吸烟对牙周炎患者龈下刮治和根面平整术疗效影响的研究

[摘要] 目的 比较吸烟与不吸烟牙周炎患者实施龈下刮治和根面平整治疗术(scaling and root planning,SRP)时,对探诊深度(probing depth,PD)和临床附着水平(clinical attachment level,CAL)的影响。方法 选择临床上中到重度的牙周炎患者,其中53例吸烟患者,56例非吸烟患者,局麻下行龈下刮治和根面平整术(SRP)后,局部龈下放置25%的甲硝唑膜。由同一位检查者分别于初诊及6个月复诊时用牙周探针检查记录探诊深度(PD)和临床附着水平(CAL)。结果 治疗后6个月复诊时,吸烟组PD减小量和CAL增加量均小于不吸烟组(P<0.05),螺旋体比例降低量吸烟组亦较小(P<0.05)。结论 吸烟患者对SRP治疗的反应性较差,且对于局部抗生素治疗的敏感性亦较低。     

阿莫西林与甲硝唑联合龈下刮治和根面平整术治疗侵袭性牙周炎的短期疗效观察

目的观察龈下刮治和根面平整术（scaling and root planing,SRP）联合应用阿莫西林和甲硝唑治疗侵袭性牙周炎的短期临床疗效。方法采取随机法将30例侵袭性牙周炎患者分为单纯机械洁刮治的对照组与机械洁刮治联合药物治疗的试验组。分别在治疗前、治疗后3个月检查记录探诊出血（bleeding on probing,BOP）、探诊深度（probing depth,PD）及临床附着丧失（clinical attachment loss,CAL）情况,对所得数据进行统计学分析。结果 2组治疗3个月后BOP阳性率、PD、CAL均较治疗前明显改善。对照组患牙的平均PD值为（3.2±0.6）mm,试验组为（2.7±0.5）mm,2组比较差异有统计学意义（P〈0.05）;30例患者治疗后CAL均有改善,平均改善0.96 mm;试验组PD〈5 mm的平均位点百分比的增加值明显高于对照组,差异有统计学意义（P〈0.05）。结论 SRP联合应用阿莫西林和甲硝唑治疗侵袭性牙周炎短期效果显著优于单纯SRP治疗,临床指标得到明显改善。     

光动力疗法联合龈下刮治术治疗慢性牙周炎疗效观察

目的 观察光动力疗法联合龈下刮治和根面平整术治疗慢性牙周炎的临床效果.方法 选择中、重度慢性牙周炎患者30例,随机分为3组,每组10人.A组:单纯龈下刮治和根面平整术治疗;B组:龈下刮治和根面平整术治疗后即刻行光动力疗法;C组:龈下刮治和根面平整术治疗后1周行光动力疗法.治疗前、龈下刮治和根面平整术治疗后6周、12周时分别记录牙周袋探诊深度及探诊出血的阳性牙位点,并进行统计学分析.结果 龈下刮治和根面平整术后6周和12周结果显示,3组牙周袋探诊深度和探诊出血情况较术前均有改善(P＜0.05).B组和C组的牙周袋探诊深度和探诊出血情况改善效果均优于A组(P＜0.05);B组与C组间差异无统计学意义(P＞0.05).结论 对中、重度慢性牙周炎患者应用光动力疗法联合龈下刮治和根面平整术治疗,较单独使用龈下刮治和根面平整术治疗效果更佳.光动力疗法可作为新的辅助治疗手段用于牙周病的治疗.     

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.     

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。     

半导体激光辅助治疗中重度慢性牙周炎的临床疗效分析

目的评价半导体激光辅助治疗中重度慢性牙周炎的临床疗效。方法采用随机、自身对照、单盲法。将10位中重度慢性牙周炎患者的左右侧牙列随机分为实验组和对照组,每个象限选取探诊深度(Probing depth,PD)≥6 mm的两个位点,共80个位点。初诊时进行龈上洁治,2周后,实验组龈下刮治(Scaling and root planing,SRP)+半导体激光(980 nm,2 W)照射30 s,对照组只进行SRP,比较治疗前及治疗后3个月PD、临床附着丧失(Clinical attachment loss,CAL)和探诊出血(Bleeding on probing,BOP)的变化。结果治疗前,两组各临床指标均无明显差异(P>0.05)。治疗后3个月,两组各临床指标均较治疗前明显降低(P<0.05),实验组PD(4.15±0.24)mm,CAL(5.45±0.28)mm,BOP阳性率20%,对照组PD(4.13±0.28)mm,CAL(5.15±0.30)mm,BOP阳性率42.5%。其中,实验组BOP阳性率明显低于对照组(P<0.05),两组PD和CAL的变化值无明显差别(P>0.05)。结论半导体激光辅助治疗中重度慢性牙周炎可以有效改善牙龈炎症,其长期疗效有待进一步研究。     

米诺环素对慢性牙周炎的辅助治疗作用

目的 :探讨米诺环素对慢性牙周炎的辅助治疗作用。方法 :将 2 0个病例中患中度及重度慢性牙周炎的患牙 80个随机分成 4组 :①米诺环素 +刮治组 (SRP +M ) ;②单纯刮治组 (SRP) ;③单纯用米诺环素组 (M ) ;④未处理组 (U)。分别在基线、1周 ,4周时检测菌斑指数 (PI)、牙龈指数 (GI)、探诊出血指数 (BOP)、探诊深度 (PD)、附着丧失 (AL)等牙周病临床指标。结果 :SRP +M组在 1周和 4周时探诊深度和探诊出血率显著低于其它 3组 (P <0 .0 5 )。结论 :龈下局部应用米诺环素联合刮治术和根面平整术在降低探诊深度和探诊出血方面比单纯实施刮治术和根面平整术组效果明显。     

氯己定局部缓释系统辅助龈下刮治和根面平整效果的Meta分析

目的:比较并评价在慢性牙周炎治疗过程中,牙周袋内应用氯己定局部释药系统辅助龈下刮治和根面平整(scaling and root planing,SRP)的临床效果是否优于单纯SRP。方法:主要检索6个数据库,一些全文通过手工检索获得。收集至2009年5月公开发表的中英文牙周局部应用氯己定释药系统辅助龈下刮治和根面平整的随机对照试验,随访时间至少3个月。观察指标为术后牙周探诊深度(probing depth,PD)的减少和临床附着水平(clinical attachment level,CAL)的增加。结果:最终有7个研究纳入本系统评价。Meta分析结果显示,牙周局部应用氯己定释药系统辅助SRP与单纯SRP相比,可以使PD显著降低,而CAL在2个治疗组间无统计学差异。结论:在慢性牙周炎的治疗过程中,牙周局部应用氯己定释药系统辅助SRP可以使牙周探诊深度显著降低。     

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...     

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。     

甘氨酸龈下喷砂辅助治疗老年伴糖尿病牙周炎疗效分析

目的:观察甘氨酸龈下喷砂辅助治疗老年伴糖尿病牙周炎后,牙周炎症的改善情况以及糖尿病相关指标的变化.方法:2018年6月～2019年6月于浙江医院口腔科就诊的40例老年伴糖尿病牙周炎患者(男20例,女20例,年龄60～78岁)为研究对象.随机分为对照组(超声龈下刮治+根面平整术)和实验组(超声龈下刮治+根面平整术+甘氨酸...     

糖尿病患者牙周非手术治疗对血糖水平的影响

目的　探讨牙周非手术治疗对糖尿病患者牙周炎症控制及血糖水平的影响。方法　从83例胰岛素非依赖性糖尿病牙周炎患者中选出代谢控制不良的 31例 ,行牙周非手术治疗 ,测量并比较术前、术后 4、8周的探诊出血、探诊深度及糖化血红蛋白水平。结果　所有患者治疗后探诊出血、探诊深度明显减少。重度牙周炎患者糖化血红蛋白从 ( 9 86± 2 1 0 ) %降低为 ( 8 77± 1 62 ) % ,差异有显著性 (P <0 0 1 ) ;中轻度牙周炎患者糖化血红蛋白的变化差异无显著性 (P >0 0 5)。结论　糖尿病患者牙周炎症控制能在一定程度上改善代谢水平 ,但改善的效果可能与治疗前血糖水平和牙周状况有关     

糖尿病和牙周病临床相互关系的初步研究

目的通过临床问卷调查,初步探讨牙周病与胰岛素非依赖性糖尿病的相互关系,并探讨通过牙周非手术治疗对胰岛素非依赖性糖尿病患者牙周病变控制及血糖水平的影响。方法选取齐鲁医院内科住院患者120例,分为胰岛素非依赖性糖尿病组63例、对照组57例。两组均设计相同问卷进行临床调查,比较两组牙周患病率及牙周健康状况(牙龈出血、牙齿松动、牙齿缺失、牙龈萎缩)的差异。并对63例胰岛素非依赖性糖尿病患者中的26例行牙周非手术治疗,测量并比较患者术前及术后4、8周的牙龈出血、牙周袋深度及糖化血红蛋白的水平。结果胰岛素非依赖性糖尿病组的牙周病患病率(50.05%)高于对照组(33.25%),胰岛素非依赖性糖尿病组牙周健康状况差于对照组,统计学检验两组差异有显著性(P<0.01)。胰岛素非依赖性糖尿病患者牙周非手术治疗后,牙龈出血减轻或消失、牙周袋变浅、重型牙周炎患者糖化血红蛋白降低。结论牙周病与胰岛素非依赖性糖尿病之间存在一定的相关性,胰岛素非依赖性糖尿病患者牙周炎症的控制能在一定程度上改善代谢水平及治疗效果。     

Efficacy of Local Antimicrobials in the Non‐Surgical Treatment of Patients With Periodontitis and Diabetes: A Systematic Review

Background: Patients with diabetes present a worse response to periodontal treatment. Local antimicrobials as an adjunct to scaling and root planing (SRP) provide additional benefits in the treatment of periodontitis in healthy patients. This review aims to evaluate the effects of local antimicrobials as an adjunct to SRP, compared with SRP alone, on periodontal clinical parameters of patients with chronic periodontitis (CP) and diabetes mellitus (DM). Methods: Only randomized controlled trials with: 1) at least 6 months of follow‐up; 2) SRP, in combination with local antimicrobials; and 3) patients with periodontitis and DM were considered eligible. MEDLINE, EMBASE, and LILACS databases were searched for articles published up to January 2016. Random‐effects meta‐analyses were conducted for clinical attachment level (CAL), probing depth (PD), bleeding on probing, and gingival index change after treatment. Results: Of 153 papers potentially relevant to this review, six were included. The majority of trials showed a significant PD reduction and CAL gain associated with use of local antimicrobials in patients with type 1 and type 2 DM. Only studies that included well‐controlled patients and applied antimicrobials at the deepest sites or sites with baseline PD ≥5 mm presented significant PD reduction and CAL gain. Conclusion: In patients with DM and CP, use of local antimicrobials as an adjunct to SRP may result in additional benefits compared with SRP alone in PD reduction and CAL gain, especially in well‐controlled individuals and deep sites.     

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。     

Ⅱ型糖尿病患者的牙周状况及对糖化血红蛋白(HbAIc)的影响

目的 观察Ⅱ型糖尿病患者患牙周炎经过牙周基础治疗后，牙周状况以及糖化血红蛋白(HbAIc)的变化：方法：选择已确诊的Ⅱ型糖尿病同时患牙周炎的患者33例，进行牙周基础治疗，比较治疗前及治疗后4周的牙周状况和HbAIc水平。结果：患者经过牙周基础治疗后、探诊出血指数、探诊深度明显减轻；重度牙周炎患者经治疗后4周，HbAIc明显降低；中度及轻度牙周炎患者治疗前后HbAIc无明显改变。结论：成人牙周炎的糖尿病患者牙周基础治疗后短期效果是满意的，牙周治疗可降低糖化血红蛋白的水平.     

Effects of full-mouth scaling and root planing in conjunction with systemically administered azithromycin

BACKGROUND: One-stage full-mouth disinfection (FMD), in which full-mouth scaling and root planing (SRP) is performed with adjunctive use of chlorhexidine, was introduced in 1995. There have been several reports on the effectiveness of this treatment protocol. However, FMD was reported to induce pyrexia frequently. We examined the effects of full-mouth SRP in conjunction with azithromycin administered orally before SRP to control the number of bacteria. The purpose of this study was to compare the effects of full-mouth SRP using azithromycin with conventional SRP. METHODS: Thirty-four subjects (17 in the test group and 17 in the control group) with severe chronic periodontitis were selected. The subjects of the test group had azithromycin 3 days before full-mouth SRP. Clinical parameters (probing depth [PD], gingival index [GI], bleeding on probing [BOP], and gingival crevicular fluid [GCF]), total number of bacteria, and number of black pigment-producing rods (BPRs) were evaluated at baseline and 5, 13, and 25 weeks after baseline. RESULTS: All clinical parameters improved in the test group more than in the control group. In the bacteriologic examination, the total number of bacteria did not change during the examination. In the test group, BPRs were not detected until 13 weeks. However, BPRs were detected in the control group by 13 weeks. CONCLUSION: It was shown that full-mouth SRP using systemically administered azithromycin was a clinically and bacteriologically useful basic periodontal treatment for severe chronic periodontitis.     

Efect of periodontal disease and non surgical periodontal treatment on C-reactive protein. Evaluation of type 1 diabetic patients

Objectives: The purpose of this study was to analyze how anti-infectious periodontal treatment affects C reactive protein (CRP) values in patients with type 1 diabetes, and correlate baseline CRP levels with periodontal disease severity. Study Design: A cohort of fifty three subjects with type 1 diabetes and moderate to severe periodontitis were recruited. Periodontal parameters were measured, and blood samples were obtained to evaluate high-sensitivity C-reactive protein (hs-CRP). Group 1 was treated with scaling, root planning, and systemic administration of doxycycline. Group 2 received only scaling and root planning. Results: Hs-CRP was reduced after periodontal treatment in group 1 (-0.22 mg/l) and 2 (-0.21 mg/l ) but this reduction was not statistically significant, even in the patients with the best response to periodontal treatment. However, significant correlation appeared between hs-CRP and mean probing pocket depth (PPD) (p=0, 01) and mean clinical attachment level (CAL) (p=0,03). Conclusions: Non-surgical periodontal treatment couldn’t reduce hs-CRP values, however, it was found an association between advanced periodontitis and elevated blood hs-CRP levels in patients with type 1 diabetes. It can be speculated that periodontal disease increases production of pro-inflammatory mediators in patients with type 1 diabetes, but other producing sources of these pro-inflammatory substances may exist. Key words:Periodontal disease, periodontitis, diabetes mellitus type 1, periodontal therapy, C reactive protein.     

Locally Delivered 0.5% Azithromycin as an Adjunct to Non‐Surgical Treatment in Patients With Chronic Periodontitis With Type 2 Diabetes: A Randomized Controlled Clinical Trial

Background: Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered azithromycin (AZM; 0.5% concentration) as an adjunct to scaling and root planing (SRP) for treating chronic periodontitis in patients with type 2 diabetes. Methods: A total of 63 patients were categorized into two treatment groups: 1) group 1: SRP + placebo gel and 2) group 2: SRP + 0.5% AZM. Clinical parameters were recorded at baseline and 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). Results: Both therapies resulted in significant improvements. Using a patient‐based analysis, patients in group 2 treated with SRP + 0.5% AZM showed enhanced reductions in PI, GI, mSBI, and PD and gains in CAL (P <0.05) over 9 months compared with group 1. Conclusion: Although both treatment strategies seem to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug delivery system enhances the clinical outcome.     

牙周治疗对非胰岛素依赖型糖尿病患者的短期影响

目的　研究非胰岛素依赖型糖尿病牙周病患者牙周常规非手术治疗后 ,牙周状况及糖代谢的改变。方法　选择非胰岛素依赖型糖尿病患者 2 5例 ,进行牙周非手术治疗 ,比较治疗前及治疗后 4周、8周牙周状况 (探诊出血 ,牙周袋深度 )和糖化血红蛋白的水平。结果　患者治疗后 ,牙周探诊出血、探诊深度明显减轻。重度牙周炎患者治疗后 4周、8周糖化血红蛋白的水平降至 9.0 1± 0 .85 %和 8.84± 1.5 2 % ,与治疗前相比差异有显著性。轻中度牙周炎组治疗后 4周糖化血红蛋白略有下降 ,8周时与治疗前相比差异无显著性。结论　非胰岛素依赖型糖尿病患者牙周炎症控制短期内使糖代谢水平得到一定改善 ,但远期影响尚不肯定 ,有待进一步研究