McGuire Michael K, Scheyer E Todd, Snyder Mark B
Private practice, Houston, TX.
J Periodontol. 2014 Oct;85(10):1361-70. doi: 10.1902/jop.2014.140006. Epub 2014 Apr 3.
In a previously reported split-mouth, randomized controlled trial, Miller Class II gingival recession defects were treated with either a connective tissue graft (CTG) (control) or recombinant human platelet-derived growth factor-BB + β-tricalcium phosphate (test), both in combination with a coronally advanced flap (CAF). At 6 months, multiple outcome measures were examined. The purpose of the current study is to examine the major efficacy parameters at 5 years.
Twenty of the original 30 patients were available for follow-up 5 years after the original surgery. Outcomes examined were recession depth, probing depth, clinical attachment level (CAL), height of keratinized tissue (wKT), and percentage of root coverage. Within- and across-treatment group results at 6 months and 5 years were compared with original baseline values.
At 5 years, all quantitative parameters for both treatment protocols showed statistically significant improvements over baseline. The primary outcome parameter, change in recession depth at 5 years, demonstrated statistically significant improvements in recession over baseline, although intergroup comparisons favored the control group at both 6 months and 5 years. At 5 years, intergroup comparisons also favored the test group for percentage root coverage and change in wKT, whereas no statistically significant intergroup differences were seen for 100% root coverage and changes to CAL.
In the present 5-year investigation, treatment with either test or control treatments for Miller Class II recession defects appear to lead to stable, clinically effective results, although CTG + CAF resulted in greater reductions in recession, greater percentage of root coverage, and increased wKT.
在先前报道的一项双侧对照随机临床试验中,对Miller II类牙龈退缩缺损采用结缔组织移植(CTG)(对照组)或重组人血小板衍生生长因子-BB + β-磷酸三钙(试验组)进行治疗,二者均联合冠向复位瓣(CAF)。在6个月时,对多项结果指标进行了检查。本研究的目的是在5年时检查主要疗效参数。
原始30例患者中有20例在初次手术后5年可进行随访。检查的结果指标包括退缩深度、探诊深度、临床附着水平(CAL)、角化组织高度(wKT)和牙根覆盖百分比。将6个月和5年时治疗组内及治疗组间的结果与原始基线值进行比较。
在5年时,两种治疗方案的所有定量参数均显示出相对于基线有统计学意义的改善。主要结局参数,即5年时退缩深度的变化,显示出相对于基线退缩有统计学意义的改善,尽管组间比较在6个月和5年时均有利于对照组。在5年时,组间比较在牙根覆盖百分比和wKT变化方面也有利于试验组,而在100%牙根覆盖和CAL变化方面未观察到组间有统计学意义的差异。
在本次5年的研究中,对于Miller II类退缩缺损,试验组或对照组治疗似乎都能带来稳定的临床有效结果,尽管CTG + CAF在退缩减少、牙根覆盖百分比增加和wKT增加方面效果更佳。