关键词: 牙周内窥镜, 翻瓣术, 微创治疗, 龈下清创

Abstract:

Objective To evaluate the clinical efficacy of periodontal endoscope-assisted subgingival debridement compared with periodontal flap surgery for residual deep periodontal pockets in molar regions. Methods A retrospective study with non-inferiority analysis was performed on 40 patients with Stage Ⅲ/Ⅳ periodontitis who presented with residual periodontal pockets of probing depth (PD) ≥ 5 mm in the molar area after initial periodontal therapy.The 40 patients were allocated into two groups: 20 cases (96 teeth, 214 sites) in the endoscopy group received residual deep periodontal pocket debridement using periodontal endoscopy combined with ultrasonic instrumentation. Another 20 cases (78 teeth, 184 sites) in the flap group underwent open flap debridement for residual deep periodontal pockets. Clinical attachment level (CAL), probing depth (PD) and gingival recession (GR) were measured at baseline, 3 and 6 months after surgery to evaluate the efficacy of the two treatment modalities. The intergroup difference in the change of CAL at 6 months postoperatively was defined as the primary outcome indicator. The intergroup difference in the change of CAL at 3 months postoperatively, as well as the intergroup differences in the changes of PD and GR at 3 and 6 months postoperatively, were set as secondary outcome indicators. Based on baseline CBCT measurements, the pattern and severity of alveolar bone resorption and the classification of furcation lesions in the molar region were recorded, and their influences on the efficacy of the two treatments were further evaluated. Results At 6 months postoperatively, in the endoscopy group, the CAL change was (2.25±1.64) mm, PD change was (3.02±1.61) mm, and GR change was (-0.77±0.92) mm; in the flap group, the CAL change was (0.56±1.89) mm, PD change was (1.85±1.60) mm, and GR change was (-1.29±1.26) mm. The improvements in CAL and PD in the endoscopy group were significantly greater than those in the flap group (P<0.000 1), whereas GR was significantly smallerin the endoscopy group (P<0.000 1). At sites with baseline PD ≥7 mm, the PD change in the endoscopy group (4.08±1.60) mm was significantly greater than that in the flap group (2.38±1.75) mm (P<0.001). For grade Ⅰ and Ⅱ furcation involvement, the improvements in CAL and PD in the endoscopy group were also significantly greater than those in the flap group (P<0.05), but no statistically significant difference in ΔPD was found between the two groups in grade Ⅲ furcation involvement. In addition, at sites with horizontal and non-horizontal bone resorption, the endoscopy group showed significantly greater improvements in CAL and PD (P<0.001) and significantly less gingival recession (P<0.05) compared with the flap group. Conclusion Periodontal endoscopy-assisted subgingival debridement can effectively ameliorate periodontal inflammation in molars. Its clinical efficacy is non-inferior to open flap debridement, with prominent advantages indeep periodontal pockets and grade Ⅰ and Ⅱ furcation involvements.Meanwhile, it canbetter preserve periodontal soft tissues, serving as an effective minimally invasive therapeutic option.

Key words: periodontal endoscopy, periodontal flap surgery, minimally invasive treatment, subgingival debridement