Periodontol 2000. 2015 Jun;68(1):182-216. doi: 10.1111/prd.12086.
Intrabony periodontal defects are a frequent complication of periodontitis and, if left untreated, may negatively affect long-term tooth prognosis. The optimal outcome of treatment in intrabony defects is considered to be the absence of bleeding on probing, the presence of shallow pockets associated with periodontal regeneration (i.e. formation of new root cementum with functionally orientated inserting periodontal ligament fibers connected to new alveolar bone) and no soft-tissue recession. A plethora of different surgical techniques, often including implantation of various types of bone graft and/or bone substitutes, root surface demineralization, guided tissue regeneration, growth and differentiation factors, enamel matrix proteins or various combinations thereof, have been employed to achieve periodontal regeneration. Despite positive observations in animal models and successful outcomes reported for many of the available regenerative techniques and materials in patients, including histologic reports, robust information on the degree to which reported clinical improvements reflect true periodontal regeneration does not exist. Thus, the aim of this review was to summarize, in a systematic manner, the available histologic evidence on the effect of reconstructive periodontal surgery using various types of biomaterials to enhance periodontal wound healing/regeneration in human intrabony defects. In addition, the inherent problems associated with performing human histologic studies and in interpreting the results, as well as certain ethical considerations, are discussed. The results of the present systematic review indicate that periodontal regeneration in human intrabony defects can be achieved to a variable extent using a range of methods and materials. Periodontal regeneration has been observed following the use of a variety of bone grafts and substitutes, guided tissue regeneration, biological factors and combinations thereof. Combination approaches appear to provide the best outcomes, whilst implantation of alloplastic material alone demonstrated limited, to no, periodontal regeneration.
内源性牙周缺损是牙周炎的常见并发症，如果不进行治疗，可能会对长期牙齿预后产生负面影响。内源性牙周缺损的最佳治疗效果被认为是探诊时无出血、存在与牙周再生相关的浅牙周袋（即形成具有功能性定向插入牙周韧带纤维的新牙根牙骨质，与新牙槽骨相连）和无软组织退缩。为了实现牙周再生，已经采用了多种不同的手术技术，这些技术通常包括植入各种类型的骨移植物和/或骨替代品、牙根表面脱矿质、引导组织再生、生长和分化因子、釉基质蛋白或各种组合。尽管在动物模型中观察到了积极的结果，并且许多现有的再生技术和材料在患者中也取得了成功的结果，包括组织学报告，但关于报告的临床改善在多大程度上反映了真正的牙周再生的信息并不存在。因此，本综述的目的是系统地总结使用各种类型的生物材料进行重建性牙周手术对人类内源性牙周缺损中牙周愈合/再生效果的现有组织学证据。此外，还讨论了进行人类组织学研究和解释结果的固有问题以及某些伦理考虑因素。本系统综述的结果表明，使用多种方法和材料，在一定程度上可以实现人类内源性牙周缺损的牙周再生。已经观察到使用各种骨移植物和替代品、引导组织再生、生物因子及其组合可以实现牙周再生。联合方法似乎提供了最好的结果，而单独植入同种异体材料则显示出有限的，甚至没有牙周再生。
