Department of Periodontology and Implantology, Temple University Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA.
Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Clin Adv Periodontics. 2024 Sep;14(3):201-210. doi: 10.1002/cap.10254. Epub 2023 Jul 4.
Regenerative approaches performed in periodontics seems to be efficient in treating intrabony defects. There are, however, many factors that may affect the predictability of the regenerative procedures. The present article aimed to propose a new risk assessment tool for treating periodontal intrabony defects by regenerative therapy.
Different variables that could affect the success of a regenerative procedure were considered based on their impact on (i) the wound healing potential, promoting wound stability, cells, and angiogenesis, or (ii) the ability to clean the root surface and maintain an optimal plaque control or (iii) aesthetics (risk for gingival recession).
The risk assessment variables were divided into a patient, tooth, defect, and operator level. Patient-related factors included medical conditions such as diabetes, smoking habit, plaque control, compliance with supportive care, and expectations. Tooth-related factors included prognosis, traumatic occlusal forces or mobility, endodontic status, root surface topography, soft tissue anatomy, and gingival phenotype. Defect-associated factors included local anatomy (number of residual bone walls, width, and depth), furcation involvement, cleansability, and number of sides of the root involved. Operator-related factors should not be neglected and included the clinician's level of experience, the presence of environmental stress factors, and the use of checklists in the daily routine.
Using a risk assessment comprised of patient-, tooth-, defect- and operator-level factors can aid the clinician in identifying challenging characteristics and in the treatment decision process.
牙周再生治疗似乎在治疗骨内缺损方面非常有效。然而，有许多因素可能会影响再生程序的可预测性。本文旨在提出一种新的风险评估工具，用于评估通过再生疗法治疗牙周骨内缺损的风险。
根据其对（i）伤口愈合潜力、促进伤口稳定性、细胞和血管生成，或（ii）清洁根面和保持最佳菌斑控制或（iii）美学（牙龈退缩风险）的影响，考虑了可能影响再生程序成功率的不同变量。
风险评估变量分为患者、牙齿、缺损和操作人员水平。与患者相关的因素包括糖尿病等医疗状况、吸烟习惯、菌斑控制、对支持性护理的依从性和期望。与牙齿相关的因素包括预后、创伤性咬合力或松动度、牙髓状况、根面形貌、软组织解剖结构和牙龈表型。与缺损相关的因素包括局部解剖结构（剩余骨壁的数量、宽度和深度）、分叉受累情况、可清洁性以及根受累的侧面数量。操作人员相关的因素也不容忽视，包括临床医生的经验水平、环境应激因素的存在以及在日常工作中使用检查表。
使用包括患者、牙齿、缺损和操作人员水平因素的风险评估，可以帮助临床医生识别具有挑战性的特征，并在治疗决策过程中做出决策。
