80例二次龈下刮治与牙周翻瓣术治疗慢性牙周炎的临床疗效比较

The comparison of effect of repeated SRP and periodontal flap surgery applied in 80 cases of chronic periodontitis

目的比较二次龈下刮治与牙周翻瓣术在慢性牙周炎基础治疗后效果欠佳的患牙中的应用效果。方法选择2011年8月~2014年8月期间我院诊治的慢性牙周炎患者共80例,同名牙分别随机分为翻瓣组和刮治组,翻瓣组给予改良Widman翻瓣术,局部浸润麻醉下首先作内斜切口将袋内壁上皮组织切除,清理肉芽组织,保留健康组织瓣并翻起,暴露根面牙石,术者在直视条件下将牙石刮净,并平整根面。刮治组给予二次龈下刮治术,采用手用牙周治疗器械,将牙周袋内残存上皮及炎性肉芽组织以及在牙根表面附着的牙石和菌斑刮净,同时将病变牙本质一并刮除,平整根面,尖探针确认根面光洁。比较两组患牙治疗前后探诊深度、附着丧失、龈沟出血指数、菌斑指数等牙周临床指标以及牙槽骨的吸收情况等。结果两组患牙再次治疗术前的探诊深度、附着丧失、龈沟出血指数以及菌斑指数等无统计学差异（t=0.002、0.001、0.003、0.004,均P〉0.05）。术后1个月及术后3个月均较术前明显好转（均P〈0.05）,但组间比较差异无统计学意义（均P〉0.05）。翻瓣组术后控制牙槽骨吸收有效率为91.25%,刮治组的有效率为88.75%,两组有效率组间比较无统计学差异（χ2=0.163,P〉0.05）。结论对于未累及根分叉的中度牙周炎患牙,采用二次龈下刮治术能获得理想治疗效果,手术操作更为简单,对患者造成损伤更小,更易于被患者所接受,值得临床推广。

Objective To compare the effect of repeated SRP and periodontal flap surgery applied after periodental non-surgical treatment in chronic periodontitis. Methods A total of 80 cases of chronic periodontitis patients treated by author from August 2011 to 2014 were selected and homonym teeth were grouped in flap group and SRP group ran- domly. Modified Widman flap surgery was given in flap group. Internal bevel incision was made after local infiltra- tion anesthesia to exsect periodontal pocket wall tissue,clean granulation tissue, retain and upturn healthy tissue, ex- pose dental calculus on root surface. Dental calculus was removed and root surface was planed by operator open. Re- peated SRP was given in SRP group. Hand periodontal treatment instrument was applied to remove the remaining ep- ithelium and inflammatory granulation tissue in periodontal pocket and dental calculus and dental plaque on root sur- face. The lesion dentin was removed and root surface planed at the same time. Needle was applied to comfier the smooth and clean of the root surface. The probing depth, attachment loss, suleus bleeding index,plaque index and ab- sorbing of alveolar between the two groups were compared. The situations of periodontol clinical index and alveolar bone absorption after treatment were compared. Results There were no significant difference of PD, AL,SBI and PLI in the two groups before repeated treatment （t=0.002,0.001,0.003,0.004,all P〉0.05）. The effects 1 month and 3 months later were better than that before repeated treatment （both P〈0.05）,but there was no significant difference between the two groups at the same time （both P〉0.05）. The efficient of alveolar bone absorption control was 91.25% in flap group, and 88.75% in SRP group. There was no significant difference between the two groups （χ2=0.163,P〉0.05）. Conclusion It is effective to apply repeated SRP in chronic periodontitis cases in which the region of root fureation is not involved, and it is easier, less damage and more acceptable. It is worthy of clinical.