Genius激光与传统手术治疗牙龈增生的临床疗效的对比研究

发布时间：2018-05-07 12:04

本文选题：创口愈合 + 细胞因子　；参考：《重庆医科大学》2017年硕士论文

【摘要】：背景:牙龈增生是牙周疾病常见的临床特征之一,可由菌斑生物膜或其它因素引起。临床上,牙龈增生经牙周基础治疗后通常采取手术治疗。传统的手术治疗包括采用手术刀和电刀进行牙龈切除术、成形术,但存在术后术区肿胀、舒适度欠佳、影响咀嚼说话等缺点。激光作为一种新的治疗手段,具有手术视野清晰、术中术后止血效果好、术后舒适度较高等优点,已在医学领域开展运用,并已有大量研究报道。Genius激光,又称水冷型Nd:YAG激光,已运用于牙龈切除、成形术等牙周软组织手术。激光照射牙周组织,无论激光波长的长短,均可影响GCF及其所含的细胞因子的浓度水平,以及被照射组织的愈合速度。GCF中含有大量与疾病活动相关的细胞和生化分子,如中性粒细胞、抗体、补体蛋白、细胞因子等。生化分析GCF是判断牙周有无炎性反应的重要手段之一。GCF中的细胞因子由活化的免疫细胞和某些基质细胞分泌,其主要功能为介导和调节免疫及炎症反应。其中,IL-8、IL-1β水平与牙周病的严重程度呈正相关,也可作为监测牙周翻瓣术后伤口愈合的重要指标。TGF-β1是重要的抗炎因子之一,并且在伤口愈合中起重要的作用。MMP-8是组织发生炎症最早开始变化的生化指标。目的:本研究旨在研究Genius激光与传统的手术刀、电刀行牙龈切除术、牙龈成形术相比,短期内患者术后创口的炎症反应、创口愈合速度及舒适度的区别,为临床医生的选择提供一定的理论指导依据。方法:本实验一共收集43名患者,共计270颗前牙,进行随机分口自身对照实验(a randomized controlled clinical trial with split-mouth design),分为激光组、手术刀组和电刀组,每组分别含有95颗、95颗和80颗牙。分别收集术前、术后一周和术后两周GCF,并测定GCF的量以及GCF中IL-8、IL-β1、MMP-8和TGF-β1表达水平。同时,术后一周内回访三组的疼痛度(“VAS”分值表),以及是否出血的情况。结果:激光组术后一周和术后两周的GCF的量和GCF中IL-1β、MMP-8水平,较手术刀组和电刀组低(P0.05,P0.05;P0.05,P0.01;P0.05,P0.05),且差异具有统计学意义。激光组术后一周GCF中IL-8和TGF-β1的水平较手术刀组和电刀组均低(P0.05,P0.05),且差异具有统计学意义,术后两周,二组无明显差异(P0.05,P0.05)。在术后7天的回访中,激光组的疼痛值在术后三天内显著低于手术刀组和电刀组(P0.05),差异具有统计学意义,术后第4天到第7天无明显差异(P0.05)。手术刀组在术后第一天有3例患者术后出血,其余两组未见。结论:研究结果表明与传统手术方式相比,Genius激光行牙周软组织手术具有术后创口炎性反应低、创口愈合较快、舒适度高等优点,可以作为临床医师的优选方案。
[Abstract]:Background: gingival hyperplasia is one of the common clinical features of periodontal diseases, which can be caused by plaque biofilm or other factors. Clinically, gingival hyperplasia is usually treated surgically after periodontal basic treatment. The traditional surgical treatment includes gingivectomy with scalpel and electric knife, but there are some shortcomings such as swelling of operation area, poor comfort and influence on chewing and speaking. As a new treatment method, laser has many advantages, such as clear operation visual field, good hemostatic effect after operation and high postoperative comfort. It has been widely used in medical field, and has been widely reported. Genius laser, also called water-cooled Nd:YAG laser, has been widely used in the field of medicine. Has been used in gingival resection, plastic surgery and other periodontal soft tissue surgery. Laser irradiation of periodontal tissue, regardless of the length of the laser wavelength, can affect the concentration of GCF and its cytokines, and the healing rate of irradiated tissue. GCF contains a large number of cells and biochemical molecules associated with disease activity. Such as neutrophil, antibody, complement protein, cytokine and so on. Biochemical analysis of GCF is one of the important means of judging periodontal inflammatory response. Cytokines are secreted by activated immune cells and some stromal cells. Its main function is to mediate and regulate the immune and inflammatory responses. The level of IL-8 and IL-1 尾 was positively correlated with the severity of periodontal disease, and could also be used as an important index to monitor wound healing after periodontal flap flap. TGF- 尾 1 was one of the important anti-inflammatory factors. And it plays an important role in wound healing. MMP-8 is the earliest biochemical indicator of tissue inflammation. Objective: the purpose of this study was to study the difference of inflammatory reaction, wound healing speed and comfort between Genius laser and conventional surgical scalpel, electrosurgical resection and gingival plasty. To provide a theoretical basis for the selection of clinicians. Methods: a total of 43 patients (270 anterior teeth) were randomly divided into three groups: laser group, scalpel group and electric scalpel group. Each group contained 95 teeth and 80 teeth. The levels of GCF, IL-8 and TGF- 尾 1 in GCF were measured before, one week and two weeks after operation, respectively. At the same time, the pain degree ("VAS" score) of the three groups was reviewed within one week after operation. Results: the quantity of GCF and the level of IL-1 尾 -MMP-8 in GCF in laser group were lower than those in scalpel group and electric scalpel group one week and two weeks after operation, and the difference was statistically significant. The levels of IL-8 and TGF- 尾 _ 1 in the laser group were lower than those in the scalpel group and the electric scalpel group one week after operation, and the difference was statistically significant. Two weeks after operation, there was no significant difference in IL-8 and TGF- 尾 _ 1 between the two groups. The pain value of the laser group was significantly lower than that of the scalpel group and the electric scalpel group within 3 days after operation, and the difference was statistically significant. There was no significant difference between the laser group and the electric scalpel group from the 4th to the 7th day after operation (P 0.05). Bleeding was found in 3 patients in the scalpel group on the first day after operation, but not in the other two groups. Conclusion: compared with the traditional operation, Genius laser has the advantages of lower inflammatory response, faster wound healing and higher comfort. It can be used as the best choice for clinicians.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.4

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