Nd: YAP激光治疗牙周炎的疗效评价及其对龈下微生物的影响

Clinical and microbiological evaluation of Nd: YAP laser for adjuvant treatment of periodontitis

目的比较龈下刮治和根面平整术(scaling and root planning,SRP)联合Nd:YAP激光与单纯SRP治疗对牙周炎患者疗效的差异和龈下微生物的影响。方法选择符合纳入标准的牙周炎患者。每位患者龈上洁治1周后为本研究基线,随机半口分组。试验侧采用SRP联合Nd:YAP激光治疗;对照侧仅采用SRP治疗。每位患者选择一组同颌同名单根牙,进行龈沟液(gingival crevicular fluid,GCF)和龈下菌斑取样。分别在基线、治疗完成后6周和12周进行探诊深度(probing depth,PD)和探诊出血(bleeding on probing,BOP)的数据采集、龈沟液及龈下菌斑样本的采集。ELISA法检测龈沟液中炎症因子白细胞介素6(interleukin-6,IL-6)的浓度。16S rDNA高通量测序对各龈下菌斑样本的菌群构成进行分析和比较。结果试验侧与对照侧的各项临床指标较基线时均有显著改善(P<0.05),但两组间无明显差异。两组的IL-6浓度较基线均显著下降,治疗后6周,试验侧的IL-6浓度明显低于对照组(P<0.05)。龈下菌斑α多样性分析,治疗后6周及12周,对照侧的Shannon指数高于基线,Simpson指数低于基线(P<0.05)。测序结果显示,治疗后6周,试验侧的普氏菌属(Prevotella)和Saccharibacteria_incertae_incerta_sedis的相对丰度较基线显著下降;密螺旋体属(Treponema)的相对丰度低于对照侧,嗜二氧化碳噬细胞菌属(Capnocytophaga)的相对丰度高于对照侧(P<0.05),12周时无明显差异。结论在本研究中,Nd:YAP激光联合SRP和单纯SRP治疗牙周炎均有明显效果,而两种治疗方法在临床指标上无明显差异,辅助使用Nd:YAP激光在短时间内更有利于GCF IL-6浓度的降低和部分牙周致病菌的控制。

Objective To compare the efficacy of subgingival scaling and root planning(SRP) combined with Nd: YAP laser and SRP alone in the treatment of periodontitis and the influence on subgingival micro-organisms. Methods Patients met inclusion criteria with generalized periodontitis were enrolled in this randomized controlled split-mouth clinical study, one week after supragingival scaling as the baseline. The test side was treated with SRP combined with Nd: YAP laser, while the control side was treated with SRP alone. Periodontitis-affected sites from the homonymous single root teeth in a homomaxillary pair in each patient were selected for gingival crevicular fluid(GCF) and subgingival plaque sampling. The probing depth(PD) and bleeding on probing(BOP)were detected, while GCF and subgingival plaque samples were collected at baseline, 6 weeks and 12 weeks after treatment. ELISA was used to detect the concentration of interleukin-6(IL-6) in GCF. We analyzed and compared microbial compositions of each sample by 16 S rDNA high-throughput sequencing. Results Clinical indicators of the test and control sides were significantly improved compared with baseline, but there was no significant difference between the two groups. The IL-6 concentration in GCF in two groups was significantly lower than that in the baseline. Six weeks after treatment, the IL-6 concentration in the test side was significantly lower than that in the control group(P<0.05). α-diversity analysis showed that Shannon index was higher and Simpson index was lower on the control side at both 6 weeks and 12 weeks after treatment than at baseline. Sequencing results showed that, at 6 weeks after treatment, the relative abundance of Prevotella and Saccharibacteria_incertae_incerta_sedis in the test side decreased significantly compared with the baseline(P<0.05). The relative abundance of Treponema was lower, and the relative abundance of Capnocytophaga was higher than that of the control side(P<0.05). There was no significant difference at 12 weeks. Conclusion Nd: YAP laser combined with SRP and SRP alone both have significant effect on treating periodontitis. There was no significant difference in clinical indicators between these two therapeutic methods. However, Nd: YAP laser may be beneficial to the reduction of GCF IL-6 concentration and the inhibition of certain periodontal pathogens in subgingival plaque in a short time.