脉冲式掺铒钇铝石榴石激光与乙二胺四乙酸联合治疗模式处理不同深度天然牙三壁骨缺损同期植入种植体的研究

Effect of Er:YAG laser combined with ethylenediamine tetra acetic acid on three-walled periodontal intrabony defects adjacent to implant sites

目的评价种植同期联合应用脉冲式掺饵钇铝石榴石(Er:YAG)激光与乙二胺四乙酸(EDTA)处理天然牙三壁骨缺损的临床效果。方法选取单颗牙缺失伴天然牙近缺隙侧三壁骨缺损患者30例,按照垂直骨缺损深度分为组1和组2。两组均使用EDTA+Er:YAG激光联合应用处理天然牙暴露根面+同期种植+骨增量术,术后10 d行软组织愈合评估,记录并比较两组术后6月骨高度变化量以及修复后6月边缘骨吸收量,修复后6个月随访记录并比较天然牙的临床指标,包括邻牙探诊深度(PD)、牙周附着水平(CAL)、龈沟出血指数(SBI),比较两组天然牙保留率和种植体存留率。结果组1一期愈合率为92.31%,组2一期愈合率为82.35%,组1一期愈合率高于组2,但差异无统计学意义(P>0.05)。术后6月,组1和组2的骨高度量变化量分别为(2.85±1.81)、(4.92±2.22)mm,差异具统计学意义(P<0.05);组1和组2边缘骨吸收量变化量为(0.70±0.32)、(1.25±0.47)mm,差异无统计学意义(P>0.05)。修复后6月,两组临床指标(PD、CAL、SBI)差异均无统计学意义(P>0.05);两组天然牙保留率分别为100%、94.12%,种植体存留率均为100%。结论联合应用EDTA+Er:YAG激光处理不同深度天然牙三壁骨缺损同期种植病例均取得较好骨增量效果,且在组2骨增量效果优于组1。通过上述联合治疗以及同期植入种植体,将不同深度的三壁骨缺损均转化为有利于成骨的三维空间形态,恢复类似的牙周再附着效果,从而获得较好天然牙保留率、种植体存留率。

Objective To investigate the clinical effect of Er:YAG laser combined with ethylenediamine tetra acetic acid(EDTA)on three-walled periodontal intrabony defects adjacent to implant sites.Methods A total of 30 patients with three-walled periodontal intrabony defects adjacent to implant sites were treated with the combination therapy.Patients with three-walled intrabony defects were divided into two groups according to the depth of the intrabony pocket between the implant and natural teeth.Evaluation of wound healing was performed 10 days after the operation,and bone augmentation was evaluated 6 months after the operation.Results Primary healing in group 1 was 92.31%,primary healing in group 2 was 82.35%.No significant difference was observed between the two groups(P>0.05).Bone augmentation in group 1 and group 2 were(2.85±1.81),(4.92±2.22)mm.There was significant difference between the two groups(P<0.05).New bone growth occurred more slowly in group 1(0.70 mm±0.32 mm)than in group 2(1.25 mm±0.47 mm)(P>0.05).Probe depths(PD),clinical attachment levels(CAL),and sulcus bleeding indices(SBI)showed no statistically significant difference between the two groups(P>0.05).The one-year survival rate of natural tooth in group 1 and group 2 were 100%,94.2%,and the one-year survival rate of implants in both groups was 100%.Conclusion The effect of bone augmentation with combination therapy was more ideal in group 2 than in group 1.Implant placement with combination therapy may be a viable technique to reconstruct three-walled intrabony defects due to the space maintenance provided by implants and bone grafts and the good root surface biocompatibility provided by the Er:YAG laser and EDTA.