国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (1): 29-34.doi: 10.7518/gjkq.2021012

• 牙周专栏 • 上一篇    下一篇

龈下清创术与根面平整术

闫乐,侯建霞()   

  1. 北京大学口腔医学院·口腔医院牙周科 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室 北京 100081
  • 收稿日期:2020-03-28 修回日期:2020-09-19 出版日期:2021-01-01 发布日期:2021-01-20
  • 通讯作者: 侯建霞
  • 作者简介:闫乐,博士,Email: yanyue2012kq@126.com

Subgingival debridement and root planing

Yan Yue,Hou Jianxia()   

  1. Dept. of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2020-03-28 Revised:2020-09-19 Online:2021-01-01 Published:2021-01-20
  • Contact: Jianxia Hou

摘要:

自20世纪70年代起,为了清除“病变牙骨质”,需专用手工器械完成的根面平整术成为牙周炎非手术治疗的核心内容。随后部分有关根面内毒素的研究认为没有必要使用根面平整术过度去除牙骨质,主张“龈下清创术”。目前规范化牙周治疗的主流观点仍强调在龈下清创后使用手工器械处理牙根表面作为去除病因的重要程序,从而使根面具有生物相容性。既往有关根面平整术的研究主要是对比单纯超声龈下清创术和单纯手工龈下刮治及根面平整术,缺乏超声龈下清创术与超声龈下清创联合手工根面平整术的对比研究。本文综述以往关于龈下清创术和根面平整术的相关研究,为临床医生治疗方案选择提供指导,同时也为将来开展相关的临床研究提供参考。

关键词: 龈下刮治术, 根面平整术, 龈下清创术

Abstract:

Since the 1970s, root planing has become the core of non-surgical treatment of periodontitis to eliminate “infected cementum”. Subsequent studies on root endotoxin have concluded that excessive removal of the cementum by root planing is unnecessary, which also prompt the concept of “subgingival debridement”. At present, the mainstream view of standardized periodontal treatment still emphasizes the use of manual instruments to make the root surface biocompatible as an important procedure for removing the pathogens after subgingival debridement. Previous studies on root planing mainly focused on the comparison of ultrasonic subgingival debridement with manual subgingival scaling and root planing. Ultrasonic subgingival debridement has yet to be compared with ultrasonic subgingival debridement combined with manual root planing. This article reviews previous studies on subgingival debridement and root planing to provide guidance of decision-making for clinicians and references for future clinical research.

Key words: subgingival scaling, root planing, subgingival debridement

中图分类号: 

  • R781.4 +2
[1] 孟焕新 . 临床牙周病学[M]. 2版. 北京: 北京大学医学出版社, 2014: 267-291.
Meng HX. Clinical periodontology[M]. 2nd ed. Bei-jing: Peking University Medical Press, 2014: 267-291.
[2] Laleman I, Cortellini S, de Winter S, et al. Subgingival debridement: end point, methods and how often[J]. Periodontol 2000, 2017,75(1):189-204.
doi: 10.1111/prd.12204
[3] Newman MG, Takei HH, Klokkevold PR , et al. Carranza's clinical periodontology[M]. 12th ed. St. Louis: Elsevier Saunders, 2015: 506. e7.
[4] Apatzidou DA . Modern approaches to non-surgical biofilm management[M] //Frontiers of Oral Biology. Basel: Karger, 2011: 99-116.
[5] 孙卫斌 . 根面平整术的新进展[J]. 国外医学(口腔医学分册), 1994,21(4):196-199.
Sun WB . New progress in root planing[J]. Foreign Med Sci (Stomatol), 1994,21(4):196-199.
[6] Aleo JJ, De Renzis FA, Farber PA , et al. The pre-sence and biologic activity of cementum-bound endotoxin[J]. J Periodontol, 1974,45(9):672-675.
[7] Aleo JJ, De Renzis FA, Farber PA . In vitro attachment of human gingival fibroblasts to root surfaces[J]. J Periodontol, 1975,46(11):639-645.
[8] Jones WA, O'Leary TJ. The effectiveness of in vivo root planing in removing bacterial endotoxin from the roots of periodontally involved teeth[J]. J Perio-dontol, 1978,49(7):337-342.
[9] Assad DA, Dunlap RM, Weinberg SR , et al. Biolo-gic preparation of diseased root surfaces[J]. J Perio-dontol, 1987,58(1):30-33.
[10] O'Leary TJ . The impact of research on scaling and root planing[J]. J Periodontol, 1986,57(2):69-75.
doi: 10.1902/jop.1986.57.2.69 pmid: 3514839
[11] Daly CG, Seymour GJ, Kieser JB . Bacterial endotoxin: a role in chronic inflammatory periodontal disease[J]. J Oral Pathol Med, 1980,9(1):1-15.
[12] Nakib NM, Bissada NF, Simmelink JW , et al. Endotoxin penetration into root cementum of periodontally healthy and diseased human teeth[J]. J Periodontol, 1982,53(6):368-378.
pmid: 7050340
[13] Hughes FJ, Smales FC . Immunohistochemical investigation of the presence and distribution of cementum-associated lipopolysaccharides in periodontal disease[J]. J Periodontal Res, 1986,21(6):660-667.
pmid: 2947999
[14] Hughes FJ, Auger DW, Smales FC . Investigation of the distribution of cementum-associated lipopolysaccharides in periodontal disease by scanning electron microscope immunohistochemistry[J]. J Periodontal Res, 1988,23(2):100-106.
[15] Hughes FJ, Smales FC . The distribution and quantitation of cementum-bound lipopolysaccharide on pe-riodontally diseased root surfaces of human teeth[J]. Arch Oral Biol, 1990,35(4):295-299.
pmid: 2378584
[16] Smart GJ, Wilson M, Davies EH , et al. The assessment of ultrasonic root surface debridement by determination of residual endotoxin levels[J]. J Clin Periodontol, 1990,17(3):174-178.
pmid: 2180992
[17] 耿素芳, 徐莉, 曹采方 , 等. 手工和超声波龈下刮治的临床疗效及图像分析[J]. 上海口腔医学, 1992, 1(2): 73-76, 129-130.
Geng SF, Xu L, Cao CF , et al. Clinical evaluation of manual and ultrasonic subgingival scaling using image analysis[J]. Shanghai J Stomatol, 1992, 1(2): 73-76, 129-130.
[18] Tunkel J, Heinecke A, Flemmig TF . A systematic review of efficacy of machine-driven and manual subgingival debridement in the treatment of chronic periodontitis[J]. J Clin Periodontol, 2002,29(Suppl 3):72-81.
[19] Walmsley AD, Lea SC, Landini G , et al. Advances in power driven pocket/root instrumentation[J]. J Clin Periodontol, 2008,35(8 suppl):22-28.
[20] Ioannou I, Dimitriadis N, Papadimitriou K , et al. Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis: a randomi-zed clinical and microbiological trial[J]. J Clin Perio-dontol, 2009,36(2):132-141.
[21] Krishna R, de Stefano JA . Ultrasonic vs. hand instrumentation in periodontal therapy: clinical outcomes[J]. Periodontol 2000, 2016,71(1):113-127.
[22] Needleman I, Nibali L, di Iorio A. Professional mechanical plaque removal for prevention of periodontal diseases in adults‒systematic review update[J]. J Clin Periodontol, 2015,42:S12-S35.
doi: 10.1111/jcpe.12341
[23] 高小芳, 梁妍 . 单独龈下超声刮治与结合人工刮治两种方法的临床效果比较[J]. 口腔材料器械杂志, 2012,21(3):137-139.
Gao XF, Liang Y . Clinical evaluation of using subgingival ultrasonic scaling and combined with hand scaling[J]. Chin J Dent Mater Devices, 2012,21(3):137-139.
[24] 孙颖, 李璐 . 单独超声龈下刮治与合并手工刮治治疗根分叉病变的疗效比较[J]. 吉林医学, 2014,35(22):4886-4888.
Sun Y, Li L . Comparison of the effects of ultrasonic scaler solo and hand-ultrasonic simultaneous instru- mentation on furcation defects of molars[J]. Jilin Med J, 2014,35(22):4886-4888.
[25] Claffey N, Polyzois I, Ziaka P . An overview of nonsurgical and surgical therapy[J]. Periodontol 2000, 2004,36(1):35-44.
[26] Rohanizadeh R, LeGeros RZ. Ultrastructural study of calculus-enamel and calculus-root interfaces[J]. Arch Oral Biol, 2005,50(1):89-96.
doi: 10.1016/j.archoralbio.2004.07.001 pmid: 15598421
[27] Gellin RG, Miller MC, Javed T , et al. The effectiveness of the Titan-S sonic scaler versus curettes in the removal of subgingival calculus. A human surgical evaluation[J]. J Periodontol, 1986,57(11):672-680.
doi: 10.1902/jop.1986.57.11.672 pmid: 3550033
[28] Prakash S, Vastardis S, Marda P , et al. A comparison of root surface instrumentation using manual, ultrasonic and rotary instruments: an in vitro study using scanning electron microscopy[J]. Indian J Dent Res, 2012,23(2):164.
doi: 10.4103/0970-9290.100420 pmid: 22945704
[29] Oosterwaal PJM, Matee MI, Mikx FHM , et al. The effect of subgingival debridement with hand and ultrasonic instruments on the subgingival microflora[J]. J Clin Periodontol, 1987,14(9):528-533.
doi: 10.1111/j.1600-051x.1987.tb00995.x pmid: 3316297
[30] Christgau M, Männer T, Beuer S , et al. Periodontal healing after non-surgical therapy with a new ultrasonic device: a randomized controlled clinical trial[J]. J Clin Periodontol, 2007,34(2):137-147.
[31] Cadosch J, Zimmermann U, Ruppert M , et al. Root surface debridement and endotoxin removal[J]. J Periodontal Res, 2003,38(3):229-236.
doi: 10.1034/j.1600-0765.2003.00376.x pmid: 12753358
[32] Schmidlin PR, Beuchat M, Busslinger A , et al. Too- th substance loss resulting from mechanical, sonic and ultrasonic root instrumentation assessed by li-quid scintillation[J]. J Clin Periodontol, 2008,28(11):1058-1066.
doi: 10.1034/j.1600-051x.2001.281111.x pmid: 11686828
[33] Vastardis S, Yukna RA, Rice DA , et al. Root surface removal and resultant surface texture with diamond-coated ultrasonic inserts: an in vitro and SEM study[J]. J Clin Periodontol, 2005,32(5):467-473.
doi: 10.1111/j.1600-051X.2005.00705.x pmid: 15842261
[34] Aspriello SD, Piemontese M, Levrini L , et al. Ultramorphology of the root surface subsequent to hand-ultrasonic simultaneous instrumentation during non-surgical periodontal treatments: an in vitro study[J]. J Appl Oral Sci, 2011,19(1):74-81.
doi: 10.1590/s1678-77572011000100015 pmid: 21437474
[35] Busslinger A, Lampe K, Beuchat M , et al. A comparative in vitro study of a magnetostrictive and a piezoelectric ultrasonic scaling instrument[J]. J Clin Periodontol, 2001,28(7):642-649.
doi: 10.1034/j.1600-051x.2001.028007642.x pmid: 11422585
[36] Kawashima H, Sato S, Kishida M , et al. A comparison of root surface instrumentation using two piezoelectric ultrasonic scalers and a hand scaler in vivo[J]. J Periodontal Res, 2007,42(1):90-95.
doi: 10.1111/j.1600-0765.2006.00924.x pmid: 17214645
[37] Khosravi M, Bahrami ZS, Atabaki MSJ , et al. Comparative effectiveness of hand and ultrasonic instrumentations in root surface planing in vitro[J]. J Clin Periodontol, 2004,31(3):160-165.
pmid: 15016018
[38] Eick S, Bender P, Flury S , et al. In vitro evaluation of surface roughness, adhesion of periodontal ligament fibroblasts, and Streptococcus gordonii follo-wing root instrumentation with Gracey curettes and subsequent polishing with diamond-coated curettes[J]. Clin Oral Investig, 2013,17(2):397-404.
doi: 10.1007/s00784-012-0719-z pmid: 22526889
[39] Flemmig TF, Petersilka GJ, Mehl A , et al. Working parameters of a sonic scaler influencing root substance removal in vitro[J]. Clin Oral Investig, 1997,1(2):55-60.
doi: 10.1007/s007840050011 pmid: 9552818
[40] Flemmig TF, Petersilka GJ, Mehl A , et al. The effect of working parameters on root substance removal using a piezoelectric ultrasonic scaler in vitro[J]. J Clin Periodontol, 1998,25(2):158-163.
doi: 10.1111/cpe.1998.25.issue-2
[41] Zappa U, Smith B, Simona C , et al. Root substance removal by scaling and root planing[J]. J Periodontol, 1991,62(12):750-754.
doi: 10.1902/jop.1991.62.12.750 pmid: 1765938
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