Alzahrani Ahmed S
Division of Periodontics, College of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia.
J Int Acad Periodontol. 2017 Dec 24;20(1):3-11.
As a primary objective, we examined the gingival crevicular fluid (GCF) levels of the endogenously released platelet-derived growth factor (PDGF-BB) and vascular endothelial growth factor (VEGF) following the use of minimally invasive surgical flap reflection (MIS) and compared them with those in traditional open flap debridement (OFD). The secondary objective was to determine if any correlation exists between the expression of growth factors (GF), indicated by their levels, and associated clinical outcomes.
Twenty-eight non-smoking individuals with severe chronic periodontitis were recruited in this prospective, randomized and single-blinded trial. Each person presented one interproximal defect that was randomly assigned to either the experimental MIS group (14 sites) or the open flap debridement (OFD) control group (14 sites). Plaque index, gingival index, probing depth (PD), clinical attachment level (CAL) and the intra-bony depth of the defect (IBD) were measured at baseline for the patient's enrollment. Gingival crevicular fluid (GCF) samples were collected on days 1, 3, 7, 14, 21 and 30 after therapy. Clinical follow-ups were scheduled at 6 and 9 months following the therapy.
In both groups, the highest levels of VEGF and PDGF-BB concentrations were found in the GCF during the period from 1 to 14 days. During the early stages of healing (1, 3, 7 and 14 days), the mean VEGF and PDGF-BB levels at sites treated with MIS were significantly higher than those at the OFD-treated sites. Growth factor levels decreased sharply in the samples obtained at days 21 and 30 in both groups, with non-significant differences between the patient and control groups. MIS-treated sites reported significantly more PD reduction and attachment gain 9 months following therapy. No significant difference in intrabony defect reduction was reported between the patient and control groups.
Within the limits of the present study, we can surmise that MIS treatment of periodontal defects is associated with initially higher GCF levels of the studied growth factors. These increased GF levels are well correlated with the improved soft-tissue parameters of the periodontal defects.
作为主要目标，我们检测了采用微创翻瓣术（MIS）后内源性释放的血小板衍生生长因子（PDGF-BB）和血管内皮生长因子（VEGF）在龈沟液（GCF）中的水平，并将其与传统开放性翻瓣清创术（OFD）中的水平进行比较。次要目标是确定生长因子（GF）水平所指示的表达与相关临床结果之间是否存在任何相关性。
在这项前瞻性、随机、单盲试验中招募了28名患有重度慢性牙周炎的非吸烟个体。每个人均有一个邻面缺损，该缺损被随机分配至试验性MIS组（14个部位）或开放性翻瓣清创术（OFD）对照组（14个部位）。在患者入组时测量菌斑指数、牙龈指数、探诊深度（PD）、临床附着水平（CAL）以及缺损的骨内深度（IBD）。在治疗后的第1、3、7、14、21和30天收集龈沟液（GCF）样本。在治疗后的6个月和9个月安排临床随访。
在两组中，第1至14天期间龈沟液中VEGF和PDGF-BB浓度最高。在愈合早期（第1、3、7和14天），MIS治疗部位的平均VEGF和PDGF-BB水平显著高于OFD治疗部位。两组在第21天和30天获得的样本中生长因子水平急剧下降，患者组和对照组之间无显著差异。治疗9个月后，MIS治疗部位的探诊深度减少和附着增加明显更多。患者组和对照组在骨内缺损减少方面无显著差异。
在本研究的范围内，我们可以推测牙周缺损的MIS治疗与所研究生长因子的龈沟液水平最初较高有关。这些生长因子水平的升高与牙周缺损软组织参数的改善密切相关。
