Eick Sigrun, Mathey Ayse, Vollroth Karolin, Kramesberger Martin, Bürgin Walter, Sculean Anton, Ramseier Christoph, Jentsch Holger
Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
Centre for Periodontology, Department of Cariology, Endodontology and Periodontology, University Hospital of Leipzig, Liebigstr. 12, 04103, Leipzig, Germany.
Clin Oral Investig. 2017 Mar;21(2):665-674. doi: 10.1007/s00784-016-1933-x. Epub 2016 Aug 24.
The aim of this study was to evaluate the quality of prediction for stable results after nonsurgical periodontal therapy by several microbiological variables of the subgingival biofilm and biomarkers of gingival crevicular fluid or oral lavage.
Forty-six individuals with moderate or severe chronic periodontitis receiving nonsurgical periodontal therapy were monitored for clinical variables, selected microorganisms, and biomarkers at baseline and 3 and 6 months thereafter. Logistic regression analysis and general linear model (GLM) were applied for analysis of variance and covariance.
At 6 months, 20 patients showed a high response (HR) to treatment (at least 60 % of reduction of numbers of sites with PD >4 mm), whereas 26 did not (low response, LR). All clinical variables were significantly improved at 3 and 6 months within each group (p < 0.001, each compared with baseline). Modeling the impact of Porphyromonas gingivalis, Treponema denticola, and median of MMP-8 on to the response to treatment as continuous variables by GLM showed a significant influence of these variables (p = 0.045) with the strongest influence of P. gingivalis (p = 0.012) followed by T. denticola (p = 0.045) and no association with MMP-8 (p = 0.982). Samples tested positively for P. gingivalis decreased only in HR (3 months: p = 0.003; 6 months: p = 0.002). Calprotectin levels in GCF were lower in the HR group compared with the LR group at 3 months (p = 0.008) and at 6 months (p = 0.018).
Persistence of P. gingivalis combined with a high GCF level of calprotectin may have a negative predictive value on response to periodontal therapy.
Microbiological diagnostics for P. gingivalis before and 3 months after SRP may have a predictive value on response to periodontal therapy. The combination with MMP-8 in oral lavage or preferably calprotectin in GCF might give additional information.
本研究旨在通过龈下生物膜的若干微生物学变量以及龈沟液或口腔冲洗液的生物标志物，评估非手术牙周治疗后稳定结果的预测质量。
对46例接受非手术牙周治疗的中度或重度慢性牙周炎患者在基线时以及之后3个月和6个月时监测临床变量、选定的微生物和生物标志物。应用逻辑回归分析和一般线性模型（GLM）进行方差分析和协方差分析。
6个月时，20例患者对治疗有高反应（HR）（牙周袋深度>4 mm的位点数量减少至少60%），而26例患者无高反应（低反应，LR）。每组内3个月和6个月时所有临床变量均有显著改善（p<0.001，每组与基线相比）。通过GLM将牙龈卟啉单胞菌、具核梭杆菌和基质金属蛋白酶-8中位数作为连续变量对治疗反应的影响进行建模，结果显示这些变量有显著影响（p=0.045），其中牙龈卟啉单胞菌影响最强（p=0.012），其次是具核梭杆菌（p=0.045），与基质金属蛋白酶-8无关联（p=0.982）。牙龈卟啉单胞菌检测呈阳性的样本仅在高反应组中减少（3个月：p=0.003；6个月：p=0.002）。高反应组龈沟液中钙卫蛋白水平在3个月时（p=0.008）和6个月时（p=0.018）低于低反应组。
牙龈卟啉单胞菌持续存在并伴有龈沟液中高钙卫蛋白水平可能对牙周治疗反应具有负面预测价值。
在龈上洁治术（SRP）前及术后3个月对牙龈卟啉单胞菌进行微生物学诊断可能对牙周治疗反应具有预测价值。与口腔冲洗液中的基质金属蛋白酶-8或更理想的龈沟液中的钙卫蛋白联合检测可能会提供更多信息。
