牙周内窥镜下根面清创与牙周翻瓣术疗效比较

doi:10.19723/j.issn.1671-167X.2023.04.024

北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (4): 716-720. doi: 10.19723/j.issn.1671-167X.2023.04.024

牙周内窥镜下根面清创与牙周翻瓣术疗效比较

裴喜燕¹,阳雯¹,欧阳翔英^2,*(),孙凤¹

1. 北京大学口腔医学院·口腔医院门诊部, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100034
2. 北京大学口腔医学院·口腔医院牙周科, 北京 100081

收稿日期:2020-08-15 出版日期:2023-08-18 发布日期:2023-08-03
通讯作者: 欧阳翔英 E-mail:kqouyangxy@bjmu.edu.cn
基金资助:
北京大学口腔医院临床新技术新疗法项目(PKUSSNCT-18B14)

Comparison of clinical effects between periodontal endoscopy aiding subgingival debridement and flap surgery

Xi-yan PEI¹,Wen YANG¹,Xiang-ying OUYANG^2,*(),Feng SUN¹

1. First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100034, China
2. Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing 100081, China

Received:2020-08-15 Online:2023-08-18 Published:2023-08-03
Contact: Xiang-ying OUYANG E-mail:kqouyangxy@bjmu.edu.cn
Supported by:
the New Technology and New Treatment Foundation of Peking University School and Hospital of Stomatology(PKUSSNCT-18B14)

摘要/Abstract

摘要：

目的: 比较牙周内窥镜辅助龈下根面清创与牙周翻瓣术治疗深牙周袋的疗效。方法: 采用随机对照单盲设计, 收集牙周基础治疗后仍有残余牙周深袋的牙周炎患牙, 排除需要行骨成形或再生手术的情况, 分为试验组和对照组。试验组用牙周内窥镜辅助龈下根面清创, 对照组使用牙周翻瓣术。记录基线和3个月时的探诊深度、附着丧失、出血指数、菌斑指数、治疗时间、舒适度[采用视觉模拟评分(visual analogue scale, VAS)], 拍定位数字片。结果: 入选41个有深牙周袋牙齿的邻面位点(试验组21个, 对照组20个), 两组匹配性好。治疗后3个月复查, 试验组的探诊深度由基线的(5.62±0.86) mm改善为(3.95±0.74) mm, 对照组的探诊深度由基线的(5.95±1.19) mm改善为(3.70±0.73) mm, 两组的改善差异均有统计学意义(P < 0.05), 但组间差异无统计学意义。治疗后3个月复查时, 所有位点均降低至5 mm及以下, 试验组76%的位点降至4 mm及以下, 对照组85%的位点降至4 mm及以下。试验组和对照组的出血指数均显著降低, 但组间差异无统计学意义。试验组的菌斑指数改善趋势较对照组更明显, 对照组的牙槽骨高度较试验组有下降趋势, 但组间差异无统计学意义。两组的治疗时间差异无统计学意义, 试验组(VAS评分为0.60±0.89)较对照组(VAS评分为1.20±1.64)有更舒适的趋势。结论: 短期研究发现牙周内窥镜辅助龈下根面清创具有显著的临床治疗效果, 可以降低牙周深袋及改善探诊出血, 其疗效与牙周翻瓣术相当, 可以减少部分牙周手术的必要性, 且舒适度上有比牙周翻瓣术更好的趋势。

关键词: 牙周内窥镜, 牙周翻瓣术, 慢性牙周炎

Abstract:

Objective: To compare the clinical effects of periodontal endoscopy aiding subgingival debridement with periodontal flap surgery on residual deep pockets of chronic periodontitis. Methods: In the single-blind randomized control clinical study, residual deep pockets of periodontitis patients were still existing when re-evaluation after receiving initial periodontal treatment.The pockets which were necessary for bone surgery or guided tissue regeneration surgery were excluded.The sites were divided into test group and control group randomly.Test group sites underwent periodontal endoscopy aiding debridement and control group sites had periodontal flap surgery.At the baseline and 3 months later, parameters, such as plaque index (PLI), bleeding index (BI), probing depth (PD), attachment loss (AL) were examined.Bone height was measured by parallelly digital X-ray dental film.Meanwhile, treatment time and comfort scale (visual analogue scale, VAS) were also recorded. Results: At baseline, 41 proximal sites with residual deep pockets were enrolled (test sites=21, control sites=20).All the parameters were not significantly different between the two groups.PD decreased by (1.67±0.91) mm from (5.62±0.86) mm to (3.95±0.74) mm in test group and by (2.25±1.12) mm from (5.95±1.19) mm to (3.70±0.73) mm in control group significantly (P < 0.05).The difference between the two groups was not significant.The PD of all the sites decreased lower than 5 mm, meanwhile, 76% was lower than 4 mm in test group and 85% was lower than 4 mm in control group.The BI decreased by 0.81±0.93 in test group and 0.65±0.99 in control group significantly (P < 0.05).The difference between the two groups was not significant.The PLI showed a tendency of decrease more in test group and bone height showed a trend of decrease more in control group, however, the difference was not significant.The treatment time was almost the same.The patients felt more comfortable in the test group (VAS was 0.60±0.89) than the control group (VAS was 1.20±1.64), however, the difference was not significant. Conclusion: Periodontal endoscopy aiding subgingival debridement could improve periodontal status by reducing the PD and BI significantly in short term.The effect was almost the same with periodontal surgery and endoscopy treatment may decrease the necessity of surgery.Meanwhile, periodontal endoscopy has more comfortable treatment experience than flap surgery and does not need extra treatment time.

Key words: Periodontal endoscopy, Flap surgery, Chronic periodontitis

中图分类号:

R781.4

裴喜燕,阳雯,欧阳翔英,孙凤. 牙周内窥镜下根面清创与牙周翻瓣术疗效比较[J]. 北京大学学报（医学版）, 2023, 55(4): 716-720.

Xi-yan PEI,Wen YANG,Xiang-ying OUYANG,Feng SUN. Comparison of clinical effects between periodontal endoscopy aiding subgingival debridement and flap surgery[J]. Journal of Peking University (Health Sciences), 2023, 55(4): 716-720.

图/表 6

表1

图1

表2

表3

表4

表5

参考文献 13

1	谭葆春, 张鹏, 李厚轩, 等. 内窥镜在牙周诊疗中的应用进展[J]. 中国实用口腔科杂志, 2018, 11 (7): 385- 391.
2	Osborn JB , Lenton PA , Lunos SA , et al. Endoscopic vs. tactile evaluation of subgingival calculus[J]. J Dent Hyg, 2014, 88 (4): 229- 236.
3	李铮, 季瑾, 刘洋, 等. 牙石残留率对牙周治疗效果影响的研究[J]. 北京口腔医学, 2018, 26 (5): 270- 274.
4	Blue CM , Lenton P , Lunos S , et al. A pilot study comparing the outcome of scaling/root planing with and without perioscope technology[J]. J Dent Hyg, 2013, 87 (3): 152- 157.
5	Kuang Y , Hu B , Chen J , et al. Effects of periodontal endoscopy on the treatment of periodontitis: A systematic review and meta-analysis[J]. J Am Dent Assoc, 2017, 148 (10): 750- 759. doi: 10.1016/j.adaj.2017.05.011
6	廖雁婷, 刘园, 江泳, 等. 牙周内镜辅助龈下刮治与根面平整术的临床疗效观察[J]. 中华口腔医学杂志, 2016, 51 (12): 722- 727.
7	Ribeiro FV , Casarin RC , Palma MA , et al. Clinical and micro-biological changes after minimally invasive therapeutic approaches in intrabony defects: A 12-month follow-up[J]. Clin Oral Investig, 2013, 17 (7): 1635- 1644. doi: 10.1007/s00784-012-0855-5
8	Nibali L , Yeh YC , Pometti D , et al. Long-term stability of intrabony defects treated with minimally invasive non-surgical therapy[J]. J Clin Periodontol, 2018, 45 (12): 1458- 1464. doi: 10.1111/jcpe.13021
9	Harrel SK . Videoscope-assisted minimally invasive surgery (VMIS) for bone regeneration around teeth and implants: A literature review and technique update[J]. Dent J (Basel), 2018, 6 (3): 30.
10	Harrel SK , Nunn ME , Abraham CM , et al. Videoscope assisted minimally invasive surgery (VMIS): 36-month results[J]. J Periodontol, 2017, 88 (6): 528- 535. doi: 10.1902/jop.2017.160705
11	Harrel SK , Abraham CM , Rivera-Hidalgo F , et al. Videoscope-assisted minimally invasive periodontal surgery: One-year outcome and patient morbidity[J]. Int J Periodontics Restorative Dent, 2016, 36 (3): 363- 371. doi: 10.11607/prd.2759
12	Graetz C , Schorr S , Christofzik D , et al. How to train periodontal endoscopy? Results of a pilot study removing simulated hard deposits in vitro[J]. Clin Oral Investig, 2020, 24 (2): 607- 617.
13	Rosling B , Nyman S , Lindhe J , et al. The healing potential of the periodontal tissues following different techniques of periodontal surgery in plaque-free dentitions. A 2-year clinical study[J]. J Clin Periodontol, 1976, 3 (4): 233- 250.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Group	n	Baseline/mm, $\bar x \pm s$	3 months later/mm, $\bar x \pm s$	Change/mm, $\bar x \pm s$	P value
Test group	21	5.62±0.86	3.95±0.74	1.67±0.91	< 0.001
Control group	20	5.95±1.19	3.70±0.73	2.25±1.12	< 0.001
P value		0.31	0.28	0.07

Group	n	Baseline/mm, $\bar x \pm s$	3 months later/mm, $\bar x \pm s$	Change/mm, $\bar x \pm s$	P value
Test group	21	4.40±1.44	4.04±1.16	0.36±1.20	0.38
Control group	20	4.95±1.76	4.45±1.39	0.50±1.43	0.32
P value		0.28	0.32	0.73

Group	n	Baseline, $\bar x \pm s$	3 months later, $\bar x \pm s$	Change, $\bar x \pm s$	P value
Test group	21	2.95±0.67	2.14±0.97	0.81±0.93	< 0.001
Control group	20	2.75±0.79	2.10±0.72	0.65±0.99	< 0.009
P value		0.38	0.85	0.60

Group	n	Baseline, $\bar x \pm s$	3 months later, $\bar x \pm s$	Change, $\bar x \pm s$	P value
Test group	21	0.62±0.66	0.43±0.60	0.19±0.92	0.34
Control group	20	0.85±0.81	0.95±0.76	0.1±0.64	0.69
P value		0.32	0.02	0.25

Group	n	Baseline/mm, $\bar x \pm s$	3 months later/mm, $\bar x \pm s$	Change/mm, $\bar x \pm s$	P value
Test group	21	3.90±0.95	3.91±1.10	0.02±0.43	0.96
Control group	20	4.03±1.43	3.95±1.23	0.08±0.54	0.84
P value		0.72	0.92	0.52

牙周内窥镜下根面清创与牙周翻瓣术疗效比较

Comparison of clinical effects between periodontal endoscopy aiding subgingival debridement and flap surgery

RICH HTML

PDF (PC)

摘要/Abstract

引用本文

使用本文

图/表 6

参考文献 13

相关文章 3

Metrics

本文评价

推荐阅读 0

[1]	张勇,刘畅,陈彬,陈帆,段晋瑜,张孟钧,焦剑. 糖尿病前期患者糖代谢异常与慢性牙周炎的相关性[J]. 北京大学学报（医学版）, 2020, 52(1): 71-76.
[2]	石姝雯,孟洋,焦剑,李文静,孟焕新,栾庆先,王万春. 根分叉病变患牙经牙周非手术治疗后5年失牙状况及多因素分析[J]. 北京大学学报（医学版）, 2019, 51(5): 913-918.
[3]	张又文，辛天艺，焦剑，周彦恒，施捷. 慢性牙周炎的减数正畸治疗[J]. 北京大学学报(医学版), 2018, 50(2): 308-313.