Ooba M
Department of Periodontology, Kanagawa Dental College.
Kanagawa Shigaku. 1990 Sep;25(2):187-208.
The purpose of the present study was to clarify wound healing process of periodontal tissue following experimental flap surgery, when applied the guided tissue regeneration (GTR) technique using a cross-linked atelocollagen membrane (AM). Mucoperiosteal flaps were made on the palatal gingiva of maxillary first molars of rats. The cementum was removed by curettage in order to expose the dentin surface. An AM was implanted into the site of dissection in the experimental group, while the control group received no implantation. The resorption processes of AM and wound healing processes of exposed root surface in the experimental group were examined by electron microscopic observation, 1, 3, 5, 7, 14 and 21 days, and 2, 3 months after the implantation. While the wound healing processes of periodontal tissue in the control group were examined at the fine structural level, 2 and 3 months after the flap surgery. The results were as follows. At the resorption processes of AM, the early invasion of a large number of neutrophils appeared in the site of of implantation. Neutrophils were attracted to and adhered to the AM fibers over the first few days after. AM was resolved to fine fibrous structure by the neutrophils between 1 and 3 days. A large number of macrophages appeared in the implanted site between 3 and 7 days, and neutrophils subsided after 5 days. The implanted material was rapidly resolved be macrophages with active phagocytosis, sometimes forming giant cells. Fibroblasts were invading to peripheral gingival connective tissue and were development of microfilament were observed. The implanted materials were completely resolved after 14 days. In light microscopical findings, of the experimental group, epithelial downgrowth was markedly inhibited, fibrous bundles of the gingival connective tissue were clearly arranged vertical to the root surface and new cementum tissue deposited to the root surface after 21 days. At electron microscopic observation in early stage of healing, dens granular layer (d. g. l.) was presented to the dentin surface. After 2 or 3 months of the control group, high density fibrous layer increased to the root surface. Connective tissue fiber bundles were paralleled to the root surface. The above results indicate that the GTR technique using an atelocollagen membrane may provide an effective method to promote periodontal tissue regeneration after periodontal surgery.
本研究的目的是阐明在使用交联去端胶原蛋白膜(AM)应用引导组织再生(GTR)技术时,实验性翻瓣手术后牙周组织的伤口愈合过程。在上颌第一磨牙的腭侧牙龈制作黏骨膜瓣。通过刮治去除牙骨质以暴露牙本质表面。实验组将AM植入剥离部位,而对照组不进行植入。在植入后1、3、5、7、14和21天以及2、3个月,通过电子显微镜观察检查实验组中AM的吸收过程和暴露根面的伤口愈合过程。在翻瓣手术后2和3个月,在精细结构水平检查对照组中牙周组织的伤口愈合过程。结果如下。在AM的吸收过程中,大量中性粒细胞早期侵入植入部位。中性粒细胞在术后最初几天被吸引并黏附于AM纤维。在1至3天之间,AM被中性粒细胞分解为细纤维结构。在3至7天之间,大量巨噬细胞出现在植入部位,5天后中性粒细胞减少。植入材料被具有活跃吞噬作用的巨噬细胞迅速分解,有时形成巨细胞。成纤维细胞侵入周围牙龈结缔组织,并观察到微丝的发育。植入材料在14天后完全分解。在实验组的光学显微镜观察结果中,上皮向下生长明显受到抑制,牙龈结缔组织的纤维束清晰地垂直于根面排列,21天后新的牙骨质组织沉积到根面。在愈合早期的电子显微镜观察中,牙本质表面出现致密颗粒层(d.g.l.)。对照组在2或3个月后,根面高密度纤维层增加。结缔组织纤维束与根面平行。上述结果表明,使用去端胶原蛋白膜的GTR技术可能为促进牙周手术后牙周组织再生提供一种有效方法。