目的 探讨激光联合米诺环素治疗慢性牙周炎的临床效果和可能的机制.方法 选择2020年6月至2023年6月,慢性牙周炎患者80例的临床资料,随机分为对照组和观察组,每组患者40例.两组患者均先接受常规宣教,配合龈上洁治术、超声龈下刮治后,对照组患者使用米诺环素治疗,每周1次,4周为一个疗程.观察组在此基础上加用Nd:YAP激光治疗,照射功率5 W、脉宽150 μs,脉冲频率30 Hz、光斑1.2 mm、能量160 μJ,每周1次,4周为1个疗程.治疗前、治疗后1个月,比较两组患者的牙周探针深度(probing depth,PD)、探诊出血(bleeding on probing,BOP);采用酶联免疫吸附法检测龈沟液中C反应蛋白(C-reactive protein,CRP)、白介素1α(interleukin 1α,IL-1α)、肿瘤坏死因子α(tumor necrosis factor alpha,TNF-α)的水平;采用放射免疫法检测龈沟液中骨代谢指标骨碱性磷酸酶(bone alkaline phosphatase,BALP)、Ⅰ 型胶原 C 端肽(C-telopeptide of type Ⅰ collagen,CTX-1)、总 Ⅰ 型胶原氨基端延长肽(total procollagen Ⅰ n-terminal propeptide,tPINP)、骨钙素(bone gamma-carboxyglutamic-acid-containing proteins,BGP)的水平改变,评估近期疗效差异.结果 治疗前,两组患者PD、BOP比较差异无统计学意义(P＞0.05);龈沟液CRP、IL-1β、TNF-α等炎症因子水平比较差异无统计学意义(P＞0.05);骨代谢指标BALP、CTX-1、tPINP、BGP水平比较差异无统计学意义(P＞0.05).治疗后1个月,观察组患者的PD、BOP低于对照组患者(P＜0.05);龈沟液CRP、IL-1β、TNF-α水平低于对照组患者(P＜0.05);骨代谢指标BALP水平高于对照组患者,CTX-1、tPINP、BGP水平低于对照组患者(P＜0.05).治疗后1个月,观察组患者的近期疗效分级、总有效率均优于对照组(P＜0.05).结论 激光联合米诺环素治疗慢性牙周炎可显著减轻牙周症状及炎症、积极逆转牙槽骨代谢过程,是一种理想的治疗方式.
Therapeutic Effect of Nd:YAP Laser Combined with Minocycline in Treatment of Chronic Periodontitis
Objective Exploring the clinical efficacy and possible mechanisms of laser combined with minocycline in the treatment of chronic periodontitis.Methods Totally 80 patients with chronic periodontitis treated over the period from Jun.2020 to Jun.2023 were selected and randomly divided into a control group and an observation group,40 patients in each group.The patients of both groups were given routine education,followed by supragingival scaling and ultrasonic subgingival scraping.Then,the patients in the control group were given minocycline treatment once a week,which lasted for 4 weeks to compose a course of treatment.Besides minocycline,the patients in the observation group were given Nd:YAP laser treatment(irradiation power:5 W,pulse width:150 μs,pulse frequency:30 Hz,spot:1.2 mm and energy:160 µJ)once a week for 4 weeks.The patients in both groups were treated for a month and followed up for a month.For both groups,the probing depth(PD)and bleeding on probing(BOP)of the patients before and one month after the treatment were compared.The levels of C-reactive protein(CRP),interleukin-1β(IL-1β)and tumor necrosis factor α(TNF-α)in gingival crevicular fluid were detected with enzyme-linked immunosorbent assay.Radioimmunoassay was used to detect changes in bone metabolism indicators such as bone alkaline phosphatase(BALP),C-telopeptide of type Ⅰ collagen(CTX-1),total procollagen ⅠN-terminal prolonging peptide(tPINP)and bone gamma carboxyglutamic acid containing proteins(BGP)in gingival crevicular fluid for the sake of evaluating the difference in recent efficacy.Results Before the treatment,there was no remarkable difference in PD and BOP between the two groups of patients(P＞0.05).Their differences in the levels of inflammatory factors such as CRP,IL-1β and TNF-α in gingival crevicular fluid were not significant(P＞0.05).Moreover,there was no significant difference in the levels of bone metabolism indicators like BALP,CTX-1,tPINP and BGP(P＞0.05).One month after the treatment,the PD and BOP in the observation group were lower than those in the control group patients(P＜0.05),and the levels of CRP,IL-1β and TNF-α in gingival crevicular fluid were lower in the observation group than in the control group(P＜0.05).The bone metabolism index BALP level in the observation group was higher than that in the control group while the levels of CTX-1,tPINP and BGP being lower than those of the control group(P＜0.05).One month after the treatment,the short-term efficacy grading and overall effectiveness rate of the observation group were better than those of the control group(P＜0.05).Conclusions The combination of laser and minocycline will significantly reduce periodontal symptoms and inflammation and actively reverse alveolar bone metabolism,which makes an ideal treating method for chronic periodontitis.
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