Hasturk Hatice, Kantarci Alpdogan, Van Dyke Thomas E
Department of Periodontology, The Forsyth Institute, Cambridge, MA, USA.
Front Oral Biol. 2012;15:160-76. doi: 10.1159/000329678. Epub 2011 Nov 11.
It is becoming clear that variations in inflammatory response are a major determinant in susceptibility to periodontitis. However, our understanding of the relationship of the causal agents in periodontitis to the pathogenesis is not as clear as we once thought, and thus therapies based on etiopathogenesis are similarly in question. We are entering a new era of therapeutic discovery that may have a major impact on our management of the periodontal diseases. Fundamentally, periodontitis is an irreversible condition and once both soft and hard tissues are lost, the healthy periodontal architecture cannot be completely or predictably rebuilt. The discovery of new families of lipid mediators of resolution of inflammation (the lipoxins) and eicosapentaenoic-acid- and docosahexaenoic-acid-derived chemical mediators (the resolvins and protectins) opens new avenues to designing resolution-targeted therapies to control the unwanted side effects of excessive inflammation. The novel protective and therapeutic actions of pro-resolution lipid mediators following microbial challenge are mediated by regulation of the local and systemic inflammatory response that has a direct impact on the organization of the biofilm (plaque) and suggests a new paradigm in clinical periodontal therapeutics.
越来越明显的是，炎症反应的差异是易患牙周炎的一个主要决定因素。然而，我们对牙周炎致病因素与发病机制之间关系的理解并不像我们曾经认为的那样清晰，因此基于病因发病机制的治疗方法同样受到质疑。我们正在进入一个治疗发现的新时代，这可能会对我们对牙周疾病的管理产生重大影响。从根本上说，牙周炎是一种不可逆的病症，一旦软硬组织丧失，健康的牙周结构就无法完全或可预测地重建。炎症消退的脂质介质新家族（脂氧素）以及二十碳五烯酸和二十二碳六烯酸衍生的化学介质（消退素和保护素）的发现，为设计以消退为目标的疗法开辟了新途径，以控制过度炎症的不良副作用。微生物攻击后促消退脂质介质的新型保护和治疗作用是通过调节局部和全身炎症反应介导的，这对生物膜（菌斑）的组织有直接影响，并提示了临床牙周治疗的新范式。
