Gamal Ahmed Y, Aziz Mohamed, Salama M H, Iacono Vincent J
J Int Acad Periodontol. 2014 Apr;16(2):55-63.
In guided tissue regenerative surgery, membrane perforations may serve as a mechanism for the passage of cells and biologic mediators from the periosteum and overlying gingival connective tissue into the periodontal defects. To test this assumption, this study was designed to evaluate levels of bone morphogenetic protein-2 (BMP-2) in gingival crevicular fluid (GCF) during the early stages of healing for sites treated with modified perforated membranes (MPMs) as compared with occlusive membranes (OMs).
Fifteen non-smoking patients with severe chronic periodontitis participated in this prospective, randomized and single-blinded clinical trial. Each patient contributed two interproximal contralateral defects that were randomly assigned to either an experimental modified perforated membrane group (15 sites) or a control occlusive membrane group (15 sites). Plaque index, gingival index, probing depth(PD), clinical attachment level (CAL) and the relative intrabony depth of the defect (rIBD) were measured at baseline and reassessed at three, six and nine months after therapy. Gingival crevicular fluid samples were collected on day 1 and 3, 7, 14, 21, and 30 days after therapy.
The MPM-treated group showed a statistically significant improvement in PD reduction and clinical attachment gain compared to the OM control group. Similarly, rIBD was significantly reduced in MPM-treated sites as compared with those of the OM group. BMP-2 concentrations peaked in the MPM samples obtained during the early postoperative period (days 1, 3 and 7) with a statistically significant difference compared with OM-treated groups. BMP-2 levels decreased sharply in the samples obtained at days 14, 21 and 30 with non-significant higher levels in MPM samples as compared with those of OM sites.
Within the limits of the present study, one can conclude that MPM coverage of periodontal defects is associated with a significant initial increase in GCF levels of BMP-2, a factor that could improve the clinical outcomes of guided tissue regenerative surgery.
在引导组织再生手术中，膜穿孔可能是细胞和生物介质从骨膜及覆盖的牙龈结缔组织进入牙周缺损的一种机制。为验证这一假设，本研究旨在评估与封闭性膜（OMs）相比，使用改良穿孔膜（MPMs）治疗的部位在愈合早期龈沟液（GCF）中骨形态发生蛋白-2（BMP-2）的水平。
15名患有重度慢性牙周炎的非吸烟患者参与了这项前瞻性、随机、单盲临床试验。每位患者提供两个相邻的对侧缺损部位，随机分配至实验性改良穿孔膜组（15个部位）或对照封闭性膜组（15个部位）。在基线时测量菌斑指数、牙龈指数、探诊深度（PD）、临床附着水平（CAL）以及缺损的相对骨内深度（rIBD），并在治疗后3个月、6个月和9个月重新评估。在治疗后第1天、3天、7天、14天、21天和30天收集龈沟液样本。
与OM对照组相比，MPM治疗组在PD减少和临床附着增加方面显示出统计学上的显著改善。同样，与OM组相比，MPM治疗部位的rIBD显著降低。MPM样本中BMP-2浓度在术后早期（第1天、3天和7天）达到峰值，与OM治疗组相比有统计学显著差异。在第14天、21天和30天获得的样本中，BMP-2水平急剧下降，与OM部位相比，MPM样本中的水平虽略高但无统计学意义。
在本研究的范围内，可以得出结论，牙周缺损的MPM覆盖与GCF中BMP-2水平的显著初始增加相关，这一因素可能改善引导组织再生手术的临床结果。
