Gamal A Y, Abdel-Ghaffar K A, Iacono V J
Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt.
Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.
J Periodontal Res. 2016 Jun;51(3):407-16. doi: 10.1111/jre.12321. Epub 2015 Nov 9.
Perforated barrier membranes open channels between the suprabony and intrabony compartments of the defect, which could allow for more physiologic cellular interactions between different components of the periodontium during guided tissue regeneration surgery. To test this assumption, this study was designed to evaluate levels of vascular endothelial cell growth factor (VEGF) and platelet-derived growth factor (PDGF)-BB in gingival crevicular fluid during the early stages of healing of localized intrabony defects treated with perforated membranes (PMs) or non-PMs, as compared with open flap debridement.
Thirty non-smoking patients with severe chronic periodontitis participated in this prospective, randomized and single blinded trial. Each patient contributed one interproximal defect that was randomly assigned to the PM group (n = 10), occlusive membrane (OM) group (n = 10) or open flap debridement (OFD) group (n = 10). Plaque index, gingival index, probing depth, clinical attachment level and the intrabony depth of the defect were measured at baseline and reassessed at 6 and 9 mo after therapy. Gingival crevicular fluid samples were collected on days 1, 3, 7, 14, 21 and 30 d after therapy for the changes in VEGF and PDGF-BB levels.
During the early stages of healing (1, 3 and 7 d), the mean VEGF and PDGF-BB concentrations at sites treated with PMs and OFD peaked with a statistically significant difference as compared with the OM-treated group. VEGF and PDGF-BB levels at sites treated with PMs and OFD were not statistically different. Growth factor levels decreased sharply in the samples obtained at days 21 and 30 with non-significant differences between the three groups. Nine months after therapy, the PM-treated group showed a statistically significant improvement in probing depth, clinical attachment level and intrabony defect compared to the OM and OFD groups.
Within the limits of the present study, one can conclude that PM coverage of periodontal defects is associated with initial gingival crevicular fluid growth factor upregulation that could improve the clinical outcomes of guided tissue regeneration surgery.
穿孔屏障膜在骨上袋和骨内袋之间开通通道，这可能使引导组织再生手术期间牙周组织不同成分之间的细胞相互作用更符合生理状态。为验证这一假设，本研究旨在评估与开放性翻瓣清创术相比，用穿孔膜（PM）或非穿孔膜治疗局限性骨内袋缺损愈合早期龈沟液中血管内皮生长因子（VEGF）和血小板衍生生长因子（PDGF）-BB的水平。
30例重度慢性牙周炎非吸烟患者参与了这项前瞻性、随机、单盲试验。每位患者提供一个邻面缺损，随机分为PM组（n = 10）、封闭性膜（OM）组（n = 10）或开放性翻瓣清创术（OFD）组（n = 10）。在基线时测量菌斑指数、牙龈指数、探诊深度、临床附着水平和缺损的骨内深度，并在治疗后6个月和9个月重新评估。在治疗后第1、3、7、14、21和30天收集龈沟液样本，检测VEGF和PDGF-BB水平的变化。
在愈合早期（第1、3和7天），与OM治疗组相比，PM和OFD治疗部位的平均VEGF和PDGF-BB浓度达到峰值，差异有统计学意义。PM和OFD治疗部位的VEGF和PDGF-BB水平无统计学差异。在第21天和30天获得的样本中，生长因子水平急剧下降，三组之间无显著差异。治疗9个月后，与OM组和OFD组相比，PM治疗组在探诊深度、临床附着水平和骨内缺损方面有统计学意义的改善。
在本研究的范围内，可以得出结论，牙周缺损的PM覆盖与龈沟液生长因子的初始上调有关，这可能改善引导组织再生手术的临床效果。
