Application Of Photo-activated Disinfection(PAD) In Subgingival Scaling And Root Planing

Objective: Use photo-activated disinfection technology(PAD) in patints with chronic periodontitis before and after subgingival scaling and rootplanning(SRP), to observe the curative effect of photo-activated disinfection technology in auxiliary treatment of chronic periodontitis.Method: According to the diagnostic criteria of chronic periodontitis presented by USA Periodontal Disease Classification Symposium in 1999, 40 outpatients of chronic periodontitis were selected randomly from Hebei Medical University oral medicine clinic, aged from 30 to 65 years old and average age was 42, 23 male and 17 female. After supragingival scaling, the selected patients were randomly divided into 4 groups: Group A: Simple SRP treatment; Group B: Using PAD before SRP treatment; Group C: Using PAD before and after SRP treatment; Group D: Using PAD after SRP treatment. In each stage, baseline(1 week after supragingival scaling,T1), 6 weeks after treatment(T2) and 12 weeks after treatment(T3), observe changes of following clinical indicators: PD(probing depth), BOP(bleeding on probing) and CAL(clinical attachment level). Randomly select two loci(PD≥5mm) from each patient, and detect the changes of Porphyromonas gingivalis(Pg) content relative to total bacteria in subgingival plaque and changes of Tumor Necrosis Factor-α(TNF-α) and Interleukin-1α(IL-1α) content in each group by using real-time PCR technology and ELISA. Analyze data with repeated measures analysis of variance by using SPSS21.0 software, compare data at different time points and between different groups respectively.Results:1 Clinical indicators: After treatment, gingival swelling almost disappeared, texture changed from soft to tough, the amount of bleeding decreased in four groups. Repeated measures analysis of variance showed that there were interaction at different time points and between groups(P<0.05), further analyze single effect. At the baseline, there was no statistically significant difference in PD, BOP, CAL among four groups(P>0.05). Compared with the baseline, there was statistically significant difference in PD, BOP, CAL in four groups 6 weeks and 12 weeks after treatment(P<0.05). 6 weeks and 12 weeks after treatment, no statistically significant difference in PD, CAL among four groups(P>0.05). 6 weeks and 12 weeks after treatment, BOP positive loci in Group A were significantly more than Group B, C, D(P<0.05), but no statistically significant differences among Group B, C, D(P>0.05).2 Pg content relative to total bacteria: Repeated measures analysis of variance showed that there were interaction at different time points and between groups(P<0.05), further analyze single effect. At baseline, there was no statistically significant difference in Pg content relative to total bacteria among four groups(P>0.05). Compared with the baseline, there was statistically significant difference in Pg content relative to total bacteria in four groups 6 weeks and 12 weeks after treatment(P<0.05). 6 weeks and 12 weeks after treatment, Pg content relative to total bacteria in Group B, C, D was significantly lower than Group A(P<0.05), Group C was significantly lower than Group B,D(P<0.05), and there was no statistically significant difference between group B, D(P>0.05).3 TNF-α and IL-1α content in gingival crevicular fluid: Repeated measures analysis of variance showed that there were interaction at different time points and between groups(P<0.05), further analyze single effect. At baseline, there was no statistically significant difference in TNF-α content in gingival crevicular fluid among four groups(P>0.05). Compared with the baseline, there was statistically significant difference in TNF-α content in gingival crevicular fluid in four groups 6 weeks and 12 weeks after treatment(P<0.05). 6 weeks and 12 weeks after treatment, TNF-α content in gingival crevicular fluid in Group B, C, D was significantly lower than Group A(P<0.05), while there was no statistically significant difference among Group B, C, D(P>0.05). 6 weeks after treatment, there was no statistically significant difference in IL-1α content in gingival crevicular fluid among four groups(P>0.05). 12 weeks after treatment, IL-1α content in gingival crevicular fluid in Group B, C, D was significantly lower than Group A(P<0.05), while there was no statistically significant difference among Group B, C, D(P>0.05).Conclusions:1 Simple SRP treatment and PAD-assisted SRP treatment of chronic periodontitis could both control infection and eliminate inflammation, but the latter had a better effect.2 PAD-assisted SRP treatment of chronic periodontitis is demonstrably superior to simple SRP treatment in killing Pg, but using PAD before and after SRP treatment works best.3 Simple SRP treatment and PAD-assisted SRP treatment of chronic periodontitis could both effectively reduce TNF-α and IL-1α content in gingival crevicular fluid, while the latter had a better effect.4 PAD has characteristics of simple operation, good safety performance, high efficient sterilization and so on, which make PAD available to assist SRP treatment of chronic periodontitis.