Ximénez-Fyvie L A, Haffajee A D, Som S, Thompson M, Torresyap G, Socransky S S
Department of Periodontology, The Forsyth Institute, Boston, MA 02115, USA.
J Clin Periodontol. 2000 Sep;27(9):637-47. doi: 10.1034/j.1600-051x.2000.027009637.x.
BACKGROUND, AIMS: The purpose of the present investigation was to determine the effect of weekly professionally administered supragingival plaque removal on the composition of the supra and subgingival microbiota.
18 adult subjects with periodontitis who had been treated and were in a maintenance phase of therapy were clinically and microbiologically monitored at baseline, 3, 6 and 12 months. After the baseline visit, the subjects received scaling and root planing followed by professional supragingival plaque removal every week for 3 months. Clinical measures of plaque accumulation, bleeding on probing (BOP), gingival redness, suppuration, pocket depth and attachment level were made at 6 sites per tooth at each visit. Separate supra (N = 1804) and subgingival (N = 1804) plaque samples were taken from the mesial aspect of all teeth excluding third molars in each subject at each time point and evaluated for their content of 40 bacterial taxa using checkerboard DNA-DNA hybridization. Significance of changes in mean counts, prevalence and proportions of bacterial species over time in both supra and subgingival samples were determined using the Quade test and adjusted for multiple comparisons.
Mean % of sites exhibiting plaque, gingival redness and BOP were significantly reduced during the course of the study. Significant decreases in mean counts were observed in both supra and subgingival samples. Mean total DNA probe counts (x10(5), +/-SEM) at baseline, 3, 6 and 12 months were: 133+/-19, 95+/-25, 66+/-6, 41+/-6 (p<0.001) for supragingival samples and 105+/-22, 40+/-10, 19+/-4, 13+/-3 (p<0.001) for subgingival samples. Mean counts of 22 of 40 and 34 of 40 species tested were significantly reduced in the supra and subgingival samples respectively over the monitoring period. For example, mean counts of Porphyromonas gingivalis x10(5) at baseline, 3, 6 and 12 months in the subgingival plaque samples were 2.0+/-0.4, 0.5+/-0.2, 0.6+/-0.3, 0.3+/-0.1 (p<0.001); Bacteroides forsythus 2.0+/-0.6, 0.4+/-0.1, 0.4+/-0.2, 0.1+/-0.2 (p<0.001); Treponema denticola 3.4+/-1.1, 0.8+/-0.3, 0.4+/-0.2, 0.3+/-0.3 (p<0.01). Similar reductions were seen in supragingival plaque samples. While counts were markedly reduced by professional plaque removal, the proportion and prevalence of the 40 test species were marginally affected.
Weekly professional supragingival plaque removal profoundly diminished counts of both supra- and subgingival species creating a microbial profile comparable to that observed in periodontal health. This profile was maintained at the final monitoring visit, 9 months after completion of therapy.
本研究旨在确定每周由专业人员进行龈上菌斑清除对龈上和龈下微生物群组成的影响。
对18名已接受治疗并处于治疗维持期的成年牙周炎患者在基线、3个月、6个月和12个月时进行临床和微生物学监测。在基线检查后，患者接受龈上洁治和根面平整，随后每周进行专业的龈上菌斑清除，持续3个月。每次就诊时，在每颗牙齿的6个位点进行菌斑积聚、探诊出血（BOP）、牙龈发红、化脓、牙周袋深度和附着水平的临床测量。在每个时间点，从每个受试者所有牙齿（不包括第三磨牙）的近中面分别采集龈上（N = 1804）和龈下（N = 1804）菌斑样本，使用棋盘式DNA-DNA杂交法评估其中40种细菌类群的含量。使用Quade检验确定龈上和龈下样本中细菌种类的平均计数、流行率和比例随时间变化的显著性，并对多重比较进行校正。
在研究过程中，出现菌斑、牙龈发红和BOP的位点平均百分比显著降低。龈上和龈下样本中的平均计数均显著下降。龈上样本在基线、3个月、6个月和12个月时的平均总DNA探针计数（×10(5)，±SEM）分别为：133±19、95±25、66±6、41±6（p<0.001）；龈下样本分别为105±22、40±10、19±4、13±3（p<0.001）。在监测期内，所检测的40种细菌中的22种和34种在龈上和龈下样本中的平均计数分别显著降低。例如，龈下菌斑样本中牙龈卟啉单胞菌×10(5)在基线、3个月、6个月和12个月时的平均计数分别为2.0±0.4、0.5±0.2、0.6±0.3、0.3±0.1（p<0.001）；福赛坦氏菌分别为2.0±0.6、0.4±0.1、0.4±0.2、0.1±0.2（p<0.001）；具核梭杆菌分别为3.4±1.1、0.8±0.3、0.4±0.2、0.3±0.3（p<0.01）。龈上菌斑样本中也观察到类似的减少。虽然通过专业的菌斑清除计数显著降低，但40种检测菌种的比例和流行率受到的影响较小。
每周进行专业的龈上菌斑清除可显著减少龈上和龈下菌种的计数，形成与牙周健康状态下观察到的微生物谱相似的情况。这种微生物谱在治疗完成9个月后的最后一次监测就诊时得以维持。
