A clinical evaluation of periodontal treatment effect using periodontal endoscope for patients with periodontitis: a split-mouth controlled study

目的 探索应用牙周内镜辅助龈下刮治及根面平整术进行牙周炎基础治疗,评估牙周内镜技术对临床治疗效果的影响.方法 收集2015年2月至2016年2月北京大学口腔医学院·口腔医院综合二科门诊的中重度牙周炎患者11例,共58对双侧同名牙(受试牙均须满足至少1个位点探诊深度≥6 mm、附着丧失≥3 mm),采用分口自身对照设计,按照随机数字表法,一侧行内镜辅助龈下刮治与根面平整术(scaling and root planing,SRP)(内镜组),另一侧行传统的SRP(SRP组).以超声洁治后1周为基线,基线时与术后6周、术后3个月分别测量菌斑指数、出血指数、探诊深度和附着丧失,比较两种方法治疗前后各项牙周指标的变化及两组的差异.结果 共116颗患牙(前牙26颗,后牙90颗)的696个位点纳入临床观察.术后6周和术后3个月时,两组的探诊深度、出血指数和附着丧失均较基线时显著下降(P＜0.001).术后3个月与术后6周相比,仅内镜组在基线探诊深度≥6 mm位点,探诊深度、附着丧失有进一步改善,差异有统计学意义[探诊深度分别为(4.0±1.2)、(4.4±1.3) mm,P＜0.01;附着丧失分别为(3.8±0.9)、(4.1±1.1)mm,P＜0.05].两组临床指标在基线、术后6周以及术后3个月时差异均无统计学意义.对于前牙探诊深度≥6 mm的位点,内镜组术后3个月时探诊深度[(3.2±0.9) mm]显著低于SRP组[(3.7±0.9)mm] (P＜0.05);同时附着丧失[(2.9±1.2)mm]也低于SRP组[(3.6±1.3)mm],但差异无统计学意义(P=0.061).结论 牙周内镜辅助SRP在临床上能取得显著疗效,对深牙周袋的中远期预后,尤其是在前牙的应用上更具优势.Objective To compare the clinical effects of periodontal treatment using periodontal endoscope with that of conventional treatment method for patients with periodontitis.Methods Eleven periodontal patients with moderate to advanced periodontal destruction were recruited and treated with scaling and root planing in a split-mouth design randomly with (test group) or without (control group)periodontal endoscope.Changes of such clinical parameters as plaque index (PLI),bleeding index (BI),probing depth (PD) and attachment loss (AL) before and after treatments as well as the difference between test and control groups were examined and compared.Results Both groups showed significant reductions in PD,BI and AL values at 6 weeks and 3 months after treatment (P ＜ 0.001).Only in the test group,for sites with PD≥6 mm at baseline,PD value ([4.0±1.2] mm) and AL value ([3.8±0.9] mm) at the end of 3 months were significantly lower than that at the end of 6 weeks (PD[4.4± 1.3] mm,P ＜ 0.00 I;AL[4.1± 1.1] mm,P ＜0.05).There were no significant differences between two groups at the baseline,at the end of 6 weeks and 3 months,respectively.However,for the sites with PD≥6 mm in anterior teeth,PD value in test group at the end of 3 months was significantly lower than that in control group ([3.2±0.9] mm vs [3.7±0.9] mm,P ＜ 0.05),while AL value tend to be lower ([2.9± 1.2] mm vs [3.6± 1.3] mm,P=0.061).Conclusions Periodontal treatment using endoscope is obviously effective,especially for the medium and long term prognosis of deep pockets and single rooted teeth.北京大学口腔医院临床新技术新疗法项目PKUSSNCT-14B05; 北京大学口腔医学院青年科研基金PKUSS20150202中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)12722-7275