Objective: To compare the clinical efficacy of combined application of glycine powder air-polishing and mechanical submucosal debridement in non-surgical treatment of peri-implant diseases.
Methods: A randomized controlled clinical study was carried out on patients diagnosed with peri-implant diseases in the Department of Periodontology, Peking University School and Hospital of Stomatology, between May of 2020 and June of 2021.Twenty-eight patients with totally sixty-two implants were enrolled.The patients were randomly divided into the test group and control group. The patients in the test group (13 subjects/32 implants) received mechanical submucosal debridement using titanium curettes combined with application of glycine powder air-polishing, while the control group (15 subjects/30 implants) received mechanical submucosal debridement using titanium only. Clinical parameters, such as plaque index (PLI), pocket probing depth (PPD), bleeding index (BI) and the percentage of suppuration on probing on implants' level (SoP%) were measured at baseline and 8 weeks after non-surgical intervention. Changes and group differences of clinical parameters of the implants before and 8 weeks after non-surgical intervention were compared.
Results: Mean PLI, PPD, BI of both the test group and control group significantly reduced 8 weeks after non-surgical intervention (P < 0.05). Compared with the control group, the test group achieved lower BI (2.7±0.8 vs. 2.2±0.7, P < 0.05), more reduction of BI (0.6±0.7 vs. 1.1±0.6, P < 0.01) and more reduction of SoP% (21.9% vs. 10%, P < 0.05) after non-surgical intervention. Both the control and test groups exhibited comparable PLI and PPD reductions (P>0.05). For the implants diagnosed with peri-implant mucositis, the test group revealed more signi-ficant reduction in BI and SoP% than the control group (1.0±0.7 vs. 0.4±0.7, P=0.02; 6.3% vs. 0, P=0.012). There was no significant difference existing in PLI and PD improvement between the control group and test group (P>0.05). For the implants diagnosed with peri-implantitis, there was no significant difference existing in PLI, PPD, BI and SoP% improvement values between the test and control groups (P>0.05). No complications or discomforts were reported during the study.
Conclusion: Both treatment procedures could relieve the inflammation of peri-implant soft tissue. Non-surgical mechanical submucosal debridement combined application of glycine powder air-polishing is associated with significant reduction of soft tissue bleeding and suppuration on probing especially in the implants diagnosed with peri-implant mucositis.
目的: 比较单纯手工黏膜下刮治与联合应用甘氨酸粉喷砂在非手术治疗种植体周病中的临床疗效。
方法: 本研究为随机临床对照研究，研究对象为2020年5月至2021年6月就诊于北京大学口腔医院牙周科的种植体周病患者。共纳入28例患者的62颗种植体，采用随机数字表法将患者随机分为试验组和对照组，其中试验组(13例/32颗种植体)采用钛刮治器行黏膜下刮治联合应用甘氨酸粉喷砂治疗，对照组(15例/30颗种植体)单纯使用钛刮治器行黏膜下刮治。分别记录基线期和治疗后8周种植体周探诊深度(peri-implant probing depth，PPD)、出血指数(bleeding index，BI)、菌斑指数(plaque index，PLI)和探诊溢脓种植体占该组总种植体数目的百分比(suppuration on probing %，SoP%)，比较治疗前后种植体周临床指标的变化及治疗后组间差异。
结果: 治疗后8周两组种植体的平均PLI、PPD、BI均下降，差异具有统计学意义(P＜0.05)。与对照组相比，治疗后试验组BI更低(2.7±0.8 vs. 2.2±0.7，P＜0.05)，BI改善值更大(0.6±0.7 vs. 1.1±0.6，P＜0.01)，SoP%降低更多(21.9% vs. 10.0%, P＜0.05)，差异均具有统计学意义。其中罹患种植体周黏膜炎的种植体，试验组BI及SoP%改善值大于对照组(1.0±0.7 vs. 0.4±0.7，P=0.02；6.3% vs. 0，P=0.012)，差异具有统计学意义，而两组间PLI和PPD改善值差异均无统计学意义(P＞0.05)。罹患种植体周炎的种植体，两组间PLI、PPD、BI及SoP%改善值差异均无统计学意义(P＞0.05)。
结论: 联合应用甘氨酸粉喷砂和单纯手工黏膜下刮治均可改善种植体周软组织炎症，而前者在改善种植体周软组织出血及探诊溢脓，特别是罹患种植体周黏膜炎的效果方面更佳。
Keywords: Dental polishing; Glycine; Peri-implant mucositis; Peri-implantitis; Powders.