引导组织再生术治疗Ⅲ度要分叉病变的研究现状

引导组织再生术治疗骨内科缺损和下颌磨牙Ⅱ度根分叉病变,在组织学及临床研究中均获得了理想的效果.但对Ⅲ度根分叉病变,有研究探讨了多种方法,目前并未观察到确切一致的疗效.本文对应用引导组织再生太治疗Ⅲ度根分叉病变的对照研究进行综述,以期为临床工作提供一定参考.     

引导组织再生术治疗Ⅲ度要分叉病变的研究现状

引导组织再生术治疗骨内缺损和下颌磨牙Ⅱ度根分叉病变,在组织学及临床研究中均获得了理想的效果。但对Ⅲ度根分叉病变,有研究探讨了多种方法,目前并未观察到确切一致的疗效。本文对应用引导组织再生术治疗Ⅲ度根分叉病变的对照研究进行综述,以期为临床工作提供一定参考。     

牙周引导组织再生术治疗根分叉病变的临床观察

目的：对引导组织再生术（GTR）治疗Ⅱ°-Ⅲ°根分叉病变的临床疗效进行评价。方法：选取Ⅱ°-Ⅲ°根分叉病变的患牙47个,给予翻瓣术＋胶原膜治疗24个,单纯翻瓣术治疗23个,术后1年通过观察牙龈指数（GI）、附着水平（AL）、根分叉垂直探诊深度（PD）与根分叉水平探诊深度（PFD）的变化以及X线片的比较,对2种手术方法的临床疗效进行分析。结果：①.临床检验指标：术后1年,GTR组所有临床指标比术前明显改善,且有显著性差异（P〈0.05）,翻瓣组临床附着水平与根分叉水平探入深度无显著性差异（P〉0.05）。GTR组与翻瓣组比较,除牙龈指数外,各项指标均有显著性差异（P〈0.05）。②.X线测量：2组根分叉区骨密度均增高,GTR组与对照组比较,垂直向骨密度增高明显,有显著性差异（P〈0.05）。结论：GTR治疗Ⅱ°-Ⅲ°根分叉病变,比单纯翻瓣术有更好的临床疗效。     

引导组织再生术治疗根分叉病变15例临床报道

目的：对引导组织再生术（GTR）治疗Ⅱ-Ⅲ度根分叉病变的临床疗效进行评价。方法：选取Ⅱ-Ⅲ度根分叉病变的患牙30颗,翻瓣术＋胶原膜治疗15颗,单纯翻瓣术治疗15颗,术后半年通过观察牙龈指数（GI）、附着水平（AL）、根分叉垂直探诊深度（PD）与根分叉水平探诊深度（PFD）的变化,对两种手术方法的临床疗效进行比较。结果：术后半年,两组病例所有临床指标比术前明显改善,且有显著性差异（P〈0.05）。GTR组与翻瓣组比较,各项指标均有显著性差异（P〈0.05）。结论：GTR组治疗Ⅱ-Ⅲ度根分叉病变,比单纯翻瓣术有更好的临床疗效。     

Biomesh膜引导组织再生治疗Ⅱ度根分叉病变

目的：评价Biomesh膜引导组织再生治疗磨牙II度根分叉病变的效果。方法：6例患者8颗上,下颌第一或第二靡牙I渡根分叉商病变采用Biomesh膜进行治疗,通过术前及术后6个月牙周袋和附着水平的探诊及X线片上牙槽骨的变化进行评价。结果：8颗患牙手术后均无肿胀,疼痛等反应,术后半年与术前比较均有明显的牙周袋深度减少,临床附着水平的获得及X线片上可见的牙槽骨增加,结论：Biomesh膜用于治疗II度根分叉病变的引导组织再生术可以获得满意的临床效果。     

胶原膜与聚四氟乙烯膜治疗Ⅱ～Ⅲ度根分叉骨病变的临床比较

目的比较聚四氟乙烯膜和胶原膜治疗Ⅱ～Ⅲ度根分叉病变的短期临床疗效.方法选取Ⅱ～Ⅲ度根分叉病变的患牙21颗,聚四氟乙烯膜治疗10颗,胶原膜治疗11颗,术后3个月通过观察牙龈指数、附着水平、牙周袋垂直与水平探诊深度的变化;实验室检测龈沟液量(GCF)及龈沟液碱性磷酸酶(GCF-ALP)活性水平的变化;计算机测量分析根尖片,对两种屏障膜的临床疗效进行比较.结果术后3个月①自身前后比较,两组的牙龈指数均无显著性差异(P＞0.05),牙周袋垂直与水平探诊深度与临床附着水平,均有明显改善,且有显著性差异(P＜0.05),聚四乙烯膜组和胶原膜组相比较,牙周袋垂直探诊深度与附着水平的改变无显著性差异(P＞0.05),而牙周袋水平探诊深度减小幅度较大,与胶原膜组有显著性差异(P＜0.05).②实验室观察,自身前后对照比较,各组GCF量均无显著性差异(P＞0.05),GCF-ALP浓度均减少,且有统计学意义(P＜0.05).聚四乙烯膜组GCF-ALP浓度减小幅度较胶原膜组大,但无统计学差异(P＞0.05).③根尖片的测量,聚四氟乙烯组与胶原膜组之间无显著性差异(P＞0.05).结论胶原膜与聚四氟乙烯膜临床治疗效果相类似,但这两种膜的临床疗效是否有差异还需进行长期临床观察     

组织引导再生胶原膜在根分叉病变治疗中的应用

牙周病是人类失牙最严重的口腔常见和多发性疾病。根分叉病变可发生于任何类型的牙周炎。由于分叉的解剖特点,使其治疗难度大大提高。近年来,由于微生物学、免疫学等现代生物医学科学与技术的发展促进了对牙周病病因和发病机理的研究,大大推动了牙周病治疗技术的发展和概念的更新,临床治疗方法也日益丰富。国内外相继开展了牙周组织引导再生的研究。采用在根分叉植入生物陶瓷、骨形成蛋白等以及诱导性组织再生手术(GudedTissue Regeneration,GTR)等,促使该处有新附着形成,虽然成功率尚有待提高,但前景看好。     

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。     

磷酸三钙联合引导组织再生术治疗根分叉病变（附10例报告）

目的：总结磷酸三钙联合引导组织再生术（GTR）治疗根分叉病变的临床疗效。方法：选择30个Ⅱ度根分叉病变患牙,随机分为三组,其中多孔磷酸三钙生物陶瓷联合引导组织再生技术治疗10个（GTR组）,根分叉区行翻瓣术中植入多孔磷酸三钙组10个（TCP组）,常规牙周翻瓣术治疗10个（OFD组）作为对照组。在术前和术后半年、一年分别观察各组的牙周袋深度（PD）、根分叉水平探入深度（HPD）、牙周附着丧失（AL）、牙松动度（TM）和牙龈指数（GI）等临床指标变化。用SPSS10.0软件对相关数据进行统计学分析。结果：术后三组病例PD、AL和GI均有明显减少,有显著性差异（P〈0.01）。而TM、HPD在OFD组术前与术后无明显改变,（P〉0.05）,而在其他两组的TM、HPD减少较为明显,有显著性差异（P〈0.01）。TCP组、GTR组与OFD组相比较PD、AL、GI、HPD和TM,减少更为明显,有显著性差异（P〈0.01）。GTR组与TCP组相比,PD、HPD、GI、AL和TM减少也较为明显,有显著性差异（P〈0.01）。结论：多孔磷酸三钙生物陶瓷联合GTR技术是治疗根分叉病变的一种有效方法。     

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     

Glycosaminoglycans in gingival crevicular fluid of patients with periodontal class II furcation involvement before and after guided tissue regeneration. A pilot study

BACKGROUND: The levels of glycosaminoglycans in gingival crevicular fluid (GCF) are good indicators of underlying tissue turnover. We hypothesize that connective tissue elements in GCF may be used as indicators of tissue maturation underneath barrier membranes. Therefore, we investigated the levels of sulfated glycosaminoglycans in GCF at sites before and after guided tissue regeneration (GTR). METHODS: Six patients were selected on the basis of having at least one Class II buccal furcation involvement on a molar tooth. Each molar furcation was treated with the standard GTR surgical protocol using a non-resorbable expanded polytetrafluoroethylene membrane. Gingival crevicular fluid samples were taken at baseline (immediately prior to insertion of the membrane) and at 1, 2, 3, 4, 5, and 6 weeks (immediately prior to removal of the membrane). Glycosaminoglycan levels were determined using an Alcian blue dye detection system. RESULTS: The mean levels of chondroitin sulfate and total sulfated glycosaminoglycans in GCF significantly decreased during the first 4 weeks after GTR surgery. By week 5, the levels began to rise, and by week 6 the levels had returned to baseline levels. CONCLUSIONS: Sulfated glycosaminoglycans can be monitored in GCF at healing GTR sites. It is proposed that this is a useful means of monitoring the status of the regenerating tissues. However, further longitudinal studies are required to assess if the sulfated glycosaminoglycans can be used as indicators of tissue maturation under guided tissue membranes used to treat periodontal defects.     

Collagen I carboxyterminal propeptide in human gingival crevicular fluid before and after periodontal treatment

The amount of procollagen I carboxyterminal propeptide (PICP) in crevicular fluid (CF) was measured in three periodontitis patients. Samples were collected from 29 sites before treatment (scaling, root planing, and curettage) and 2, 5, 10, 20, and 40 days after treatment, by placing two paper strips in periodontal pockets for 5 s. The amount of fluid in strips was measured by the Periotron device. Control samples were collected from subjects with minimal gingival inflammation. PICP was extracted into saline solution and determined by a radioimmunologic method. Plaque index, papilla bleeding index, and pocket depth were recorded before and 40 days after treatment. The CF PICP mean concentration was 4.2 mg/1 in the pretreatment samples. Five days after treatment a statistically significant increase in PICP concentration was seen in all subjects. The peak appeared on days 5 or 10 in 27 sites. The mean peak PICP concentrations of the subjects were 5-10 times higher than the pretreatment values. Twenty days after treatment, mean PICP concentration decreased to pretreatment level. PICP concentrations did not correlate with the clinical parameters. In control samples PICP amounts were below the detection limit. CF PICP is a new marker of type 1 collagen metabolism in periodontal tissues. It was concluded that elevated PICP concentrations in CF after periodontal treatment reflected increased type I collagen synthesis in periodontal tissues and that the peak in type I collagen synthesis takes place 5-10 days after treatment.     

Changes in transforming growth factor-beta1 in gingival crevicular fluid following periodontal surgery

OBJECTIVES: Growth factors play a major part in wound healing, including in the periodontium. However, the presence of growth factors in gingival crevicular fluid (GCF) in humans during periodontal wound healing has not yet been determined. Our hypothesis is that such factors are present in GCF and that changes in their levels might be of value as a prognostic marker of wound-healing activity and therapeutic progress following periodontal surgery. The aim of this study was therefore to measure transforming growth factor-beta1 (TGF-beta1) in GCF collected from sites that have undergone guided tissue regeneration (GTR) and conventional flap (CF) surgery and to compare these with GCF collected from unaffected healthy sites. MATERIALS AND METHODS: GCF samples were collected, using filter paper strips, at baseline (pre-surgical) and then at intervals up to 26 weeks from 16 patients undergoing GTR and from 11 patients undergoing CF surgery. After elution and acid treatment, TGF-beta1 levels were measured by ELISA. RESULTS: Treatment of periodontal defect sites significantly reduced the mean probing pocket depth (PPD) and improved the mean lifetime cumulative attachment loss (LCAL). Average GCF volumes also significantly increased at all sites at 2 weeks post-surgery and thereafter declined to baseline levels, except at the GTR test sites that were still elevated at 7 weeks. TGF-beta1 could be detected in almost all GCF samples, and 2 weeks after surgery, the average levels increased two-fold at the surgically treated but not at the control sites, which remained unchanged. CONCLUSION: TGF-beta1 is readily detectable in GCF and increases transiently following periodontal surgery. This suggests that changes in the levels of this growth factor in GCF might be useful for monitoring the progress of periodontal repair and regeneration.     

牙周炎患者龈沟液和龈组织中IL—8的测定

采用ELISA间接夹心法测定了23名成人牙周炎患者34个患牙龈沟液中的IL-8.并用免疫组织化学法对相应的炎性龈组织进行检测.结果表明IL-8与牙周炎症密切相关,牙周炎龈沟液(GCF)中IL-8检出率为88.24%.IL-8含量范围为0.006～2.772ng/μl.其含量与牙龈指数相关非常显著,与牙周袋深度相关显著,与附着丧失、菌班指数无明显相关.炎性龈组织切片染色表明龈上皮组织和胶原组织中含有大量的阳性染色,从组织学上证明了GCF中IL-8的来源.提示IL-8可能在牙周炎发病机制中起着重要作用.     

Levels of interleukin-17 in gingival crevicular fluid and in supernatants of cellular cultures of gingival tissue from patients with chronic periodontitis

BACKGROUND AND AIMS: Interleukin-17 (IL-17) is a T-cell-derived cytokine that may play an important role in the initiation or maintenance of the pro-inflammatory response and has recently been found to stimulate osteoclastic resorption. The purpose of the present study was to determine the presence of IL-17 in gingival crevicular fluid (GCF) samples and in the culture supernatants of gingival cells from patients with chronic periodontitis. METHOD: GCF samples were collected during 30 s from two sites in 16 patients from periodontally affected sites (probing depth > or =5 mm, attachment loss > or =3 mm). The comparison with healthy controls was carried out by collecting GCF samples from eight healthy volunteers. GCF was collected using a paper strip and ELISA was performed to determine the total amount of IL-17. Supernatant cellular cultures of gingival cells were obtained from periodontal biopsies taken from 12 periodontitis patients and from eight healthy control subjects during the surgical removal of wisdom teeth. Spontaneous and phytohaemagglutinin (PHA)-stimulated levels of IL-17 were determined by ELISA. RESULTS: The total amount of cytokine IL-17 was significantly higher in the periodontitis group than the control group (45.9 versus 35.6 pg, p=0.005). Significantly higher GCF volume and amount of total proteins were obtained from periodontitis patients as compared with control subjects (0.98 versus 0.36 microl, p=0.0005; 0.12 versus 0.05 microg, p=0.0005, respectively). A higher concentration of IL-17 was detected in culture supernatants from periodontitis patients compared with healthy subjects, either without stimulation (36.28+/-8.39 versus 28.81+/-1.50 microg/ml, p=0.011) or with PHA stimulation (52.12+/-14.56 versus 39.00+/-4.90 microg/ml, p=0.012). Treatment with PHA induced a significant increase in the production of IL-17 in healthy subjects and periodontitis patients (p=0.001 and 0.003). CONCLUSIONS: The total amount of cytokine IL-17 in GCF samples and in the culture supernatants of gingival cells are significantly increased in periodontal disease.     

Leptin levels in gingival crevicular fluid in periodontal health and disease

BACKGROUND AND OBJECTIVE: A high concentration of leptin is associated with healthy gingival tissue, and the concentration of leptin decreases as periodontal disease progresses. However, to date, the leptin concentration in gingival crevicular fluid has not been documented. Hence, the present study was carried out to explore the presence of leptin in gingival crevicular fluid in periodontal health and disease, and to probe further into its possible role in periodontal disease progression. MATERIAL AND METHODS: A total of 45 adult patients were selected, based on their body mass index, for the study. They were categorized into three groups of 15 patients each, based on their periodontal tissue status, as follows: group I (clinically healthy gingiva with no loss of attachment); group II (chronic gingivitis with no loss of attachment); and group III (chronic periodontitis). Gingival crevicular fluid samples of 1 microL were collected extracrevicularly using white color-coded 1-5 microL calibrated volumetric microcapillary pipettes from one site in each person, and samples were analyzed for leptin using a commercially available enzyme-linked immunosorbent assay kit. RESULTS: The concentration of leptin in gingival crevicular fluid of patients in group I (2292.69 pg/mL) was statistically higher (p < 0.05) than in those of groups II (1409.95 pg/mL) and III (1071.89 pg/mL). This suggests a negative correlation of gingival crevicular fluid leptin concentration with clinical attachment loss (p < 0.05). CONCLUSION: As periodontal tissue destruction increased, there was a substantial decrease in gingival crevicular fluid leptin concentration. This observation extends our knowledge of the protective role of leptin in periodontal health.     

Calprotectin in gingival crevicular fluid correlates with clinical and biochemical markers of periodontal disease

Clinical and biochemical markers of periodontal disease have been used for precise objective diagnosis of periodontal inflammation. Interleukin 1beta (IL-1beta) and prostaglandin E2 (PGE2), inflammatory factors, levels in gingival crevicular fluid (GCF) of patients with periodontal disease are elevated and have been studied as biochemical markers. The levels of calprotectin, a leukocyte protein, in body fluids of patients with some inflammatory diseases are raised. Recently, we detected calprotectin in GCF and its concentrations in periodontal pockets were higher than those in healthy gingival crevices. In this study, we investigated the correlations between GCF calprotectin levels and clinical indicators (probing depth and bleeding on probing, BOP), and the IL-1beta or PGE2 levels in GCE Probing depth and BOP at 130 sites of 110 subjects with periodontal or other oral diseases were examined, then GCF samples were collected and their calprotectin, IL-1beta and PGE2 were determined by ELISA. The calprotectin level correlated positively with the probing depth and was significantly higher at BOP-positive than BOP-negative sites. There were significant, positive correlations between the calprotectin and IL-1beta or PGE2 concentrations. These results indicate that the calprotectin level in GCF correlates well with clinical and biochemical markers of periodontal disease and suggest that calprotectin may be useful for evaluating the extent of periodontal inflammation.     

Gingival crevicular fluid glycosaminoglycan levels in patients with chronic adult periodontitis

Abstract This study investigated levels of hyaluronan and chondroitin-4-sulphate in the crevicular fluid of patients with chronic adult periodontitis at diseased and healthy sites before and after treatment. The relationship between clinical diagnostic parameters and levels of glycosaminoglycans in gingival crevicular fluid were also analysed. Within each patient. 4 sites either mesial or distal and on single rooted teeth were classified as diseased or healthy using a modified gingival index, pocket depth and attachment loss. Crevicular fluid was collected from each site using glass micropipettes and analysed for glycosaminoglycan content by cellulose acetate electrophoresis. Significantly higher levels of chondroitin-4-sulphate were detected at diseased sites prior to treatment correlating with increased pocket depth or attachment levels. Following a period of treatment consisting of oral hygiene instruction and root planing, the patients were reassessed for their response to treatment by measuring the modified gingival index, pocket depth, attachment loss and levels of glycosaminoglycans. Analysis of glycosaminoglycan levels at diseased sites that demonstrated a poor response to treatment also demonstrated significantly higher levels of chondroitin-4-sulphate than those sites that responded well to treatment. Hyaluronan levels were less significantly associated with clinically succesful treatment. This study confirmed the use of the sulphated glycosaminoglycan chondroitin-4–sulphate as a potential diagnostic aid of periodontal tissue destruction; however, further longitudinal studies are required to assess their performance.