【摘要】 目的 评估Er,Cr:YSGG激光辅助治疗种植体周炎(peri-implantitis,PI)的临床疗效，初步探索种植体周炎治疗前后炎症因子的水平差异。方法 本研究选取种植体周炎患者19例，共22颗种植体，随机分为3组。SRP组采用钛刮治器进行机械清创; SRPL1组采用钛刮治器进行机械清创后，使用1.5 W Er,Cr:YSGG激光进行辅助治疗; SRPL2组采用钛刮治器进行机械清创后，使用2.0 W Er,Cr:YSGG激光进行辅助治疗。术前和术后1、3个月分别记录并比较3组种植体周临床指标，包括探诊深度(probing depth,PD)、改良龈沟出血指数(modified sulcus bleeding index,m SBI)、改良菌斑指数(modified plaque index,m PLI);同时收集种植体周围龈沟液，ELISA检测炎症因子白介素(interleukin,IL)-17、血管内皮生长因子(vascular endothelial growth factor,VEGF)、IL-1ra表达水平，并分析临床指标及炎症因子的相关性;术后2 h通过视觉模拟量表(visual analogue scale,VAS)记录受试者疼痛程度。结果 3组术后PD和m SBI均较术前明显改善(P<0.05),m PLI无明显改善，且组间差异无统计学意义(P>0.05);术后1个月，SRPL1组、SRPL2组PD、m SBI均明显低于SRP组(P<0.05)，但SRPL1组、SRPL2组间差异无统计学意义(P>0.05);术后3个月，与SRP组相比，SRPL1组、SRPL2组仅PD明显降低(P<0.05),2组间差异无统计学意义(P>0.05)。术后1、3个月，3组IL-17和VEGF水平较术前明显下降(P<0.05),IL-1ra水平明显上升(P<0.05);术后1个月，与SRP组相比，SRPL1组、SRPL2组IL-17和VEGF水平明显下降(P<0.05),IL-1ra水平明显上升(P<0.05);术后3个月，3组间差异无统计学意义(P>0.05)。各组中IL-17、VEGF与PD均呈正相关(P<0.05),IL-1ra与PD、m SBI均呈负相关(P<0.05)。SRP组VAS评分明显高于SRPL1组、SRPL2组(P<0.05)。结论 Er,Cr:YSGG激光辅助SRP治疗种植体周炎在改善临床指标、调控炎症因子水平和减轻术后疼痛方面表现优异，种植体周围龈沟液中IL-17、VEGF和IL-1ra水平可为种植体周炎的疗效评价提供有效信息。更多还原

【Abstract】 Objective To evaluate the clinical efficacy of Er,Cr: YSGG laser-assisted treatment for peri-implantitis( PI) and to preliminarily explore the differences in the levels of inflammatory factors before and after treatment. Methods This study included 19 patients with peri-implantitis,involving a total of 22 implants,which were randomly divided into three groups. The SRP group received subgingival debridement with a titanium scaler; the SRPL1 group underwent subgingival debridement followed by 1.5 W Er,Cr: YSGG laser-assisted treatment; and the SRPL2 group received subgingival debridement followed by 2.0 W Er,Cr: YSGG laser-assisted treatment. Clinical parameters,including probing depth( PD),modified sulcus bleeding index( m SBI),and modified plaque index( m PLI),were recorded and compared before treatment and 1 and 3 months post-treatment. Peri-implant sulcular fluid was collected for ELISA detection of inflammatory factors,including interleukin( IL)-17,vascular endothelial growth factor( VEGF),and IL-1 ra,and the correlations between clinical parameters and inflammatory factors were analyzed. Pain levels were recorded using the visual analogue scale( VAS) at 2 h after treatment. Results All three groups showed significant improvement in PD and m SBI at post-treatment compared to pre-treatment values( P<0.05). However,there was no significant improvement in m PLI,and no differences were observed among the groups( P>0.05). At 1 month post-treatment,both the SRPL1 and SRPL2 groups had significantly lower PD and m SBI values than the SRP group( P < 0. 05),but no statistically significant difference was found between the SRPL1 and SRPL2 groups( P >0.05). At 3 months post-treatment,only PD was significantly lower in the SRPL1 and SRPL2 groups compared to the SRP group( P<0.05).No significant difference was observed between the two groups( P >0.05). One and three months post-treatment,IL-17 and VEGF levels were significantly reduced( P < 0. 05). At 1 month post-treatment,compared to the SRP group,the SRPL1 and SRPL2 groups showed a significant decrease in IL-17 and VEGF levels( P < 0.05) and a significant increase in IL-1 ra levels( P < 0. 05). At 3 months posttreatment,no significant differences were observed among the three groups( P> 0.05). PD were positively correlated with IL-17 and VEGF( P<0.05),while IL-1 ra was negatively correlated with PD and m SBI( P>0.05). The VAS scores were significantly higher in the SRP group compared to the SRPL1 and SRPL2 groups( P< 0.05). Conclusion Er,Cr: YSGG laser-assisted SRP treatment for peri-implantitis demonstrates excellent clinical outcomes,including improvements in clinical parameters,regulation of inflammatory factor levels,and reduced postoperative pain. The levels of IL-17,VEGF,and IL-1 ra in peri-implant sulcular fluid can provide valuable information for the diagnosis,treatment,and evaluation of peri-implantitis.更多还原