Cohort Study on Management System for Periodontal Maintenance Patients.

【牙周治疗后长期效果评估】SUZUKI观察了68例牙周患者治疗后维持期的变化，结果显示维持良好组牙周袋保持原有深度，而下坡组在治疗32个月后牙周病变复发导致再次拔牙。KUMAGAYA调查了208名患者治疗后的变化。初始斑块评分与治疗后结果之间没有相关性，这意味着宿主因素可能比寄生虫因素对维持患者更重要。[宿主因素分析]ISHIKAWA报道，放线菌和牙龈卟啉单胞菌抗体均较高的患者治疗后效果较差。MURAYAMA证实了ISHIKAWA的观察结果，并进一步提出趋化和吞噬活性、总T细胞数量、Th/I比值可作为牙周病进一步发展的危险指标。MURAKAMI从维持患者中提取出5年内x线片显示牙槽骨吸收增加至少4%的高危组。高危患者龈沟液中il - 1浓度明显升高，龈下菌斑中牙龈卟啉菌浓度较高，对卟啉菌的抗体滴度也较高。【主动牙周治疗后的危险指标】HASEGAWA利用细菌监测试剂盒检测了卟啉菌、牙密螺旋体等牙周细菌的特异性酶，认为该系统对监测治疗后效果非常有用。这个结果与村上的发现不谋而合。WATANABE建议在风险指标、阶段标记和状态标记中采用两种不同的概念。附着水平应被视为阶段标志，探测口袋深度应被视为状态标志。

[Assessment of long term results after periodontal treatment]SUZUKI observed post treatment changes during maintenance period in 68 periodontal patients, and indicated that periodontal pocket keep their original depth in well maintenained group, however in down hill group recurrence of periodontal pathosis resulting in retreatment of tooth extraction occurred 32 months after treatment. KUMAGAYA surveyed post treatment changes in 208 patients. The relationships were not found between initial plaque score and post treatment results, which means host factor might be more important than parasite factor in maintenance patients.[Analysis of host factor]ISHIKAWA reported that patients who have higher antibodies to both Actinobacillus actinomycetemcomitance and porphylomonas gingivalis showed poorer post treatment results than others. MURAYAMA confirmed ISHIKAWA's observation, and suggested further that chemotactic and phagocytotic activities, total T cell number, Th/I ratio would be regarded as risk indicators for the further progression of periodontal diseases. MURAKAMI extracted high risk group which showed at least 4% further alveolar bone resorption on the X-ray pictures during 5 years from maintenance patiehts. The high risk patients exhibited significantly higher IL-l concentration in Gingival Crevicular Fluid, higher concentration of P.gingivalis in the subgingival plaque, and higher antibody titer to P.g.[Risk indicator after active periodontal treatment]HASEGAWA used a bacterial monitoring kit to detect specific enzyme for periodontopahtic bacteria such as P.g.and Treponema denticola, and concluded that this system was extremely useful in monitoring post-treatment effect. This result coincide to MURAKAMI's finding. WATANABE suggested to employ tow defferent concept in risk indicator, stage marker and state marker. Attachment level should be regarded as a stage marker and probing pocket depth as a state marker.