五倍子穿心莲内酯提取液治疗牙周牙髓联合病变的临床疗效评价

Evaluation on clinical effect of Chinese medicine gallnut and andrographolide extract in treatment of periodontal-endodontic combined lesions

目的:研究中药五倍子穿心莲内酯提取液联合超声荡洗和牙周内窥镜治疗牙周牙髓联合病变的临床疗效,为牙周牙髓联合病变的有效治疗提供理论依据。方法:108例牙周牙髓联合病变患者按就诊顺序分为对照组、过氧化氢(H 2O 2)组和实验组,每组36例,3组患牙均进行根管预备,术中分别使用蒸馏水、3%H 2O 2和五倍子穿心莲内酯提取液进行根管冲洗;根管预备完成后,使用超声荡洗并采用不同冲洗剂进行化学交替冲洗,封药,待炎症消除后封闭根管,且X线检查显示根管充填为恰填;3组患者均进行龈上洁治,在牙周内窥镜辅助下,进行龈下刮治,并分别使用不同的冲洗剂进行牙周袋内冲洗。各组患者均以3个月为1个疗程。观察各组患者治疗前后牙周指数,包括改良龈沟出血指数(mSBI)、改良菌斑指数(mPLI)、探诊深度(PD)和附着丧失(AL),检测治疗1个疗程后各组患者龈沟液(GCF)中白细胞介素1β(IL-1β)水平。结果:治疗前各组患者的牙周指数和GCF中IL-1β水平比较差异均无统计学意义(P>0.05)。治疗后,与对照组比较,H 2O 2组患者PD、AL和GCF中IL-1β水平明显降低(P<0.05),实验组患者mSBI、mPLI、PD、AL和GCF中IL-1β水平明显降低(P<0.05);与H 2O 2组比较,实验组患者mSBI、mPLI、PD、AL和GCF中IL-1β水平明显降低(P<0.05)。结论:中药五倍子穿心莲内酯提取液联合超声荡洗和牙周内窥镜治疗牙周牙髓联合病变效果良好,可改善患者牙周指数并降低患者GCF中IL-1β水平。

Objective:To study the clinical effect of Chinese medicine gallnut and andrographolide extract combined with ultrasonic irrigation and periodontal endoscope in the treatment of periodontal-endodontic combined lesions,and to provide a theoretical basis for the effective treatment of periodontal-endodontic combined lesions.Methods:A total of 108 patients with periodontal-endodontic combined lesions were divided into control group,hydrogen peroxide(H 2O 2)group and experimental group,there were 36 cases in each group.Root canal preparation was carried out in all 3 groups,and distilled water,3%hydrogen peroxide,gallnut and andrographolide extract were used for root canal irrigation.After preparation,ultrasonic irrigation and different washing agents were used for alternating chemical washing.The medicine was sealed.After the inflammation was eliminated,the root canal was closed.And the X-ray examination results showed that the root canal was filled exactly.After supragingival scaling of the affected tooth,subgingival scaling was performed assisted with periodontal endoscope,the periodontal pockets of the patients in three groups were washed respectively with different washing agents.All patients in various groups were treated for 3 months.The periodontal indexes including modified sulcus bleeding index(mSBI),modified plaque index(mPLI),probing depth(PD)and attachment loss(AL)of the patients in various groups were observed before and after treatment;and the levels of interleukin-1β(IL-1β)in the gingival crevicular fluid(GCF)of the patients in various groups were detected after one course of treatment.Results:There were no significant differences in the periodontal indexes and the levels of IL-1βin GCF of the patients before treatment between various groups(P>0.05).Compared with control group,the PD and AL,the level of IL-1βin GCF of the patients in H 2O 2 group after treatment were reduced(P<0.05);the mSBI,mPLI,PD and AL,the level of IL-1βin GCF of the patients in experimental group were significantly reduced(P<0.05).Compared with H 2O 2 group,the mSBI,mPLI,PD and AL,the level of IL-1βin GCF of the patients in experimental group after treatment were obviously reduced(P<0.05).Conclusion:Gallnut and andrographolide exact combined with ultrasonic irrigation and periodontal endoscope has a better therapeutic effect on the periodontal-endodontic combined lesions,which could improve the periodontal indexes and reduce the level of IL-1βin GCF of the patients.