Bertl Kristina, Vlachou Stefania, Pandis Nikolaos, Zampelis Antonios, Stavropoulos Andreas
Department of Periodontology, Dental Clinic, Faculty of Medicine, Sigmund Freud University Vienna, Freudplatz 3, 1020, Vienna, Austria.
Department of Periodontology, Blekinge Hospital, Hälsovägen, Byggnad 13, 371 41, Karlskrona, Sweden.
Clin Oral Investig. 2024 Feb 20;28(2):158. doi: 10.1007/s00784-024-05505-9.
To assess the effect of hyaluronic acid (HyA) application as adjunct to re-instrumentation of residual pockets in patients undergoing regular supportive periodontal care (SPC).
Chronic periodontitis patients (stage III and IV, grade B and C) with 4 interproximal residual pockets were randomly assigned to the test (HyA gel) or control (saline) group. After subgingival instrumentation, test or control substance was applied subgingivally, then daily supragingivally for 3 months, and if required a second time after subgingival re-instrumentation after 3 months. Clinical and patient reported outcome parameters were recorded every 3 months for 12 months. Pocket closure [probing pocket depth (PPD) ≤ 4mm with absence of bleeding on probing (BoP) at PPD = 4mm] was the main outcome parameter.
Fifty-six patients (221 experimental sites) were analysed. Pocket closure was achieved in 56.8 and 46.6% of the experimental sites in the test and control group, respectively (p > 0.05), while median PPD and PPD distribution (< 5mm/5mm/ > 5mm) differed significantly between groups in favour of the test group, at 12 months. Further, significantly fewer sites in the HyA group required re-instrumentation at 3 months, and sites in the HyA group showed a tendency for lower odds to remain diseased compared to the control group (OR 0.48, 95%CI 0.22-1.06). The odds for a site to remain diseased after 12 months increased significantly in the presence of plaque (OR 7.94, 95%CI 4.12-15.28), but in general, decreased significantly over time (OR 0.48, 95%CI 0.28-0.81).
Re-instrumentation of residual pockets in SPC patients, per se, leads to a significant increase in pocket closure over time; this was impeded by poor plaque control. Repeated local application of HyA results in fewer sites requiring re-instrumentation and might slightly improve the rate of pocket closure. (clinicaltrials.gov registration nr. NCT04792541).
HyA gel is easy to apply, well accepted by patients, and may have some positive effect in terms of fewer sites requiring re-instrumentation at 3 months and higher pocket closure rate at 12 months.
评估透明质酸（HyA）作为辅助手段应用于接受定期支持性牙周治疗（SPC）患者的残余牙周袋再治疗的效果。
将有4个邻间残余牙周袋的慢性牙周炎患者（III期和IV期，B级和C级）随机分为试验组（HyA凝胶）或对照组（生理盐水）。在龈下器械治疗后，将试验组或对照组物质龈下应用，然后每天龈上应用3个月，若有需要，3个月后龈下再器械治疗后再次应用。在12个月内每3个月记录临床和患者报告的结局参数。牙周袋闭合[探诊牙周袋深度（PPD）≤4mm且PPD = 4mm时探诊无出血（BoP）]是主要结局参数。
分析了56例患者（221个试验部位）。试验组和对照组试验部位的牙周袋闭合率分别为56.8%和46.6%（p>0.05），而在12个月时，两组之间的PPD中位数和PPD分布（<5mm/5mm/>5mm）有显著差异，试验组更有利。此外，HyA组在3个月时需要再器械治疗的部位明显更少，与对照组相比，HyA组的部位患病几率有降低趋势（比值比0.48，95%置信区间0.22 - 1.06）。在有菌斑的情况下，一个部位在12个月后患病的几率显著增加（比值比7.94，95%置信区间4.12 - 15.28），但总体而言，随着时间推移显著降低（比值比0.48，95%置信区间0.28 - 0.81）。
SPC患者残余牙周袋的再器械治疗本身会随着时间推移显著提高牙周袋闭合率；这受到菌斑控制不佳的阻碍。重复局部应用HyA可减少需要再器械治疗的部位，并可能略微提高牙周袋闭合率。（clinicaltrials.gov注册号：NCT04792541）
HyA凝胶易于应用，患者接受度良好，在3个月时需要再器械治疗的部位更少以及12个月时牙周袋闭合率更高方面可能有一些积极作用。
