Armitage Gary C, Robertson Paul B
Division of Periodontology, Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, 521 Parnassus Ave., C-628, Box 0650, San Francisco, California 94143-0650, USA.
J Am Dent Assoc. 2009 Sep;140 Suppl 1:36S-43S. doi: 10.14219/jada.archive.2009.0356.
Major scientific advances in periodontology in the past 150 years have fundamentally changed how clinicians detect and treat periodontal diseases. These advances include the demonstration that gingivitis and periodontitis are biofilm-induced infections caused by components of the indigenous oral microbiota, and that host inflammatory-immunologic responses to these microbial challenges are responsible for most of the observed tissue damage.
In this brief overview, the authors focus on the discovery of the relationships between dental plaque and the host periodontal tissues. They highlight some of the pioneers in the United States who shaped new approaches to prevention and treatment of periodontal disease.
Biofilms that cause gingivitis and periodontitis are complex polymicrobial communities that are resistant to antimicrobial agents and host defense mechanisms. An increased understanding of natural inflammation-resolving mechanisms suggests that control of inflammation is at least as important as is antimicrobial therapy in the treatment of periodontal infections. Data from randomized controlled clinical trials have shown that most conventional forms of periodontal therapy are effective as long as patients comply with posttreatment maintenance programs.
Many mechanisms involved in the repair and regeneration of periodontal tissues have been identified. Results of laboratory studies of factors that enhance prevention and treatment of periodontal disease have made the transition to clinical practice. Advances in the fields of molecular biology, human genetics and stem cell biology have set the stage for significant discoveries that will pave the way for the development of procedures needed for the predictable regeneration of periodontal tissues. As a result, new generations of people in the United States can expect to retain a healthy and functional dentition for a lifetime.
在过去的150年里，牙周病学的重大科学进展从根本上改变了临床医生检测和治疗牙周疾病的方式。这些进展包括证实牙龈炎和牙周炎是由口腔固有微生物群的成分引起的生物膜诱导感染，以及宿主对这些微生物挑战的炎症免疫反应是观察到的大部分组织损伤的原因。
在本简要概述中，作者重点关注牙菌斑与宿主牙周组织之间关系的发现。他们强调了美国一些塑造牙周病预防和治疗新方法的先驱者。
导致牙龈炎和牙周炎的生物膜是复杂的多微生物群落，对抗菌剂和宿主防御机制具有抗性。对自然炎症消退机制的进一步了解表明，在牙周感染的治疗中，控制炎症至少与抗菌治疗同样重要。随机对照临床试验的数据表明，只要患者遵守治疗后的维护计划，大多数传统形式的牙周治疗都是有效的。
已经确定了许多参与牙周组织修复和再生的机制。增强牙周病预防和治疗的因素的实验室研究结果已转化为临床实践。分子生物学、人类遗传学和干细胞生物学领域的进展为重大发现奠定了基础，这些发现将为可预测的牙周组织再生所需程序的开发铺平道路。因此，美国的新一代有望终身保持健康且功能正常的牙列。
