内窥镜辅助下超声龈下刮治和根面平整术对牙根表面的影响  

Effects of ultrasonic subgingival scaling and root planing with a periodontal endoscope on the root surface

作　　者：赵俊杰[1] 谭葆春[1] 李丽丽[1] 张杨珩 陈盛[2] ZHAO Junjie;TAN Baochun;LI Lili;ZHANG Yangheng;CHEN Sheng(Department of Periodontology,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of Oral Pathology,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院·南京市口腔医院牙周病科,江苏南京210008 [2]南京大学医学院附属口腔医院·南京市口腔医院口腔病理科,江苏南京210008

出　　处：《口腔疾病防治》2021年第10期684-688,共5页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金⁃青年科学基金项目(81801041);江苏省自然科学基金项目(BK20190133);南京市医学科技发展项目(南京市卫生计生委)(YKK17139)。

摘　　要：目的评价牙周内窥镜辅助下超声龈下刮治和根面平整术(subgingival scalingandrootplaning,SRP)后根面牙结石残留量和牙骨质保存情况。方法选取在南京大学医学院附属口腔医院牙周病科因重度牙周炎需拔除的患牙12颗,随机分为3组,每组4颗:①内窥镜辅助下超声SRP组:在牙周内窥镜辅助下配合EMS超声治疗仪清理患牙根面;②传统SRP组:对患牙进行超声刮治并配合Gracey刮治器行手工根面平整;③未处理组:不进行任何刮治处理;以上操作由同一位高年资医师完成操作,局麻下每颗患牙均刮治10 min后拔除;观察并记录各组菌斑染色后根面牙结石的残留量,测量各组根颈1/3处保留牙骨质的厚度。结果内窥镜辅助下SRP组根面牙结石残留率最低,与传统SRP组和未处理组比较有显著差异(P<0.001)。组织学观察各组牙根颈1/3处剩余牙骨质厚度均值从牙根表面釉牙骨质界(cementoenamel junction,CEJ)处、CEJ下2.5 mm处、CEJ下5 mm处呈递增趋势,与传统SRP组相比,内窥镜辅助下超声SRP对牙骨质的损伤较少,能较好保存牙骨质(P<0.001)。结论牙周内窥镜辅助下SRP比传统SRP能更有针对性地清除龈下菌斑和牙结石,且可较好的保留根面牙骨质。Objective To evaluate the effects of root calculus residue and root cement preservation by ultrasonic subgingival scaling and root planing(SRP)with or without perioscopy.Methods Twelve teeth extracted due to severe periodontitis were randomly divided into three groups with four teeth in each group:(1)Endoscope-assisted SRP group.The root surfaces of the affected teeth were cleaned with an EMS ultrasonic treatment instrument.(2)Traditional SRP group.The affected teeth were treated by ultrasonic subgingival scaling and hand root planing with a Gracey curette.(3)Untreat group.The above operations were performed by the same senior physician.Under local anesthesia,each tooth was scraped for 10 minutes and then extracted.The residual amount of calculus on the root surface after plaque staining was observed and recorded.The thickness of the retained cementum at 1/3 of the root neck was measured.Results The residual rate of calculus on the root surface was the lowest in the endoscope-assisted SRP group,which was significantly different from the traditional SRP group and the untreated group(P<0.001).Histological observation showed that the mean residual cementum thickness at 1/3 of the root neck increased gradually from the cemento-enamel junction(CEJ),2.5 mm below the CEJ and 5 mm below the CEJ.Ultrasound SRP assisted by endoscopy caused less damage to the cementum and preserved the cementum better than traditional subgingival scaling(P<0.001).Conclusion Compared with traditional SRP therapy,endoscope-assisted SRP treatment can remove subgingival plaque and calculus more effectively and can better preserve the cementum of the root surface.

关 键 词：牙周炎 龈下菌斑 牙结石 牙周内窥镜 超声龈下刮治 Gracey刮治器 龈下刮治 根面平整术 根面 釉牙骨质界 牙骨质 微创治疗 

分 类 号：R78[医药卫生—口腔医学]