Takata T, Donath K
Department of Oral Pathology, University of Hamburg, Germany.
J Periodontol. 1988 Apr;59(4):215-21. doi: 10.1902/jop.1988.59.4.215.
Two hundred eighteen human teeth with surrounding periodontal tissues in different stages of pathogenesis were studied under light microscopy using the "sawing and grinding" technique. This was done without decalcification and with special emphasis on the dentogingival junction area so as to study the mechanism of pocket formation. Thirty early, 133 established, and 214 advanced lesions were included. No initial lesion was seen. Pocket formation, provoked by microbacterial plaque, seemed to be initiated by the degenerative changes in the second or third cell layers from the innermost cells in the most coronal part of the junctional epithelium facing the microbial plaque. Consequently, an intraepithelial cleavage was formed followed by the degeneration and desquamation of the cells lining the split. This resulted in a deep crevice and gingival pocket formation in both early and established lesions. In advanced lesions, the deep pocket epithelium was exposed for such a long distance adjacent to the plaque and calculus, that the epithelium could be directly affected by toxic bacterial products and mechanical irritation of calculus. Finally, the epithelium became very thin and ulcerated, and a typical periodontal pocket was formed. The disruption of the epithelial barrier along with the concomitant penetration of bacteria and/or their toxic products were considered to be the most significant factors related to the conversion of an established lesion to an aggressive lesion.
采用“锯磨”技术，在光学显微镜下对218颗带有不同发病阶段牙周组织的人牙进行了研究。研究过程中未进行脱钙处理，特别着重于龈牙结合部区域，以研究牙周袋形成的机制。研究纳入了30例早期病变、133例确立期病变和214例晚期病变。未观察到初期病变。由微生物菌斑引发的牙周袋形成，似乎始于结合上皮最冠方最内层细胞的第二或第三细胞层的退行性改变，该细胞层面向微生物菌斑。随后，上皮内形成裂隙，接着裂隙内衬细胞发生变性和脱落。这在早期和确立期病变中均导致了深的龈沟和牙周袋形成。在晚期病变中，深牙周袋上皮在紧邻菌斑和牙石处暴露了很长一段距离，以至于上皮可直接受到有毒细菌产物和牙石机械刺激的影响。最终，上皮变得非常薄且发生溃疡，形成典型的牙周袋。上皮屏障的破坏以及随之而来的细菌和/或其有毒产物的侵入被认为是与确立期病变转变为侵袭性病变相关的最重要因素。
