Duraphat对慢性牙周炎患者基础治疗疗效观察和疼痛感受评价

目的:观察Duraphat对慢性牙周炎患者基础治疗疗效观察和疼痛感受评价。方法:选择80例慢性牙周炎维护期的患者,其全口4个象限每个象限至少各有2颗牙齿, 其邻面至少有1位点探诊深度>4 mm,有探诊出血, 根据随机表将4个象限随机分常规牙周基础治疗A组和基础治疗结合DuraphatB组两组。根据牙周探诊深度分为PD≥4 mm和PD>6 mm。常规牙周基础治疗组42例, 基础治疗结合Duraphat组38例。记录基线和治疗后1个月和3个月时,入选位点的牙周探诊深度、临床附着丧失、出血指数及刮治当时的疼痛程度VAS值。比较治疗后与治疗前的差值。结果:牙周探诊深度、临床附着丧失和出血指数在治疗后各组都有明显改善,同时患者在治疗中的疼痛程度涂布Duraphat组较常规组VAS值明显降低。结论:Duraphat可以对不同程度的慢性牙周炎患者基础治疗辅助使用,并可以明显降低病人的疼痛感受。     

Vector治疗仪在慢性牙周炎非手术治疗中的疗效观察

目的：比较Vector治疗仪与Hu—Friedy刮治器在慢性牙周炎非手术治疗中的疗效。方法：临床随机选择68例慢性牙周炎患者,随机分成Vector治疗仪组及Hu—Friedy刮治器组,在基点及治疗6个月后,分别记录：牙周探针出血（BOP）,牙周探诊深度（PD）,临床附着丧失（CAL）。结果：在基点及6个月,各临床参数两组间无统计学差异。结论：Vector治疗仪与传统的手工刮治器在慢性牙周炎非手术治疗短期疗效相似。     

Vector治疗仪与派丽奥联合治疗老年牙周炎的疗效观察

目的:观察Vector治疗仪与派丽奥联合治疗老年牙周炎的临床疗效。方法:选择40例老年牙周病患者,采用自身对照法,选择左右对称病情相近的后牙40颗,先行龈上洁治,一周后行Vector龈下刮治,3%过氧化氢及生理盐水冲洗牙周袋,实验组牙周袋内放置派丽奥凝胶,对照组牙周袋内放置碘甘油,每周一次,共4次。观察基线、用药4周及3月后的菌斑指数(PLI)、龈沟出血指数(SBI)、牙周袋深度(PD)的变化。结果:治疗后4周、3月时各指标均有明显改善(P<0.05),4周时实验组菌斑指数指标改善较对照组明显(P<0.05),龈沟出血指数、牙周袋深度指标两组差异无显著性(P>0.05)。3月时各项观察指标实验组均优于对照组(P<0.05)。结论:派丽奥辅助Vector治疗仪治疗老年牙周炎有很好的临床效果。     

慢性牙周炎维护治疗期临床纵向观察

目的:了解慢性牙周炎维护治疗期临床指标变化规律。方法:对牙周非手术基础治疗后进入维护治疗期的22名慢性牙周炎病人进行9个月的纵向观察。每3个月给予口腔卫生宣教,龈上下洁刮治和根面平整。并在基线和每次复查时记录临床检查指标,包括探诊深度(PD)、临床附着水平(CAL)、探诊出血(BOP)。结果:后牙较前牙更易出现牙周袋加深,>6 mm深袋的比例6个月后显著下降,CAL改善在邻面及舌侧更加明显,BOP比例持续下降。结论:非手术基础治疗配合定期维护,可使临床指标在较短期内获得明显改善。     

慢性牙周炎基础治疗后维护期疗效纵向观察及分析

目的观察慢性牙周炎患者基础治疗后维护期的疗效,并分析牙位和位点因素对牙周袋探诊深度变化的影响。方法对牙周基础治疗后进入维护期的22例慢性牙周炎患者进行9个月的纵向观察。每3个月给予口腔卫生宣教,龈上洁治、龈下刮治和根面平整。在基线(基础治疗完成后)和每次复查时记录牙周袋探诊深度、临床附着丧失和探诊出血情况。结果维护治疗期间,牙周袋探诊深度、临床附着丧失、探诊出血等临床指标均有进一步改善。牙周袋深度前牙减少(0.52±1.02)mm,后牙减少(0.37±1.26)mm,差异有统计学意义(P<0.05);邻面位点与非邻面位点相比,邻面位点的牙周袋深度减少更显著(P<0.05);6 mm及以上的位点牙周袋深度减少(1.88±2.19)mm,4~5 mm的位点牙周袋深度减少(1.12±1.32)mm,差异有统计学意义(P<0.05)。结论慢性牙周炎患者基础治疗后每3个月进行维护治疗,可使牙周临床指标进一步改善,牙位与位点因素均对牙周袋深度的变化有影响。     

患者依从性对慢性牙周炎临床疗效影响的观察

目的：观察不同依从性的慢性牙周炎患者的临床治疗效果。方法：选择经牙周基础治疗4周后进入牙周维护治疗的广泛性中度慢性牙周炎患者150例作为研究对象,通过2年追踪随访、临床检查及再治疗,分析完全依从性与不完全依从性牙周炎患者的第1年、第2年临床指标（PD、AL、BOP）改变。结果：完全依从性组的牙周探诊深度、探诊后出血率在第1、第2年均较基线明显下降,差异有统计学意义（P〈0.001）,附着丧失均值有所下降,差异有统计学意义（P〈0.001）;不完全依从性组牙周探诊深度、探诊后出血率、附着丧失在第1、第2年均值较基线明显增高,达到初诊水平,差异有统计学意义（P〈0.001）;在第1、第2年AL≥1 mm位点百分比及活动性进展率较基线均有提高,差异有统计学意义（P〈0.001）。结论：完全依从性慢性牙周炎患者疗效稳定持久;不完全依从性慢性牙周炎患者疗效较差,活动性发生率较高。     

Vector系统应用于牙周基础治疗的临床研究

目的研究Vector系统进行牙周基础治疗的临床效果。方法采用口内自身对照方法,选择58例慢性牙周炎患者,口内A、D区设为试验组,B、C区设为对照组。所有患者行超声洁治后,试验组应用Vector系统行龈下刮治及根面平整术（scaling and root planning,SRP）,对照组应用Gracey刮治器械行SRP。对2组SRP的治疗时间,SRP前（基线期）及SRP后1、3、6个月的龈沟出血指数、探诊出血、探诊深度及附着水平进行比较,视觉模拟疼痛评级法（visual analogue scale,VAS）评定2组的疼痛程度。结果试验组每区的SRP治疗时间为（25.15±1.35）min,明显短于对照组的（40.11±1.08）min（Z=3.625,P〈0.05）。SRP后各观察时点,2组的各项牙周指数较治疗前均有明显改善（P〈0.05）,但2组间各项牙周指数的差异均无统计学意义（P〉0.05）。试验组SRP结束时（Zc=2.356,P〈0.05）及治疗后1d（Zc=3.138,P〈0.05）的VAS评分明显低于对照组。结论Vector系统能缩短临床操作时间,提高牙周基础治疗舒适度,有效改善慢性牙周炎的临床症状。     

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.     

龈下喷砂应用于慢性牙周炎患者维护治疗的效果评价

目的：评价龈下喷砂应用于慢性牙周炎患者维护治疗的临床效果。方法选择慢性牙周炎维护期患者30例,按照随机、对照、单盲原则,将患牙分为2组,所有患牙均使用AIR-FLOW MASTER PIEZON超声治疗仪治疗。试验组使用AIR-FLOW POWER PERIO砂粉进行龈下喷砂,对照组应用PS工作尖进行超声龈下刮治。记录基线和治疗后3个月时入选位点的菌斑指数、探诊深度、附着丧失、出血指数,用视觉模拟评分法评估两组治疗时的疼痛程度。所得数据用t检验进行统计学分析。结果试验组和对照组菌斑指数、探诊深度、附着丧失和出血指数在治疗后都有明显改善,探诊深度、附着丧失和出血指数两组间差别无统计学意义（ P＞0．05）;患者在治疗中的疼痛程度视觉模拟评分值试验组和对照组分别为2．465±0．446和4．049±0．617,差异有统计学意义（ t＝－8．397,P＜0．05）。结论龈下喷砂治疗在慢性牙周炎维护治疗中能取得与超声龈下刮治同样的疗效,并且更有利于降低治疗中患者的不适感。     

龈下刮治在伴牙周炎口腔扁平苔藓患者治疗中的意义和疗效评估

目的:探讨在伴牙周炎口腔扁平苔藓(oral lichen planus plus periodontitis,OLPP)患者系统性治疗中,是否行龈下刮治对口腔扁平苔藓整体疗效的影响.方法:纳入OLPP患者40例,其中糜烂型(erosive OLPP,EOLPP)与非糜烂型(non-erosive OLPP,NEOLPP...     

两种治疗仪在牙周基础治疗中的临床疗效和患者疼痛感受的比较

目的 比较牙周炎患者对两种超声治疗仪在牙周基础治疗中的临床疗效及患者疼痛感受的差异,以期为临床提供参与.方法 选择38例轻、中度牙周炎患者,对患者口内一、四象限用奇数、偶数随机法选择A(Vector治疗仪,德国D(U)RR齿科公司)或B(Suprasson P5 Newtron(R)超声多功能牙科治疗仪,法国赛特力公司)超声治疗仪进行治疗,第2天对二、三象限使用另一系统进行治疗.治疗结束后即刻用视觉模拟评分法(visual analogue scale,VAS)对患者行疼痛评估.治疗前及治疗后1个月检测菌斑指数(plaque index,PLI)、探诊出血(bleeding on probing,BOP)和探诊深度(probing depth,PD)等各项临床指标.结果 用两种超声系统行牙周基础治疗后,患者PLI、BOP和PD均较术前明显改善(P<0.01);两者BOP和PD的改变差异无统计学意义(P>0.05),与B治疗仪相比,A治疗仪治疗区域的PLI明显改善(P<0.05).A、B治疗仪在牙周基础治疗中患者主观感受疼痛VAS值分别为(22.5±7.5)mm和(37.2±11.3)mm,前者约为后者疼痛值的60%,两者差异有统计学意义(P<0.01).结论 在轻、中度牙周炎牙周基础治疗过程中,A、B两种超声治疗仪均疗效确切,A治疗仪能明显减轻患者在牙周治疗过程中的疼痛感.     

A new ultrasonic device in maintenance therapy: perception of pain and clinical efficacy

BACKGROUND: A recently introduced piezo-driven ultrasonic device (Vector) generates longitudinal oscillations. As a result, the instrument tip moves parallel to the tooth surface. By avoiding vertical oscillations, maintenance treatment with the Vector device should be less painful than treatment with conventional systems. We investigated whether patients perceive treatment with the Vector device as less painful than with a conventional ultrasonic device, and whether the clinical efficacy of the Vector device is comparable with that of the conventional ultrasonic device in maintenance patients. MATERIAL AND METHODS: Thirty-eight maintenance patients with moderate to advanced periodontal disease took part in this prospective, randomized controlled clinical study. Each patients had to have at least two teeth with probing depths of >4 mm. They were treated either with Dentsply (n=22) at a reduced power setting or with the Vector device (n=16). The observation period was 6 months. Probing pocket depth, attachment level, and bleeding upon probing were assessed at six sites on each treated tooth by a blinded investigator Patient were asked to report perceived pain during instrumentation with a visual analog scale immediately after treatment, in the evening of the treatment day, and in the evenings 1 and 2 days after treatment. RESULTS: Bleeding on probing, probing depth, and attachment level improved in both instrumentation groups from baseline to month 6; however, there was no difference between the two instrumentation modalities. The patients perceived treatment with neither instrument as unpleasant, and their perception of pain intensity both during instrumentation and on the following days did not differ. CONCLUSION: In maintenance therapy, clinical efficacy of the vector device is comparable with that of conventional ultrasonic device. It makes no difference whether the ultrasonic device at a reduced power setting or the Vector device is used, since patients perceive both instruments as causing very little pain.     

医学院学生牙周健康维护3年随访调查

目的:观察评估青年人群的牙周病状况,以及干预措施对控制牙周病发展的作用.方法:纳入153名医学院学生,随机分为A组(接受干预措施)和B组(未接受干预措施),随访3a.A组受试者纳入后进行口腔卫生宣教,详细讲解牙刷的选择、刷牙方式,牙线、牙缝刷的使用,同时根据纳入者实际情况给予牙周基础治疗,每隔半年再次进行口腔卫生宣教、牙周维护治疗,加强菌斑控制.比较随访前、后指数牙的菌斑软垢指数(debris index,DI)、牙石指数(calculus index,CI)、探诊深度(probing depth,PD)、临床附着丧失(clinical attachment loss,CAL)、探诊出血(bleeding on probing,BOP)和牙龈指数(gingival index,GI)的变化.采用SAS6.12软件包对数据进行统计学分析.结果:3年后,实验组的CI、DI评分和基线相比显著下降(P＜0.01),对照组和基线相比无显著差异(P＞0.05).实验组和对照组之间PD、BOP、GI变化有显著差异(P＜0.01),CAL的变化也有显著差异(P＜0.05),对照组CAL的增加显著高于实验组.结论:定期牙周健康维护及口腔卫生教育对人群牙周健康水平有积极影响.     

An evaluation of basic periodontal therapy using sonic and ultrasonic sealers

10 adult patients with periodontitis were treated with oral hygiene instruction and a single episode of supra- and subgingival debridement using either a sonic or an ultrasonic instrument in a split-mouth design. The clinical response was evaluated by measurements of dental plaque, bleeding on probing, probing depths, and probing attachment levels taken at baseline and every 3rd month for 12 months. An improvement of periodontal conditions was observed during the initial 3-6 month period followed by a stabilization of parameters. No difference in clinical response could be observed between sites treated with the sonic or ultrasonic instruments.     

The significance of maintenance care in the treatment of periodontal disease

Abstract The present investigation was performed to assess the efficacy of a maintenance care program to prevent recurrence of disease in patients subjected to treatment of advanced periodontitis. In addition, the periodontal status was monitored of a group of patients who following the end of active treatment were referred back to genera] practitioners for maintenance care. The material consisted of 90 patients who in 1972 were referred for specialist treatment of advanced periodontal disease. The patients were first subjected to an initial examination including assessment of oral hygiene, gingivitis, probing depths and attachment levels. They were on an individual basis given case presentation, instructed how to practice proper tooth-cleaning methods, their teeth were scaled and eventually the periodontal pockets were treated using the modified Widman technique. During the first 2 months following surgery the patients were recalled once every 2 weeks for professional tooth cleaning. Two months after the end of surgical treatment, the patients were reexamined to provide baseline data. Every third patient was thereafter referred back to the general dentist for maintenance care. Two out of three patients were maintained in a carefully designed and controlled maintenance care program at the university clinic. This program involved recalls once every 2–3 months and included instruction and practice in oral hygiene, meticulous scaling and professional tooth cleaning. The patients were reexamined 3 and 6 years after the baseline examination. The results demonstrated that in patients suffering from destructive periodontitis, a treatment program that involved oral hygiene instruction, scaling, root planing and modified Widman flap procedures resulted in the establishment of clinically healthy gingiva and shallow pockets. Patients who were placed on a carefully designed recall program were over a 6-year period able to maintain excellent oral hygiene standards and unaltered attachment levels. In contrast patients who subsequent to active treatment were not maintained in a supervised program showed obvious signs of recurrent periodontitis at the follow-up examinations.     

Survival analysis of periodontal sites before and after periodontal therapy

Periodontal diseases appear to progress with bursts of destructive activity at individual sites. One effect of treatment might be to diminish the frequency of such bursts. Survival analysis was employed to seek such effects on the periodontal sites of 16 individuals with prior evidence of destructive periodontal disease. The subjects were monitored at bi-monthly intervals and actively breaking down sites were detected using attachment level measurements and the tolerance method of analysis. When active sites were detected, control sites of equal pocket depth and attachment loss were selected and microbiological and immunological samples were taken. The subjects were treated by modified Widman flap surgery and systemically administered tetracycline. On completion of therapy, bi-monthly monitoring was reinstituted. Life tables were constructed for periodontal sites in each of the 16 subjects prior to and after therapy. A site losing more than 3 mm of attachment at any time interval was considered to have relapsed or "died". Survivor functions were calculated for each time period indicating the % of sites which survived at any time. The subjects were divided into 3 categories on the basis of post-therapy survivor functions. The annual hazard rate in 9 good treatment response subjects (group 1) was reduced from 0.10/year to 0.01/year. The hazard rate of 5 intermediate treatment response subjects (group 2A) was reduced from 0.16/year to 0.04/year and that of 2 poor treatment response subjects (group 2B) from 0.15/year to 0.07/year. Group 2A and 2B individuals were combined and differences were sought in clinical, microbiological and immunological parameters between the good and poor treatment response groups. 5 out of 7 of the poor responding individuals showed elevated humoral antibody responses to 3 or more gram-negative subgingival species tested. Many of the elevated responses in this group were to organisms which are widely distributed and return quickly after therapy such as Fusobacterium nucleatum, Eikenella corrodens, Bacteroides intermedius and Capnocytophaga sputigena. The predominant cultivable microbiota in subgingival samples taken prior to therapy from the good responding group had significantly greater proportions of Actinobacillus actinomycetemcomitans, C. ochracea and B. intermedius than the poor responding group. The latter group showed significantly elevated proportions of F. nucleatum, Peptostreptococcus micros and Streptococcus intermedius.     

牙周维护治疗的重要性

牙周病是由菌斑微生物所引起的牙周支持组织慢性感染性疾病。菌斑微生物的控制是牙周病重要的治疗手段。由于口腔环境及牙周组织结构的特殊性,牙周系统治疗无法一劳永逸,是一个长期的过程。因此,牙周维护治疗应贯穿整个治疗过程,是牙周系统治疗中必不可少的组成部分,也是牙周疗效得以长期保持的重要手段。文章就牙周系统治疗中牙周维护治疗的重要性做一综述。     

Effect of the simulated periodontal ligament on cast post-and-core removal using an ultrasonic device

Objective

The aim of this study was to evaluate the effect of simulated periodontal ligament (SPDL) on custom cast dowel and core removal by ultrasonic vibration.

Material and Methods

Thirty-two human maxillary canines were included in resin cylinders with or without SPDL made from polyether impression material. In order to allow tensile testing, the roots included in resin cylinders with SPDL were fixed to cylinders with two stainless steel wires. Post-holes were prepared by standardizing the length at 8 mm and root canal impressions were made with self-cured resin acrylic. Cast dowel and core sets were fabricated and luted with Panavia F resin cement. Half of the samples were submitted to ultrasonic vibration before the tensile test. Data were analyzed statistically by two-way ANOVA and Tukey''s post-hoc tests (p<0.05).

Results

The ultrasonic vibration reduced the tensile strength of the samples directly included in resin cylinders. There was no difference between the values, whether or not ultrasonic vibration was used, when the PDL was simulated. However, the presence of SPDL affected the tensile strength values even when no ultrasonic vibration was applied.

Conclusion

Simulation of PDL has an effect on both ultrasonic vibration and tensile testing.     

Pain levels in patients during periodontal probing and mechanical non-surgical therapy

The purpose of this study was to assess the degree of pain during periodontal probing and mechanical non-surgical therapy according to age, gender, and intersubject variation such as tooth type, tooth surfaces or regions of mouth, probing depth, and bleeding on probing. The study was carried out on 64 patients with chronic periodontitis. Pain/discomfort of patients during both periodontal probing and scaling and root planing (SRP) was measured using a visual analog scale (VAS). During periodontal probing and SRP, VAS scores decreased with increasing age for two procedures (Spearman ρ, −0.301 and −0.348, respectively; P < 0.01). VAS scores were considerably lower for oral sites than for facial sites. VAS scores in probing were significantly higher in sites ≥4 mm deep than sites <4 mm deep. Sites bleeding on probing had a significantly higher VAS scores than sites no bleeding on probing (p < 0.05). The results showed that although there is no difference between genders, the intensity of pain during periodontal probing and SRP was different dramatically between patients as well as vary between different locations in the same mouth. If pain responses for probing in different several regions in the same mouth during initial examination were noted into patient chart used for initial examination, the therapist will recognize patients with elevated pain responses. If need be, they will then apply some pain control medication or anesthetic for patients during probing and SRP.     

Variation in tobacco use profiles obtained from periodontal maintenance patients

OBJECTIVES: To compare methods of tobacco use profiling in patients undergoing maintenance treatment for periodontitis. METHODS: The smoking status of 108 subjects attending a university-based specialist periodontics clinic was assessed by examination of referring records, patient-completed questionnaires, clinician-administered interviews and by salivary cotinine and expired-air carbon monoxide (ECO) measurement. RESULTS: Ten percent of the detected smokers (salivary cotinine>14.2ngml(-1)) reported to be non-smokers in the clinician-administered interview. 4.2% of the smokers detected by ECO analysis (ECO>8ppm) reported to be non-smokers in the clinician-administered interview. Systematic under reporting of tobacco use was also apparent in patient-completed questionnaires from the periodontics clinic and, to a larger degree, in the referring clinic records when compared to the clinician-administered interview. CONCLUSIONS: By biochemically analyzing recent cigarette smoke exposure, our data show that clinician assessment is the most accurate means by which to obtain anamnestic data concerning tobacco use. ECO analysis using portable CO monitors is inexpensive and simple with no requirement for laboratory support. The combination of ECO measurement and clinician-administered tobacco use interview represents a clinically applicable method to improve the detection of an important, periodontally susceptible population-regular smokers who deny smoking.