Department of Oral Medicine and Periodontology, Faculty of Dentistry, Kafrelsheikh University, Kafr El Sheikh, Egypt.
Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt.
J Periodontal Res. 2020 Jan;55(1):85-95. doi: 10.1111/jre.12692. Epub 2019 Aug 26.
Perforated barrier membranes (PBM) were suggested to enhance periodontal regeneration by allowing positive charity of wanted elements from the gingival tissue side. The present study was designed to evaluate clinically and biochemically the use of PBM combined with simvastatin (SMV) gel with and without an associated EDTA gel root surface etching as a suggested option that could improve SMV availability and clinical outcomes of PBM.
Forty patients having moderate-to-severe chronic periodontitis with 40 intrabony defects were randomly divided into four treatment groups (10 sites each). Patients in group 1 received 1.2% SMV gel and covering the defect with occlusive membrane (OM). Patients in group 2 received 1.2% SMV gel and covering the defect with PBM. Group 3 received 24% EDTA root surface etching, 1.2% SMV gel, and defect coverage with OM (eOM). Patients in group 4 were treated as in group 3 but the defect was covered with PBM (ePBM). Clinical parameters were recorded at baseline before surgical procedures and were reassessed at 6 and 9 months after therapy. The mean concentration of SMV in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography at days 1, 7, 14, 21, and 30.
At 6- and 9-month observation periods, groups 3 and 4 showed a statistically significant improvement in PD reduction and CAL gain compared with groups 1 and 2. Group 4 showed a statistically significant more defect fill compared with groups 1, 2, and 3 (P ≤ .05). Group 2 showed statistically significant higher defect fill compared with group 1 and group 3 (P < .05). Bone density was significantly increased with no significant difference between the four groups at 6- and 9-month observation periods. SMV-GCF concentration in group 4 showed the highest mean concentration with no significant difference than that of group 3.
The use of perforated barrier membranes in association with SMV enhances the clinical hard tissue parameters compared with occlusive ones in treating intrabony periodontal defects. Moreover, EDTA root surface treatment could enhance SMV availability in the defect area.
穿孔屏障膜（PBM）被认为可以通过允许牙龈组织侧的所需元素的积极慈善作用来增强牙周再生。本研究旨在通过临床和生化评估，评价将 PBM 与辛伐他汀（SMV）凝胶联合使用，以及将其与 EDTA 凝胶联合使用（作为一种建议的选择）是否可以提高 SMV 的可用性，并改善 PBM 治疗的临床效果。
将 40 名患有中重度慢性牙周炎且有 40 个骨内缺损的患者随机分为 4 个治疗组（每组 10 个位点）。第 1 组患者接受 1.2% SMV 凝胶治疗，并覆盖封闭膜（OM）。第 2 组患者接受 1.2% SMV 凝胶治疗，并覆盖 PBM。第 3 组患者接受 24% EDTA 根面蚀刻、1.2% SMV 凝胶治疗，并覆盖 OM（eOM）。第 4 组患者的治疗方法与第 3 组相同，但用 PBM 覆盖缺损（ePBM）。在手术前和治疗后 6 个月和 9 个月记录临床参数。采用反相高效液相色谱法在第 1、7、14、21 和 30 天估计龈沟液（GCF）中 SMV 的平均浓度。
在 6 个月和 9 个月的观察期内，第 3 组和第 4 组的 PD 减少和 CAL 增加均有统计学意义，与第 1 组和第 2 组相比。第 4 组与第 1 组、第 2 组和第 3 组相比，缺损填充有统计学意义上的改善（P≤.05）。第 2 组与第 1 组和第 3 组相比，缺损填充有统计学意义上的改善（P<.05）。在 6 个月和 9 个月的观察期内，4 组的骨密度均显著增加，无显著差异。第 4 组的 SMV-GCF 浓度最高，与第 3 组相比无显著差异。
与封闭膜相比，PBM 联合 SMV 治疗骨内牙周缺损可增强临床硬组织参数。此外，EDTA 根面处理可提高缺损区 SMV 的可用性。
