双波长激光联合辅助治疗牙周牙髓联合病变的疗效及对患者PLI、BI、PD和CAL指标的影响

Curative effect of dual-wavelength laser combined with adjuvant therapy for combined periodontal-endodontic lesions and the influence on plaque index, bleeding index, periodontal probing depth and clinical attachment level

目的探讨掺钕钇铝石榴石激光(Nd:YAG)与掺铒钇铝石榴石激光(Er:YAG)联合辅助治疗牙周牙髓联合病变的临床疗效及对牙周临床指标的影响。方法选取2017年1月至2018年1月期间于解放军第306医院口腔科就诊的牙周牙髓联合病变患者102例为研究对象,根据随机数表法分为观察组和对照组,每组51例。对照组采用碘伏消毒根管+盐酸米诺环素处理牙周袋,观察组采用Nd:YAG消毒根管+Er:YAG处理牙周袋。比较两组根管填充后疼痛程度,术前、术后6周、12周菌斑指数(PLI)、出血指数(BI)、牙周探诊深度(PD)和临床附着水平(CAL)指标变化,术后6个月牙齿松动、叩痛、牙周炎等情况以及临床疗效。结果观察组患者的根管填充后无疼痛37例,14例轻中度疼痛,对照组无疼痛18例,33例轻度至重度疼痛,差异有统计学意义(P<0.05);治疗后6周,观察组患牙的PLI、BI、PD和CAL分别为(1.06±0.63)、(1.42±0.72)、(4.22±0.59) mm和(3.36±0.42) mm,明显低于对照组的(1.34±0.48)、(2.13±0.83)、(4.87±0.57) mm和(3.72±0.41) mm,治疗后12周,观察组患牙的PLI、BI、PD和CAL分别为(1.12±0.71)、(1.60±0.64)、(4.08±0.53) mm和(3.20±0.39) mm,低于对照组的(1.24±0.53)、(1.85±0.74)、(4.81±0.64) mm和(3.68±0.45) mm,差异均有统计学意义(P<0.05);治疗后6个月,观察组患牙松动、叩痛及牙周炎发生率分别为5.75%、9.20%和8.05%,均明显低于对照组的25.56%、36.67%和26.67%,差异均有统计学意义(P<0.05);观察组患者的治疗总有效率90.80%,高于对照组的73.33%,差异有统计学意义(P<0.05)。结论牙周牙髓联合病变患者采用Nd:YAG和Er:YAG双波长激光联合辅助治疗具有较好临床疗效,值得推广应用。

Objective To investigate the clinical curative effect of neodymium-doped yttrium aluminum garnet(Nd:YAG) combined with erbium-doped yttrium aluminum garner(Er:YAG) in the treatment of combined periodontal-endodontic lesions and the influence on clinical periodontal indexes. Methods A total of 102 patients with combined periodontal-endodontic lesions treated in the Department of Stomatology at the 306 thHospital of Chinese PLA from January 2017 to January 2018 were selected as subjects. They were randomly divided into an observation group and a control group according to the random number table method, with 51 cases in each group. The control group was treated with iodophor disinfecting root canals and minocycline hydrochloride treating periodontal pockets. The observation group received Nd:YAG disinfection of root canals and Er:YAG treatment of periodontal pockets. The pain degree after root canal filling was compared between the two groups, as well as the changes of plaque index(PLI), bleeding index(BI), periodontal probing depth(PD) and clinical attachment level(CAL) before surgery, at 6 weeks and 12 weeks after surgery, as well as the conditions of loose tooth, percussed pain and periodontitis and clinical effect at 6 months after surgery. Results In the observation group, there were 37 patients without pain and 14 patients with mild to moderate pain after root canal filling;however, there were 18 patients without pain and 33 patients with mild to moderate pain in the control group;the differences were statistically significant(P<0.05). At 6 weeks after treatment, the PLI, BI, PD and CAL of the observation group were respectively 1.06±0.63, 1.42±0.72,(4.22±0.59) mm, and(3.36±0.42) mm, which were significantly lower than 1.34±0.48, 2.13±0.83,(4.87±0.57) mm, and(3.72±0.41) mm in the control group. At 12 weeks after treatment, the PLI, BI, PD and CAL of the observation group were respectively 1.12±0.71, 1.60±0.64,(4.08±0.53) mm,and(3.20±0.39) mm, which were lower than 1.24±0.53, 1.85±0.74,(4.81±0.64) mm, and(3.68±0.45) mm in the control group. There were statistically significant differences in the change trend of PLI, BI, PD and CAL between the two groups at different time points(P<0.05). At 6 months after treatment, the incidence of loose tooth, percussed pain and periodontitis in the observation group were respectively 5.75%, 9.20% and 8.05%, which were significantly lower than corresponding 25.56%, 36.67% and 26.67% in the control group(P<0.05). The total effective rate of treatment in the observation group(90.80%) was higher than that in the control group(73.33%), P<0.05. Conclusion Nd:YAG and Er:YAG dual-wavelength laser combined with adjuvant therapy is effective in the treatment of combined periodontal-endodontic lesions, thus worthy of clinical popularization and application.