吸烟对慢性牙周炎患者牙槽骨缺损影响研究

Effect of smoking on alveolar bone defect in patients with chronic periodontitis

目的探讨吸烟对慢性牙周炎患者牙槽骨缺损的影响。方法从2012年10月至2014年3月中国医科大学附属口腔医院牙周科确诊为慢性牙周炎的患者中选择吸烟与非吸烟患者各30例,分别作为吸烟组与非吸烟组。采用Florida探针检查其全口牙齿近中、远中、唇(颊)侧及舌(腭)侧4个位点的牙周探诊深度(PD)及附着丧失水平(AL)。采用锥形束CT(CBCT)对入选对象进行扫描,并应用其自带的NNT软件测量切牙区、尖牙区、前磨牙区及磨牙区牙齿近中、远中、唇(颊)侧及舌(腭)侧4个位点的牙槽骨缺损程度。结果吸烟组与非吸烟组的PD和AL差异无统计学意义(P>0.05),吸烟组的平均牙槽骨缺损程度较非吸烟组重,差异有统计学意义(P<0.05)。吸烟组与非吸烟组相比,相同牙位的各个位点牙槽骨缺损都较重,差异有统计学意义(P<0.05)。两组中各牙位牙槽骨缺损程度最轻的部位位于尖牙区,缺损程度最重的部位位于磨牙区(P<0.05)。吸烟组中相同牙位的不同位点之间牙槽骨缺损程度差异有统计学意义(P<0.05),其中缺损程度最重的位于上颌磨牙区腭侧;除下颌磨牙区远中位点和下颌切牙区颊舌侧位点外,上颌各牙位牙槽骨缺损程度较下颌相应牙位重,差异有统计学意义(P<0.05)。非吸烟组中不同牙位相同位点的牙槽骨缺损程度自磨牙区向尖牙区呈逐渐减小的趋势;但下颌切牙区各位点牙槽骨缺损程度明显高于上颌切牙区,差异有统计学意义(P<0.05)。结论慢性牙周炎患者中,吸烟者较非吸烟者牙槽骨缺损重。吸烟对于慢性牙周炎患者牙槽骨缺损的影响存在牙位和位点特异性表现,最严重的部位位于上颌磨牙区腭侧。CBCT的应用有利于临床医生更好地了解牙槽骨缺损的形式,会对牙周病诊断及治疗提供更大的帮助。

Objective To study the effect of smoking on alveolar hone defect in patients with chronic peridontitis. Meth- ods Select thirty patients respectively in smoking and non-smoking patients with chronic periodontitis, who are scanned by cone beam CT（CBCT）. Florida probe is applied to measure the PD and AL of all the teeth（including teeth＇s mesial, distal, buccal, lingual）. NNT software is applied to measure the average degree of alveolar bone defects in differ- ent regions ： incisor area, canine area, premolar area and molar area（including teeth＇s mesial, distal, buccal, lingual）. Re- suits The periodontal probing depth and attachment loss level had no significant difference（P 〉 0.05）in smoking group and non-smoking group ; smoking group＇s alveolar bone defect degree was more serious than non-smoking group, the dif- ference being statistically significant （P 〈 0.05）. Compared with the non-smoking group, alveolar bone defects in smok- ing group in each site of the same teeth were more serious, the difference being statistically significant （P 〈 0.05）. In two groups, the alveolar bone defect of canine area was the mildest, the most serious part of the alveolar bone defect in molar area（P 〈 0.05）. The alveolar bone defect had sig- nificant differences in smoking group among different sites of the same teeth（P 〈 0.05）, while the most serious part in maxillary molars palatal. In smoking group, except for the distal sites of mandibular molar area and buccal and lingual sites of mandibular incisor area, the alveolar bone de- fect of maxillary teeth was more serious than mandibular teeth, the difference being statistically significant （P 〈 0.05）. In non-smoking group, the alveolar bone defect of the same site in different teeth showed a decreasing trend from the molar area to the canine area. But the alveolar bone defect of each point in mandibullar incisor area was significantly higher than maxillary incisor area, the difference being statistically significant （P 〈 0.05）. Conclusion In chronic periodonti- tis patients, the alveolar bone defect of smokers is more serious than non-smokers. The alveolar bone defects of smokers with chronic periodontitis present teeth and site-specific effects and the most serious area is located in maxillary molars palatal. The application of CBCT is conducive for the clinicians to have a better understanding of the alveolar bone defect forms, and provides more help to the diagnosis and treatment of periodontal disease.