Machtei E E, Hausmann E, Schmidt M, Grossi S G, Dunford R, Schifferle R, Munoz K, Davies G, Chandler J, Genco R J
Periodontal Disease Research Center, Department of Oral Biology, School of Dental Medicine, State University of New York, Buffalo 14214-3092, USA.
J Periodontol. 1998 May;69(5):590-5. doi: 10.1902/jop.1998.69.5.590.
Mechanical periodontal therapy is widely used for a variety of periodontal conditions. While the clinical efficacy of this treatment has been validated, the radiographic response has not been studied in depth. The purpose of the present study was to examine the clinical and radiographic response to mechanical periodontal therapy, and assess the factors associated with these changes. One hundred and eight patients, with established periodontitis, received oral hygiene instruction and mechanical periodontal therapy for a period of 4 to 5 weeks. Scheduled maintenance visits were performed at 3, 6, 9, and 15 months. Probing depth (PD) and attachment level (AL) measurements were performed at baseline, and at 3 and 15 months. Intraoral radiographs were taken at baseline and 12 to 15 months postsurgery using a Rinn alignment system. Alveolar crestal height (ACH) measurements were performed on a pair of digitized images of the previously taken radiographs. An overall mean of patients' changes for PD, AL, and ACH was initially computed. Active sites (gainers and losers) were determined using a threshold method, and expressed as patient's percentage of active sites (number of active sites of the total sites measured in each patient). Mean overall probing reduction and AL gain was 0.5 mm and 0.44 mm, respectively. Of all sites measured, 16.6% exhibited AL gain, while only 6.2% of all sites exhibited AL loss. Mean overall change in ACH was -0.07 mm, of which 11.8% of all sites exhibited ACH gain, while 15.1% exhibited loss beyond the threshold. Non-smokers presented no change in bone loss, while smokers continued to lose bone at an annual rate of 0.17 mm, despite treatment (P <0.005). Likewise, the average percent of sites per patients showing attachment gain beyond the threshold were much greater in non-smokers (13.9%) compared to 9.0% in smokers (P <0.01). Mean probing reduction was 50% greater among non-smokers (0.6 mm) when compared to smokers (0.4 mm), which was also statistically significant (P <0.05). A positive and significant correlation was established between the percentage of sites with AL gain and sites with ACH gain (Rho =0.40; P=0.0001). It is suggested that monitoring sites for AL and ACH gain expressed as changes beyond a selective threshold is an important outcome variable in treatment studies.
机械性牙周治疗广泛应用于各种牙周疾病。虽然这种治疗的临床疗效已得到验证，但对其影像学反应尚未进行深入研究。本研究的目的是检查机械性牙周治疗的临床和影像学反应，并评估与这些变化相关的因素。108例确诊为牙周炎的患者接受了口腔卫生指导和为期4至5周的机械性牙周治疗。在3、6、9和15个月时安排了定期复诊。在基线以及3个月和15个月时测量探诊深度（PD）和附着水平（AL）。使用Rinn定位系统在基线和术后12至15个月拍摄口腔内X光片。在之前拍摄的X光片的一对数字化图像上测量牙槽嵴顶高度（ACH）。最初计算患者PD、AL和ACH变化的总体平均值。使用阈值法确定活跃部位（改善部位和恶化部位），并表示为患者活跃部位的百分比（每位患者测量的总部位中活跃部位的数量）。平均总体探诊深度减少和AL增加分别为0.5毫米和0.44毫米。在所有测量部位中，16.6%的部位表现出AL增加，而所有部位中只有6.2%的部位表现出AL减少。ACH的平均总体变化为-0.07毫米，其中所有部位的11.8%表现出ACH增加，而15.1%的部位表现出超过阈值的减少。非吸烟者的骨质流失没有变化，而吸烟者尽管接受了治疗，但仍以每年0.17毫米的速度继续骨质流失（P<0.005）。同样，与吸烟者的9.0%相比，非吸烟者中每位患者显示附着增加超过阈值的部位平均百分比要高得多（13.9%）（P<0.01）。与吸烟者（0.4毫米）相比，非吸烟者的平均探诊深度减少幅度大50%（0.6毫米），这也具有统计学意义（P<0.05）。在有AL增加的部位百分比和有ACH增加的部位之间建立了正相关且显著的相关性（Rho=0.40；P=0.0001）。建议将以超过选择性阈值的变化表示的AL和ACH增加的监测部位作为治疗研究中的一个重要结局变量。
