MANDIBULAR BONE MINERAL DENSITY

成人牙周炎是一种慢性细菌性炎症性疾病，可导致牙槽骨丢失。最近有报道称，患有成人牙周炎的女性牙槽骨量减少。此外，脊柱骨质疏松症患者与正常女性相比，下颌骨骨量较低。在动物和人类身上的研究表明，双膦酸阿伦磷酸酯可以通过抑制破骨细胞介导的骨吸收来防止骨丢失，还可以减少局部和全身的炎性细胞因子水平和一些新骨形成。然而，双磷酸盐和其他疗法并不能使骨量恢复正常。然而，双磷酸盐和其他疗法并不能使骨量恢复正常。已发现通过每天感染甲状旁腺激素(hPTH1-34)来刺激患者新骨形成。本研究的目的是修复严重牙周炎和下颌骨骨量低的成人患者的丢失的骨。这项研究的基本假设是：(1)与单独使用传统牙周疗法相比，两年的双磷酸盐治疗结合常规牙周治疗将显著增加新骨形成以及临床附着和牙槽骨高度的增加，并且(2)与接受安慰剂和双磷酸盐治疗的患者相比，在双磷酸盐患者中，与接受常规牙周治疗的患者相比，添加hPTH(1-34)治疗将显著增加牙槽骨量，并有可能使牙槽骨量恢复正常。为了验证这些假设，将进行一项为期两天的研究。在1-3年，将进行一项为期两年的随机、安慰剂对照试验，以确定传统牙周疗法加双磷酸盐是否会促进成人牙周炎和下颌骨骨量低的患者的临床附着和牙槽骨高度的增加。在第二阶段(3年至4年)，双膦酸盐治疗组将被重新随机分为hPTH(1-34)组或安慰剂组，以确定添加hPTH是否进一步恢复骨量和临床附着水平。次要结果包括确定特定的IL-1基因型别与治疗反应是否存在关联。

Adult periodontitis is a chronic inflammatory disease of bacterial etiology that results in alveolar bone loss. It has been reported recently that alveolar bone mass is reduced in women who have adult periodontitis. In addition, individuals with spinal osteoporosis have low mandibular bone mass compared to normal women. Studies in animals and humans have shown that the bisphosphonate, alendronate, can prevent bone loss by inhibiting osteoclast-mediated bone resorption and may also reduce local and systemic levels of inflammatory cytokines and some new bone formation. However, bisphosphonates and other therapies do not return bone mass to normal. However, bisphosphonates and other therapies do not return bone mass to normal. Administration by daily infection of parathyroid hormone (hPTH 1-34) has been found to stimulate new bone formation in patients. The goal of the present study is to restore lost bone in adult patients with severe periodontitis and low mandibular bone mass. The hypothesis underlying this study are: (1) that two years of bisphosphonate administration in conjunction with conventional periodontal therapy will lead to significantly greater new bone formation and gains in clinical attachment and alveolar bone height than conventional therapy alone, and that (2) in patients with bisphosphonate, the addition of hPTH (1-34) treatment, when used in conjunction with conventional periodontal treatment will significantly increase alveolar bone mass and may restore alveolar bone mass toward normal as compared to individuals treated with placebo and bisphosphonate. To test these hypotheses, a two-study will be conducted. In years 1-3, a 2-year randomized, placebo-controlled trial will be performed to determine if conventional periodontal therapy plus bisphosphonate will promote gains in clinical attachment and alveolar bone height in patients with adult periodontitis and low mandibular bone mass. In phase two (years 3-4), the bisphosphonate treatment group will be re-randomized to either hPTH (1-34) or placebo to determine whether addition of hPTH further restores bone mass and clinical attachment levels. Secondary outcomes include determining whether there is an association about specific IL-1 genotype and responsiveness to treatments.