EFFECTS OF TREATMENT ON EARLY ONSET PERIODONTITIS

治疗早发性牙周炎的效果

• 批准号: 6176031
• 负责人: FRANK A ROBERTS
• 金额: $ 13.54万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-01 至 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6176031
• 关键词: antibody formation; antibody titering; body fluids; clinical research; disease /disorder onset; gingiva; host organism interaction; human subject; human therapy evaluation; humoral immunity; immunoglobulin G; inflammation; interleukin 1; periodontitis; prostaglandin E; root canal therapy

This proposal for a mentored patient-oriented research career development award will provide the candidate with a broad knowledge in the design and conduct of complex clinical oral health trials and the ability to bridge the gap between direct patient assessment, treatment and sampling, and complimentary basic laboratory research. The didactic portion of the training emphasizes courses in clinical research ethics as well as courses in study design, biostatistics, epidemiology, and outcomes assessment. The clinical research component involves an investigation of treatment effects on early onset (rapidly progressive) periodontitis patients and understanding the host response mechanisms involved in tooth debridement in this patient group. In most periodontitis patients, treatment by scaling and root planing results in marked improvement of clinical status. This improvement has traditionally been related to the removal of bacterial substances from the root surfaces. We hypothesize that a portion of the observed improvement results from treatment-induced activation of the host defense mechanisms following scaling and root planing. We will determine whether significant improvement in periodontal health can be demonstrated for untreated teeth in mouths otherwise treated by scaling and root planing and assess the role of antibodies and the mediators released by inflammatory cells in effecting these changes at untreated sites. Future studies will examine the efficacy of other forms of periodontal therapy including surgical flap debridement and dental implant rehabilitation. Forty adults having rapidly progressive periodontitis (RPP) will be randomized into treatment and no treatment groups. The treatment group will have all teeth scaled and root planed except for three teeth clustered in a single experimental quadrant. The teeth in the no treatment group will not be treated until the termination of the study, twelve months later. The outcome for treated and untreated teeth will be assessed by measurement of clinical parameters including pocket depth and attachment level, changes in alveolar bone density and height by digital subtraction radiography, changes in serum antibody titers for suspected periodontal pathogens, and expression of inflammatory mediators (IL-1beta and PGE2) in the gingival crevicular fluid. Based on data from a completed pilot study, we estimate that as much as one-half of the improvement observed following scaling and root planing may be due to factors other than just the removal of plaque, calculus, and irritants. This project will enhance our understanding of the effects of root debridement on host defense systems and help to develop more effective treatment options for this complex inflammatory disease.

这项以指导患者为导向的研究职业发展奖的提案将为候选人提供设计和实施复杂临床口腔健康试验的广泛知识，以及弥合直接患者评估、治疗和抽样以及免费基础实验室研究之间差距的能力。培训的教学部分强调临床研究伦理课程，以及研究设计、生物统计学、流行病学和结果评估课程。临床研究部分包括对早发（快速进展）牙周炎患者的治疗效果的调查，并了解该患者组牙齿清创中涉及的宿主反应机制。在大多数牙周炎患者中，通过刮治和牙根刨平治疗可显著改善临床状况。传统上，这种改善与去除根表面的细菌物质有关。我们假设，部分观察到的改善是由于处理诱导的宿主防御机制激活后的鳞片和根刨削。我们将确定是否可以证明未经治疗的口腔牙齿在牙周健康方面的显著改善，否则通过刮除和牙根刨除进行治疗，并评估抗体和炎症细胞释放的介质在影响未经治疗部位的这些变化中的作用。未来的研究将检查其他形式的牙周治疗的疗效，包括手术皮瓣清创和种植牙康复。40名患有快速进行性牙周炎（RPP）的成年人将被随机分为治疗组和非治疗组。治疗组除三颗牙齿集中在一个实验象限外，所有牙齿都要进行刮除和牙根刨平。未治疗组的牙齿在12个月后研究结束后才进行治疗。治疗和未治疗牙齿的结果将通过测量临床参数来评估，包括牙袋深度和附着水平，通过数字减影x线造影术测量牙槽骨密度和高度的变化，怀疑牙周病原体的血清抗体滴度变化以及龈沟液中炎症介质（il -1 β和PGE2）的表达。根据一项已完成的初步研究的数据，我们估计，除牙菌斑、牙石和刺激物的清除外，多达一半的改善可能是由于刮除和牙根刨除后观察到的其他因素。该项目将增强我们对根清创对宿主防御系统影响的理解，并有助于为这种复杂的炎症性疾病开发更有效的治疗方案。