重度广泛型侵袭性牙周炎患者牙周序列治疗的临床研究

目的：观察重度广泛型侵袭性牙周炎（generalized aggressive periodontitis, GAgP）患者牙周序列治疗后临床指标的变化,并评价其治疗效果。方法：15例GAgP患者在龈上洁治后1个月内完成龈下刮治、根面平整及光动力治疗,刮治后4周再评估,行翻瓣及翻瓣植骨术,每3个月进行1次牙周维护,序列治疗后纵向观察12个月。在基线和维护期各时间点记录全口探诊深度（probing depth,PD）、探诊出血（bleeding on probing, BOP）和牙齿松动度,磨牙记录根分叉病变的程度。结果：在基线时患者平均PD（3．96±2．21）mm,BOP阳性位点占88．1％。序列治疗后12个月平均PD（2．36±1．28）mm,BOP阳性位点减少至8．7％,其中轻、中、重度位点治疗后PD值与治疗前比较差异有统计学意义（P〈0．05）。结论：GAgP患者经牙周序列治疗和定期牙周维护能取得良好的治疗效果。     

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。     

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.     

全口超声龈下刮治两次法对轻中度慢性牙周炎老年患者的近期疗效观察

目的:观察全口超声龈下刮治两次法对轻中度牙周炎的治疗效果。方法:按病例纳入标准选择年龄60岁以上、轻中度牙周炎患者42例,经口腔卫生宣教、超声龈上洁治术后,进行基线检查:牙龈出血指数(GBI),探针出血(BOP)阳性位点,牙周探诊深度(PD)及附着水平(AL),然后进行两次全口超声龈下刮治。术后1个月、3个月复查。所得数据进行配对t检验,统计学分析各临床指标治疗前后的变化。结果:术后1个月的PD由治疗前平均3.18 mm减少至平均2.45 mm(P<0.05),附着水平由平均4.51 mm提高至平均3.34mm(P<0.05),术后3个月的PD及AL分别为2.37 mm(P<0.05)及3.27 mm(P<0.05)。GBI术前平均为3.17,术后一个月及三个月分别减少至1.67(P<0.05)及1.82(P<0.05)。BOP阳性率由术前的37.2%,在术后一个月及三个月分别下降至13.2%(P<0.05)和16.8%(P<0.05)。结论:全口超声龈下刮治两次法短期可改善老年轻中度牙周炎患者的牙龈出血及附着水平,牙周袋探诊深度也有减少的趋势,同时相对于传统的分区龈下刮治及根面平整术,可减少患者复诊次数。     

牙周微创非手术治疗对薄龈生物型牙周炎患者上前牙区的疗效评价

目的 探讨薄龈生物型牙周炎患者上前牙区患牙实施牙周微创非手术治疗(minimally invasivenon-surgical therapy, MINST)的临床必要性。方法 选取2020年5月至2021年9月在南京医科大学附属口腔医院牙周科就诊的Ⅲ期/Ⅳ期薄龈生物型牙周炎患者18例,随机分成2组,针对上前牙,一组患者行牙周微创非手术治疗(MINST组),另一组行传统龈下刮治和根面平整术(subgingival scaling and root planing, SRP)(SRP组)。比较基线、术后3个月和术后6个月时患者的探诊深度(probing depth, PD)、临床附着丧失(clinical attachment loss, CAL)、牙龈退缩(gingival recession, GR)和探诊出血(bleeding on probing, BOP)阳性率指标变化及差异。术后即刻和术后1周记录受试者疼痛/不适的视觉模拟评分(visual analog scale, VAS),术后6个月记录受试者对治疗结果的VAS评分并进行美学效果的满意度调查。结果 无论基线位点的PD如何...     

伴冠心病牙周炎患者牙周基础治疗的临床疗效观察

目的 观察伴有冠状动脉粥样硬化性心脏病(以下简称冠心病)的牙周炎患者牙周基础治疗后临床指标的变化,并评价其治疗效果.方法 32例伴有冠心病的牙周炎患者,在1个月内完成口腔卫生指导、洁治、刮治和根面平整术,治疗后6周复查,进行牙周维护,在治疗前和治疗后3个月时记录全口牙周情况:菌斑指数(plaque index,PLI)、探诊深度(probing depth,PD)、附着丧失(attachment loss,AL)、牙龈出血指数(bleeding index,BI),并进行血清超敏C-反应蛋白(high-sensitivity C-reactive,hs-CRP)、总胆固醇、甘油三酯、高密度脂蛋白胆固醇(high-density lipoprotein,HDL)、低密度脂蛋白胆固醇(low-density lipoprotein,LDL)及血糖的检测.结果 牙周治疗后3个月患者的临床指标显著改善,平均PD由(3.95±0.15)mm减少至(2.93±0.21)mm,平均AL由(3.08±0.43)mm降至(2.43±0.37)mm,PD≥5 mm的位点百分比由(22.37±6.88)%降至(3.00±1.80)%,差异均有统计学意义(P＜0.01).牙周治疗后3个月患者的hs-CRP水平显著降低,由(2.71±2.69)mg/L降至(1.99±2.14)mg/L,差异有统计学意义(P＜0.01);总胆固醇,甘油三酯、HDL、LDL及血糖的测定值与治疗前相比差异均无统计学意义(P＞0.05).结论 在本研究范围内,对于伴有冠心病的牙周炎患者,牙周基础治疗取得良好的治疗效果,患者的牙周临床指标改善,血清hs-CRP水平降低.     

氯己定薄片辅助牙周治疗的疗效观察

目的评价控释药氯己定薄片(chip)辅助牙周刮治(scaling and root planing, SRP)治疗牙周炎的疗效和安全性.方法 65例成人牙周炎患者经全口SRP后,左右侧象限均至少有一个牙位探诊深度(probing depth, PD)≥5 mm且探诊出血(bleeding on probing, BOP),选此种牙为受试牙,检查和记录其临床指标,并随机选择一侧的受试牙刮治后放药,另一侧受试牙刮治后不做处理,临床观察6个月.结果用药组在第6个月时的PD减少(1.32 mm)以及附着增加(0.91 mm)均显著高于对照组(0.77 mm,0.40 mm),差异有非常显著性(P<0.001),第6个月用药组的BOP阳性率(79.4%)明显低于对照组(92.4%)(P<0.001);两组的牙面着色指数无统计学差别.44.6%的患者反映用药部位不适,主要为牙龈轻度胀痛.结论 SRP+氯己定薄片组在减少PD、增加牙周附着和减轻牙周组织炎症方面优于单纯SRP组,是一种适于牙周维护治疗的有效且安全的局部用药.     

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。     

超声刮治在老年重度慢性牙周炎患者维护期的应用效果

目的:观察龈下超声根面平整在老年重度慢性牙周炎患者牙周支持治疗期间(原为维护期)的应用效果.方法:选择60岁以上诊断为重度牙周炎,经基础治疗后仍有5 mm以上牙周袋和探诊出血,为翻瓣术的适应证,且拒绝手术治疗的患者60例.分别于基础治疗后4周(基线)、6个月和12个月复诊行超声刮治前,检测菌斑指数(plaque index,PLI)、出血指数(bleeding index,BI)、探诊出血(bleeding on probing,BOP)、探诊深度(probing depth,PD)的变化.1年后对结果进行t检验.结果:与基线相比,6个月复查时所有临床牙周指数均有显著改善(P<0.01),6个月与12个月相比无显著差异(P>0.05).结论:未经翻瓣术治疗的老年重度牙周炎患者,在其牙周支持治疗期间定期施以龈下超声治疗短期可取得较好的治疗效果.     

二次牙周龈下刮治与牙周翻瓣术短期临床疗效比较

目的比较二次牙周龈下刮治和根面平整（scaling and root planning,SRP）与牙周翻瓣术治疗慢性牙周炎的短期临床疗效。方法选取牙周基础治疗3个月后牙周探诊深度为5～7mm的前牙或前磨牙共52颗作为研究对象,随机分为2组,二次SRP组行龈下刮治和根面平整术,翻瓣组进行改良Widman翻瓣术。分别在治疗前、治疗后3个月和6个月,检查记录探诊出血（bleeding on probing,BOP）、探诊深度（probing depth,PD）、牙龈退缩（gingival recession,GR）及临床附着水平（clinical attachment level,CAL）,并比较分析。结果二次SRP组和翻瓣组患牙的BOP阳性率、PD、GR、CAL治疗前分别为91.30%、（5.60±0.99）mm、（0.37±0.49）mm、（5.98±1.17）mm和92.13%、（5.87±1.02）mm、（0.30±0.47）mm、（6.03±1.30）mm,治疗后6个月分别为17.39%、（2.87±0.78）mm、（2.00±0.62）mm、（5.07±1.01）mm和11.23%、（2.53±0.51）mm、（2.36±0.68）mm、（4.89±0.84）mm,2组治疗后6个月各项指标与治疗前比较差异均有统计学意义（P〈0.01）。治疗后6个月2组间BOP阳性率、PD及CAL比较差异无统计学意义（P〉0.05）,但翻瓣组GR明显高于二次SRP组（P〈0.05）。结论对于前牙或前磨牙,二次SRP与牙周翻瓣术可达到相同的治疗效果,翻瓣术后牙龈退缩较二次牙周龈下刮治和根面平整后明显。     

内窥镜辅助下微创牙周基础治疗的临床疗效评价

目的 探讨牙周内窥镜辅助下超声龈下刮治及根面平整(subgingival scaling and root planning,SRP)对重度牙周炎治疗的临床疗效.方法 选取2017年6月至2019年1月于南京大学医学院附属口腔医院就诊的Ⅲ-Ⅳ期牙周炎患者19例,随机分为内窥镜组及对照组.内窥镜组在龈上洁治术1周后,牙周...     

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.     

慢性牙周炎维护治疗期临床纵向观察

目的:了解慢性牙周炎维护治疗期临床指标变化规律。方法:对牙周非手术基础治疗后进入维护治疗期的22名慢性牙周炎病人进行9个月的纵向观察。每3个月给予口腔卫生宣教,龈上下洁刮治和根面平整。并在基线和每次复查时记录临床检查指标,包括探诊深度(PD)、临床附着水平(CAL)、探诊出血(BOP)。结果:后牙较前牙更易出现牙周袋加深,>6 mm深袋的比例6个月后显著下降,CAL改善在邻面及舌侧更加明显,BOP比例持续下降。结论:非手术基础治疗配合定期维护,可使临床指标在较短期内获得明显改善。     

不同程度慢性牙周炎患者病情的二年自然进展

目的　观察不同程度慢性牙周炎的自然进展规律。方法　纵向观察 16 9例轻、中、重度慢性牙周炎患者在 2年中的疾病自然进展 ,检查除第三磨牙外的全口牙 ,每颗牙 6个位点 ,以探诊深度、附着丧失为指标 ,两次检查之间附着丧失加重≥ 3mm的牙位定为活动性进展。结果　活动性发生率依基线时疾病的轻、中、重程度而逐渐增高 ,按位点活动性的发生率分别为 0 14 %、0 39%及0 73% ,按个体活动性的发生率分别为 15 5 6 %、2 9 89%及 4 3 2 4 % ,差异有统计学意义。结论　重度牙周炎患者是牙周破坏活动性进展的高危人群。     

Timing affects the clinical outcome of adjunctive systemic antibiotic therapy for generalized aggressive periodontitis

BACKGROUND: Systemic antibiotics improve the outcome of scaling and root planing (SRP) in patients exhibiting severe periodontitis. This study evaluated the influence of timing of adjunctive systemic antibiotics in the sequence of periodontal therapy. METHODS: Two cohorts of patients with generalized aggressive periodontitis and treated by SRP, adjunctive antibiotics, and supportive periodontal therapy (SPT) were analyzed retrospectively. Cohort A (17 patients; 36 +/- 5 years of age) received systemic amoxicillin/metronidazole immediately after SRP ("immediate"); cohort B (17 patients; 36 +/- 4 years of age) received the same regimen 3 months after SRP, following SPT, including subgingival reinstrumentation ("late"). Clinical parameters, including probing depth (PD), relative attachment level (RAL), bleeding on probing (BOP), and suppuration, were recorded with a pressure-sensitive electronic probe at baseline and 3 and 6 months after SRP. RESULTS: Significant time*group interactions were found for all clinical parameters except BOP, i.e., timing of antibiotic therapy affected the course of clinical changes over time. Immediate antibiotic therapy produced significantly higher initial changes (0 to 3 months) in PD and RAL. Late antibiotic therapy at 3 months resulted in additional significant improvements in all clinical parameters between 3 and 6 months. In initially deep sites (baseline PD >6 mm), improvements in PD and RAL over 6 months were significantly higher with immediate antibiotic therapy compared to late antibiotic therapy. CONCLUSION: Within the limits of a retrospective analysis, these findings indicate that administration of amoxicillin/metronidazole immediately after initial SRP provides more PD reduction and RAL "gain" in initially deep sites than late administration at SPT with reinstrumentation after 3 months.     

Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: a preliminary randomized controlled clinical study

BACKGROUND: The treatment of aggressive periodontitis has always presented a challenge for clinicians, but there are no established protocols and guidelines for the efficient control of the disease. METHODS: Ten patients with a clinical diagnosis of aggressive periodontitis were treated in a split-mouth design study to either photodynamic therapy (PDT) using a laser source with a wavelength of 690 nm associated with a phenothiazine photosensitizer or scaling and root planing (SRP) with hand instruments. Clinical assessment of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and relative clinical attachment level (RCAL) were made at baseline and 3 months after treatment with an automated periodontal probe. RESULTS: Initially, the PI was 1.0 +/- 0.5 in both groups. At the 3-month evaluation, the plaque scores were reduced and remained low throughout the study. A significant reduction of GI and BOP occurred in both groups after 3 months (P <0.05). The mean PD decreased in the PDT group from 4.92 +/- 1.61 mm at baseline to 3.49 +/- 0.98 mm after 3 months (P <0.05) and in SRP group from 4.92 +/- 1.14 mm at baseline to 3.98 +/- 1.76 mm after 3 months (P <0.05). The mean RCAL decreased in the PDT group from 9.93 +/- 2.10 mm at baseline to 8.74 +/- 2.12 mm after 3 months (P <0.05), and in the SRP group, from 10.53 +/- 2.30 mm at baseline to 9.01 +/- 3.05 mm after 3 months. CONCLUSION: PDT and SRP showed similar clinical results in the non-surgical treatment of aggressive periodontitis.     

光动力疗法辅助治疗Ⅲ期、Ⅳ期牙周炎的临床效果评价

目的: 探讨光动力疗法（photodynamic therapy,PDT）辅助龈下刮治术（subgingival scaling and root planning,SRP）在Ⅲ、Ⅳ期牙周炎治疗中的临床效果。方法: 根据2018年牙周病新分类,选择Ⅲ期和Ⅳ期牙周炎患者,经龈上洁治1周后,记录牙周探诊深度（probing depth, PD）、牙龈指数（gingival index, GI）和探诊出血（bleeding on probing,BOP）为基线。将患者分为3组,SRP组进行SRP治疗;PDT1组在SRP后即刻对口内所有PD≥5 mm的位点进行PDT;PDT2组在SRP+PDT后6周,对原位点再进行1次PDT。基线治疗后3、6个月复查,比较PD、GI和BOP阳性率的变化。采用SPSS 22.0软件包对数据进行统计学分析。结果: 共纳入30例患者、1 289个位点。SRP组、PDT1组和PDT2组各10例患者,位点数分别为476个（36.9%）、384个（29.8%）和429个（33.3%）。3组治疗后3个月、6个月复查时,PD、GI、BOP阳性率较基线均显著降低（P<0.05）; 6个月与3个月的复查结果无显著差异。PD≥5 mm的位点,PDT1组和PDT2组可以显著降低患牙的GI和BOP阳性率（P<0.05）;PD≥7 mm时,PDT2组PD显著降低（P<0.05）。结论: 对于Ⅲ、Ⅳ期牙周炎,PDT辅助SRP治疗可以获得比单纯SRP更好的临床效果。