复方氯己定含漱液与西吡氯铵含片和西帕依固龈液预防种植体植入后早期感染的疗效

Curative effect of compound gargle solution chlorhexidine giuconatie, cetylpyridinium chloride buccal tablets and Xipayi mouth rinse in prevention of early infection after implant implantation

  • 摘要: 目的 分析复方氯己定含漱液与西吡氯铵含片和西帕依固龈液预防种植体植入后早期感染的临床价值。方法 选择2017年2月-2018年1月浙江萧山医院收治的200例择期行种植手术的患者随机分为A、B、C、D组每组50例,A组种植术后常规应用生理盐水漱口7 d,B、C、D组术后分别应用复方氯己定含漱液、西吡氯铵含片、西帕依固龈液持续7 d,统计各组术后早期细菌培养情况,术后次日采用视觉模拟评分法(Visual analogue scale,VAS)评定患者口腔疼痛程度,并测定术后7 d各组牙周指数情况及伤口愈合情况,术后4周评定各组种植效果,术前、术后4周均采集患者种植体周围龈沟液,测定骨桥蛋白(osteopontin,OPN)、碱性磷酸酶(alkaline phosphatase,ALP)水平。结果 四组患者龈下菌斑专性厌氧菌计数、术后VAS评分比较差异有统计学意义(P<0.05),B、C、D组专性厌氧菌计数低于A组(P<0.05),VAS评分无痛分别占34.00%、40.00%、54.00%高于A组的0(P<0.05);四组患者术后1周改良菌斑指数(modified plaque index,mPLI)比较差异有统计学意义(P<0.001),B、C、D组mPLI分别为(0.61±0.51)、(0.60±0.48)、(0.58±0.51)分低于A组(1.26±0.42)分(P<0.05);四组术后1周伤口愈合分级比较差异有统计学意义,B、C、D组术后伤口愈合效果优于A组(P<0.05),B、C、D组愈合良好所占比例分别为74.00%、80.00%、86.00%均高于A组32.00%(P<0.05);术后4周,四组OPN、ALP比较差异有统计学意义(P<0.05),B、C、D组上述指标分别为(0.51±0.09)、(226.53±18.71)pg/ml;(0.52±0.08)、(220.72±20.51)pg/ml和(0.51±0.10)、(221.92±21.53)pg/ml均低于A组(0.79±0.04)、(405.23±42.53)pg/ml(P<0.05);四组种植成功率分别为98.00%、100.00%、100.00%、100.00%,差异无统计学意义(P=0.392)。结论 复方氯己定含漱液、西吡氯铵含片、西帕依固龈液均可有效预防种植体植入后早期感染,有助于减轻患者术后口腔疼痛,促进伤口愈合,改善牙周指数,减轻种植体周围炎症。

     

    Abstract: OBJECTIVE To analyze the clinical value of compound gargle solution chlorhexidine giuconatie, cetylpyridinium chloride buccal tablets and Xipayi mouth rinse in the prevention of early infection after implant implantation.METHODS A total of 200 patients undergoing elective implantation during the period from Feb. 2017 to Jan. 2018 were randomly divided into four groups(A, B, C and D), with 50 cases in each group. Group A rinsed the mouth with normal saline for 7 days after surgery while group B, C and D rinsed the mouth with compound gargle solution chlorhexidine giuconatie, cetylpyridinium chloride buccal tablets and Xipayi mouth rinse for 7 days, respectively. Early bacterial culture in each group after surgery was analyzed. The degree of oral pain was assessed by visual analogue scale(VAS) on the next day after surgery. The periodontal index and wound healing in each group were measured on day 7 after surgery. The effects of implantation in each group were evaluated at 4 weeks after surgery. The gingival crevicular fluid around the implant was collected before surgery and at 4 weeks after surgery to determine the levels of osteopontin(OPN) and alkaline phosphatase(ALP).RESULTS There were significant differences in subgingival obligate anaerobes counts and postoperative VAS scores among the four groups(P<0.05). The obligate anaerobes counts in group B, C and D were significantly lower than that in group A(P<0.05). The proportions of VAS score-painless(34.00%, 40.00%, 54.00%) were significantly higher than those in group A(0)(P<0.05). There were significant differences in modified plaque index(mPLI) among the four groups at 1 week after surgery(P<0.001). The mPLI in group B, C or D (0.61±0.51),(0.60±0.48),(0.58±0.51) was significantly lower than that in group A (1.26±0.42)(P<0.05). There were significant differences in wound healing grade among the four groups at 1 week after surgery. The wound healing effect of group B, C and D was significantly better than that of group A(P<0.05). The proportions of good wound healing in group B, C or D(74.00%, 80.00%, 86.00%) was significantly higher than that in group A(32.00%)(P<0.05). There were significant differences in OPN and ALP among the four groups at 4 weeks after surgery(P<0.05), and the above indexes in group B (0.51±0.09),(226.53±18.71) pg/ml, C(0.52±0.08),(220.72±20.51) pg/ml and D(0.51±0.10),(221.92±21.53) pg/ml were significantly lower than those in group A (0.79±0.04),(405.23±42.53)(P<0.05). There was no significant difference in the success rates of implantation among the four groups(98.00%, 100.00%, 100.00%, 100.00%)(P=0.392).CONCLUSION Compound gargle solution chlorhexidine giuconatie, cetylpyridinium chloride buccal tablets and Xipayi mouth rinse can all effectively prevent early infection after implant implantation, which helps to relieve postoperative oral pain, promote wound healing, improve periodontal index and relieve inflammation around the implant.

     

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