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。     

3种清创方法对模拟维护期治疗的牙周炎患牙根面结构影响的体外研究

目的:评价3种清创方式对牙周炎患牙根面结构的影响,为牙周维护治疗选择合适的治疗方式提供理论依据。方法:将43颗因重度牙周炎拔除的患牙标记出66个方形的体外研究区域(4 mm×4 mm),分别完成根面刮治后,随机分成超声处理组、手工刮治组和喷砂抛光组,模拟牙周炎维护期阶段进行清创。记录每组治疗前、治疗1、20、50、100次维护后的根面粗糙度Ra值;并在扫描电镜下观察：(1)牙根表面菌斑、牙石残留;(2)划痕、凹槽等损伤情况;(3)牙骨质剥脱、牙本质暴露。结果:3组均随着清创次数的增加Ra值减小,提示根面逐渐趋于光滑。其中手工组对根面粗糙度的改变最大,在完成1次治疗后,Ra即有明显改善,差异有统计学意义(P<0.05);喷砂组根面抛光的效果明显,在完成20次治疗时,Ra已趋于稳定。扫描电镜观察手工组根面损伤最严重;超声次之;喷砂组损伤最小,保留根面牙骨质效果最好。结论:龈下喷砂在根面抛光的同时对根面的损伤最小,超声次之,手工刮治器械损伤最大。在维护治疗阶段清洁菌斑生物膜推荐使用喷砂器械以尽量保存根面组织。     

牙周内窥镜下刮治与传统刮治对龈下牙石清除效果的比较

目的比较内窥镜下龈下刮治与传统龈下刮治清除龈下牙石的效果。方法收集16例患者26颗无保留价值的重度慢性牙周炎患牙,随机分为两组,每组8例13颗患牙,分别行牙周内窥镜下龈下刮治(A组)及传统龈下刮治(B组),每颗患牙均刮治10min后拔除,亚甲基蓝染色后,蓝色显示残留牙石,对每颗牙颊、舌、近中及远中面拍照并用Image Pro Plus图像分析软件检测、计算各牙面的牙石残留率。比较两组患牙治疗后的牙石残留率以及吸烟、牙周探诊出血位点数和牙周探诊深度对牙石清除效果的影响。结果 A组患牙平均牙石残留率为(8.34±1.70)%,B组患牙平均牙石残留率为(13.02±3.36)%,差异有统计学意义(P<0.05)。吸烟、探诊出血位点数、牙周探诊深度对治疗后的牙石残留率均有影响(P<0.05)。结论在牙周内窥镜下行龈下刮治,清除牙石的效果明显优于传统龈下刮治。吸烟、探诊出血、探诊深度对牙石残留率均有影响。     

超声结合手用器械进行龈下刮治效果的扫描电镜观察

目的:超声龈下刮治结合手工刮治,用扫描电镜的方法观察效果.方法:选6名慢性牙周炎病人共8个单根牙,分为4组:超声龈下刮治组、手工刮治组、超声结合手工刮治组和不做处理的对照组,每组2个牙.用扫描电镜观察各组根面的菌斑、残留物及光滑程度.结果:超声结合手工刮治组根面光滑,无菌斑,无堆积物,效果最好.结论:建议超声刮治后使用手工器械,以求制造一个更加平整的根面,得到最佳的临床效果.     

手工和超声波龈下刮治的临床疗效及图像分析

本文对8名中、重度牙周炎患者的48颗牙,分别行手工或超声波龈下刮治术,2个月后观察临床指标(PD、AL、BI)均有明显改善,且深袋的效果优于浅袋,但两种方法临床疗效无显著性差异。另外对6名重度牙周炎患者17颗无保留价值的牙,亦行手工或超声波刮治后立即拔除,以未刮治的离体牙作为对照,进行了根面残留牙石、菌斑面积及根面三维重建线扫描的图像分析。结果表明:手工和超声波刮治后,根面残留的牙石、菌斑均显著减少.但手工的除石效果及根面光滑度均优于超声波刮治。     

常用龈下刮治器械对磨牙根面刮治效率的比较

目的:比较压电式、磁伸缩式超声龈下刮治器及龈下手工器械3种临床常用龈下刮治器对磨牙根面的刮治效率,研究牙周袋深度及超声功率设定大小对超声器械龈下刮治效率的影响.方法:分别以压电式、磁伸缩式超声龈下刮治器械和龈下刮治手工器械在2 min内对30例实验根面进行5或7 mm袋深、全功率或半功率设置的模拟龈下刮治,比较不同器械间的根面刮治效率.采用SAS6.12软件包对数据进行统计学分析.结果:不同参数设定下超声器械的刮治残留率均小于手工器械,全功率、5 mm袋深下磁伸缩式刮治残留率显著小于压电式(P＜0.01);而7 mm袋深则压电式刮治残留率显著小于磁伸缩式;半功率、5 mm袋深下压电式与磁伸缩式无显著差异(P=-0.217);而7 mm袋深时压电式、磁伸缩式与手工器械3者均无显著差异(P=0.574);7mm袋深时的刮治残留率均显著高于5 mm袋深时(P＜0.01);功率设定不同对于压电式或磁伸缩式超声器械的刮治影响均不显著.结论:超声龈下器械的刮治效率优于手工器械,3种器械的刮治效率均随牙周袋深度增加而下降.压电式与磁伸缩式器械无显著差异.超声龈下刮治器械的半功率设置对刮治效率的影响并不显著.     

多根牙龈下超声和手工刮治临床疗效及离体牙图像分析

目的 比较超声细线器和传统手工法对多根牙龈下刮治的临床和离体牙的除石效果。方法 １２例中、重度牙周炎患者的２４颗磨牙,分别经两种方法智治后１个月,评价临床指标的改善。另外６例牙周炎患者的１２颗应拔的牙,智治后用图像分析仪,离体观察刮治后根面和根分叉区残留菌斑、牙石的百分比。结果 两种方法治疗后,临床指标均有改善（Ｐ〈０．０５）,当附着水平≥７ｍｍ时,细线器组优于手工组。在离体牙的根分叉区,细线器的     

超声和手用器械龈下洁治后牙根面的扫描电镜观察

目的：通过超声和手用器械对牙周炎患牙根面处理的比较，来评价超声龈下洁治在牙周治疗中的作用。方法：选择１０个新鲜拔除的牙周炎患牙，随机分别用手用器械（第１组）和超声（第２组）洁治；选择４个临床诊断需拔除的牙周炎患牙分别行手用器械（第３组）和超声（第４组）龈下洁治，然后将患牙拔除。所有牙齿均在扫描电镜下观察。结果：超声龈下洁治能有效去除龈下菌斑及牙石，使根面较光滑平整，与手用器械洁治相比，无明显差异。结论：超声龈下洁治器是一种进行龈下洁治和根面平整的有效工具。     

超声和手工龈下刮治对龈下微生物影响的研究

目的 :比较Perioproline超声龈下刮治和手工龈下刮治对龈下微生物的影响 ,评价Periopro line超声龈下刮治系统的临床疗效和工作效率。方法 :选取慢性成人牙周炎患者 7名 ,共 2 0个左右基本对称牙被纳入研究 ,随机分入实验组 (超声组 )和对照组 (手工组 )。记录治疗时间和治疗前、治疗后 0d、7d和 14d的PD ,BOP值 ,及采集龈下菌斑样本培养鉴定 ,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 :两组在治疗后PD、BOP值及龈下菌斑总量 (CFU)和牙周可疑致病菌数量及检出率均显著下降 (P <0 .0 5) ;治疗前后各时段组间均无明显差别 ;超声组的治疗时间明显少于手工组 (P <0 .0 5)。结论 :Perioproline超声龈下刮治和手工龈下刮治均可有效减少龈下微生物的量 ,改善患牙的牙周临床状况 ,且两者间无差异 ,但Perioproline超声龈下刮治明显较手工刮治节省时间     

单纯机械治疗对慢性牙周炎患者龈下菌群微生态的影响

目的 采用16S rRNA高通量测序技术,探讨单纯机械治疗对慢性牙周炎龈下菌群微生态的影响.方法 纳入广泛型中重度慢性牙周炎患者,接受口腔卫生宣教,并同时进行龈上洁治.一周后进行超声结合手工龈下刮治及根面平整,在基线、治疗后3个月和治疗后6个月,记录临床指标并采集龈下菌斑.利用Illu-mina MiSeq平台进行16...     

Nd:YAG激光照射对牙周病患牙根面的影响

目的 :研究Nd :YAG激光照射对未处理过的和用超声波或手工器械刮治过的牙周病患牙根面的影响。方法 :选择因严重牙周病而须拔除的单根牙 18颗 ,随机平均分为 6组 ,在临床麻醉下分别先后作如下治疗 :超声波刮治 +激光照射 ;激光照射 +超声波刮治 ;手工器械刮治 +激光照射 ;激光照射 +手工器械刮治 ;超声波刮治 ;手工器械刮治。然后拔除患牙作扫描电镜观察。结果 :单纯用超声波或手工器械刮治过的牙根表面均有明显的涂层 ,而用激光 (2 0pps、2 .0W、3min)照射 ,无论是在刮治前还是刮治后 ,均有助于根面涂层的去除 ,但激光对牙根表面结构有不同程度的影响。结论 :先用Nd :YAG激光照射、再行龈下刮治 ,牙根表面的涂层被清除 ,而结构改变最小。     

In vitro evaluation of Er:YAG laser scaling of subgingival calculus in comparison with ultrasonic scaling

The purpose of the present study was to evaluate the effectiveness of Er:YAG laser scaling and the morphological and histological changes of the laser-scaled root surface in comparison with the effectiveness and root surface changes produced by conventional ultrasonic scaling. Fifty-three periodontally involved human extracted teeth with a band of subgingival calculus were used. The teeth were divided randomly into 2 groups for laser scaling and ultrasonic scaling. Laser irradiation was performed at an energy output of 40 mJ/pulse and 10 pulses/s under water spray, with the probe tip contacted obliquely to the root surface. Ultrasonic scaling was performed at a clinically standard power setting. The time required for scaling, the scaled area and the temperature changes were determined using both methods of treatment. The features of the scaled surfaces were examined by histological and scanning electron microscope (s.e.m.) observations. The Er:YAG laser provided subgingival calculus removal on a level equivalent to that provided by the ultrasonic scaler, without major thermal elevation. Macroscopically, the laser-treated root surface was somewhat rougher than or similar to the ultrasonically scaled root. However, the efficiency of the laser scaling was lower than that of the ultrasonic scaling. In addition, histological examination revealed a thin deeply stained zone on the lased root surface, and s.e.m. analysis revealed a characteristic microroughness on the lased surface. The laser scaling provided a level of calculus removal that was similar to that provided by the ultrasonic scaling. However, the Er:YAG laser produced superficial, structural and thermal microchanges on the root cementum.     

Er，Cr：YSGG激光在慢性牙周炎非手术治疗中的应用

目的：探讨超声龈下刮治结合Er,Cr：YSGG激光治疗慢性牙周炎的临床效果。方法纳入12名慢性牙周炎患者,超声龈上洁治后2周进行基线检查,采用分口设计,四个象限随机分组。实验组在超声龈下刮治的基础上,激光照射1次或3次;对照组在超声龈下刮治基础上进行手工根面平整。治疗结束后分别记录每象限治疗用时,患者对每象限治疗时的舒适程度视觉模拟评分。在基线、治疗后6周及12周检查牙周临床指标,包括菌斑指数、牙龈出血指数、探诊深度及临床附着丧失。结果实验组和对照组各项临床指标均有显著改善,且临床疗效相当。和传统手工根面平整术比较,激光照射治疗所需时间较长,舒适度更加;和激光照射1次比较,照射3次并无明显优势。结论超声龈下刮治结合Er,Cr：YSGG激光照射治疗慢性牙周炎的临床疗效良好,且激光照射在治疗过程中更为舒适,超声龈下刮治结合Er,Cr：YSGG激光照射1次可作为牙周炎非手术治疗可选方法之一。     

A scanning electron micrographical study of root surfaces and subgingival bacteria after hand and ultrasonic instrumentation

The effects of hand and ultrasonic instrumentation on root surface topography and subgingival plaque were studied. One approximal subgingival root surface on each of two single rooted teeth of six patients was root planed. The opposing proximal surfaces were not treated and served as controls. On each patient, the two test surfaces were randomly treated by hand or ultrasonic instrumentation (Cavitron) until clinically smooth. The teeth were extracted, divided into mesial and distal sides, and processed for scanning electron microscopy (SEM). The observations were restricted to an area 2 mm by 3 mm just coronal to the plaque-free zone. The root surfaces were scanned by SEM, both at low (x 100) and at higher magnifications (x 5000). At low power, a photomontage was produced of the surface area of the test teeth. At low magnifications (x 100, x 500), the topography resulting from hand instrumentation appeared smooth with parallel scratches compared to scaly but flat surfaces with occasional deep gouges with the ultrasonic method. At high magnifications (x 5000), tooth surfaces were similar in topography when instrumented by either hand or ultrasonic methods. Root surfaces were covered in some areas by a fibrillar-like membrane that resembled fibrin. Individual bacteria were found on the surfaces of this material. On other areas not covered by this membrane, bacterial plaque was only observed when tooth surfaces had not been contacted by either hand or ultrasonic instrumentation.     

Healing following ultrasonic debridement and PVP-iodine in individuals with severe chronic periodontal disease: a randomized, controlled clinical study

OBJECTIVE: Antiseptics and antibiotics delivered either locally or systemically have been used as an adjunct to scaling and root planing procedures in order to control the subgingival biofilm and thereby enhancing the treatment outcome. The results presented in the literature are, however, inconclusive. Povidone-iodine (PVP-iodine) has a bactericidal effect and is effective against most bacteria, including putative periodontal pathogens. The aim of the present study was to evaluate the clinical effect of PVP-iodine as an adjunct to ultrasonic scaling in the treatment of severe chronic periodontitis. MATERIAL AND METHODS: Twenty patients were recruited to the study. Each test site and the related quadrant were randomly assigned to one of four different treatment modalities: ultrasonic scaling + subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth, ultrasonic scaling + subgingival irrigation with sterile saline solution for 5 min/tooth, subgingival irrigation with sterile saline solution for 5 min/tooth, and subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth. The individuals were followed longitudinally for 6 months. RESULTS: The present study showed that non-surgical periodontal therapy by means of an ultrasonic device was effective in attaining a healthy periodontal status in patients with severe periodontal lesions. No additive effect was found when PVP-iodine was included. CONCLUSIONS: Ultrasonic debridement using Odontogain is effective in controlling infection in patients with severe chronic periodontitis. PVP-iodine does not add any clinical benefit to the ultrasonic debridement alone under these circumstances.     

Microbiological effect of the use of an ultrasonic device and iodine irrigation in patients with severe chronic periodontal disease: a randomized controlled clinical study

OBJECTIVE: Instrumentation of the subgingival area is aimed at removing as much as possible of the bacterial biofilm and subgingival calculus. Since mechanical root debridement is a technically demanding procedure, antiseptics and antibiotics delivered either locally or systemically have been used as adjunct to scaling and root-planning procedures in order to control the subgingival biofilm and thereby enhance the treatment outcome. Our aim was to study the microbiological effect of ultrasonic debridement with or without povidone-iodine (PVP-iodine) in the treatment of severe chronic periodontitis. MATERIAL AND METHODS: Twenty patients were recruited to the study. Each test site and the related quadrant were randomly assigned to one of four different treatment modalities: ultrasonic scaling+subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth, ultrasonic scaling+subgingival irrigation with sterile saline solution for 5 min/tooth, subgingival irrigation with sterile saline solution for 5 min/tooth and subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth. The individuals were followed longitudinally for 6 months. RESULTS: The present study showed that non-surgical periodontal therapy with the use of an ultrasonic device was effective in reducing the analyzed putative periodontal bacteria. No statistically significant difference between ultrasonic+saline and ultrasonic+PVP-iodine was found. CONCLUSIONS: Ultrasonic debridement reduced the periodontal markers in patients with severe chronic periodontitis. The reduction was selective. A concentration of 0.5% PVP-iodine did not add any anti-microbiological effect compared to ultrasonic debridement alone.     

Healing following ultrasonic debridement and PVP-iodine in individuals with severe chronic periodontal disease: A randomized,controlled clinical study

Objective. Antiseptics and antibiotics delivered either locally or systemically have been used as an adjunct to scaling and root planing procedures in order to control the subgingival biofilm and thereby enhancing the treatment outcome. The results presented in the literature are, however, inconclusive. Povidone-iodine (PVP-iodine) has a bactericidal effect and is effective against most bacteria, including putative periodontal pathogens. The aim of the present study was to evaluate the clinical effect of PVP-iodine as an adjunct to ultrasonic scaling in the treatment of severe chronic periodontitis. Material and Methods. Twenty patients were recruited to the study. Each test site and the related quadrant were randomly assigned to one of four different treatment modalities: ultrasonic scaling?+?subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth, ultrasonic scaling?+?subgingival irrigation with sterile saline solution for 5 min/tooth, subgingival irrigation with sterile saline solution for 5 min/tooth, and subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth. The individuals were followed longitudinally for 6 months. Results. The present study showed that non-surgical periodontal therapy by means of an ultrasonic device was effective in attaining a healthy periodontal status in patients with severe periodontal lesions. No additive effect was found when PVP-iodine was included. Conclusions. Ultrasonic debridement using Odontogain® is effective in controlling infection in patients with severe chronic periodontitis. PVP-iodine does not add any clinical benefit to the ultrasonic debridement alone under these circumstances.     

Comparative effectiveness of ultrasonic and hand scaling for the removal of subgingival plaque and calculus

The purpose of the study was two-fold: to determine the nature of stainable deposits on periodontally diseased root surfaces subsequent to in vivo scaling and root planing procedures, and to quantify the distribution of residual plaque on instrumented root surfaces. Thirty molar and 30 nonmolar teeth which were condemned for periodontal or prosthetic reasons and had proximal probing depths of 4 to 7 mm were treated. Half of these were instrumented with I.U. curettes and the other half with an ultrasonic scaling device. Instrumentation was continued until the root surface felt hard and smooth to an explorer tip. The location of the gingival margin was recorded by notching the treated proximal surface with a No. 1/2 round bur. Twenty control teeth, 10 molar and 10 nonmolar, were extracted without instrumentation. Control and experimental teeth were irrigated with saline and stored in a 2.5% glutaraldehyde fixative solution until the time of assessment. All teeth were stained with a 0.5% solution of toluidine blue, and the amount of residual stained material and calculus was assessed under the stereomicroscope using an eyepiece fitted with a 10 X 10 optical grid. Stained deposits were marked by placing small V-shaped notches in the adjacent root surface as an aid to identification after the specimens were processed for scanning electron microscopic (SEM) examination. The nature of stained deposits on selected teeth was then characterized using the SEM. Treated root surfaces were also surveyed in detail to assess the quantity and extent of residual plaque deposits. The findings showed that although a large percentage of the treated proximal root surface may possess stainable deposits, these surfaces were often unexpectedly free of microbial organisms. In this study, the majority of stained deposits were composed of adherent fibrin and instrumentation debris. When bacterial plaque was present, it was usually found in small "mini-colonies" smaller than 0.5 mm across. Such findings cast doubt on the validity of using histologic and disclosing stains as an indicator for the presence of bacterial plaque immediately after instrumentation. Although only partially effective in removing subgingival calculus, both methods of instrumentation in this study appeared to be remarkably effective in bacterial debridement of subgingival root surfaces.     

Microbiological effect of the use of an ultrasonic device and iodine irrigation in patients with severe chronic periodontal disease: A randomized controlled clinical study

Objective. Instrumentation of the subgingival area is aimed at removing as much as possible of the bacterial biofilm and subgingival calculus. Since mechanical root debridement is a technically demanding procedure, antiseptics and antibiotics delivered either locally or systemically have been used as adjunct to scaling and root-planning procedures in order to control the subgingival biofilm and thereby enhance the treatment outcome. Our aim was to study the microbiological effect of ultrasonic debridement with or without povidone-iodine (PVP-iodine) in the treatment of severe chronic periodontitis. Material and Methods. Twenty patients were recruited to the study. Each test site and the related quadrant were randomly assigned to one of four different treatment modalities: ultrasonic scaling+subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth, ultrasonic scaling+subgingival irrigation with sterile saline solution for 5 min/tooth, subgingival irrigation with sterile saline solution for 5 min/tooth and subgingival irrigation with 0.5% PVP-iodine for 5 min/tooth. The individuals were followed longitudinally for 6 months. Results. The present study showed that non-surgical periodontal therapy with the use of an ultrasonic device was effective in reducing the analyzed putative periodontal bacteria. No statistically significant difference between ultrasonic+saline and ultrasonic+PVP-iodine was found. Conclusions. Ultrasonic debridement reduced the periodontal markers in patients with severe chronic periodontitis. The reduction was selective. A concentration of 0.5% PVP-iodine did not add any anti-microbiological effect compared to ultrasonic debridement alone.