EFFECTS OF TREATMENT ON EARLY ONSET PERIODONTITIS

治疗早发性牙周炎的效果

• 批准号: 6523811
• 负责人: FRANK A ROBERTS
• 金额: $ 13.58万
• 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/6523811
• 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.

这一指导性的以患者为导向的研究职业发展奖的提案将为候选人提供在设计和进行复杂的临床口腔健康试验方面的广泛知识，以及弥合直接患者评估、治疗和采样与免费基础实验室研究之间的差距的能力。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。临床研究部分涉及对早发性（快速进展）牙周炎患者的治疗效果的调查，并了解该患者组中牙齿清创术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术治疗可显著改善临床状况。这种改善传统上与从根表面去除细菌物质有关。我们推测，观察到的改善结果的一部分，从治疗诱导的激活宿主防御机制后，缩放和根面平整。我们将确定是否可以证明牙周健康的显着改善未经治疗的牙齿在口腔中，否则通过刮治和根面平整治疗，并评估抗体和炎症细胞释放的介质在影响这些变化在未经治疗的网站的作用。未来的研究将检查其他形式的牙周治疗，包括外科皮瓣清创术和牙科种植体康复的疗效。将40名患有快速进展性牙周炎（RPP）的成人随机分为治疗组和非治疗组。治疗组将对所有牙齿进行刮除和牙根刨平，除了在单个实验象限中聚集的三颗牙齿。未治疗组中的牙齿将不进行治疗，直到研究结束，12个月后。将通过测量临床参数评估治疗和未治疗牙齿的结局，包括牙周袋深度和附着水平、通过数字减影X线摄影测量的牙槽骨密度和高度的变化、疑似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-1 β和PGE 2）的表达。根据一项已完成的试点研究的数据，我们估计，在洁治和根面平整后观察到的改善中，有多达一半可能是由于除牙菌斑、牙石和刺激物之外的其他因素。该项目将增强我们对根清创术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。