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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。     

脉冲Nd：YAG激光照射对实验性大鼠慢性牙周炎的作用

目的:探讨脉冲Nd:YAG激光照射对大鼠实验性牙周炎牙周临床指标及牙周组织中一氧化氮(NO)含量的影响.方法:健康Sprague-Dawley大鼠共64只,随机分为8组,正常对照组(N组),药物对照治疗组(D组),牙周炎阳性对照组(P组),其余5组按照给予不同剂量激光照射治疗.末次治疗15 d后测量牙周临床指标牙龈指数(GI),牙槽骨吸收值ABL(Alver bone loss),菌斑指数(plaque index,PLI),采用分光光度仪测定大鼠牙周组织中NO的含量.结果:各剂量组ABL、NO值较末照射组(P组)显著降低(P＜0.05).1.5～2.0 W 20 pps剂量组激光照射后牙周指数均较P组显著降低(P＜0.05),与D组无显著差异.结论:在1.5～2.0 W 20pps剂量范围内,采用脉冲Nd:YAG激光牙周袋内照射能有效改善牙周指数,降低实验大鼠牙周组织中NO含量,起到治疗牙周炎的作用.     

超声洁治和局部用派丽奥治疗人工冠和固定义齿引起的慢性牙周炎

目的：评价采用超声龈上洁治术和20g／L盐酸二甲胺四环素(派丽奥)治疗人工和固定义齿引起的慢性牙周炎的疗效。方法：将30个由人工冠和固定义齿引起的慢性牙周炎患牙随机分为超声龈上洁治组和派丽奥组并在基线和治疗后1周、12周时检查患牙的临床指标。结果：两种治疗方法均可使菌斑指数和牙龈指数等指标改善。结论：超声龈上洁治术和局部用盐酸二甲胺四环素是治疗人工冠和固定义齿引起的慢性牙周炎的安全有效的方法。     

Trauma from instrumentation after non-surgical periodontal treatment with ultrasonic scalers and Nd:YAG laser

Abstract

Objective. Periodontal therapies aimed at altering the progression of periodontal diseases must include meticulous mechanical debridement during both the non-surgical and the surgical phases of periodontal treatment. The aim of this study was to evaluate and compare the immediate effect of trauma from instrumentation on clinical attachment level after non-surgical periodontal treatment with ultrasonic scalers and a Nd:YAG laser. Materials and methods. Twenty-four patients with untreated chronic periodontitis, presenting probing depths of 4–6 mm on anterior teeth, upper and lower, were entered into the study. The selected teeth were probed with a pressure-controlled probe, guided by stents. Each quadrant was randomly allocated in a split-mouth design either to treatment with Nd:YAG laser using an energy of 1W, 100mj, 1064nm (test group) or to periodontal treatment using ultrasonic scalers (control group). Clinical parameters, including plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD) and probing attachment level (PAL) were acquired prior to and immediately after treatment. Results. Statistical analysis demonstrated no differences between groups at baseline for all parameters (p > 0.05). Immediately after treatment, the control group showed a greater PAL loss than the test group (p < 0.05). For the control group, there were statistically significant differences between PAL immediately before and after treatment (p < 0.05), but not test group (p > 0.05). Conclusions. Within the limits of the present study, it may be concluded that non-surgical periodontal treatment with ultrasonic scalers causes a mean immediate attachment loss of 0.68 mm and that a Nd:YAG laser seems to reduce significantly the trauma the instrumentation produced.     

应用Nd:YAG激光减轻牙周刮治术中疼痛的临床观察

目的:探讨Nd:YAG激光在牙周病治疗中的镇痛效果方法:通过101例60岁以上的慢性牙周炎患者自身对照,左、右侧各选一侧使用Nd:YAG激光牙周治疗仪辅助超声+手用刮治器,另一侧使用超声+手用刮治器作为对照,治疗后即刻进行视觉模拟评分法(Visual Analogue Scale,VAS)评分,对比Nd:YAG激光与传统牙周刮治术在临床应用中的疼痛程度结果:激光治疗侧的VAS值(1.67±0.67)明显低于牙周机械治疗侧(6.18±0.87),其差异有统计学意义(P＜0.01).女性在激光侧和对照侧的VAS值均高于男性,但无显著性差异(P＞0.05).结论:Nd:YAG激光在牙周病治疗术中使疼痛敏感程度降低,患者的舒适度较高.     

Combined effects of Nd:YAG laser irradiation with local antibiotic application into periodontal pockets

The purpose of the present study was to assess the effects of Nd:YAG laser irradiation into periodontal pockets with or without the combination of local antibiotic application on clinical parameters and microbiological prevalence. Sixteen patients, each of whom had 4 or more sites with probing depth e x 4mm were included in this study. They were monitored clinically and microbiologically at baseline, 1 and 3 months after the treatment. Subgingival plaque samples were taken from periodontally involved sites with a probing depth of e x 4mm. A total of 135 sites were randomly assigned to the following treatments; Nd:YAG laser alone (Group L: 10 pps, 200 mJ for 90 sec, n = 37), local minocycline administration following laser treatment (Group LP, n = 33), povidone-iodine irrigation following laser treatment (Group LI, n = 33), and control group (Group C: sham procedure, n = 32). The prevalence of 18 subgingival taxa were determined using the checkerboard technique. The mean value of the pocket probing depth (PPD) significantly decreased in Group L, Group LP and Group LI, and the mean clinical attachment loss (CAL) decreased in all three treatment groups. Multivariate logistic regression analysis showed that Group LP showed the most improvement in PPD or CAL at 3 months. The proportions of Porphyromonas gingivalis, Tannerella forsythia (formerly Bacteroides forsythus) and Prevotella intermedia were significantly lower in Group LP than in Group L after 3 months. These results showed that Nd:YAG laser irradiation plus local minocycline provides a much greater reduction in PPD, CAL and the amount of periodontopathogenic bacteria than laser irradiation alone in periodontitis patients.     

Comparison of Nd:YAG laser versus scaling and root planing in periodontal therapy

BACKGROUND: The Nd:YAG laser has recently been used in the treatment of periodontal disease. However, although a clinical reduction of probing depth and gingival inflammation to this new approach has been reported, it has not been fully evaluated. Interleukin-1 beta (IL- 1beta), a potent stimulator of bone resorption, has been identified in gingival crevicular fluid (GCF), which is closely associated with periodontal destruction. The aim of this study was to compare the effects of Nd:YAG laser treatment versus scaling/root planing (SRP) treatment on crevicular IL-1beta levels in 52 sampled sites obtained from 8 periodontitis patients. METHODS: One or 2 periodontitis-affected sites with a 4 to 6 mm probing depth and horizontal bone loss from 3 adjacent single-root teeth in each of 4 separate quadrants were selected from patients for clinical documentation and IL-1beta assay. Sampling site(s) from each diseased quadrant was randomly assigned to one of the following groups: 1) subgingival laser treatment (20 pps, 150 mJ) only; 2) SRP only; 3) laser treatment first, followed by SRP 6 weeks later; or 4) SRP first, followed by laser therapy 6 weeks later. The GCF was collected and the amount of IL-1beta was assayed by enzyme-linked immunosorbent assay (ELISA). Clinical parameters and GCF were measured at baseline and biweekly after therapy for 12 weeks. RESULTS: An obvious clinical improvement (marked decrease in the number of diseased sites with gingival index > or =2) and reduction of crevicular IL- 1beta were found in all groups. The level of IL- 1beta was significantly lower in the SRP group (P = 0.035) than in the laser therapy group for the duration of the 12 weeks. The laser combined SRP therapy group showed a further reduction of IL- 1beta (6 to 12 weeks after treatment) than either laser therapy alone or SRP combined laser therapy. CONCLUSIONS: Our data suggest that laser therapy appeared to be less effective than traditional SRP treatment. Of the 4 treatment modalities, inclusion of SRP was found to have a superior IL- 1beta response, when compared to other therapies without it. In addition, no additional benefit was found when laser treatment was used secondary to traditional SRP therapy.     

The effectiveness of scaling and root planing with combined application of air polishing and Nd:YAG laser in periodontal pockets of stage III grade C periodontitis patients: a single-blinded randomized clinical trial

Clinical Oral Investigations - Evaluating the efficiency of combined air polishing and Nd:YAG laser application in addition to scaling and root planning (SRP) in treatment of periodontal pockets of...     

Nd:YAG激光消毒用于慢性根尖周炎一次性根管治疗

目的 :探讨一定剂量的脉冲Nd :YAG激光根管消毒一次性治疗慢性根尖周炎的临床可靠性和优越性。方法 :收集无症状的慢性根尖周炎患者 12 4例 13 7牙 ,常规根管预备后按根管消毒方式随机分为 3组 :激光组以 2W或 1.5W 2 0Hz 5s× 4剂量根管内照射 ;碘伏组以 5g/L的碘伏液冲洗 ;FC组封FC药。然后前 2组即刻根充 ,一次性完成治疗 ;后 1组封药复诊 ,无症状后同法完成。 3组根充后 2 4h、1、12、2 4周分期随访 ,记录自发痛、叩痛 ,2 4周拍X线牙片行根尖周指数 (PAI)评分。综合评价 3组临床疗效。结果 :根充后 2 4h内 3组自发痛发生率及其程度无显著差异 ,但有窦道者发生率明显低且程度轻 ;叩痛发生率 3组在 1、12周无显著性差异 ,而 2 4周时激光组显著低于FC组。结论 :激光用于根管消毒一次性治疗慢性根尖周炎 ,疗效优于FC组 ,且可缩短疗程 ,具有较好的临床应用前景     

激光联用洁治改善固定正畸患者牙周状况的临床研究

目的:评价Nd:YAG激光辅助改善固定正畸患者牙周状况的效果.方法:选择60例接受固定正畸治疗的男性患者,以右下颌第一磨牙为实验牙,左下颌第一磨牙为对照牙,分别比较它们在正畸治疗开始前、激光、超声洁牙和两者联用治疗前以及3种治疗1周和6个月后的龈沟液(GCF)量、天门冬氨酸氨基转移酶(AST)与碱性磷酸酶(ALP)水平的变化.结果:激光治疗、超声洁治术以及两者联用均能在短期内降低GCF量、ALP及AST水平(P＜0.05),但激光治疗和两者联用后局部GCF量、AST及AL P水平较超声洁牙后降幅更大(P＜0.05);3组6个月后GCF量、ALP及AST水平均有所提高(P＜0.05),但联用组提高较少(P＜0.05).结论:Nd:YAG激光可应用于固定正畸患者以改善其牙周状况,若能配合超声洁治,效果更理想.     

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提要：牙周炎是指发生在牙周支持组织的慢性感染性疾病,可导致牙周组织的附着丧失和牙槽骨的进行性破坏。近些年来,国内外学者们致力于激光在慢性牙周炎治疗中的研究。本文就不同能量的激光在牙周炎治疗中的应用做一综述。     

Effect of Nd: YAG laser irradiation on the treatment of oral malodour associated with chronic periodontitis

AIM: To investigate, using a randomised-controlled, single clinical trial whether treating periodontitis with non-surgical periodontal treatment procedures and laser applications can decrease the effect of oral malodour and compare the effectiveness of the different therapies. METHODS: Sixty patients suffering from chronic periodontitis and complaining of oral malodour were included in the study. The parameters measured included organoleptic scoring, volatile sulphur compound (VSC) levels, gingival index, plaque index, probing depth and clinical attachment levels before and after the different treatment procedures (oral hygiene instructions, scaling-root planing-SRP and subgingival Nd: YAG laser irradiation). RESULTS: There were significant relationships between oral malodour and the specific periodontal parameters. For all patients, there were statistically significant (p < 0.05) decreases in the clinical index scores and VSC values after all treatments. Although the VSC values decreased in all groups after treatment, laser treatment alone did not cause as large decreases as that achieved by SRP and SRP + laser irradiation. CONCLUSION: The results confirmed that in the population studied, oral malodour levels were significantly reduced after treating chronic periodontitis. The data indicated a possible adjunctive role for Nd: YAG lasers in periodontal therapy and treatment of oral malodour.     

Aggressive periodontitis: laser Nd:YAG treatment versus conventional surgical therapy

AIM: The aim of the study was to compare two methods of treatment for aggressive periodontitis: traditional surgical and Nd:YAG laser, evaluating their possible objective clinical advantages. MATERIALS AND METHODS: A total of 36 hemiarches of 18 patients were analysed, 10 males and 8 females of average age of 14, selected according to predefined criteria. Overall we examined 70 radicular surfaces (sites) of 50 teeth. Each hemiarch to treat was randomly assigned to one of two treatment groups. RESULTS AND CONCLUSION: The results, analysed using the Friedman's test, showed a clinically appreciable validity both for the surgical and the laser treatment, while the Wilcoxon signed-rank test didn't highlight any statistically significant difference between the two types of treatment. The laser itself appears as a valid alternative to conventional therapy, in relation to the young age of the patients and for individuals at increased anaesthesiological risk and/or with coagulation and platelet function disorders.     

龈下刮治和根面平整术联合Nd: YAG激光治疗慢性牙周炎的疗效评价

目的 研究龈下刮治和根面平整术（SRP）联合Nd: YAG激光治疗对慢性牙周炎患者的疗效。方法 选择口内有4颗及以上牙齿,探诊深度为4~8 mm的慢性牙周炎患者,研究位点为分布在口内4个不同象限的互不毗邻的单根牙。随机分成4组:对照组（不治疗）、SRP组（单纯SRP）、SRP+L组（SRP后行激光治疗）、L+SRP组（激光治疗后行SRP）。观测时间点为基线（临床处理前）和临床处理后1周、1个月、3个月,比较不同组在不同观测点牙周临床指标和龈下菌群中红色复合体（包括牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体）的组成变化。结果 牙周临床指标:SRP、SRP+L、L+SRP组的各项临床指标变化均优于对照组;3个治疗组组间比较,探诊出血、探诊深度和临床附着丧失量之间无明显差异（P>0.05）,但在3个月时,L+SRP和SRP+L组的菌斑指数百分比下降较SRP组明显（P<0.05）。微生物检测结果:SRP、SRP+L、L+SRP组龈下菌斑中牙龈卟啉单胞菌、福赛斯坦纳菌、齿垢密螺旋体百分比均较基线下降,3个治疗组间也存在一定差异（P<0.05）,但在不同观测时间点的差异不完全相同。结论 慢性牙周炎治疗中,Nd: YAG激光联合SRP治疗较单纯SRP治疗未见明显优势,且Nd: YAG激光和SRP的治疗先后对临床效果也无明显影响;但激光联合SRP治疗可能较单纯SRP更有利于局部菌斑的控制。     

超声龈下洁治和手工龈下刮治在慢性牙周炎治疗中疗效的比较

选取2014-01～2014-12慢性牙周炎患者80例,分2组,分别使用超声龈下洁治（超声组）和手工龈下刮治（手工组）的方法进行治疗,发现在牙周治疗术后4周和12周时2组患者的菌斑指数（PLI）、牙龈出血指数（GBI）、牙周袋深度（PD）和附着水平（CAL）等牙周指标较治疗前均显著下降（P ＜0．05）,超声组治疗后菌斑指数小于手工组（P ＜0．05）,余各项牙周指标在2组患者间均无统计学差异（P ＞0．05）。     

Microbiologic analysis of periodontal pockets and carotid atheromatous plaques in advanced chronic periodontitis patients

BACKGROUND: In recent years, many researchers have focused their attention on the ability of periodontal pathogens to colonize atheromatous plaques. Nevertheless, a clear correlation between the detection rates of periodontopathic bacterial DNA in atheromas and in subgingival plaque samples has not been established. The aim of our study was to assess the presence of five periodontal pathogens (Actinobacillus actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia [formerly Tannerella forsythensis]) in periodontal pockets and in carotid atheromas recovered from the same patients. METHODS: Thirty-three patients with advanced chronic periodontitis scheduled for endarterectomy were enrolled in the study. DNA was extracted from subgingival plaque samples and carotid atheromas. Universal bacteria primers for general detection of bacteria and species-specific primers for detection of periodontal pathogens were used to amplify part of the 16S rRNA gene by polymerase chain reaction. RESULTS: All subgingival plaque samples were positive for at least one target microorganism. The prevalence of T. forsythia, P. gingivalis, T. denticola, P. intermedia, and A. actinomycetemcomitans were 69.7%, 63.6%, 54.5%, 45.4%, and 33.3%, respectively. Bacterial DNA was detected in 31 out of 33 endarterectomy specimens. However, none of the samples tested positive for DNA from periodontal pathogens. CONCLUSION: The presence of periodontal bacteria in atheromatous plaques was not confirmed by this investigation; thus, no correlation could be drawn between periodontitis bacteria and microorganisms involved in the atherosclerotic lesions.