Sculean A, Donos N, Brecx M, Karring T, Reich E
Department of Periodontology and Conservative Dentistry, University of Saarland, D-66421 Homburg, Germany.
Clin Oral Investig. 2000 Mar;4(1):50-6. doi: 10.1007/s007840050113.
The aim of the present study was to evaluate histologically in monkeys the healing in acute fenestration-type defects following treatment with guided tissue regeneration (GTR) or enamel matrix proteins (EMD). Standardized "critical size" fenestration-type defects were produced surgically at the vestibular aspect of teeth 13, 23, 33, 43 in three monkeys (Macaca fascicularis). The vestibular bone plates were removed and the root surfaces were debrided by means of hand instruments in order to completely remove the root cementum. Following root conditioning with ethylenediaminetetraacetate (EDTA), the defects were treated using one of the following therapies: (1) GTR, (2) EMD, or (3) control (coronally repositioned flaps). After 5 months the animals were killed 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. Eight-micrometer-thick step serial histological sections were cut in a vestibulo-oral direction, stained with hematoxylin and eosin or oxone-aldehyde-fuchsin-Halmi, and subsequently examined under the light microscope. The results showed that, in the defects treated with GTR, a new connective tissue attachment (i.e., new cementum with inserting collagen fibers) and new bone formation had consistently occurred, whereas, in the defects treated with EMD or with coronally repositioned flaps, new attachment and new bone reformed to a varying extent. The quality of the cementum did not differ after EMD, GTR, or flap surgery. It was concluded that GTR treatment with bioresorbable membranes seems to predictably promote new attachment and new bone formation, whereas the application of EDTA or EMD may also enhance periodontal healing to a certain extent. Further studies with higher numbers of animals and defects are needed in order to definitely clarify the effect of root surface conditioning with EDTA and EMD on periodontal healing.
本研究的目的是通过组织学方法评估在猴子中，引导组织再生（GTR）或釉基质蛋白（EMD）治疗后急性开窗型缺损的愈合情况。在三只猕猴（食蟹猴）的13、23、33、43号牙前庭侧通过手术制造标准化的“临界尺寸”开窗型缺损。去除前庭骨板，并用手动器械清理根面，以完全去除根骨质。用乙二胺四乙酸（EDTA）进行根面处理后，缺损采用以下治疗方法之一：（1）GTR，（2）EMD，或（3）对照（冠向复位瓣）。5个月后处死动物，用10%缓冲甲醛灌注固定。将包含缺损及周围组织的标本分离出来，在EDTA中脱钙，然后石蜡包埋。沿前庭-口腔方向切取8微米厚的连续组织学切片，用苏木精和伊红或臭氧-醛-品红-哈尔米染色，随后在光学显微镜下检查。结果显示，在接受GTR治疗的缺损中，始终会出现新的结缔组织附着（即有插入胶原纤维的新牙骨质）和新骨形成，而在接受EMD或冠向复位瓣治疗的缺损中，新附着和新骨在不同程度上得以重塑。EMD、GTR或瓣手术治疗后牙骨质的质量没有差异。得出的结论是，使用生物可吸收膜的GTR治疗似乎可预测地促进新附着和新骨形成，而EDTA或EMD的应用在一定程度上也可能促进牙周愈合。为了明确阐明用EDTA和EMD进行根面处理对牙周愈合的影响，需要对更多动物和缺损进行进一步研究。
