Ellegaard B
Dtsch Zahnarztl Z. 1979 Apr;34(4):310-2.
New attachment of periodontal tissues can be obtained following surgical treatment of intrabony pockets. To day flap procedures with complete surgical opening to the defect and removal of all soft material from the intrabony lesion often followed by bone transplantation constitute the accepted approach to obtain a new connective tissue attachment. However, since the epithelium of elevated full thickness flaps are well preserved, the placement of these flaps adjacent to the treated areas facilitate the migration of epithelium into the defects. In a search for means to retard epithelial proliferation into the defects, disintegration of epithelium of free gingival grafts within the first days following transplantation might possibly be utilized in new attachment attempts. It has been demonstrated in three-wall intrabony defects in monkeys and in humans, that if the intrabony defect is covered with a free transplantat following a split flap procedure the epithelial migration into the defect will be delayed. This procedure resulted in a greater amount of new attachment when compared with traditional flap surgery and less residual pockets. The succes of new attachment procedures is directly related to the abscense of plaque in the area where regeneration takes place. Without absolute plaque control a further loss of attachment can be seen.
骨内袋经过手术治疗后可实现牙周组织的新附着。如今，采用全层翻瓣手术完全暴露骨内袋并清除骨内病变的所有软组织，随后常常进行骨移植，这已成为实现新的结缔组织附着的公认方法。然而，由于全厚瓣提升后的上皮得以良好保留，将这些瓣放置在治疗区域附近会促使上皮向缺损处迁移。为寻求延缓上皮向缺损处增殖的方法，在新附着尝试中，或许可以利用移植后最初几天内游离龈瓣上皮的崩解。在猴子和人类的三壁骨内袋缺损研究中已证实，如果在翻瓣手术后用游离移植物覆盖骨内袋缺损，上皮向缺损处的迁移将会延迟。与传统翻瓣手术相比，该方法能产生更多的新附着，且残余袋更少。新附着手术的成功与再生区域无菌斑直接相关。若没有绝对的菌斑控制，将会出现进一步的附着丧失。
