Abstract:

Objective To observe the clinical efficacy of plan-do-check-Act （PDCA） cycle management model combined with pulsed tooth punch applied in maintenance period of the patients with moderate to severe periodontitis， and to provide the theoretical basis for application of the PDCA cycle management model in the periodontitis patients. Methods A total of 50 patients with moderate to severe periodontitis were selected based on predefined inclusion， exclusion， and elimination criteria. The patients were randomly divided into experiment group （n=25） and control group （n=25）. The patients in experiment group underwent maintenance care with pulsed tooth punch in combination with the BASS brushing technique， while the patients in control group maintained oral hygiene with the BASS brushing technique alone.The patients in both two groups were managed with the PDCA cycle management model. The patients were asked to return for follow-up visits at 2， 4， 8， and 12 weeks of self-care， and the personalized corrections and guidance were provided based on the plaque accumulation. The clinical periodontal parameters， including plaque index （PLI）， probing depth （PD），and bleeding index （BI），at 4 and 12 weeks of self-care， as well as the levels of tumor necrosis factor-α （TNF-α） and interleukin-17 （IL-17） in the gingival crevicular fluid of the patients in two groups were observed and recorded. Results After 4 and 12 weeks of self-care， compared with control group，the PLI， PD， and BI of the patients in experiment group were significantly decreased （P<0.01）； compared with baseline， the PLI， PD， and BI of the patients in both two groups at 4 and 12 weeks of self-care were increased （P<0.05 or P<0.01）； Compared with 4 weeks of self-care， the PLI， PD， and BI of the patients at 12 weeks of self-care were increased （P<0.01）. After 4 and 12 weeks of self-care， compared with control group，the levels of TNF-α and IL-17 in gingival crevicular fluid of the patients in experiment group were significantly decreased （P<0.01）； compared with baseline，the levels of TNF-α and IL-17 in gingival crevicular fluid of the patients in two groups at 4 and 12 weeks of self-care were increased （P<0.01）. Conclusion The use of pulsed tooth punch under the PDCA cycle management model can significantly decrease the PLI， PD， BI， and the levels of inflammatory factors in gingival crevicular fluid of the patients with moderate to severe periodontitis，and inhibit the plaque formation and control the gingival inflammation， benefite the maintenance of efficacy of the patients with moderate to severe periodontitis.

Key words: Plan-do-check-action cycle, Plaque, Chronic periodontitis, Pulsed tooth punch, Maintenance period