Abstract:

Periodontitis is a chronic inflammatory disease that is initiated by bacteria. Pathogens and their virulence factors alter normal cellular metabolic activity and deteriorate periodontal microconditions. Owing to the complexity of tooth structure and the limitation of conventional treatment, we may not live up to all patients’ expectations, especially those with grade C and stage Ⅲ or Ⅳ periodontitis. With the advantages of bactericidal effects, high safety, inhibition of bacterial drug resistance and promotion of tissue healing, photodynamic therapy （PDT） seems to be an ideal technology in periodontal treatment. However, it cannot remove subgingival stones and still cannot replace mechanical treatment to preliminarily control periodontal inflammation. Therefore, near-infrared low-energy light combined with traditional photosensitizers is mostly used in clinical periodontal adjuvant treatment. In periodontal maintenance treatment on a regular basis, a single application can also reduce the sensitivity of patients and effectively control plaque, but its effect will be affected by the degree of periodontal inflammation, the concentration and type of photosensitizer, the energy of the light source, etc. With the further development of material science, the performance of photosensitizers to accelerate oxides and target bacteria will be optimized. In the future, parameters of PDT need to be designed in large-scale studies in accord with different stages and grades of periodontitis.

Key words: periodontitis, supportive periodontal therapy, dental plaque control, periodontal mechanical therapy, photodynamic therapy, light source, photosensitizer, oxygen, bactericidal

摘要：

牙周炎是一种以细菌为始动因素的慢性炎症性疾病,高危致病菌及其毒力因子可通过改变局部组织细胞正常的代谢活动打破牙周微环境的平衡,促进炎症的发生发展。研究表明,由于牙体解剖结构的复杂性和机械清创的局限性,C级或Ⅲ/Ⅳ期牙周炎患者仅行洁治术和刮治术不一定能达到预期的治疗效果。光动力疗法（photodynamic therapy,PDT）具有低毒性、高效杀菌、不引起细菌耐药性、利于组织愈合等优点,是一种可用于牙周菌斑控制的理想疗法。但是它无法清除龈下的结石,仍不能代替机械治疗来初步控制牙周的炎症,所以临床中多选用近红外低能量光配合传统光敏剂进行牙周辅助治疗。在定期进行牙周维护治疗时,单独应用可减轻患者的敏感程度,有效控制菌斑,但其效果会受到患者牙周炎症程度、光敏剂浓度和种类、光源能量大小等的影响。随着材料学研究的日趋深入,光敏剂的氧产物催生性能、靶向结合细菌性能及PDT的杀菌消炎性能也显著优化。同时,与不同分期、分级的牙周炎病情相匹配的PDT参数仍需进行长期、大样本的深入研究。

关键词: 牙周炎, 牙周维护治疗, 牙周菌斑控制, 牙周机械治疗, 光动力疗法, 光源, 光敏剂, 氧气, 杀菌