Zucchelli G, De Sanctis M, Clauser C
Department of Periodontology, Faculty of Odontology, Bologna University, Italy.
J Periodontol. 1997 Oct;68(10):996-1004. doi: 10.1902/jop.1997.68.10.996.
The objective of this study was to evaluate the relationship between integrated connective tissue (ICT), that is, the presence of connective tissue into the membrane structure, and the clinical outcome of membrane-supported periodontal surgery. Twenty-six systemically healthy subjects affected by chronic adult periodontitis were enrolled in the study. One tooth site per patient, associated with an angular bony defect and an attachment loss of > 7 mm, was selected to be treated by means of a guided tissue regeneration procedure using a bioabsorbable membrane. Barrier material was surgically removed after 4 weeks for SEM analysis. For each treated site, the difference in clinical attachment loss, probing depth, and gingival recession between the baseline examination and follow-up 6 months after the second surgery was calculated. Gain of attachment was statistically (P < 0.001) greater in sites with no membrane exposure when compared to sites with exposed barrier material (5.5 +/- 1.0 vs. 4.0 +/- 0.6), while further gingival recession was greater (3.0 +/- 0.9 vs. 2.1 +/- 0.5) in sites with clinically exposed membranes. The results of SEM analysis revealed that when connective tissue structures were observed on membrane surfaces, no bacteria could be detected; conversely, areas heavily colonized by bacteria did not show the presence of connective tissue. Regression analysis indicated that integrated connective tissue on the external layer of the barrier material was positively correlated with the amount of attachment gain and negatively with the amount of gingival recession. Bacterial colonization of the membrane was negatively correlated with attachment gain and positively with gingival recession. It was concluded that connective tissue integration is an important biological phenomenon in preventing membrane exposure and bacterial plaque colonization and thus in enhancing the clinical outcome following guided tissue regeneration surgery.
本研究的目的是评估整合性结缔组织（ICT），即结缔组织在膜结构中的存在情况，与膜支持性牙周手术临床结果之间的关系。26名患有慢性成人牙周炎的全身健康受试者参与了本研究。为每位患者选择一个与角形骨缺损和附着丧失>7mm相关的牙位，采用生物可吸收膜通过引导组织再生程序进行治疗。4周后手术取出屏障材料进行扫描电子显微镜（SEM）分析。对于每个治疗部位，计算第二次手术后6个月随访时与基线检查相比临床附着丧失、探诊深度和牙龈退缩的差异。与屏障材料暴露的部位相比，无膜暴露部位的附着获得在统计学上（P<0.001）更大（5.5±1.0 vs. 4.0±0.6），而临床膜暴露部位的进一步牙龈退缩更大（3.0±0.9 vs. 2.1±0.5）。SEM分析结果显示，当在膜表面观察到结缔组织结构时，未检测到细菌；相反，细菌大量定植的区域未显示结缔组织的存在。回归分析表明，屏障材料外层的整合性结缔组织与附着获得量呈正相关，与牙龈退缩量呈负相关。膜的细菌定植与附着获得呈负相关，与牙龈退缩呈正相关。得出的结论是，结缔组织整合是一种重要的生物学现象，可防止膜暴露和细菌菌斑定植，从而提高引导组织再生手术后的临床结果。
