激光辅助伴2型糖尿病牙周炎非手术治疗的疗效评价

doi:10.13591/j.cnki.kqyx.2024.03.001

口腔医学 ›› 2024, Vol. 44 ›› Issue (3): 161-167.doi: 10.13591/j.cnki.kqyx.2024.03.001

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激光辅助伴2型糖尿病牙周炎非手术治疗的疗效评价

肖诗梦,刘翼,李茂雪,丁一()

口腔疾病防治全国重点实验室,国家口腔医学中心,国家口腔疾病临床医学研究中心,四川大学华西口腔医院牙周科,四川成都(610041)

收稿日期:2024-01-15 出版日期:2024-03-28 发布日期:2024-03-20
通讯作者: 丁一 E-mail:yiding2000@126.com
作者简介:丁一,四川大学华西口腔医学院牙周科教授、主任医师,博士生导师。现任中华口腔医学会牙周病学专业委员会副主任委员,中华口腔医学会口腔激光医学专业委员会候任主任委员,国际牙医师学院专家组成员(ICD fellow),香港大学牙学院和美国加州大学牙学院(UCSF)访问学者。
长期从事各型牙周疾病的规范化治疗,临床经验丰富,擅长重度牙周炎、伴全身疾病牙周炎、牙周-牙髓联合病变、种植体周围炎的系统治疗、激光微创牙周治疗等,主编、参编《牙周病诊疗与操作常规》,卫生部规划教材《口腔临床药物学》(第3、4版),《牙周病就医指南》等多部专著的编写工作,主译专著《种植体周围炎》。主持和完成国家级和部省级科研项目9项,获省级科技进步二等奖1项,在国内外期刊上发表学术论文近200篇,培养博士、硕士研究生70余名。
基金资助:
国家自然科学基金青年科学基金(52203179)

Evaluation of the efficacy of laser-assisted non-surgical treatment of periodontitis with type 2 diabetes mellitus

XIAO Shimeng,LIU Yi,LI Maoxue,DING Yi()

State Key Laboratory of Oral Diseases, National Center for Stomatology & National Clinical Research Center for Oral Diseases, Department of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2024-01-15 Online:2024-03-28 Published:2024-03-20

摘要/Abstract

摘要：

牙周炎与2型糖尿病是一组具有共同危险因素的慢性炎性破坏性疾病,具有明确的双向影响关系。对伴2型糖尿病牙周炎患者的牙周治疗常存在一定的感染风险。激光辅助牙周非手术治疗能够减少细菌积累、减轻局部炎症,有利于伴2型糖尿病牙周炎患者的炎症消退与组织修复,还可能辅助控制血糖指标。该文就当前国内外的激光辅助治疗伴2型糖尿病牙周炎患者的临床研究进行总结评价,以分析激光辅助治疗对伴2型糖尿病牙周炎患者的额外增益,并探讨其潜在机制,旨在为激光辅助临床诊疗提供依据。

关键词: 激光治疗, 牙周炎, 糖尿病, 牙周非手术治疗

Abstract:

Periodontitis and type 2 diabetes mellitus are chronic inflammatory destructive diseases with common risk factors, and there is a clear mutual relationship between them. There is a certain risk of infection in the periodontal treatment of periodontitis patients with type 2 diabetes mellitus. Laser-assisted non-surgical periodontal treatment can reduce bacterial accumulation and local inflammation, which is beneficial to the resolution of inflammation and tissue repair in periodontitis patients with type 2 diabetes mellitus, and may also assist in the control of blood glucose. This article summarizes and evaluates the current clinical studies at home and abroad on laser-assisted therapy for periodontitis patients with type 2 diabetes mellitus, in order to analyze its additional benefits and explore its potential mechanisms, so as to provide a basis for laser-assisted clinical treatment.

Key words: laser therapy, periodontitis, type 2 diabetes mellitus, non-surgical periodontal treatment

中图分类号:

R781.4

肖诗梦, 刘翼, 李茂雪, 丁一. 激光辅助伴2型糖尿病牙周炎非手术治疗的疗效评价[J]. 口腔医学, 2024, 44(3): 161-167.

XIAO Shimeng, LIU Yi, LI Maoxue, DING Yi. Evaluation of the efficacy of laser-assisted non-surgical treatment of periodontitis with type 2 diabetes mellitus[J]. Stomatology, 2024, 44(3): 161-167.

图/表 1

表1

激光辅助治疗伴T2DM牙周炎患者近5年临床研究文献总结"

研究者(发表年份)	研究类型	分组	激光类型	激光能量参数	观察指标
Soi等(2021)	随机对照试验	SRP组; SRP+DL组	940 nm DL	脉冲模式,平均功率0.8 W,脉宽1 ms,脉冲间隔1 ms,24 J,光纤直径300 μm,单侧15 s	PI、GI、PD、CAL、随机血糖、空腹血糖、HbA1c
Feng等 (2022)	分口随机对照试验	NSPT组; NSPT+Er:YAG 激光组	2 940 nm Er:YAG激光	去除结石:脉宽100 μs, 100 mJ/P,10 Hz,平均功率1.0 W,水8档气4档袋内壁杀菌:脉宽300 μs,60 mJ/P,20 Hz,平均功率1.2 W,水8档气4档,3 min/牙	BOP、PD、CAL、空腹血糖、HbA1c、hs-CRP
Sufaru等 (2022)	随机对照试验	SRP组; SRP+aPDT组	810 nm DL+ 5 mg/mL吲哚菁绿	吲哚菁绿1 mL处理60 s,连续波模式,0.2 W,照射60 s,总能量12 J	PI、BOP、PD、CAL、 HbA1c
李凤等 (2018)	随机对照试验	牙周基础治疗组; 牙周基础治疗+ LLLT组	808 nm DL	连续波模式,平均输出功率0.25 W,光斑面积0.28 cm²,能量密度4 J/cm²,照射时间前牙10 s、后牙20 s	PD、SBI、CAL、HbA1、FPG,龈沟液的TNF-α、IL-1、hs-CRP、LPS及瘦素水平
Dos Santos等 (2019)	随机对照试验	超声治疗组; 超声治疗+PBM组	660 nm DL	连续波模式,0.03 W,能量密度22 J/cm²,功率密度1.1 W/cm²,光斑面积0.028 cm²,总能量0.6 J,光纤直径600 μm,照射时间20 s	CAL、PD、BOP、PI
?zberk等 (2020)	分口随机对照试验	NSPT组; NSPT+PBM组	980 nm DL	连续波模式,0.4 W,能量密度0.5 J/cm²,光斑面积0.785 cm²,光纤直径1 cm,照射时间15 s	PD、CAL、PI、GI、龈沟液体积、龈沟液IL-1β水平
Chandra等 (2018)	随机对照试验	SRP组; SRP+DL组	808 nm DL	连续波模式,1.5~1.8 W,光纤直径320 nm	PI、GI、CAL、PD、A.actinomycetemcomitans和 P.gingivalis菌落计数
Kocak等 (2020)	随机对照试验	SRP组; SRP+DL组	940 nm DL	脉冲模式,峰值功率1.5 W,平均功率0.75 W,脉冲间隔20 ms,脉宽20 ms,平均功率密度1.061 W/cm²,光纤直径300 μm,20 s/牙	RT-PCR检测P.gingiv-alis、T.denticola和T.forsythia
Cláudio等 (2021)	随机对照试验	SRP组; SRP+aPDT组	660 nm DL+10 mg/mL亚甲蓝	亚甲蓝处理60 s,连续波模式,0.1 W,能量密度157 J / cm²,光纤直径0.03 cm,照射50 s	CAL、PD、BOP、PI、牙龈退缩,HbA1c,RT-PCR检测P.gingivalis与P.intermedia
Mrasori等 (2021)	随机对照试验	牙周基础治疗组; 牙周基础治疗+LLLT	660 nm DL	连续波模式,0.01 W,每天照射8 min	龈沟液IL-6水平
Mirza等 (2019)	随机对照试验	SRP; SRP+aPDT组	670 nm DL+ 0.005%亚甲蓝	0.005%亚甲蓝处理10 s,连续波模式,0.15 W,能量密度22 J/cm²,功率密度1.1 W/cm²,照射时间60 s	PI、BOP、PD、CAL、HbA1c、龈沟液内AGEs水平
Barbosa等 (2018)	随机对照试验	NSPT组; NSPT+aPDT组	660 nm DL+10 mg/mL亚甲蓝	10 mg/mL亚甲蓝处理5 min,连续波模式,0.04 W,4.8 J/牙,照射时间2 min/牙	PD、PI、CAL、牙龈探诊出血、HbA1c、果糖胺

表1

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激光辅助伴2型糖尿病牙周炎非手术治疗的疗效评价

Evaluation of the efficacy of laser-assisted non-surgical treatment of periodontitis with type 2 diabetes mellitus

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