Liu C M, Hou L T, Wong M Y, Lan W H
Department of Periodontology, School of Dentistry, College of Medicine, National Taiwan University, ROC.
J Periodontol. 1999 Nov;70(11):1276-82. doi: 10.1902/jop.1999.70.11.1276.
The Nd:YAG laser has recently been used in the treatment of periodontal disease. However, although a clinical reduction of probing depth and gingival inflammation to this new approach has been reported, it has not been fully evaluated. Interleukin-1 beta (IL- 1beta), a potent stimulator of bone resorption, has been identified in gingival crevicular fluid (GCF), which is closely associated with periodontal destruction. The aim of this study was to compare the effects of Nd:YAG laser treatment versus scaling/root planing (SRP) treatment on crevicular IL-1beta levels in 52 sampled sites obtained from 8 periodontitis patients.
One or 2 periodontitis-affected sites with a 4 to 6 mm probing depth and horizontal bone loss from 3 adjacent single-root teeth in each of 4 separate quadrants were selected from patients for clinical documentation and IL-1beta assay. Sampling site(s) from each diseased quadrant was randomly assigned to one of the following groups: 1) subgingival laser treatment (20 pps, 150 mJ) only; 2) SRP only; 3) laser treatment first, followed by SRP 6 weeks later; or 4) SRP first, followed by laser therapy 6 weeks later. The GCF was collected and the amount of IL-1beta was assayed by enzyme-linked immunosorbent assay (ELISA). Clinical parameters and GCF were measured at baseline and biweekly after therapy for 12 weeks.
An obvious clinical improvement (marked decrease in the number of diseased sites with gingival index > or =2) and reduction of crevicular IL- 1beta were found in all groups. The level of IL- 1beta was significantly lower in the SRP group (P = 0.035) than in the laser therapy group for the duration of the 12 weeks. The laser combined SRP therapy group showed a further reduction of IL- 1beta (6 to 12 weeks after treatment) than either laser therapy alone or SRP combined laser therapy.
Our data suggest that laser therapy appeared to be less effective than traditional SRP treatment. Of the 4 treatment modalities, inclusion of SRP was found to have a superior IL- 1beta response, when compared to other therapies without it. In addition, no additional benefit was found when laser treatment was used secondary to traditional SRP therapy.
钕钇铝石榴石（Nd:YAG）激光最近已用于牙周疾病的治疗。然而，尽管已有报道称这种新方法可使探诊深度和牙龈炎症在临床上有所减轻，但尚未得到充分评估。白细胞介素-1β（IL-1β）是一种强效的骨吸收刺激因子，已在龈沟液（GCF）中被鉴定出来，而龈沟液与牙周破坏密切相关。本研究的目的是比较Nd:YAG激光治疗与龈上洁治/根面平整（SRP）治疗对8例牙周炎患者52个采样部位龈沟内IL-1β水平的影响。
从患者中选取4个不同象限中每个象限3颗相邻单根牙上1个或2个探诊深度为4至6mm且有水平骨吸收的牙周炎患牙部位，用于临床记录和IL-1β检测。每个患病象限的采样部位随机分配至以下组之一：1）仅龈下激光治疗（20次/秒，150毫焦）；2）仅SRP治疗；3）先进行激光治疗，6周后进行SRP治疗；或4）先进行SRP治疗，6周后进行激光治疗。收集龈沟液，采用酶联免疫吸附测定（ELISA）法检测IL-1β的含量。在基线时以及治疗后每两周测量12周的临床参数和龈沟液情况。
所有组均出现明显的临床改善（牙龈指数≥2的患病部位数量显著减少）以及龈沟内IL-1β水平降低。在12周的观察期内，SRP组的IL-1β水平显著低于激光治疗组（P = 0.035）。激光联合SRP治疗组在治疗后6至12周时IL-1β水平的降低幅度大于单独激光治疗组或SRP联合激光治疗组。
我们的数据表明激光治疗似乎不如传统的SRP治疗有效。在这4种治疗方式中，与未包含SRP的其他治疗方法相比，包含SRP的治疗方式对IL-1β的反应更佳。此外，在传统SRP治疗后再进行激光治疗未发现额外益处。
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