3种清创方法对模拟维护期治疗的牙周炎患牙根面结构影响的体外研究

In Vitro Study on Effect of Three Methods of Debridement on Periodontitis Root Surface

目的:评价3种清创方式对牙周炎患牙根面结构的影响,为牙周维护治疗选择合适的治疗方式提供理论依据。方法:将43颗因重度牙周炎拔除的患牙标记出66个方形的体外研究区域(4 mm×4 mm),分别完成根面刮治后,随机分成超声处理组、手工刮治组和喷砂抛光组,模拟牙周炎维护期阶段进行清创。记录每组治疗前、治疗1、20、50、100次维护后的根面粗糙度Ra值;并在扫描电镜下观察:(1)牙根表面菌斑、牙石残留;(2)划痕、凹槽等损伤情况;(3)牙骨质剥脱、牙本质暴露。结果:3组均随着清创次数的增加Ra值减小,提示根面逐渐趋于光滑。其中手工组对根面粗糙度的改变最大,在完成1次治疗后,Ra即有明显改善,差异有统计学意义(P<0.05);喷砂组根面抛光的效果明显,在完成20次治疗时,Ra已趋于稳定。扫描电镜观察手工组根面损伤最严重;超声次之;喷砂组损伤最小,保留根面牙骨质效果最好。结论:龈下喷砂在根面抛光的同时对根面的损伤最小,超声次之,手工刮治器械损伤最大。在维护治疗阶段清洁菌斑生物膜推荐使用喷砂器械以尽量保存根面组织。

Objective: To assess the damage of three instruments to the root surface of periodontitis, and to provide reference for the reasonable selection in the treatment of periodontal maintenance. Methods: Forty-three teeth with severe periodontitis were randomly demarcated into 66 regions of 4 mm×4 mm. After subgingival scaling, the remaining areas were randomly divided into ultrasonic group, manual group, and sandblasting group. The root surface debridement was completed several times. The root surface roughness values(Ra) before treatment, after the first treatment, after the 20 th treatment, after the 50 th treatment, and after the 100 th treatment were recorded for each group. The surface of root was observed under scanning electron microscope(SEM). Results: With the increase of debridement times, the root surface in all three groups gradually became smooth, but the roughness of the root surface in the manual group changed the most. Ra was significantly improved after the first treatment(P<0.05). The root surface polishing effect was the best in the sandblasting group, and Ra was stable after the 20 th treatment. SEM observation demonstrated that the manual group had the best debridement effect on the root surface, but the damage to the root surface was the most serious, followed by ultrasound, and the sandblasting group had the least damage, and the best retention effect to the root surface cementum. Conclusion: Subgingival sandblasting caused the least damage to root surface while polishing the root surface, followed by ultrasonic, and then the manual instrument. Sand blasting is recommended for cleaning plaque biofilms during maintenance and treatment to preserve root tissue as much as possible.