Genius激光与传统手术治疗牙龈增生的术后反应与舒适度临床对比研究

目的 比较Genius激光(水冷型Nd:YAG激光)和手术刀两种方式行牙龈切除术和成形术术后患者的创口愈合情况及舒适度.方法 收集牙龈增生患者31例,共计172颗前牙,实验分为激光组和手术刀组,每组各86颗.分别收集术前、术后1周及术后2周的龈沟液(gingival crevicular fluid,GCF),比较GCF量的变化及GCF中转化生长因子-β1(transforming growth factor-β1,TGF-β1)和白细胞介素-1β(interleukin-1β,IL-1β)水平的变化,同时比较患者术前术后牙龈外形色泽、术后1周内的疼痛及出血情况.结果 术后1周2组GCF量无明显差异(P =0.091),术后2周GCF量在激光组较手术刀组低,且差异具有统计学意义(P =0.000).术后1周及术后2周TGF-β1和IL-1β水平在激光组均较手术刀组低,且差异具有统计学意义(P =0.003,P=0.000;P=0.006,P=0.008).术后第1天和第2天激光组疼痛均较手术刀组低,且差异具有统计学意义(P =0.008,P=0.006),从术后第3天开始2组无统计学差异(P =0.238).激光组术后均未出血,手术刀组除术后第1天有3例出血外,其余均未出血.术后1周手术刀组牙龈较激光组红肿,术后2周手术刀组有23例患者的牙龈较激光组稍红肿.结论 Genius激光与手术刀比较具有术后创口愈合炎症反应低、创面愈合快和舒适度高的优势,可以作为临床医师行牙周软组织手术的优选方式.

Comparison of postoperative reaction and comfort between Genius laser and traditional surgery for gingival hyperplasia

Objective To compare the wound healing and comfort in the patients following gingivectomy and gingivoplasty via Genius laser and scalpel surgery.Methods A total of 31 patients (172 anterior teeth) treated in our hospital from May 2015 to April 2016 were enrolled in this study.The trial was divided into laser group and scalpel surgery group randomly,with each group including 86 teeth.Gingival crevicular fluid (GCF) samples were collected preoperatively,and in 1 and 2 weeks postoperatively.The contents of transforming growth factor-β1 (TGF-β1) and interleukin-1β (IL-1β) in the GCF,gingival morphology and color,postoperative pain and bleeding within 1 weeks after surgery were compared between the 2 groups.Results There was no difference in the amount of GCF between the 2 groups at 1 week postoperatively(P =0.091),but the amount of the laser group was significantly less in the laser group than the scalpel surgery group at 2 weeks (P =0.000).The GCF contents of TGF-β1 and IL-1 β in the laser group were significantly lower than those in the scalpel surgery group at 1 and 2 weeks postoperatively (P =0.003,P =0.000;P =0.006,P =0.008).Postoperative pain was significantly milder in the laser group than the scalpel surgery group at the first day and second day (P =0.008,P =0.006),but no such difference was seen since the third day.And there was no bleeding case in the laser group,but there had 3 cases at the first day in the scalpel surgery group.At 1 week after operation,the gingival in all the patients of the scalpel surgery group was more swollen and red than the laser group,and in 2 weeks later,gingival swelling and redness were mildly severer in 23 cases of the surgical group than the laser group.Conclusion Genius laser is superior to conventional scalpel surgery in gingivectomy and gingivoplasty with respect to postoperative wound healing,inflammatory reaction and patient's comfort.Genius laser is a preferred option in periodontal surgery in clinical practice.