Gera István, Döri Ferenc, Keglevich Tibor, Anton Sculean, Szilágyi Emese, Windisch Péter
Semmelweis Egyetem, Budapest.
Fogorv Sz. 2002 Aug;95(4):143-7.
Various bone replacement graft materials have been used in attempting to restore periodontal bone structure lost as a result of periodontal inflammation. The pure beta-tricalcium phosphate has been successfully used in oral surgery for replacing lost bone but the periodontal data available are very limited. The major objective of the present clinical trial is to evaluate the regenerative-reparative potential of beta-tricalcium phosphate (CERASORB) in the treatment of two-three-wall vertical periodontal bony defect. 21 patients with advanced intrabony defects were selected for this study. Parameters used for assessment: Bleeding on probing, Clinical Probing Depths (CPD), Clinical Attachment Loss (CAL), Clinical Gingival Recession (CGR) and Radiological evaluation on standardized periapical radiographs. Following local anesthesia, intracervicular incisions is placed and a full thickness mucoperiosteal flap is raised vestibularly and lingually. The granulation tissue was completely removed from the defects and the roots were thoroughly scaled and planed using hand and ultrasonic instruments. Osseous recontouring was not performed. Following defect debridement, the CERASORB bone-grafting material was carefully applied and gently condensed in the bone crater then the flaps were repositioned in a coronal position and closed with vertical or horizontal mattress sutures. Six months after surgery CPD, CAL and CGR parameters were also measured and compared to baseline data. Bone defects treated with beta-TCP bone grafting materials showed a great variation in healing tendency. The best radiological results (bone fill) were obtained in three wall defects. Even using the most thorough suturing technique substantial part of the bone grafting material was lost during the first post-surgical week. If no sequestration occurred substantial bone fill and clinical attachment gain occurred especially in the three wall defects one year after grafting. The use of biological barrier membranes are recommended.
为了修复因牙周炎而丧失的牙周骨结构,人们尝试使用了各种骨替代移植材料。纯β-磷酸三钙已成功用于口腔外科手术中替代缺失的骨组织,但现有的牙周数据非常有限。本临床试验的主要目的是评估β-磷酸三钙(CERASORB)在治疗两壁至三壁垂直牙周骨缺损中的再生修复潜力。本研究选取了21例患有严重骨内缺损的患者。用于评估的参数包括:探诊出血、临床探诊深度(CPD)、临床附着丧失(CAL)、临床牙龈退缩(CGR)以及标准化根尖片的影像学评估。在局部麻醉后,做颈内切口,在前庭和舌侧掀起全厚黏骨膜瓣。从缺损处彻底清除肉芽组织,并用手动器械和超声器械对牙根进行彻底的刮治和根面平整。未进行骨外形修整。在缺损清创后,小心地应用CERASORB骨移植材料并轻轻压实于骨坑内,然后将瓣向冠方复位,并用垂直或水平褥式缝合关闭创口。术后6个月,还测量了CPD、CAL和CGR参数,并与基线数据进行比较。用β-TCP骨移植材料治疗的骨缺损在愈合趋势上有很大差异。在三壁缺损中获得了最佳的影像学结果(骨填充)。即使采用最彻底的缝合技术,在术后第一周仍有相当一部分骨移植材料丢失。如果没有发生骨分离,在移植后一年尤其是在三壁缺损中会出现大量的骨填充和临床附着增加。建议使用生物屏障膜。