Windisch Péter, Szendroi-Kiss Dóra, Horváth Attila, Suba Zsuzsanna, Gera István, Sculean Anton
Department of Periodontology, Semmelweis University, Budapest, Hungary.
Clin Oral Investig. 2008 Sep;12(3):257-64. doi: 10.1007/s00784-008-0194-8. Epub 2008 Mar 21.
Treatment of intrabony periodontal defects with a combination of a natural bone mineral (NBM) and guided tissue regeneration (GTR) has been shown to promote periodontal regeneration in intrabony defects. In certain clinical situations, the teeth presenting intrabony defects are located at close vicinity of the resorbed alveolar ridge. In these particular cases, it is of clinical interest to simultaneously reconstruct both the intrabony periodontal defect and the resorbed alveolar ridge, thus allowing insertion of endosseous dental implants. The aim of the present study was to present the clinical and histological results obtained with a new surgical technique designed to simultaneously reconstruct the intrabony defect and the adjacently located resorbed alveolar ridge. Eight patients with chronic advanced periodontitis displaying intrabony defects located in the close vicinity of resorbed alveolar ridges were consecutively enrolled in the study. After local anesthesia, mucoperiosteal flaps were raised, the granulation tissue removed, and the roots meticulously scaled and planed. A subepithelial connective tissue graft was harvested from the palate and sutured to the oral flap. The intrabony defect and the adjacent alveolar ridge were filled with a NBM and subsequently covered with a bioresorbable collagen membrane (GTR). At 11-20 months (mean, 13.9+/-3.9 months) after surgery, implants were placed, core biopsies retrieved, and histologically evaluated. Mean pocket depth reduction measured 3.8+/-1.7 mm and mean clinical attachment level gain 4.3+/-2.2 mm, respectively. Reentry revealed in all cases a complete fill of the intrabony component and a mean additional vertical hard tissue gain of 1.8+/-1.8 mm. The histologic evaluation indicated that most NBM particles were surrounded by bone. Mean new bone and mean graft area measured 17.8+/-2.8% and 32.1+/-8.3%, respectively. Within their limits, the present findings indicate that the described surgical approach may be successfully used in certain clinical cases to simultaneously treat intrabony defects and to reconstruct the resorbed alveolar ridge.
天然骨矿物质（NBM）与引导组织再生（GTR）联合治疗骨内牙周缺损已被证明可促进骨内缺损的牙周再生。在某些临床情况下，存在骨内缺损的牙齿位于吸收的牙槽嵴附近。在这些特殊情况下，同时重建骨内牙周缺损和吸收的牙槽嵴具有临床意义，从而允许植入骨内牙种植体。本研究的目的是展示一种旨在同时重建骨内缺损和相邻吸收牙槽嵴的新手术技术所获得的临床和组织学结果。八名患有慢性重度牙周炎且骨内缺损位于吸收牙槽嵴附近的患者连续纳入本研究。局部麻醉后，掀起粘骨膜瓣，去除肉芽组织，并仔细刮治和平整牙根。从腭部获取上皮下结缔组织移植物并缝合至口腔瓣。骨内缺损和相邻牙槽嵴用NBM填充，随后用可生物吸收的胶原膜（GTR）覆盖。术后11 - 20个月（平均13.9±3.9个月），植入种植体，获取核心活检组织并进行组织学评估。平均袋深减少量为3.8±1.7mm，平均临床附着水平增加量为4.3±2.2mm。再次手术显示所有病例的骨内部分均完全填充，平均额外垂直硬组织增加量为1.8±1.8mm。组织学评估表明，大多数NBM颗粒被骨包围。平均新骨面积和平均移植物面积分别为17.8±2.8%和32.1±8.3%。在其局限性范围内，本研究结果表明，所描述的手术方法在某些临床病例中可成功用于同时治疗骨内缺损和重建吸收的牙槽嵴。
