牙周内窥镜辅助超声龈下刮治对残留牙周袋临床疗效的评价研究

目的 评价牙周内窥镜下超声龈下刮治对牙周基础治疗后残留牙周袋的临床治疗效果.方法 收集20例慢性牙周炎患者259颗经牙周基础治疗后仍残留深牙周袋的患牙,行牙周内窥镜下超声龈下刮治,比较治疗前及治疗后3个月全口牙周探诊出血(BOP)和牙周探诊深度(PD)的变化.结果 内窥镜治疗后3个月全口平均PD值和BOP位点百分比有显著改善(P<0.001).单根牙和多根牙的平均PD均显著降低(P<0.001),PD≥5mm位点百分比显著改善(P<0.05),其中重度牙周袋位点的改善更明显(P<0.05).根分叉病变位点百分比治疗前后无明显变化.结论 残留牙周深袋经牙周内窥镜辅助超声龈下刮治后,单根牙和多根牙都有显著治疗效果,并且单根牙重度牙周袋位点改善更明显,但是多根牙II度及以上根分叉病变位点的改善有限.     

牙周内窥镜辅助治疗对牙根表面影响的初步研究

目的:评价牙周内窥镜辅助超声龈下刮治及根面平整术(SRP)对比传统SRP后根面形态的改变和粗糙度的影响。方法:纳入12颗因牙周炎拔除的患牙,分为3组(n=4):(1)内窥镜辅助超声SRP;(2)传统SRP,超声刮治后用Gracey刮治器根面平整;(3)不做处理。另取4颗健康牙作对照。处理后用扫描电镜观察牙根表面微观结构改变,通过三维光学轮廓仪测量牙根表面粗糙度Ra值。结果:内窥镜组根面残留牙石较少,牙骨质保留较完整,与健康组类似。传统刮治组根面有大片坑状的牙骨质剥脱。2种治疗方式下牙周炎患牙比较,2组Ra值没有显著差异(P>0.05)。结论:牙周内窥镜辅助治疗比传统治疗能更有针对性地清除龈下菌斑和牙石,且可保留相对完整的根面形态。     

超声龈下刮治同步药物冲洗对龈下微生物的影响

目的 :比较Master 40 0超声龈下刮治同步药物冲洗系统与传统超声龈下刮治 +药物冲洗对龈下微生物的影响及临床疗效。方法 :选取慢性成人牙周炎患牙 2 0个 ,随机分入实验组 (超声龈下刮治同步药物冲洗 )和对照组 (传统超声龈下刮治 +药物冲洗 )。记录治疗前、后 0、7、14d的探诊出血 (BOP)、探诊深度 (PD) ,并采集龈下菌斑样本培养 ,观察比较总菌落形成单位 (CFU)和牙周可疑致病菌检出率及检出量的变化。结果 :治疗后两组PD、BOP、CFU和牙周可疑致病菌数量均显著减少 (P <0 .0 5 ) ;实验组牙龈卟啉单胞菌 (P <0 .0 1)和二氧化碳噬纤维菌 (P <0 .0 5 )明显少于对照组。结论 :Master 40 0超声龈下刮治同步药物冲洗系统比传统超声龈下刮治 +药物冲洗能更有效地减少龈下致病微生物的数量     

光动力疗法联合龈下刮治术治疗慢性牙周炎疗效观察

目的 观察光动力疗法联合龈下刮治和根面平整术治疗慢性牙周炎的临床效果.方法 选择中、重度慢性牙周炎患者30例,随机分为3组,每组10人.A组:单纯龈下刮治和根面平整术治疗;B组:龈下刮治和根面平整术治疗后即刻行光动力疗法;C组:龈下刮治和根面平整术治疗后1周行光动力疗法.治疗前、龈下刮治和根面平整术治疗后6周、12周时分别记录牙周袋探诊深度及探诊出血的阳性牙位点,并进行统计学分析.结果 龈下刮治和根面平整术后6周和12周结果显示,3组牙周袋探诊深度和探诊出血情况较术前均有改善(P＜0.05).B组和C组的牙周袋探诊深度和探诊出血情况改善效果均优于A组(P＜0.05);B组与C组间差异无统计学意义(P＞0.05).结论 对中、重度慢性牙周炎患者应用光动力疗法联合龈下刮治和根面平整术治疗,较单独使用龈下刮治和根面平整术治疗效果更佳.光动力疗法可作为新的辅助治疗手段用于牙周病的治疗.     

龈下超声波和手工刮治效果评价

作者用超声波和手工对３８颗无保留价值的患牙分别行龈下刮治，离体下用体视镜及图象分析仪观察并计算根面残留菌斑及牙石占观察面积的比率。结果表明无论在浅袋区或深袋区，两种方法清除牙石及菌斑效果相同。超微结构显示超声波洁治组根面出现牙骨质部分或全层剥脱，手工刮治组部分根面出现划痕，两种方法均不能完全清除深袋区牙石和菌斑。     

派丽奥与牙康治疗牙周炎的疗效比较

目的　比较派丽奥(2%盐酸米诺环素软膏)与牙康(甲硝唑棒)治疗牙周炎的临床疗效及对牙周可疑致病菌的清除作用。方法　选取11例慢性牙周炎患者的26颗牙周炎患牙为研究对象。患牙要求:①牙周袋探诊深度≥4 mm,且探诊后出血;②左右对称。26颗患牙随机分成实验组(派丽奥治疗组)13颗,对照组(牙康治疗组)13 颗。观察用药前及用药后7 d和14 d,患牙的牙周临床指标菌斑指数(PLI)、牙龈指数(GI)、探诊深度(PD)、探诊出血(BOP)的变化和龈下附着菌斑中螺旋体、球菌、杆菌的百分比,以及非附着菌斑中牙龈卟啉单胞菌、中间普氏菌、二氧化碳噬纤维菌等牙周可疑致病菌百分比的变化。结果　实验组和对照组患牙在用药前各项牙周临床指标和微生物学指标均无显著性差异(P>0.05)。用药后,两组患牙绝大部分牙周临床指标和微生物学指标均较用药前明显改善(P<0.05),但两组间无显著性差异(P>0.05)。结论　派丽奥与牙康均是治疗牙周炎有效、安全的局部治疗药物,两者的疗效无显著性差异。     

超声龈下刮治对根面影响的扫描电镜研究

目的 研究不同功率超声龈下刮治对根面的影响。方法 选择因重度牙周炎需拔除的患牙12颗，随机分成小功率超声刮治组、大功率超声刮治组、手工刮治组及病变对照组四个组，每组3颗。记录刮治时间，扫描电镜观察各组标本的菌斑、牙石残留及损伤情况。结果 大功率超声刮治效率最高、最省时，小功率次之，手工刮治最慢；大功率超声刮治对根面损伤最大，小功率超声刮治损伤轻微，手工刮治损伤最小。结论 超声龈下刮治能有效地去除根面的菌斑、牙石，且省时、省力，但功率不宜过大。     

超声龈下刮治同步药物冲洗对牙周炎的治疗作用

目的探讨超声龈下刮治同步药物冲洗对牙周炎的治疗效果。方法选取中、重度慢性牙周炎患牙34颗,随机分为三组：A组（蒸馏水组）超声龈下刮治同步无菌蒸馏水冲洗（11颗牙）;B组（消炎痛组）超声龈下刮治同步0.1%消炎痛药物冲洗（13颗牙）;C组（甲硝唑组）超声龈下刮治同步0.2%甲硝唑药物冲洗（10颗牙）。比较龈上洁治、龈下刮治前后28日临床检查指标,及治疗后7、28日龈沟液的量和龈沟液中IL-6的水平变化。结果三组治疗后菌斑指数（PLI）、探诊深度（PD）、龈沟出血指数（SB I）、龈沟液的量及龈沟液中IL-6水平明显降低,有显著性差异;附着丧失（AL）降低不明显;消炎痛组和甲硝唑组治疗后龈沟液中IL-6水平降低程度大于蒸馏水组,有显著性差异。结论超声龈下刮治同步药物冲洗能够明显提高牙周炎的治疗效果。     

吸烟对牙周炎患者龈下刮治和根面平整术疗效影响的研究

[摘要] 目的 比较吸烟与不吸烟牙周炎患者实施龈下刮治和根面平整治疗术(scaling and root planning,SRP)时,对探诊深度(probing depth,PD)和临床附着水平(clinical attachment level,CAL)的影响。方法 选择临床上中到重度的牙周炎患者,其中53例吸烟患者,56例非吸烟患者,局麻下行龈下刮治和根面平整术(SRP)后,局部龈下放置25%的甲硝唑膜。由同一位检查者分别于初诊及6个月复诊时用牙周探针检查记录探诊深度(PD)和临床附着水平(CAL)。结果 治疗后6个月复诊时,吸烟组PD减小量和CAL增加量均小于不吸烟组(P<0.05),螺旋体比例降低量吸烟组亦较小(P<0.05)。结论 吸烟患者对SRP治疗的反应性较差,且对于局部抗生素治疗的敏感性亦较低。     

VECTOR牙周治疗仪治疗慢性牙周炎的临床疗效观察

目的　观察VECTOR牙周治疗仪治疗慢性牙周炎的临床效果。方法　 选择慢性牙周炎患者30例,随机分成VECTOR牙周治疗仪组和Grace龈下刮治器组,分别在治疗后3、6个月复查牙周探诊出血(BOP)及牙周探诊深度(PD),同时记录临床症状和体征,摄片并进行有效评定。结果　 在术后3、6个月的复查中,VECTOR牙周治疗仪组和Grace龈下刮治器组在改善牙周临床指数上无明显统计学差异。结论　 VECTOR牙周治疗仪和Grace龈下刮治器在治疗慢性牙周炎上均能达到良好的临床效果。     

The efficacy of subgingival calculus removal with endoscopy-aided scaling and root planing: a study on multirooted teeth

BACKGROUND: The dental endoscope was developed to facilitate visualization of the subgingival environment as an aid in diagnosis and non-surgical root debridement. The purpose of this study was to determine whether endoscopy-aided scaling and root planing (SRP) resulted in a greater reduction of residual calculus compared to SRP alone in multirooted teeth. METHODS: Twenty-four patients were enrolled and contributed 35 tooth pairs (70 teeth in total). Each tooth per pair was randomly assigned to receive endoscopy-aided SRP (test) or SRP alone (control). Both teeth were extracted immediately after treatment, washed with water, and stained with methylene blue. The percentage of residual calculus was determined via stereomicroscopy and digital image software by a single masked examiner. RESULTS: Overall, there was 1.16% (P = 0.097) less residual calculus at test versus control sites. At interproximal surfaces, test roots had 2.63% less residual calculus than control roots (P = 0.003), whereas test roots had slightly more residual calculus than controls at buccal/lingual surfaces (0.36%; P = 0.652). There were no statistically significant differences in residual calculus between groups at deeper probing depths or at sites with deep furcation invasions. Only at shallower interproximal sites with probing depths < or =6 mm was significantly less residual calculus seen in roots treated with endoscopy (P = 0.020). Treatment time decreased significantly as operator experience increased; however, no significant improvement in residual calculus levels was noted with greater experience. CONCLUSION: Within the confines of this study, the use of the endoscope as an adjunct to traditional SRP provided no significant improvement in calculus removal in multirooted molar teeth.     

The effectiveness of subgingival scaling and root planing: an evaluation of therapy with and without the use of the periodontal endoscope

BACKGROUND: A fiber-optic periodontal endoscope was developed to aid in the visualization of subgingival structures and to improve the diagnosis and management of periodontal diseases. The purpose of this study was to determine whether use of the periodontal endoscope with scaling and root planing (SRP) resulted in a decrease in residual calculus compared to SRP alone. METHODS: Fifteen subjects with 50 tooth pairs participated in this study. Each tooth per pair was randomized to receive SRP with or without the endoscope. Teeth were extracted, and a stereomicroscope and digital image analysis was used to determine percent residual calculus present in a masked fashion. RESULTS: There was 2.14% (P < 0.001) more residual calculus at control versus test sites. At buccal/lingual and interproximal surfaces, mean differences in residual calculus were 1.30% (P <0.015) and 2.93% (P < 0.001), respectively. Test treatment time decreased significantly as operator experience increased. There were no statistically significant differences between residual calculus for test and control teeth at shallower probing depths; however, at deeper probing depths, the use of the endoscope resulted in significantly less residual calculus. CONCLUSIONS: The use of the periodontal endoscope resulted in a statistically significant overall improvement in calculus removal during SRP, which was most evident in deeper probing depths. The clinical significance of this level of improvement is unknown.     

牙体预备形态对烤瓷贴面复合体抗折强度及断裂模式的影响

目的比较三种牙体预备方法对烤瓷贴面复合体（PVCs）抗折强度及断裂模式的影响。方法分别对离体上颌中切牙进行3种形态（I型、L型、U型）牙体预备，制作长石质烤瓷贴面，树脂黏接剂黏接．用MTS力学实验机测试各牙的断裂载荷值，记录瓷贴面的断裂频数，数据作统计学分析。结果I、L、U三型牙体预备的PVCs与天然牙对照组的断裂载荷值分别为278．61±73．86N（n=9）．295．17±71．76N（n=9），303．42±96．87N（n=8），332．29±60．06N（n=10），经统计学分析四组间断裂载荷值及瓷贴面的断裂模式差别无统计学意义（P〉0．05），3组实验组与对照组的牙体断裂模式差异有统计学意义（P〈0．05）。结论在正中[牙合]瓷贴面间接受力的条件下，采用3种牙体预备设计的PVCs均具有良好的的抗折性能．但烤瓷贴面修复改变了牙体组织在加载条件下的力学特性。     

Efficacy of subgingival calculus removal with Er:YAG laser compared to mechanical debridement: an in situ study

OBJECTIVES: The aim of the present study was to compare the effectiveness of subgingival calculus removal from periodontally involved root surfaces with an Er:YAG laser compared to hand instrumentation in situ. METHODS: The mesial and distal surfaces of 30 single-rooted teeth with untreated periodontitis were treated either by hand instrumentation (scaling and root planing (SRP)) or by Er:YAG laser irradiation with the aim of achieving a calculus-free root surface. Subgingival plaque samples were obtained before and immediately after treatment for microbiological evaluation by culture and DNA probe analysis. The teeth were extracted and the residual calculus was measured by means of digitized planimetry. The morphology of the root surface was evaluated by scanning electron microscopy, and undecalcified sections were analyzed to determine residual calculus and the extent of cementum removal following both treatments. RESULTS: Following laser irradiation, 68.4+/-14.4% of the root surface was calculus free in contrast to 93.9+/-3.7% after SRP when both treatments were performed for the same time (2:15+/-1:00 min). If laser irradiation was allowed twice the time used for hand instrumentation, 83.3+/-5.7% of the root surface was devoid of calculus. The effectiveness of both treatments was not related to initial probing depth. The histologic evaluation showed that after SRP 73.2% of root dentin was completely denuded from cementum, while only a minimal cementum reduction was apparent after laser irradiation. Both treatment modalities resulted in a similar reduction of periodontopathogens. DISCUSSION: The present investigation could demonstrate the in vivo capability of the Er:YAG laser to remove calculus from periodontally involved root surfaces, although the effectiveness did not reach that achieved by hand instrumentation. The lack of cementum removal in contrast to SRP may qualify the laser as an alternative approach during supportive periodontal therapy.     

2种牙周洁刮治系统应用于下前牙治疗的疼痛程度评估

目的比较应用KAVO气动声波洁刮治系统和传统超声洁刮治系统行下颌前牙龈上洁治术及龈下刮治术时患者的疼痛程度。方法拟行牙周洁刮治治疗的牙周病患者196例,在患者下颌前牙区随机选取一侧使用传统超声沽刮治系统（对照组）,另一侧使用KAVO气动声波洁刮治系统（试验组）进行洁治,于洁治术后1周再分别行龈下刮治术。治疗结束时间卷调查,患者的疼痛程度采用视觉模拟量表（visualanalogueseale,VAS）进行评价。,结果在洁治过程中,下颌前牙区试验组VAS值为3．50±0．26,对照组为4．20±0．13,试验组低于对照组,两组差异有统计学意义（t=2．377,P〈0．05）;在刮治过程中．下颌前牙区试验组VAS值为3．90±0．32,对照组为4．80±0．17．试验组低于对照组,两组差异有统计学意义（t=1．396,P〈0．05）。结论与传统超声洁刮治系统相比,KAVO气动声波沽刮治系统在下颌前牙龈上洁治及龈下刮治术中,患者牙齿的主观疼痛感较低。     

龋病患牙牙周健康状况调查分析

目的：检查龋病患牙的牙周健康状况,探讨龋病对牙周健康状况的影响。方法：在武汉大学口腔医学院牙体牙髓科和牙周黏膜科就诊的患者中,选择一侧牙有龋,而对侧同名牙无龋的牙齿86对,每对牙齿依次检查牙体龋坏情况（包括冠龋和根龋）及牙周状况（包括探诊深度、探诊出血、牙石指数、牙龈退缩程度、松动度）,并进行统计学分析,研究龋病患牙的牙周健康状况。结果：86对牙齿比较结果显示,有龋组的牙周探诊深度、牙石指数、牙龈退缩程度、松动度均显著高于无龋组（P〈0.05）。对有龋组牙仅有冠龋的71对牙齿做比较,结果显示有龋组患牙的牙周探诊深度、牙石指数、牙龈退缩程度均高于无龋组,有显著性差异,且探诊深度、牙石指数有非常显著的差异（P〈0.01）。对有龋组中既有冠龋又有根龋的15对牙齿牙周情况做比较,结果显示有龋组牙龈退缩、松动度均高于无龋组且有显著性差异（P〈0.05）。结论：在同一口腔环境中龋病的发生和牙周炎症程度呈正相关,两者的微生态联系和相互影响有待深入的研究。     

Treatment with subantimicrobial dose doxycycline improves the efficacy of scaling and root planing in patients with adult periodontitis

BACKGROUND: In a previous study, subantimicrobial dose doxycycline (SDD) significantly improved clinical parameters associated with periodontal health in patients with adult periodontitis (AP) when used as an adjunct to a maintenance schedule of supragingival scaling and dental prophylaxis. In this double-blind, placebo-controlled, parallel-group, multicenter study, the efficacy and safety of SDD were evaluated in conjunction with scaling and root planing (SRP) in patients with AP. METHODS: Patients (n = 190) received SRP at the baseline visit and were randomized to receive either SDD 20 mg bid or placebo bid for 9 months. Efficacy parameters included the per-patient mean changes in clinical attachment level (CAL) and probing depth (PD) from baseline, the per-patient percentages of tooth sites with attachment loss (AL) > or = 2 mm and > or = 3 mm from baseline, and the per-patient percentage of tooth sites with bleeding on probing. Prior to analysis, tooth sites were stratified by the degree of disease severity evident at baseline RESULTS: In tooth sites with mild to moderate disease and severe disease (n = 183, intent-to-treat population), improvements in CAL and PD were significantly greater with adjunctive SDD than with adjunctive placebo at 3, 6, and 9 months (all P <0.05). In tooth sites with severe disease, the per-patient percentage of sites with AL > or = 2 mm from baseline to month 9 was significantly lower with adjunctive SDD than with adjunctive placebo (P<0.05). Improvements in clinical outcomes occurred without detrimental shifts in the normal periodontal flora or the acquisition of doxycycline resistance or multiantibiotic resistance. SDD was well tolerated, with a low incidence of discontinuations due to adverse events. CONCLUSIONS: The adjunctive use of SDD with SRP is more effective than SRP alone and may represent a new approach in the long-term management of AP.     

残根牙体剩余量对纤维桩核全冠修复体力学性能的影响

目的：评价侧向加载条件下,不同牙体剩余量对纤维桩复合树脂核全冠修复体抗折性能的影响。方法：将正畸拔除的单根前磨牙分为5组（0mm组、1mm组、2mm组、3mm组和对照组）,离体牙行纤维桩复合树脂核金属烤瓷全冠修复,使用速率为1mm/min的45°角侧向加载;结果：0mm组的荷载力值（600.94±83.30N）和1mm组的荷载力值（665.46±58.81N）小于2mm组（949.94±74.80N）、3mm组（1004.52±93.99N）和对照组（1026.87±79.59N）,存在显著性差异（P〈0.05）。结论：对于纤维桩复合树脂核全冠修复体,随着牙体剩余量的增加,修复体的抗折能力也增加,因此,临床上要尽可能保留较多的牙体组织,使修复效果更好。     

Scaling and root planing, systemic metronidazole and professional plaque removal in the treatment of chronic periodontitis in a Brazilian population. I. clinical results

OBJECTIVE: The current investigation evaluated the clinical effects of scaling and root planing (SRP) alone or in combination with systemic metronidazole and/or repeated professional removal of supragingival plaque in subjects with chronic periodontitis. METHODS: Fourty-four adult subjects (mean age: 45+/-6 years) with periodontitis were randomly assigned to four treatment groups; a control (C, n=10) that received SRP and placebo and three test groups treated as follows: Test 1 (T1) (n=12) received SRP and metronidazole (400 mg t.i.d., M) for 10 days; Test 2 (T2) (n=12) received SRP, weekly professional supragingival plaque removal for three months (professional cleaning (PC)) and placebo; and Test 3 (T3) (n=10) received SRP, M and PC. Pocket depth (PD), attachment level (AL), bleeding on probing (BOP) and presence of visible plaque and suppuration were measured at six sites per tooth at baseline and at 90 days post-therapy. Significance of differences over time was determined using the Wilcoxon test, and among groups using ancova. RESULTS: A reduction in full-mouth mean clinical parameters was observed at 90 days after all therapies. Sites with baseline PD<4 mm showed an increase in mean PD in the control group and in mean AL in all treatment groups. Sites with baseline PD of 4-6 mm in subjects who received PC as part of therapy (T2, T3) showed a marked reduction in PD, AL and in the % of sites with BOP. Subjects who received metronidazole (T1 and T3) showed the best clinical response at sites with an initial PD of >6 mm. The major clinical benefit occurred when the combination of SRP, M and PC was used. Group T3 showed the least attachment loss in initially shallow pockets. This group also exhibited the greatest reduction in the % of sites with BOP and suppuration as well as in mean PD and AL at sites with baseline PD>4 mm. CONCLUSION: The data suggest a significant clinical benefit in combining SRP, systemic metronidazole and weekly professional supragingival plaque removal for the treatment of chronic periodontitis.