牙周内窥镜辅助龈下刮治治疗残存牙周袋的临床研究

doi:10.7518/hxkq.2021.04.010

摘要/Abstract

摘要： 目的

探究牙周内窥镜辅助龈下刮治和传统龈下刮治对非手术治疗后残存牙周袋的临床疗效差异。

方法

收集2019年6—12月于四川大学华西口腔医院牙周病科就诊的牙周炎患者13例，以基础治疗后4~6周再评估时探诊深度（PD）≥4 mm、附着丧失（AL）≥4 mm且探诊出血的残存牙周袋为研究对象，进行分口设计的单盲随机对照试验，口内一侧行传统龈下刮治（对照组），另一侧行牙周内窥镜辅助龈下刮治（内窥镜组）。在基线、治疗后6周和治疗后3月分别测量菌斑指数（PLI）、PD、AL及出血指数（BI），比较治疗前后2组各项牙周指标的变化和组间差异，并比较2组患者报告结局的差异。

结果

共251颗患牙的694个位点纳入临床试验。治疗后6周和3月2组各项牙周指标均显著改善（P<0.001）。对于单根牙、探诊深度≥5 mm的位点以及牙槽骨无角形吸收且无根分叉病变的位点，治疗后6周及3月内窥镜组的PD均低于对照组（P<0.05）。

结论

牙周内窥镜辅助龈下刮治对单根牙、PD≥5 mm及牙槽骨无角形吸收且无根分叉病变的残存牙周袋的疗效优于传统龈下刮治。

关键词: 牙周炎, 牙周内窥镜, 龈下刮治, 残存牙周袋

Abstract: Objective

To compare the treatment effects of periodontal endoscope-assisted and traditional subgingival scaling on residual pockets.

Methods

A total of 13 patients with periodontitis from Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University were recruited. After 4-6 weeks of initial treatment, the residual pockets with a probing depth (PD) of ≥4 mm and attachment loss (AL) of ≥4 mm and bleeding on probing were examined with traditional (control group) and periodontal endoscope-assisted subgingival scaling (endoscopy group) in a randomly controlled split-mouth design. At baseline and 6 weeks and 3 months after treatment, plaque index (PLI), PD, AL, and bleeding index (BI) were measured. Differences in these clinical parameters within and between groups and patient-reported outcomes were compared.

Results

A total of the 694 sites of 251 teeth were included in this trial. Both groups showed significant improvement in each periodontal parameters 6 weeks and 3 months after treatment (P<0.001). For sites in a single-rooted tooth, sites with PD≥5 mm, and sites without vertical alveolar bone resorption and furcation involvement, the PD in endoscopy group was significantly lower than that in the control group at 6 weeks and 3 months after treatment (P<0.05).

Conclusion

Periodontal endoscope-assisted subgingival scaling resulted in better effects than traditional subgingival scaling when the residual pockets were in a single-rooted tooth, with a PD of ≥5 mm but without vertical alveolar bone resorption and furcation involvement.

Key words: periodontitis, periodontal endoscope, subgingival scaling, residual pocket

中图分类号:

R 781.05

徐玉娟, 赵蕾, 吴亚菲, 段丁瑜. 牙周内窥镜辅助龈下刮治治疗残存牙周袋的临床研究[J]. 华西口腔医学杂志, 2021, 39(4): 441-446.

Xu Yujuan, Zhao Lei, Wu Yafei, Duan Dingyu. Clinical study of periodontal endoscope-assisted subgingival scaling in the treatment of residual pocket[J]. West China Journal of Stomatology, 2021, 39(4): 441-446.

图/表 4

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组别	总数	牙齿类型		PD/mm			根分叉病变	牙槽骨角形吸收
组别	总数	单根牙	多根牙	4	5~6	>6	根分叉病变	牙槽骨角形吸收
内窥镜组	337	198	139	52	248	37	51	60
对照组	357	236	121	62	265	30	31	40

牙周指标	组别	单根牙位点			多根牙位点
牙周指标	组别	基线	治疗后6周	治疗后3月	基线	治疗后6周	治疗后3月
PD/mm	内窥镜组	5.27±0.99	3.56±0.91^ab	3.43±0.94^ab	5.49±0.95	4.32±1.20^b	4.01±1.06^b
PD/mm	对照组	5.16±0.88	3.83±1.03^b	3.78±1.12^b	5.42±0.90	4.17±1.04^b	4.07±1.13^b
AL/mm	内窥镜组	6.18±1.58	5.13±1.62^b	5.04±1.72^b	6.12±1.49	5.24±1.73^b	4.98±1.59^b
	对照组	5.86±1.34	4.89±1.64^b	4.87±1.66^b	6.05±1.44	5.12±1.50^b	4.97±1.53^b
BI	内窥镜组	3.37±0.66	2.11±0.85^b	2.03±0.86^b	3.37±0.66	2.63±1.02^b	2.52±0.97^b
	对照组	3.38±0.75	2.23±0.99^b	1.96±0.88^b	3.47±0.73	2.67±0.98^b	2.44±1.02^b
PLI	内窥镜组	1.45±0.83	1.14±0.82^b	1.37±0.79^b	1.88±0.83	1.51±0.92^b	1.53±0.85^b
	对照组	1.47±0.80	1.11±0.77^b	1.41±0.81^b	1.93±0.86	1.52±0.98^b	1.64±0.97^b

牙周指标	组别	PD=4 mm的位点			5 mm≤PD≤6 mm的位点			PD>6 mm的位点
牙周指标	组别	基线	治疗后6周	治疗后3月	基线	治疗后6周	治疗后3月	基线	治疗后6周	治疗后3月
PD/mm	内窥镜组	4±0	3.04±0.44^b	3.00±0.63^b	5.35±0.48	3.88±1.03^b	3.68±0.97^abc	7.38±0.72	5.03±1.19^b	4.51±1.22^ab
PD/mm	对照组	4±0	3.16±0.63^b	3.05±0.73^b	5.31±0.46	3.95±0.91^b	3.89±0.98^b	7.30±0.47	5.53±1.04^b	5.43±1.36^b
AL/mm	内窥镜组	4.71±1.13	4.04±1.20^b	3.90±1.19^b	6.15±1.24	5.21±1.62^b	5.09±1.62^b	8.27±1.54	6.54±1.41^b	6.05±1.70^b
	对照组	4.74±1.29	4.11±1.53^b	4.08±1.55^b	6.03±1.22	5.00±1.52^b	4.94±1.55^b	7.47±0.82	6.43±1.25^b	6.27±1.28^b
BI	内窥镜组	3.19±0.63	1.90±0.96^b	1.96±0.93^b	3.44±0.71	2.36±0.96^b	2.24±0.92^b	3.73±0.51	2.65±0.75^b	2.51±0.99^b
	对照组	3.15±0.90	2.11±1.10^b	1.77±1.03^b	3.44±0.71	2.42±0.96^b	2.17±0.93^b	3.67±0.48	2.63±1.07^b	2.40±0.86^b
PLI	内窥镜组	1.58±0.89	1.13±0.97^b	1.38±0.82^b	1.65±0.84	1.34±0.86^b	1.45±0.81^b	1.57±0.87	1.16±0.87^b	1.41±0.86^b
	对照组	1.37±0.87	1.11±0.79^b	1.32±0.90^b	1.67±0.83	1.25±0.89^b	1.54±0.86^b	1.77±0.90	1.50±0.86^b	1.40±0.97^b

牙周指标	组别	根分叉病变位点			牙槽骨角形吸收位点
牙周指标	组别	基线	治疗后6周	治疗后3月	基线	治疗后6周	治疗后3月
PD/mm	内窥镜组	5.41±1.13	4.49±1.35^b	4.18±1.23^b	5.70±0.94	4.70±1.31^b	4.40±1.22^b
	对照组	5.58±0.99	4.23±1.20^b	4.26±1.21^b	5.58±0.98	4.38±1.25^b	4.28±1.43^b
AL/mm	内窥镜组	6.47±1.80	5.92±2.07^b	5.57±1.92^b	6.50±1.49	5.83±1.82^b	5.63±1.77^b
	对照组	6.61±1.58	5.68±1.68^b	5.65±1.56^b	6.50±1.30	5.68±1.62^b	5.48±1.65^b
BI	内窥镜组	3.39±0.67	2.61±1.23^b	2.49±1.03^b	3.28±0.61	2.98±0.81^b	2.77±0.95^b
	对照组	3.52±0.57	2.61±1.02^b	2.29±1.19^b	3.33±0.66	2.65±0.98^b	2.35±0.89^b
PLI	内窥镜组	1.75±0.84	1.20±0.83	1.45±0.86	1.87±0.79	1.68±0.85	1.58±0.87
	对照组	1.84±0.86	1.23±0.99	1.58±1.06	1.68±0.76	1.45±0.93	1.58±0.90

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