Utility of 5 major putative periodontal pathogens and selected clinical parameters to predict periodontal breakdown in patients on maintenance care
Utility of 5 major putative periodontal pathogens and selected clinical parameters to predict periodontal breakdown in patients on maintenance care
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DOI：
10.1111/j.1600-051x.1996.tb00556.x
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发表时间：
1996-04-01
影响因子：
6.7
通讯作者：
Slots, J
中科院分区：
文献类型：
--
作者：
Rams, TE;Listgarten, MA;Slots, J
对78名参加为期3个月的维持治疗计划的成年患者进行了为期12个月的牙周炎复发预测，评估了5种主要假定的牙周病微生物种类、“重复感染”微生物和几个临床牙周参数的预测作用。在基线时，收集每位患者的龈下微生物样本，并进行全口探探深度、相对牙周附着水平、分叉受累程度以及菌斑和牙龈炎症指标的评估。67名（85.9%）受试者在基线时培养阳性，检测出放线菌酵母菌、牙龈卟啉单胞菌、中间普氏菌、直弯曲杆菌或微小胃链球菌，其中48名（61.5%）受试者产生上述一种或多种细菌的阈值比例≥0.01%，牙龈卟啉单胞菌≥0.1%，中间卟啉单胞菌≥2.5%。≥2.0%的C. rectus,≥3.0%的P. micros。从12名受试者中检出龈下酵母菌，7名检出葡萄球菌，6名检出肠棒/假单胞菌；然而，没有受试者在牙龈下标本中发现这些“重复感染”生物体的基线比例大于或等于1.0%。研究对象的牙周炎复发定义为任何牙周部位表现为探诊深度比基线增加大于或等于3mm，或探诊深度比基线增加大于或等于2mm，同时相对牙周附着物损失比基线增加大于或等于2mm。15例（19.2%）研究对象在6个月内出现牙周炎复发，25例（32.1%）在12个月内出现牙周炎复发。单纯的5种主要试验菌和“重复感染”菌的基线存在并不是牙周炎在12个月内复发的显著预测因子。然而，5种主要测试中有一种或多种达到或高于指定基线阈值比例的受试者，在12个月内牙周炎复发的相对风险为2.5 （p = 0.022, Mantel-Haenszel chi(2)检验）。微生物学分析对牙周炎复发的阳性预测值，包括5种主要测试物种，达到或高于指定的阈值比例，随着时间的增加而提高，在12个月时达到约42%。在多元回归分析中共同提供的基线变量是，在12个月的时间内，受试者牙周炎复发的最佳预测能力是5种主要测试种中的一种或多种达到或高于指定阈值比例的恢复，每位受试者大于或等于5毫米探探深度的部位比例，以及平均全口探探深度。这些发现表明，牙龈下比例升高的5种主要假定牙周病原体中的一种或多种，加上探诊深度增加，使成年人在维持护理时易患复发性牙周炎。
The predictive utility of 5 major putative periodontopathic microbial species, ''superinfecting'' organisms, and several clinical periodontal parameters were assessed relative to periodontitis recurrence over a 12-month period in 78 treated adult patients participating in a 3-month maintenance care program. At baseline, pooled subgingival microbial samples were collected from each patient, and whole-mouth evaluations of probing depth, relative periodontal attachment level, furcation involvement, and indices of plaque and gingival inflammation mere carried out. 67 (85.9%) subjects were culture-positive at baseline for presence of either Actinobacillus actinomzycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Campylobacter rectus or Peptostreptococcus micros, with 48 (61.5%) subjects yielding one or more of these species at or above designated threshold proportions of greater than or equal to 0.01% for A. actinomycetemcomitans, greater than or equal to 0.1% for P. gingivalis, greater than or equal to 2.5% for P. intermedia, greater than or equal to 2.0% for C. rectus, and greater than or equal to 3.0% for P. micros. Subgingival yeasts were recovered from 12 subjects, staphylococci from 7, and enteric rods/pseudomonads from 6; however, no subjects revealed greater than or equal to 1.0% baseline proportions of these ''superinfecting'' organisms in subgingival specimens. Periodontitis recurrence in subjects was defined as any periodontal site exhibiting either a probing depth increase of greater than or equal to 3 mm from baseline, or a probing depth increase of greater than or equal to 2 mm from baseline together with a loss in relative periodontal attachment of greater than or equal to 2 mm from baseline. 15 (19.2%) study subjects showed periodontitis recurrence within 6 months of baseline, and 25 (32.1%) within 12 months. The mere baseline presence of the 5 major test species and ''superinfecting'' organisms were not significant predictors of periodontitis recurrence over 12 months. However, a 2.5 relative risk for periodontitis recurrence over 12 months was found for subjects yielding one or more of the 5 major test species at or above the designated baseline threshold proportions (p = 0.022, Mantel-Haenszel chi(2) test). The positive predictive value for periodontitis recurrence of a microbiologic analysis encompassing the 5 major test species at or above the designated threshold proportions improved with increasing time from baseline, up to approximately 42% at 12 months. Baseline variables jointly providing in multiple regression analysis the best predictive capability for periodontitis recurrence in subjects over a 12-month period were recovery of one or more of the 5 major test species at or above designated threshold proportions, the proportion of sites per subject with greater than or equal to 5 mm probing depth, and the mean whole-mouth probing depth. These findings indicate that one or more of 5 major putative periodontal pathogens in elevated subgingival proportions together with increased probing depth predispose adults on maintenance care to recurrent periodontitis.