侵袭性牙周炎在非手术治疗后不同治疗反应位点的临床和可疑致病微生物特性

Clinical and putative periodontal pathogens' features of different sites with probing depth reduction after non-surgical periodontal treatment of patients with aggressive periodontitis

目的:探讨侵袭性牙周炎(aggressive periodontitis,Ag P)患者接受牙周基础治疗后袋深减少不同位点的临床和龈下可疑致病微生物的特征,以期为临床治疗及预后判断提供指导。方法:20例Ag P患者拍全口根尖片,完成牙周基础治疗并定期复查,每位患者每象限取同1个位点采集治疗前和治疗后6个月的龈沟液,同时记录菌斑指数、出血指数、牙周袋探诊深度和附着水平,检测龈沟液中6种牙周可疑致病微生物和6种微生物代谢产物有机酸浓度,分析治疗前后不同袋深减少位点间的临床指标、牙周可疑致病微生物检出率及代谢产物有机酸浓度的特征。结果:袋深减少>2 mm的位点在治疗前的探诊深度、附着丧失和出血指数,琥珀酸、乙酸、丙酸和丁酸浓度,齿垢密螺旋体的检出率均高于袋深减少≤2 mm的位点,差异有统计学意义(P<0.05),但是治疗后两组临床指标、有机酸浓度和牙周可疑致病微生物检出率间差异无统计学意义(P<0.05);治疗后探诊深度≥6 mm的位点仍有红色复合体微生物的感染,多数伴有角型骨吸收。结论:侵袭性牙周炎患者治疗后袋深减少与治疗前的临床指标有关,基础治疗后深袋位点仍有红色复合体微生物的感染,需要积极的进行感染控制。

Objective： To evaluate the differences of clinical parameters and putative periodontal pathogens in sites of different probing depth（ PD） reduction after non-surgical periodontal treatment in patients with aggressive periodontitis（ Ag P）. Methods： Clinical examinations including plaque index,probing depth（ PD）,attachment level（ AL） and bleeding index（ BI）,and full-mouth periapical photographs were collected from 20 patients with Ag P. All the patients received non-surgical periodontal treatment,including oral hygiene instruction,supra-gingival scaling,subgingival scaling and root planing（ SRP）and were followed up for 6 months post-therapy. Gingival crevicular fluids（ GCF） were collected at 1 site in each quadrant before and at the end of 6 months post-therapy. Six kinds of putative periodontal pathogens and 6 kinds of short chain fatty acids（ SCFAs） were detected in the GCF samples. Results： The baseline clinical parameters of PD,AL and BI,the baseline concentration of succinic acid,acetic acid,propionic acid and butyric acid,and the prevalence of Treponema denticola were significantly higher in sites with PD reduction more than 2 mm sites compared with PD reduction no more than 2 mm sites[（ 7. 7 ± 1. 2） mm vs.（ 5. 1 ± 1. 8） mm,（ 6. 3 ± 1. 9） mm vs.（ 4. 5 ± 2. 2） mm,3. 8 ± 0. 4 vs. 3. 3 ±0. 8,1. 66 mmol / L vs. 1. 10 mmol / L,31. 67 mmol / L vs. 17. 78 mmol / L,3. 31 mmol / L vs. 1. 95 mmol /L,84. 6% vs. 56. 1%,P 0. 05]. However,there were no significant differences in the clinical parameters,the 6 kinds of putative periodontal pathogen detection and SCFAs concentration between the 2groups at the end of 6 months post-treatment. In sites with PD 〉5 mm at the end of 6 months post-therapy,all were found with red complex bacteria infection. Conclusion： The baseline clinical parameters are important factors in predicting PD reduction after non-surgical periodontal treatment in patients with Ag P.In sites with deep pockets after non-surgical periodontal treatment,the active control of red complex bacteria is recommended.