De Vree H, Steenackers K, De Boever J A
Department of Periodontology, Dental School, University of Gent, Belgium.
J Clin Periodontol. 2000 May;27(5):354-60. doi: 10.1034/j.1600-051x.2000.027005354.x.
This paper reports the treatment of the periodontal component of the Papillon-Lefèvre syndrome in 2 siblings (case A, born 1974; case B, born 1976).
The initial treatment, in 1982, consisted of extraction of all primary teeth, scaling and rootplaning of the erupted permanent teeth and systemic antibiotic therapy. During 15 years, continuous and intensive periodontal treatment consisted of chlorhexidine 0.2% rinses, bi-weekly professional prophylaxis, scaling and rootplaning or surgery if indicated. Systemic antibiotics often accompanied mechanical therapy after bacteriological analysis.
In case A, a favourable number of permanent teeth could be maintained, but in case B, all permanent teeth were lost in spite of the intensive treatment. Darkfield microscopy at different intervals revealed high numbers of spirochetes and motile rods in both siblings. Only in case A were they temporarily reduced to zero after scaling and rootplaning combined with metronidazole. Anaerobic cultering revealed high numbers of Actinobacillus actinomycetemcomitans (A.a) in both patients. In 1994, 2 years after combined amoxicillin/metronidazole therapy, no A.a could be detected in case A. In case B, A.a could still be detected and was found to be resistant to metronidazole. One year after extraction of all permanent teeth, could no A.a be detected in case B.
Intensive periodontal treatment combined with antibiotic therapy was not able to prevent complete tooth loss in case B. In case A, the treatment was more effective, resulting in preserving a number of permanent teeth in a stable clinical situation. In these 2 cases, no attempt was made to create an edentulous period between the periodontally-diseased mixed dentition and the eruption of the remaining teeth, which may have contributed to treatment failure.
本文报告了对2名患有帕皮永-勒费弗尔综合征（Papillon-Lefèvre syndrome）的同胞（病例A，出生于1974年；病例B，出生于1976年）的牙周病部分的治疗情况。
1982年的初始治疗包括拔除所有乳牙、对已萌出的恒牙进行龈上洁治和根面平整以及全身抗生素治疗。在15年期间，持续且强化的牙周治疗包括用0.2%洗必泰漱口、每两周进行一次专业口腔预防、龈上洁治和根面平整，必要时进行手术。细菌学分析后，全身抗生素治疗常与机械治疗同时进行。
在病例A中，可以保留数量可观的恒牙，但在病例B中，尽管进行了强化治疗，所有恒牙还是都掉光了。在不同时间间隔进行的暗视野显微镜检查显示，两名同胞的样本中都有大量螺旋体和活动杆菌。只有在病例A中，在龈上洁治和根面平整联合甲硝唑治疗后，这些细菌数量暂时降至零。厌氧培养显示，两名患者样本中都有大量伴放线放线杆菌（A.a）。1994年，即联合阿莫西林/甲硝唑治疗两年后，在病例A中未检测到A.a。在病例B中，仍能检测到A.a，且发现其对甲硝唑耐药。在拔除所有恒牙一年后，病例B中未检测到A.a。
强化牙周治疗联合抗生素治疗未能防止病例B中的牙齿完全脱落。在病例A中，治疗更有效，使得一些恒牙得以保留，临床状况稳定。在这两个病例中，未尝试在患牙周病的混合牙列与剩余牙齿萌出之间形成无牙期，这可能是导致治疗失败的原因之一。
