抗菌光动力疗法辅助龈下刮治治疗慢性牙周炎临床效果观察

Clinical observation of antibacterial photodynamic therapy assisted subgingival curettage for the treatment of chronic periodontitis

目的探讨抗菌光动力疗法(antibacterial photodynamic therapy,aPDT)辅助龈下刮治和根面平整(scaling and root planing,SRP)治疗慢性牙周炎的临床效果。方法本研究已通过单位伦理委员会审查通过,并获得患者知情同意。研究采用随机、对照分口设计,符合纳入标准的16例慢性牙周炎患者随机分为试验侧与对照侧。对照侧接受常规SRP,试验侧SRP基础上联合aPDT治疗(SRP+aPDT)。记录治疗前(基线)、治疗后1个月、3个月和6个月时牙周探诊深度(probing depth,PD)、菌斑指数(plaque index,PLI)、出血指数(bleed⁃ing index,BI)和探诊出血(bleeding on probing,BOP)阳性位点占比(BOP%)。结果13例患者完成了全部随访。对照侧356颗受试牙,2136个位点;试验侧360颗受试牙,2160个位点。治疗前,两侧基线水平各指标差异无统计学意义。在治疗后1个月、3个月和6个月时,试验侧和对照侧的牙周临床指标PD、PLI、BI、BOP%相较于治疗前均有明显改善(P<0.05)。在各时间点,与常规SRP相比,SRP+aPDT联合治疗侧PD、PLI和BI均有改善。SRP+aPDT联合治疗侧在治疗后3个月时BOP%和PLI的改善明显优于常规SRP侧(P<0.05)。结论aPDT辅助治疗慢性牙周炎可以在早期更好地改善牙龈出血,控制牙周炎症。

Objective To investigate the efficacy of antibacterial photodynamic therapy(aPDT)as an adjunct to subgingival scaling and root planning in the treatment of chronic periodontitis.Methods This study followed medical ethics guidelines,and informed consent was obtained from all patients.Sixteen patients were recruited for this random⁃ized split⁃mouth controlled trial.The control group underwent subgingival scaling and root planning(SRP),while the ex⁃perimental group received subgingival scaling and root planing plus aPDT treatment using Perowave®with a toluidine blue O solution photosensitizer.The probing pocket depth(PD),recession,plaque index(PLI),bleeding index(BI)and proportion of positive sites of bleeding on probing(BOP)(BOP%)at all sites were examined at baseline(before treat⁃ment)and at 1,3 and 6 months after treatment.Results Follow⁃up was completed for 13 patients.On the control side,356 teeth were tested at 2136 sites.A total of 360 teeth on the test side and 2160 sites were included in the study.Before treatment,there was no significant difference in the baseline indicators between the two groups.After treatment,both groups showed significant improvement in clinical parameters,including PD,PLI,BI,and BOP%,compared with baseline.At 3 months,the BOP%and PLI in the experimental group were significantly lower than those in the control group(P<0.05).The improvement in BOP%and PLI in the experimental group was significantly greater than that in the control group 3 months after treatment(P<0.05).Conclusion aPDT,as an adjuvant treatment to SRP for chronic periodontitis,can improve gingival bleeding and control periodontal inflammation in the early stage.