Objective: To analysis the effect of nonoperative periodontal treatment on morphological changes of the schneiderian membrane of maxillary sinus in the chronic periodontitis patients by using oro-maxillaofacial cone-beam CT (CBCT) in order to provide the foundation in the diagnosis and treatment of maxillary sinusitis caused by chronic periodontitis. Methods: Totally 30 chronic periodontitis patients with schneiderian membrane thickening [(40.0±5.6) years old (ranged 26-55 years old), 18 males and 12 females] were randomly recruited in Department of Periodontics, School of Stomatology, China Medical University from June 2014 to December 2016. All patients were scanned by CBCT. The probing depth (PD), clinical attachment loss (CAL), plaque index (PLI) and bleeding index (BI) of the maxillary first and second premolars and molars were recorded. All patients received systematic nonoperative periodontal treatment. After six months, patients were reviewed, periodontal indexes and CBCT scanning were recorded. The thickness of the schneiderian membrane of maxillary sinus were analyzed by the software of CBCT. The changes of clinical parameters, parameter dimensional values of membrane thickness before and after treatment were statistically compared by t test. Results: In 30 chronic periodontitis patients, there was no statistically significant difference in the dimension and length of the maxillary sinus mucosa between the right and the left (P>0.05). The dimension of the mucosal thickening was positively correlated with PD and CAL values, and the correlation was statistically significant (P<0.05). Totally 58 maxillary sinus showed mucosal thickening. There were 20 mild thickening cases, and the dimension of mucosal thickening 6 months after treatment [(1.1±0.6) mm] was significantly lower than that before treatment [(2.5±0.7) mm] (P<0.05). There were 30 moderate thickening cases and the dimension of mucosal thickening 6 months after treatment [(2.3±0.6) mm] was significantly lower than that before treatment [(5.8±0.5) mm] (P<0.01). There were 8 severe thickening cases and the dimension of mucosal thickening 6 months after treatment [(4.2±0.4) mm] was also significantly lower than that before treatment [(11.2±1.8) mm] (P<0.01). The periodontal indexes of patients with mild, moderate and severe mucosal thickening in maxillary sinus showed statistically significant difference after treatment compared with before treatment (P<0.05). Conclusions: Nonoperative periodontal treatment has a positive therapeutic significance for improving the schneiderian membrane thickening of maxillary sinus.
目的： 应用口腔颌面锥形束CT评价牙周非手术治疗对慢性牙周炎上颌窦黏膜变化的影响，为慢性牙周炎引起的牙源性上颌窦炎的诊疗提供参考。 方法： 采用简单随机抽样法选取2014年6月至2016年12月就诊于中国医科大学口腔医学院牙周科，经口腔颌面锥形束CT扫描诊断为慢性牙周炎伴上颌窦黏膜增厚的患者30例，其中男性18例，女性12例，年龄（40.0±5.6）岁（26~55岁），检测并记录患者上颌第一前磨牙、第二前磨牙、第一磨牙和第二磨牙的牙周探诊深度、临床附着丧失、菌斑指数和出血指数，进行牙周治疗，6个月后复查，记录患者各项牙周检查指标并进行口腔颌面锥形束CT扫描复查，通过锥形束CT自带软件对上颌窦黏膜变化进行分析。采用配对t检验对治疗前后的各项临床指标、上颌窦黏膜厚度值和长度值进行比较。 结果： 30例慢性牙周炎患者右侧与左侧上颌窦黏膜厚度值及长度值相比，差异均无统计学意义（P>0.05）；上颌窦黏膜厚度值与探诊深度、临床附着丧失呈显著正相关关系（P<0.05）。共58侧上颌窦黏膜出现增厚现象，其中轻度上颌窦黏膜增厚20侧，治疗后6个月黏膜厚度值[（1.1±0.6）mm]显著小于治疗前[（2.5±0.7）mm]（P<0.05）；中度上颌窦黏膜增厚30侧，治疗后6个月黏膜厚度值[（2.3±0.6）mm]显著小于治疗前[（5.8±0.5）mm]（P<0.01）；重度上颌窦黏膜增厚8侧，治疗后6个月黏膜厚度值[（4.2±0.4）mm]亦显著小于治疗前[（11.2±1.8）mm]（P<0.01）。轻、中、重度上颌窦黏膜增厚者治疗后各项牙周指标与治疗前相比差异均有统计学意义（P<0.05）。 结论： 牙周非手术治疗对改善上颌窦黏膜增厚有积极意义。.
Keywords: Chronic periodontitis; Cone-beam computed tomography; Maxillary sinusitis; Periodontal nonoperative treatment.