一次性全口和分区龈下刮治术与全身急性炎症反应的关系

Association of full-mouth subgingival scaling and root planning and quadrant subgingival scaling and root planning with systemic acute inflammatory reaction

目的观察中、重度牙周炎患者在一次性全口龈下刮治(FM-SRP)或分区龈下刮治(Q-SRP)治疗后全身急性炎症反应的发生情况。方法将20例中、重度牙周炎患者随机分为FM-SRP组(一次性完成全口龈下刮治和根面平整)和Q-SRP组(每次进行单个象限的刮治),每组10例。测量并比较两组患者菌斑指数(PI)、牙龈指数(GI)、探诊出血(BOP)、探诊深度(PD)及临床附着丧失(CAL)等临床指标的基线值。分别于刮治开始前和刮治完成后2h,检测血清炎症因子C反应蛋白(CRP)水平;采用问卷调查方式记录患者术中和术后牙龈疼痛程度、是否服用止痛药物以及发热等急性炎症反应发生情况。结果两组患者临床指标的基线值比较差异无统计学意义(P>0.05)。FM-SRP组和Q-SRP组患者血清CRP水平,治疗前分别为(3.17±0.54)mg/L和(3.42±0.71)mg/L,治疗后2h分别为(3.17±0.54)mg/L和(3.46±0.83)mg/L,同一时点两组患者间比较以及治疗前后患者自身对照比较,差异均无统计学意义(P>0.05)。问卷调查的术中和术后反应情况分析显示,在同一时点两组患者间比较以及治疗前后患者自身对照比较,差异均无统计学意义(P>0.05)。结论 FM-SRP和Q-SRP均未引起中、重度牙周炎患者全身急性炎症反应,临床医师可根据实际情况选择合适的龈下刮治方法。

Objective To observe the systemic acute inflammatory reaction after full-mouth subgingival scaling and root planning （FM-SRP） or quadrant subgingival scaling and root planning （Q-SRP） in patients with moderate or severe periodontitis.Methods Twenty patients with moderate or severe periodontitis were randomly divided into FM-SRP group and Q-SRP group （n=10）.The baseline clinical parameters of plaque index （PI）,gingival index （GI）,bleeding on probing （BOP）,probing depth （PD） and clinical attachment loss （CAL） were measured and compared.Serum C-reactive protein （CRP） was detected before and 2 h after scaling.Questionnaire survey was conducted to record the gingival pain during and after operation,the use of analgesic drugs and the conditions of acute inflammatory reaction such as fever.Results There was no significant difference in the baseline clinical parameters between the two groups （P0.05）.There was no significant difference in CRP levels between FM-SRP group and Q-SRP group before scaling [（3.17±0.54） mg/L vs （3.42±0.71） mg/L] and 2 h after scaling [（3.17±0.54） mg/L vs （3.46±0.83） mg/L]（P0.05）,and there was no significant change after scaling within groups （P0.05）.Questionnaire survey revealed that there was no significant difference in operative and postoperative reactions between groups,and there was no significant changes after scaling within groups （P0.05）.Conclusion Both FM-SRP and Q-SRP may not lead to systemic acute inflammatory reaction in patients with moderate or severe periodontitis,and proper subgingival scaling modality may be chosen according to the clinical practice.