Petersilka Gregor J, Ehmke Benjamin, Flemmig Thomas F
Clinic of Periodontology, University of Münster, Germany.
Periodontol 2000. 2002;28:56-71. doi: 10.1034/j.1600-0757.2002.280103.x.
Self-performed plaque removal using manual or powered toothbrushes and interdental cleaning devices is improved in subjects that have received oral hygiene instructions. Personal oral hygiene coupled with regular professional supragingival debridement may further improve the level of plaque control but still fails to achieve a completely plaque-free dentition. Both patient-performed and professional supragingival plaque removal has an effect on subgingival microbiota that is limited to the marginal 3 mm of the periodontal pocket. At sites with 4 mm or more of probing depth, only subgingival scaling leads to a significant reduction of the bacterial load. The subgingival microflora can be further reduced by pocket elimination surgery. Due to the sequence of bacterial recolonization that occurs following mechanical debridement, the level of periodontal pathogens such as B. forsythus, P. gingivalis and T. denticola may be reduced for several months. Mechanical debridement also influences the patient's immune system response, resulting in antibody titers and avidity against periodontal pathogens. As a basis for the restoration and maintenance of periodontal health, repeated subgingival debridement, as performed in supportive periodontal therapy, can reduce the number and proportions of periodontopathogenic bacteria in subgingival plaque. However, intensive subgingival scaling and root planing should be avoided in sites that probe less than 3 mm, as this is likely to traumatize the periodontium and cause attachment loss.
接受过口腔卫生指导的受试者，使用手动或电动牙刷以及牙间隙清洁工具进行自我牙菌斑清除的效果有所改善。个人口腔卫生加上定期的专业龈上洁治可能会进一步提高牙菌斑控制水平，但仍无法实现完全无牙菌斑的牙列状态。患者自行进行的龈上牙菌斑清除和专业的龈上牙菌斑清除都会对龈下微生物群产生影响，这种影响仅限于牙周袋边缘3毫米处。在探诊深度为4毫米或更深的部位，只有龈下刮治能显著降低细菌载量。通过牙周袋消除手术可进一步减少龈下微生物群。由于机械清创后会发生细菌再定植的过程，诸如福赛坦氏菌、牙龈卟啉单胞菌和齿垢密螺旋体等牙周病原体的水平可能会在数月内降低。机械清创还会影响患者的免疫系统反应，导致针对牙周病原体的抗体滴度和亲和力发生变化。作为恢复和维持牙周健康的基础，在支持性牙周治疗中进行的反复龈下清创，可以减少龈下菌斑中牙周致病细菌的数量和比例。然而，在探诊深度小于3毫米的部位应避免进行深度龈下刮治和根面平整，因为这很可能会损伤牙周组织并导致附着丧失。
