Worch K P, Listgarten M A, Korostoff J M
Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, USA.
J Periodontol. 2001 Jan;72(1):96-106. doi: 10.1902/jop.2001.72.1.96.
The diagnosis and treatment of early-onset forms of periodontitis (EOP) represent a major challenge to periodontists. In this case report, we describe a multidisciplinary approach for the treatment of a patient with severe generalized juvenile periodontitis (GJP). Our approach incorporates clinical laboratory evaluation with conventional concepts of periodontal pathogenesis and therapeutics to diagnose and effectively treat EOP.
The 17-year-old female patient presented with clinical and radiographic evidence of severe attachment loss. Microbiological testing showed the presence of known periodontal pathogens including Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Routine immunological tests did not reveal any of the functional defects thought to play a role in the pathogenesis of EOP After initiation of therapy, which consisted of scaling and root planing, supplemented with administration of systemic antibiotics, a reduction in probing depth and gain in clinical attachment could be demonstrated. Microbiological testing was used to monitor the composition of the periodontal microbiota and to adjust antimicrobial therapy accordingly.
Using a non-surgical approach to treatment, except for 2 root amputations performed without flap reflection, we have been able to stabilize this patient's periodontal condition over the course of a 2-year follow-up period.
This treatment strategy provides an efficacious alternative to more aggressive forms of therapy and should therefore be considered for the treatment of patients with severe EOP.
早发性牙周炎（EOP）的诊断和治疗对牙周病医生来说是一项重大挑战。在本病例报告中，我们描述了一种多学科方法来治疗一名患有严重广泛性青少年牙周炎（GJP）的患者。我们的方法将临床实验室评估与牙周病发病机制和治疗的传统概念相结合，以诊断和有效治疗EOP。
这名17岁女性患者有严重附着丧失的临床和影像学证据。微生物检测显示存在包括伴放线放线杆菌、中间普氏菌和牙龈卟啉单胞菌在内的已知牙周病原体。常规免疫学检测未发现任何被认为在EOP发病机制中起作用的功能缺陷。在开始治疗（包括龈上洁治和根面平整，并辅以全身抗生素给药）后，可以证明探诊深度有所降低，临床附着有所增加。微生物检测用于监测牙周微生物群的组成，并据此调整抗菌治疗。
采用非手术治疗方法，除了在不翻瓣的情况下进行了2次牙根切除术外，我们在2年的随访期间成功稳定了该患者的牙周状况。
这种治疗策略为更激进的治疗形式提供了一种有效的替代方案，因此应考虑用于治疗重度EOP患者。
