应用Er:YAG激光治疗慢性牙周炎的短期临床疗效观察

A short-term clinical evaluation of periodontal treatment with an Er:YAG laser for patients with chronic periodontitis: a split-mouth controlled study

目的:比较单独使用Er:YAG激光与传统的超声龈下刮治联合手工根面平整术治疗慢性牙周炎的短期临床疗效差异。方法:共纳入17例慢性牙周炎患者,以超声洁治后2周作为基线。采用分口设计方案,按照随机原则一侧(实验侧)应用Er:YAG激光进行龈下治疗,另一侧(对照侧)为联合应用超声龈下刮治和手工根面平整术。治疗完成即刻应用视觉模拟评分法(visual analogue scale,VAS)让患者对治疗产生的疼痛度进行评分。基线和治疗后2个月、4个月由一名牙周探诊经过校准的并且不清楚治疗方案的医师测量如下指标:菌斑指数(plaqueindex,PLI)、牙龈出血指数(bleeding index,BI)、探诊深度(probing depth,PD)和附着丧失(attachment loss,AL)。结果:激光组产生的疼痛度显著低于对照组,VAS值分别为3(2,4.5)和5(4,6),P=0.013。无论是激光治疗组还是对照组,治疗后2个月和4个月时PLI、PD、BI和AL与基线比较均有明显下降。对于基线时PD≥4 mm的位点,激光治疗组治疗后2个月和4个月时PD均值由基线的(5.6±1.1)mm分别降到(3.6±1.1)mm和(3.4±1.0)mm,AL均值由(5.1±1.5)mm降到(3.9±1.6)mm和(3.8±1.7)mm,同时BI也有明显下降,P=0.000。对照组治疗后2个月和4个月时PD均值由基线的(5.6±1.1)mm分别降到(3.8±1.1)mm和(3.5±1.0)mm,AL均值由(4.8±1.6)mm降到(3.8±1.6)mm和(3.6±1.8)mm,BI也有明显改善。激光治疗组和对照组之间临床指标的变化无显著差异。结论:Er:YAG激光作为慢性牙周炎的非手术治疗方法是安全有效的,可以用于一些对疼痛较敏感的牙周炎患者的替代治疗方法。

Objective：To compare the short-term clinical effects following non-surgical periodontal treatment with Er：YAG laser or with combination of ultrasonic subgingival scaling and root planing with hand instrument（SRP） for patients with chronic periodontitis.Methods： In the study,17 patients with chronic periodontitis were randomly treated in a split-mouth design with Er：YAG laser（test group） or a combination of ultrasonic subgingival scaling and root planing with hand instrument（control group）.The degree of discomfort experienced during the treatment was graded by the patient using visual analogue scale（VAS） immediately after the completion of test and control treatment procedures.The following clinical parameters were recorded by a calibrated and blinded examiner： plaque index（PLI）,bleeding index（BI）,probing depth（PD） and attachment loss（AL）.Results： The mean VAS score of Er：YAG laser treatment [3（2,4.5）] was significantly lower than that of control treatment [5（4,6）,P=0.013].Both the groups showed significant reduction of PLI,PD,AL and BI values 2 months and 4 months after treatment.For sites with PD≥4 mm at baseline,the sites treated with Er：YAG laser demonstrated mean PD change from（5.6±1.1） mm to（3.6±1.1） mm and to（3.4±1.0） mm at the end of 2 months and 4 months respectively and demonstrated mean AL change from（5.1±1.5） mm to（3.9±1.6） mm and to（3.8±1.7） mm at the end of 2 months and 4 months respectively,meanwhile the BI value showed significant decrease,P=0.000;the sites treated with conventional SRP demonstrated mean PD change from（5.6±1.1） mm to（3.8±1.1） mm and（3.5±1.0） mm at the end of 2 months and 4 months respectively and demonstrated mean AL change from（4.8±1.6） mm to（3.8±1.6） mm and（3.6±1.8） mm at the end of 2 months and 4 months respectively,and the BI value also showed significant improvement.No statistical difference for all clinical parameters were found between the two treatment groups.Conclusion： The present results indicate that non-surgical periodontal therapy with Er：YAG laser is safe and effective,and Er：YAG laser therapy could be used for patients who was sensitive to pain.