中重度多根牙牙周炎患者牙周内窥镜下非手术治疗的临床应用

Clinical application of non-surgical treatment under periodontal endoscope in patients with moderate-to-severe periodontitis of multirooted teeth

目的:观察牙周内窥镜下非手术治疗对牙周基础治疗后仍残留中重度牙周袋多根牙的治疗效果,阐明牙周内窥镜在辅助牙周非手术治疗中的临床意义。方法:24例牙周炎患者经牙周基础治疗后仍有127颗多根牙残留中重度牙周袋。对纳入的多根牙行牙周内窥镜辅助下的牙周非手术治疗,采用牙周风险评估(PRA)系统评估牙周风险因素控制状况,采用Florida探针系统检测治疗后患牙探诊深度(PD)、探诊出血(BOP)、附着丧失(AL)和牙石清除率,观察根分叉病变患牙百分比。结果:牙周内窥镜辅助牙周非手术治疗3个月后,所有患牙治疗后风险因素减少,预后较好。与治疗前比较,治疗后患牙的PD值和BOP阳性位点百分比明显降低(P<0.01),其中近远中位点的PD值较中央位点的PD值下降更为明显(P<0.01);牙石阳性率明显降低(P<0.01),AL差异无统计学意义(P>0.05)。与治疗前比较,治疗后Ⅰ度根分叉病变患牙占多根牙总数的百分率明显降低(P<0.05),但Ⅱ度及以上根分叉病变患牙百分率差异无统计学意义(P>0.05)。结论:对残留中重度牙周袋的多根牙行牙周内窥镜下非手术治疗的效果良好,可在一定程度上避免牙周手术治疗。

Objective : To observe the curative effect of non-surgical treatment under periodontal endoscope in the patients with moderate-to-severe periodontal pockets of multirooted teeth after scaling and root planning(SRP), and to expound the clinical significance of periodontal endoscope in assisting periodontal non-surgical treatment. Methods : After SRP, there were still more than 127 multirooted teeth with moderate-to-severe periodontal pockets in 24 patients with periodontitis. The above multirooted teeth received non-surgical treatment under periodontal endoscope, the control of periodontal risk factors was evaluated by the periodontal risk assessment(PRA) model;the probing depth(PD),bleeding on probing (BOP), attachment loss (AL), calculus residual rate of the patients after treatment were detected by Florida Probe system;the percentage of furcation defect was detected. Results : After 3 months of periodontal endoscope-assisted periodontal non-surgical treatment, the risk factors of the patients after treatment were reduced and the patients had good prognosis.The PD value and percentage of BOP positive sites of the teeth of the patients after treatment were significantly decreased compared with before treatment ( P < 0.01);the PD value of the near-distal median point was obviously decreased compared with the PD value of the central site( P < 0.01);the positive rate of calculus was significantly decreased( P <0.01);there was no significant difference in the AL( P >0.05). The percentage of teeth with Class Ⅰ furcation involvement among the multirooted teeth after treatment was significantly lower than before treatment ( P <0.05), but the percentage of teeth with Class Ⅱ and above furcation involvement had no significantly difference between before and after treatment ( P >0.05). Conclusion : The effect of periodontal endoscope-assisted non-surgical treatment for the multirooted teeth with residual moderate-to-sever periodontal pockets after SRP, and it can avoid periodontal operation to some extent.