龈下刮治和根面平整术联合Nd: YAG激光治疗慢性牙周炎的疗效评价

doi:10.7518/hxkq.2017.06.011

华西口腔医学杂志 ›› 2017, Vol. 35 ›› Issue (6): 618-624.doi: 10.7518/hxkq.2017.06.011

龈下刮治和根面平整术联合Nd: YAG激光治疗慢性牙周炎的疗效评价

殷艳丽^1,², 许春梅², 吴亚菲², 赵蕾²

1.襄阳市口腔医院牙周病科,襄阳 441000
2.口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院牙周病科,成都 610041

收稿日期:2017-01-05 修回日期:2017-04-02 出版日期:2017-12-20 发布日期:2017-12-01
作者简介:
殷艳丽,主治医师,硕士,E-mail:346035034@qq.com
基金资助:
国家卫生和计划生育委员会牙周病科国家临床重点专科建设项目（2010）;教育部留学回国人员科研启动项目（2013-693-11-11）

Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with Nd: YAG laser and scaling and root planning

Yanli Yin^1,², Chunmei Xu², Yafei Wu², Lei Zhao²

1. Dept. of Periodontics, Stomatological Hospital of Xiangyang, Xiangyang 441000, China
2. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2017-01-05 Revised:2017-04-02 Online:2017-12-20 Published:2017-12-01
Supported by:
Supported by: The National Key Clinical Practice Foundation of the Department of Periodontal Diseases of the Health Com-mission of China (2010);The Project for Launching Scientific Research for Returned Students from Ministry of Education (2013-693-11-11)

摘要/Abstract

摘要：

目的研究龈下刮治和根面平整术（SRP）联合Nd: YAG激光治疗对慢性牙周炎患者的疗效。方法选择口内有4颗及以上牙齿,探诊深度为4~8 mm的慢性牙周炎患者,研究位点为分布在口内4个不同象限的互不毗邻的单根牙。随机分成4组:对照组（不治疗）、SRP组（单纯SRP）、SRP+L组（SRP后行激光治疗）、L+SRP组（激光治疗后行SRP）。观测时间点为基线（临床处理前）和临床处理后1周、1个月、3个月,比较不同组在不同观测点牙周临床指标和龈下菌群中红色复合体（包括牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体）的组成变化。结果牙周临床指标:SRP、SRP+L、L+SRP组的各项临床指标变化均优于对照组;3个治疗组组间比较,探诊出血、探诊深度和临床附着丧失量之间无明显差异（P>0.05）,但在3个月时,L+SRP和SRP+L组的菌斑指数百分比下降较SRP组明显（P<0.05）。微生物检测结果:SRP、SRP+L、L+SRP组龈下菌斑中牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体百分比均较基线下降,3个治疗组间也存在一定差异（P<0.05）,但在不同观测时间点的差异不完全相同。结论慢性牙周炎治疗中,Nd: YAG激光联合SRP治疗较单纯SRP治疗未见明显优势,且Nd: YAG激光和SRP的治疗先后对临床效果也无明显影响;但激光联合SRP治疗可能较单纯SRP更有利于局部菌斑的控制。

关键词: 慢性牙周炎, 龈下刮治和根面平整术, Nd: YAG激光, 龈下菌斑, 红色复合体

Abstract:

Objective Our research aimed to detect the efficacy of non-surgical periodontal treatment with Nd: YAG laser and scaling and root planning (SRP) for chronic periodontitis. Methods We recruited chronic periodontitis patients who have more than four teeth with clinical pocket depth of 4-8 mm. These teeth were distributed in four different zones within the oral cavity. Moreover, the teeth were single root teeth and not adjacent to each other. The subordinated teeth were randomized into four groups, as follows: no treatment (C group), simple SRP (SRP group), Nd: YAG laser after SRP treatment (SRP+L group), and SRP after Nd: YAG laser treatment (L+SRP group). The four experimental observation points were as follows: before treatment (baseline) and 1 week, 1 month, and 3 months after treatment. We measured clinical indicators and collected subgingival deposits in the four time points to analyze changes of red complex in periodontitis. Results The clinical indi-cators were better in all treatment groups than in the control group. Comparison among treatment groups indicated that the value of bleeding on probing, periodontal probing depth, and clinical attachment loss showed no difference. However, the value of plaque index in SRP+L and L+SRP presented a significant reduction at 3 months after treatment. The percentages of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola in all treatment groups decreased after clinical treatment, and differences were observed among the treatment groups at different time points. Conclusion Non-surgical periodontal treatment with SRP and Nd: YAG laser is not more effective than SRP monotherapy. The sequence of laser treatment and SRP has no significant effect on the treatment. However, SRP with Nd: YAG laser was beneficial for plaque control. Non-surgical periodontal treatment with Nd: YAG laser may be used as an alternative to reduce and control the proliferation of microorganisms in persistent periodontitis, but it still needs further verification.

Key words: chronic periodontitis, scaling and root planning, Nd: YAG laser, subgingival plaque, red complex

中图分类号:

R781.4

殷艳丽, 许春梅, 吴亚菲, 赵蕾. 龈下刮治和根面平整术联合Nd: YAG激光治疗慢性牙周炎的疗效评价[J]. 华西口腔医学杂志, 2017, 35(6): 618-624.

Yanli Yin, Chunmei Xu, Yafei Wu, Lei Zhao. Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with Nd: YAG laser and scaling and root planning[J]. West China Journal of Stomatology, 2017, 35(6): 618-624.

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参考文献 20

[1]	Qadri T, Miranda L, Tunér J, et al.The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation[J]. J Clin Periodontol, 2005, 32(7):714-719.
[2]	Qadri T, Poddani P, Javed F, et al.A short-term evaluation of Nd:YAG laser as an adjunct to scaling and root planing in the treatment of periodontal inflammation[J]. J Periodontol, 2010, 81(8):1161-1166.
[3]	Qadri T, Javed F, Poddani P, et al.Long-term effects of a single application of a water-cooled pulsed Nd:YAG laser in supplement to scaling and root planing in patients with periodontal inflammation[J]. Lasers Med Sci, 2011, 26(6):763-766.
[4]	Slot DE, Kranendonk AA, Van der Reijden WA, et al. Ad-junctive effect of a water-cooled Nd:YAG laser in the treat-ment of chronic periodontitis[J]. J Clin Periodontol, 2011, 38(5):470-478.
[5]	Slot DE, Timmerman MF, Versteeg PA, et al.Adjunctive clinical effect of a water-cooled Nd:YAG laser in a perio-dontal maintenance care programme: a randomized controlled trial[J]. J Clin Periodontol, 2012, 39(12):1159-1165.
[6]	曾雄群, 李梅, 谭澍良, 等. Nd: YAG激光照射对牙周病患牙根面的影响[J]. 口腔医学纵横, 2001, 17(2):132-134.
	Zeng XQ, Li M, Tan SL, et al.Effect of Nd: YAG laser on periodontally involved root surfaces in vivo[J]. J Comprehens Stomatol, 2001, 17(2):132-134.
[7]	Gaspirc B, Skaleric U.Morphology, chemical structure and diffusion processes of root surface after Er:YAG and Nd:YAG laser irradiation[J]. J Clin Periodontol, 2001, 28(6):508-516.
[8]	Armitage GC.Development of a classification system for periodontal diseases and conditions[J]. Ann Periodontol, 1999, 4(1):1-6.
[9]	Silness J, Loe H.Periodontal disease in pregnancy. Ⅱ. Cor-relation between oral hygiene and periodontal condtion[J]. Acta Odontol Scand, 1964, 22:121-135.
[10]	O’Leary TJ, Drake RB, Naylor JE. The plaque control record[J]. J Periodontol, 1972, 43(1):38.
[11]	Siqueira JF Jr, Rôças IN.Simultaneous detection of Dialis-ter pneumosintes and Filifactor alocis in endodontic infections by 16S rDNA-directed multiplex PCR[J]. J Endod, 2004, 30(12):851-854.
[12]	Lopes BM, Theodoro LH, Melo RF, et al.Clinical and mi-crobiologic follow-up evaluations after non-surgical perio-dontal treatment with erbium:YAG laser and scaling and root planing[J]. J Periodontol, 2010, 81(5):682-691.
[13]	Yoshida A, Suzuki N, Nakano Y, et al.Development of a 5’ fluorogenic nuclease-based real-time PCR assay for quan-titative detection of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis[J]. J Clin Microbiol, 2003, 41(2):863-866.
[14]	Kato H, Yoshida A, Awano S, et al.Quantitative detection of volatile sulfur compound- producing microorganisms in oral specimens using real-time PCR[J]. Oral Dis, 2005, 11(Suppl 1):67-71.
[15]	Kelbauskiene S, Baseviciene N, Goharkhay K, et al.One-year clinical results of Er,Cr:YSGG laser application in addition to scaling and root planing in patients with early to moderate periodontitis[J]. Lasers Med Sci, 2011, 26(4):445-452.
[16]	Schwarz F, Sculean A, Berakdar M, et al.Periodontal treat-ment with an Er:YAG laser or scaling and root planing. A 2-year follow-up split-mouth study[J]. J Periodontol, 2003, 74(5):590-596.
[17]	Eltas A, Orbak R.Clinical effects of Nd:YAG laser appli-cations during non-surgical periodontal treatment in smoking and nonsmoking patients with chronic periodontitis[J]. Pho-tomed Laser Surg, 2012, 30:360-366.
[18]	Sgolastra F, Severino M, Petrucci A, et al.Nd:YAG laser as an adjunctive treatment to nonsurgical periodontal therapy: a meta-analysis[J]. Lasers Med Sci, 2014, 29(3):887-895.
[19]	Tomasi C, Schander K, Dahlén G, et al.Short-term clinical and microbiologic effects of pocket debridement with an Er:YAG laser during periodontal maintenance[J]. J Perio-dontol, 2006, 77(1):111-118.
[20]	Haffajee AD, Cugini MA, Dibart S, et al.The effect of SRP on the clinical and microbiological parameters of periodontal diseases[J]. J Clin Periodontol, 1997, 24(5):324-334.

实验菌株	目的基因	引物序列
细菌通用引物	16S rRNA	正向:5’-CGCAGAAGGTGAAAGTCCTGTAT-3’
		反向:5’-TGTGACGGGCGGTGTGTA-3’
福赛斯坦纳菌	16S rRNA	正向:5’-ATCCTGGCTCAGGATGAACG-3’
		反向:5’-TACGCATACCCATCCGCAA-3’
牙龈卟啉单胞菌	16S rRNA	正向:5’-TACCCATCGTCGCCTTGGT-3’
		反向:5’-CGGACTAAAACCGCATACACTTG-3’
齿垢密螺旋体	16S rRNA	正向:5’-AGAGCAAGCTCTCCCTTACCGT-3’
		反向:5’-TAAGGGCGGCTTGAAATAATGA-3’

测量项目	观测时间	SRP组（n=122）	SRP+L组（n=124）	L+SRP组（n=136）	C组（n=123）
测量值	基线	4.91±1.10	4.80±0.93	5.04±1.18	5.07±0.99
	1周	4.06±1.31^1）	4.06±1.19^1）	4.32±1.20^1）	5.00±1.00
	1个月	3.47±1.13^1）	3.19±1.06^1）	3.51±1.18^1）	4.76±1.16
	3个月	3.26±1.27^1）	3.03±1.07^1）	3.26±1.26^1）	4.85±1.11
与基线差值	1周	0.85±0.86^2）	0.75±0.81^2）	0.71±1.20^2）	0.07±0.56
	1个月	1.44±0.91^2）3）	1.61±1.29^2）3）	1.53±1.27^2）3）	0.31±0.78
	3个月	1.64±0.97^2）4）	1.77±1.27^2）4）	1.77±1.30^2）4）	0.22±0.73

测量项目	观测时间	SRP组（n=122）	SRP+L组（n=124）	L+SRP组（n=136）	C组（n=123）
测量值	基线	5.45±1.45	5.36±1.35	5.61±1.26	5.37±0.99
	1周	4.82±1.74^1）	5.01±1.57^1）	5.24±1.48^1）	5.30±0.99
	1个月	4.50±1.61^1）	4.41±1.64^1）	4.76±1.60^1）	5.06±1.16
	3个月	4.38±1.79^1）	4.53±1.55^1）	4.66±1.71^1）	5.15±1.11
与基线差值	1周	0.63±0.89^2）5）	0.35±0.82^2）	0.36±0.84^2）	0.07±0.56
	1个月	0.94±1.08^2）3）	0.94±1.56^2）3）	0.84±1.16^2）3）	0.31±0.78
	3个月	1.07±1.15^2）4）	0.82±1.57^2）4）	0.94±1.14^2）4）	0.22±0.73

龈下刮治和根面平整术联合Nd: YAG激光治疗慢性牙周炎的疗效评价

Clinical and microbiologic follow-up evaluations after non-surgical periodontal treatment with Nd: YAG laser and scaling and root planning

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