臺灣博碩士論文加值系統

本研究探討再生膜暴露對引導組織再生術在臨床及微生物學方面的影響。本研究觀察32到57歲的30個患有成人型牙周炎的患者，在經過全口牙菌斑控制、超音波洗牙及牙根刮平…等的初步治療後，以Gore-Tex再生膜治療病患口中的2壁或3壁型骨缺損，病患手術後每8小時服用amoxicillin 500毫克5到7天，再生膜置放4到6週；所有治療開始前，手術前及術後6個月記錄受試者的牙菌斑指數、牙齦指數、探測流血比率、探測深度、探測附連高度及邊緣組織退縮，以聚合酵素鏈反應偵測Porphyromonas gingivalis及Actinobacillus actinomycetemcomitans 的量。利用Mann-Whitney U test分析未暴露組與暴露組之間總細菌數、P. gingivalis或A. actinomycetemcomitans菌數的差異，以非依賴性T-test或Mann-Whitney U test分析兩組之間臨床測量值的差異以及細菌與臨床檢查值的關係，並進一步以線性迴歸分析細菌與臨床檢查值之間的關係。結果發現暴露組在術後6個月的邊緣組織退縮顯著增加 (1.7 ± 1.5毫米相對於0 ± 1.5毫米，P = 0.006)，且會有較多的A. actinomycetemcomitans菌(P = 0.006)。進一步分析顯示再生膜上總細菌數大於等於106個的受試者比小於106個的受試者術後6個月的臨床附連增加較少(1.9 ± 2.0毫米相對於3.1 ± 1.4毫米，P = 0.028)；再生膜上A. actinomycetemcomitans大於等於106個的受試者比小於106個的受試者術後6個月的臨床附連增加較少(2.0 ± 2.0毫米相對於3.2 ± 1.2毫米，P = 0.041)，且A. actinomycetemcomitans菌每增加為10倍，臨床附連增加就會減少1.04毫米。

Clinical and microbiologic aspects of guided tissue regeneration (GTR) with or without membrane exposure were investigated. Thirty patients, aged 32-57 years, and having adult periodontitis were recruited. Guided tissue regenerations with Gore-Tex membranes were performed at 30 intrabony osseous defects after initial treatments, including plaque control program, scaling and root planing…etc. Amoxicillin 500 mg was taken every eight hours for 5~7 days postoperatively. Plaque index, gingival index , bleeding on probing (%), probing depth, clinical attachment level as well as marginal tissue recession were evaluated at initial visit, immediately prior to and 6 months after the GTR. The occurrence and quantity of Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans on the retrieved membranes were determined using polymerase chain reaction (PCR). Mann-Whitney U test, independent-samples T test and linear regression were used for the statistical analysis. P < 0.05 was set as the statistical significance. The results show that exposure group had higher degree of marginal tissue recession (1.7 ± 1.5 mm vs. 0 ± 1.5 mm, P = 0.006) and higher quantity of A. actinomycetemcomitans (P = 0.006) 6 months after the GTR. Further analysis showed that lesser clinical attachment gain was obtained at those with the count of total bacteria more than 106 per retrieved membrane (1.9 ± 2.0 mm vs. 3.1 ± 1.4 mm，P = 0.028) or A. actinomycetemcomitans more than 106 per retrieved membrane (2.0 ± 2.0 mm vs. 3.2 ± 1.2 mm, P = 0.041). Clinical attachment gain will decrease 1.04 mm, if the amount of A. actinomycetemcomitans increased 10 times.

緒論
引導牙周組織再生術
影響牙周組織再生術效果的因子
再生膜受細菌的污染
研究細菌的方法
再生膜合併抗生素或抑菌劑的使用
再生膜受細菌污染對引導牙周組織再生的影響
再生膜暴露與引導牙周組織再生術效果的關係
材料與方法
受試者的選擇
牙周臨床測量
病患治療過程
再生膜牙菌斑標本採集
核酸抽取
聚合酵素鏈反應(polymerase chain reaction，PCR)
瓊脂凝膠電泳分析(agarose gel electrophoresis)
引子對敏感度(sensitivity)測試
統計分析
結果
受試者及再生膜
受試者術前健康狀況
受試牙齒牙周狀況與再生膜暴露的關係
核酸抽取與引子對敏感度
再生膜上的細菌與再生膜暴露的關係
再生膜上的細菌與牙周狀況的關係
討論

1.Karer HS: Periodontal Microbiology. In: Clinical Periodontology. 8th ed, WB Saunder Co, pp.84-103, 1997.
2.Nyman S, Lindhe J, Karring T and Rylander H: New attachment following surgical treatment of human periodontal disease. J Clin Periodontol 9: 290-296, 1982.
3.Gottlow J, Nyman S, Lindhe J, Karring T and Wennstrom J: New attachment formation in the human periodontium by guided tissue regeneration. Case reports. J Clin Periodontol 13: 604-616, 1986.
4.Chung KM, Salkin LM, Stein MD and Freedman AL: Clinical evaluation of a biodegradable collagen membrane in guided tissue regeneration. J Periodontol 61: 732-736, 1990.
5.Caton J, Greenstein G and Zappa U: Synthetic bioabsorbable barrier for regeneration in human periodontal defects. J Periodontol 65: 1037-1045, 1994.
6.Gottlow J: Guided tissue regeneration using bioresorbable and non-resorbable devices: initial healing and long-term results. J Periodontol 64: 1157-1165, 1993.
7.Polson AM, Southard GL, Dunn RL and Polson AP: Healing patterns associated with an Atrisorb barrier in guided tissue regeneration. Compendium 14: 1162, 1164, 1166 passim, 1993.
8.Gottlow J, Nyman S, Karring T and Lindhe J: New attachment formation as the result of controlled tissue regeneration. J Clin Periodontol 11: 494-503, 1984.
9.Melcher AH: On the repair potential of periodontal tissues. J Periodontol 47: 256-260, 1976.
10.Becker W, Berg L and Becker BE: The long term evaluation of periodontal treatment and maintenance in 95 patients. Int J Periodont Restor Dent 4: 54-71, 1984.
11.Becker W, Becker BE, Prichard JF, Caffesse R, Rosenberg E and Gian-Grasso J: Root isolation for new attachment procedures. A surgical and suturing method: three case reports. J Periodontol 58: 819-826, 1987.
12.Pitaru S, Tal H, Soldinger M and Noff M: Collagen membranes prevent apical migration of epithelium and support new connective tissue attachment during periodontal wound healing in dogs. J Periodont Res 24: 247-253, 1989.
13.Wikesjo UM, Nilveus RE and Selvig KA: Significance of early healing events on periodontal repair: a review. J Periodontol 63: 158-165, 1992.
14.Lu HK: Topographical characteristics of root trunk length related to guided tissue regeneration. J Periodontol 63: 215-219, 1992.
15.Caffesse RG and Quinones CR: Guided tissue regeneration: biologic rationale, surgical technique, and clinical results. Compendium 13: 166, 168, 170 passim, 1992.
16.Selvig KA, Nilveus RE, Fitzmorris L, Kersten B and Khorsandi SS: Scanning electron microscopic observations of cell populations and bacterial contamination of membranes used for guided periodontal tissue regeneration in humans. J Periodontol 61: 515-520, 1990.
17.Nowzari H, Matian F and Slots J: Periodontal pathogens on polytetrafluoroethylene membrane for guided tissue regeneration inhibit healing. J Clin Periodontol 22: 469-474, 1995.
18.Nowzari H, London R and Slots J: The importance of periodontal pathogens in guided periodontal tissue regeneration and guided bone regeneration. Compend Contin Educ Dent 16: 1042, 1044, 1046 passim, 1995.
19.Nowzari H and Slots J: Microorganisms in polytetrafluoroethylene barrier membranes for guided tissue regeneration. J Clin Periodontol 21: 203-210, 1994.
20.De Sanctis M, Zucchelli G and Clauser C: Bacterial colonization of barrier material and periodontal regeneration. J Clin Periodontol 23: 1039-1046, 1996.
21.Warrer K and Karring T: Guided tissue regeneration combined with osseous grafting in suprabony periodontal lesions. An experimental study in the dog. J Clin Periodontol 19: 373-380, 1992.
22.Guillemin MR, Mellonig JT and Brunsvold MA: Healing in periodontal defects treated by decalcified freeze-dried bone allografts in combination with ePTFE membranes (I). Clinical and scanning electron microscope analysis. J Clin Periodontol 20: 528-536, 1993.
23.Selvig KA, Kersten BG, Chamberlain AD, Wikesjo UM and Nilveus RE: Regenerative surgery of intrabony periodontal defects using ePTFE barrier membranes: scanning electron microscopic evaluation of retrieved membranes versus clinical healing. J Periodontol 63: 974-978, 1992.
24.Christgau M, Bader N, Schmalz G, Hiller KA and Wenzel A: Postoperative exposure of bioresorbable GTR membranes: effect on healing results. Clin Oral Invest 1: 109-118, 1997.
25.Johansson A, Bergenholtz A and Holm SE: Cytotoxicity in bacterial cultures: interaction and cell-specificity, possible factors in periodontal disease. J Periodont Res 29: 318-323, 1994.
26.Scragg MA, Cannon SJ, Rangarajan M, Williams DM and Curtis MA: Targeted disruption of fibronectin-integrin interactions in human gingival fibroblasts by the RI protease of Porphyromonas gingivalis W50. Infect Immun 67: 1837-1843, 1999.
27.Busscher HJ, Uyen MH, van Pelt AW, Weerkamp AH and Arends J: Kinetics of adhesion of the oral bacterium Streptococcus sanguis CH3 to polymers with different surface free energies. Appl Environment Microbiol 51: 910-914, 1986.
28.Hogt AH, Dankert J, Hulstaert CE and Feijen J: Cell surface characteristics of coagulase-negative staphylococci and their adherence to fluorinated polyethylenepropylene. Infect Immun 51: 294-301, 1986.
29.Hogt AH, Dankert J and Feijen J: Adhesion of coagulase-negative staphylococci to methacrylate polymers and copolymers. J Biomed Mat Res 20: 533-545, 1986.
30.Stimpson SA, Brown RR, Anderle SK, Klapper DG, Clark RL, Cromartie WJ and Schwab JH: Arthropathic properties of cell wall polymers from normal flora bacteria. Infect Immun 51: 240-249, 1986.
31.Wang HL, Yuan K, Burgett F, Shyr Y and Syed S: Adherence of oral microorganisms to guided tissue membranes: an in vitro study. J Periodontol 65: 211-218, 1994.
32.Carlsson J: Presence of various types of non-haemolytic streptococci in dental plaque and in other sites of the oral cavity in man. Odontol Revy 18: 55-74, 1967.
33.Irving JT, Socransky SS and Heeley JD: Histological changes in experimental periodontal disease in gnotobiotic rats and conventional hamsters. J Periodont Res 9: 73-80, 1974.
34.Newman MG: The role of Bacteroides melaninogenicus and other anaerobes in periodontal infections. Rev Infect Dis 1: 313-324, 1979.
35.Vincent JW, Suzuki JB, Falkler WA, Jr. and Cornett WC: Reaction of human sera from juvenile periodontitis, rapidly progressive periodontitis, and adult periodontitis patients with selected periodontopathogens. J Periodontol 56: 464-469, 1985.
36.Saglie FR, Simon K, Merrill J and Koeffler HP: Lipopolysaccharide from Actinobacillus actinomycetemcomitans stimulates macrophages to produce interleukin-1 and tumor necrosis factor mRNA and protein. Oral Microbiol Immunol 5: 256-262, 1990.
37.Ricci G, Rasperini G, Silvestri M and Cocconcelli PS: In vitro permeability evaluation and colonization of membranes for periodontal regeneration by Porphyromonas gingivalis. J Periodontol 67: 490-496, 1996.
38.Sela MN, Steinberg D, Klinger A, Krausz AA and Kohavi D: Adherence of periodontopathic bacteria to bioabsorbable and non-absorbable barrier membranes in vitro. Clin Oral Impl Res 10: 445-452, 1999.
39.Chen YT, Wang HL, Lopatin DE, O'Neal R and MacNeil RL: Bacterial adherence to guided tissue regeneration barrier membranes exposed to the oral environment. J Periodontol 68: 172-179, 1997.
40.Zucchelli G, Cesari C, Clauser C and DeSanctis M: Early bacterial accumulation on guided tissue regeneration membrane materials. An in vivo study. J Periodontol 69: 1193-1202, 1998.
41.Moore WE, Holdeman LV, Cato EP, Smibert RM, Burmeister JA and Ranney RR: Bacteriology of moderate (chronic) periodontitis in mature adult humans. Infect Immun 42: 510-515, 1983.
42.Furcht C, Eschrich K and Merte K: Detection of Eikenella corrodens and Actinobacillus actinomycetemcomitans by use of the polymerase chain reaction (PCR) in vitro and in subgingival plaque. J Clin Periodontol 23: 891-897, 1996.
43.Riggio MP, Macfarlane TW, Mackenzie D, Lennon A, Smith AJ and Kinane D: Comparison of polymerase chain reaction and culture methods for detection of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in subgingival plaque samples. J Periodont Res 31: 496-501, 1996.
44.Watanabe K and Frommel TO: Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Treponema denticola detection in oral plaque samples using the polymerase chain reaction. J Clin Periodontol 23: 212-219, 1996.
45.Doungudomdacha S, Rawlinson A and Douglas CW: Enumeration of Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans in subgingival plaque samples by a quantitative-competitive PCR method. J Med Microbiol 49: 861-874, 2000.
46.Vest TM, Greenwell H, Drisko C, Wittwer JW, Bichara J, Yancey J, Goldsmith J and Rebitski G: The effect of postsurgical antibiotics and a bioabsorbable membrane on regenerative healing in Class II furcation defects. J Periodontol 70: 878-887, 1999.
47.Demolon IA, Persson GR, Moncla BJ, Johnson RH and Ammons WF: Effects of antibiotic treatment on clinical conditions and bacterial growth with guided tissue regeneration. J Periodontol 64: 609-616, 1993.
48.Demolon IA, Persson GR, Ammons WF and Johnson RH: Effects of antibiotic treatment on clinical conditions with guided tissue regeneration: one-year results. J Periodontol 65: 713-717, 1994.
49.Rifkin BR, Vernillo AT and Golub LM: Blocking periodontal disease progression by inhibiting tissue-destructive enzymes: a potential therapeutic role for tetracyclines and their chemically-modified analogs. J Periodontol 64: 819-827, 1993.
50.Sasaki T, Ramamurthy NS and Golub LM: Tetracycline administration increases collagen synthesis in osteoblasts of streptozotocin-induced diabetic rats: a quantitative autoradiographic study. Calcif Tiss Int 50: 411-419, 1992.
51.Sasaki T, Ramamurthy NS, Yu Z and Golub LM: Tetracycline administration increases protein (presumably procollagen) synthesis and secretion in periodontal ligament fibroblasts of streptozotocin-induced diabetic rats. J Periodont Res 27: 631-639, 1992.
52.Somerman MJ, Foster RA, Vorsteg GM, Progebin K and Wynn RL: Effects of minocycline on fibroblast attachment and spreading. J Periodont Res 23: 154-159, 1988.
53.Tempro PJ and Nalbandian J: Colonization of retrieved polytetrafluoroethylene membranes: morphological and microbiological observations. J Periodontol 64: 162-168, 1993.
54.Lin SJ, Hou LT, Liu CM, Liao CS, Wong MY, Ho JY and Chang WK: Bacterial morphotypes and early cellular responses in clinically infected and non-infected sites after combination therapy of guided tissue regeneration and allograft. J Dent 28: 199-206, 2000.
55.Mandell RL, Tripodi LS, Savitt E, Goodson JM and Socransky SS: The effect of treatment on Actinobacillus actinomycetemcomitans in localized juvenile periodontitis. J Periodontol 57: 94-99, 1986.
56.Fiehn NE and Westergaard J: Doxycycline-resistant bacteria in periodontally diseased individuals after systemic doxycycline therapy and in healthy individuals. Oral Microbiol Immunol 5: 219-222, 1990.
57.Slots J and Rams TE: Antibiotics in periodontal therapy: advantages and disadvantages. J Clin Periodontol 17: 479-493, 1990.
58.Frandsen EV, Sander L, Arnbjerg D and Theilade E: Effect of local metronidazole application on periodontal healing following guided tissue regeneration. Microbiological findings. J Periodontol 65: 921-928, 1994.
59.Sander L, Frandsen EV, Arnbjerg D, Warrer K and Karring T: Effect of local metronidazole application on periodontal healing following guided tissue regeneration. Clinical findings. J Periodontol 65: 914-920, 1994.
60.Zucchelli G, Sforza NM, Clauser C, Cesari C and De Sanctis M: Topical and systemic antimicrobial therapy in guided tissue regeneration. J Periodontol 70: 239-247, 1999.
61.Markman C, Fracalanzza SE, Novaes AB, Jr. and Novaes AB: Slow release of tetracycline hydrochloride from a cellulose membrane used in guided tissue regeneration. J Periodontol 66: 978-983, 1995.
62.Chung CP, Kim DK, Park YJ, Nam KH and Lee SJ: Biological effects of drug-loaded biodegradable membranes for guided bone regeneration. J Periodont Res 32: 172-175, 1997.
63.Dowell P, al-Arrayed F, Adam S and Moran J: A comparative clinical study: the use of human type I collagen with and without the addition of metronidazole in the GTR method of treatment of periodontal disease. J Clin Periodontol 22: 543-549, 1995.
64.Zarkesh N, Nowzari H, Morrison JL and Slots J: Tetracycline-coated polytetrafluoroethylene barrier membranes in the treatment of intraosseous periodontal lesions. J Periodontol 70: 1008-1016, 1999.
65.Grevstad HJ and Leknes KN: Ultrastructure of plaque associated with polytetrafluoroethylene (PTFE) membranes used for guided tissue regeneration. J Clin Periodontol 20: 193-198, 1993.
66.Murphy KG: Postoperative healing complications associated with Gore-Tex Periodontal Material. Part I. Incidence and characterization. Int J Periodont Restor Dent 15: 363-375, 1995.
67.Bratthall G, Soderholm G, Neiderud AM, Kullendorff B, Edwardsson S and Attstrom R: Guided tissue regeneration in the treatment of human infrabony defects. Clinical, radiographical and microbiological results: a pilot study. J Clin Periodontol 25: 908-914, 1998.
68.Simion M, Trisi P, Maglione M and Piattelli A: Bacterial penetration in vitro through GTAM membrane with and without topical chlorhexidine application. A light and scanning electron microscopic study. J Clin Periodontol 22: 321-331, 1995.
69.Zucchelli G, Pollini F, Clauser C and De Sanctis M: The effect of chlorhexidine mouthrinses on early bacterial colonization of guided tissue regeneration membranes. An in vivo study. J Periodontol 71: 263-271, 2000.
70.Mombelli A, Lang NP and Nyman S: Isolation of periodontal species after guided tissue regeneration. J Periodontol 64: 1171-1175, 1993.
71.Machtei EE, Cho MI, Dunford R, Norderyd J, Zambon JJ and Genco RJ: Clinical, microbiological, and histological factors which influence the success of regenerative periodontal therapy. J Periodontol 65: 154-161, 1994.
72.De Sanctis M, Zucchelli G and Clauser C: Bacterial colonization of bioabsorbable barrier material and periodontal regeneration. J Periodontol 67: 1193-1200, 1996.
73.Zucchelli G, De Sanctis M and Clauser C: Integrated connective tissue in bioabsorbable barrier material and periodontal regeneration. J Periodontol 68: 996-1004, 1997.
74.Yoshinari N, Tohya T, Mori A, Koide M, Kawase H, Takada T, Inagaki K and Noguchi T: Inflammatory cell population and bacterial contamination of membranes used for guided tissue regenerative procedures. J Periodontol 69: 460-469, 1998.
75.Smith MacDonald E, Nowzari H, Contreras A, Flynn J, Morrison J and Slots J: Clinical and microbiological evaluation of a bioabsorbable and a nonresorbable barrier membrane in the treatment of periodontal intraosseous lesions. J Periodontol 69: 445-453, 1998.
76.Nowzari H, MacDonald ES, Flynn J, London RM, Morrison JL and Slots J: The dynamics of microbial colonization of barrier membranes for guided tissue regeneration. J Periodontol 67: 694-702, 1996.
77.Parra B and Slots J: Detection of human viruses in periodontal pockets using polymerase chain reaction. Oral Microbiol Immunol 11: 289-293, 1996.
78.Silness P and Loe H: Periodontal disease in pregnancy. Acta Odontol Scand 22: 121-135, 1964.
79.Loe H and Silness P: Periodontal disease in pregnancy. Acta Odontol Scand 21: 533-551, 1963.
80.Dix K, Watanabe SM, McArdle S, Lee DI, Randolph C, Moncla B and Schwartz DE: Species-specific oligodeoxynucleotide probes for the identification of periodontal bacteria. J Clin Microbiol 28: 319-323, 1990.
81.Conrads G, Mutters R, Fischer J, Brauner A, Lutticken R and Lampert F: PCR reaction and dot-blot hybridization to monitor the distribution of oral pathogens within plaque samples of periodontally healthy individuals. J Periodontol 67: 994-1003, 1996.
82.Trombelli L, Schincaglia GP, Scapoli C and Calura G: Healing response of human buccal gingival recessions treated with expanded polytetrafluoroethylene membranes. A retrospective report. J Periodontol 66: 14-22, 1995.
83.Sander L and Karring T: New attachment and bone formation in periodontal defects following treatment of submerged roots with guided tissue regeneration. J Clin Periodontol 22: 295-299, 1995.