超声龈下清创联合手工根面平整术治疗重度牙周炎的临床效果

Clinical outcomes of ultrasonic subgingival debridement combined with manual root planing in severe periodontitis

目的:比较超声龈下清创术和超声龈下清创联合手工根面平整术的临床效果,探讨超声龈下清创术后实施手工根面平整术的临床必要性。方法:选择2017年10月至2018年10月在北京大学口腔医院牙周科就诊的符合纳入标准的23例重度牙周炎患者,采用分口设计的方法,洁治后进行基线检查及随机分组,上、下颌各有一个象限为试验组,单纯采用超声龈下清创联合手工根面平整术治疗,另两个象限为对照组,单纯采用超声龈下清创术治疗,每位患者分上、下半口两次完成治疗,间隔1周,在治疗后2周、1个月、3个月及6个月时随访,记录并比较治疗前后组内及组间探诊深度(probing depth,PD)、临床附着丧失(clinical attachment loss,CAL)和出血指数(bleeding index,BI)的变化。结果:基线时,试验组和对照组的各项临床指标差异无统计学意义,治疗后试验组和对照组的PD、CAL及BI较治疗前均有显著改善。治疗后1个月及3个月,试验组PD减少量均高于对照组,差异有统计学意义[1个月:(2.13±1.31)mm vs.(1.79±1.33)mm,P<0.01;3个月:(2.46±1.33)mm vs.(2.17±1.38)mm,P<0.01],试验组CAL减少量均高于对照组,差异有统计学意义[1个月:(1.89±2.03)mm vs.(1.65±1.93)mm,P<0.01;3个月:(2.03±2.05)mm vs.(1.83±1.97)mm,P<0.05];术后6个月,试验组PD减少量为(2.52±1.40)mm,对照组PD减少量为(2.35±1.37)mm,试验组的改善优于对照组(P<0.01);两组CAL分别减少了(1.89±2.14)mm和(1.77±2.00)mm,差异无统计学意义(P>0.05)。治疗后1、3及6个月两组的BI有所改善,但差异无统计学意义(P>0.05)。结论:与超声龈下清创术相比,超声龈下清创联合手工根面平整术能更有效地降低牙周袋深度及减少临床附着丧失,临床上有必要在超声龈下清创后使用手工器械进行根面平整,以获得更好的临床效果。

Objective:To compare the clinical effects of ultrasonic subgingival debridement and ultrasonic subgingival debridement combined with manual root planing on severe periodontitis and then to investigate the necessity and significance of manual root planing.Methods:Twenty-three patients with severe periodontitis participated in this split-mouth randomized-controlled clinical trial.Baseline examination and randomization were performed after supragingival scaling:each of the upper and lower jaws had a quadrant as the test group treated with ultrasonic subgingival debridement combined with manual root planing,whereas the other two quadrants were the control group treated with ultrasonic subgingival debridement.Treatment of each patient was at intervals of one week and completed in two visits.Clinical indicators concerning probing depth(PD),clinical attachment loss(CAL)and bleeding index(BI)were recorded at baseline and 1 month,3 months,6 months after treatment.Results:There was no significant difference of periodontal indicators between the test group and the control group at baseline.Both the test group and control group resulted in significant improvement of PD,CAL and BI.One and three months after treatment,reduction of PD in the test group was higher than that in the control group[1 month:(2.13±1.31)mm vs.(1.79±1.33)mm,P<0.01;3 months:(2.46±1.33)mm vs.(2.17±1.38)mm,P<0.01]and reduction of CAL in the test group was higher than that in the control group[1 month:(1.89±2.03)mm vs.(1.65±1.93)mm,P<0.01;3 months:(2.03±2.05)mm vs.(1.83±1.97)mm,P<0.05].Six months after treatment,PD in the test group and the control group decreased by(2.52±1.40)mm and(2.35±1.37)mm respectively,and the improvement in the test group was significantly better than that in the control group(P<0.01).CAL in the test group and the control group decreased by(1.89±2.14)mm and(1.77±2.00)mm respectively,and there was no statistical difference between the groups.There was no significant difference in the changes of BI between the two groups 1,3 and 6 months after treatment.Conclusion:Ultrasonic subgingival debridement combined with manual root planing has more reduction in PD and CAL compared with ultrasonic subgingival debridement.Therefore,it is still necessary to use manual instruments for root planing following ultrasonic subgingival debridement.