Westfelt E, Rylander H, Dahlén G, Lindhe J
Department of Periodontology, Faculty of Odontology, Göteborg University, Sweden.
J Clin Periodontol. 1998 Jul;25(7):536-41. doi: 10.1111/j.1600-051x.1998.tb02484.x.
The aim of the present trial was to study the effect of meticulous supragingival plaque control on (i) the subgingival microbiota, and (ii) the rate of progression of attachment loss in subjects with advanced periodontal disease. An intra-individual group of sites exposed to non-surgical periodontal therapy served as controls. 12 patients with advanced periodontal disease were subjected to a baseline examination (BL) including assessments of oral hygiene status, gingival condition (BoP), probing depth, clinical attachment level and subgingival microbiota from pooled samples from each quadrant. The assessments were repeated after 12, 24 and 36 months. Following BL, a split mouth study was initiated. The patients received oral hygiene instruction, supragingival scaling and case presentation. 2 quadrants in each patient were identified as "test" and the remaining 2 as "control" quadrants. Subgingival therapy was performed in all bleeding sites in the control quadrants. Oral hygiene instructions and plaque control exercises were repeated once every 2 weeks during the initial 3 months of the study. Thereafter the plaque control program was repeated once every 3 months for the duration of the 3 years. Sites demonstrating loss of clinical attachment > or =2 mm in the test quadrants were treated subgingivally. The results showed that in both test and control quadrants repeated oral hygiene instructions and supragingival plaque removal procedures resulted in low plaque scores throughout the study. The gingival bleeding scores and the frequency of periodontal pockets > or =4 mm was, however, significantly higher in the test quadrants than in the control quadrants. At the end of the 3 year study, the control quadrants showed significantly more reduced (> or =2 mm) pockets than the test quadrants, 265 versus 96. The number of sites in the test quadrants showing probing attachment loss > or =2 mm was more than 4x greater than in the control quadrants (59 versus 13). The microbiological findings indicate a more pronounced reduction only for P. gingivalis in the control quadrants. None of the other 4 marker bacteria consistently reflected or predicted the clinical parameters. The present study shows that only supragingival plaque control fails to prevent further periodontal tissue destruction in subjects with advanced periodontal disease.
本试验的目的是研究严格的龈上菌斑控制对（i）龈下微生物群，以及（ii）晚期牙周病患者附着丧失进展速率的影响。一组接受非手术牙周治疗的个体内部位作为对照。12名晚期牙周病患者接受了基线检查（BL），包括评估口腔卫生状况、牙龈状况（探诊出血）、探诊深度、临床附着水平以及从每个象限的混合样本中检测龈下微生物群。在12、24和36个月后重复进行评估。基线检查后，启动了一项半口研究。患者接受了口腔卫生指导、龈上洁治和病例介绍。每位患者的2个象限被确定为“试验”象限，其余2个为“对照”象限。对照象限中所有出血部位均进行了龈下治疗。在研究的最初3个月内，每2周重复一次口腔卫生指导和菌斑控制练习。此后，在3年的时间里，每3个月重复一次菌斑控制计划。试验象限中临床附着丧失≥2mm的部位进行了龈下治疗。结果显示，在整个研究过程中，试验象限和对照象限反复进行口腔卫生指导和龈上菌斑清除程序后，菌斑评分均较低。然而，试验象限的牙龈出血评分和牙周袋深度≥4mm的频率显著高于对照象限。在3年研究结束时，对照象限显示出比试验象限显著更多的深度减少（≥2mm）的牙周袋，分别为265个和96个。试验象限中探诊附着丧失≥2mm的部位数量比对照象限多4倍以上（分别为59个和13个）。微生物学研究结果表明，仅对照象限中的牙龈卟啉单胞菌有更明显的减少。其他4种标记细菌均未始终反映或预测临床参数。本研究表明，对于晚期牙周病患者，仅进行龈上菌斑控制无法预防牙周组织的进一步破坏。
