龈下超声器械的现状和进展

龈下超声器械的发展使超声治疗器械在牙周基础治疗中的重心由龈上逐渐转向牙周袋内壁和深层裸露根面等龈下组织结构。相对于传统的手用刮治器械而言，龈下超声器械在工作效率方面具有突出优势。其工作尖外形、使用材料不断得到改进，清创方式逐渐优化，某些龈下超声器械甚至配备了专门的冲洗或探测系统，对提高龈下刮治的效果产生了积极的影响。但在龈下超声治疗开展过程中，也存在着根面物质额外损失、龈下根面特殊解剖部位清创效率不明确等问题。本文谨以近年来有关龈下超声器械的使用、改进和发展趋势等发表的一些文献，对龈下超声器械使用现状及可能的发展方向进行综述，以期探讨在牙周基础治疗中普遍应用龈下超声器械的前景。     

超声龈下刮治对根面影响的扫描电镜研究

目的 研究不同功率超声龈下刮治对根面的影响。方法 选择因重度牙周炎需拔除的患牙12颗，随机分成小功率超声刮治组、大功率超声刮治组、手工刮治组及病变对照组四个组，每组3颗。记录刮治时间，扫描电镜观察各组标本的菌斑、牙石残留及损伤情况。结果 大功率超声刮治效率最高、最省时，小功率次之，手工刮治最慢；大功率超声刮治对根面损伤最大，小功率超声刮治损伤轻微，手工刮治损伤最小。结论 超声龈下刮治能有效地去除根面的菌斑、牙石，且省时、省力，但功率不宜过大。     

超声结合手用器械进行龈下刮治效果的扫描电镜观察

目的:超声龈下刮治结合手工刮治,用扫描电镜的方法观察效果.方法:选6名慢性牙周炎病人共8个单根牙,分为4组:超声龈下刮治组、手工刮治组、超声结合手工刮治组和不做处理的对照组,每组2个牙.用扫描电镜观察各组根面的菌斑、残留物及光滑程度.结果:超声结合手工刮治组根面光滑,无菌斑,无堆积物,效果最好.结论:建议超声刮治后使用手工器械,以求制造一个更加平整的根面,得到最佳的临床效果.     

高压氧结合龈上下洁治治疗牙周炎的疗效观察

目的：探讨高压氧(HBO)结合龈上下洁治对牙周炎的治疗效果。方法：将牙周炎患者随机分为3组：龈上下洁治治疗组、HBO治疗组、HBO结合龈上下洁治治疗组，比较3种疗法治疗前后牙周炎各临床参数及龈沟液中天冬氨酸转氨酶(GCF—AST)水平的变化。结果：3种疗法对牙周炎均有不同程度的疗效，以HBO结合龈上下洁治对牙周炎的治疗效果最好。结论：HBO结合龈上下洁治对牙周炎有协同治疗作用。     

内窥镜辅助下超声龈下刮治和根面平整术对牙根表面的影响

目的 评价牙周内窥镜辅助下超声龈下刮治和根面平整术(subgingival scaling and root planing,SRP)后根面牙结石残留量和牙骨质保存情况.方法 选取在南京大学医学院附属口腔医院牙周病科因重度牙周炎需拔除的患牙12颗,随机分为3组,每组4颗:①内窥镜辅助下超声SRP组:在牙周内窥镜辅助下配...     

2种超声器械龈下刮治的效果评价及扫描电镜观察

目的：比较0dontogain和Prophy Max超声治疗仪在牙周龈下刮治治疗中的效果,并对刮治后的牙根进行扫描电镜观察.方法：选取20例慢性牙周病患者,采用半口对照,随机分为A组（0dontogain组）和B组（Prophy Max组）,每组6个患牙.按照分组,分别对受试牙进行超声龈下刮治术.在龈下刮治术前,术后1个月、2个月分别检查观察牙的各项临床指标（BOP、PD、CAL）,同时记录2组的操作时间.选择10个离体单根牙,随机分为A组和B组,分别用Odontogain和Prophv Max超声仪进行刮治,记录每颗牙的操作时间,并对刮治后的离体牙根作扫描电镜观察.实验结果采用SAS6.12软件包进行分析.结果：A组和B组在龈下刮治术后1个月和2个月,各项牙周临床指标均有明显改善（P＜0.01）,A组的改善稍优于B组,但无显著性差异（P＞0.05）.在临床及离体牙的操作时间上,A组明显优于B组（P＜0.01）.扫描电镜显示,离体牙经刮治后,2组的牙根邻面均较光滑,且A组残留的牙石较少.结论：2种超声治疗仪在牙周治疗中都能达到较好的治疗效果,Odontogain超声治疗仪更快捷、高效.     

显微镜下与直视下超声洁治的根面情况比较研究

目的:观察比较在显微镜下与直视下超声洁治后的离体牙的根面情况。方法:选择因重度牙周炎拔除的患牙10颗,每颗牙随机一面在显微镜下进行超声洁治,另一面在直视下超声洁治,然后用亚甲蓝染色分析。选择因重度牙周炎拔除的单根牙6颗及因正畸拔除的单根牙2颗,随机分成显微镜组,直视组,未处理组和正畸牙组,于扫描电镜下观察。结果:直视组和显微镜组结石残留差异具有显著性(P<0.05),显微镜下结石去除效果较好。结论:显微镜有助于提高超声洁治的清洁效果。     

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）。     

PR-ZH1磁致伸缩牙科综合治疗仪的研制与临床应用

目的:基于磁致伸缩原理研制一种多功能牙科综合治疗仪,为临床牙周、根管治疗提供新的超声治疗选择。方法:基于磁致伸缩基本原理,从设计思路、技术加工和技术参数等方面对磁致伸缩式多功能牙科综合治疗仪进行研制和功能完善,然后结合临床应用对其满足牙周洁治、龈下刮治、根面平整及根管超声荡洗等多方面的功能进行评价。结果:研制成功磁致伸缩牙科综合治疗仪,仪器工作性能稳定,具有牙周洁治、龈下刮治及超声根管荡洗等多种功能。结论:PR-ZH1磁致伸缩牙科综合治疗仪功能多、用途广,工作性能优异,值得在临床根管治疗及牙周基础治疗中推广应用。     

龈下清创术与根面平整术

自20世纪70年代起,为了清除“病变牙骨质”,需专用手工器械完成的根面平整术成为牙周炎非手术治疗的核心内容。随后部分有关根面内毒素的研究认为没有必要使用根面平整术过度去除牙骨质,主张“龈下清创术”。目前规范化牙周治疗的主流观点仍强调在龈下清创后使用手工器械处理牙根表面作为去除病因的重要程序,从而使根面具有生物相容性。既往有关根面平整术的研究主要是对比单纯超声龈下清创术和单纯手工龈下刮治及根面平整术,缺乏超声龈下清创术与超声龈下清创联合手工根面平整术的对比研究。本文综述以往关于龈下清创术和根面平整术的相关研究,为临床医生治疗方案选择提供指导,同时也为将来开展相关的临床研究提供参考。     

A comparison of root surface instrumentation using two piezoelectric ultrasonic scalers and a hand scaler in vivo

BACKGROUND AND OBJECTIVE: This study compared the effectiveness of two piezoelectric ultrasonic scalers and a hand scaler for subgingival scaling and root planing in vivo. MATERIAL AND METHODS: Fifteen patients with advanced periodontal disease and with teeth scheduled for extraction were selected for this study. Three experimental groups of 10 teeth each were treated with one of two piezoelectric ultrasonic scalers [Vector scaler and Enac scaler] or with a hand scaler. Instrumentation was continued until the root surface felt hard and smooth to an explorer tip. The root surface characteristics after instrumentation were examined using scanning electron microscopy, and the amount of remaining calculus, roughness and loss of tooth substance were estimated using the remaining calculus index and roughness loss of tooth substance index. RESULTS: The remaining calculus index did not differ significantly among the three groups. The roughness loss of tooth substance index was significantly lower for the Vector scaler and Enac scaler groups than for the hand scaler group and also differed significantly between the Vector scaler and Enac scaler groups. CONCLUSION: This study suggests that the Vector scaler produces a smooth root surface with minimal loss of tooth substance. It is a reasonable choice for gentle periodontal maintenance treatment.     

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提要：龈下刮治和根面平整术是牙周病基础治疗的最重要手段,普遍应用的龈下刮治器械分为手用和超声波两种。常规全口行龈下刮治和根面平整,可分4～6次进行,也可一次性完成。无论是采用手工还是超声波刮治器械进行龈下刮治和根面平整均能明显改善临床症状和微生物学指标,并取得良好疗效。     

A clinical and microbiological comparison of the effects of water and 0.02% chlorhexidine as coolants during ultrasonic scaling and root planing

The maxillary teeth of 10 patients with moderately advanced chronic periodontitis were treated in a split-mouth design study. The baseline examination included plaque and bleeding scores, probing depths and probing attachment levels. 2 sites in each quadrant were selected for dark-field microscopic analysis. Each quadrant was randomly assigned to test or control and instrumented with an ultrasonic scaler using either 0.02% chlorhexidine or water as the coolant. Measurements were repeated 2, 6 and 10 weeks later, together with additional plaque sampling. Ultrasonic instrumentation with either chlorhexidine or water was equally effective in reducing bleeding scores and improving probing attachment levels. 42% of chlorhexidine- and 38.7% of water-treated sites showed gains of 1 mm or more in clinical attachment. Mean reductions in probing depth were similar (0.9 mm chlorhexidine, and 0.8 mm water). At the final examination, the chlorhexidine-treated quadrants had significantly more sites with probing depths in the 1-3 mm category and less in the greater than 3 mm category than the control quadrants (P less than 0.05). Both treatments reduced the microscopic counts of motiles and spirochaetes, resulting in a subgingival microbiota consistent with periodontal health. The results indicate that chlorhexidine has a slight adjunctive effect in the reduction of pocket depth when used as a coolant during ultrasonic root planing for the treatment of chronic periodontitis.     

Bacteriologic status of the root canal after sonic, ultrasonic and hand instrumentation

Abstract The purpose of this study was to assess the bacteriologic status of the root canal after sonic, ultrasonic and hand instrumentation. Root canal infection was induced in 50 single-rooted teeth in young dogs by removing the pulp and filling the canals with dental plaque. After 7 clays the root canals were instrumented under aseptic conditions with conventional hand instruments, a sonic vibratory device or an ultrasonic device. Sterile saline or 2.5% sodium hypochlorite was used as irrigating solution. Following instrumentation a sterile paper point was sealed into the root canals. After 7 d the root canals were reopened under aseptic conditions and the paper points were incubated for the demonstration of bacteria, using pre-reduced thioglycolate culture medium and anaerobic chambers. The results obtained with the different instrumentation techniques and irrigating solutions were compared by means of the Chi-square test. The results indicated that the sonic and ultrasonic devices were not more effective in the elimination of bacteria from the root canal than conventional hand instrumentation. Irrigation with sodium hypochlorite appeared to be more effective than saline in producing bacteria-free root canals; however, this difference was not statistically significant. Thus, it appeared that more than one appointment and the supporting action of an antibacterial medicament between appointments would be necessary to achieve bacteria-free root canals in infected teeth in a predictable manner.     

超声和手工龈下刮治对龈下微生物影响的研究

目的 :比较Perioproline超声龈下刮治和手工龈下刮治对龈下微生物的影响 ,评价Periopro line超声龈下刮治系统的临床疗效和工作效率。方法 :选取慢性成人牙周炎患者 7名 ,共 2 0个左右基本对称牙被纳入研究 ,随机分入实验组 (超声组 )和对照组 (手工组 )。记录治疗时间和治疗前、治疗后 0d、7d和 14d的PD ,BOP值 ,及采集龈下菌斑样本培养鉴定 ,观察比较总菌落形成单位 (CFU)和牙周可疑致病菌检出率及检出量的变化。结果 :两组在治疗后PD、BOP值及龈下菌斑总量 (CFU)和牙周可疑致病菌数量及检出率均显著下降 (P <0 .0 5) ;治疗前后各时段组间均无明显差别 ;超声组的治疗时间明显少于手工组 (P <0 .0 5)。结论 :Perioproline超声龈下刮治和手工龈下刮治均可有效减少龈下微生物的量 ,改善患牙的牙周临床状况 ,且两者间无差异 ,但Perioproline超声龈下刮治明显较手工刮治节省时间     

基于高通量测序技术研究慢性牙周炎患者龈下刮治和根面平整术治疗前后龈下菌群的变化

目的 采用基于16S核糖体DNA(rDNA)的高通量测序技术,分析10例慢性牙周炎患者接受龈下刮治和根面平整术(SRP)治疗前后龈下菌斑多样性及相对丰度的变化,探讨应用微生物群落的构成变化作为牙周炎诊断及预后评估指标的可行性.方法 选择2014年3—9月在首都医科大学附属北京口腔医院牙周科就诊的10例慢性牙周炎患者作为研究对象,在SRP治疗前及治疗后3个月分别在研究对象的同一位点采集龈下菌斑样本,提取样本基因组DNA,采用Illumina Miseq平台测序,分析各组样本从门到种各水平的菌群分布及相对丰度.结果 在门水平上,共检测到16个菌门,有8个门的细菌在牙周龈下菌斑菌群结构中占主要地位(99%);在属水平上,共检测到128个不同菌属,SRP治疗后3个月坦纳菌属(Tannerella)的相对丰度较治疗前明显降低(P<0.05),纤毛菌属(Leptotrichia)和链球菌属(Streptococcus)的相对丰度较治疗前明显上升(P<0.05);在种水平上,6种牙周可疑致病菌被检出,SRP治疗后3个月福赛坦纳菌(Tannerella forsythia)和中间普氏菌(Prevotella intermedia)的相对丰度较治疗前明显减少(P<0.05).结论 慢性牙周炎患者龈下菌群具多样性,SRP治疗前后,牙周可疑致病菌的相对丰度降低,而有益菌的相对丰度升高,SRP治疗可以明显改变龈下菌群构成.