Kovács Viola, Tihanyi Dóra, Gera István
Parodontológiai Klinika, Budapest.
Fogorv Sz. 2007 Dec;100(6):295-300.
One of the leading local risk factors for chronic periodontitis is the presence of plaque retentive factors in the oral cavity. The main objective of the study was to assess how the local irritation and plaque retention caused by untreated carious lesions, subgingival and approximal overhanging crown margins can affect the attachment loss at patients with chronic periodontitis. The incidence of plaque retentive factors were evaluated on 200 panoramic radiographs randomly selected from the archive of the Department of Periodontology. On the radiographs each fully erupted tooth were studied under magnifying glasses (1:2 magnification), and the distance between CEJ and the most coronal bone level was measured with a ruler with mm scales. The quality of restorations were evaluated based on the approximal adaptation of their margins. During the clinical examination the presence of local plaque retentive factors were registered by tooth, and the radiological alveolar bone level were recorded around both the healthy and restored or filled teeth. Statistical analyzes were made with linear regression analysis and ANOVA. Only 177 out of the randomly selected 200 radiographs met the incursion criteria and could be evaluated. The average age of patients was 49.98 years and the average approximal bone loss was 5.439 mm, showing increasing tendency with age. The 177 patients had a total of 3618 teeth and 1407 teeth presented plaque retentive factors including 164 untreated approximal carious lesions, and 1243 faulty restorations with approximal overhangs or open margins. Radiographically 82.5% of the restorations had incorrect approximal marginal adaptation. The majority of the untreated carious lesions occurred in the molar as well as in the front regions. The average bone loss at the teeth with faulty restorations were higher than at the sound teeth. 113 patients had an average bone loss higher than >4 mm. In those patients the differences between sound and restored teeth were smaller than those in the groups of patients with mild bone loss. Nevertheless neither group showed statistically significant differences between restored and sound teeth. In mild to moderate periodontitis local plaque retentive factors, overhanging crown margins or carious lesions are decisive aggregating factors both in gingivitis and periodontitis, especially in the susceptible population. In severe periodontitis according to our data there were only minimal differences between the attachment level around sound teeth and teeth with faulty restorations and local plaque retentive factors.
慢性牙周炎的主要局部危险因素之一是口腔中存在菌斑滞留因素。本研究的主要目的是评估未经治疗的龋损、龈下和邻面悬突冠边缘所引起的局部刺激和菌斑滞留如何影响慢性牙周炎患者的附着丧失。从牙周病科存档中随机选取200张全景X线片，评估菌斑滞留因素的发生率。在X线片上，在放大镜（1:2放大倍数）下研究每颗完全萌出的牙齿，并用带毫米刻度的尺子测量牙骨质界（CEJ）与最冠方骨水平之间的距离。根据修复体边缘的邻面贴合情况评估修复体的质量。在临床检查中，按牙齿记录局部菌斑滞留因素的存在情况，并记录健康牙齿以及修复或充填牙齿周围的放射学牙槽骨水平。采用线性回归分析和方差分析进行统计分析。随机选取的200张X线片中只有177张符合纳入标准并可进行评估。患者的平均年龄为49.98岁，平均邻面骨丧失为5.439毫米，且随年龄增长呈上升趋势。这177名患者共有3618颗牙齿，其中1407颗牙齿存在菌斑滞留因素，包括164处未经治疗的邻面龋损以及1243处有邻面悬突或开放边缘的不良修复体。在X线片上，82.5%的修复体邻面边缘贴合不正确。大多数未经治疗的龋损发生在磨牙以及前部区域。有不良修复体的牙齿的平均骨丧失高于健康牙齿。113名患者的平均骨丧失高于4毫米。在这些患者中，健康牙齿与修复牙齿之间的差异小于轻度骨丧失患者组。然而，两组中修复牙齿与健康牙齿之间均未显示出统计学上的显著差异。在轻至中度牙周炎中，局部菌斑滞留因素、悬突冠边缘或龋损在牙龈炎和牙周炎中都是决定性的聚集因素，尤其是在易感人群中。根据我们的数据，在重度牙周炎中，健康牙齿与有不良修复体及局部菌斑滞留因素的牙齿周围的附着水平之间只有极小的差异。
