牙周微创非手术治疗对薄龈生物型牙周炎患者上前牙区的疗效评价

Evaluation of periodontal minimally invasive non-surgical therapy for the treatment of upper anterior teeth of patients with thin gingival phenotype

目的 探讨薄龈生物型牙周炎患者上前牙区患牙实施牙周微创非手术治疗(minimally invasivenon-surgical therapy, MINST)的临床必要性。方法 选取2020年5月至2021年9月在南京医科大学附属口腔医院牙周科就诊的Ⅲ期/Ⅳ期薄龈生物型牙周炎患者18例,随机分成2组,针对上前牙,一组患者行牙周微创非手术治疗(MINST组),另一组行传统龈下刮治和根面平整术(subgingival scaling and root planing, SRP)(SRP组)。比较基线、术后3个月和术后6个月时患者的探诊深度(probing depth, PD)、临床附着丧失(clinical attachment loss, CAL)、牙龈退缩(gingival recession, GR)和探诊出血(bleeding on probing, BOP)阳性率指标变化及差异。术后即刻和术后1周记录受试者疼痛/不适的视觉模拟评分(visual analog scale, VAS),术后6个月记录受试者对治疗结果的VAS评分并进行美学效果的满意度调查。结果 无论基线位点的PD如何,术后两组的PD、CAL、BOP阳性率和GR均较基线时明显改变(P<0.01)。4 mm≤PD≤6 mm位点:术后6个月时SRP组GR的改变值大于MINST组(P=0.035);术后6个月与术后3个月相比,仅SRP组GR值进一步增大(P<0.001)。PD>6 mm位点:MINST组PD、CAL的改变值均大于SRP组(P<0.01),术后6个月SRP组GR的改变值大于MINST组(P=0.014);术后6个月与术后3个月相比,两组PD值均有进一步改善(P<0.05),SRP组GR也持续加重(P=0.025)。术后1周SRP组受试者的疼痛/不适感和牙根敏感症状明显较MINST组严重(P<0.05),但两组受试者对治疗效果的评价和美学满意度差异无统计学意义。结论 对于薄龈生物型牙周炎患者前牙区患牙,尤其是PD>6 mm的位点,MINST在减小牙周袋、增加附着水平、维持牙龈位置和提高患者术后舒适度上都不同程度优于传统SRP,临床上有必要对该类患牙采取MINST以获得更好的牙周健康,但尚不能认为MINST可以获得患者更高的美学评价。

Objective To investigate the clinical necessity of periodontal minimally invasive non-surgical therapy(MINST) in upper anterior teeth of patients with thin gingival phenotype. Methods Eighteen cases of grade Ⅲ and Ⅳ periodontitis with thin gingiva, who visited the Department of Periodontology of the Affiliated Stomatological Hospital of Nanjing Medical University from May 2020 to September 2021,were recruited and divided into two groups randomly. Their upper anterior teeth were treated with MINST(MINST group) or conventional subgingival scaling and root planing(SRP group). Changes of clinical parameters, such as probing depth(PD), clinical attachment loss(CAL), gingival recession(GR) and bleeding on probing(BOP) positive rates, were examined and compared between baseline and 3 and 6 months after therapy, as well as intergroup differences. Patients′ perception of discomfort/pain experienced during and after therapy was evaluated using visual analog scale(VAS) immediately and 7 d after procedure. After 6 months, patients′ perception regarding outcomes of the therapy wasalso measured by VAS in the same way. In addition, patients′ aesthetic satisfaction of the treated teeth was also recorded. Results Regardless of PD at the baseline, both groups had significant changes in PD, CAL, BOP positive rates and GR(P<0.01). For sites of 4 mm≤PD≤6 mm, at 6 months after operation, change values of GR in the SRP group were greater than those in the MINST group(P=0.035). Also, only in SRP group, higher GR values were observed after 6 months compared to measurements after 3 months(P<0.001). For sites with PD>6 mm, intergroup analysis showed that change values of PD and CAL in MINST group were higher than those in SRP group(P<0.01). At 6 months after operation, change values of GR in SRP group were higher than those in MINST group(P=0.014). In addition, at 6 months postoperatively, further changes in PD values in both groups(P<0.05) and in GR values(P=0.025)in SRP group were observed, compared to 3 months. In addition, the complaint of discomfort/pain and root hypersensitivity during the first post-therapy week was more severe in SRP group(P<0.05), and no significant differences in the perception of therapy outcomes and aesthetic satisfaction levels of the treated teeth were observed between groups. Conclusion For upper anterior teeth with thin gingiva, especially for sites with PD>6 mm, MINST presents obvious advantages in PD reduction, CAL gain, maintaining position of the gingival margin and improving post-operative comfort experience of patients. Therefore, it is necessary to use MINST to achieve better periodontal health. However, it cannot be considered that MINST can achieve higher aesthetic evaluation from patients.