牙周内窥镜辅助牙周非手术治疗对龈下微生物和牙龈探诊出血的影响  

Efficacy of periodontoscopic-assisted ultrasonic scaling and root planning(SRP)in treatment of chronic periodontitis

作　　者：陆卫青 向文静 张炜亮 阴杰 曹伟玉 杨立 LU Weiqing;XIANG Wenjing;ZHANG Weiliang;YIN jie;CAO Weiyu;YANG Li(Department of Periodontology,Dental and Ophthalmic Clinic of Putuo District,Shanghai 200060,China;Department of Oral Surgery,Dental and Ophthalmic Clinic of Putuo District,Shanghai 200060,China;Department of Prosthodontics,Dental and Ophthalmic Clinic of Putuo District,Shanghai 200060,China)

机构地区：[1]上海市普陀区眼病牙病防治所牙周科,上海200060 [2]上海市普陀区眼病牙病防治所口腔外科,上海200060 [3]上海市普陀区眼病牙病防治所口腔修复科,上海200060

出　　处：《同济大学学报（医学版）》2022年第4期521-526,共6页Journal of Tongji University(Medical Science)

基　　金：上海市普陀区卫生健康系统科技创新项目(Ptkwws201822)。

摘　　要：目的探索牙周内窥镜辅助下超声龈下刮治及根面平整术对上颌侧切牙唇侧龈下微生物和牙龈探诊出血的影响。方法从2020年6月—2020年12月就诊于上海市普陀区眼病牙病防治所牙周科的患者中收集36例中、重度慢性牙周炎患者作为受试者,要求双侧上颌侧切牙唇侧牙周探诊深度(probing depth,PD)均达47 mm,唇侧附着丧失(attachment loss,AL)≥3 mm,采用单盲随机半口自身对照设计方案,先行全口超声龈上洁治术,2周时用抽签法随机确定一侧上颌侧切牙行牙周内窥镜辅助下超声龈下刮治和根面平整术(scaling and root planing,SRP)(内镜组),对侧侧切牙行常规SRP(SRP组)作为对照,术后菌斑控制,记录基线、术后3个月和术后6个月时上颌侧切牙唇侧近中、中和远中3个位点的PD和探诊出血指数(bleeding on probing,BOP),并用暗视野显微镜观察这3个位点龈下的球菌(Co)、螺旋体(S)、能动菌(M)和其他微生物(O)并计数,对治疗前后各项指标差异进行统计分析。结果基线时各指标均无统计学意义(P>0.05),螺旋体为主要龈下微生物,BOP多为阳性。治疗3个月后,两组PD、BOP、螺旋体和能动菌数值均显著下降(P<0.05),球菌(Co)数量显著上升(P<0.05),在龈下微生物中占主导地位;两组间相比,PD差异无统计学意义(P>0.05),但球菌(Co)、螺旋体(S)、能动菌(M)和BOP差异均有统计学意义(P<0.05)。治疗6个月后,与治疗3个月后相比,内窥镜组PD显著降低(P<0.05);与基线相比,两组PD和BOP差异均有统计学意义(P<0.05);两组的球菌(Co)、螺旋体(S)和能动菌(M)数量有反弹,与基线和治疗3个月后相比,差异均有统计学意义(P<0.05),其中,球菌(Co)仍然是龈下主要菌种;两组间PD差异无统计学意义(P>0.05),而球菌(Co)、螺旋体(S)和能动菌(M)以及BOP差别均有统计学意义(P<0.05)。在整个观察期间,其他微生物(O)组间差异均无统计学意义(P>0.05)。结论内窥镜辅助下牙周�Objective To investigate the efficacy of periodontoscopic-assisted ultrasonic scaling and root planning(SRP)in treatment of chronic periodontitis.Methods Thirty-six patients with moderate to advanced chronic periodontitis treated in Department of Periodontology of Shanghai Putuo District Dental and Ophthalmic Clinic from June 2020 to December 2020 were enrolled in the study.The labial periodontal probing depth(PD)of two lateral maxillary incisors was 47 mm,and the labial attachment loss(AL)was more than 3 mm in all patients.A single-blind self-control randomized design was used in the study.The lateral maxillary incisors of one side was treated with periodontoscopic-assisted ultrasonic scaling and root planning(SRP)(test group)and the contralateral periodontium was treated with conventional SRP(control group).PD and bleeding on probing(BOP)at the mesial,middle and distal loci of the labial of the maxillary lateral incisor were recorded at baseline,3 and 6 months after treatment,respectively.The subgingival coccus(Co),spirochete(S),motida(M)and other microorganisms(O)were observed by dark field microscope and counted.Results There were no significant differences in all indexes at baseline between the two groups(P>0.05).Spirochete was the main subgingival microorganism and BOP was positive at many sites.Three months after treatment,the numbers of PD,BOP,spirochete and motile bacteria in both groups were significantly decreased(P<0.05),while the number of cocci(Co)was significantly increased and(P<0.05)and was the dominant subgingival microbes.There were no significant differences in PD between the two groups(P>0.05),but there were significant differences in coccus(Co),spirochete(S)and motile bacteria(M)as well as BOP between the two groups(P<0.05).At 6 months after treatment,compared with 3 months,PD decreased significantly in test group(P<0.05).There were significant differences in PD and BOP of the two groups compared with baseline(P<0.05).In both groups the numbers of Cocci(Co),spirochete(S)and motile bacteria(M

关 键 词：超声龈下刮治术 根面平整术 牙周内窥镜 龈下微生物 探诊出血指数 

分 类 号：R781.4[医药卫生—口腔医学]