tests. The level of significance was set at P <0.05. Results: After the selection process, four randomized clinical trials were included. Results of the meta-analysis showed significant CAL gain (WMD = 0.21; 95% CI = 0.02 to 0.4; P <0.05) and PD reduction (WMD = 0.43; 95% CI = 0.24 to 0.63; P <0.05) in favor of SRP + AMX/MET. No significant differences were found for bleeding on probing (WMD = 10.77; 95% CI = -3.43 to 24.97; P >0.05) or suppuration (WMD = 1.77; 95% CI = -1.7 to 5.24; P >0.05). Conclusion: The findings of this meta-analysis seem to support the effectiveness of SRP + AMX/MET; however, future studies are needed to confirm these results.     

Clinical effects of scaling and root planing with an adjunctive periodontal endoscope for residual pockets: a randomized controlled clinical study

目的 比较牙周内窥镜辅助龈下刮治和根面平整（SRP）与传统SRP对慢性牙周炎患者基础治疗后残留牙周袋的临床疗效。方法 将牙周基础治疗后口内每个区至少有1个位点探诊深度（PD）≥5 mm的患者纳入研究,随机分为内窥镜组和SRP组,分别对残留牙周袋位点进行内窥镜辅助SRP治疗和传统SRP治疗。在治疗前（基线）、治疗后3、6个月检查PD、探诊出血（BOP）和附着丧失（AL）,采用SPSS 20.0统计学软件对数据进行统计分析。结果 与基线相比,治疗后3、6个月内窥镜组及SRP组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）。治疗后6个月与3个月相比,内窥镜组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）,而SRP组差异无统计学意义（P>0.05）。与SRP组相比,内窥镜组治疗后3及6个月PD≥5 mm位点百分比、PD均降低,治疗后6个月AL、BOP阳性位点百分比降低（P<0.05）。结论 牙周内窥镜辅助SRP对于基础治疗后的残留牙周袋（PD≥5 mm）的临床疗效优于传统SRP,尤其具有更好的远期预后。     

Efficacy of statin delivery as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A meta‐analysis

The action of statins in stimulating bone formation and having other pleiotropic effects, such as anti‐inflammatory and immunomodulatory effects, has justified their use as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP). The aim of the present study was to evaluate the efficacy of statin delivery as an adjunct to SRP in the treatment of CP. Electronic searches were conducted using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, up until July 2017. The primary outcome was probing depth (PD), while the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. Eleven studies were included, and all showed significant PD reduction, CAL gain, and BD fill with adjunctive statin delivery compared to SRP alone. The meta‐analysis showed significant improvement in periodontal parameters for atorvastatin (PD: weighted mean difference [WMD] = ?1.84, ?2.56 to ?1.12, P < .001; CAL: WMD = ?2.31, ?3.58 to ?1.03, P < .001; BD fill: WMD = 2.66, ?3.92 to ?1.39, P < .001), simvastatin (PD: WMD = ?1.91, ?2.27 to ?1.55, P < .001; CAL: WMD = ?1.91, ?2.27 to ?1.55, P = .001; BD: WMD = ?1.52, ?2.20 to ?0.85, P < .001), and rosuvastatin (PD: WMD = ?0.94, ?1.32 to ?0.55, P < .001; CAL: WMD = ?1.00, ?1.41 to ?0.60, P < .001; BD fill: WMD = ?1.30, ?1.80 to ?0.79, P < .001). Adjunctive statin delivery appears to be effective in reducing PD, CAL gain, and BD fill in CP, and therefore, these drugs could be a promising therapeutic option for periodontal regeneration in future.