牙周引导组织再生术治疗根分叉区骨缺损临床观察

目的 :对引导组织再生术治疗Ⅱ°～Ⅲ°根分叉区骨缺损的近期临床疗效进行评价。方法 :　选取Ⅱ°～Ⅲ°根分叉区骨缺损患牙 2 1个 ,牙周引导组织再生术 (GTR)治疗 11个 ,常规翻瓣术治疗 10个 ,术后 3个月观察附着水平、牙周袋深度的变化 ,通过计算机测量分析根尖片 ,对两种手术方法进行比较。结果 :术后 3个月 ,两组牙周袋探诊深度自身对照 ,有明显改善 ,差异有显著性 (P <0 .0 5 )。GTR组临床附着水平有明显改善 ,且有显著性差异 (P <0 .0 5 ) ,翻瓣组临床附着水平变化则无显著性差异 (P >0 .0 5 ) ;GTR组与翻瓣术组比较 ,各项临床指标均有显著性差异 (P <0 .0 5 )。计算机测量分析根尖片 ,GTR组较翻瓣组垂直向骨高度增加显著 ,有统计学意义 (P <0 .0 5 )。结论 :治疗Ⅱ°～Ⅲ°根分叉区骨缺损 ,GTR术可获得良好的近期临床疗效。     

Wound healing of degree III furcation involvements following guided tissue regeneration and/or Emdogain. A histologic study

BACKGROUND: The use of enamel matrix proteins (EMD) has been recently introduced as a new treatment alternative for periodontal regeneration. However, no histological studies are available investigating the effect of EMD in the treatment of degree III furcation involvements. OBJECTIVES: The aim of this study was to evaluate the healing of mandibular degree III furcation involvements histologically following treatment with guided tissue regeneration (GTR), EMD and a combination of EMD and GTR. MATERIAL AND METHODS: Degree III furcation involvements were surgically created at the teeth 36, 37, 46, 47 in three monkeys (Macaca fascicularis). Spontaneous healing of the defects was prevented by placing impression material into the defects. After 6 weeks, full-thickness flaps were elevated at the buccal and lingual aspect of the experimental teeth. Following removal of all granulation tissue from the furcation defects, scaling/root planing and conditioning of the root surfaces with 24% EDTA gel, the defects were treated with one of the following treatment modalities: (i) EMD, (ii) GTR or (iii) a combination of EMD and GTR. The defects serving as control did not receive any treatment, except from complete coverage with coronally displaced flaps. After 5 months of healing, the animals were killed and perfused with 10% buffered formalin for fixation. The experimental teeth with surrounding tissues were dissected free, decalcified in EDTA, dehydrated and embedded in paraffin. 8 microm thick histological sections were cut and stained and subsequently examined under the light microscope. RESULTS: The histological analysis revealed that with GTR or combined EMD and GTR treatment, new attachment formation (new cementum with inserting collagen fibers) had occurred on almost the entire circumference of the furcation and new bone was almost filling the defect in the situations where the membrane was not exposed. The sites treated only with EMD exhibited new attachment and new bone formation to a varying extent, while the control sites presented only limited new attachment and bone formation. CONCLUSION: The results provided histological evidence suggesting that both GTR and EMD may result in true periodontal regeneration, and suggest that this type of healing might be favored by such treatments in comparison with flap surgery.     

Smoking affects the outcome of guided tissue regeneration with bioresorbable membranes: a retrospective analysis of intrabony defects

OBJECTIVES: To disclose factors that may influence the results of guided tissue regeneration (GTR) treatment in intrabony defects with bioresorbable membranes. METHODS: Forty-seven intrabony defects in 32 patients were treated by means of polylactic acid/citric acid ester copolymer bioresorbable membranes. At baseline and after 1 year, the following parameters were recorded: (1) probing pocket depth (PPD), (2) gingival recession (REC), (3) probing attachment level (PAL)=PPD+REC, (4) presence/absence of plaque (PI), (5) presence/absence of bleeding on probing (BOP) and (6) intrabony component (IC) configuration (i.e. primarily presence of one, two, or three bone walls). Occurrence of membrane exposure and smoking habits were also recorded. Significance of differences between categorical variables was evaluated with McNemar's test, and between numerical variables with the t-test for paired observations. Generalized linear models were constructed to evaluate the influence of various factors on PAL gain and PPD after 1 year, including in the analysis only one defect per patient (i.e. 32 defects) chosen at random. Odds ratios were calculated using the Mantel-Haenszel method. Differences between smokers and non-smokers were evaluated by means of Pearson's chi2 and Student's t-test for non-paired observations. RESULTS: At baseline, a mean PPD of 8.6+/-1.1 mm and a mean PAL of 9.8+/-1.6 mm was recorded. Statistically significant clinical improvements were observed 1 year after GTR treatment. An average residual PPD of 3.7+/-1.1 mm and a mean PAL gain of 3.8+/-1.5 mm were recorded. IC configuration and exposure of the membrane did not seem to influence the results, while a negative effect of smoking on the clinical parameters was observed. Smokers gained approximately 1 mm less in PAL than non-smokers (3.2+/-1.4 versus 4.3+/-1.3, respectively; p=0.03) and had approximately seven times less chances to gain 4 mm in PAL as compared with patients who did not smoke (odds ratio: 0.15). PPD reduction was less pronounced in smokers than in non-smokers (4.5+/-0.7 versus 5.5+/-0.7, respectively; p<0.01), resulting in somewhat deeper residual PPD in smokers than in non-smokers (3.6+/-1.0 versus 3.4+/-1.1; p>0.05). CONCLUSION: Smoking impairs the healing outcome of GTR treatment of intrabony defects with bioresorbable membranes.     

Guided tissue regeneration for the treatment of intraosseous defects using a biabsorbable membrane A controlled clinical study

Abstract. The aim of this controlled, clinical study was to evaluate guided tissue regeneration using a bioabsorbable membrane in periodontal intraosscous defects. Forty patients, each contributing one defect ≥4 mm in depth participated. The control group (18 individuals) received conventional flap therapy, while the test group (22 individuals) was treated using the bioabsorbable membrane, Guidor^®. Clinical assessments were made by one examiner, blinded with respect to treatment group, at baseline. 6 and 12 months following surgery. Baseline probing pocket depths of 7.7±1.4 mm in the membrane group and 7.6±1.9 mm in the control group were measured. Twelve month results showed a significant clinical attachment level gain in both control (1.1 ± 1.8 mm), and membrane group (1.3±2.1 mm). Probing pocket depth reduction of 2. 6±1.9 mm and 2.7±1.9 mm was observed in the respective groups. Bone sounding showed a non-significant gain of 0. 4±1.8 mm and 0.6±1.4 mm at membrane and control sites, respectively. Radiographic evaluation confirmed these results. There were no significant differences found between treatment groups for any of the tested variables. Smoking had a negative effect on healing in both groups. In conclusion, clinical and radiographic results indicate that guided tissue regeneration using a bioabsorbable membrane at intraosseous defects did not predictably achieve greater clinical attachment level gain nor bone gain when compared to conventional flap therapy.     

引导骨再生术和引导组织再生术治疗牙周根分叉病变的临床研究

目的探讨多孔矿化骨(Bio-oss)与双层胶原膜(Bio-gide)对牙周根分叉病变骨缺损治疗的临床效果和骨引导作用。方法45例Ⅱ~Ⅲ度根分叉病变患牙随机分为3组,分别为:①植入Bio-oss组(GBR);②植入Bio-oss后覆盖Bio-gide组(GTR)和③对照组,即根分叉区行翻瓣术组(OFD)。在术前和术后3、6和12个月观察牙龈指数(GI)、牙周袋深度(PD)、附着丧失(AL)、牙松动度(TM),X线片观察牙槽骨的变化。结果术后3个月时,3组GI、PD、AL较术前均减少(P<0.01),GBR组或GTR组PD和AL比OFD组降低,X线片见GBR组或GTR组骨高度和骨密度轻度增加。术后6、12个月时,GBR组或GTR组PD、AL与OFD比差异有显著性,TM较术前减轻,GTR组的PD、AL比GBR组减少,松动度较GBR组轻度减轻,各组GI无明显差异,X线片见GBR组或GTR组骨高度比术前明显增加,GTR组比GBR组骨高度轻度增高。结论Bio-oss和Bio-gide能有效修复根分叉病变的牙周骨缺损,改善临床指标,促进骨再生及牙周新附着形成,两者合用效果更好,其作用可维持1年以上。     

Evaluation of guided tissue regeneration in interproximal defects

Abstract This study clinically evaluates the use of expanded polytetrafluoroethylene (ePTFE) membranes with or without the addition of decalcified freeze-dried hone allograft (DFDBA) in the treatment of interproximal intraosseous defects, 25 patients (26 paired defects) diagnosed with advanced periodontitis and having at least 2 bilateral interproximal probing depths of s6 mm participated in the study. After the hygiene phase, measurements were made to determine soft tissue recession, pocket depth, and clinical attachment levels. Defects from each pair were randomly treated with either ePTFE alone (control), or ePTFE + DFDBA (experimental). Measurements were made during the surgery to determine crestal resorption, defect resolution and defect fill. Membranes were removed at 4 to 6 weeks. At 6 months, the soft and hard tissue measurements (surgical reentry) were repeated. Both groups showed statistically significant improvement when compared to baseline (p<0.001), but no difference was determined between groups. Control sites showed a 50% bone fill and experimental sites had 54% bone fill. The defect resolution changes were also similar between control and experimental groups, respectively (80%, 74%). For this short-term study, it was concluded that either technique was beneficial for the treatment of intraosseous defects. Other studies are needed to assess the long-term stability of the improvements rendered by these treatments.     

Treatment of 3rd molar-induced periodontal defects with guided tissue regeneration

Abstract Recent reports provide evidence of increased attachment levels when using guided tissue regeneration (GTR) techniques for the treatment of periodontal defects. Periodontal defects frequently occur at the distal aspect of mandibular 2nd molars which are next to mesioangular impacted 3rd molars that have oral communication. The purpose of this study was to determine whether the use of GTR can enhance probing attachment levels (PALs) following extraction of mesioangular impacted third molars. 12 patients with bilateral soft tissue impacted mandibular 3rd molars entered this split mouth study. After extractions, the previously exposed distal root surface of the 2nd molars were debrided. The defects on the randomly selected experimental sites were covered with expanded polytetraflouro-ethylene (e-PTFE) membrane and the tissue was replaced to cover the membrane. Membranes were removed after 6 weeks. Control sites were treated identically except no membrane was placed. GI, PII, PD, PAL and BOP records were obtained at 0, 3 and 6 months. The use of barrier material did not provide statistically-significant differences in PAL when comparing experimental versus control sites. Nevertheless, PAL gain was consistently greater at 3 and 6 months when GTR techniques were used in sites with deep impactions.     

引导组织和骨组织再生术及其生长因子在牙周骨缺损治疗中的应用

引导组织再生术和引导骨再生术广泛用于牙周骨缺损的治疗中,给牙周组织再生开辟了广泛的空间,但二者单独使用却存在一定的局限性。因此,目前的研究多趋向于将骨移植材料和膜材料与多肽生长因子联合应用于牙周骨缺损的修复。下面就引导组织再生膜材料、引导骨再生支架材料和碱性成纤维细胞生长因子的理化性质、生物学功能,以及三者联合应用于牙周骨缺损治疗中的作用作一综述。     

Retrospective analysis of factors related to clinical outcome of guided tissue regeneration procedures in intrabony defects

Abstract The purpose of this retrospective study was to determine factors affecting clinical outcome of guided tissue regeneration (GTR) in the treatment of intrabony periodontal defects. 38 patients each contributing 1 isolated intrabony defect treated with GTR were included in this analysis. Patient and defect characteristics, and defect-specific recordings relative to clinical outcome 6 months postsurgery were assessed. GTR treatment resulted in clinically and statistically significant improved probing depths (PD), clinical attachment levels (CAL), and probing bone levels (PBL). Presurgery PD and PBL were of predictive value for CAL gain and PBL gain, respectively. CAL and PBL gain did not correlate to defect depth or configuration. Cigarette smoking exhibited a highly significant negative correlation to parameters of clinical outcome.     

Treatment of intrabony defects with guided tissue regeneration and enamel-matrix-proteins. An experimental study in monkeys

BACKGROUND: Enamel matrix proteins (EMD) have recently been introduced in regenerative periodontal treatment. However, no histological data are yet available concerning the effect of treating intrabony periodontal defects with EMD, and no histological comparisons have been made comparing the result of treatment of intrabony defects with EMD with that of the treatment with guided tissue regeneration (GTR). AIM: Therefore, the aim of the present study was to evaluate histologically in monkeys the effect of treating intrabony defects with EMD, GTR or combined EMD and GTR. METHOD: Intrabony periodontal defects were produced surgically at the distal aspect of teeth 14, 11, 21, 24, 34, 31, 41 and 44 in 3 monkeys (Macaca fascicularis). In order to prevent spontaneous healing and to enhance plaque accumulation metal strips were placed into the defects. After 6 weeks the defects were exposed using a full-thickness flap procedure. The granulation tissue was removed and the root surfaces were debrided by means of hand instruments. Subsequently, the defects were treated using one of the following therapies: (i) GTR, (ii) EMD, or (iii) combination of EMD and GTR. The control defects were treated with coronally repositioned flaps. After 5 months, the animals were sacrificed and perfused with 10% buffered formalin for fixation. Specimens containing the defects and surrounding tissues were dissected free, decalcified in EDTA and embedded in paraffin. 8 microm thick histological sections were cut and stained and subsequently examined under the light microscope. RESULTS: In the control specimens, the healing was characterized by a long junctional epithelium and limited periodontal regeneration (i.e., new periodontal ligament, new cementum with inserting connective tissue fibers and new bone) in the bottom of the defect. The GTR-treated defects consistently presented periodontal regeneration when the membranes were not exposed whereas the sites treated only with EMD presented regeneration to a varying extent. The combined therapy did not seem to improve the results. CONCLUSION: It can be concluded that all 3 treatment modalities favor periodontal regeneration.     

Healing response of gingival recession defects following guided tissue regeneration procedures in smokers and non-smokers

Abstract This retrospective study evaluated healing response in gingival recession defects following guided tissue regeneration (GTR) in smokers. 22 systemically healthy patients who had been treated for deep (4 mm), buccal. Miller's class I or II gingival recession defects with ePTFE membranes were included. Patients were regarded as smokers if they smoked more than 10 cigarettes/day at the time of surgical procedure. Occasional and former smokers were excluded. 9 patients (6 male, mean age 29 years) were smokers, while 13 patients (4 male, mean age 35 years) were non smokers. Clinical parameters, recorded pre surgery and at 6 months post surgery. included defect-specific plaque (DPI) and bleeding on probing (BoP) scores, recession depth (RD). probing depth (PD). clinical attachment level (CAL). and keratinized tissue width (KG). Extent of membrane exposure (ME) and newly formed tissue (NFT) gain were assessed at membrane removal. Statistical analysis revealed no significant differences between smokers and non-smokers in demographic and pre surgery defect characteristics. DPI and BoP scores were similar pre surgery and remained almost unchanged thorough out the observation interval in both groups. ME was significantly greater in smokers (2.6±1.4 mm) than in non smokers (1.3±0.6 mm). NFT gain was 2.8±1.0 mm in smokers and 3.6±1.4 mm in non-smokers, the difference being not statistically significant. Smokers showed significantly less RD reduction and root coverage (2.5±1.2 mm and 57%, respectively) compared to non-smokers (3.6±1.1 mm and 78%, respectively). In conclusion, the results indicate that treatment outcome following GTR in gingival recession defects is impaired in cigarette smokers.     

Treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration. A prospective controlled clinical study

BACKGROUND: Utilisation of enamel matrix proteins (EMD) and application of the guided tissue regeneration principle (GTR) are treatment modalities which both have been shown to result in periodontal regeneration. However, it is yet unknown whether the combination of EMD and GTR may additionally favor the regeneration process. AIM: The aim of the present controlled study was to evaluate clinically the treatment effect of EMD, GTR, combination of EMD and GTR, and flap surgery (control) on intrabony defects. MATERIAL AND METHODS: 56 patients each of whom displaying one intrabony defect of a depth of at least 6 mm were randomly treated with one of the treatment modalities. Prior to surgery and at one year after, the following parameters were evaluated by a blinded examiner: Plaque index (PlI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), gingival recession (GR) and clinical attachment level (CAL). No statistical significant differences between the four groups were observed at baseline for any of the investigated parameters. RESULTS: At 1 year after therapy, the sites treated with EMD demonstrated a mean PPD reduction of 4.1 +/- 1.7 mm and a mean CAL gain of 3.4 +/- 1.5 mm (p<0.001). The sites treated with GTR showed a mean PPD reduction of 4.2 +/- 1.9 mm and a mean CAL gain of 3.1 +/- 1.5 mm (p<0.001). The sites treated with the combined treatment showed a mean PPD reduction of 4.3 +/- 1.4 mm and a mean CAL gain of 3.4 +/- 1.1 mm (p<0.001). In the control group, the mean PPD reduction was 3.7 +/- 1.4 mm (p<0.001) and the mean CAL gain measured 1.7 +/- 1.5 mm (p<0.01). All 4 treatments led to statistically significant PPD reduction and CAL gain. All three regenerative treatments led to higher CAL gain than the control treatment (p<0.05). No statistical significant differences in PPD reduction and CAL gain were observed between the three regenerative treatments. CONCLUSION: It may be concluded that (a) all 3 regenerative treatment modalities may lead to higher CAL gain than the control one, and (b) the combined treatment does not seem to improve the outcome of the regenerative procedure.     

引导性组织再生术治疗II度根分叉病变

目的 观察引导性组织再生术（ｇｕｉｄｅｄ ｔｉｓｓｕｅ ｒｅｇｅｎｅｒａｔｉｏｎ,ＧＴＲ）治疗Ⅱ度根分叉病变的疗效,分析影响其疗效的因素。方法 使用不全胶原膜对１７例患者的２６处Ⅱ度根分叉为行ＧＴＲ术,手术前、后检查临床指标并行定位Ｘ线片数字减影分析。结果 术后３、６、１２个月水平探入深度分别减少１．８、２．２及２．５ｍｍ。且有探诊深工减少和附着获得,差异均有显著性;髓量于术后２个月已有增加,并随     

Prognostic factors for alveolar regeneration: effect of tissue occlusion on alveolar bone regeneration with guided tissue regeneration

OBJECTIVES: Design criteria for guided tissue regeneration (GTR) devices include biocompatibility, cell occlusion, space-provision, tissue integration, and ease of use. The objective of this study was to evaluate the effect of cell occlusion and space-provision on alveolar bone regeneration in conjunction with GTR. METHODS: Routine, critical-size, 6 mm, supra-alveolar, periodontal defects were created in 6 young adult Beagle dogs. Space-providing ePTFE devices, with or without 300-microm laser-drilled pores were implanted to provide for GTR. Treatments were alternated between left and right jaw quadrants in subsequent animals. The gingival flaps were advanced for primary intention healing. The animals were euthanized at week 8 post surgery. The histometric analysis assessed regeneration of alveolar bone relative to space-provision by the ePTFE device. RESULTS: A significant relationship was observed between bone regeneration and space-provision for defect sites receiving the occlusive (beta = 0.194; p < 0.02) and porous (beta = 0.229; p < 0.0004) GTR devices irrespective of treatment (p = 0.14). The bivariate analysis showed that both space-provision and device occlusivity significantly enhanced bone regeneration. Hence, sites receiving the occlusive GTR device and sites with enhanced space-provision showed significantly greater bone regeneration compared to sites receiving the porous GTR device (p = 0.03) or more limited space-provision (p = 0.0002). CONCLUSIONS: Cell occlusion and space-provision may significantly influence the magnitude of alveolar bone regeneration in conjunction with guided tissue regeneration.