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。

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.