Cortellini Pierpaolo, Tonetti Maurizio S
Department of Periodontology, Eastman Dental Institute and Hospital, University College London, London, UK.
J Periodontol. 2005 Mar;76(3):341-50. doi: 10.1902/jop.2005.76.3.341.
The aim of the present study was to evaluate the clinical performance of a regenerative strategy for the treatment of deep intrabony defects.
This patient cohort study involved 40 patients with one deep interdental intrabony defect each. They were treated with periodontal regeneration using four different regenerative methods (expanded polytetrafluoroethylene [ePTFE] titanium reinforced membranes, bioabsorbable membranes alone, bioabsorbable membranes with a bone replacement graft [combination], or enamel matrix derivative), according to predefined criteria and decision-making algorithms. Defects were accessed with papilla preservation flaps performed with the aid of an operating microscope and microsurgical instruments. A stringent plaque control regimen was enforced in all the patients during the 1-year observation period. Outcomes included evaluation of the complete primary closure of the interdental space (CLOSURE), gains in clinical attachment (CAL), and reductions in probing depths (PD).
CLOSURE was achieved in all treated defects and was maintained in 90% of cases for the entire healing period. At 1 year the observed CAL gains were 6 +/- 1.8 mm on average, corresponding to a resolution of 92.1% +/- 12% of the initial intrabony (CAL%) component of the defect. Average PD reduction was 6.1 +/- 1.9 mm and was associated with minimal increase in gingival recession (-0.1 +/- 0.7 mm). The 12 sites treated with titanium reinforced ePTFE membranes resulted in a 1-year CAL gain of 6.8 +/- 2.2 mm (CAL%: 94.7 +/- 13.4); the 11 cases treated with combination therapy showed a 1-year CAL gain of 5.4 +/- 1.7 mm (CAL%: 88.2 +/- 9.6); the seven sites treated with bioabsorbable barriers resulted in 5.9 +/- 1.2 mm of CAL gain (CAL%: 88.9 +/- 11.5); and the 10 sites treated with enamel matrix gained on average 5.9 +/- 1.5 mm of CAL (CAL%: 88.9 +/- 11.5). No significant differences were observed among the four approaches.
The use of an evidence-based regenerative strategy resulted in clinically relevant amounts of CAL gains, shallow pockets, and minimal gingival recession with the four regenerative approaches.
本研究的目的是评估一种再生策略治疗深部骨内缺损的临床效果。
这项患者队列研究纳入了40例患者，每位患者均有一处深部牙间骨内缺损。根据预定义的标准和决策算法，采用四种不同的再生方法（膨体聚四氟乙烯[ePTFE]钛增强膜、单纯生物可吸收膜、生物可吸收膜与骨替代移植物联合使用[联合]或釉基质衍生物）对他们进行牙周再生治疗。借助手术显微镜和显微手术器械，通过保留乳头瓣进入缺损部位。在1年的观察期内，所有患者均实施严格的菌斑控制方案。观察指标包括评估牙间间隙的完全一期关闭（CLOSURE）、临床附着丧失（CAL）的改善以及探诊深度（PD）的降低。
所有治疗的缺损均实现了CLOSURE，并且在90%的病例中在整个愈合期得以维持。1年后，观察到的CAL平均改善为6±1.8mm，相当于缺损初始骨内（CAL%）部分的92.1%±12%得到解决。平均PD降低为6.1±1.9mm，且牙龈退缩增加极少（-0.1±0.7mm）。用钛增强ePTFE膜治疗的12个部位1年后CAL改善为6.8±2.2mm（CAL%：94.7±13.4）；联合治疗的11例患者1年后CAL改善为5.4±1.7mm（CAL%：88.2±9.6）；用生物可吸收屏障治疗的7个部位CAL改善为5.9±1.2mm（CAL%：88.9±11.5）；用釉基质治疗的10个部位CAL平均改善为5.9±1.5mm（CAL%：88.9±11.5）。四种方法之间未观察到显著差异。
使用基于证据的再生策略，四种再生方法均在临床上实现了显著的CAL改善、浅袋形成以及极少的牙龈退缩。
