Faculty of Medicine, Department of Clinical Dentistry, University of Bergen, Aarstadveien 19, 5009, Bergen, Norway.
Faculty of Dentistry, Institute for Oral Biology, University of Oslo, Oslo, Norway.
BMC Oral Health. 2021 Jan 21;21(1):38. doi: 10.1186/s12903-021-01397-3.
Due to complex morphology and limited access, the cleaning of the furcation area is extremely challenging. Therefore, novel therapeutic approaches need to be tested to potentially overcome debridement limitations. The aim of the present prospective 12-month study was to compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.
Twenty patients with grade II mandibular molar furcation defects volunteered to enroll in this single-centre, examiner masked, randomized controlled trial. In a split-mouth study design, two furcation sites in each patient were randomly assigned to either receive subgingival debridement using erythritol air-polishing (test) or conventional ultrasonic/curette debridement (control) at baseline, and at 3, 6, 9 and 12 months. Probing depth, clinical attachment level and bleeding on probing were recorded at 3-month intervals. Subgingival microbiological samples obtained at baseline, 6 and 12 months were analyzed using checkerboard DNA-DNA hybridization. Discomfort from treatment was scored at 12 months using a visual analogue scale. The differences between treatments, and time-points, were tested using multilevel analysis (mixed effect models and robust variance estimates).
A significant reduction in probing depth took place following both treatments (p < 0.001). Control sites experienced a significant mean gain in clinical attachment level of 0.5 mm (± 0.2) (p = 0.004), whereas a non-significant gain of 0.4 mm (± 0.3) was observed at test sites (p = 0.119). At 6 months, a significant between-treatment difference of 0.8 mm (± 0.4) was observed in favor of the control (p = 0.032). No significant between-treatment differences were observed in microbial load or composition. Notably, at 12 months patients experienced significantly less discomfort following air-polishing compared with control (p = 0.001).
The 12-month observations indicate that erythritol air-polishing and conventional mechanical debridement both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favour of control debridement at 6 months. In terms of patient comfort, erythritol air-polishing is superior.
The clinical trial was retrospectively registered in ClinicalTrial.gov with registration NCT04493398 (07/28/2020).
由于解剖形态复杂，操作空间有限，分叉区的清洁极具挑战性。因此，需要测试新的治疗方法来克服清创的局限性。本前瞻性 12 个月研究的目的是比较牙周维护患者中，使用赤藓糖醇喷砂与传统机械清创治疗分叉缺损的临床和微生物学效果。
20 名下颌磨牙二级分叉缺损患者自愿参加这项单中心、检查者盲法、随机对照试验。在一项分侧研究设计中，每位患者的两个分叉区随机接受以下两种治疗：基线时使用赤藓糖醇喷砂（试验组）或传统超声/刮治（对照组）进行龈下清创，然后在 3、6、9 和 12 个月时进行。每隔 3 个月记录探诊深度、临床附着水平和探诊出血。在基线、6 和 12 个月时采集龈下微生物样本，使用斑点杂交 DNA-DNA 杂交技术进行分析。使用视觉模拟评分法在 12 个月时对治疗引起的不适进行评分。使用多水平分析（混合效应模型和稳健方差估计）检验治疗方法之间以及各时间点之间的差异。
两种治疗方法均显著降低了探诊深度（p<0.001）。对照组的临床附着水平平均增加了 0.5 毫米（±0.2）（p=0.004），而试验组的增加量无统计学意义，为 0.4 毫米（±0.3）（p=0.119）。6 个月时，对照组的治疗效果显著优于试验组，差异为 0.8 毫米（±0.4）（p=0.032）。两种治疗方法在微生物负荷或组成方面无显著差异。值得注意的是，12 个月时，患者接受喷砂治疗后的不适感明显低于对照组（p=0.001）。
12 个月的观察结果表明，赤藓糖醇喷砂和传统机械清创均能支持临床改善。然而，在 6 个月时，检测到对照组在临床附着水平方面的治疗效果显著优于试验组。就患者舒适度而言，赤藓糖醇喷砂优于传统机械清创。
该临床试验在 ClinicalTrial.gov 上进行了回顾性注册，注册号为 NCT04493398（2020 年 7 月 28 日）。
