歯周処置後の経過観察に関する研究

Abstract

Recently, the diagnosis and therapy of periodontal disease, especially chronic marginal periodontitis, have advanced remarkably.In observing the postoperative process of a periodontal patient, it is considered necessary that observations of the oral conditions should be combined with the transposition of the alveolar bone.Therefore, the author was concerned with the clinical findings, especially regarding the plaque Index (Pl. I.), gingival Index (G. I.) and periodontal pocket depth (P. D.), as radiographed in the alveolar bone both preoperatively and postoperatively.The sample of this study was a consist of 52 patients (27 males and 25 females) who were treated in the periodontics of Nihon University Dental Hospital, ranging from 16 to 62 years in age. At the time their initial consultation, these subjects were classified into 1) vertical type and 2) horizontal type according to the resorption pattern of their alveolar bone. Concerning the latter type, they were further classified as P1 P2 and P3 groupes based on Russell's Index.The subjects were further divided into a group of toothbrushing instruction together with the removal of dental calculus and a group of flap operation. The former group was subjected to the standardized intraoral radiography at the initial construction, after 3 months, 6 months and 10 months, whereas the latter group were examined at the initial construction, 3 months after initial therapy, 3 months post-treatment, 6 months and 10 months postoperatively in conjuction with their clinical findings and radiographs. The results were as follows:1. The patients who were instructed in toothbrushing and removal of their dental calculus were found to be reduced in Pl. I. and G. I. as well as P. D. proportionately to the passage of time.But there were observed some differences according to the degree of alveolar bone resorption and clinical findings as above classified.2. In the patients who were subjected to the flap operation, Pl. I. and G. I. as well as P. D., the values were observed to have been much reduced after operations. Therefore, no remarkable change was noted after the operations.3. The height and change in the alveolar bone area were measured on the standardized dental radiographs. As a consequence, it was found that the height showed a tendency of increase postoperatively in common with the different types of periodontal diseases.However, the area of P2 and P3 in the horizontal group decreased till about 3 months after the toothbrushing instruction and removal of dental calculus but this tendency did not change till 10 months of experiments.As regards the horizontal P1 and vertical groups, on the other hand, there was observed a tendency of an increase in the surface area from 3 months onward from the removal of dental calculus.This was also true of the cases of flap operation after 3 months of the toothbrushing instruction and the removal of dental calculus. This tendency was particularly noteworthy with the vertical group.4. The patients who were subjected to flap operation were divided, after 10 months, into those Pl. I. was less than 0.4 and larger than 0.4. of cases having the Pl. I. less than 0.4 was found to have the tendency of an increase.As a result of statistical difference determination, there was confirmed a statistical difference at α=0.01 between the two groups.