| ObjectiveTo irradiate the early peri-implantitis teeth with different energy of Er:YAG laser,and to compare the improvement of clinical symptoms of dental teeth with minocycline hydrochloride,and after irradiating with different energy of Er:YAG laser,the changes of bacterial content in gingival crevicular fluid.To clear and definite the clinical efficacy of Er:YAG laser with different energy for early peri-implantitis teeth and the sterilization ability of anaerobic bacteria in gingival crevicular fluid which in such teeth.In order to provide a certain reference for dentist to use Er:YAG laser while how to set the right parameters around implants.Methods1.Clinical study During November 2017 to February 2019,90 patients(51 males and 39 females,aged 24-69 years old)with early peri-implantitis were selected from 585 patients who underwent oral implantology and prosthodontia in the Department of Stomatology of the First Affiliated Hospital of the Medical College,Shihezi University in the past ten years,all of them were posterior teeth.Random number table method was used to divide A,B,C,D into four groups,of which the experimental groups A,B,C were respectively 40 mJ group,60 mJ group,80 mJ group;Group D for the minocycline hydrochloride which was the control one.Before the operation,record the baseline value for each group: Plaque Index(PLI),Bleeding Index(BI),Probing Depth(PD),bone Defect Depth(DD).Then all patients were treated with supragingival gum and subgingival shaving.The experimental groups respectively used Er:YAG lasers of 40 mJ,60mJ,and 80mJ(Fotona,Germany,R14 hand tool,SP mode,20 Hz,water 8,gas 4)into the pocket around the implant by vertically,near the bottom of the gingival gum pocket about 1mm,irradiating following the buccal side and the lingual side around the implant crown in pull-up way for 60 s.Keep the spot moving at the same speed as much as possible.The parameter was set in accordance with the appropriate range recommended by the manufacturer’s instructions.During the operation,the visual analgue scale score(VAS)was used to record the pain of patients.In the control group,minocycline hydrochloride was smoothly and evenly injected into the deep implant periodontal pocket,which effectively wrapping around the implant by the drug,stopped when the drug slightly overflowed,and mouthwash,drinking and eating were not allowed within 30 minutes after injecting the medication.All operations were performed by the same physician.Each group was treated once / week,3 times as a course of treatment.After treatment,the clinical indexes of each group at the first week,the fourth week,the eighth week,and the twelfth week were recorded and compared with the baseline indicators.Compared the clinical efficacy of each group at the eighth week.The inspection site of the periimplantitis teeth at every reviewed back was the same one as which in the baseline tooth.2.Bacterial research Gingival crevicular fluid extraction: Collect all the gingival crevicular fluid of the four groups named A,B,C,D before clinical operation and the experimental group after irradiation with different energy of Er:YAG laser,and the control group after subgingival plastic shaving by hand to incubate the anaerobic bacteria at the constant temperature for three days.Recorded the total number of anaerobi bacterial count after incubating.Results1.Comparison the values of PLI and BI in each group: values of PLI and BI showed a downward trend during treatment,and there were no difference in the improvement of PLI between different periods for different groups;the improvement values of BI in different periods between groups were different(P<0.05),and at the first week,which in group C were superior to those in groups A,B,and D,which in group B were superior to those in groups A and D,and there were no significant difference between group A and group D;at the 4th week,which in group C were superior to those in group A,B,D,and those in group A,B,D had no difference;at the 8th week,which in group C were superior to those in group A,B,and D,group A and D had no difference,which in group B were better than those in group D;at the 12 th week,which in group C were superior to those in group B and group A and group D.2.Comparison the values of PD and DD in each group: At the first week,those in group B,C,and D were better than that in Group A(P<0.05).At the 4th,8th and 12 th week,the effect of group B and C were better than those in group A and D(P<0.05).The difference was statistically significant at the 12 th week between four groups(P<0.05),And the effect of group B and C was better than that in group A and D(P<0.05).3.Evaluation for intraoperative VAS pain: The difference between group A,B,and C was statistically significant(P<0.05).Among them,the pain degree of VAS in group C was higher than that in group A and B.4.Comparison of curative effect at the 8th week: The curative effect between the groups at the 8th week has no statistically significant(P<0.05).5.Comparison of bacterial contents before and after treatment in each group: The results before and after treatment in each groupwere statistically different(P <0.05).Among them,the results in group B were higher than those in group C,but lower than those in group A.Conclusion1.Within range for 40mJ-80 mJ,by the higher energy,Er:YAG laser can improve the clinical index for PLI but has no difference with four groups.The great effect,the higher energy for improving BI and PD.But Er:YAG’s energy of 60 mJ and 80 mJ have an advantage over for improving DD.However,there is no significant difference in the total clinical effectiveness for Er:YAG laser with different energy parameters on early peri-implantitis at the 8th week.2.Within range for 40mJ-80 mJ,the higher the energy,the better the sterilization effect.While,the subjective discomfort of patients is more obvious during the irradiation,but all were within the range of slight pain,which patients can tolerate. |
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