内窥镜辅助牙周微创非手术治疗深骨下袋的2年愈合趋势分析

杨智宇; 王金孟; 雷浪; 李厚轩

doi:10.12016/j.issn.2096-1456.2024.05.004

口腔疾病防治 ›› 2024, Vol. 32 ›› Issue (5) : 350 -358. DOI: 10.12016/j.issn.2096-1456.2024.05.004

临床研究

内窥镜辅助牙周微创非手术治疗深骨下袋的2年愈合趋势分析

杨智宇, 王金孟, 雷浪, 李厚轩

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Two-year follow-up of the outcomes of endoscope-assisted minimally invasive nonsurgical periodontal therapy for deep intrabony defects

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摘要

目的探讨内窥镜辅助的牙周微创非手术治疗（minimally-invasive non-surgical periodontal therapy，MINST）对深骨下袋的临床治疗效果、影像学变化，并将其与传统刮治和根面平整（scaling and root planning，SRP）的效果对比，为牙周临床治疗提供参考。方法本研究获医院伦理委员会审批。回顾骨下袋 ≥ 4 mm的牙周病患者资料，分为经内窥镜辅助的MINST组（20例，81个位点）和传统SRP组（20例，80个位点）；比较治疗前（T0）、治疗后12个月（T1）、治疗后24个月（T2）的探诊深度（probing depth，PD）、临床附着丧失（clinical attachment loss，CAL）的临床指标，并分析影像学骨下袋缺损高度、角度的变化；初次治疗后12个月内每3个月进行随访和维护治疗，治疗后12至24个月内每6个月进行随访和维护治疗。结果 MINST组病人组内比较：PD、CAL随治疗后时间持续减小（P<0.001），且影像学检查显示骨下袋缺损高度减小（P<0.001），骨下袋变浅；骨缺损角度随治疗后时间增大（P<0.001），前12个月的高度减小和角度增大变化大于后12个月（P<0.001）。SRP组病人组内比较结果与MINST组相同。治疗后12个月和24个月，MINST组PD和CAL均小于SRP组（P<0.001）；MINST组缺损高度恢复量大于SRP组（P<0.001），MINST组缺损角度增加大于SRP组（P<0.001）。结论牙周微创非手术治疗能明显促进深骨下袋愈合及牙槽骨的再生，影像学反映的牙槽骨愈合具有先快后慢的特点，内窥镜辅助的MINST相对于传统SRP可以获得更好的骨下袋临床指标和影像学变化。

Abstract

Objective To explore the clinical efficacy and imaging changes of minimally invasive nonsurgical periodontal therapy (MINST) assisted by endoscopy for deep intrabony defects and to compare its effectiveness with that of traditional scaling and root planning (SRP) to therefore provide a reference for clinical periodontal treatment. Methods Patients with deep intrabony defects ≥ 4 mm in size were selected and divided into two groups: the MINST (MINST, 20 cases, 81 sites) group and the classic scaling and root planing (SRP, 20 cases, 80 sites) group. Before treatment and 12 and 24 months after treatment, probing depth (PD) and clinical attachment loss (CAL) were examined. Moreover, changes in the depth and angle of the intrabony defects were analyzed. Follow-up examination and maintenance treatment should be conducted every 3 months for 12 months after the initial treatment and every 6 months thereafter until 24 months. Results The PD and CAL of patients in both groups continued to decrease (P<0.001), and imaging examinations revealed a decrease in defect depth and an increase in intrabony defect angle (P<0.001). The changes in the first 12 months were significantly greater than those in the last 12 months in both groups (P<0.001). The decreases in PD, CAL, and depth of intrabony defects and increase in angle in the MINST group were significantly greater than those in the SRP group (P<0.001). At 12 and 24 months after treatment, the PD and CAL in the MINST group were lower than those in the SRP group (P<0.001). The defect height of the MINST group decreased more than that of the SRP group (P<0.001), and the defect angle of the MINST group increased more than that of the SRP group (P<0.001). Conclusion Minimally invasive nonsurgical periodontal therapy can significantly promote the healing of deep intrabony defects and the regeneration of alveolar bone. Imaging reflects that alveolar bone healing is rapid at first and then slows. Compared with traditional SRP, endoscopically assisted MINST can yield better clinical indicators and imaging changes in intrabony defects.