Batista E L, Novaes A B, Simonpietri J J, Batista F C
School of Dentistry, Federal University of Rio de Janeiro, Brazil.
J Periodontol. 1999 Sep;70(9):1000-7. doi: 10.1902/jop.1999.70.9.1000.
Different filling materials have been associated with guided tissue regeneration (GTR) in order to improve its regenerative potential and predictability. Anorganic bovine bone (ABB) has demonstrated biocompatibility and osteoconductive properties; however, there are limited data regarding its performance in the treatment of intrabony defects. This investigation aimed to evaluate the clinical outcome of the association of anorganic bovine bone with cellulose membranes in intrabony defects after 6 months.
Twenty-six paired intrabony defects were selected from 11 non-smoking patients with no relevant medical history. The defects were similar regarding the number of bony walls and defect depth, and presented pocket depths > or = 6 mm. Four weeks after completion of basic therapy, probing depth (PD), clinical attachment level (CAL), and gingival margin position (GP) were recorded (baseline values). The defects were then surgically accessed and debrided, and the intrabony component measured to the nearest millimeter with periodontal probes and customized acrylic stents (distance from the stent to the base of the defect and from the stent to the alveolar crest). Each intrabony defect was randomly assigned to receive the membrane alone (control, C) or the membrane with anorganic bovine bone (test, T). The patients were re-evaluated after 6 months, and re-entry procedures were performed.
Significant (P <0.01) improvement in all variables was observed: mean pocket reduction of 4.61+/-1.60 mm (C) and 4.46+/-1.50 mm (T) and clinical attachment gain of 2.85+/-1.46 mm (C) and 3.15+/-1.40 mm (T); the difference between groups was not significant (P >0.05). Nevertheless, gingival recession in the control group (1.84+/-0.89 mm) was significantly (P <0.05) more pronounced than that observed in the test group (1.30+/-0.48 mm). Bone measurements indicated a significant resolution of the defects (P <0.01). A mean defect resolution of 2.76+/-0.72 mm (C) and 2.69+/-1.03 mm (T) and crestal resorption of 1.07+/-0.64 mm (C) and 1.30+/-0.85 mm (T) were detected (P >0.05). Stepwise multiple regression analysis indicated that for both groups, the baseline depth of the defects and the alveolar crest resorption accounted for 82% of the variability of bone fill observed in the control group (F = 23.65, P <0.001) and 89% in the test group (F = 41.32, P <0.001).
ABB may be used in conjunction with GTR in the treatment of intrabony defects. Its use, however, did not result in a better outcome than the use of membranes alone. Studies employing more patients would be of interest in order to determine the advantages and indications of the tested approaches on a more predictable basis.
为了提高引导组织再生（GTR）的再生潜力和可预测性，已将不同的填充材料与之联合使用。无机牛骨（ABB）已显示出生物相容性和骨传导特性；然而，关于其在治疗骨内缺损方面性能的数据有限。本研究旨在评估6个月后无机牛骨与纤维素膜联合用于治疗骨内缺损的临床效果。
从11名无相关病史的非吸烟患者中选取26对骨内缺损。这些缺损在骨壁数量和缺损深度方面相似，且牙周袋深度≥6mm。在完成基础治疗4周后，记录探诊深度（PD）、临床附着水平（CAL）和牙龈边缘位置（GP）（基线值）。然后通过手术进入并清理缺损，用牙周探针和定制的丙烯酸支架将骨内部分测量至最接近的毫米数（从支架到缺损底部以及从支架到牙槽嵴的距离）。每个骨内缺损随机分配接受单纯膜（对照组，C）或膜与无机牛骨联合（试验组，T）。6个月后对患者进行重新评估，并进行再次手术。
观察到所有变量均有显著（P<0.01）改善：对照组平均牙周袋减少4.61±1.60mm，试验组为4.46±1.50mm；临床附着增加对照组为2.85±1.46mm，试验组为3.15±1.40mm；两组间差异无统计学意义（P>0.05）。然而，对照组的牙龈退缩（1.84±0.89mm）比试验组（1.30±0.48mm）显著（P<0.05）更明显。骨测量表明缺损有显著改善（P<0.01）。检测到对照组平均缺损改善2.76±0.72mm，试验组为2.69±1.03mm；牙槽嵴吸收对照组为1.07±0.64mm，试验组为1.30±0.85mm（P>0.05）。逐步多元回归分析表明，对于两组，缺损的基线深度和牙槽嵴吸收分别占对照组观察到的骨填充变异性的82%（F=23.65，P<0.001）和试验组的89%（F=41.32，P<0.001）。
ABB可与GTR联合用于治疗骨内缺损。然而，其使用并未比单纯使用膜产生更好的效果。采用更多患者的研究将有助于在更可预测的基础上确定所测试方法的优势和适应证。
