Blakey G H, White R P, Offenbacher S, Phillips C, Delano E O, Maynor G
School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA.
J Oral Maxillofac Surg. 1996 Oct;54(10):1150-60. doi: 10.1016/s0278-2391(96)90339-0.
This prospective clinical study was designed to determine the clinical and biologic outcomes of treatment for minor signs and symptoms of pericoronitis.
Patients (n = 20) with all third molars, presenting consecutively to an academic clinical center for treatment of minor signs and symptoms of pericoronitis, were enrolled in the study. At the initial visit, gingival crevicular fluid (GCF) samples to assess levels of the cytokines interleukin- 1b (IL-1b) IL-1b and prostaglandin E2 (PGE2) as a measure of the host inflammatory response, and plaque samples to identify microorganisms, were collected from the distal of all second molars and the mesial of first molars. Standardized vertical bite wing radiographs were taken to assess alveolar bone height on the distal of the second molars and the inclination and the degree of eruption of the third molar. Full-mouth periodontal probing was conducted to determine probing depths and relative clinical attachment levels (CAL). Pain levels were assessed with Gracely verbal descriptor scales for sensory intensity and unpleasantness and 10-cm visual analog scales. Symptomatic third molar sites were treated with local debridement and irrigation after baseline data collection. One week after entry, data were collected again. Subsequently, the patients were scheduled for removal of all third molars. Data collection was repeated 3 months postsurgery. As controls, data were collected from 12 subjects who had asymptomatic third molars removed previously.
At entry, symptomatic mandibular third molars (n = 21) were mostly vertical (n = 18) and at or above the occlusal plane (n = 19). No maxillary teeth had symptoms. Microbial counts were elevated for specific anaerobic microorganisms. GCF IL-1b levels were elevated at the distal of second molars adjacent to symptomatic third molars, as compared with asymptomatic third molars and second molars in control patients. Alveolar bone levels and CAL on the distal of second molars were normal. At 1 week, patients' pain symptoms and IL-1b levels were reduced, but microbial counts remained high. Three months after surgery, patients had no pain symptoms, and alveolar bone levels and CAL were similar to entry levels. IL-1b levels were elevated at both the distal of second molars and the mesial of first molars for all patients; microbial counts decreased, although not to levels of control patients. No increase in microbial counts for Porphyromonas gingivalis or Bacteroides forsythus, or GCF PGE2 levels, risk factors for progressive periodontal disease, was detected in samples taken from the study patients.
Pericoronitis expressed by minor signs/symptoms in these patients was associated with considerable discomfort. Symptomatic mandibular third molars were vertical and at or near the occlusal plane. Additionally, this condition was characterized by microbial flora and GCF inflammatory mediator levels that are more consistent with gingivitis than periodontitis. Removal of third molars eliminated symptoms, but the microbial burden and an affected patient's inflammatory response, as measured by IL-1b levels, remained elevated as compared with controls. Further study is needed to determine which of these factors can be used to identify patients at risk for pericoronitis before symptoms arise.
本前瞻性临床研究旨在确定智齿冠周炎轻微体征和症状的治疗的临床及生物学结局。
连续到某学术临床中心治疗智齿冠周炎轻微体征和症状的所有第三磨牙患者（n = 20）纳入本研究。初诊时，从所有第二磨牙远中及第一磨牙近中采集龈沟液（GCF）样本以评估细胞因子白细胞介素-1β（IL-1β）和前列腺素E2（PGE2）水平作为宿主炎症反应的指标，以及采集菌斑样本以鉴定微生物。拍摄标准化垂直咬翼片以评估第二磨牙远中的牙槽骨高度以及第三磨牙的倾斜度和萌出程度。进行全口牙周探诊以确定探诊深度和相对临床附着水平（CAL）。使用格雷西言语描述量表评估感觉强度和不愉快程度的疼痛水平以及10厘米视觉模拟量表。在收集基线数据后，对有症状的第三磨牙部位进行局部清创和冲洗治疗。入组1周后再次收集数据。随后，安排患者拔除所有第三磨牙。术后3个月重复收集数据。作为对照，从12名先前拔除无症状第三磨牙的受试者收集数据。
入组时，有症状的下颌第三磨牙（n = 21）大多为垂直位（n = 18）且位于或高于咬合平面（n = 19）。上颌牙均无症状。特定厌氧微生物的微生物计数升高。与对照患者的无症状第三磨牙和第二磨牙相比，有症状第三磨牙相邻的第二磨牙远中GCF IL-1β水平升高。第二磨牙远中的牙槽骨水平和CAL正常。1周时，患者的疼痛症状和IL-1β水平降低，但微生物计数仍然很高。术后3个月，患者无疼痛症状，牙槽骨水平和CAL与入组时相似。所有患者第二磨牙远中和第一磨牙近中的IL-1β水平均升高；微生物计数下降，尽管未降至对照患者的水平。在研究患者的样本中未检测到牙周炎进展的危险因素牙龈卟啉单胞菌或福赛坦氏菌的微生物计数增加或GCF PGE2水平升高。
这些患者中由轻微体征/症状表现出的智齿冠周炎与相当大的不适相关。有症状的下颌第三磨牙为垂直位且位于或接近咬合平面。此外，这种情况的特征是微生物菌群和GCF炎症介质水平更符合牙龈炎而非牙周炎。拔除第三磨牙消除了症状，但与对照相比，微生物负荷和通过IL-1β水平测量的受影响患者的炎症反应仍然升高。需要进一步研究以确定这些因素中的哪些可用于在症状出现前识别有智齿冠周炎风险的患者。
