Quintessence Int. 2023 Nov 28;54(10):808-820. doi: 10.3290/j.qi.b4325359.
The objective of the present study was to evaluate the clinical and radiographic outcomes of intrabony defects treated with decortication (intramarrow penetration) alone versus decortication combined with platelet-rich fibrin in periodontitis patients followed up for 6 months postsurgery.
A total of 46 intrabony defects from periodontitis patients with a mean age of 36.30 ± 6.10 years were randomly assigned into two treatment groups. The control group (n = 23) intrabony sites were accessed with simplified papilla preservation flap (SPPF) followed with debridement, decortication, and closure. The test group (n = 23) sites were accessed with SPPF, followed with debridement, decortication, platelet-rich fibrin placement, and closure. The clinical parameters Plaque Index, Gingival Index, probing pocket depth, relative attachment level, gingival marginal level, along with radiographic defect depth and defect width were recorded at baseline, 3 months, and 6 months postsurgery. Gain in clinical attachment level was the primary outcome, and probing pocket depth reduction and radiographic bone fill were secondary outcomes of the study.
The Plaque Index and Gingival Index scores showed nonsignificant difference on intra- and intergroup comparison at baseline, 3 months, and 6 months. The probing pocket depth was 8.17 ± 1.56 mm, 6.65 ± 1.30 mm, and 5.26 ± 1.18 mm for the control group, and 8.17 ± 2.01 mm, 6.26 ± 1.42 mm, and 4.78 ± 1.28 mm for the test group, at baseline, 3 months, and 6 months, respectively. The relative attachment level was 8.83 ± 1.40 mm, 6.78 ± 1.31 mm, and 5.39 ± 1.16 mm for the control group, and 8.39 ± 1.62 mm, 6.96 ± 1.36 mm, and 5.48 ± 1.20 mm for the test group at baseline, 3 months, and 6 months, respectively. Statistically significant reductions were observed for probing pocket depth for the control (2.91 mm, P < .001) and test groups (3.39 mm, P < .001), as well as for relative attachment level for the control (3.44 mm, P < .001) and test groups (2.91 mm, P < .001). However, intergroup differences were nonsignificant for probing pocket depth and relative attachment level. The radiographic defect depth was reduced by 0.31 mm for the control and 1.57 mm for the test group. The radiographic defect width was reduced by 0.18 mm for the control and 0.83 mm for the test group. Intergroup statistically significant differences were observed at the 6-month follow-up (P < .001) for radiographic defect depth and width.
Within the limitations of the present study, the results demonstrate statistically significant intragroup improvements in clinical outcomes with decortication alone and decortication combined with platelet-rich fibrin in the treatment of intrabony defects in periodontitis patients. The addition of platelet-rich fibrin did not improve the clinical results beyond decortication alone, and unacceptable postsurgery residual pockets were observed in both the protocols. Considering the small sample size, the addition of platelet-rich fibrin resulted in significant bone fill over and above that of decortication alone.
本研究旨在评估单独进行骨切开术（骨髓穿透）与骨切开术联合富含血小板纤维蛋白治疗牙周炎患者的临床和放射学结果，随访时间为术后 6 个月。
共有 46 名来自牙周炎患者的骨内缺损，平均年龄为 36.30 ± 6.10 岁，被随机分配到两个治疗组。对照组（n = 23）骨内部位采用简化乳头保留瓣（SPPF），然后进行清创、骨切开和闭合。实验组（n = 23）部位采用 SPPF，然后进行清创、骨切开、放置富含血小板纤维蛋白和闭合。记录基线、3 个月和 6 个月时的菌斑指数、牙龈指数、探诊袋深度、相对附着水平、牙龈边缘水平以及放射学缺损深度和缺损宽度。临床附着水平的增加是主要结果，探诊袋深度的减少和放射学骨填充是该研究的次要结果。
菌斑指数和牙龈指数评分在基线、3 个月和 6 个月时的组内和组间比较均无显著差异。对照组的探诊袋深度分别为 8.17 ± 1.56mm、6.65 ± 1.30mm 和 5.26 ± 1.18mm，实验组分别为 8.17 ± 2.01mm、6.26 ± 1.42mm 和 4.78 ± 1.28mm。对照组的相对附着水平分别为 8.83 ± 1.40mm、6.78 ± 1.31mm 和 5.39 ± 1.16mm，实验组分别为 8.39 ± 1.62mm、6.96 ± 1.36mm 和 5.48 ± 1.20mm。对照组和实验组的探诊袋深度（对照组 2.91mm，P<.001；实验组 3.39mm，P<.001）以及相对附着水平（对照组 3.44mm，P<.001；实验组 2.91mm，P<.001）均有统计学意义的显著降低。然而，两组之间的探诊袋深度和相对附着水平差异无统计学意义。对照组的放射学缺损深度减少了 0.31mm，实验组减少了 1.57mm。对照组的放射学缺损宽度减少了 0.18mm，实验组减少了 0.83mm。两组在 6 个月的随访时（P<.001），放射学缺损深度和宽度均有统计学显著差异。
在本研究的限制范围内，结果表明，单独进行骨切开术和骨切开术联合富含血小板纤维蛋白治疗牙周炎患者的骨内缺损，在临床结果方面有统计学意义的组内改善。富含血小板纤维蛋白的添加并没有改善单独骨切开术的临床结果，并且两种方案都观察到术后不可接受的残留袋。考虑到样本量小，富含血小板纤维蛋白的添加导致的骨填充量显著超过单独骨切开术。
