EFFECTS OF TREATMENT ON EARLY ONSET PERIODONTITIS

这一以患者为导向的研究职业发展奖的提议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，并能够弥合患者直接评估、治疗和采样与免费基础实验室研究之间的差距。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性(快速进展性)牙周炎患者的治疗效果的调查，以及了解这一患者组牙齿清创所涉及的宿主反应机制。在大多数牙周炎患者中，通过刮治和根面平整治疗可以显著改善临床状况。这一改进传统上与去除根部表面的细菌物质有关。我们假设，观察到的改善的一部分是由于治疗诱导的宿主防御机制在结垢和根面平整后的激活。我们将确定口腔中未经治疗的牙齿是否可以显示出显著的牙周健康改善，否则通过刮除和根面平整治疗，并评估抗体和炎症细胞释放的介质在未治疗部位影响这些变化中的作用。未来的研究将检查其他形式的牙周治疗的效果，包括手术瓣清创和牙种植体修复。40名患有快速进展性牙周炎(RPP)的成年人将被随机分为治疗组和非治疗组。治疗组将除三颗牙齿聚集在一个实验象限外，其余所有牙齿都将被刮平和根面平整。不治疗组的牙齿将在研究结束后12个月才接受治疗。治疗和未治疗牙齿的结果将通过测量临床参数来评估，包括牙槽深度和附着水平，数字减影牙槽骨密度和高度的变化，可疑牙周病原体的血清抗体滴度的变化，以及龈沟液中炎症介质(IL-1β和PGE2)的表达。基于一项已完成的先导性研究的数据，我们估计，在洁治和根面平整后观察到的改善中，多达一半可能是由于除牙菌斑、结石和刺激物之外的其他因素。该项目将加深我们对根部清创对宿主防御系统影响的了解，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。

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.