Cortellini Pierpaolo, Tonetti Maurizio S
Department of Periodontology, Eastman Dental Institute, University College London, London, UK.
J Periodontol. 2004 May;75(5):672-8. doi: 10.1902/jop.2004.75.5.672.
The longevity of the clinical benefits of guided tissue regeneration (GTR) has not been fully explored. The aim of this investigation was to assess the long-term survival of GTR treated sites in terms of clinical attachment level (CAL) stability and tooth loss.
A total of 175 patients with one deep intrabony defect were selected for a retrospective investigation of tooth retention and CAL stability. All sites had been treated with GTR more than 2 years previously and had received full periodontal examinations every 2 years for up to 16 years. Definitions of events for survival analyses were tooth loss, loss of > or = 2 mm compared with the CAL observed before GTR treatment, and loss of > or = 2 mm compared with the CAL observed 1 year after completion of GTR.
Teeth were severely compromised by the presence of CAL loss of 10.7 +/- 2.4 mm, probing depths of 8.7 +/- 2.3 mm and deep intrabony defects (average depth 6.6 +/- 2.1 mm). After GTR, CAL gains were 4.6 +/- 2 mm. Average follow up was 8 +/- 3.4 years; 66.9% of subjects strictly complied with a periodontal maintenance program. Tooth survival was greater than 96% more than 10 years after GTR. CAL was equal or coronal with respect to pretreatment in 92% of cases followed for 15 years after treatment, while loss of CAL compared to the 1-year post-GTR result was observed in 37.8% of cases. Cox proportional hazard models indicated that incidence-free survival was negatively affected by smoking and positively affected by full compliance with a periodontal maintenance program in a specialist practice.
Within the limits of this study, data suggest that tooth retention and clinical improvements following GTR treatment of intrabony defects can be maintained long term in the great majority of cases and thus that regenerative periodontal treatment represents an important alternative for the management of severely compromised teeth.
引导组织再生术（GTR）临床益处的持久性尚未得到充分研究。本研究的目的是从临床附着水平（CAL）稳定性和牙齿缺失方面评估接受GTR治疗部位的长期存留情况。
总共选取了175例患有一处深部骨内缺损的患者，对其牙齿存留情况和CAL稳定性进行回顾性研究。所有部位均在2年多以前接受了GTR治疗，并且每2年接受一次全面的牙周检查，最长达16年。生存分析事件的定义为牙齿缺失、与GTR治疗前观察到的CAL相比丧失≥2mm，以及与GTR完成后1年观察到的CAL相比丧失≥2mm。
牙齿因CAL丧失10.7±2.4mm、探诊深度8.7±2.3mm和深部骨内缺损（平均深度6.6±2.1mm）而受到严重损害。GTR治疗后，CAL增加了4.6±2mm。平均随访时间为8±3.4年；66.9%的受试者严格遵守牙周维护计划。GTR治疗10年多后牙齿存留率大于96%。治疗后随访15年的病例中，92%的病例CAL与治疗前相当或位于牙冠方，而与GTR治疗后1年的结果相比，37.8%的病例出现了CAL丧失。Cox比例风险模型表明，在专科诊所，无事件生存率受到吸烟的负面影响，并受到完全遵守牙周维护计划的积极影响。
在本研究的范围内，数据表明，在大多数情况下，GTR治疗骨内缺损后牙齿存留情况和临床改善可以长期维持，因此再生性牙周治疗是治疗严重受损牙齿的一种重要替代方法。
