Wang H L, Bunyaratavej P, Labadie M, Shyr Y, MacNeil R L
Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA.
J Periodontol. 2001 Oct;72(10):1301-11. doi: 10.1902/jop.2001.72.10.1301.
In early case studies, use of a collagen barrier as a guided tissue regeneration (GTR) material has shown particular promise in procedures aimed at root coverage. The similarities between collagen membrane and subepithelial connective tissue graft (SCTG) have made collagen membrane an attractive and a possible alternative material for root coverage. The purpose of this randomized clinical trial was to compare these 2 techniques, SCTG versus a GTR-based procedure (GTRC), for root coverage/recession treatment.
Sixteen patients with bilateral Miller's Class I or II (gingival recession > or = 3.0 mm) recession defects were treated either with SCTG or GTRC using a newly designed collagen membrane. Clinical parameters monitored included recession depth (RD), clinical attachment level (CAL), probing depth (PD), width of keratinized gingiva (KG), attached gingiva (AG), and recession width (RW), each measured at the mid-buccal area to the nearest 0.5 mm. Measurements were taken at baseline and 6 months. A standard mucogingival surgical procedure was performed. Data were reported as means +/- SD and were analyzed using the paired t test for univariate analysis and restricted/residual maximal likelihood (REML)-based mixed effect model for multivariate analysis.
No statistically significant differences were observed in RD, CAL, KG, and AG between test and control groups at either time period. However, SCTG showed significantly more residual PD and more RW gain when compared to GTRC at 6 months. Both treatments resulted in a statistically significant (P < 0.05) reduction of recession defects (2.5 mm and 2.8 mm), gain of CAL (2.8 mm and 2.3 mm), reduction of RW (1.9 mm and 2.7 mm), and increase of KG (0.7 mm and 1.1 mm) and AG (0.7 mm and 0.5 mm) for GTRC and SCTG, respectively, when comparing 6-month data to baseline. Mean root coverage of 73% (collagen membrane) and 84% (subepithelial connective tissue graft) was achieved.
The 2 techniques are clinically comparable. Use of a modified collagen membrane to attain root coverage may alleviate the need for donor site procurement of connective tissue.
在早期的病例研究中，使用胶原屏障作为引导组织再生（GTR）材料在旨在覆盖牙根的手术中显示出特别的前景。胶原膜与上皮下结缔组织移植（SCTG）之间的相似性使胶原膜成为用于牙根覆盖的一种有吸引力且可能的替代材料。这项随机临床试验的目的是比较这两种技术，即SCTG与基于GTR的手术方法（GTRC），用于牙根覆盖/牙龈退缩治疗。
16例双侧米勒I类或II类（牙龈退缩≥3.0mm）退缩缺损患者，使用新设计的胶原膜，分别接受SCTG或GTRC治疗。监测的临床参数包括退缩深度（RD）、临床附着水平（CAL）、探诊深度（PD）、角化龈宽度（KG）、附着龈（AG）和退缩宽度（RW），均在颊侧中部区域测量，精确到最接近的0.5mm。在基线和6个月时进行测量。实施标准的膜龈手术。数据以均值±标准差报告，并使用配对t检验进行单变量分析，使用基于受限/残差最大似然法（REML）的混合效应模型进行多变量分析。
在两个时间段内，试验组和对照组在RD、CAL、KG和AG方面均未观察到统计学上的显著差异。然而，在6个月时，与GTRC相比，SCTG显示出更多的残余PD和更多的RW增加。将6个月的数据与基线数据相比，两种治疗方法均使退缩缺损有统计学意义的减少（分别为2.5mm和2.8mm）、CAL增加（分别为2.8mm和2.3mm）、RW减少（分别为1.9mm和2.7mm），以及GTRC和SCTG的KG分别增加（分别为0.7mm和1.1mm）和AG增加（分别为0.7mm和0.5mm）。实现了平均73%（胶原膜）和84%（上皮下结缔组织移植）的牙根覆盖。
这两种技术在临床上具有可比性。使用改良的胶原膜实现牙根覆盖可能减少对结缔组织供区取材的需求。
