牙周内窥镜辅助重度广泛型牙周炎非手术治疗的疗效观察

Efficacy of periodontal endoscope-assisted non-surgical treatment for severe and generalized periodontitis

目的评估牙周内窥镜在辅助治疗年轻患者的重度广泛型牙周炎非手术治疗中发挥的作用。方法观察了13例重度广泛型牙周炎患者738个位点,在经过牙周非手术治疗前后各项牙周指标的差异。根据所接受的治疗分为3组:A组龈下刮治术+根面平整术(SRP)治疗(n=7,408个位点);B组内窥镜辅助下行SRP治疗(n=4,188个位点);C组SRP治疗后3个月在内窥镜辅助下再次行SRP治疗(n=2,142个位点)。根据每个位点的基线PD值再将各组分为2个亚组:4<PD≤6 mm记为亚组1,PD>6 mm记为亚组2。记录各组的牙周探诊深度(PD)、附着丧失(AL)、牙龈退缩程度(GR)、探诊出血(BOP)。结果治疗后3个月,A1组PD、AL和GR的改善程度比B1组更明显(P<0.05),但2组的BOP值则无明显差异;B2组的PD下降量显著高于A2组(P<0.001),并且BOP的改善情况优于A2组(P<0.0001),GR值则大于A2组(P<0.0001),但A2、B2组治疗前后AL的差异无统计学意义(P=0.2968)。C1组在内窥镜辅助治疗前后的PD、AL及GR均无明显差异,但治疗有效降低了BOP(P<0.0001)。C2组PD以及AL值在内窥镜辅助治疗后有所改善,并且与仅行SRP治疗时相比,差异有统计学意义(P=0.0005,P=0.0002),同时其GR更为明显(P=0.0005)。结论在使用非手术方式治疗年轻患者重度广泛型牙周炎时,对于4~6 mm深的牙周袋,仅采用单纯的SRP治疗已可以获得较好的治疗效果;对于大于6 mm深的牙周袋,采用牙周内窥镜辅助治疗时可以增加其疗效,这可能是对当前牙周非手术治疗方案的一个有效补充。

Objective To evaluate the effectiveness of periodontal endoscope as an adjuvant therapy for the non-surgical periodontal treatment of patients with severe and generalized periodontitis.Methods Patients(n=13)were divided into three groups:patients treated with conventional subgingival scaling and root planing(SRP)(n=7,408 sites)(group A),SRP using periodontal endoscope(n=4,188 sites)(group B)or SRP with periodontal endoscope 3 months after initial SRP(n=2,142 sites)(group C).Two subgroups were divided into 2 subgroups according to PD at the baseline:4<PD≤6 mm as subgroup 1 and PD>6 mm as subgroup 2.Probing depth(PD),attachment loss(AL),gingival recession(GR)and bleeding on probing(BOP)were recorded.Results The results of 3 months after treatment showed all PD,AL,and GR values in group A1 were less than those in group B1(P<0.05),but no significant difference in BOP was found between the two groups.The decrease in PD,BOP in group B2 was more obvious than those in group A2(P<0.0001),and the GR values in group B2 were more than those in group A2(P<0.0001).But the improvement of AL showed no statistical difference between the two groups(P=0.2968).In group C1,no significant difference in PD,AL,and GR was observed after endoscopy-assisted therapy,but it was more effective for BOP(P<0.0001).In group C2,the improvement in PD and AL was significantly different from the improvement in SRP alone(P=0.0005,P=0.0002)and was accompanied by more GR(P=0.0005).Conclusion In non-surgical treatment of severe and generalized periodontitis,SRP can achieve good therapeutic effect on sites with 4<PD≤6 mm.For sites with PD>6 mm,the application of periodontal endoscopy can increase the effect,reducing PD and GR,which may be an effective supplement to the current non-surgical periodontal treatment.