光动力疗法辅助治疗种植体周炎的短期非随机对照临床研究

doi:10.13591/j.cnki.kqyx.2024.06.003

摘要/Abstract

摘要：

目的探究使用光动力疗法(photodynamic therapy,PDT)辅助机械性龈下清创(mechanical debridement,MD)治疗种植体周炎(peri-implantitis)的短期临床疗效。方法根据2018牙周病新分类标准,纳入临床上诊断为种植体周炎的单颗种植体(单冠修复)患者,治疗前记录种植体周探诊深度(probing depth,PD)、改良龈沟出血指数(modified sulcus bleeding index,mSBI)和改良菌斑指数(modified plaque index,mPLI),以mSBI≥1的位点作为治疗位点。MD组为对照组,仅对治疗位点行机械性龈下清创;PDT组为治疗组,在龈下清创后即刻和治疗后1周,共行两次辅助性光动力治疗。结束治疗后6周、12周复查,检查所纳入患者种植体治疗位点的PD、mSBI和mPLI的变化。结果本研究共纳入35例患者,发生种植体周炎的植体38枚,共计154个治疗位点。PDT组和MD组各纳入20枚和18枚植体,其中PDT组纳入治疗位点共78个,PD≥6 mm的位点共51个,PD<6 mm的位点共27个;对照组纳入治疗位点共76个,PD≥6 mm的位点共53个,PD<6 mm的位点共23个。基线时两组的PD、mSBI和mPLI均无统计学差异,治疗后6周及12周复查时,两组各临床指标与基线相比均获得显著改善(P<0.05),其中PDT组治疗后6周的mSBI显著低于MD组(P<0.05)。在PD≥6 mm的位点中,PDT组的mSBI在治疗后6周、12周复查时均显著低于MD组(P<0.05)。PDT组和MD组在12周复查时达到治疗终点的植体百分比分别为70.00%和55.56%,无统计学差异(P>0.05)。结论光动力疗法辅助机械清创可以有效治疗种植体周炎,是一种安全有效的辅助治疗手段,对改善深种植体周袋(PD≥6 mm)的炎症以及mSBI具有显著疗效。

关键词: 光动力疗法, 种植体周炎, 机械清创

Abstract:

Objective To evaluate the short-term clinical efficacy of photodynamic therapy (PDT) assisted mechanical debridement (MD) in the treatment of peri-implantitis. Methods According to the new international classification of periodontal diseases and peri-implant diseases in 2018, single tooth implants diagnosed as peri-implantitis were included. Before treatment, the probing depth (PD), modified sulcus bleeding index (mSBI), and modified plaque index (mPLI) were recorded as the baseline, with mSBI ≥ 1 sites as the treatment sites. The MD group was a control group, and only mechanical subgingival debridement was performed. The PDT group was treated with photodynamic therapy twice, immediately after subgingival debridement and one week after. Follow-up was arranged at 6 and 12 weeks after the end of treatment to examine the changes in PD, mSBI, and mPLI at the included implant treatment sites. Results A total of 35 patients were included in this study, with 38 teeth affected by peri-implantitis and 154 treatment sites. The PDT group and MD group included 20 and 18 implants respectively, with a total of 78 treatment sites included in the PDT group, 51 sites with PD ≥ 6 mm, and 27 sites with PD<6 mm. A total of 76 treatment sites were included in the MD group, including 53 sites with PD ≥ 6 mm and 23 sites with PD<6 mm. At baseline, there was no statistically significant difference in PD, mSBI, and mPLI between the two groups. At 6 and 12 weeks after treatment, there were statistically significant differences in clinical indicators between the two groups compared to baseline (P<0.05). Among them, the mSBI in the PDT group was significantly lower than that in the MD group at 6 weeks after treatment (P<0.05). At sites with PD ≥ 6 mm, the mSBI of the PDT group was significantly lower than that of the MD group at 6 and 12 weeks after treatment (P<0.05). The number of implants in the PDT group and MD group that reached the treatment endpoint at 12 weeks follow-up was 70.00% and 55.56%, respectively, and there was no difference between the two groups (P>0.05). Conclusion Photodynamic therapy assisted with mechanical debridement can effectively treat peri-implantitis and is a safe and effective auxiliary method, and has significant therapeutic effects on inflammation control and improvement of mSBI in those sites with PD ≥ 6 mm.

Key words: photodynamic therapy, peri-implantitis, mechanical debridement

中图分类号:

R781.4

王依玮, 束蓉, 谢玉峰, 钱洁蕾, 林智恺. 光动力疗法辅助治疗种植体周炎的短期非随机对照临床研究[J]. 口腔医学, 2024, 44(6): 414-420.

WANG Yiwei, SHU Rong, XIE Yufeng, QIAN Jielei, LIN Zhikai. A short-time non-randomized controlled clinical study on adjunctive photodynamic therapy in the treatment of peri-implantitis[J]. Stomatology, 2024, 44(6): 414-420.

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参考文献 34

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指标	MD组	PDT组
年龄/岁($\bar{x} \pm s$)	51.53±10.17	49.00±8.98
性别(n(%))
男	8(22.86)	7(20.00)
女	9(25.71)	11(31.43)
牙位(n(%))
切牙	5(13.16)	4(10.53)
尖牙	0(0)	0(0)
前磨牙	5(13.16)	7(18.42)
磨牙	8(21.05)	9(23.68)
治疗位点(n(%))
PD≥6 mm	53(34.42)	51(33.12)
PD<6 mm	23(14.94)	27(17.53)

指标	组别	基线	治疗后6周	χ²	P^a*	治疗后12周	χ²	P^b*	χ²	P^c*
PD/mm	MD组	6.50(4.00,8.00)	4.28(3.00,5.00)	9.490	<0.01^#	4.49(3.00,5.00)	8.638	<0.01^#	-0.852	0.394
	PDT组	6.42(4.00,8.00)	4.19(3.00,5.00)	9.728	<0.01^#	4.40(3.00,5.00)	8.647	<0.01^#	-1.081	0.280
	U^?	0.303	0.159			0.004
	P^?	0.762	0.874			0.997
mSBI	MD组	1.95(1.00,2.00)	0.57(0,1.00)	8.517	<0.01^#	0.66(0,2.00)	7.908	<0.01^#	-0.608	0.543
	PDT组	1.91(1.00,3.00)	0.22(0,0.00)	9.327	<0.01^#	0.35(0,1.00)	8.567	<0.01^#	-0.761	0.447
	U^?	0.464	2.559			1.746
	P^?	0.643	0.010^#			0.081
mPLI	MD组	0.75(0.00,1.00)	0.36(0.00,1.00)	2.180	0.029^#	0.33(0,1.00)	2.239	0.025^#	0.059	0.953
	PDT组	0.79(0.75,1.00)	0.3(0.00,1.00)	2.516	0.012^#	0.31(0,1.00)	3.019	0.003^#	0.503	0.615
	U^?	-0.482	-0.125			0.310
	P^?	0.630	0.901			0.756

指标	组别	基线	治疗后6周	χ²	P ^a*	治疗后12周	χ²	P^b*	χ²	P^c*
PD/mm	MD组	7.64(6.00,9.00)	4.98(4.00,6.00)	8.159	<0.01^#	5.26(4.00,6.00)	7.285	<0.01^#	-0.874	0.382
	PDT组	7.73(6.00,9.00)	4.92(4.00,6.00)	8.070	<0.01^#	5.22(4.00,6.00)	6.931	<0.01^#	-1.139	0.255
	U^?	-0.127	-0.155			0.597
	P^?	0.899	0.877			0.550
mSBI	MD组	2.30(2.00,3.00)	0.74(0.00,2.00)	7.409	<0.01^#	0.85(0.00,2.00)	6.736	<0.01^#	-0.674	0.501
	PDT组	2.30(2.00,3.00)	0.24(0.00,0.00)	8.020	<0.01^#	0.41(0.00,1.00)	7.129	<0.01^#	-0.891	0.373
	U^?	-0.536	2.919			2.110
	P^?	0.592	0.004^#			0.035^#

指标	组别	基线	治疗后6周	χ²	P ^a*	治疗后12周	χ²	P^b*	χ²	P^c*
PD/mm	MD组	3.87(3.50,4.00)	2.65(2.00,3.00)	4.866	<0.01^#	2.70(2.00,3.00)	4.644	<0.01^#	-0.221	0.825
	PDT组	3.96(4.00,4.00)	2.81(3.00,3.00)	5.357	<0.01^#	2.85(3.00,3.00)	5.239	<0.01^#	-0.136	0.892
	U^?	-0.680	-1.174			-1.010
	P^?	0.497	0.240			0.312
mSBI	MD组	1.13(1.00,1.00)	0.17(0.00,0.00)	4.350	<0.01^#	0.22(0.00,0.00)	4.276	<0.01^#	-0.074	0.941
	PDT组	1.11(1.00,1.00)	0.19(0.00,0.00)	4.831	<0.01^#	0.22(0.00,0.00)	4.763	<0.01^#	-0.068	0.946
	U^?	0.207	-0.102			-0.041
	P^?	0.836	0.918			0.968