吸烟影响生物可吸收膜引导组织再生的效果：一项关于骨内缺损的回顾性分析。

Smoking affects the outcome of guided tissue regeneration with bioresorbable membranes: a retrospective analysis of intrabony defects.

作者信息

Stavropoulos Andreas, Mardas Nikolaos, Herrero Federiko, Karring Thorkild

机构信息

Department of Periodontology and Oral Gerontology, Royal Dental College, Aarhus University, Denmark.

出版信息

J Clin Periodontol. 2004 Nov;31(11):945-50. doi: 10.1111/j.1600-051X.2004.00589.x.

DOI:10.1111/j.1600-051X.2004.00589.x

PMID:15491308

Abstract

OBJECTIVES

To disclose factors that may influence the results of guided tissue regeneration (GTR) treatment in intrabony defects with bioresorbable membranes.

METHODS

Forty-seven intrabony defects in 32 patients were treated by means of polylactic acid/citric acid ester copolymer bioresorbable membranes. At baseline and after 1 year, the following parameters were recorded: (1) probing pocket depth (PPD), (2) gingival recession (REC), (3) probing attachment level (PAL)=PPD+REC, (4) presence/absence of plaque (PI), (5) presence/absence of bleeding on probing (BOP) and (6) intrabony component (IC) configuration (i.e. primarily presence of one, two, or three bone walls). Occurrence of membrane exposure and smoking habits were also recorded. Significance of differences between categorical variables was evaluated with McNemar's test, and between numerical variables with the t-test for paired observations. Generalized linear models were constructed to evaluate the influence of various factors on PAL gain and PPD after 1 year, including in the analysis only one defect per patient (i.e. 32 defects) chosen at random. Odds ratios were calculated using the Mantel-Haenszel method. Differences between smokers and non-smokers were evaluated by means of Pearson's chi2 and Student's t-test for non-paired observations.

RESULTS

At baseline, a mean PPD of 8.6+/-1.1 mm and a mean PAL of 9.8+/-1.6 mm was recorded. Statistically significant clinical improvements were observed 1 year after GTR treatment. An average residual PPD of 3.7+/-1.1 mm and a mean PAL gain of 3.8+/-1.5 mm were recorded. IC configuration and exposure of the membrane did not seem to influence the results, while a negative effect of smoking on the clinical parameters was observed. Smokers gained approximately 1 mm less in PAL than non-smokers (3.2+/-1.4 versus 4.3+/-1.3, respectively; p=0.03) and had approximately seven times less chances to gain 4 mm in PAL as compared with patients who did not smoke (odds ratio: 0.15). PPD reduction was less pronounced in smokers than in non-smokers (4.5+/-0.7 versus 5.5+/-0.7, respectively; p<0.01), resulting in somewhat deeper residual PPD in smokers than in non-smokers (3.6+/-1.0 versus 3.4+/-1.1; p>0.05).

CONCLUSION

Smoking impairs the healing outcome of GTR treatment of intrabony defects with bioresorbable membranes.

摘要

目的

揭示可能影响使用可生物吸收膜治疗骨内缺损时引导组织再生（GTR）效果的因素。

方法

采用聚乳酸/柠檬酸酯共聚物可生物吸收膜对32例患者的47处骨内缺损进行治疗。在基线期和1年后，记录以下参数：（1）探诊深度（PPD），（2）牙龈退缩（REC），（3）探诊附着水平（PAL）=PPD+REC，（4）菌斑存在/不存在情况（PI），（5）探诊出血存在/不存在情况（BOP）以及（6）骨内成分（IC）形态（即主要存在一壁、两壁或三壁骨）。还记录了膜暴露情况和吸烟习惯。分类变量之间差异的显著性采用McNemar检验评估，数值变量之间差异的显著性采用配对观察t检验评估。构建广义线性模型以评估各种因素对1年后PAL增加量和PPD的影响，分析中仅随机选择每位患者的一处缺损（即32处缺损）。使用Mantel-Haenszel方法计算比值比。吸烟者与非吸烟者之间的差异通过Pearson卡方检验和非配对观察的Student t检验进行评估。

结果

基线期，记录的平均PPD为8.6±1.1mm，平均PAL为9.8±1.6mm。GTR治疗1年后观察到有统计学意义的临床改善。记录的平均残余PPD为3.7±1.1mm，平均PAL增加量为3.8±1.5mm。IC形态和膜暴露似乎不影响治疗效果，而观察到吸烟对临床参数有负面影响。吸烟者的PAL增加量比非吸烟者少约1mm（分别为3.2±1.4与4.3±1.3；p=0.03），与不吸烟患者相比，吸烟者PAL增加4mm的机会约少7倍（比值比：0.15）。吸烟者的PPD减少不如非吸烟者明显（分别为4.5±0.7与5.5±0.7；p<0.01），导致吸烟者的残余PPD比非吸烟者略深（3.6±1.0与3.4±1.1；p>0.05）。