輔助性抗菌光動力治療於牙周炎非手術性治療之臨床成效：隨機分派臨床試驗

Adjunctive antimicrobial photodynamic therapy in the non-surgical treatment of periodontitis: A randomized clinical trial

陳悅安(Yueh-An Chen)

指導教授 ： 郭彥彬

共同指導教授 ： 杜裕康(Yu-Kang Tu)

國立臺灣大學/醫學院/臨床牙醫學研究所/碩士(2020年)

https://doi.org/10.6342/NTU202003505

摘要

台灣約有六成的人口受到牙周炎影響而逐步破壞牙周組織，結石清除與根面整平是牙周治療中必要的步驟之一，輔助性療法包含雷射的運用被使用在牙周炎的治療以達到進一步的療效。低能量雷射治療以及抗菌光動力治療都被證實能有效輔助非手術牙周炎的治療。本研究旨在觀察輔助性抗菌光動力治療相較於輔助
性低能量雷射治療在於牙周炎的臨床療效。
本分口隨機臨床試驗納入 36 位牙周炎之患者，其口內有左右成對的牙齒，且每一顆牙至少存在兩個位點≥5 毫米的探測囊袋深度。所有患者皆接受全口非手術性結石清潔、牙根整平以及口腔清潔指導，之後隨機分配每位病患右側或左側至實驗組，另一側則是控制組。實驗組將進行一周一次、連續三周的抗菌光動力治療，控制組也接受類似的療程，唯一差別在於沒有給予光感染劑，而是以生理食鹽水取代。臨床數據分別於試驗起始點、抗菌光動力療程後的 12 週以及 24 週測量。試驗主要結果為探測囊袋的下降，以商業軟體統計分析系統 SAS 9.4 進行成對樣本 t 檢定以及多階層模型分析其結果。
總共 36 位受試者參加並完成試驗。相較於控制組，初始探測囊袋深度 (4.48±1.7 vs 4.66±1.77 mm) 以及初始附連組織高度 (4.97±1.78 vs 5.18±1.85 mm) 在實驗組顯著較低。兩組之間在探測囊袋深度的下降量於 12 週以及 24 週均無顯著差異(p>0.05)。以多階層模型分析下，基礎狀態數值則在兩組之間沒有顯著差異。以探測囊袋深度為結果分析，在兩種模型下於 12 週以及 24 週皆無顯著傾向任何一組治療。額外分析鄰近位點的基礎狀態得到鄰近位點的探測囊袋深度以及附連組織高度會顯著調整以探測囊度深度為結果的數值。
在本試驗為期六個月的追蹤上，輔助性抗菌光動力治療相較於輔助性低能量雷射治療，在牙周炎治療上沒有顯著的額外好處。在分析巢型結構樣本時，可使用多階層模型來得到更精確的結果，且在多階層模型分析下試驗起始時的鄰近狀態，其探測囊袋深度以及附連組織高度可以預測治療後的探測囊袋深度，並可運
用在治療前就得知治療反應不佳的位點，藉此可提前規劃不同的治療計劃來達到最佳的治療結果。

關鍵字

牙周炎 ； 抗菌光動力治療 ； 多階層模型

並列摘要

Background: Periodontitis progressively caused the breakdown of periodontium in
nearly 60% of the population in Taiwan. Scaling and root planing (SRP) were essential in treating periodontitis. Adjunctive treatments were utilized including laser application. Low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT) were proved effective as an adjunctive measure in treating periodontitis. Thus, the aim of this study was to observe the efficacy of adjunctive aPDT in treating periodontitis compared to adjunctive LLLT.
Material and Methods: Thirty-six patients with periodontitis harboring at least 2 sites PD≥5mm within a tooth, and a contralateral tooth with same condition were included in this randomized split mouth study. All patients received full mouth SRP and oral hygiene instruction. Randomization of allocation to test group to either right or left side of each subject was then conducted with the other side as control. In the test group, aPDT was performed weekly for consecutive 3 weeks, while control group had the same treatment with photosensitizer replaced with normal saline. Clinical parameters were collected at baseline, 12, and 24 weeks after aPDT intervention. PD reduction was evaluated as primary treatment endpoint in paired t-test and multilevel modeling using SAS (Statistics Analysis System) 9.4.
Results: A total of 36 subjects completed the trial. Significantly lowered baseline value of PD (4.48±1.7 vs 4.66±1.77 mm) and CAL (4.97±1.78 vs 5.18±1.85 mm) in test
group were shown in paired t-test. No significant difference (p>0.05) in PD reduction was shown between test and control group at 12-weeks and 24-weeks to baseline. In multilevel modeling, baseline difference was not significant after a three-leveled hierarchical structure was considered. In reporting outcome PD, no significant difference favoring any group was shown at 12-week and 24-week in two models. Additional evaluation of neighboring site at baseline showed PD and CAL significantly adjusted the value of outcome PD.
Conclusion: The adjunctive aPDT didn’t offer additional benefit in treating periodontitis compared to adjunctive low-level laser therapy within the 6 months follow up of the trial. Multilevel modeling can be utilized for analyzing hierarchical data in order to report an unbiased result. Further analysis of neighboring status at baseline revealed adjacent PD and CAL may act as a predictor for future treatment outcome. Alternative treatment could be planned ahead in non-responding site to periodontal treatment.

並列關鍵字

Periodontitis ； antimicrobial photodynamic therapy ； multilevel modeling

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