Foo Lean Heong
Periodontic Unit, Department of Restorative Dentistry, National Dental Centre Singapore, Singapore.
Eur J Dent. 2021 Oct;15(4):806-811. doi: 10.1055/s-0041-1731841. Epub 2021 Sep 14.
Guided tissue regeneration (GTR) has been proven to promote attachment and regeneration of periodontal tissue. However, there is a 20 to 40% incidence of attachment loss on regenerated attachments reported in the literature. To my knowledge, this is the first case report on a second attempt in GTR on a previous successful grafted site with clinical attachment loss. A healthy 17-year-old Chinese male patient had GTR performed with xenograft particles and bovine resorbable membrane on his root-canal treated, fused upper right lateral incisor and upper right canine (#12-#13) in 2007. Probing depth on the mid-palatal region of #12-#13 was reduced to 4 mm and maintained for the next 4 years. But in the fifth year, probing depth increased to 11 mm with no endodontic symptoms, and a second attempt of GTR using the same materials was carried out. The probing depth at the surgical site was reduced to 4 mm and successfully maintained for another 5 years. Irregular maintenance and the presence of plaque retentive factor could have caused the clinical attachment loss on #12-#13. This case shows it is possible to attempt GTR on a previous successfully grafted site. GTR did not increase tissue resistance against periodontal breakdown. Hence, proper maintenance planning for GTR sites is important to prevent periodontal breakdown.
引导组织再生术（GTR）已被证实可促进牙周组织的附着和再生。然而，文献报道再生附着部位的附着丧失发生率为20%至40%。据我所知，这是首例关于在先前成功移植且出现临床附着丧失的部位再次进行GTR的病例报告。一名17岁健康的中国男性患者于2007年在其经根管治疗的右上侧切牙和右上尖牙（#12 - #13）融合牙上使用异种移植颗粒和牛可吸收膜进行了GTR。#12 - #13腭中区域的探诊深度降至4 mm，并在接下来的4年中保持稳定。但在第5年，探诊深度增至11 mm，且无牙髓症状，遂使用相同材料再次进行GTR。手术部位的探诊深度降至4 mm，并成功维持了另外5年。不规律的维护以及菌斑滞留因素可能导致了#12 - #13的临床附着丧失。该病例表明在先前成功移植的部位再次尝试GTR是可行的。GTR并未增加组织对牙周破坏的抵抗力。因此，对GTR部位进行恰当维护规划对于预防牙周破坏很重要。
