Department of Conservative Dentistry and Periodontology, University Hospital, LMU Goethestr. 70, 80336, Munich, Germany.
Private practice, Munich, Germany.
Clin Oral Investig. 2024 Sep 13;28(10):523. doi: 10.1007/s00784-024-05904-y.
This study aims to analyse the association between the baseline microbial load of selected periodontopathogenic bacteria collected from gingival crevicular fluid (GCF) and the primary outcome of steps I and II therapy.
222 patients with stage III periodontitis were included into this retrospective analysis that received steps 1 and 2 periodontal therapy without adjunctive systemic antibiotics. Baseline GCF samples were quantitatively analysed using ELISA-based kits for levels of periodontopathogens (Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Treponema denticola (Td), and Tannerella forsythia (Tf)) and associated with the primary therapy outcome using a "treat-to-target" therapy endpoint (TE) defined as ≤ 4 sites with PD ≥ 5 mm six months after therapy.
38.2% of the patients achieved TE. Patients failing to achieve TE revealed significantly increased levels of Pg, Fn, and Tf at baseline (Pg: p = 0.010, Fn: p = 0.008 Tf: p = 0.004). Multivariate binary logistic regression adjusted for sex, mean probing depth, diabetes, and current smoking status showed an independent relationship between Tf and the TE (aOR 2.570, p = 0.023).
Increased microbial load is associated with decreased responsiveness to therapy. The findings suggest that specifically baseline Tf levels are associated with poorer treatment outcomes and might improve the accuracy of periodontal diagnosis.
The findings of this study support the concept of a critical biomass that is sufficient to induce and maintain an immune response within the periodontal pocket, which ultimately leads to irreversible tissue destruction. However, calculating this level in advance may serve as an early indicator for intervention.
Baseline Tannerella forsythia levels are associated with poorer treatment outcome.
本研究旨在分析从龈沟液（GCF）中采集的选定牙周致病菌的基线微生物负荷与 I 期和 II 期治疗的主要结局之间的关系。
本回顾性分析纳入了 222 名患有 III 期牙周炎的患者，他们接受了 I 期和 II 期牙周治疗，没有辅助全身抗生素治疗。使用基于 ELISA 的试剂盒对基线 GCF 样本进行定量分析，以确定牙周病病原体（牙龈卟啉单胞菌（Pg）、伴放线放线杆菌（Aa）、中间普氏菌（Pi）、核梭杆菌（Fn）、牙髓密螺旋体（Td）和福赛坦纳氏菌（Tf））的水平，并使用“以目标为导向的治疗”（TE）治疗终点（定义为治疗后 6 个月 PD≥5mm 的位点≤4 个）将其与主要治疗结果相关联。
38.2%的患者达到了 TE。未能达到 TE 的患者在基线时 Pg、Fn 和 Tf 的水平显著升高（Pg：p=0.010，Fn：p=0.008，Tf：p=0.004）。经过性别、平均探诊深度、糖尿病和当前吸烟状况调整的多变量二元逻辑回归显示 Tf 与 TE 之间存在独立关系（优势比 2.570，p=0.023）。
微生物负荷的增加与治疗反应性降低有关。研究结果表明，基线 Tf 水平与较差的治疗效果相关，可能提高牙周病诊断的准确性。
本研究的结果支持这样一种概念，即临界生物量足以在牙周袋内引发和维持免疫反应，最终导致不可逆转的组织破坏。然而，提前计算这个水平可能作为早期干预的指标。
基线福赛坦纳氏菌水平与治疗效果较差相关。
