Adequate toothbrushing method following periodontal tissue regeneration

本研究的目的是确定牙周组织再生治疗后开始刷牙的适当阶段和最佳刷牙力/持续时间。实验选取6只beagle犬，首先拔除上颌第二前臼齿和下颌第三前臼齿。大小为4x4x4毫米，在上颌第一和第三前磨牙之间以及下颌第二和第四前磨牙之间形成。然后在根表面刻痕，记录骨缺损的底部。在骨缺损处植入金属基质诱导牙周炎，饲养8周，喂食软性食物。治疗后，去除金属基质，使用Emdogain进行牙周组织再生治疗。实验牙按每只狗的开口设计分为四组。对照牙每天用手器械清除牙菌斑。另外3例患者在牙周再生治疗后1天（1D）、3天（3D）和7天（7D）每天进行专业刷牙。刷牙的力度和持续时间分别设定为200g和20秒。采用应力纱布控制刷牙力。组织学观察发现牙龈炎症和牙槽骨重塑的结果相似。各组均未见明显的炎症反应，无明显的管状上皮下降。在初始骨缺损面积的三分之一左右发现新形成的牙槽骨。切口周围有少量新形成的骨质。然而，1D和3D狗的上皮细胞部分下降。本研究结果显示，牙周手术后第二天即可开始刷牙。

The purpose of the present study was to determine an adequate stage for initiating tooth-brushing and optimal tooth-brushing force/duration following periodontal tissue regenerative therapy.Six beagle dogs were involved in the experiment First, the maxillary second premolar and mandibular third premolar were extracted. 4x4x4 mm of size, was formed between the maxillary first and third premolars and between the mandibular second and fourth premolars. Then, notch was marked on the root surface for recording the bottom of bone defect. In order to induce periodontitis, metal matrix was inserted in the area of bone defect The dogs were then kept for 8 weeks with being fed by soft food. After these treatments, the metal matrix were removed and periodontal tissue regenerative therapy was performed using Emdogain. Experimental teeth were divided into four groups according to the split-mouth design for each dog. The control tooth was given daily plaque removal using a hand instrument. The other three was given daily professional tooth-brushing following 1 day (1D), 3 days (3D), or 7 days (7D) after the periodontal regenerative therapy. The force and duration of tooth-brushing was set for 200g and 20 seconds, respectively. The stress gauze was used for controlling the tooth-brushing force.Histological observation found similar results with respect to gingival inflammation and remodeling of alveolar bone. No marked inflammation and down growth of sulcular epithelium was observed in all the groups. Newly-formed alveolar bone was found around the one-third of initial bone defect area. A little amount of newly formed cementum was observed around the notch. However, epithelial downgrowth was partially observed for 1D, 3D dogs.The results of this study indicate that tooth-brushing can be initiated next day after periodontal surgical treatment.