赤藓糖醇喷砂辅助牙周炎患者维护期治疗的疗效及对环境污染的评估

Observation on the efficacy and environmental contamination of erythritol air-polishing during periodontal maintenance phase

目的遵循以菌斑控制为导向的牙周治疗理念,对牙周维护期复诊患者,赤藓糖醇喷砂、传统超声清除菌斑及残存牙石治疗,比较治疗时间、舒适度、患者感受及治疗后临床疗效。同时,探讨喷砂和超声洁治过程中产生的环境污染状况。方法20名全身健康且不吸烟的牙周维护期患者,采取左、右侧自身对照的分口设计,治疗前菌斑染色,试验侧及种植体采用赤藓糖醇喷砂、对照侧采用传统超声清除菌斑,两种方法彻底清除菌斑和记录治疗时间,并比较舒适度及患者感受。最后超声清除牙面残存牙石,橡皮杯+抛光膏抛光牙面。治疗前及治疗后3个月、6个月测量天然牙及种植体的牙周临床指标(菌斑指数、探诊深度、出血指数、牙龈退缩)。使用100个培养基,在治疗过程中通过平板暴露法(沉降法)检测患者、医生和助手胸前30 cm的菌落数目。治疗前10 min、喷砂时和超声洁治时及治疗后10 min,检测距患者150 cm边台面的菌落数。结果两组治疗后3个月及6个月的牙周临床指标较基线均有改善,但两组间各项临床指标的差异均无统计学意义。喷砂治疗后3个月种植体的探诊深度、改良龈沟出血指数较基线减小,治疗后6个月改良龈沟出血指数仍较基线减小。喷砂组医生侧及患者侧的空气平均菌落数分别为46.08±28.33 CFU、19.75±13.38 CFU,超声组为6.00±4.56 CFU、3.73±6.57 CFU,差异有统计学意义(P<0.001)。喷砂组环境中空气平均菌落总数为77.67±34.85 CFU,超声为14.10±10.28 CFU,差异有统计学意义(P<0.001)。喷砂清除菌斑的平均治疗时间为260.05±103.7 s,显著低于超声409.05±121.13 s。喷砂的舒适度评分亦显著优于超声(P<0.001)。结论以菌斑为导向的赤藓糖醇喷砂治疗应用于维护期的牙周炎患者,可同时清除天然牙和种植体周菌斑,减轻炎症,治疗时间更短、患者更舒适。但喷砂过程中对医、患均可能有一定的环境污染,需科学防护。

Objective To investigate and compare the clinical effects on removing plaque between erythritol airpolishing and ultrasonic scaling+rubber-cup polishing on natural teeth and implants in patients with periodontitis during the maintenance phase based on the concept of Guided Biofilm Therapy(GBT),and to explore the environmental air pollution caused by the process of treatment.Methods intervention trial includes two groups,the test group(erythritol air-polishing,AP)and the control group(ultrasonic scaling,US).A total of 20 systematically healthy patients at age of 33-69(6 males and 14 females)were involved in the study.According to the split-mouth design,one side of the mouth was randomly assigned to the AP group while the other side was to the US group.Apply the disclosing agent to make the plaque visible before any treatment.The clinical parameters including plaque index(PLI),probing depth(PD),percentages of bleeding on probing(BOP%)and gingival recession(REC)of natural teeth,modified plaque index(mPLI),probing depth(PD),modified sulcus bleeding index(mSBI)and gingival recession(REC)of implants were recorded before treatment and at 3 and 6 months after the treatment.Treatment time was recorded and compared between groups.The patient's perception was evaluated by visual analogue scale(VAS)and their comments on treatment were collected.A total of 100 blood agar plates were used to evaluate air contamination during the treatment process.They were put on the chest of patients,the chest of the doctor and the chest of the assistant during the treatment process,and were put on the desk in the clinic room before and after the treatment,respectively.ResultsThe periodontal parameters of two groups were improved from baseline to 3 and 6 months,while there was no significant difference between groups.PD and mSBI of the implants decreased from baseline to 3 months and 6 months after the erythritol air-polishing.The mean number of bacterial colonies at the doctor's side and the patient's side was46.08±28.33 CFU and 19.75±13.38 CFU in AP group,and 6.00±4.56 CFU and 3.73±6.57 CFU in US group,respectively,and the difference was statistically significant(P<0.001).The mean total number of bacterial colonies was 77.67±34.85 CFU in AP group and 14.10±10.28 CFU in US group,and the difference was statistically significant(P<0.001).The mean treatment time was 260.05±103.7 s in AP group and 409.05±121.13 s in US group,the difference was statistically significant(P<0.001).The mean VAS score in AP group was also significantly better than that in US group(P<0.001).Conclusion polishing to remove plaque first can achieve similar clinical effects to traditional ultrasonic scaling as a kind of supportive periodontal therapy.Advantages of using erythritol air-polishing to remove plaque include time-saving,more comfortable and able to clean implants at the same time.While there can be a certain level of air contamination during the process of erythritol air-polishing,both clinicians and patients need to take strict protection.