牙周引导组织再生技术治疗牙周病的临床疗效及影响因素分析

Clinical Efficacy and Influencing Factors of Periodontal Guided Tissue Regeneration in the Treatment of Periodontal Diseases

目的探讨牙周引导组织再生技术(GTR)在牙周病临床治疗中的价值及影响疗效的相关危险因素。方法回顾性分析118例进行GTR治疗的牙周病患者临床资料,记录其治疗前后相关指标[菌斑指数(PLI)、探诊深度(PD)、牙松动度(TM)、附着丧失(AL)、牙龈指数(GI)]检查结果差异;根据治疗效果将118例受试者分为疗效优良组(n=86)和疗效不佳组(n=32),比较其年龄、性别、吸烟情况、口腔卫生条件、治疗早期广谱抗生素应用情况、牙周骨缺失形态、龈瓣厚度、牙根解剖形态、术后维护情况、术后屏障膜暴露情况等一般资料差异,对单因素分析后存在显著性差异的指标行非条件Logistic多元逐步回归分析,记录影响GTR疗效的危险因素。结果治疗1年后,118例受试者PLI、PD、AL、GI等指标检查结果均较治疗前明显降低,TMⅠ度率则较治疗前明显提高,差异均有统计学意义(P<0.05)。疗效优良组和疗效不佳组患者性别比较无统计学意义(P>0.05);经多因素logistic回归分析可知,吸烟、治疗早期使用广谱抗生素情况、牙周骨缺失形态、龈瓣厚度、牙根解剖形态、术后维护情况及术后屏障膜暴露等是影响GTR治疗效果的独立危险因素(P<0.05)。结论GTR能有效促进牙周病患者病情转归;吸烟、治疗早期使用广谱抗生素情况、牙周骨缺失形态、龈瓣厚度、牙根解剖形态、术后维护情况及术后屏障膜暴露等同GTR疗效关系密切,需引起重视。

Objective To investigate the value of periodontal guided tissue regeneration(GTR)in the treating of periodontal diseases and related risk factors.Methods The clinical data of 118 patients with periodontal diseases who underwent GTR were analyzed retrospectively.The related indexes[plaque index(PLI),probing depth(PD),tooth mobility(TM),attachment loss(AL),gingival index(GI)]were compared before and after treatment;According to the clinical effect,the subjects were divided into excellent outcome group(n=86)and poor outcome group(n=32).Age,gender,smoking status,oral hygiene,use of broad-spectrum antibiotics in early treatment,the shape of periodontal bone loss,gingival flap thickness,root anatomic form,postoperative maintenance,postoperative exposure of barrier membrane,and other general data were compared.For indexes with significant differences after univariate analysis,they were analyzed by non-conditional multivariate Logistic regression analysis,and the risk factors affecting the efficacy of GTR were recorded.Results After one year of treatment,PLI,PD,AL and GI were significantly lower than those before treatment while the rate of TM grade I was significantly higher(P<0.05),and there was no significant difference between the excellent outcome group and the poor outcome group(P>0.05);Multivariate logistic regression analysis showed that smoking,use of broad-spectrum antibiotics in early treatment,the shape of periodontal bone loss,gingival flap thickness,root anatomic form,postoperative maintenance and postoperative exposure of barrier membrane were the independent risk factors influencing the effect of GTR(P<0.05).Conclusion GTR can effectively promote the outcome of patients with periodontal diseases;smoking,use of broad-spectrum antibiotics in early treatment,the shape of periodontal bone loss,gingival flap thickness,root anatomic form,postoperative maintenance,and postoperative exposure of barrier membrane is related to the effect of GTR.