牙周炎患者种植修复后可疑致病菌的变化研究

Suspicious pathogenic bacteria changes of periodontitis patients after implant restoration

目的比较牙周炎种植患者和牙周健康种植患者修复后不同时段几种常见致病菌的变化情况,为牙周炎种植治疗的开展及维护提供微生物学帮助。方法临床选取44名种植患者的55枚种植体,并将其分成A、B两组,A组是有牙周炎病史的患者种植体26枚,为实验组。B组是牙周健康的患者种植体29枚,为对照组。记录了修复后1个月,6个月,12个月四个时段,入选种植牙的菌斑指数,牙龈指数,牙龈出血指数,探诊深度;采用牙龈卟啉单胞菌、中间普氏菌、具核梭杆菌及粘性放线菌的选择性培养基对龈下菌斑标本进行了分离培养、计数,统计分析各项临床和实验室数据。结果横向比较:A、B两组之间牙龈卟啉单胞菌、中间普氏菌、具核梭杆菌、牙龈指数、牙龈出血指数、探诊深度有统计学差异,其余各检测指标无统计学意义。修复后1月时,A、B两组之间牙龈卟啉单胞菌、中间普氏菌计数值已有统计学差异。纵向比较:有牙周炎病史的患者种植体周各指数三个时段纵向比较,牙龈卟啉单胞菌,中间普氏菌,具核梭杆菌,粘性放线菌随时间变化有统计学差异,其余指标随时间变化无统计学差异。结论有牙周炎病史的患者种植体周的微生物指标在种植早期即高于正常种植患者,应指导该类患者及早进行种植牙及天然牙的清洁和维护,预防种植体周围炎的发生,提高牙周炎种植的成功率。

Objective To study the main pathogenic bacterias of the implants in patients with or without a history of periodontitis, provide periodontally compromised implant patients microbiology help. Methods Collect 55 implants in 44 patients and divide them into two groups： group A-the experimental group, 26 implants of patients with a history of periodontitis; group B-the control group, 29 implants in healthy patients. Evaluate, in the four stages of one month, 6 months and 12 months after restoration, their Plaque Index（PLI）, Gingival Index（GI）, Gingival Bleeding Index（GBI）, and Probing Depth（PD）. Subgingival plaque samples were taken and culture methods were used for detection of porphyromonas gingivalis, prevotella intermedia, F.nucleatum, Actinomyces viscosus. Results The parallel comparison of group A and group B shows that： the value of porphyromonas gingivalis, prevotella intermedia, F.nucleatum, GI, GBI, PD in group A is statistically different from group B. Other tested indexes show no statistic difference. One month after restoration, the value of porphyromonas gingivalis, prevotella intermedia in group A is significantly different from group B.In the longitudinal comparison of the two groups,：the value of porphyromonas gingivalis, prevotella intermedia, F.n,A.v in group A and group B shows significant changes as time extended and other tested indexes show no statistic difference.Conclusion The microbiological indexes of patients with a history of periodontitis are higher than normal patients, even in the early stage of implant, and hence should be guided to do cleaning and maintenance in oral cavity as early as possible, so as to prevent peri-implantitis and increase success rate in implants of this kind.