Tonetti M S, Prato G P, Cortellini P
Department of Periodontology and Fixed Prosthodontics, School of Dental Medicine, University of Bern, Switzerland.
J Clin Periodontol. 1996 Jun;23(6):548-56. doi: 10.1111/j.1600-051x.1996.tb01823.x.
Identification and control of significant factors determining clinical outcomes is of paramount importance to improve expected results of a variety of therapeutic procedures. The aim of this investigation was to identify, with a multivariate approach, factors associated with healing outcomes of 3 periodontal surgical procedures in deep intrabony defects. 45 patients with evidence of deep intrabony defects were randomly assigned to 3 treatment groups: access flap (group C), conventional guided tissue regeneration (GTR) with non-resorbable expanded polytetrafluoroethilene (ePTFE) membranes (group B), and GTR with self supporting membranes combined with the modified papilla preservation technique (group A). In both GTR procedures, membranes were positioned coronal to the interproxymal alveolar crest. Primary outcome variables (i.e., probing attachment level gains at 1 year and the amount of newly formed tissue present at membrane removal) were explained in terms of a series of patient, defect morphology and surgical factors, using a multivariate approach. Highly significant treatment effects were observed, indicating that the 3 tested therapeutic modalities resulted in significant differences in primary outcome variables. Detailed analysis assessing the significance of the tested factors in determining the healing outcomes following each procedure was performed with a stepwise elimination approach of non-significant factors. The results indicated that: (i) the need to create and maintain space should be a key objective of regenerative approaches based upon the principles of guided tissue regeneration; (ii) control of patient's oral hygiene and residual periodontal infection in the oral cavity are strongly associated with clinical outcomes of both regenerative and conventional surgical procedures and should receive proper attention.
识别和控制决定临床结果的重要因素对于提高各种治疗程序的预期效果至关重要。本研究的目的是采用多变量方法，识别与深部骨内缺损的3种牙周手术愈合结果相关的因素。45例有深部骨内缺损证据的患者被随机分为3个治疗组：翻瓣术（C组）、使用不可吸收的膨体聚四氟乙烯（ePTFE）膜的传统引导组织再生术（GTR）（B组），以及使用自支撑膜结合改良乳头保留技术的GTR（A组）。在两种GTR手术中，膜均放置在邻间牙槽嵴的冠方。使用多变量方法，根据一系列患者、缺损形态和其他因素来解释主要结局变量（即1年时的探诊附着水平增加量以及去除膜时新形成组织的量）。观察到高度显著的治疗效果，表明3种测试的治疗方式在主要结局变量上存在显著差异。采用逐步排除非显著因素的方法，对评估各手术中测试因素在决定愈合结果方面的显著性进行了详细分析。结果表明：（i）基于引导组织再生原理的再生方法的关键目标应该是创造和维持空间；（ii）患者口腔卫生的控制以及口腔内残余的牙周感染与再生性手术和传统手术的临床结果密切相关，应予以适当关注。
