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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)

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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
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ISSN 1671-167X
CN 11-4691/R
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