Froum S, Lemler J, Horowitz R, Davidson B
Department of Surgical Services, New York University College of Dentistry, USA.
Int J Periodontics Restorative Dent. 2001 Oct;21(5):437-49.
An investigation of the periodontal literature reveals four critical factors necessary for a regenerative response in the treatment of intrabony defects. These include root preparation to remove toxins and altered cementum, space creation by the graft or membrane barrier for migration of progenitor cells, stabilization and flap coverage of the graft, and use of a membrane barrier or enamel matrix derivative (EMD). This article reviews the literature supporting this concept and presents a clinical decision tree to determine when to use EMD alone or with autogenous grafts and membrane barriers in the treatment of defects of varying morphologies. The clinical decision tree is designed to increase the predictability of a positive clinical response. Cases are shown to demonstrate the indication for each treatment.
对牙周病学文献的调查揭示了在治疗骨内缺损时实现再生反应所需的四个关键因素。这些因素包括进行牙根预备以去除毒素和病变牙骨质、通过移植材料或膜屏障创造空间以供祖细胞迁移、对移植材料进行稳定处理并覆盖瓣以及使用膜屏障或釉基质衍生物（EMD）。本文回顾了支持这一概念的文献，并提出了一个临床决策树，以确定在治疗不同形态的缺损时何时单独使用EMD，或与自体移植材料和膜屏障联合使用。该临床决策树旨在提高获得积极临床反应的可预测性。文中展示了病例以说明每种治疗方法的适应证。
