医用纳米羟基磷灰石治疗慢性牙周炎的临床研究
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摘要
目的:应用医用纳米羟基磷灰石治疗慢性牙周炎,探讨治疗慢性牙周炎,为口腔牙周病患者的治疗方面拓展新思路。
方法:分析了广西医科大学第四附属医院口腔科2009年6月～2010年12月收治的50例牙周病患者,按治疗方法不同分两组:(对照组)根面平整术组:利用改良Widman翻瓣术充分暴露病变区组织,行根面平整术后严密缝合牙龈。(实验组)根面平整术+纳米羟基磷灰石植入组:利用改良Widman翻瓣术充分暴露病变区组织,在直视下刮净牙根表面的牙石,将适量纳米羟基磷灰石送入骨袋内,配合使用水平褥式缝合或垂直褥式严密缝合牙龈将植入材料严密覆盖;每组25例。
术前明确牙周病诊断的严重标准、准确筛选符合如选研究对象的标准,对组间可能影响疗效的相关因素如年龄、全身疾病、牙周情况、是否正在进行如正畸矫治等进排除,消除组间差异,增强可比性;术中分别由专人负责各环节的检查和操作,指定专人负责各种资料的收集和复核,保证实验过程中的各项试验数据的准确性;记录每组于术前、术后第6周、12周分别复诊时,口腔内检查牙齿松动度、牙周探诊深度及附着丧失等数据,进行组间对照研究。
结果:实验组对照组各25例。对比两组术后牙周探诊深度、附着丧失数值,实验组各项数值优于对照组,差异有统计学意义(P<0.05)。
结论:根面平整术+纳米羟基磷灰石植入用来治疗慢性牙周炎患者,术后恢复情况良好,且能改善患者的牙周状况,是治疗慢性牙周炎的理想方法,值得临床进一步推广应用。
Objective This paper aims at the treatment of periodontal disease with medical nano hydroxyapatite, which makes a preliminary discussion about the clinical effect in improving the degree of the loose teeth, the depth of periodontal treatment and the loosing of gum adhesion to explore the new treatment of periodontal disease patients.
Methods This paper makes a retrospective analysis of 50 cases of periodontal disease patients of the Department of Stomatology in the fourth affiliated hospital, Guangxi medical university from June, 2009 to December, 2010, according to the different treatment method, who are divided into two groups:(Group A)Pure root surface smooth operation group and ( Group B ) root surface smooth operation + nano hydroxyapatite implant group; each group has 25 cases.
The standard of periodontal disease and selecting the object of the study should be clear and definite before operation. The factors which may affect curative effect such as age, systemic disease, periodontal situation and orthodontic correction etc should be excluded so as to eliminate the between-group differences and enhance the comparability. The statistics related with the flossing degree of the teeth, periodontal CPI index and perturbation X-ray examination are recorded respectively in 1, 4, 12 weeks, which carries on the contrast between groups.
Results (Group A)Pure root surface smooth operation group of 25 cases,(Group B)Root surface smooth operation + nano hydroxyapatite implant group of 25 cases,postoperative comparison periodontal probing depth, attachment loss values, hydroxyapatite implant was superior to root planning alone group, Statistically significant(P<0.05)。
Conclusion Root surface smooth operation + nano hydroxyapatite applied for the treatment of periodontal disease patients implanted little injury to make a postoperative recovery in good conditions, which is the ideal methods that can also improve the periodontal status of periodontal disease patients and worth being clinically further popularized.
方法:分析了广西医科大学第四附属医院口腔科2009年6月～2010年12月收治的50例牙周病患者,按治疗方法不同分两组:(对照组)根面平整术组:利用改良Widman翻瓣术充分暴露病变区组织,行根面平整术后严密缝合牙龈。(实验组)根面平整术+纳米羟基磷灰石植入组:利用改良Widman翻瓣术充分暴露病变区组织,在直视下刮净牙根表面的牙石,将适量纳米羟基磷灰石送入骨袋内,配合使用水平褥式缝合或垂直褥式严密缝合牙龈将植入材料严密覆盖;每组25例。
术前明确牙周病诊断的严重标准、准确筛选符合如选研究对象的标准,对组间可能影响疗效的相关因素如年龄、全身疾病、牙周情况、是否正在进行如正畸矫治等进排除,消除组间差异,增强可比性;术中分别由专人负责各环节的检查和操作,指定专人负责各种资料的收集和复核,保证实验过程中的各项试验数据的准确性;记录每组于术前、术后第6周、12周分别复诊时,口腔内检查牙齿松动度、牙周探诊深度及附着丧失等数据,进行组间对照研究。
结果:实验组对照组各25例。对比两组术后牙周探诊深度、附着丧失数值,实验组各项数值优于对照组,差异有统计学意义(P<0.05)。
结论:根面平整术+纳米羟基磷灰石植入用来治疗慢性牙周炎患者,术后恢复情况良好,且能改善患者的牙周状况,是治疗慢性牙周炎的理想方法,值得临床进一步推广应用。
Objective This paper aims at the treatment of periodontal disease with medical nano hydroxyapatite, which makes a preliminary discussion about the clinical effect in improving the degree of the loose teeth, the depth of periodontal treatment and the loosing of gum adhesion to explore the new treatment of periodontal disease patients.
Methods This paper makes a retrospective analysis of 50 cases of periodontal disease patients of the Department of Stomatology in the fourth affiliated hospital, Guangxi medical university from June, 2009 to December, 2010, according to the different treatment method, who are divided into two groups:(Group A)Pure root surface smooth operation group and ( Group B ) root surface smooth operation + nano hydroxyapatite implant group; each group has 25 cases.
The standard of periodontal disease and selecting the object of the study should be clear and definite before operation. The factors which may affect curative effect such as age, systemic disease, periodontal situation and orthodontic correction etc should be excluded so as to eliminate the between-group differences and enhance the comparability. The statistics related with the flossing degree of the teeth, periodontal CPI index and perturbation X-ray examination are recorded respectively in 1, 4, 12 weeks, which carries on the contrast between groups.
Results (Group A)Pure root surface smooth operation group of 25 cases,(Group B)Root surface smooth operation + nano hydroxyapatite implant group of 25 cases,postoperative comparison periodontal probing depth, attachment loss values, hydroxyapatite implant was superior to root planning alone group, Statistically significant(P<0.05)。
Conclusion Root surface smooth operation + nano hydroxyapatite applied for the treatment of periodontal disease patients implanted little injury to make a postoperative recovery in good conditions, which is the ideal methods that can also improve the periodontal status of periodontal disease patients and worth being clinically further popularized.
引文
[1]孟焕新,我国牙周病学的临床现状及思考,中华口腔医学杂志2008年5月第43卷第5期,Chin J Stomatol,May 2008,Vol.43,No.5
[2]王珊,牙周病的研究进展,中国医药指南2008年5月第6卷第5期
[3]丁一,牙周病对全身健康的影响中华临床医师杂志2008年9月第2卷第9期
[4]丁一杨悉彬吴亚菲,牙周病的预防-自我菌斑控制的机械方法[J] .牙体牙髓牙周病学杂志,2002,1 2(3):16 4一167.
[5]张纬.牙周病固定夹板修复治疗[J].中华口腔医学杂志,2003(1):52-54
[6] Barendregt DS,Van der Velden U,Timmerman MF,et al.Comparison of two automated periodontal mainetnance patients [J].J Clin periodontol.2006,33(4);276-282.
[7]曹采方,孟焕新,阎福华等,牙周疾病新分类简介(1999年国际研讨会)中华口腔医学杂志2001年9月第36卷第5期,Chin J Stomatol, September 2001, Vol 36, No.5
[8] Armitage GC.The complete periodontal examination. Periodontol 2004,34:22-33.
[9]欧阳翔英,曹彩方,Henry Liu,胡文杰,J Leslie Winston.不同程度慢性牙周炎患者病情的二年自然进展.中华口腔医学杂志2004年5月第39卷第3期
[10]陈峰,周艳,田园,超声洁牙机在根面平整术中的应用,上海口腔医学2002年9月第11卷第3期,ShaghiJo nmalor S mmaortogy Vol 11 No.3 September,2002
[11]孟焕新,张立.侵袭性牙周炎的诊断及治疗.中华口腔医学杂志2005年1月第40卷第1期
[12] Gary C.Armitage,牙周疾病和状况的诊断及分类系统所面临的挑战.中华口腔医学杂志2008年5月第43卷第5期
[13]潘亚萍,赵溪达,牙周病临床诊断方法,中国实用口腔科杂志,2008年7月第1卷第7期
[14]慕红文,于静,牙周病与全身疾病相关性的研究进展,医学综述2008年8月第14卷第16期
[15]张萍,朱聪惠,裘松波,牙周病非手术治疗进展,中国药业杂志,2008年第17卷第3期
[16] Golub LM,Me Namara TF,Ryan ME,et al.Adjunctive treatment with Subantimic robial doses of doxycycline:effects on gingival fluid collage-nase activity and attachment loss in adult periodontitis[J].J Clin Periodontol, 2001,28(2):146一156.
[17] Ramamurthy NS,Rifkin BR,Greenwald RA,et al.Inhibition of matrix metallop rote inase一mediated periodontal bone loss in rate:a c omparison of 6 chemically modified tetracyclines[J],J Periodontol, 2002,73(7):726一734.
[18] Karimbux NY,Ramamurthy NS,Golub LM,et al.The expression of collage I and XII mRNAs In Porphyormonas gingivalis一induced periodontitisin rats :the effect of doxycycline And chemicallymod- ifiedtetracycline[J].JPeriodontol,1998,69(1):34一40[19] Bezerra MM,Brito GA, Ribeiro RA, et al. Low-dose doxycycline
[19] prevents inflammatory bone resorption in rats[J].B raz J Med Biol Res,2002,35(5) :613一616.
[20] Sorsa T, Ding Y, Salo T,et al.Effects of tetracyclines on neutrophil, gingival, and salivary collagenases :a functional and western一blotassessment with special reference to their cellular sources in periodontal diseases [J ].Ann NY Acad S ci,1994,732(6):112一131.
[21]陶伟.中药与治疗牙周炎的对比研究[J].天津中医,2000,17 (6 ): 15.
[22] Sekino S,Ramberg P,Lindhe J.The effect of systemic administration of ibuprofen in the exoerimental gingivitis model[J].J Clin Periodontol , 2005,32:182-187
[23] Ciancio SG.Systemic medications:clinical significance in Periodonti- cs [J] .J Clin periodontol,2002,29(suppl 2):14-18.
[24] Rocha ML,Malacara JM,Sanchez-Marin FJ.et al.Effect of alendrinate on periodontal desease in postmenopausal women:arandomized placebo-controlled trial [J].J Periodontol, 2004, 75:1579-1585.
[25] Lane N,Armitage GC,Loomer P,et al.Bisphosphonate therapyomproves the outcome of conventional periodontal treatment: results of 12-month, randomized, placebo-controlled study [J]. J Periodontol, 2005, 76: 1113-1122.
[26]赵蕾,吴亚菲.DOXY和CMTs调节牙周中宿主反应的研究进展[J].国外医学口腔医学分册,2005,32(2):128-130.
[27]赵蕾,吴亚菲.双磷酸盐类药物用于牙周炎治疗的研究进展[J].牙体牙髓牙周病学杂志,2006,16(16):355-357
[28] Caffease RG,Mota LF,Quinones CR,et a1.Clinical comparison of resorbable and non—resorbable barriers for guide dperiodonta- hissue regeneration.J Clin Periodontol,1997,24:747-750.
[29]刘泉,黄文,拔牙后牙槽窝即刻植入纳米羟基磷灰石的临床观察《口腔医学研究》2007年05期
[1]孟焕新,我国牙周病学的临床现状及思考,中华口腔医学杂志2008年5月第43卷第5期,Chin J Stomatol,May 2008,Vol.43,No.5
[2]王珊,牙周病的研究进展,中国医药指南2008年5月第6卷第5期
[3]丁一,牙周病对全身健康的影响中华临床医师杂志2008年9月第2卷第9期
[4]丁一杨悉彬吴亚菲,牙周病的预防—自我菌斑控制的机械方法[J] .牙体牙髓牙周病学杂志,2002,1 2(3):16 4一167.
[5]张纬.牙周病固定夹板修复治疗[J].中华口腔医学杂志,2003(1):52-54
[6] Barendregt DS,Van der Velden U,Timmerman MF,et al.Comparison of two automated periodontal mainetnance patients [J].J Clin periodontol.2006,33(4);276-282.
[7]曹采方,孟焕新,阎福华等,牙周疾病新分类简介(1999年国际研讨会)中华口腔医学杂志2001年9月第36卷第5期,Chin J Stomatol, September 2001, Vol 36, No.5
[8] Armitage GC.The complete periodontal examination. Periodontol 2000,2004,34:22-33.
[9]欧阳翔英,曹彩方,Henry Liu,等,不同程度慢性牙周炎患者病情的二年自然进展.中华口腔医学杂志2004年5月第39卷第3期
[10]陈峰,周艳,田园,超声洁牙机在根面平整术中的应用,上海口腔医学2002年9月第11卷第3期,ShaghiJo nmalor S mmaortogy Vol 11 No.3 September,2002
[11]孟焕新,张立.侵袭性牙周炎的诊断及治疗.中华口腔医学杂志2005年1月第40卷第1期
[12] Gary C.Armitage.牙周疾病和状况的诊断及分类系统所面临的挑战.中华口腔医学杂志2008年5月第43卷第5期
[13]潘亚萍,赵溪达,牙周病临床诊断方法,中国实用口腔科杂志,2008年7月第1卷第7期
[14]慕红文,于静,牙周病与全身疾病相关性的研究进展,医学综述2008年8月第14卷第16期
[15]张萍,朱聪惠,裘松波,牙周病非手术治疗进展,中国药业杂志,2008年第17卷第3期
[16] Golub LM,Me Namara TF,Ryan ME,et al.Adjunctive treatment with Subantimic robial doses of doxycycline:effects on gingival fluid collage-nase activity and attachment loss in adult periodontitis [J].J Clin Periodontol, 2001,28(2):146一156.
[17] Ramamurthy NS,Rifkin BR,Greenwald RA,et al.Inhibition of matrix metallop rote inase一mediated periodontal bone loss in rate:a c omparison of 6 chemically modified tetracyclines[J] , J Periodontol,2002,73(7):726一734.
[18] Karimbux NY,Ramamurthy NS,Golub LM,et al.The expression ofcollage I and XII mRNAs In Porphyormonas gingivalis一induced periodontitisin rats :the effect of doxycycline Andchemically modifiedte tracycline [J]. Periodontol,1998,69(1):34一40
[19] Bezerra MM,Brito GA, Ribeiro RA, et al. Low一dose doxycycline p revents inflammatory bone resorption in rats[J].B raz J Med Biol Res,2002,35(5) :613一616.
[20] Sorsa T, Ding Y, Salo T,et al.Effects of tetracyclines on neutrophil,gingival, and salivary collagenases :a functional and western一blotassessment with special reference to their cellular sources in periodontal diseases [J ] . Ann N Y Acad S ci,1994,732(6):112一131.
[21]陶伟.中药与治疗牙周炎的对比研究[J].天津中医,2000,17 (6 ): 15.
[22] Sekino S,Ramberg P,Lindhe J.The effect of systemic administration of ibuprofen in the exoerimental gingivitis model[J].J Clin Periodontol,2005,32:182-187
[23] Ciancio SG.Systemic medications:clinical significance in Periodontics [J].J Clin periodontol,2002,29(suppl 2):14-18.
[24] Rocha ML,Malacara JM,Sanchez-Marin FJ.et al.Effect of alendrinate on periodontal desease in postmen pausal women: a randomized placebo-controlled trial[J].J ,2004,75:1579-1585.
[25] Lane N,Armitage GC,Loomer P,et al.Bisphosphonate therapy omproves the outcome of conventional periodontal treatment: resultsof 12-month, randomized, placebo-controlled study [J]. J Periodontol, 2005, 76: 1113-1122.
[26]赵蕾,吴亚菲.DOXY和CMTs调节牙周中宿主反应的研究进展[J].国外医学口腔医学分册,2005,32(2):128-130.
[27]赵蕾,吴亚菲.双磷酸盐类药物用于牙周炎治疗的研究进展[J].牙体牙髓牙周病学杂志,2006,16(16):355-357
[28] Caffease RG,Mota LF,Quinones CR,et a1.Clinical comparison of resorbable and non—resorbable barriers for guided periodontal hissue regeneration.J Clin Periodontol,1997,24:747-750.
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[2]王珊,牙周病的研究进展,中国医药指南2008年5月第6卷第5期
[3]丁一,牙周病对全身健康的影响中华临床医师杂志2008年9月第2卷第9期
[4]丁一杨悉彬吴亚菲,牙周病的预防-自我菌斑控制的机械方法[J] .牙体牙髓牙周病学杂志,2002,1 2(3):16 4一167.
[5]张纬.牙周病固定夹板修复治疗[J].中华口腔医学杂志,2003(1):52-54
[6] Barendregt DS,Van der Velden U,Timmerman MF,et al.Comparison of two automated periodontal mainetnance patients [J].J Clin periodontol.2006,33(4);276-282.
[7]曹采方,孟焕新,阎福华等,牙周疾病新分类简介(1999年国际研讨会)中华口腔医学杂志2001年9月第36卷第5期,Chin J Stomatol, September 2001, Vol 36, No.5
[8] Armitage GC.The complete periodontal examination. Periodontol 2004,34:22-33.
[9]欧阳翔英,曹彩方,Henry Liu,胡文杰,J Leslie Winston.不同程度慢性牙周炎患者病情的二年自然进展.中华口腔医学杂志2004年5月第39卷第3期
[10]陈峰,周艳,田园,超声洁牙机在根面平整术中的应用,上海口腔医学2002年9月第11卷第3期,ShaghiJo nmalor S mmaortogy Vol 11 No.3 September,2002
[11]孟焕新,张立.侵袭性牙周炎的诊断及治疗.中华口腔医学杂志2005年1月第40卷第1期
[12] Gary C.Armitage,牙周疾病和状况的诊断及分类系统所面临的挑战.中华口腔医学杂志2008年5月第43卷第5期
[13]潘亚萍,赵溪达,牙周病临床诊断方法,中国实用口腔科杂志,2008年7月第1卷第7期
[14]慕红文,于静,牙周病与全身疾病相关性的研究进展,医学综述2008年8月第14卷第16期
[15]张萍,朱聪惠,裘松波,牙周病非手术治疗进展,中国药业杂志,2008年第17卷第3期
[16] Golub LM,Me Namara TF,Ryan ME,et al.Adjunctive treatment with Subantimic robial doses of doxycycline:effects on gingival fluid collage-nase activity and attachment loss in adult periodontitis[J].J Clin Periodontol, 2001,28(2):146一156.
[17] Ramamurthy NS,Rifkin BR,Greenwald RA,et al.Inhibition of matrix metallop rote inase一mediated periodontal bone loss in rate:a c omparison of 6 chemically modified tetracyclines[J],J Periodontol, 2002,73(7):726一734.
[18] Karimbux NY,Ramamurthy NS,Golub LM,et al.The expression of collage I and XII mRNAs In Porphyormonas gingivalis一induced periodontitisin rats :the effect of doxycycline And chemicallymod- ifiedtetracycline[J].JPeriodontol,1998,69(1):34一40[19] Bezerra MM,Brito GA, Ribeiro RA, et al. Low-dose doxycycline
[19] prevents inflammatory bone resorption in rats[J].B raz J Med Biol Res,2002,35(5) :613一616.
[20] Sorsa T, Ding Y, Salo T,et al.Effects of tetracyclines on neutrophil, gingival, and salivary collagenases :a functional and western一blotassessment with special reference to their cellular sources in periodontal diseases [J ].Ann NY Acad S ci,1994,732(6):112一131.
[21]陶伟.中药与治疗牙周炎的对比研究[J].天津中医,2000,17 (6 ): 15.
[22] Sekino S,Ramberg P,Lindhe J.The effect of systemic administration of ibuprofen in the exoerimental gingivitis model[J].J Clin Periodontol , 2005,32:182-187
[23] Ciancio SG.Systemic medications:clinical significance in Periodonti- cs [J] .J Clin periodontol,2002,29(suppl 2):14-18.
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