Er:YAG激光联合引导骨组织再生术治疗种植体周围炎骨缺损的临床效果

目的 评估Er:YAG激光(erbium-doped:yttrium aluminium garnet)联合引导骨组织再生术(guided bone regeneration,GBR)治疗种植体周围炎骨缺损的临床效果.方法 选择形成环形牙槽骨吸收的种植体周围牙周炎患者15例,共26颗患牙,按照随机照原则分为2组,试验组(14颗)采用Er:YAG激光联合GBR的方式治疗种植体周围骨缺损;对照组(12颗)采用机械刮治联合GBR治疗牙槽骨的缺损.在基线和6个月时进行临床牙周指标的检查测定,包括菌斑指数(plaque index,PI)、龈沟出血指数(sulcus bleeding index,SBI)、牙周探诊深度(probing depth,PD)及临床附着丧失(clinical attachment lost,CAL),并进行比较.结果 2组术后PI、SBI、PD及CAL均较术前有明显改善(P<0.05).术后2组PI均值都维持在一个较低的水平,差异无统计学意义(P>0.05);试验组与对照组的SBI分别为(0.8±0.2)、(1.1±0.2);PD分别为(5.8±0.8)mm、(6.2±0.6)mm;CAL分别为(2.3±0.7)mm、(3.6±0.6)mm.组间比较差异均有统计学意义(P<0.05).结论 Er:YAG激光联合GBR在治疗种植体周炎骨缺损具有较好的临床效果.     

种植体打磨抛光联合药物及激光治疗对种植体周围炎的短期疗效观察

目的 观察种植体表面打磨抛光技术联合药物及Er:YAG激光治疗对种植体周围炎的短期临床疗效。方法 选择2018年01月至2021年12月期间在我院口腔科收治的种植体周围炎患者共计113例作为研究对象,采用2×2析因设计的方式,随机数字表法将全部患者随机分为Ⅰ、Ⅱ、Ⅲ、Ⅳ组,Ⅰ组患者给予种植体打磨抛光疗法,Ⅱ组患者给予种植体打磨抛光与盐酸米诺环素联合疗法,Ⅲ组患者给予种植体打磨抛光与Er:YAG激光联合疗法,Ⅳ组患者给予种植体打磨抛光、盐酸米诺环素与Er:YAG激光联合疗法。于治疗前,治疗后第6周及治疗后第12周三个时间点对四组患者的种植体菌斑指数（PLI）、牙周探诊深度（PD）、龈沟出血指数（SBI）、龈沟液中炎症因子（TNF-α、IL-8、MMP-8）进行分析,以此作为临床疗效的评价依据。结果 接受不同治疗方法的四组患者的PLI、PD、SBI均得到不同程度的改善,其中接受种植体打磨抛光、盐酸米诺环素与Er:YAG激光三种方式联合疗法的患者治疗效果明显优于单纯种植体打磨抛光疗法,也明显优于种植体打磨抛光与盐酸米诺环素或Er:YAG激光两种方式联合疗法的治疗效果。结论 种植体打磨抛光技术...     

种植体打磨抛光联合Er:YAG激光对种植体周围炎的长期临床疗效

目的:评价种植体表面打磨抛光技术联合Er:YAG激光治疗种植体周围炎的长期临床疗效.方法:选取2015年1月～2017年1月在唐山市协和医院口腔科行牙种植且诊断为种植体周围炎的114例患者(120颗种植体,均为磨牙,采用瑞士ITI种植体)作为研究对象.将患者随机分为3组(每组40颗种植体),其中A组患者的种植体采用种植体打磨抛光和Er:YAG激光联合治疗,B组患者的种植体采用种植体打磨抛光技术治疗,C组患者的种植体采用Er:YAG激光治疗.评价、记录和比较3组患者治疗前和治疗后1、6、12和36个月的种植体菌斑指数(PLI)、龈沟出血指数(SBI)、牙周探诊深度(PD),以及患者术中疼痛程度.结果:3组患者经不同方法治疗后,同组间PLI、SBI和PD均得到明显改善.治疗36个月后,不同组间PLI、SBI和PD改善情况比较,A组显著优于B组和C组,且B组与C组之间无明显差异.此外,3组患者在不同方法治疗时均发生术中疼痛,且C组治疗时术中疼痛发生率显著低于A、B两组,但A、B两组间无明显差异.结论:种植体表面打磨抛光技术联合Er:YAG激光治疗种植体周围炎比单独应用种植表面打磨抛光技术或Er:YAG激光对种植体周围炎的长期临床疗效更好.     

Er:YAG激光治疗种植体周围炎的基础研究进展

临床治疗种植体周围炎的关键是去除种植体周围的微生物和感染组织。Er:YAG激光因其特殊的热机械效应具有显著的去污杀菌作用及较高的安全性能,广泛应用于临床种植体周围炎的治疗中。大量临床研究显示Er:YAG治疗种植体周围炎能取得比较理想的细菌清除及临床治疗效果。近年来研究者们更多关注于Er:YAG激光治疗对种植体及其周围组织的作用及对后续骨再生的影响,本文就Er:YAG激光在种植体周围炎治疗中的基础研究进展进行一综述。     

使用Er：YAG激光微爆技术治疗TiUnite表面种植体周围炎

种植体植入可能导致种植体周围炎．过去用于治疗这种炎症反应的方法没有一种能达到可预期的效果。临床上几乎不可能有效治疗具有骨诱导性能的Tiunite表面（钛氧化物涂层）种植体的感染．可是找到一种有效的治疗方法又很有必要。对比格犬进行实验以确定Er：YAG激光用以去除被污染的钛氧化层的最佳照射强度．测量Er：YAG激光的照射下相应的种植体发热度．观察用Er：YAG激光微爆从种植体表面去除一层后是否还能产生骨结合。Er：YAG激光可有效去除一层平滑的钛氧化物涂层,通过局部喷水控制种植体照射后的产热．保护周围骨组织免受热损伤。结果证明运用Er：YAG激光可有效治疗种植体周围炎。     

Er:YAG激光在治疗种植体周围炎中的研究进展

随着种植牙的普遍应用，种植体周围炎也逐渐成为影响种植体稳定的一大隐患，因此引起了诸多学者的关注。种植体周围炎的始动因素是牙菌斑，相关危险因素包括牙周病、高血糖、口腔卫生不良、牙周支持治疗不足、种植牙冠修复体咬合过载等。种植体周围炎的治疗措施总体来说可分为手术与非手术治疗两类。随着无创及微创观念的普及，非手术治疗已渐成主流，包括机械清创（超声洁治、手动刮治、空气喷砂等）、药物治疗（氯己定、碘甘油、盐酸米诺环素等）和激光治疗。然而随着传统治疗方法的缺陷逐渐显现，激光成为口腔学者关注的焦点。Er:YAG激光因其波长位于水和羟基磷灰石的吸收峰值附近，能够直接作用于含水或羟基磷灰石的组织，是目前广泛应用于切割软、硬组织的激光，在种植体周围炎治疗中的有效作用已得到国内外专家的认可。应用合适参数的Er:YAG激光不仅可以有效清除感染植体表面的菌斑微生物，而且对种植体及其周围组织无损伤，有利于种植体周围组织再附着。本文就种植体周围炎的研究现状、Er:YAG激光对种植体表面形态、理化性能、周围软硬组织的影响及治疗种植体周围炎的合适能量参数等作一综述，并展望Er:YAG激光在种植体周围炎治疗中的发展前景。     

Er：YAG激光应用于种植体周围炎治疗的临床效果评估

目的：探讨Er：YAG激光( erbium-doped： yttrium aluminium garnet)与机械刮治治疗种植体周围炎的有效性。方法22例种植体周围炎患者,按照单盲随机分组对照原则将种植体分成2组,试验组采用Er：YAG激光照射,激光能量设定为100 mJ/脉冲、频率10 Hz;对照组采用塑料刮治器和0.2%洗必泰抗菌治疗。在基线、3个月和6个月时进行临床牙周指标的检查测定,包括菌斑指数、出血指数、临床附着水平和探诊深度。结果基线时试验组和对照组间各项临床牙周指标的差异无统计学意义(P>0.05)。治疗后3个月(P<0.01)和6个月(P<0.05),试验组出血指数、菌斑指数和对照组比较差异具有统计学意义;2组探诊深度在治疗后3个月和6个月均有降低,且2组探诊深度的差异均有统计学意义(P<0.05);然而2组临床附着水平差异无统计学意义(P>0.05)。结论 Er：YAG激光治疗后能显著改善种植体周围炎炎症水平,控制种植体周围炎的有效性优于机械刮治治疗。     

前列腺素E2在种植体周围龈沟液中的含量测定及其临床意义

目的：探讨前列腺素E2（Prstaglandin E2,PGE2）在种植体周龈沟液中的含量水平与种植牙牙周组织临床指数-菌斑指数（plaque index,PI）,牙龈指数（gingival index,GI）和牙周探诊深度（probing pocket depths,PPD）之间的关系.方法：检查实验组36颗和对照组36颗种植体牙周情况,实验组为有明显炎症的种植体,牙周探诊深度均超过3mm.同时试纸收集种植体周围龈沟液,ELISA法检测其龈沟液中的PGE2含量,所得数据用t检验和Pearson相关分析进行统计学处理.结果：PGE2表达和患种植体周围炎的种植体牙周指数呈显著相关（P＜0.05）,且实验组和对照组的PGE2表达统计学差异明显（P＜0.05）.结论：龈沟液中PGE2含量可为种植体周围炎病变的诊断提供客观参考.     

Er:YAG激光在口腔种植中应用的研究进展

近年来,口腔种植迅速发展,在牙列缺失、缺损以及颌面部缺损修复治疗中的应用日趋广泛。由于Er:YAG激光具有对种植体表面形态改变小、产热少、杀菌效应强、能促进种植体-牙龈界面形成生物学封闭以及促进骨增加及骨整合等特点,它越来越受到人们重视。本文就Er:YAG激光在种植体表面处理、切割软组织、切除骨组织和种植体周围炎中的应用作一综述。     

大黄提取物治疗伴糖尿病重度牙周炎的疗效观察

目的: 观察大黄提取物局部应用治疗伴糖尿病重度牙周炎的临床疗效。方法: 将50例伴糖尿病的重度牙周炎患者随机分为对照组（龈下刮治和根面平整术）和实验组（龈下刮治和根面平整术+术后局部应用大黄提取物软膏）。2组患者均在治疗前、治疗后6周、治疗后12周检查牙周探诊深度(probing pocket depth, PD)、临床附着水平(clinical attachment level, CAL)、探诊出血指数(bleeding on probing, BOP)。采用SPSS 20.0软件包对实验数据进行统计学分析。结果: 相比治疗前,2组患者在治疗后6周和治疗后12周, PD、CAL、BOP均有下降,实验组低于对照组,有统计学差异。表明2组患者经过治疗后牙周状况都有明显改善,实验组改善优于对照组。整个实验过程中未发生药物不良反应。结论: 大黄提取物局部应用辅助治疗伴糖尿病的重度牙周炎有良好的临床疗效。     

Clinical evaluation of periodontal surgical treatment with an Er:YAG laser: 5-year results

BACKGROUND: The aim of the present study was to evaluate and compare the long-term clinical outcomes of erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser-assisted periodontal flap surgery versus conventional treatment with the modified Widman flap procedure. METHODS: A total of 146 single-rooted periodontally involved teeth from 25 patients were included in this study. In each patient, left or right maxillary single-rooted teeth were assigned randomly to one of two groups: group A (Er:YAG laser) and group B (modified Widman flap surgery). Er:YAG laser was used to debride the bone pockets, scale the root surface, and trim the periodontal flap. Recession, probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and bleeding on probing (BOP) scores were recorded at baseline and at 3, 6, 12, 24, 36, 48, and 60 months. RESULTS: Both treatments resulted in decreases in PD, PI, GI, and BOP, increases in gingival recession, and gains in CAL. PD reduction in group A versus group B was statistically significant at 6, 12, 24, and 36 months (P < 0.05). Gains in CAL were significantly greater in group A versus group B at 6, 12, 24, and 36 months. BOP scores were significantly lower in group A versus group B at 3 and 6 months (P < 0.05). All other differences between treatment groups were not statistically significant. CONCLUSIONS: Surgical treatment of single-rooted teeth with chronic periodontitis using the Er:YAG laser yields greater PD reduction and gains in CAL for up to 3 years compared to conventional Widman flap surgery. The short-term results obtained with both treatments can be maintained over 5 years.     

激光法治疗种植体周围炎的短期临床效果评估

目的 探讨Er:YAG激光法治疗种植体周围炎临床效果,以期对今后种植体周围炎的临床治疗有所帮助。方法 20名种植体周围炎患者,满足纳入标准和排除标准后随机分为两组,试验组采用Er:YAG激光法治疗,对照组采用碳纤维刮治器和0.2% 洗必泰抗菌治疗。分别记录治疗前（基线水平）、治疗后3个月和6个月时相关的牙周临床指标,包括菌斑指数、探诊后出血指数、龈沟出血指数、探诊深度、临床附着水平。所有的检查均使用牙周探诊器(PCP12)。结果 基线时试验组和对照组间各项临床牙周指标的差异无统计学意义(P＞0.05)。治疗后3个月,与基线水平相比,各项临床牙周指标均有所降低,激光治疗比刮治治疗的降低幅度大,并且这种降低是具有统计学意义的(P＜0.05)。治疗后6个月时,总体来说牙周各项临床指标仍是低于基线水平的,但与3个月时相比,除了出血指数仍然降低以外,其他牙周指数都有略微反弹的趋势。结论 手工刮治和激光治疗都可以改善种植体周围炎患者的各项临床牙周指标,激光治疗可能疗效更为显著,但稳定性稍显不足。这种改善可能只是短期的,长期的疗效还需要依赖大样本长时间的观察随访。     

Short-term clinical and immunologic effects of scaling and root planing with Er:YAG laser in chronic periodontitis

BACKGROUND: Recently, the erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser has been used for periodontal therapy. This study compared Er:YAG laser irradiation (100 mJ/pulse, 10 Hz, 12.9 J/cm(2)) with or without conventional scaling and root planing (SRP) to SRP only for the treatment of periodontal pockets affected with chronic periodontitis. METHODS: Twenty-one subjects with pockets from 5 to 9 mm in non-adjacent sites were studied. In a split-mouth design, each site was randomly allocated to a treatment group: SRP and laser (SRPL), laser only (L), SRP only (SRP), or no treatment (C). The plaque index (PI), gingival index (GI), bleeding on probing (BOP), and interleukin (IL)-1beta levels in crevicular fluid were evaluated at baseline and at 12 and 30 days postoperatively, whereas probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were evaluated at baseline and 30 days after treatment. A statistical analysis was conducted (P <0.05). RESULTS: Twelve days postoperatively, the PI decreased for SRPL and SRP groups (P <0.05); the GI increased for L, SRP, and C groups but decreased for the SRPL group (P <0.05); and BOP decreased for SRPL, L, and SRP groups (P <0.01). Thirty days postoperatively, BOP decreased for treated groups and was lower than the C group (P <0.05). PD decreased in treated groups (P <0.001), and differences were found between SRPL and C groups (P <0.05). CAL gain was significant only for the SRP group (P <0.01). GR increased for SRPL and L groups (P <0.05). No difference in IL-1beta was detected among groups and periods. CONCLUSION: Er:YAG laser irradiation may be used as an adjunctive aid for the treatment of periodontal pockets, although a significant CAL gain was observed with SRP alone and not with laser treatment.     

牙周牙髓联合病变激光与药物辅助治疗观察及菌群分析

目的:探讨双波长激光对比盐酸米诺环素治疗牙周牙髓联合病变的差别及牙周袋菌群分析。方法:收集牙周牙髓联合病变患者60颗患牙,随机分为2组:实验组Nd:YAG消毒根管一次性充填根管+Er: YAG处理牙周袋;对照组碘伏消毒根管一次性根管充填+盐酸米诺环素牙周袋上药。按视觉模拟评分法(visual analogue scale,VAS)观察两组治疗后1 d疼痛差异,对比两组治疗1周、2周、3周、3月、6月、1年的牙周袋深度(the depth of periodontal pocket,PD)、牙周附着水平(clinical periodontal attachment level,CAL),探诊出血指数(bleeding on probing,BOP),评价疗效。抽取两组病例各4例,并定期采集患牙牙周袋菌斑行高通量测序。结果:实验组与对照组治疗1 d疼痛有差异;不同时间点间PD、CAL静息状态下VAS评分有差别;BOP阳性位点发生率有差别。2组牙周袋菌斑多样性差异不大,以韦荣氏菌、变性链球菌、卟啉单胞菌、消化链球菌为主。结论:双波长激光联合辅助治疗牙周牙髓联合病变的效果优于盐酸米诺环素,具有较好的临床应用前景。     

Clinical evaluation of an Er:YAG laser combined with scaling and root planing for non-surgical periodontal treatment. A controlled,prospective clinical study

OBJECTIVES: The purpose of the present controlled clinical trial was to compare the treatment of advanced periodontal disease with a combination of an Er:YAG laser (KEY II, KaVo, Germany) and scaling and root planing with hand instruments (SRP) to laser alone. MATERIAL AND METHODS: Twenty healthy patients with moderate to advanced periodontal destruction were randomly treated in a split-mouth design with a combination of an Er:YAG laser and SRP (test) or with laser (control) alone. The used energy setting for laser treatment was 160 mJ/pulse at a repetition rate of 10 Hz. Prior to treatment and 3, 6 and 12 months later the following parameters were evaluated by a blinded examiner: Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR) and clinical attachment level (CAL). Subgingival plaque samples were taken at each appointment and analysed using darkfield microscopy for the presence of cocci,-non-motile rods, motile rods and spirochetes. No statistical significant differences in any of the investigated parameters between both groups were observed at baseline. RESULTS: Initially, the plaque index was 1.0 +/- 0.6 in both groups. At the 3-month examination the plaque scores were markedly reduced and remained low throughout the study. A significant reduction of the GI and BOP occurred in both groups after 3, 6 and 12 months (P < 0.05, P < 0.05, respectively). The mean PD decreased in the test group from 5.2 +/- 0.8 mm at baseline to 3.2 +/- 0.8 mm after 12 months (P < 0.05) and in the control group from 5.0 +/- 0.7 mm at baseline to 3.3 +/- 0.7 mm after 12 months (P < 0.05). The mean CAL decreased in the test group from 6.9 +/- 1.0 mm at baseline to 5.3 +/- 1.0 mm after 12 months (P < 0.05) and in the control group from 6.6 +/- 1.1 mm at baseline to 5.0 +/- 0.7 after 12 months (P < 0.05). Both groups showed a significant increase of cocci and-non-motile rods and a decrease in the amount of motile rods and spirochetes. Conclusion: In conclusion, the present results have indicated that: (i) non-surgical periodontal therapy with both an Er:YAG laser + SRP and an Er:YAG laser alone may lead to significant improvements in all clinical parameters investigated, and (ii) the combined treatment Er:YAG laser + SRP did not seem to additionally improve the outcome of the therapy compared to Er:YAG laser alone.     

Periodontal treatment with an Er: YAG laser compared to scaling and root planing. A controlled clinical study

BACKGROUND: The aim of the present study was to compare the effectiveness of an Er:YAG laser to that of scaling and root planing for non-surgical periodontal treatment. METHODS: Twenty patients with moderate to advanced periodontal destruction were treated under local anesthesia and the quadrants were randomly allocated in a split-mouth design to either Er:YAG laser using an energy level of 160 mJ/pulse and 10 Hz or scaling and root planing (SRP) using hand instruments. Clinical assessments of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made prior to and at 3 and 6 months after treatment. Subgingival plaque samples were taken at each appointment and analyzed using darkfield microscopy for the presence of cocci, non-motile rods, motile rods, and spirochetes. Differences in clinical parameters and prevalence of bacterial species were analyzed using the paired t-test. RESULTS: The PI remained nearly unchanged while a significant reduction of the GI occurred in both groups after 6 months (P < or =0.001, P< or =0.001, respectively). The mean value of BOP decreased in the laser group from 56% at baseline to 13% after 6 months (P < or =0.001) and in the SRP group from 52% at baseline to 23% after 6 months (P < or =0.001). The mean value of the PD decreased in the laser group from 4.9+/-0.7 mm at baseline to 2.9+/-0.6 mm after 6 months (P< or =0.001) and in the SRP group from 5.0+/-0.6 mm at baseline to 3.4+/-0.7 mm after 6 months (P < or =0.001). The mean value of the CAL decreased in the laser group from 6.3+/-1.1 mm at baseline to 4.4+/-1.0 mm after 6 months (P < or =0.001) and in the SRP group from 6.5+/-1.0 mm at baseline to 5.5+/-1.0 after 6 months (P < or =0.001). The reduction of the BOP score and the CAL improvement was significantly higher in the laser group than in the SRP group (P < or =0.05, P < or =0.001, respectively). Both groups showed a significant increase of cocci and non-motile rods and a decrease in the amount of motile rods and spirochetes. CONCLUSIONS: An Er:YAG laser may represent a suitable alternative for non-surgical periodontal treatment.     

种植体周围疾病发病率及危险因素的研究

目的:明确国人种植体周围疾病发病率并探索种植体周围炎的风险因素。方法:收集北京大学口腔医院第二门诊部种植修复后的736例患者的1612枚种植体复查情况,平均负重时间(22.64±0.92)个月,记录种植体周围菌斑指数、探诊深度(probing depth,PD)、探诊出血指数(bleeding index, BI),角化龈宽度,粘接剂残留、骨吸收情况,记录口内天然牙PD、BI。分析不同种植系统及不同复查时间段种植体周围炎的发病率,Logistic回归分析种植体周围炎的相关风险因素。结果:在个体和植体水平,种植体周围黏膜炎发病率分别为81.90%、83.60%,种植体周围炎发病率分别为4.50%和3.70%。各系统间种植体周围炎发病率无显著差异,在修复后1~5年各时间段组种植体周围炎发病率无显著差异,修复后0.5~1年和5~7年发病率显著低于1~5年各时间段组(P<0.05)。Logistic回归分析显示,在调整性别、年龄、吸烟、粘接剂、角化龈宽度等变量后,口内缺牙数、种植体周围PD、BI是种植体周围炎的风险因素(P<0.01)。结论:种植体周围黏膜炎发病广泛,种植体周围炎的发病率并非随着修复时间的延长而增加,对种植体周围探诊深度和出血的控制是预防种植体周围炎发生的关键。