不同能量Er∶YAG激光治疗种植体周围炎对sTREM-1表达的影响

Effect of Different Laser Energy Settings on Treatment of Peri-implantitis and Evaluation of sTREM-1 Expression Fluctuation

目的比较不同能量的Er∶YAG激光治疗种植体周围炎的效果和对龈沟液肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、可溶性髓样细胞触发性受体-1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)的影响。方法选取2018年2月至2020年4月,种植体周围炎患者120例,按随机数表法分为低能量组、中能量组和高能量组共三组,每组患者各40例。三组患者均采取Er∶YAG激光治疗,其中低能量组、中能量组、高能量组激光能量分别为40 mJ、60 mJ、80mJ,三组患者每周治疗1次,共治疗3周。比较三组术中疼痛程度(参照VAS量表评估)、治疗后12周的总有效率,基线和治疗后12周的菌斑指数(plaque index,PLI)、出血指数(bleeding index,BI)、探诊深度(probing depth,PD)、骨缺损深度(defect depth,DD)、TNF-α以及sTREM-1浓度改变。结果低、中和高能量组的术中疼痛VAS评分分别为(0.96±0.3)分、(1.07±0.3)分、(2.09±0.6)分,低能量组与中能量组术中的疼痛VAS评分均低于高能量组(P<0.05),低能量组与中能量组比较差异无统计学意义(P>0.05)。低、中、高能量组总有效率分别为92.5%、90.0%和97.5%,差异无统计学意义(P>0.05)。治疗后12周,三组患者的PLI、BI、PD、DD均较基线值降低(P<0.05)。三组治疗后12周的PLI的两两比较,差异均无统计学意义(P>0.05)。中、高能量组治疗后12周的BI、PD、DD低于低能量组(P<0.05),高能量组BI低于中能量组(P<0.05)。治疗后12周,三组患者龈沟液TNF-α、sTREM-1浓度均较基线值降低(P<0.05)。中、高能量组治疗后12周的龈沟液TNF-α、sTREM-1低于低能量组(P<0.05)。结论Er∶YAG激光选择60 mJ的能量可有效去除种植体和周围的微生物和感染组织,控制菌斑,并促进种植体与骨再结合及骨组织再生,且术中疼痛与不适相对较轻,是轻度种植体周围炎的理想选择。

Objective To compare the effect of Er:YAG laser with different laser energy on peri-implant inflammation and their effect on gingival crevicular fluid tumor necrosis factor-α(TNF-α) and soluble triggering receptor expressed on myeloid cells-1(sTREM-1).Methods Totally 120 patients with peri-implantitis treated during the period from Feb.2018 to Apr.2020 were selected and divided randomly into three groups:the low energy group,medium energy group and high energy group,each group consisting of 40 patients.All the patients were treated with Er:YAG laser once a week for 3 weeks,but the laser energy used for the low energy group,medium energy group and high energy group were 40 mJ,60 mJ and 80 mJ respectively.The intraoperative pain(VAS scale),total effective rate 12 weeks after the completion of treatment,plaque index(PLI),bleeding index(Bl),probing depth(PD),bone defect depth(DD) and concentrations of TNF-α and sTREM-1 after the treatment were compared among the three groups.Results The intraoperative pain VAS scores of the low,medium and high energy groups were(0.96±0.3),(1.07±0.3) and(2.09±0.6) respectively.The scores of the low energy group and medium energy group were apparently lower than that of the high energy group(P<0.05),but the difference between the low energy group and medium energy group was not statistically significant(P>0.05).The total effective rates of the low,medium and high energy groups were 92.5%,90.0% and 97.5% respectively,and the differences were not statistically significant(P>0.05).Twelve weeks after the treatment,the PLI,BI,PD and DD of the three groups were all lower than the baseline values(P<0.05).No significant difference appeared in pairwise comparison of PLI for the three groups 12 weeks after the treatment(P>0.05).Twelve weeks after the treatment,the BI,PD and DD of the middle and high-energy groups were lower than those of the low-energy group(P<0.05),and the BI,PD and DD of the high energy group were lower than those of the middle-energy group(P<0.05).In addition,for all the three groups,the concentrations of TNF-α and sTREM-1 were lower than the baseline values(P<0.05).The levels of TNF-α and sTREM-1 in the gingival crevicular fluid of the middle and high energy group were lower than those in the low energy group(P<0.05).Conclusions 60 mJ Er:YAG laser is ideal for mild peri-implantitis as it will effectively remove the microorganisms and infected tissues around the implant,control plaque and promote the recombination of the implant and bone and the regeneration of bone tissue while bringing in relatively light pain and discomfort during the operation.