Email Alert | RSS

北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (1): 64-70. doi: 10.19723/j.issn.1671-167X.2020.01.010

• 论著 • 上一篇    下一篇

超声龈下清创联合手工根面平整术治疗重度牙周炎的临床效果

闫乐1,王宪娥1,詹雅琳2,苗莉莉1,韩烨1,张楚人1,岳兆国1,胡文杰1,△(),侯建霞1,△()   

  1. 1. 北京大学口腔医学院·口腔医院,牙周科　国家口腔疾病临床医学研究中心　口腔数字化医疗技术和材料国家工程实验室　口腔数字医学北京市重点实验室,北京　100081
    2. 北京大学口腔医学院·口腔医院门诊部综合科,北京　100034
  • 收稿日期:2019-10-14 出版日期:2020-02-18 发布日期:2020-02-20
  • 通讯作者: 胡文杰,侯建霞 E-mail:huwenjie@pkuss.bjmu.edu.cn;jxhou@163.com
  • 基金资助:
    国家自然科学基金(81470738);国家自然科学基金(81800976)

Clinical outcomes of ultrasonic subgingival debridement combined with manual root planing in severe periodontitis

Yue YAN1,Xian-e WANG1,Ya-lin ZHAN2,Li-li MIAO1,Ye HAN1,Chu-ren ZHANG1,Zhao-guo YUE1,Wen-jie HU1,△(),Jian-xia HOU1,△()   

  1. 1. Department of Periodontology,Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of General Dentistry, First Clinical Division, Peking University School and Hospital of Stomatology, Beijing 100034, China
  • Received:2019-10-14 Online:2020-02-18 Published:2020-02-20
  • Contact: Wen-jie HU,Jian-xia HOU E-mail:huwenjie@pkuss.bjmu.edu.cn;jxhou@163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81470738);Supported by the National Natural Science Foundation of China(81800976)

RICH HTML

 41   

PDF (PC)

426

摘要：

目的:比较超声龈下清创术和超声龈下清创联合手工根面平整术的临床效果,探讨超声龈下清创术后实施手工根面平整术的临床必要性。方法:选择2017年10月至2018年10月在北京大学口腔医院牙周科就诊的符合纳入标准的23例重度牙周炎患者,采用分口设计的方法,洁治后进行基线检查及随机分组,上、下颌各有一个象限为试验组,单纯采用超声龈下清创联合手工根面平整术治疗,另两个象限为对照组,单纯采用超声龈下清创术治疗,每位患者分上、下半口两次完成治疗,间隔1周,在治疗后2周、1个月、3个月及6个月时随访,记录并比较治疗前后组内及组间探诊深度(probing depth, PD)、临床附着丧失(clinical attachment loss, CAL)和出血指数(bleeding index, BI)的变化。结果:基线时,试验组和对照组的各项临床指标差异无统计学意义,治疗后试验组和对照组的PD、CAL及BI较治疗前均有显著改善。治疗后1个月及3个月,试验组PD减少量均高于对照组,差异有统计学意义 [1个月: (2.13±1.31) mm vs. (1.79±1.33) mm, P<0.01; 3个月: (2.46±1.33) mm vs. (2.17±1.38) mm, P<0.01],试验组CAL减少量均高于对照组,差异有统计学意义 [1个月: (1.89±2.03) mm vs. (1.65±1.93) mm, P<0.01; 3个月: (2.03±2.05) mm vs. (1.83±1.97) mm, P<0.05];术后6个月,试验组PD减少量为(2.52±1.40) mm,对照组PD减少量为(2.35±1.37) mm, 试验组的改善优于对照组(P<0.01);两组CAL分别减少了(1.89±2.14) mm和(1.77±2.00) mm,差异无统计学意义(P>0.05)。治疗后1、3及6个月两组的BI有所改善,但差异无统计学意义(P>0.05)。结论:与超声龈下清创术相比,超声龈下清创联合手工根面平整术能更有效地降低牙周袋深度及减少临床附着丧失,临床上有必要在超声龈下清创后使用手工器械进行根面平整,以获得更好的临床效果。

关键词: 重度牙周炎, 超声龈下清创联合手工根面平整术, 超声龈下清创术, 分口对照

Abstract:

Objective:To compare the clinical effects of ultrasonic subgingival debridement and ultrasonic subgingival debridement combined with manual root planing on severe periodontitis and then to investigate the necessity and significance of manual root planing. Methods: Twenty-three patients with severe periodontitis participated in this split-mouth randomized-controlled clinical trial. Baseline examination and randomization were performed after supragingival scaling: each of the upper and lower jaws had a quadrant as the test group treated with ultrasonic subgingival debridement combined with manual root planing, whereas the other two quadrants were the control group treated with ultrasonic subgingival debridement. Treatment of each patient was at intervals of one week and completed in two visits. Clinical indicators concerning probing depth (PD), clinical attachment loss (CAL) and bleeding index (BI) were recorded at baseline and 1 month, 3 months, 6 months after treatment. Results: There was no significant difference of periodontal indicators between the test group and the control group at baseline. Both the test group and control group resulted in significant improvement of PD, CAL and BI. One and three months after treatment, reduction of PD in the test group was higher than that in the control group [1 month: (2.13±1.31) mm vs. (1.79±1.33) mm, P<0.01; 3 months: (2.46±1.33) mm vs. (2.17±1.38) mm, P<0.01] and reduction of CAL in the test group was higher than that in the control group [1 month: (1.89±2.03) mm vs. (1.65±1.93) mm, P<0.01; 3 months: (2.03±2.05) mm vs. (1.83±1.97) mm, P<0.05]. Six months after treatment, PD in the test group and the control group decreased by (2.52±1.40) mm and (2.35±1.37) mm respectively, and the improvement in the test group was significantly better than that in the control group (P<0.01). CAL in the test group and the control group decreased by (1.89±2.14) mm and (1.77±2.00) mm respectively, and there was no statistical difference between the groups. There was no significant difference in the changes of BI between the two groups 1, 3 and 6 months after treatment. Conclusion: Ultrasonic subgingival debridement combined with manual root planing has more reduction in PD and CAL compared with ultrasonic subgingival debridement. Therefore, it is still necessary to use manual instruments for root planing following ultrasonic subgingival debridement.

Key words: Severe periodontitis, Ultrasonic subgingival debridement combined with manual root planing (SRP), Ultrasonic subgingival debridement (SD), Split-mouth design

中图分类号: 

  • R781.4

表1

在个体水平上治疗前后的平均PD值和CAL值(x?±s)"

Group Baseline/mm 1M/mm 3M/mm 6M/mm
Mean PD SD 5.45±0.61 3.69±0.62#* 3.31±0.61#* 3.14±0.58#
SRP 5.56±0.60 3.47±0.57#* 3.11±0.51#* 3.08±0.60#
Mean CAL SD 4.58±1.34 3.03±1.57# 2.76±1.65# 2.81±1.70#
SRP 4.74±1.27 2.89±1.79# 2.65±1.77# 2.84±1.87#

表2

在个体水平上治疗后的PD和CAL减少量(x?±s)"

Group 1M/mm 3M/mm 6M/mm
Reduction of PD SD 1.76±0.55☆ 2.13±0.46☆ 2.29±0.55*
SRP 2.09±0.46☆ 2.44±0.50☆ 2.48±0.62*
Reduction of CAL SD 1.64±1.16 1.85±1.18* 1.79±1.30
SRP 1.92±1.32 2.09±1.37* 1.92±1.53

表3

在位点水平上治疗前后根据基线PD分组的平均PD值(x?±s)"

Group Baseline/mm 1M/mm 3M/mm 6M/mm
4-6 mm
SD 4.78±0.63 3.31±1.03#☆ 3.03±0.96#☆ 2.89±0.90#*
SRP 4.83±0.65 3.09±0.94#☆ 2.83±0.83#☆ 2.80±0.89#*
≥7 mm
SD 7.58±0.93 4.93±1.54#☆ 4.33±1.56#* 4.02±1.46#
SRP 7.57±0.81 4.51±1.59#☆ 4.01±1.53#* 3.87±1.63#
Overall
SD 5.54±1.44 3.76±1.39#☆ 3.39±1.30#☆ 3.20±1.19#
SRP 5.63±1.43 3.51±1.33#☆ 3.18±1.21#☆ 3.11±1.26#

表4

在位点水平上治疗后根据基线PD分组的PD减少量(x?±s)"

Group 1M/mm 3M/mm 6M/mm
4-6 mm
SD 1.47±1.04☆ 1.76±1.02☆ 1.89±0.97☆
SRP 1.74±0.98☆ 1.99±0.94☆ 2.03±0.97☆
≥7 mm
SD 2.65±1.59☆ 3.26±1.60* 3.56±1.53
SRP 3.07±1.50☆ 3.57±1.46* 3.70±1.56
Overall
SD 1.79±1.33☆ 2.17±1.38☆ 2.35±1.37☆
SRP 2.13±1.31☆ 2.46±1.33☆ 2.52±1.40☆

表5

在位点水平上治疗前后根据基线PD分组的平均CAL值(x?±s)"

Group Baseline/mm 1M/mm 3M/mm 6M/mm
4-6 mm
SD 3.84±1.76 2.52±1.89# 2.33±1.94# 2.38±1.90#
SRP 3.97±1.82 2.39±2.14# 2.26±2.10# 2.44±2.13#
≥7 mm
SD 6.50±1.79 4.41±2.44# 4.10±2.35# 4.16±2.41#
SRP 6.64±1.71 4.23±2.62# 3.92±2.55# 3.99±2.67#
Overall
SD 4.58±2.13 3.07±2.24# 2.82±2.21# 2.87±2.20#
SRP 4.76±2.16 2.95±2.45# 2.75±2.37# 2.90±2.41#

表6

在位点水平上治疗后根据基线PD分组的CAL减少量(x?±s)"

Group 1M/mm 3M/mm 6M/mm
4-6 mm
SD 1.46±1.63* 1.60±1.72 1.56±1.71
SRP 1.67±1.71* 1.75±1.74 1.56±1.83
≥7 mm
SD 2.10±2.48 2.41±2.41 2.34±2.54
SRP 2.42±2.53 2.72±2.51 2.66±2.60
Overall
SD 1.65±1.93☆ 1.83±1.97* 1.77±2.00
SRP 1.89±2.03☆ 2.03±2.05* 1.89±2.14
[1] Aleo JJ, Renzis FA, De Farber PA . In vitro attachment of human gingival fibroblasts to root surfaces[J]. J Periodontol, 1975,46(11):639-645.
[2] 孟焕新 . 临床牙周病学 [M]. 2版. 北京: 北京大学医学出版社, 2014: 275-283.
[3] Daly CG, Seymour GJ, Kieser JB . Bacterial endotoxin: a role in chronic inflammatory periodontal disease[J]. J Oral Pathol, 1980,9(1):1-15.
[4] Nakib NM, Bissada NF, Simmelink JW , et al. Endotoxin penetration into root cementum of periodontally healthy and diseased human teeth[J]. J Periodontol, 1982,53(6):368-378.
[5] Laleman I, Cortellini S, De Winter S , et al. Subgingival debridement: end point, methods and how often[J]. Periodontol 2000, 2017,75(1):189-204.
[6] Badersten A, Nilveus R, Egelberg J . Effect of nonsurgical periodontal therapy[J]. J Clin Periodontol, 1984,11(1):63-76.
[7] Obeid PR, William DH, Pierre B . Comparative clinical responses related to the use of various periodontal instrumentation[J]. J Clin Periodontol, 2004,31(3):193-199.
[8] Ioannou I, Dimitriadis N, Papadimitriou K , et al. Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: a randomized clinical and microbiological trial[J]. J Clin Periodontol, 2009,36(2):132-141.
[9] Armitage GC . Development of a classification system for periodontal diseases and conditions[J]. Ann Periodontol, 1999,4(1):1-6.
[10] Papapanou PN, Sanz M, Buduneli N , et al. Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions[J]. J Periodontol, 2018,89(Suppl 1):S173-S182.
[11] Jiao J, Shi D, Cao ZQ , et al. Effectiveness of non-surgical periodontal therapy in a large Chinese population with chronic periodontitis[J]. J Clin Periodontol, 2017,44(1):42-50.
[12] Jiao J, Zhang L, Meng HX , et al. Clinical performance of non-surgical periodontal therapy in a large Chinese population with generalized aggressive periodontitis[J]. J Clin Periodontol, 2018,45(10):1184-1197.
[13] Zhan YL, Lu RF, Meng HX , et al. The role of platelets in inflammatory immune responses in generalized aggressive periodontitis[J]. J Clin Periodontol, 2017,44(2):150-157.
[14] 孟圆, 刘雪楠, 郑树国 , 等. 国内外口腔疾病负担的现况和分析[J]. 中华口腔医学杂志, 2017,52(6):386-389.
[15] Apatzidou DA . Modern approaches to non-surgical biofilm management[J]. Front Oral Biol, 2012,15:99-116.
[16] Marda P, Prakash S, Devaraj CG , et al. A comparison of root surface instrumentation using manual, ultrasonic and rotary instruments: an in vitro study using scanning electron microscopy[J]. Indian J Dent Res, 2012,23(2):164-170.
[17] 冯希平 . 中国居民口腔健康状况:第四次中国口腔健康流行病学调查报告 [R]. 西安: 2018 年中华口腔医学会第十八次口腔预防医学学术年会, 2018.
[18] 高小芳, 梁妍 . 单独龈下超声刮治与结合人工刮治两种方法的临床效果比较[J]. 口腔材料器械杂志, 2012,21(3):137-139.
[19] Tunkel J, Heinecke A, Flemmig TF . A systematic review of efficacy of machine-driven and manual subgingival debridement in the treatment of chronic periodontitis[J]. J Clin Periodontol, 2002,29(S3):72-81.
[20] Christgau M, Männer T, Beuer S , et al. Periodontal healing after non-surgical therapy with a new ultrasonic device: a randomized controlled clinical trial[J]. J Clin Periodontol, 2007,34(2):137-147.
[21] 龚逸明, 丁小军, 任颖 . 龈下刮治和根面平整术后牙本质过敏的临床评价[J]. 国际口腔医学杂志, 2009,36(3):256-259.
[22] 中华口腔医学会口腔预防医学专业委员会牙本质敏感专家组. 牙本质敏感的诊断和防治指南(2019修订版)[J]. 中华口腔医学杂志, 2019,54(4):223-227.
[23] Aspriello SD, Piemontese M, Levrini L , et al. Ultramorphology of the root surface subsequent to hand-ultrasonic simultaneous instrumentation during non-surgical periodontal treatments: an in vitro study[J]. J Appl Oral Sci, 2011,19(1):74-81.
[24] Van der Weijden GA, Timmerman MF . A systematic review on the clinical efficacy of subgingival debridement in the treatment of chronic periodontitis[J]. J Clin Periodontol, 2002,29(Suppl 3):55-71.
[25] Rohanizadeh R, Legeros RZ . Ultrastructural study of calculus-enamel and calculus-root interfaces[J]. Arch Oral Biol, 2005,50(1):89-96.
[26] Pattison AM, Pattison GL . Carranza’s clinical periodontology[M]. 12th ed. Saunders Canada: Saunders an Imprint of Elsevier Inc, 2015: 1015.
[1] 李熠，徐莉，周彦恒，欧阳翔英，曹甜. 牙周正畸牙体联合治疗1例预后无望上前牙患者的长期疗效观察#br#[J]. 北京大学学报(医学版), 2017, 49(4): 740-744.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究（英文稿）[J]. 北京大学学报（医学版）, 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报（医学版）, 2009, 41(2): 125 -128 .
[3] 成刚, 钱振华, 胡军. 艾滋病项目自愿咨询检测的技术效率分析[J]. 北京大学学报（医学版）, 2009, 41(2): 135 -140 .
[4] 卢恬, 朱晓辉, 柳世庆, 郑杰, 邱晓彦. 白细胞介素2促进宫颈癌细胞系HeLaS3免疫球蛋白G的表达[J]. 北京大学学报（医学版）, 2009, 41(2): 158 -161 .
[5] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报（医学版）, 2009, 41(2): 217 -220 .
[6] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报（医学版）, 2009, 41(1): 52 -55 .
[7] 董稳, 刘瑞昌, 刘克英, 关明, 杨旭东. 氯诺昔康和舒芬太尼用于颌面外科术后自控静脉镇痛的比较[J]. 北京大学学报（医学版）, 2009, 41(1): 109 -111 .
[8] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报（医学版）, 2009, 41(3): 297 -301 .
[9] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报（医学版）, 2009, 41(5): 599 -601 .
[10] 李伟军, 邢晓芳, 曲立科, 孟麟, 寿成超. PRL-3基因C104S位点突变体和CAAX缺失体的构建及表达[J]. 北京大学学报（医学版）, 2009, 41(5): 516 -520 .
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部