因重度牙周炎拔除的前磨牙分别经三种方法处理后牙根表面粗糙度和形态对比观察

Comparative observation of effects of three treatment methods on roughness and morphology of the root surface in premolar teeth removed due to severe periodontitis

目的对比观察因重度牙周炎拔除的前磨牙分别经Er:YAG激光处理、超声刮治、手动刮治后牙根表面粗糙度和形态。方法选择因重度牙周炎拔除的前磨牙90颗作为实验对象,分别使用40、60、80、100、120、140、160 mJ/P脉冲能量Er:YAG激光进行根面处理各10颗(分别记为A、B、C、D、E、F、G组),使用超声洁牙机进行根面处理10颗(H组),使用Gracey刮治器进行根面处理10颗(I组);另取正畸拔除的健康前磨牙10颗,不进行任何处理(J组)。使用表面轮廓仪定量分析牙根表面粗糙度,扫描电子显微镜观察牙根表面形态。结果A、B、C、D、E、F、G、H、I、J组Ra值分别为4.91±1.22、4.71±1.70、6.67±2.88、6.73±4.28、5.14±2.46、7.57±3.53、7.46±5.89、2.92±0.77、2.72±1.06、2.19±0.51,A、B、C、D、E、F、G、H、I组分别与J组比较,A、B、C、D、E、F、G组分别与H、I组比较,A、B、C、D、E组分别与F、G组比较,P均<0.05。A^E组牙根表面清洁,表面粗糙,呈颗粒突起样外观,无玷污层,无牙本质小管暴露,组织无碳化;F、G组牙根面更加粗糙,可见牙本质小管暴露;H、I组牙根表面可见玷污层,碎屑,未见牙本质小管的暴露;J组牙根表面光滑平坦,无玷污层。结论手工刮治、超声刮治、Er:YAG激光均增加了重度牙周炎患牙牙根表面粗糙度。手工刮治和超声刮治组相对激光组根面光滑,但存在玷污层,不利于牙周组织的附着;Er:YAG激光可去除根面玷污层,形成清洁的根面,有利于牙周组织的附着,优于传统手动刮治和超声刮治;Er:YAG激光处理后的根面更粗糙,40~120 mJ/P脉冲能量的Er:YAG激光照射后的根面平均粗糙度变化不大,140~160 mJ/P激光产生的表面粗糙度明显增大,建议临床应用脉冲能量在120 mJ/P范围内。

Objective To investigate the effects of manual scaling,ultrasonic scaling,and Er:YAG laser irradiation of different pulse energies on the roughness and morphology of the root surface in the scaling and root planning(SRP)of periodontitis teeth,so as to provide references for Er:YAG laser application in periodontitis therapy.Methods Ninety premolars with severe periodontitis and 10 healthy premolars were included in this study.Experimental samples were divided into four groups according to different root surface treatment.In the group A,10 healthy premolars comprised the control group without any treatment.In the group B,10 teeth were manually scraped with Gracey scraper.In the group C,10 teeth were treated with ultrasonic scaling.In the group D,samples treated with Er:YAG laser were divided into 7 subgroups according to different pulse energies(40 mJ/P,60 mJ/P,80 mJ/P,100 mJ/P,120 mJ/P,140 mJ/P,and 160 mJ/P);with 10 teeth in each.The surface roughness was quantitatively analyzed by using a surface profilometer,and the surface morphology of the root was observed by scanning electron microscopy.Results The Ra values of groups A,B,C,D,E,F,G,H,I,and J were 4.91±1.22,4.71±1.70,6.67±2.88,6.73±4.28,5.14±2.46,7.57±3.53,7.46±5.89,2.92±0.77,2.72±1.06,and 2.19±0.51,respectively,with statistically significant differences between the groups A,B,C,D,E,F,G,H,I and group J,between the groups A,B,C,D,E,F,G and groups H and I,and between the groups A,B,C,D,E and groups F and G,all P<0.05.The root surface of the teeth in the groups A to E was clean,rough,with a granular protrusion-like appearance,no smear layer,no exposed dentin tubules,and no carbonization of the tissues;the root surfaces of the groups F and G were rougher,with exposed dentin tubules;smear layer and debris were seen on the root surface of the teeth in groups H and I,and no dentin tubules were exposed;the root surface of group J was smooth and flat,with no smear layer.Conclusions Manual scaling,ultrasonic scaling,and Er:YAG laser all increase the surface roughness of the roots of teeth with severe periodontitis.Compared with the laser group,the root surface of the manual scaling and ultrasonic scaling group is smoother,but there is a smear layer,which is not conducive to the adhesion of the periodontal tissue;Er:YAG laser can remove the smear layer of the root surface to form a clean root surface,which is beneficial to the adhesion of the periodontal tissues,which is better than traditional manual and ultrasonic scaling;the root surface after Er:YAG laser treatment is rougher,and the average root surface roughness after 40-120 mJ/P pulse energies does not change much,the surface roughness produced by 140-160 mJ/P pulse energies increases obviously.Therefore,it is recommended that the pulse energy should be within 120 mJ/P for clinical application.