Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia.
Division of Endodontics, Department of Restorative Dental Science, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia.
Int J Environ Res Public Health. 2021 Jun 8;18(12):6220. doi: 10.3390/ijerph18126220.
The aim of this in-vivo study was to evaluate/compare the clinical periodontal parameters in patients with true combined endo-perio lesions (EPL), treated with gutta-percha (GP) and mineral trioxide (MTA) as an obturation material alone and with addition of bone grafting in such lesions. 120 Saudi patients (mean age = 41yrs) diagnosed with true combined EPL participated in this study. Group I (control group, = 30) was treated with conventional endodontic treatment using GP for obturation. Group II ( = 30) was treated with conventional endodontic treatment using MTA for obturation. Group III ( = 30) was treated with conventional endodontic treatment using GP for obturation + grafting procedure to fill the bony defect. Group IV ( = 30) was treated with conventional endodontic treatment using MTA for obturation + grafting procedure to fill the bony defect. Clinical parameters (Pocket depth (PD); Clinical attachment loss (CAL); keratinized tissue width (KTW); gingival phenotype (G.Ph.) and Cone Beam Computed Tomography Periapical Index (CBCTPAI)) were recorded and compared at baseline, 3, 6, 12 months' interval. For the groups III and IV, CBCTPAI showed significant difference ( < 0.0001) with the other groups at 6 months and 1-year interval. The group with MTA + bone graft showed 76% and 90% patients with 0 score at 6 months and 1-year follow-up, respectively. Comparison of mean values of PD among study groups at 3 months, 6 months and 1 year showed significant difference at 3 months, whereas the mean PD values of subjects in GP + bone graft showed significantly higher PD values than other 3 groups ( = 0.025). Use of GP and MTA for root canal obturation along with periodontal therapy and bone augmentation helps in resolving complex endo-perio lesions. Bone grafting in addition to obturation with MTA was found to be the best treatment strategy in management of EPL cases and is recommended for clinicians who are treating EPL patients.
本体内研究旨在评估/比较伴有真性牙周牙髓联合病变（EPL）的患者的临床牙周参数，这些患者接受单独使用牙胶尖（GP）和三氧化矿物（MTA）作为根管封闭材料以及在这些病变中添加骨移植的治疗。本研究纳入了 120 名沙特患者（平均年龄为 41 岁），这些患者被诊断为伴有真性牙周牙髓联合病变。第 I 组（对照组，n=30）接受常规根管治疗，使用 GP 进行根管封闭。第 II 组（n=30）接受常规根管治疗，使用 MTA 进行根管封闭。第 III 组（n=30）接受常规根管治疗，使用 GP 进行根管封闭+移植程序以填充骨缺损。第 IV 组（n=30）接受常规根管治疗，使用 MTA 进行根管封闭+移植程序以填充骨缺损。记录并比较基线、3、6、12 个月时的临床参数（牙周袋深度（PD）；临床附着丧失（CAL）；角化组织宽度（KTW）；牙龈表型（G.Ph.）和锥形束 CT 根尖指数（CBCTPAI））。对于第 III 组和第 IV 组，6 个月和 1 年随访时，CBCTPAI 与其他组相比差异有统计学意义（<0.0001）。MTA+骨移植组 6 个月和 1 年随访时分别有 76%和 90%的患者达到 0 分。第 3、6 和 12 个月时，研究组 PD 的均值比较显示，第 3 个月时差异有统计学意义，而 GP+骨移植组的 PD 均值显著高于其他 3 组（P=0.025）。使用 GP 和 MTA 进行根管封闭联合牙周治疗和骨增量有助于解决复杂的牙周牙髓联合病变。在 EPL 病例的治疗中，除了用 MTA 封闭外，还进行骨移植被认为是最佳的治疗策略，并推荐给治疗 EPL 患者的临床医生。
