二次牙周龈下刮治与牙周翻瓣术短期临床疗效比较

Clinical Effect Comparison between Repeated Scaling and Open Flap Surgery in Patients with Chronic Periodontitis

目的比较二次牙周龈下刮治和根面平整(scaling and root planning,SRP)与牙周翻瓣术治疗慢性牙周炎的短期临床疗效。方法选取牙周基础治疗3个月后牙周探诊深度为5～7mm的前牙或前磨牙共52颗作为研究对象,随机分为2组,二次SRP组行龈下刮治和根面平整术,翻瓣组进行改良Widman翻瓣术。分别在治疗前、治疗后3个月和6个月,检查记录探诊出血(bleeding on probing,BOP)、探诊深度(probing depth,PD)、牙龈退缩(gingival recession,GR)及临床附着水平(clinical attachment level,CAL),并比较分析。结果二次SRP组和翻瓣组患牙的BOP阳性率、PD、GR、CAL治疗前分别为91.30%、(5.60±0.99)mm、(0.37±0.49)mm、(5.98±1.17)mm和92.13%、(5.87±1.02)mm、(0.30±0.47)mm、(6.03±1.30)mm,治疗后6个月分别为17.39%、(2.87±0.78)mm、(2.00±0.62)mm、(5.07±1.01)mm和11.23%、(2.53±0.51)mm、(2.36±0.68)mm、(4.89±0.84)mm,2组治疗后6个月各项指标与治疗前比较差异均有统计学意义(P<0.01)。治疗后6个月2组间BOP阳性率、PD及CAL比较差异无统计学意义(P>0.05),但翻瓣组GR明显高于二次SRP组(P<0.05)。结论对于前牙或前磨牙,二次SRP与牙周翻瓣术可达到相同的治疗效果,翻瓣术后牙龈退缩较二次牙周龈下刮治和根面平整后明显。

Objective To compare the clinical effect between repeated scaling and open flap surgery in patients with chronic periodontitis. Methods A total of 52 front teeth or premolar teeth, which still had deep pockets from 5 mm to 7 mm at 3m after initial therapy, were selected. All selected teeth were randomly divided into two groups. The second subgingival scaling group received scaling and root planning, while the surgery group received modified-Widman flap surgery. Clinical parameters of bleeding on probing （BOP）, probing depth （PD）, gingival recession （GR） and clinical attachment level （CAL） were recorded at baseline and 3 m, 6 m after therapy. Results BOP%, PD, GR, CAL values at baseline in second subgingival scaling group and surgery group were respectively 91.30%, （5.6±0.99） mm, （0.37±0.49） mm, （5.98±1.17） mm and 92.13%, （5.87±1.02） mm, （0.3±0.47） mm, （6.03±1.3） mm. And all indexes in two groups at 6m after therapy were respectively 17.39%, （2.87±0.78） mm, （2.0±0.62） mm, （5.07±1.01） mm and 11.23%, （2.53±0.51） mm, （2.36±0.68） mm, （4.89±0.84） mm, which were significantly improved than those at baseline in both groups （P0.01）. However, BOP%, PD and CAL values at final examination had no significant differences between two groups （P0.05）. Both treatments caused gingival recession, and gingival recession after surgery were significantly higher than those after second subgingival scaling therapy （P0.05）. Conclusion In our study, both treatments showed similar effects in improving clinical periodontal parameters of front teeth or premolar teeth, and surgery produced more gingival recessions than the second subgingival scaling.