空管药物疗法治疗牙髓病和根尖周病疗效观察

用ＳＭＴＤ复合药物对牙髓病和根尖周病实施空管药物疗法。７８例１０３颗获得完整随访资料患牙经两年观察，９２．２％治愈率。文章介绍了治疗方法，讨论了空管药物疗法的愈合机理、优点、失败原因及其预防措施。     

The prevalence of A. actinomycetemcomitans, P. gingivalis and P. intermedia in selected subjects with periodontitis

Abstract. The present study was carried out in a private periodontal practice. 8 clinical criteria were chosen to select patients for microbiological examination. These criteria characterize prominent features of disease which at the start, during, or in the maintenance phase of treatment suggest difficulties in the progress of the periodontal therapy. Based on these clinical characteristics, an inventory was made of the prevalence of the 3 putative periodontal pathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia. Out of 320 referred patients 91 patients did meet 1 of the clinical criteria and consequently were selected for microbiological examination. Results showed that young patients (19–30 years) with periodontitis demonstrated the presence of A. actinomycetemcomitans more often (69%: p (0.005) compared to older age cohorts. A. actinomycetemcomitans was found more often when localized breakdown (in particular in the 1 st molar and incisor region) was observed and in patient who responded poorly to scaling and rootplaning. P. gingivalis and P. intermedia were most frequently recovered in patients showing primarily a bone loss pattern of angular defects of 5 mm. Retrospectively, these patients were further categorized, based on full mouth radiographs, in (1) patients with primarily horizontal bone loss and (2) patients with primarily angular bony defects. Results showed that A. actinomycetemcomitans occurred less frequently in patients showing horizontal bone loss ( p (0.05).     

Polyamines found in gingival fluid enhance the secretory and oxidative function of human polymorphonuclear leukocytes in vitro

Many bacterial and host cells contain large amounts of polyamines that can be released at infection sites as a result of cell lysis. Consequently, the putrescine and spermidine content of gingival fluid from inflamed periodontal pockets (0.1 to 1 mM) is sharply elevated in comparison to peripheral blood. At these levels, polyamines potentiated fMet-Leu-Phe-induced Ca²⁺ signaling in polymorphonuclear leukocytes (PMNs) in vitro. Consistent with the essential role of Ca²⁺ signaling in PMN activation, secondary granule release and superoxide anion production by fMet-Leu-Phe-stimulated PMNs was enhanced in the presence of polyamines. Thus, polyamines may play a local role in modulating the antimicrobial activity of PMNs in periodontal disease.     

Calcium and other salivary factors in periodontitis-affected subjects prior to treatment

Abstract Salivary calcium was shown to be higher in treated periodontitis-affected subjects (P+) than in periodontitis-free patients (P?). Here the aim was to study whether differences in calcium or other salivary factors exist prior to treatment. The test group consisted of 20 (15 men, 5 women) periodontitis-affected subjects and the control group 15 subjects (10 men, 5 women) free from periodontitis. Paraffin-stimulated whole saliva was collected to determine the flow-rate, calcium and phosphate concentrations, pH, buffering capacity, numbers of mutans streptococci, lactobacilli and yeasts. The results showed a higher calcium concentration (p < 0.05) in the P+ group (x?: 1.68 mmol/l; SE: 0.06 in men and x?: 1.49 mmol/l; SE: 0.10 in women) than in the P-group (x?: 1.48 mmol/l; SE: 0.09 in men and x?: 1.18 mmol/l; SE: 0.10 in women). The P+ group had more intact teeth (x?±SE: 9.9±0.8 in men and 11.2±2.0 in women) than the P-group (x?± SE: 8.3±0.7 in men and 8.2±2.4 in women). The present findings may indicate that an elevated level of salivary Ca is characteristic of P+ patients both before and after periodontal treatment.     

The use of locally-delivered chlorhexidine in the treatment of periodontitis. Clinical results*

Abstract. Since the advent of a nondegradable controlled local delivery of antibiotics in 1979, several second generation systems have been developed. Second generation systems have attempted to improve on the early system. Chlorhexidine has been used effectively for over 30 years as an antiseptic. In the early 1970s, chlorhexidine gluconate was incorporated at 0.2% into mouthrinses in Europe and in 1986 it was incorporated at 0.12%, in a mouthrinse in the United States. Since these mouthrinses were effective in reducing the supragingival flora, had a high safety margin, and had no reported bacterial resistance, chlorhexidine offered a therapeutic advantage for a local delivery system. This system was developed and studied. This report will discuss this new biodegradable system containing chlorhexidine gluconate as the active agent (PerioChip^®). Parmacokinetics of the system and a review of the multicenter studies in Europe and the United States are discussed. In these randomized clinical trials the chlorhexidine chip has been shown to enhance the effects of scaling and root planing. Chlorhexidine chip in conjunction with scaling and root planing, when compared to scaling and root planing alone, has shown significant improvement in probing pocket depth reduction, probing attachment level and bleeding on probing. This delivery system, in combination with scaling and root planing, has also resulted in significantly more probing depth reductions of 2 mm or more. The system is safe and efficacious. Placement of the chip is usually done in less than 1 min, it requires no retention system, biodegrades, and does not require a follow-up dental appointment.     

Local production of IgA- and IgM-rheumatoid factors in adult periodontal disease

The enzyme-linked immunospot assay was used to enumerate both the number and the frequency of spontaneous IgG, IgA, and IgM immunoglobulin-secreting cells and IgA- and IgM-rheumatoid factor (RF)-producing cells present in the gingivae and peripheral blood of adult periodontitis patients. Cells from 29 patients were incubated on plates coated with human IgG, Fc, or F(ab)₂ fragments and on plates coated with class-specific antihuman antibodies and secreted antibodies were subsequently visualized by means of an immunoenzymatic procedure. The data indicate that (1) IgA-RF- and IgM-RF-secreting cells are frequently present in the gingiva of adult periodontitis patients; (2) production of RF in gingivae of adult periodontitis patients occurs in the absence of demonstrable RF production by simultaneously obtained peripheral blood mononuclear cells, suggesting that local autoimmune reactions may occur in this disease; and (3) lack of correlation between IgA-RF and IgM-RF production in diseased gingiva suggests that the two RF isotypes are regulated independently of each other.     

巢式PCR检测龈下菌斑中HCMV、EBV、HSV-1与慢性牙周炎活动性的关系

目的　建立临床检测龈下菌斑标本中人巨细胞病毒 (HCMV)、Epstein Barr病毒 (EBV)、单纯疱疹病毒 1型 (HSV 1 )巢式PCR方法 ,研究这 3种病毒与慢性牙周炎活动性的关系。方法　收集6 2例慢性牙周炎患者 (男性 2 7例、女性 35例 ,平均年龄 5 3岁 )的牙周炎活动部位、牙周炎静止部位的龈下菌斑 ,提取DNA后使用巢式PCR检测HCMV、EBV、HSV 1 ,比较分析其在同一病人不同部位的检出率。结果　牙周炎活动部位的HCMV检出率为 38.7%,EBV的检出率为 5 8%,HSV 1的检出率为30 .6 %,两种以上病毒合并感染的检出率为 4 0 .3%;牙周炎静止部位的HCMV检出率为 1 4 .5 %,EBV为 2 2 .6 %,HSV 1为 1 1 .3%,两种以上病毒合并感染的检出率为 1 1 .3%。这 3种病毒及其合并感染在牙周炎活动部位的检出率均高于牙周炎静止部位 ,差异有统计学意义 (P <0 .0 5 )。结论　提示HC MV、EBV、HSV 1与慢性牙周炎的活动性相关。     

PCR检测龈下菌斑中齿垢密螺旋体与牙周组织破坏的关系

目的　建立龈下菌斑标本中齿垢密螺旋体PCR临床快速检测方法 ,了解齿垢密螺旋体感染与慢性牙周炎牙周组织破坏程度之间的关系。方法　 81例慢性牙周炎患者每例采取 2个不同患牙牙位的龈下菌斑标本 ,用终浓度为 1%的TritonX 10 0 10 0℃水浴 10min处理标本以制备DNA模板 ,用PCR检测标本中齿垢密螺旋体特有的相对分子质量 (Mr)为 5 3× 10 3 外膜蛋白基因 (tdpA)扩增片段。结果　 6 7例患者 ( 82 .7% )的 2份龈下菌斑标本齿垢密螺旋体tdpAPCR均为阳性 ,9例患者( 11.1% )的其中 1份龈下菌斑标本可见目的扩增片段 ,5例患者 ( 6 .2 % )的 2份龈下菌斑标本PCR均为阴性 ,16 2例龈下菌斑PCR检测总阳性率为 88.3% ( 143 16 2 )。牙槽骨吸收 >2 3和牙周袋深度≥7mm患牙龈下标本的PCR阳性率较高 (P <0 .0 5 ) ,牙龈指数与PCR阳性率无明显关系 (P >0 .0 5 )。结论　PCR检测tdpA基因可用于慢性牙周炎龈下标本中齿垢密螺旋体的临床快速诊断 ,齿垢密螺旋体感染与牙周组织破坏密切相关。