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。     

牙周引导组织再生术与植骨术联合应用的临床研究

目的　比较引导组织再生术 (GTR)和植骨术联合应用的方法与单纯GTR的方法在牙周骨内袋缺损中的疗效。方法　治疗 16例患者的 4 4个骨内袋缺损 ,其中 2 3个相似的病损联合应用了GTR加植骨术 ,而在 2 1个病损中进行了GTR术 ,疗效评价直至术后 12个月。结果　两组的手术区域 ,与术前基线比较 ,在术后 3、6、12个月观察到的临床参数如附着水平、探诊深度以及菌斑指数、探诊出血均有明显改善 (P <0 .0 0 1)。两组之间比较 ,结果无显著性差异 (P >0 .0 5 )。结论　在牙周手术中 ,植入骨代用品与GTR联合应用 ,比较单纯应用GTR方法的临床疗效没有显著性差异。     

牙周引导组织再生技术在牙周病治疗中的应用

牙周引导组织再生技术是近年来兴起的诱导牙周组织再生疗法,给牙周病治疗开辟了广泛的前景。该文旨在对牙周引导组织再生术在牙周病治疗中的应用及应用前景作一综述。     

引导组织再生术治疗牙周牙髓联合病变的观察

目的观察应用Bio-Oss骨胶原与Bio-Gide胶原膜联合进行引导组织再生术,对牙周牙髓联合病变治疗后3年疗效。方法对16例患者20颗牙周牙髓联合病变患牙,先行根管治疗,牙周基础治疗后4周,联合使用Bio-Oss骨胶原与Bio-Gide胶原膜进行引导组织再生术,术后定期维护。术前和术后6、12、18、24、30、36个月,观测记录临床牙周指标,包括探诊深度（probing depth,PD）、附着丧失（attachment loss,AL）、牙龈退缩（gingivalrecession,GR）,拍X线片,对所得数据进行统计学分析。结果患牙行引导组织再生术术前PD、AL、GR分别为（4.81±1.37）mm、（5.48±1.76）mm、（0.64±0.62）mm,术后36个月PD、AL、GR分别为（2.09±0.66）mm、（3.90±1.11）mm、（1.86±0.83）mm。术后6、12、18、24、30、36个月PD、AL均较术前减少,差异有统计学意义（P〈0.05）;术后6、12、18、24、30、36个月GR较术前有所增加,差异有统计学意义（P〈0.05）。X线片显示治疗后随时间的延长,患牙周围骨密度不断增高,骨形成量不断增加。结论 Bio-Oss骨胶原与Bio-Gide胶原膜联合进行引导组织再生术,治疗牙周牙髓联合病变可获得良好稳定的临床疗效。     

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。     

骨形态蛋白复合物联合引导组织再生技术修复牙周骨缺损的实验研究

目的评价骨形态蛋白复合物联合引导组织再生技术修复牙周骨缺损的效果。方法选择6只新西兰兔，制备下前牙牙周骨缺损模型，将其分为3组：GTR组(牙周骨缺损处植入胶原膜)、BMP组(牙周骨缺损处植入骨形态蛋白复合物和胶原膜)和OFD组(牙周骨缺损处未植入任何物，对照组)。术后12周分别观察各组缺损处的组织学变化。结果BMP组骨缺损处只见少量的软组织，新生骨组织的量及其成熟程度明显优于GTR组和OFD组，显示骨组织修复良好。结论骨形态蛋白复合物联合GTR技术修复牙周骨缺损，与传统的GTR术和牙周翻瓣术相比，更能有效促进牙周骨组织再生与修复。     

牙周植骨材料种类及其应用研究进展

牙周骨缺损是牙周病的常见表现,其常见治疗方法是以各种材料移植为基础的牙周植骨术。移植材料由于来源丰富,能满足日益增多的需求,在临床上的应用越来越广泛。本文就植骨材料的种类、原理、使用方式及其应用加以综述,为牙周植骨临床应用提供理论依据。     

牙周引导组织再生术的临床研究

牙周引导组织再生术的临床研究广州市第一人民医院口腔科（５１０１８０）梁晓敏张兵中山医科大学孙逸仙纪念医院口腔科童立文牙周新附着的完整概念是建立完整的牙周组织（包括牙骨质、牙周韧带、牙槽骨以及结缔组织附着）。长期以来，人们进行了大量的研究，包括翻瓣术、...     

构建牙周引导组织再生动物模型的研究概况

在牙周引导组织再生研究中,体内和体外实验有重要的互补作用.用于体内实验的动物模型常用来检验屏障膜在牙周引导组织再生中的安全性及有效性.牙周引导组织再生研究中的实验动物主要有啮齿类动物、兔、小型猪、犬以及非人灵长类动物等.由于各体内实验的研究目的不同,各种动物的牙周组织解剖及病理生理特点各异,故在具体牙周引导组织再生的研究中动物模型的构建也不尽相同.本文拟对近年来用于牙周引导组织再生研究的动物牙周骨缺损模型的构建方法进行回顾及综述.     

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).     

New attachment and bone formation in periodontal defects following treatment of submerged roots with guided tissue regeneration

Abstract The purpose of the present study was to examine the effect on periodontal regeneration of preventing bacterial contamination of the membrane material following the guided tissue regeneration procedure (GTR). Periodontal dehiscence defects were surgically produced in 2 monkeys. In each monkey, 8 of these defects were submerged after resection of the crowns of the teeth and a teflon (Gore-Tex Periodontal Material®) or a polyglactin (Vicryl Mesh®) membrane was adjusted to cover the defect and the exposed root surface. 4 defects on non-crown resected teeth were treated with either a teflon or a polyglactin membrane positioned with the coronal border approximately 2 mm below the margin of the covering tissue flap. Following 6 months of healing, the animals were sacrificed. Histological evaluation of the specimens revealed that roots which were kept completely covered during the healing period demonstrated new connective tissue attachment and bone formation corresponding to 67–100% of the length of the initial defect depth, whereas the amount of new connective tissue attachment and bone on non-submerged roots ranged between 30–59% and 11–31%, respectively. It seems reasonable to anticipate that it is bacterial contamination of the membrane material which jeopardizes the formation of new connective tissue attachment but in particular bone formation following the GTR-procedure.     

Collagen gel and membrane in guided tissue regeneration in periodontal fenestration defects in dogs

Abstract The effect of a collagen gel matrix as a submembranous space-maintaining material was evaluated in guided tissue regeneration procedures. In 4 dogs, contralateral surgical circular fenestration defects, 5 mm in diameter, were produced at the midbuccal aspect of the alveolar bone in 8 maxillary canines. Removal of bone, PDL and cementum was complete. Experimental sites were filled with collagen gel and covered with collagen membranes; control sites were covered with collagen membranes and the underlying space was spontaneously filled with blood. Mucogingival flaps were repositioned. Histological and histomorphometric observations, 6 weeks post-surgery, indicated that defects covered by collagen membranes presented the most impressive regeneration with almost complete coverage of the denuded root by new cementum (98.4%) and new bone (63.2%). In the experimental defects. 83.5% coverage of new cementum with only 21.9% new bone regeneration was observed. These results suggest that collagen gel. interfered with healing by PDL and bone-derived cells in the submembranous space.     

Surgical guided tissue regeneration treatment of advanced periodontal defects: a 5-year follow-up study

OBJECTIVES: To study the 5-year outcome of combined use of guided tissue regeneration (GTR) barriers and bovine bone in advanced periodontal defects. MATERIAL AND METHODS: In each of 24 patients, one defect was surgically exposed, debrided, filled with bovine bone, and covered with a bioresorbable barrier. Re-examinations were made after 1, 3, and 5 years. RESULTS: Average full-mouth plaque scores (FMPS) were 14.5% at baseline and 10.7%, 9.8%, and 18.9% after 1, 3, and 5 years, respectively. Mean probing pocket depth (PPD) was 10.0 mm at baseline. Mean PPD reduction was 5.2 mm after 1 year, 5.6 mm after 3 years, and 5.3 mm after 5 years. Mean gingival recession was 1.0 mm after 1 year, 1.6 mm after 3 years, and 1.3 mm after 5 years. Mean gain in clinical attachment level (CAL) was 4.2 mm at the 1-year, 4.1 mm at the 3-year, and 4.3 mm at the 5-year examination. Smoking significantly influenced CAL change at all re-examinations. FMPS were significantly correlated with radiographic defect depth at the 5-year examination and CAL with smoking and FMPS at the 3-year examination. CONCLUSION: Advanced periodontal defects can be successfully treated with the combined use of GTR barriers and bovine bone to substantially reduce PPD and achieve a stable, long-term gain of CAL.     

Polymer-assisted regeneration therapy with Atrisorb barriers in human periodontal intrabony defects

AIM: This study compared clinical results of 40 periodontal osseous defects treated by two types of absorbable barrier materials. MATERIAL AND METHODS: Thirty patients (23 males and seven females) suffering from moderate to advanced periodontitis (with comparable osseous defects) were randomly assigned to receive either Atrisorb barrier (n = 22; group A) or Resolut XT barrier (n = 18; group B) therapy. Periodontal phase I treatment and oral hygiene instruction were performed before periodontal surgery. Papillary preservation, partial thickness flap, citric acid root conditioning, and decortication procedures were applied during the operation. Bone defects were filled with demineralized freeze-dried bone allograft and minocycline mixture (4:1 ratio). Postoperative care included 0.10% chlorhexidine rinse daily and antibiotic medication for 2 weeks. Clinical assessments including probing depth (PD), clinical attachment level (CAL), gingival recession (GR), plaque index (PII), gingival index (GI), and radiographic examinations were taken at the baseline, preoperatively and at 3 and 6 months after regenerative surgery. RESULTS: Six months following therapy, both Atrisorb and Resolut XT groups had achieved comparable clinical improvement in pocket reduction (3.9 versus 4.4 mm), attachment tissue gain (clinical attachment gain; 3.5 versus 3.6 mm), and reduction in the GI and in the PII. Within-group comparisons showed significant attachment gain and pocket reduction between baseline data and those at both 3 and 6 months postoperatively (p < 0.01). There were no statistically significant differences in any measured data between groups A and B. CONCLUSIONS: The results of this study indicate that a comparable and favorable regeneration of periodontal defects can be achieved with both Atrisorb and Resolut XT barriers. Further long-term study and histologic observations of tissue healing are needed to evaluate whether Atrisorb is promising for clinical use.     

A systematic review of guided tissue regeneration for periodontal infrabony defects

OBJECTIVES: To systematically review the evidence for efficacy of guided tissue regeneration (GTR) for infrabony defects. BACKGROUND: The evidence for the efficacy of GTR has not yet been systematically appraised. METHODS: We searched for randomised controlled trials of at least 12 months' follow-up comparing GTR with open flap debridement (OFD). Data sources included electronic databases, hand-searched journals and contact with experts. Screening, data abstraction and quality assessment were conducted independently by multiple reviewers. The primary outcome measure was gain in clinical attachment. RESULTS: For attachment level change, the weighted mean difference between GTR alone and open flap debridement was 1.11 mm (95% CI: 0.63-1.59), chi-square for heterogeneity 31.4 (9 df ), P < 0.001) and for GTR + bone substitutes was 1.25 mm (95% CI: 0.89-1.61, chi-square for heterogeneity 0.01 (1 df), P = 0.91). The number of sites needed to treat (NNT) for GTR to achieve one extra site gaining 2 mm or more attachment over open flap debridement was 8 (95% CI: 4-33). Heterogeneity between studies was highly statistically significant for all principal comparisons and could not be explained satisfactorily by sensitivity analyses. CONCLUSIONS: Overall, GTR was more effective than OFD in improving attachment levels. However, there was marked variability between studies and general conclusions about the clinical benefit of GTR are limited by this heterogeneity. Future studies should aim to identify factors associated with achieving consistent benefits over open flap debridement. Open flap surgery should remain the control comparison in these studies.     

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)     

生长因子智能控释与牙周组织再生

牙周骨移植、引导组织再生术（guided tissue regeneration，GTR）为牙周病的治疗和牙周缺损的修复带来了新的希望，但在恢复牙周组织的结构和功能方面还远不能达到理想的目标。组织工程和基因技术才刚刚起步，离临床应用还有较远的距离；药物控释技术的迅猛发展和活性牙周生物材料的研制与开发，为损害牙周组织结构功能的修复重建开辟了新的研究空间。     

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.     

生长因子联合引导性再生技术在口腔种植治疗中的应用

随着膜屏障和骨移植材料的发展,引导性再生技术已广泛应用于口腔种植修复及外科重建领域.将生长因子复合到生物活性材料上,利用其促进骨再生的特性而进一步提高骨诱导活性并增强骨性整合已成为目前研究的热点.