目的 观察中重度牙周炎患者维护期应用质量控制（PDCA）循环管理模式联合脉冲式冲牙器的临床效果，为PDCA循环管理模式在牙周炎患者中的应用提供理论依据。 方法 通过预定的试验纳入标准、排除标准和剔除标准选取50例中重度牙周炎患者，随机分为实验组（n=25）和对照组（n=25），实验组患者通过脉冲式冲牙器联合巴氏（BASS）刷牙法维护，对照组患者单纯通过BASS刷牙法维护。2组患者均采用PDCA循环管理模式，在自我维护2、4、8和12周分别要求患者复诊，通过患者菌斑堆积量进行个性化纠正和指导，在自我维护4和12周时观察并记录2组患者牙周临床检查指标，包括菌斑指数 （PLI）、探诊深度（PD）和出血指数（BI），检测龈沟液中肿瘤坏死因子α（TNF-α）和白细胞介素17 （IL-17）水平。 结果 经过4和12周自我维护，与对照组比较，实验组患者PLI、PD和BI明显降低（P<0.01）；与基线时比较，自我维护4和12周时2组患者PLI、PD和BI均明显升高（P<0.05或P<0.01）；与自我维护4周时比较，自我维护12周时2组患者PLI、PD和BI值明显升高（P<0.01）。经过4和12周自我维护，与对照组比较，实验组患者龈沟液中TNF-α和IL-17水平明显降低（P<0.01）；与基线时比较，自我维护4和12周时2组患者龈沟液中TNF-α和IL-17水平均明显升高（P<0.01）。 结论 在PDCA循环管理模式下应用脉冲式冲牙器可明显降低中重度牙周炎患者的PLI、PD、BI和龈沟液中炎症因子水平，有效抑制菌斑的形成并控制牙龈炎症状态，有利于中重度牙周炎患者治疗效果的维护。

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.