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郭忠军, 李瑞春, 韩凤琴, 陈芳. 单纯牙周翻瓣术和牙周翻瓣术前行牙周非手术治疗对重度牙周炎的疗效比较[J]. 武警医学, 2017,28(7): 683-685
GUO Zhongjun, LI Ruichun, HAN Fengqin, CHEN Fang. Comparative study of effect of periodontal flap surgery and caling and root planning before periodontal flap surgery on severe periodontitis[J]. Medical Journal of the Chinese People's Armed Police Forces, 2017,28(7): 683-685  

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单纯牙周翻瓣术和牙周翻瓣术前行牙周非手术治疗对重度牙周炎的疗效比较
郭忠军1, 李瑞春1, 韩凤琴1, 陈芳2
1. 714000, 渭南市中心医院口腔科
2. 710032 西安,第四军医大学口腔医学院牙周黏膜科
通讯作者:陈芳,E-mail:42640291@qq.com

作者简介:郭忠军,硕士,主治医师。

收稿日期: 2016-11-08
摘要
目的 比较单纯牙周翻瓣术和牙周翻瓣术前行牙周非手术治疗两种方法治疗重度牙周炎的疗效。方法 本临床试验共纳入了28例重度牙周炎患者,随机分入实验组和对照组(每组14例)。对照组患者直接行改良的牙周翻瓣术;实验组患者接受牙周非手术治疗后行改良的牙周翻瓣术。纳入时及纳入后3、6个月检查并记录所有受试者的牙周探诊出血(bleeding on probing, BOP)、牙周探诊深度(pocket probing depth,PPD)、临床附着水平(clinical attachment lose,CAL)及牙槽骨水平(level of bone,LOB)。采用 t检验及 χ2检验对结果进行比较分析。结果 与纳入时相比,经过牙周治疗后,两组患者的BOP、PPD、 CAL均有显著改善;两组对比,纳入时无明显差异;6个月后进行复查时,实验组的牙周探诊深度的降低显著高于对照组[(4.0±0.23)mm vs (4.9±0.13)mm, P<0.01],临床附着水平的改善也优于对照组[(5.6±0.30)mm vs (5.5±0.29) mm, P<0.01]。结论 牙周翻瓣术前对重度牙周炎患者行牙周非手术治疗可以在一定程度上提高牙周手术治疗的效果。
关键词: 重度牙周炎; 牙周翻瓣术; 临床附着水平
中图分类号:R781.4
Comparative study of effect of periodontal flap surgery and caling and root planning before periodontal flap surgery on severe periodontitis
GUO Zhongjun1, LI Ruichun1, HAN Fengqin1, CHEN Fang2
1. Department of Stomatology, Weinan Central Hospital,Weinan 714000, China
2. Department of Periodontology & Oral Medicine,School of Stomatology, the Fourth Military Medical University, Xi’an 710032, China;
Abstract
Objective To compare the curative effects of periodontal flap surgery alone and periodontal flap surgery combined with periodontal non-surgery treatment for patients with chronic severe periodontitis.Methods Twenty-eight patients participated in this clinical trial and they were randomly allocated into the control group and the test group. The control group was treated with Modified Widman Flap surgery directly while the test group received scaling and root planning before the same surgery. Bleeding on probing (BOP), pocket probing depth (PPD), clinical attachment loss (CAL) and level of bone (LOB) were examined and recorded at baseline and 3, 6 months later. We used t-test and chi-square test to evaluate the difference between the two groups.Results Both therapeutic methods were conducive to patients, for the measurement indicators improved significantly compared with baseline. 6 months after enrollment, the change of PPD [(4.0±0.23) mm vs (4.9±0.13) mm, P<0.01] reduction and CAL[(5.6±0.30) mm vs (5.5±0.29) mm, P<0.01] gain that had occurred in the test group was more obvious than that of the control group, although there was no significant difference between the two groups at baseline.Conclusions Implementation of scaling and root planning before surgery may bring about better results than surgery alone.
Keyword: severe periodontitis; periodontal flap surgery; clinical attachment loss

牙周炎是牙周微生物引发的牙齿支持组织的免疫和炎性状态。牙周组织和免疫系统的相互作用导致慢性炎性、连接组织的破坏及牙槽骨的吸收[1], 牙周炎不仅会造成口腔局部的损害[2, 3, 4, 5], 而且对全身的其他疾病也有影响[6, 7, 8, 9, 10]。治疗牙周炎的原则是清除附着在牙齿及牙周组织的菌斑、牙石、色素等刺激物, 主要包括非手术治疗及手术治疗。牙周非手术治疗主要指口腔健康宣教、口腔卫生指导、洁治术和刮治术[11, 12]; 牙周手术治疗主要是牙周翻瓣术。对于轻中度牙周炎, 牙周非手术治疗一般可以取得较满意的效果[13, 14], 但是对于中重度牙周炎, 则多数不能达到治疗要求[15, 16, 17]。为了克服非手术治疗的局限性, 现多采用直接行翻瓣术的方法治疗重度牙周炎。迄今为止, 关于结合牙周非手术与手术方法治疗牙周炎的效果的研究还比较少, 笔者对比了单纯牙周手术治疗与牙周手术结合牙周非手术治疗后, 重度牙周炎患者的恢复情况, 以期为临床治疗牙周炎提供相关参考。

1 对象与方法
1.1 对象

2015-02至2015-11于陕西省渭南市中心医院口腔科就诊的符合纳入条件的共28例重度牙周炎患者, 在知情同意的情况下加入本研究, 并签署了知情同意书, 所有患者经常规龈上洁治及抛光术后2周, 进行全口牙周相关指数检查, 包括:探诊出血(bleeding on probing, BOP)、探诊深度(pocket probing depth, PPD)、附着水平(clinical attachment lose, CAL)、牙槽骨水平(level of bone, LOB), 符合纳入标准的患者被随机分为实验组和对照组, 每组14例, 实验组为行翻瓣手术前进行了非手术治疗, 对照组为仅进行常规翻瓣术。纳入标准:18岁以上; 至少3颗相邻的牙齿患有重度牙周炎(探诊深度≥ 7 mm, 附着丧失≥ 4 mm); 未患影响牙周健康及愈合的系统性疾病; 能进行较好的菌斑控制; 能按照试验要求按时复诊。排除标准为:吸烟; 妊娠期或哺乳期妇女; 过去3个月服用过抗生素或非甾体类抗炎药; 过去两年内接受过牙周系统治疗(包括非手术及手术)。

1.2 治疗方法

所有患者首次就诊时接受详细的全口牙周检查、口腔卫生指导、X线检查及洁治术。牙周检查所包括的指标有:每颗牙齿6个位点(近颊、颊侧正中、远颊、近舌、舌侧正中、远舌)的BOP、PPD、CAL、LOB, 这也是评价及比较牙周治疗术后疗效的主要变量。选取符合条件的相邻3颗牙齿作为治疗区, 对实验组进行龈上下刮治术和根面平整, 对照组行改良的牙周翻瓣术。2个月后对实验组患者的治疗区再评估后实施翻瓣术。患者纳入3个月和6个月后, 再次检查并记录所有受试者的牙周相关指标。

1.3 各指标测量方法

(1)BOP:使用Hu-Friedy 牙周探针进行探诊, 观察15 s后有出血则记为阳性, 计算结果为每颗牙齿平均出血位点数。(2)PPD:龈缘至牙周袋底的距离。(3)CAL:釉牙骨质界至牙周袋底的距离。(4)LOB:釉牙骨质界至牙槽嵴顶的距离。

1.4 统计学处理

运用SPSS 19.0 统计软件对试验数据进行统计分析。使用两样本t检验或配对样本t检验比较。两样本率的比较运用χ 2检验的方法。P< 0.05为差异有统计学意义。

2 结 果

实验组与对照组所纳入患者的年龄、性别组成及治疗前的牙周主要指标相近, 差异无统计学意义(表1)。

表1 两组重度牙周炎患者人口学特征和治疗前牙周状况比较(n=14; x̅± s)

表2显示了受试者纳入3个月和6个月时牙周主要指标与治疗前的对比情况。结果显示, 经过治疗后, 无论实验组还是对照组, 牙周状况都有显著改善, 表现为探诊出血位点变低、探诊深度减少、临床附着水平增加(因牙槽骨水平在整个实验阶段未发生显著变化, 其相关数据并未在本文列出), 且实验组牙周状况好于对照组。

表2 两组重度牙周炎患者治疗后3个月、6个月BOP、PPD、CAL的变化(n=14; x̅± s)
3 讨 论

本试验主要比较了单纯牙周手术治疗与牙周手术结合牙周非手术治疗后, 重度牙周炎患者的平均BOP位点数、PPD、CAL、LOB的变化情况, 发现除牙槽骨水平外, 两种方法治疗后都可以一定程度上使相关临床指标得到明显的改善, 但是后者更加显著。治疗前, 各指标虽然无统计学差异, 但是实验组的PPD、CAL的平均值高于对照组, 因此两种治疗方法所产生的差异可能更加明显。在此研究中, 实验组的患者取得更满意的治疗效果, 其中部分原因可能是该组患者在接受牙周基础治疗的过程中得到了更加频繁的口腔卫生指导和维护, 但这种因素所起的作用有多大, 现在还无从得知。以往有一些研究对比了单纯牙周非手术治疗与牙周手术治疗的疗效, 发现牙周手术治疗更有利于重度牙周炎患者的病情控制[18]。考虑到牙周基础治疗的局限性, 当重度牙周炎患者前来就诊时, 口腔医生可能更倾向于做出直接行牙周手术的治疗建议, 但是本文所得到的试验结果值得临床医师的思考, 如果两种方式相结合更有利于治疗牙周炎, 那么在行牙周手术治疗前行牙周非手术治疗未尝不可, 且可能有一部分位点经基础治疗后症状明显改善而不需后续的手术治疗, 从而避免相关并发症。

在此项研究中, 3个月、6个月后进行的两组间比较和治疗后与治疗前的比较都未发现牙槽骨水平有显著变化, 可能是由于观察时间较短的缘故, 这也说明牙周治疗更易达到软组织的恢复, 而对于骨组织的再生并未取得令人满意的效果。加之本研究所纳入样本较少, 因此本试验的结果尚需更大样本、更长时间观察期和计划更加详尽的研究来验证。另外, 牙周炎是由多种口腔细菌引起的牙周组织破坏[19, 20, 21, 22], 因此笔者建议后续研究可以将牙周微生物的变化考虑在内。

The authors have declared that no competing interests exist.

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