光动力疗法辅助龈下刮治和根面平整对不同性别牙周病病人的疗效观察

目的:以随机化、控制性、盲法设计分析一种新型光动力疗法治疗牙周疾病病人时存在的潜行性的性别差异.方法:本研究经伦理委员会同意后,入选45例病人(每位病人至少有4个以上≥5 mm的牙周袋并分布在两个以上区域内).所有病人在接受基础检查、龈下刮治和根面平整(subgingival scaling and root planning)治疗后,随机分为3组,其中A组在SRP之后接受一次PERIOWAVE光动力治疗,B组在SRP后接受一次PERIOWAVE治疗以及在6周后再一次接受激光治疗,而C组仅接受SRP治疗.在6周以及12周来访中检查牙周袋深度、附着丧失,以Mann-Whitney秩和检验分析疗效的性别差异.结果:SRP组、A组均为8位男性7位女性,B组为7位男性8位女性.在6周、12周时,各组CAL均增加＞1.1 mm,6周时CAL增加无明显差异,然而12周时B组男性CAL平均增加2.06 mm,明显高于女性组(1.61 mm)(P=0.031),与女性组相比,接受两次激光治疗的男性CAL增加27.4%.结论:在本研究条件下,牙周袋深度≥5 mm的男性牙周炎病人在接受两次光动力治疗后CAL增加超过女性病人27.4%.     

六味地黄丸在牙周炎维护治疗中的作用

目的　观察六味地黄丸治疗慢性成人牙周炎的临床疗效。方法　选择120例曾接受过牙周治疗的慢性成人牙周炎患者,随机分为2组,对照组仅做洁治刮治根面平整(SRP),试验组在行SRP治疗后连续口服六味地黄丸5 个月,复诊检查患者牙周情况。结果　试验组用药5个月后,牙周探诊牙周袋减少0·43 mm,牙周附着增加 0·22 mm,与对照组相比差异有显著性(P<0·01)。结论　SRP加六味地黄丸治疗在减少牙周袋深度和增加牙周附着方面优于单纯的SRP,六味地黄丸是一种安全有效持久的牙周炎维护治疗的全身药物。     

Clinical effects of scaling and root planing with an adjunctive periodontal endoscope for residual pockets: a randomized controlled clinical study

目的 比较牙周内窥镜辅助龈下刮治和根面平整（SRP）与传统SRP对慢性牙周炎患者基础治疗后残留牙周袋的临床疗效。方法 将牙周基础治疗后口内每个区至少有1个位点探诊深度（PD）≥5 mm的患者纳入研究,随机分为内窥镜组和SRP组,分别对残留牙周袋位点进行内窥镜辅助SRP治疗和传统SRP治疗。在治疗前（基线）、治疗后3、6个月检查PD、探诊出血（BOP）和附着丧失（AL）,采用SPSS 20.0统计学软件对数据进行统计分析。结果 与基线相比,治疗后3、6个月内窥镜组及SRP组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）。治疗后6个月与3个月相比,内窥镜组PD≥5 mm位点百分比、PD、AL、BOP阳性位点百分比均降低（P<0.05）,而SRP组差异无统计学意义（P>0.05）。与SRP组相比,内窥镜组治疗后3及6个月PD≥5 mm位点百分比、PD均降低,治疗后6个月AL、BOP阳性位点百分比降低（P<0.05）。结论 牙周内窥镜辅助SRP对于基础治疗后的残留牙周袋（PD≥5 mm）的临床疗效优于传统SRP,尤其具有更好的远期预后。     

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目的    评价脉冲Nd：YAG激光治疗慢性牙周炎患者牙周袋深度（PD）和附着丧失（AL）的效果。方法    选择2008年1—6月在福建医科大学附属协和医院就诊的45例慢性牙周炎患者,每例患者至少有4个以上≥6 mm的牙周袋并且分布在2个以上口腔区域内,在接受基础检查和龈上洁治术后,随机分成3组。A组（15例）：单纯接受龈下刮治和根面平整（SRP）治疗;B组（15例）：SRP+1次激光照射治疗（Nd： YAG激光,输出功率2 W,照射时间40 s）;C组（15例）：SRP+2次激光照射治疗（Nd： YAG激光,第1次照射输出功率2 W,照射时间40 s;第2次照射输出功率1 W,照射时间20s）。每组各选择40个位点。统计在基础检查,治疗2、4和12周时各组的PD和AL。结果    从第2周时,3组的PD均明显减小。而AL的改善在第4周时可以明显观察到,且C组的效果最为明显,并一直延续到12周。结论    SRP基础上辅助2次不同能量的激光治疗对慢性牙周炎PD和AL的改善效果均明显优于单独SRP使用。     

内窥镜辅助治疗牙周炎Ⅲ期B级伴错牙合畸形1例

牙周内窥镜是微创的牙周非手术治疗方法,其使用相比传统SRP可以取得更好的临床效果.现本文报告了1例Ⅲ期B级牙周炎伴有错牙合畸形(安氏Ⅱ类)的患者基础治疗后仍有较多深牙周袋(PD≥5 mm),辅助牙周内窥镜治疗后正畸治疗取得良好效果的病例.     

高压氧治疗对青少年牙周炎不同牙周袋深度的生物学影响

目的：探讨高压氧治疗（HBO）对青少年牙周炎（JP）不同牙周袋深度（PD）的临床生物学指标的影响。方法：47例青少年牙周炎患者共362颗牙齿，根据牙周袋的深度，将362颗患牙分为A、B、c三组，A组PD〈4mm，122颗牙，B组PD4～6mm，136颗牙，C组PD〉6mm，104颗牙。高压氧治疗前后，常规方法测定三组共362个患牙各临床指标的变化，观察菌斑形态分布的变化并进行统计学分析。结果：除了C组患牙牙龈松动度（TM）参数治疗前后差异没有统计学意义外，高压氧治疗后A、B、C各组GI、SBI、PD、TM变化均具有显著性差异。治疗前后A组和B组的改变幅度明显大于C组，治疗后A组袋底球菌、杆菌、梭状菌改变最大，B组次之，C组最小，治疗后螺旋体均明显减少。结论：HBO对青少年牙周炎治疗作用取决于HBO到达牙周袋底的量。     

米诺环素对慢性牙周炎辅助治疗的疗效观察

目的 评价牙周袋局部应用米诺环素软膏联合刮治和根面平整治疗慢性牙周炎的疗效。方法 64名患中到重度慢性牙周炎的男性吸烟者随机分成SRP和SRP+M两组。对SRP组患者施行刮治和根面平整,对SRP+M组患者在刮治和根面平整的基础上,牙周袋局部应用米诺环素软膏。记录两组患者在基线、3个月和6个月时的菌斑指数（PlI）、牙龈指数（GI）、探诊出血（BOP）、探诊深度（PD）及附着丧失（AL）的变化并进行统计学分析。结果 治疗过程中有6例患者被排除,有效病例数为58例,每组29例。牙周治疗3个月和6个月后,两组患者的PlI、GI和BOP均无统计学差异（P>0.05）,但PD和AL有统计学差异（P<0.05）。治疗后3个月SRP组PD下降1.32 mm,AL减轻1.14 mm;而SRP+M组PD下降1.98 mm,AL减轻1.87 mm。对于基线检查PD≥7 mm的深牙周袋,治疗后3个月SRP组PD下降2.21 mm,AL减轻1.23 mm;而SRP+M组PD下降3.48 mm,AL减轻2.62 mm。治疗后6个月PD和AL状况与3个月相比变化不大。与SRP组相比,SRP+M组临床症状改善更明显。结论 龈下局部应用米诺环素软膏辅助治疗慢性牙周炎可取得较好的疗效,特别是对于有深牙周袋、吸烟的牙周炎患者,机械治疗联合局部应用缓释抗菌素较单纯机械治疗的疗效更好。     

根面处置牙周炎患牙根面牙骨质后内毒素水平的变化

目的:观察不同方法处置牙周炎患牙根面牙骨质后内毒素水平的变化.方法:选择临床上因正畸拔除的健康前磨牙6例,重度牙周炎拔除的后牙36例.每颗牙取釉-牙骨质界下2 mm牙根,制成2片4 mm×4 mm×1 mm的牙骨质片,对每个牙周炎患牙进行编号.健康牙作为阴性对照组,36颗牙周炎患牙中,每颗牙的1个牙片不进行根面处理,作为牙周炎组.其余36片牙周炎牙片随机平均分成6组:龈下刮治及根面平整(scaling and root planning,SRP)组、SRP+抗菌肽A组、SRP+抗菌肽B组、SRP+EDTA组、SRP+ Nd:YAG激光组和SRP +Er:YAG激光组.用显色基质鲎试剂检测每个牙片的内毒素浓度.按照编号,记录每颗牙的内毒素浓度,计算每组每个牙周炎患牙治疗前、后内毒素浓度的变化.采用SPSS 17.0软件包对数据进行统计学分析.结果:与牙周炎组相比,各治疗组内毒素浓度有不同程度降低,均有显著差异(P＜0.01).与SRP组相比,SRP+抗菌肽A组、SRP+抗菌肽B组、SRP +Er:YAG激光组内毒素浓度显著下降(P＜0.01),SRP+EDTA组、SRP+ Nd:YAG激光组之间无显著差异(P＞0.05).结论:不同方法处理牙周炎患牙根面均可降低内毒素含量,抗菌肽A+SRP处理牙周炎根面可能更为有效.     

缓释氯己定凝胶在慢性牙周炎治疗中的应用

目的:观察龈上洁治术、龈下刮治术和根面平整术(scaling and root planing,SRP)结合缓释氯己定凝胶(chlorhexidine,CHX)对慢性牙周炎的治疗作用。方法:选择35～65岁的慢性牙周炎患者36例,将后牙区牙周袋数目较多的单颌设定为实验组,对颌为对照组。实验组采取SRP+CHX治疗,对照组采取SRP治疗。分别于牙周治疗前、中、后3个阶段,记录每个受试牙近颊、颊侧、远颊、近舌、舌侧和远舌位点的牙龈指数(GI)、探诊出血(BOP)、探诊深度(PD)、临床附着水平(CAL)、探诊出血指数(SBI)。结果:BOP、SBI、PD、GI四项指标在治疗后1个月,实验组与对照组之间有显著差异(P<0.05),4个月后则无显著性差异(P>0.05)。CAL在治疗后1个月,两组间无显著(P>0.05),而4个月后差异显著性差异(P<0.05)。无论是实验组还是对照组,治疗前后各项牙周指标后牙区位点对治疗的反应明显不如前牙区,但无显著性差异(P>0.05)。PD>7 mm的深牙周袋,SRP+CHX组与SRP组之间4个月后仍有显著性差异。结论:在慢性牙周炎治疗过程中,SRP+CHX治疗能够改善牙周临床指标,尤其对PD>7 mm的深牙周袋有更好的治疗作用。     

Er，Cr：YSGG激光在慢性牙周炎基础治疗中的应用观察

目的：评价Er,Cr：YSGG牙周袋内清创的临床效果。方法：纳入19名慢性牙周炎患者,采用左右半口对照研究,随机分为A组：Er,Cr：YSGG激光牙周袋内清创;B组：手工龈下刮治器械牙周袋内清刨。比较A、B组治疗后6、12周PD、BOP、CAL的变化及治疗疼痛程度VAS值。结果：基线PD≥4mm的位点治疗后6周和12周PD、CAL和BOP与基线相比,均有非常明显下降（P〈0．01）。且基线时PD≥6mm的位点,治疗后12周激光组PD降低显著高于对照组。激光组的VAS值明显低于手工器械组（P〈0．01）。结论：Er,Cr：YSGG激光对慢性牙周炎患者进行牙周袋内壁清创是安全有效的。     

Adjunctive Non‐Surgical Therapy of Inflamed Periodontal Pockets During Maintenance Therapy Using Diode Laser: A Randomized Clinical Trial

Background: Numerous studies have documented the clinical outcomes of laser therapy for untreated periodontitis, but very few have reported on lasers treating inflamed pockets during maintenance therapy. The aim of this study is to compare the effectiveness of scaling and root planing (SRP) plus the adjunctive use of diode laser therapy to SRP alone on changes in the clinical parameters of disease and on the gingival crevicular fluid (GCF) inflammatory mediator interleukin‐1β (IL‐1β) in patients receiving regular periodontal maintenance therapy. Methods: This single‐masked and randomized, controlled, prospective study includes 22 patients receiving regular periodontal maintenance therapy who had one or more periodontal sites with a probing depth (PD) ≥5 mm with bleeding on probing (BOP). Fifty‐six sites were treated with SRP and adjunctive laser therapy (SRP + L). Fifty‐eight sites were treated with SRP alone. Clinical parameters, including PD, clinical attachment level (CAL), and BOP, and GCF IL‐1β levels were measured immediately before treatment (baseline) and 3 months after treatment. Results: Sites treated with SRP + L and SRP alone resulted in statistically significant reductions in PD and BOP and gains in CAL. These changes were not significantly different between the two therapies. Similarly, differences in GCF IL‐1β levels between SRP + L and SRP alone were not statistically significant. Conclusion: In periodontal maintenance patients, SRP + L did not enhance clinical outcomes compared to SRP alone in the treatment of inflamed sites with ≥5 mm PD.     

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.     

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.     

Treatment of periodontal disease by photodisinfection compared to scaling and root planing

OBJECTIVE: The aim of the present study was to compare the effectiveness of a photodisinfection process to that of scaling and root planing (SRP) for non-surgical periodontal treatment. METHODOLOGY: Thirty-three subjects with moderate to advanced periodontal disease were randomly treated in one of three study arms with either photodisinfection (PD) alone (Group 1) using a diode laser and photosensitizer combination, with SRP alone (Group 2), or with SRP and PD combined (Group 3). Clinical assessments of bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were made at baseline, three weeks, six weeks, and 12 weeks following therapy. RESULTS: No difference in any of the investigated parameters was observed at baseline between the three groups. The mean value of BOP decreased in the PD group (Group 1) from baseline by 71% at six weeks and 73% at 12 weeks, and in the SRP alone group (Group 2) from baseline by 43% at six weeks and 56% at 12 weeks. The BOP in the combined SRP + PD group (Group 3) decreased from baseline by 65% at six and 59% at 12 weeks. The sites treated with PD alone demonstrated mean CAL gains of 0.09 +/- 0.38 mm and 0.14 +/- 0.65 mm at six and 12 weeks, respectively. Those sites treated with SRP alone demonstrated mean CAL gains of 0.37 +/- 0.34 mm and of 0.36 +/- 0.35 mm at six and 12 weeks, respectively. The final group of SRP + PD demonstrated mean CAL gains of 0.92 +/- 0.62 mm and 0.86 +/- 0.61 mm at six and 12 weeks, respectively (p < 0.01 for six weeks and p < 0.02 for 12 weeks when compared to SRP alone). The sites treated with PD alone demonstrated mean PPD reductions of 0.69 +/- 0.33 mm and of 0.67 +/- 0.44 mm at six and 12 weeks, respectively. Those sites treated with SRP alone demonstrated mean PPD reductions of 0.78 +/- 0.47 mm and 0.74 +/- 0.43 mm at six and 12 weeks, respectively. The final group of SRP + PD demonstrated mean PPD reductions of 1.16 +/- 0.39 mm and 1.11 +/- 0.53 at six and 12 weeks, respectively (p < 0.06 for six weeks and p < 0.05 for 12 weeks when compared to SRP alone). CONCLUSION: Within the limits of the present study, it can be concluded that SRP combined with photodisinfection leads to significant improvements of the investigated parameters over the use of SRP alone.     

Efficacy and Safety of Adjunctive Local Moxifloxacin Delivery in the Treatment of Periodontitis

Background: Moxifloxacin exerts excellent antibacterial activity against most putative periodontal pathogens and has been shown to kill bacteria in biofilm and host cells. Methods: Patients with chronic periodontitis were randomly assigned to receive a single subgingival application of a 0.125%, 0.4%, or 1.25% moxifloxacin gel or placebo gel immediately after full‐mouth scaling and root planing (SRP). Clinical efficacy measurements were assessed in sites with baseline probing depth (PD) of ≥5.4 mm at 6 weeks and 3 months and any adverse events were determined. In addition, putative periodontal pathogens and resistance of subgingival bacteria against moxifloxacin were assessed. Results: Data of 57 patients were included in the statistical analysis. In all treatment groups, the PD decreased from baseline to 3 months, with the greatest reduction seen in patients treated with moxifloxacin 0.4% (1.5 ± 0.6 mm; P = 0.023 compared to placebo), followed by patients receiving moxifloxacin 1.25% (1.2 ± 0.4), moxifloxacin 0.125% (1.1 ± 1.1), and placebo (1.0 ± 0.6). No linear trend for PD reduction with increasing moxifloxacin concentrations was found. Porphyromonas gingivalis showed the greatest reduction in prevalence among the assessed pathogens, without any significant intergroup differences. No correlation or systematic relationship between adverse events, including bacterial resistance against moxifloxacin, and the investigational gels was found. Conclusions: In periodontal pockets with PD of ≥5.4 mm, a single subgingival administration of a 0.4% moxifloxacin gel as an adjunct to SRP may result in additional PD reduction compared to SRP alone. In addition, the investigated moxifloxacin gels seem to be safe.     

Clinical evaluation of the use of locally delivered chlorhexidine in periodontal maintenance therapy

BACKGROUND: The objective of this study was to evaluate clinically the effectiveness of a chlorhexidine gluconate chip in sites still showing signs of disease during periodontal maintenance therapy. METHODS: Forty-two maintenance non-smoking patients (previously treated with non-surgical scaling and root planing [SRP]), presenting at least one probing depth (PD) of 5 to 8 mm, and bleeding on probing (BOP) at single-rooted teeth were assigned randomly to two groups: treated with a chlorhexidine gluconate chip (CHIP group) and treated with SRP (SRP group). Patients were assessed for plaque index, gingival index, BOP, PD, clinical attachment level (CAL), and gingival recession at baseline, 6 weeks, and 3 and 6 months. RESULTS: Both treatments resulted in improvements in all parameters evaluated. After 6 months, a reduction in PD of 2.64 +/- 0.02 mm and 2.12 +/- 0.02 mm was observed for CHIP and SRP groups, respectively (P >0.05). The observed gain in CAL was 2.19 +/- 0.87 mm and 2.07 +/- 1.53 mm for CHIP and SRP groups, respectively (P >0.05). In deep pockets, PD reduction was 3.60 +/- 0.70 mm for CHIP group and 2.83 +/- 0.62 mm for SRP group (P = 0.01). CONCLUSIONS: Both treatments were equally effective in periodontal health reestablishment in inflamed single-root sites of maintenance patients. However, for deep pockets, the chlorhexidine gluconate chip was more effective than SRP in reducing PD.     

Clinical and microbial evaluation of dental scaling associated with subgingival minocycline in chronic periodontitis subjects

The aims of this double-blind randomized clinical trial were to evaluate the presence of periodontal pathogens and the clinical response of periodontal pockets treatment to scaling and root planing (SRP) associated with subgingival minocycline (SM). A total of 36 subjects, 26 to 60 years old (40.7 +/- 9.1), who had been previously diagnosed with chronic periodontitis, were included in the present study. Eighteen subjects were selected for the test group (TG), who were treated with SRP plus SM (new treatment), and 18 subjects for the control group (CG) who received SRP plus vehicle (current treatment). Two homologous sites in each subject with a probing depth (PD) > or = 6 mm were chosen. To evaluate the clinical response after treatment, PD was measured at baseline and at 90 days. Microbiological evaluation was performed to detect 7 periodontal pathogens using polymerase chain reaction at baseline, 30, and 120 days. A mean reduction in PD of 2.8 and 2.1 mm was observed in the TG and CG, respectively. At baseline, P. gingivalis was the most prevalent organism in both test (65.8%) and control (48.6%) groups. After 120 days it fell to 30.8% in TG and to 23.1% in CG. There were no statistically significant differences between the test and control groups concerning PD (p > 0.05 by Wilcoxon test) or presence of periodontal pathogens (p > 0.05 by Wilcoxon and chi-square; p > 0.01 by Signal test). The results observed showed that the new treatment was as effective as the current treatment in reducing periodontal pathogens and PD among chronic periodontitis subjects.