胶原-羟基磷灰石人工骨与胶原膜引导牙周组织再生的动物实验研究

目的：将胶原-羟基磷灰石人工骨与胶原膜联合应用于修复牙周缺损的动物实验,探讨其用于引导牙周组织再生的可行性。方法：人工构建4只成年Beagle犬下颌后牙区牙周缺损模型,分别随机采用：胶原-羟基磷灰石人工骨/胶原膜、胶原-羟基磷灰石人工骨、空白对照治疗,每组8颗牙,12周后处死动物,进行组织学观察并测量新生组织高度。结果：与单纯植入胶原-羟基磷灰石人工骨组相比,胶原-羟基磷灰石人工骨/胶原膜组获得了更多的新附着,表现为有较多的新生牙槽骨、新生牙周膜和新生牙骨质样组织生长,2组之间新生组织差异有显著性（P〈0.05）。结论：胶原-羟基磷灰石人工骨与胶原膜联合运用修复牙周牙槽骨缺损引导牙周组织再生的效果优于单纯植入人工骨。     

胶原-羟磷灰石复合膜引导骨组织再生的动物实验研究

目的 探讨自制胶原-羟磷灰石(COL-HA)复合膜修复SD大鼠颅骨缺损的效果.方法在24只SD大鼠的颅顶骨上各制备4个缺损,其中左、右侧缺损区分别覆盖COL-HA复合单层致密膜(第2组)和COL-HA复合双层膜(第3组),额骨缺损区保留作为空白对照(第1组),枕骨缺损区覆盖Bio-Gide膜作为对比(第4组).术后2、...     

胶原-羟基磷灰石人工骨与胶原膜引导牙周组织再生的动物实验研究

人工构建4只成年Beagle犬下颌后牙区牙周缺损模型,分别随机采用:胶原-羟基磷灰石人工骨/胶原膜、胶原-羟基磷灰石人工骨、空白对照治疗,每组8颗牙,12周后处死动物,进行组织学观察并测量新生组织高度。结果:与单纯植入胶原-羟基磷灰石人工骨组相比,胶原-羟基磷灰石人工骨/胶原膜组获得了更多的新附着,表现为有较多的新生牙槽骨、新生牙周膜和新生牙骨质样组织生长,2组之间新生组织差异有显著性(P<0.05)。结论:胶原-羟基磷灰石人工骨与胶原膜联合运用修复牙周牙槽骨缺损引导牙周组织     

胶原膜引导牙周组织再生的临床观察

目的 对使用胶原膜治疗牙周病的结果进行研究，观察其治疗牙周病的效果；方法 对牙周病患牙均使用胶原膜进行引导牙周组织再生术(GTR)；结果 使用胶原膜进行引导牙周组织再生术治疗牙周病效果满意，结石、菌斑、出血、牙周袋、根分又及牙松动等临床观察指标均明显好转，尤其以牙周袋及根分叉病变的改善最为突出；结论 使用胶原膜进行引导牙周组织再生术治疗牙周病，治疗效果好。     

多孔β-TCP/BMP复合人工骨引导牙周组织再生的实验研究

目的 将骨形成蛋白(bone morphogenetic protein,BMP)和多孔β磷酸三钙(β-tricalcium phosphate,β-TCP)复合人工骨联合应用于引导组织再生(guided tissue regeneration,GTR)技术中,评价其对Ⅱ度根分叉病变牙周组织再生修复的影响和意义.方法 用健康成年杂种狗4只,制备下颌后牙区人工骨缺损.实验牙位随机分为3组:①骨形成蛋白/引导组织再生(BMP/GTR)组:缺损处植入引导膜材料和复合人工骨;②GTR组:单纯放置引导膜材料;③以常规翻瓣术为对照组.术后12周取材做组织学观察和评价.结果 两实验组均有明显新附着形成,其中BMP/GTR组有大量新生牙槽骨、牙骨质、牙周韧带生长.对照组新生组织量很少.结论 β-TCP/BMP是一种具有较强骨诱导能力,生物相容性较好的复合人工骨,在引导牙周组织再生术中有良好的应用前景.     

多孔β-0TCP/BMP复合人工骨引导牙周组织再生的实验研究

目的　将骨形成蛋白 (bonemorphogeneticprotein ,BMP)和多孔 β磷酸三钙 (β tricalciumphosphate ,β TCP)复合人工骨联合应用于引导组织再生 (guidedtissueregeneration ,GTR)技术中 ,评价其对Ⅱ度根分叉病变牙周组织再生修复的影响和意义。方法　用健康成年杂种狗 4只 ,制备下颌后牙区人工骨缺损。实验牙位随机分为 3组 :①骨形成蛋白 /引导组织再生 (BMP/GTR)组 :缺损处植入引导膜材料和复合人工骨 ;②GTR组 :单纯放置引导膜材料 ;③以常规翻瓣术为对照组。术后 12周取材做组织学观察和评价。结果　两实验组均有明显新附着形成 ,其中BMP/GTR组有大量新生牙槽骨、牙骨质、牙周韧带生长。对照组新生组织量很少。结论　β TCP/BMP是一种具有较强骨诱导能力 ,生物相容性较好的复合人工骨 ,在引导牙周组织再生术中有良好的应用前景     

复合膜引导牙周组织再生

目的：观察基因重组人骨形成蛋白-2、胶原、聚乳酸／聚羟基乙酸共聚体（rhBMP-2／Co／PLGA）复合膜引导牙周组织再生的效果。方法：在杂犬的第四前磨牙及第-磨牙颊侧部位,制备急性牙周组织缺损模型,将复合膜材料植入实验部位,设对侧为同体对照。术后8周处死动物,切取双侧下颌骨标本,行软x线照相和组织学观察。结果：实验侧可见大量新生牙槽骨、牙骨质和牙周膜纤维形成;对照侧主要是牙龈上皮和上皮下结缔组织增生。结论：rhBMP-2／Co／PLGA复合膜符合GTR的要求,能够引导牙周组织再生。     

高压氧结合胶原膜引导组织再生作用的实验研究

引导组织再生术（GuidedTissueRegeneration，GTR）近年来已逐渐用于临床。本研究选择20只日本大耳兔进行高压氧结合胶原膜引导组织再生作用的研究，于20只兔的股骨中段制备直径4mm的骨缺损，表面覆盖15×12mm的胶原膜。动物分为两组，一组进行高压氧治疗，一组为对照组。分别于2、3、4、6、8周后处死，进行肉眼、X光及组织学观察。结果显示，高压氧组于术后2周缺损边缘及中央形成新骨，对照组仅在缺损边缘有新骨产生；术后4周，高压氧组基本完成骨修复，形成的新骨结构成熟而且致密。而对照组于6周后才取得类似结果。研究表明高压氧与胶原膜结合对引导组织再生有协同作用，能加快缺损区的新骨形成，促进新骨成熟。     

双抗胶原膜引导牙周组织再生的实验性研究

目的 :观察双抗胶原膜 (BACM)引导周组织再生的疗效。方法 :在狗下颌牙P2———P4区建立急性牙周缺损模型 ,放置BACM于缺损区域 ,行引导牙周组织再生术。以常规翻瓣术为对照。结果 :实验组再生牙周组织量显著多于对照组。结论 :BACM引导牙周组织再生效果切实可靠     

引导组织再生术与联合应用植骨术治疗牙周骨内缺损的临床研究

比较引导组织再生术（GTR）与联合骨移植术治疗牙周骨内缺损的临床疗效。方法 选取45例牙周炎重度垂直骨吸收的患牙,随机平均分为翻瓣术组、单纯GTR组及联合植骨组。分别在术前和术后1年记录牙周袋深度、附着丧失、牙龈退缩并进行比较。结果 术前、后自身比较,3组的各项检查指标均有显著性改变(P<0．05);与翻瓣组相比,单纯GTR组及联合植骨组牙周袋深度及附着丧失减少更显著,具有统计学差异(P<0．05),而龈退缩量无统计学差异。单纯GTR组与联合植骨组相比各项临床指标均无统计学差异。结论 与单纯翻瓣术相比,引导组织再生术与联合应用植骨术治疗垂直型牙周骨内缺损均可获得更好的临床效果,GTR联合植骨术稍优于单纯GTR术。     

Guided tissue regeneration combined with osseous grafting in suprabony periodontal lesions

The purpose of the present investigation was to evaluate the use of bone grafts in combination with the GTR-procedure in reinstituting periodontal support around teeth with horizontal bone loss. Orthodontic elastic bands were placed around mandibular and maxillary premolars in 3 dogs in order to induce breakdown of the periodontal tissues. When the destruction had reached a level corresponding to approximately half the root length, the elastic bands were removed and the teeth were scaled. After a period with plaque control, mucoperiosteal flaps were elevated on the buccal and lingual aspects of the experimental teeth. The exposed root surfaces were curetted, and a notch was made at the level of the reduced bone crest. In randomly selected test quadrants, Kielbone mixed with fibrin sealant (Tisseel) was placed in the interproximal space and in the bifurcations. Both the buccal and lingual aspect of the test teeth were then covered by a teflon membrane (Zitex) and the raised tissue flaps sutured in a coronally displaced position. The contralateral teeth (controls) were treated the same way, except that fibrin sealant without Kielbone was applied in the bifurcations and the interproximal space prior to the placement of the membranes. The membranes were removed by a 2nd operation after 35 days. Clinically, various complications were observed during healing. The buccal and lingual flap margins consistently failed to join in the interproximal area, and increasing recession of the flap margins and exposure of the membranes, resulting in accumulation of bacterial deposits and food debris, occurred during the period the membranes were maintained.(ABSTRACT TRUNCATED AT 250 WORDS)     

Bio-oss骨代材料与Bio-gide膜治疗重度牙周病疗效评估

目的 观察联合应用Bio-oss骨代材料和Bio-gide胶原膜行引导骨组织再生术治疗重度牙周炎的疗效。方法 将46例重度牙周病患者随机分为实验组和对照组,各23例,实验组39颗患牙行Bio-oss、Bio-gide引导性组织再生术,对照组32颗患牙行常规翻瓣术刮治。分别记录术前,术后12个月患牙周牙探诊深度(periodontal probing depth,PPD)、附着丧失(attachment loss,AL)、龈沟出血指数(sulcus bleeding index,SBI)、牙松动度(teeth mobility,TM)及牙槽骨高度(alveolar bone height,AH)。结果 与术前相比两组术后PPD、AL、SBI、TM均明显减少,且有显著性差异,实验组疗效优于对照组。X线根尖片显示,实验组骨缺损区有新骨形成,AH增加;对照组未见新骨形成,AH无明显改善。而且实验组骨密度增强较对照组明显增多(P<0.05)。结论 牙周翻瓣术后植入Bio-oss骨代材料,联合应用Bio-gide可吸收胶原膜治疗重度牙周病能明显改善临床指标,且疗效优于单纯翻瓣刮治术。     

Digital subtraction radiography in assessing bone changes in periodontal defects following guided tissue regeneration

19 patients with a total of 23 periodontal lesions were selected for the study. Following flap-elevation, an occlusive membrane (Gore Tex) adjusted to the size and shape of the lesion was applied. The membrane was removed 4-6 weeks later by a 2nd operation. Clinical attachment levels were measured and intraoral radiographs taken prior to surgery, and 6 and 12 months postoperatively. The root length and marginal bone level were measured on paper drawings of the teeth magnified (15x) from the conventional radiographs. The radiographs were digitized for analysis of the subtraction images between the preoperative and the 6- and 12-month postoperative images. Clinical attachment gain was seen in 78% of the teeth after 6 months and 70% after 12 months. Bone gain was recorded in 56% and 22% after 6 months and in 44% and 66% after 12 months by conventional and digital subtraction radiography, respectively. The bone level measurements on conventional radiographs differed significantly (p = 0.001) between the preoperative and 6-month postoperative, but not between the 6- and 12-month, (p = 0.29) conventional radiographs. There was no significant relationship between the clinical measurements and the assessments of bone changes on conventional radiographs (r = 0.28, p = 0.25), while a stronger relationship was observed between assessment of clinical attachment gain and assessment of bone changes on the subtraction images (r = 0.58, p = 0.01).     

Guided tissue regeneration in intrabony periodontal defects following treatment with two bioabsorbable membranes in combination with bovine bone mineral graft. A clinical and radiographic study

AIM: Comparison of two bioabsorbable barriers (collagen and polylactic acid (PLA) membranes) combined with a bovine bone mineral (BBM) graft, with an access flap procedure (AFP) alone for treating intrabony defects. MATERIAL AND METHODS: Thirty-four subjects participated in this prospective, controlled clinical trial. Baseline clinical examination (probing depth (PD), clinical attachment level (CAL)) of selected sites was performed 2 months after completion of conservative treatment in conjunction with hard-tissue measurements to ascertain the depth of the defect (cementoenamel junction to the bottom of the defects). After randomly dividing patients into three groups (two membrane groups, one control group), full thickness flaps were elevated and exposed root surfaces planed before filling defects with bone graft and positioning a barrier membrane covering the defect. The control group was treated identically except for the barrier and bone graft placement. Clinical treatment outcomes were finally evaluated 12 months after surgery for changes of PD and CAL. Radiographs at baseline and 12 months were compared using non-standardized digital radiography. RESULTS: A mean reduction in PD value of 5.08 mm and mean CAL gain of 4.39 mm occurred in the collagen-BBM group. Corresponding values for the PLA-BBM group were 4.72 and 3.71 mm, while access flap procedure (AFP) sites produced values of 2.50 and 2.43 mm. All improvements in clinical parameters were statistically significant (p<0.001) within groups for all variables. Both membranes produced statistically greater PD reduction and CAL gain compared with AFP treatment (p<0.05). Comparison between barrier groups failed to reveal any statistically significant difference in probing pocket depth reduction (p=0.56) or in CAL gain (p=0.34). CONCLUSION: Placement of the two barrier membranes used in the present study in combination with BBM graft significantly improved clinical and radiographic parameters of deep intrabony pockets and proved superior to access flap alone.     

Immunodetection of noncollagenous matrix proteins during periodontal tissue regeneration

The interface between denuded dentin and regenerative periodontal tissue was investigated in a rat alveolar bone defect model using morphological and immunocytochemical approaches. The dentin surface was surgically exposed along the palatal roots of maxillary first molars. At 3 weeks post treatment, animals were perfused and treated regions from decalcified mandibles were embedded in Epon for ultrastructural studies or LR White for post-embedding immunogold labeling. Thin tissue sections were incubated with antibodies against noncollagenous matrix (osteopontin, bone sialoprotein, osteocalcin and fibronectin) and plasma (alpha2HS-glycoprotein and albumin) proteins. While in some cases, regenerative events took place directly on the denuded dentin surface, the interface between the denuded dentin and regenerating periodontal tissue was frequently characterized by the presence of an interfacial zone. This zone sometimes showed an electron-dense, cement line-like, planar accumulation of organic material immunoreactive for osteopontin and bone sialoprotein. Immunolabeling for osteocalcin and alpha2HS-glycoprotein was moderate and diffuse throughout the interfacial zone, whereas labeling with antibodies to albumin and fibronectin resulted in a weak reaction. It is concluded that accumulation of bone sialoprotein and osteopontin is a primary event during the formation of regenerative cementum onto denuded root surfaces.     

骨形成蛋白复合物联合胶原膜治疗牙周缺损的临床研究

目的　评价骨形成蛋白复合物联合胶原膜治疗牙周组织缺损的临床效果。方法　将骨形成蛋白复合物即重组合异种骨应用于引导组织再生(GTR)技术中,与传统的GTR技术和牙周翻瓣术对照研究。选择经过牙周基础治疗的35例4 5处牙周组织缺损,分为3组,BMP组:牙周缺损处植入骨形成蛋白复合物和胶原膜;GTR组:牙周缺损处植入胶原膜;OFD组:做牙周翻瓣术,为对照组。术后12、2 4周分别观察各组的牙周探诊深度(PPD)、临床牙周附着丧失(CAL)和龈沟出血指数(SBI)等临床指标变化。结果　3组术后PPD、CAL和SBI均有明显减少和降低。BMP组、GTR组与OFD组相比较,PPD和CAL减少、SBI降低,差异均有显著性(术后12周时P <0 .0 5 ,术后2 4周时P <0 .0 1) ;BMP组与GTR组相比,PPD和CAL减少,差异有显著性(P<0 .0 1) ,而SBI降低,差异无显著性(P >0 .0 5 )。结论　骨形成蛋白复合物联合胶原膜是治疗牙周组织缺损较为理想的方法     

中药黄芪促进牙周组织再生的初步观察

目的观察中药黄芪对牙周组织再生能力的促进效果。方法建立实验犬牙周病模型后12周分别植入BIO-OSS人工骨粉+黄芪水提液、黄芪粉末、BIO-OSS人工骨粉+蒸馏水,并设立空白对照组,测量牙周探诊深度、牙体-牙周-颌骨联合标本光镜观察,以对3种方法的效果进行比较。结果BIO-OSS人工骨粉+黄芪水提液组、单纯黄芪粉末组、BIO-OSS人工骨粉+蒸馏水组6、12、24周牙周测量深度结果较空白组有明显改善,牙体-牙周-颌骨联合标本光学观察有新生牙槽骨生长。结论中药黄芪对牙周组织再生能力具有较明显的促进作用。     

Enzymatic degradation of collagen-guided tissue regeneration membranes by periodontal bacteria

Bacterial infection in the vicinity of guided tissue regeneration barrier membranes was shown to have a negative effect on the clinical outcomes of this increasingly used technique. Several oral and specifically periodontal bacteria were shown to adhere to such membranes in vivo and in vitro with a higher affinity to membranes constructed from collagen. The present study examined the role of periodontal bacteria and their enzymes in the degradation of commercially used collagen membranes. Degradation of two collagen membranes [Biomend (Calcitek, Colla-Tec Inc., Plainsboro, NJ) and Bio-Gide (Geistlich Biomaterials, Wolhousen, Switzerland)] labeled by fluorescein isothiocyanate was examined by measuring soluble fluorescence. Porphyromonas gingivalis, Treponema denticola and Actinobacillus actinomycetemcomitans and their enzymes were evaluated. Collagenase from Clostridium hystolyticum was used as a positive control. While whole cells of P. gingivalis were able to degrade both types of membranes, T. denticola could degrade Bio-Gide membranes only and A. actinomycetemcomitans whole cells could degrade none of the membranes. Fractionation of P. gingivalis cells revealed that cell membrane associated proteases were responsible for the degradation of the two collagen membranes. In T. denticola, the purified major phenylalanine protease was found to be responsible for the degradation of Bio-Gide membranes. These results suggest that proteolytic bacterial enzymes may take part in the degradation of collagen barrier membranes used for guided tissue regeneration.     

Effect of allogeneic freeze-dried demineralized bone matrix on regeneration of alveolar bone and periodontal attachment in dogs

Abstract. This split-mouth study was designed to evaluate regeneration of alveolar bone and periodontal attachment following implantation of allogeneic. freeze-dried, demineralized bone matrix (DBM). Buccal fenestration defects (6×4 mm) were created on the maxillary canine teeth in 6 beagle dogs. DBM was implanted into one randomly selected defect in each animal. The contralateral defect served as surgical control. Tissue blocks were harvested following a 4-week healing interval and prepared for histometric analysis. DBM was discernible in all implanted defects with limited evidence of bone metabolic activity. The DBM particles appeared invested within a dense connective tissue, often in close contact to the instrumented root. Fenestration defect height averaged 3.8±0.1 and 3.7±0.3mm, total bone regeneration 0.9±0.9 and 0.4±1.2 mm, and total cementum regeneration 2.3±1.5 and 0.6±0.7 mm for DBM and control defects, respectively. Differences with regards to cementum regeneration were statistically significant ( p =0.03). In summary, the results of this study suggest that DBM implants may enhance cementum regeneration in this defect model, and that they have no apparent effect on alveolar bone regeneration. Enhanced cementum regeneration may be possibly be explained by provisions for guided tissue regeneration from the implant suppressing a significant influence of the gingival connective tissue on the healing process. Moreover, a 4-week healing interval appears insufficient for turnover of DBM.