摘要：
目的·观察Er,Cr:YSGG激光辅助龈下刮治对重度牙周炎患者的短期临床疗效.方法·纳入46例重度牙周炎患者,龈上洁治后2周行基线检查,并将患者随机分为试验组和对照组,每组23例.超声龈下刮治后,分别采用Er,Cr:YSGG激光和手工龈下刮治器对患者探诊深度(probing depth,PD)≥5 mm的位点行牙周袋内清创.比较2组患者在基线、治疗后6周和治疗后3个月的菌斑指数(plaque index,PLI)、PD、临床附着水平(clinical attachment level,CAL)和探诊出血(bleeding on probing,BOP)阳性率的变化,并采用视觉模拟评分(visual analogue scale,VAS)比较患者在治疗过程中的主观疼痛程度.结果·PD≥5 mm的位点,组内比较结果显示,2组患者于治疗后6周和治疗后3个月的PLI、PD、CAL以及BOP阳性率均较基线时明显降低,且差异具有统计学意义(均P=0.000).5 mm≤PD≤6 mm的位点,与对照组相比,试验组患者治疗后6周的CAL有所下降,且差异具有统计学意义(P=0.036).PD≥7 mm的位点,与对照组相比,试验组患者治疗后6周和治疗后3个月的PD均显著降低(P=0.002,P=0.039),患者的治疗后6周PD与其基线时水平间的下降程度也较为明显(P=0.015),且试验组患者治疗后6周的CAL也较低(P=0.011).在治疗过程中,试验组患者的VAS较对照组有所下降(P=0.005).结论·Er,Cr:YSGG激光辅助龈下刮治可达到与传统手工龈下刮治器相似的短期临床疗效,对于深牙周袋的PD降低和CAL获得等疗效更为明显,且患者体验更为舒适.Er,Cr:YSGG激光辅助龈下刮治可作为牙周非手术治疗的一种有效方法.%Objective · To observe the short-term clinical efficacy of adjunctive Er, Cr:YSGG laser application following subgingival scaling in patients with severe periodontitis. Methods · In this parallel control design clinical trial, 46 patients with severe periodontitis were selected. Baseline examination was performed 2 weeks after supragingival scaling. Then the patients were randomly divided into the test group and the control group, with 23 cases in each group. After ultrasonic subgingival scaling, sites with probing depth (PD) ≥5 mm of patients in two groups received subgingival debridement with Er, Cr:YSGG laser and hand curettes, receptively. The changes in plaque index (PLI), PD, clinical attachment level (CAL), the percentage of bleeding on probing (BOP) positive sites, and the degree of subjective pain during treatment with visual analogue scale (VAS) were compared between two groups at baseline, 6 weeks after treatment, and 3 months after treatment. Results · For sites with PD≥5 mm, PLI, PD, CAL, and the percentage of BOP positive sites significantly reduced for both groups at 6 weeks and 3 months after treatment compared with baseline (all P=0.000). For sites with 5 mm ≤ PD ≤ 6 mm, the CAL of the test group was significantly lower compared with the control group at 6 weeks after treatment (P=0.036). For sites with PD ≥ 7 mm, the PDs of the test group were significantly lower compared with the control group at 6 weeks and 3 months after treatment (P=0.002, P=0.039). The PD reduction between baseline and 6 weeks after treatment was greater in the test group compared with the control group (P=0.015). The CAL of the test group was lower compared with the control group at 6 weeks after treatment (P=0.011). The VAS of the test group was significantly lower than that of the control group (P=0.005). Conclusion · Adjunctive Er, Cr:YSGG laser application following subgingival scaling can achieve similar short-term clinical efficacy compared with traditional hand curettes. Er, Cr:YSGG laser may be beneficial particularly on the reduction of PD and regain of CAL in deep pockets on a short-term basis, which can make the patients more comfortable. Subgingival scaling with adjunctive Er, Cr:YSGG laser application can be an effective way for the non-surgical periodontal therapy.
