光动力疗法对慢性牙周炎龈下牙周致病菌的影响

Effects of photodynamic therapy on periodontal pathogens in subgingival plaque of chronic periodontitis

目的:应用PeriowaveTM光动力杀菌系统对慢性牙周炎患者进行治疗,通过龈下菌斑中牙周致病菌比例的变化,评价光动力疗法(photodynamic therapy,PDT)治疗慢性牙周炎的临床效果。方法:选取60名慢性牙周炎患者,分别给予SRP+1次PDT(A组)、SRP+2次PDT(B组)或单纯SRP(C组)治疗。利用real-time PCR技术检测A、B、C三组在治疗前、治疗后6周、治疗后12周龈下菌斑中牙周致病菌P.g、A.a、T.f所占比例的变化。结果:治疗后6周,A、B两组牙周致病菌P.g在总菌中的比例都有非常显著降低(p<0.01),C组有显著降低(p<0.05);治疗后12周,A、B组仍有非常显著的降低(p<0.01),与C组相比有非常显著差异(p<0.01),但A、B两组之间没有差异(p>0.05);而仅在治疗后12周,B组的A.a相对于总菌的比例与基线相比有显著降低(p<0.05),且这一变化显著大于A、C两组(p<0.05);在治疗后6周,A、B组T.f相对于总菌含量的下降与基线相比,明显大于C组(p<0.05),治疗后12周,A、B两组T.f相对于总菌的含量仍有非常显著的下降(p<0.01),但A组和B组之间都没有差异。结论:PDT对P.g、A.a和T.f3种牙周致病菌都有杀灭作用,但P.g、T.f对PDT更为敏感,PDT可以作为治疗慢性牙周炎的辅助方法。

Objective： This study was to determine the effect of PeriowaveTM photodynamic disinfection treatment on the subgingival microbiota of chronic periodontitis.nethod： Sixty patients with untreated chronic periodontitis were randomly divided into three groups： group A received scaling and root planing （SRP） plus a single photodynamic therapy （PDT） ;group B received SRP followed by two PDT： and group C received SRP alone. Real-time PCR was performed at baseline, 6 and 12 weeks after treatment to determine the proportions of Porphyromonas gingiwdis,ActinobaciUus actinomycetemcomitans and Tannerellaforsythia in subgingival microbiota of these patients. Result： The proportions of P. gingivalis showed significant reductions in all the three group （group A and B,p〈0.01：group C, （p〈0.05） at 6 weeks after treatment. No significant differences were observed between group A and group B （p〉0.05）：however, these two groups showed higher reductions than that of group C at 12 weeks after treatment （p〈0.01）. The proportion of A. actinomycetemcomitans significantly decreased in group B at 12 weeks after treatment （p〈0.05）.This reduction was greater than that of group A and group C （p〈0.05）. At 6 and 12 weeks after treatment, the proportions of 7： forsythia showed constant reductions in group A and B （p〈0.01）. There were no significant differences of T. forsythia proportions between group A and group B. The reductions in group A and B was greater than group C （p〈0.05） at 6 weeks after treatment. Conclusion： These data suggest that PDT was effective in reducing the proportions of periodontal pathogens in subgingival microbiota of chronic periodontitis and may serve as an adjunct to periodontal treatment.Among the three tested periodontal pathogens,P, gingivalis and T. forsythia were more sensitive to PDT than A. actinomycetemcomitans.