光动力疗法辅助治疗种植体周炎的短期非随机对照临床研究

A short-time non-randomized controlled clinical study on adjunctive photodynamic therapy in the treatment of peri-implantitis

目的探究使用光动力疗法(photodynamic therapy,PDT)辅助机械性龈下清创(mechanical debridement,MD)治疗种植体周炎(peri-implantitis)的短期临床疗效。方法根据2018牙周病新分类标准,纳入临床上诊断为种植体周炎的单颗种植体(单冠修复)患者,治疗前记录种植体周探诊深度(probing depth,PD)、改良龈沟出血指数(modified sulcus bleeding index,mSBI)和改良菌斑指数(modified plaque index,mPLI),以mSBI≥1的位点作为治疗位点。MD组为对照组,仅对治疗位点行机械性龈下清创;PDT组为治疗组,在龈下清创后即刻和治疗后1周,共行两次辅助性光动力治疗。结束治疗后6周、12周复查,检查所纳入患者种植体治疗位点的PD、mSBI和mPLI的变化。结果本研究共纳入35例患者,发生种植体周炎的植体38枚,共计154个治疗位点。PDT组和MD组各纳入20枚和18枚植体,其中PDT组纳入治疗位点共78个,PD≥6 mm的位点共51个,PD<6 mm的位点共27个;对照组纳入治疗位点共76个,PD≥6 mm的位点共53个,PD<6 mm的位点共23个。基线时两组的PD、mSBI和mPLI均无统计学差异,治疗后6周及12周复查时,两组各临床指标与基线相比均获得显著改善(P<0.05),其中PDT组治疗后6周的mSBI显著低于MD组(P<0.05)。在PD≥6 mm的位点中,PDT组的mSBI在治疗后6周、12周复查时均显著低于MD组(P<0.05)。PDT组和MD组在12周复查时达到治疗终点的植体百分比分别为70.00%和55.56%,无统计学差异(P>0.05)。结论光动力疗法辅助机械清创可以有效治疗种植体周炎,是一种安全有效的辅助治疗手段,对改善深种植体周袋(PD≥6 mm)的炎症以及mSBI具有显著疗效。

Objective To evaluate the short-term clinical efficacy of photodynamic therapy(PDT)assisted mechanical debridement(MD)in the treatment of peri-implantitis.Methods According to the new international classification of periodontal diseases and peri-implant diseases in 2018,single tooth implants diagnosed as peri-implantitis were included.Before treatment,the probing depth(PD),modified sulcus bleeding index(mSBI),and modified plaque index(mPLI)were recorded as the baseline,with mSBI≥1 sites as the treatment sites.The MD group was a control group,and only mechanical subgingival debridement was performed.The PDT group was treated with photodynamic therapy twice,immediately after subgingival debridement and one week after.Follow-up was arranged at 6 and 12 weeks after the end of treatment to examine the changes in PD,mSBI,and mPLI at the included implant treatment sites.Results A total of 35 patients were included in this study,with 38 teeth affected by peri-implantitis and 154 treatment sites.The PDT group and MD group included 20 and 18 implants respectively,with a total of 78 treatment sites included in the PDT group,51 sites with PD≥6 mm,and 27 sites with PD<6 mm.A total of 76 treatment sites were included in the MD group,including 53 sites with PD≥6 mm and 23 sites with PD<6 mm.At baseline,there was no statistically significant difference in PD,mSBI,and mPLI between the two groups.At 6 and 12 weeks after treatment,there were statistically significant differences in clinical indicators between the two groups compared to baseline(P<0.05).Among them,the mSBI in the PDT group was significantly lower than that in the MD group at 6 weeks after treatment(P<0.05).At sites with PD≥6 mm,the mSBI of the PDT group was significantly lower than that of the MD group at 6 and 12 weeks after treatment(P<0.05).The number of implants in the PDT group and MD group that reached the treatment endpoint at 12 weeks follow-up was 70.00%and 55.56%,respectively,and there was no difference between the two groups(P>0.05).Conclusion Photodynamic therapy assisted with mechanical debridement can effectively treat peri-implantitis and is a safe and effective auxiliary method,and has significant therapeutic effects on inflammation control and improvement of mSBI in those sites with PD≥6 mm.