应用引导组织再生术修复外伤后牙槽骨缺损的临床研究

Treatment of periodontal defects following tooth injury by guided tissue regeneration technique

目的:研究引导组织再生术(guided tissue regeneration,GTR)修复牙外伤后牙槽骨缺损的可行性。方法:纳入8例前牙外伤患者(4男,4女),共11处前牙邻间隙牙槽骨角形吸收,牙周基础治疗4～6周后接受GTR术,植入Bio-oss骨移植材料和Heal-all屏障膜。记录术前、术后牙周临床指标,并采用Image Pro-Plus图像分析软件对平行投照X线牙片中骨缺损区内邻间隙阴影面积(polygon area,PG)和牙根尖至角形骨吸收牙槽嵴最低点之间的牙根外表面曲线长度(length of tooth rootsurface L)进行定量分析。结果:所有患者的治疗都取得了满意的效果。术后12、24周的牙周探诊深度(PPD)和探诊附着丧失(PAL)都较术前明显减少(P<0.05),同时也出现了一定程度的牙龈退缩(P<0.05)。X线片影像分析显示,在术后12、24周时,反映牙槽骨缺损范围的PG值显著减小,反映骨缺损最低点位置的L值显著增加,都较术前有明显的变化(P<0.05)。图像软件分析的稳定点测量值一致性检验ICC值都大于0.8(α>0.4)。结论:采用Bio-oss骨移植材料和Heal-all屏障膜进行牙周GTR术,可以促进牙外伤后骨缺损的修复和牙周附着的恢复,是一种治疗牙外伤后牙槽骨缺损的可行方法。

Objective：To study the feasibility of guided tissue regeneration（GTR） in the treatment of periodontal bone defects following tooth injury.Methods：8 patients（4 male and 4 female）,altogether 11 teeth with periodontal defects,received the surgery for repair of the defects by Bio-Oss and Heal-all membrane transplantation.Probing pocket depth（PPD）,probing attachment level（PAL） and gingival recession（GR） were measured before treatment,12 weeks and 24 weeks after treatment.Radiographic measurements included the area of the dark space between two adjacent teeth,polygon area（PG）,and the length from the root apex to the deepest point of angular bone defect along the tooth root surface（L） were analysed by Image Pro-Plus software.The complications were observed after the surgery.Results：Treatment was completed in all the patients,PPD and PAL values reduced 12 and 24 weeks after treatment（P0.05）,while GR value increased（P0.05）.PG value reduced 12 and 24 weeks after treatment（P0.05）,while L value increased（P0.05）.Radiographs showed a high degree of reliability of the stable landmark ICC0.8（α0.4）.Conclusion：The application of GTR technique by using Bio-Oss and Heal-all membrane may be promising in the treatment of periodontal defects after traumatic dental injury.