宋 旭　张 琼　罗纯锐

[關键词]牙周牙髓联合病变;奥硝唑碘仿糊剂;双波长激光;白细胞介素-1β;基质金属蛋白酶-8

[中图分类号]R781.33    [文献标志码]A    [文章编号]1008-6455（2021）12-0142-04

Effect of Dual-wavelength Laser-assisted Root Canal on Aesthetic Satisfaction and Serum Inflammatory Cytokines of Combined Periodontal and Pulpal Lesions

SONG Xu， ZHANG Qiong， LUO Chun-rui

（Department of Stomatology， Panzhihua Hospital of Integrated Traditional Chinese and Western Medicine，Panzhihua 617000，Sichuan，China）

Abstract： Objective To explore the effect of dual-wavelength laser combined with ornidazole iodoform paste assisted root canal on aesthetic satisfaction and serum inflammatory cytokines of combined periodontal and pulpal lesions. Methods  From October 2017 to December 2019， 106 patients with combined periodontal and pulpal lesions in our hospital were selected. They were divided into the research group and the control group by random number table， with 53 cases in each group. Both groups were given root canal treatment.On this basis， the control group was given ornidazole iodoform paste， and the research group was given dual-wavelength laser combined with ornidazole iodoform paste. Both were treated for 3 weeks. The pain degree at 1 day after root canal filling， the curative effect at 6 months after treatment， the condition of the teeth， and the aesthetic satisfaction， serum inflammatory cytokines [interleukin-1β（IL-1β），IL-17， matrix metalloproteinase-8 （MMP-8）] before and after treatment， periodontal clinical indicators [clinical attachment level （CAL）， probing depth （PD）， bleeding index （BI）， plaque index （PLI）] levels before treatment and 3 and 6 months after treatment were compared between the two groups. Results  The pain degree of the research group after 1 day of root canal filling was lower than that of the control group （P<0.05），the levels of serum IL-1β， IL-17 and MMP-8 in the research group after 3 weeks of treatment were lower than those in the control group （P<0.05）.The levels of CAL， PD， BI， and PLI in the research group were lower than those in the control group at 3 and 6 months after treatment （P<0.05）， the total effective rate of the study group at 6 months after treatment （90.57%） was higher than that of the control group （73.58%， P<0.05），The incidence of periodontitis， tooth percussion and loosening （7.55%， 9.43%， 5.66%） in the research group was lower than that in the control group （24.53%， 30.19%， 20.75%） （P<0.05）. The aesthetic satisfaction of the research group 6 months after treatment （90.57%） was higher than that of the control group （75.47%） （P<0.05）. Conclusion The dual-wavelength laser combined with ornidazole iodoform paste assisted root canal treatment of patients with combined periodontal and pulpal lesions can significantly reduce the degree of pain after root canal filling， and reduce the levels of serum IL-1β， IL-17 and MMP-8， improve the patients' periodontal health， significantly improve the treatment effect，and the patients' aesthetic satisfaction is high.

Key words： combined periodontal and pulpal lesions; ornidazole iodoform paste; dual-wavelength laser; interleukin-1β; matrix metalloproteinase-8

牙周牙髓联合病变为临床常见疾病，两者的感染和病变可以互相影响和扩散，导致联合病变的发生，严重影响患者口腔健康及生活质量[1-2]。根管治疗为临床缓解牙周牙髓联合病变的常用方法，奥硝唑碘仿糊剂为常用根管填充材料，抗炎、杀菌作用良好，可有效促进牙根尖组织修复，且奥硝唑碘仿糊剂永久充填不会发生因吸收导致根管治疗的长期稳定性下降[3]。近年文献研究显示，激光治疗产生具有一定抗菌、消炎作用，在牙科疾病治疗中的作用越来越受临床重视[4]。有报道指出，掺钕钇铝石榴石激光（Neodymium doped yttrium aluminumgarnet，Nd：YAG）适用于根管治疗，而掺铒钇铝石榴石激光（Erbium：yttrium aluminumgarner，Er：YAG）适用于牙周炎的治疗[5]。鉴于此，本研究将双波长激光配合奥硝唑碘仿糊剂辅助根管应用于牙周牙髓联合病变患者，从美观满意度及血清炎性因子表达等方向出发探究其临床效果，现报道如下。

1  资料和方法

1.1 一般资料：选取2017年10月-2019年12月笔者医院牙周牙髓联合病变患者106例为研究对象，采用随机数字表法分为研究组和对照组，每组53例。对比两组性别、年龄、体重、患牙位置、病变分级[6]、吸烟和饮酒情况，差异均无统计学意义（P>0.05），具有可比性。见表1。

1.2 纳入标准：①结合患者临床症状及X线片检查确诊为牙周牙髓联合病变;②年龄≤65岁;③首次接受治疗者;④对本研究药物无过敏者;⑤自主行为能力良好，能配合完成研究者;⑥患者知晓本研究，已签署同意书。……