不同牙合治疗对伴有咬合创伤的慢性牙周炎患牙转归的临床研究

Effect of different periodontal occlusal therapy on teeth with chronic periodontitis and secondary occlusal trauma

目的:比较两种不同的牙合治疗方式:单纯调牙合治疗与暂时性牙周夹板治疗,对伴有咬合创伤的牙周炎患牙,牙周临床指标及咬合指标变化的影响。方法:将18例伴有咬合创伤的慢性牙周炎患者按照咬合时间测定值大小分层区组随机分为A、B两组,每组9例;0d时(基线),两组实施全口龈下刮治+根面平整治疗;第28d,A组咬合创伤牙位实施调牙合治疗,B组咬合创伤牙位实施暂时性牙周夹板治疗;第56d,B组拆除暂时性牙周夹板。调牙合在T-ScanⅢ型咬合分析系统指导下完成。在0、28、56 d、84d检查A、B两组全口牙周探诊深度、附着丧失、出血指数、咬合创伤牙位咬合时问及咬合受力百分比。采用SPSS 18.0统计软件对基线时A、B两组间牙周临床指标及咬合指标差异、各组内治疗前后牙周临床指标与咬合指标变化、两组在84d牙周临床指标与咬合指标变化值的差异进行配对t检验,检验水准为双侧d=0.05。结果:龈下刮治+根面平整后咬合创伤牙位牙周临床指标及咬合指标均显著降低(P<0.05);B组行暂时性牙周夹板治疗后后纳入牙位出血指数升高,差异有统计学意义(P<0.05),其余牙周临床指标无统计学差异(P>0.05)。84d时,A、B两组牙周临床指标较基线的改变值均无统计学差异(P>0.05);咬合时间、咬合受力百分比相比基线的改变值A组显著大于B组,有统计学差异(P<0.05)。结论:慢性牙周炎合并咬合创伤的下前牙,龈下刮治+根面平整可改善其咬合时间及受力百分比;

Objective： To evaluate the effect of temporary periodontal splint and occlusal adjustment on clinical and oc- clusal parameters in teeth with chronic periodontitis and secondary occlusal trauma. Methods： Eighteen patients with chronic periodontitis and occlusal trauma were included and randomly divided into group A and group B. On Day 0, Group A and B were treated with full-mouth subgingival scaling and root planning. On Day 28, Group A was treated with occlusal adjust- ment in occlusal trauma site, and Group B was treated with temporary periodontal splint in occlusal trauma site. On Day 56, the temporary periodontal splint was removed. Probing depth （PD）, attachment loss （AL）, bleeding index （BI） were evaluat- ed on Day 0, 28, 56 and 84, and the occlusal time （OT） and the percentage of occlusal force were evaluated in occlusal trau- ma site simultaneously. The data was statistically analyzed. Results： In baseline, the PD. AL. BI of the full-mouth and oc- clusal trauma site showed no significant difference between the two groups （P〉0.05）. There was no significant difference OT and the percentage of occlusal force in occlusal trauma site between the two groups （P〉0.05）. After SRP therapy, the periodontal clinical parameters and occlusal parameters were significantly decreased （P〈0.05）. BI of the group B were sig- nificantly increased after temporary periodontal splint therapy （P〈0.05）, the other clinical parameters exhibited no signifi- cant difference after only occlusal adjustment （P〉0.05）. On Day 84, the reduction in clinical parameters was not significantly different between the two groups （P〉0.05）. The reduction of OT and the change of the percentage of occlusal force in Group A were more significant than Group Bl. Conclusions： Occlusal adjustment alone is inadequate for control and management of periodontitis. SRP therapy can eliminate the inflammation and decrease the occlusal parameters of tooth with occlusal trauma. The temporary periodontal splint therapy may achieve more stable results.