引导组织再生术与联合应用植骨术治疗牙周骨内缺损的临床研究

Study of guided tissue regeneration with or without bone graft in the treatment of periodontal intrabony defect

目的比较引导组织再生术(GTR)与联合骨移植术治疗牙周骨内缺损的临床疗效。方法选取45例牙周炎重度垂直骨吸收的患牙,随机平均分为翻瓣术组、单纯GTR组及联合植骨组。分别在术前和术后1年记录牙周袋深度、附着丧失、牙龈退缩并进行比较。结果术前、后自身比较,3组的各项检查指标均有显著性改变(P<0.05);与翻瓣组相比,单纯GTR组及联合植骨组牙周袋深度及附着丧失减少更显著,具有统计学差异(P<0.05),而龈退缩量无统计学差异。单纯GTR组与联合植骨组相比各项临床指标均无统计学差异。结论与单纯翻瓣术相比,引导组织再生术与联合应用植骨术治疗垂直型牙周骨内缺损均可获得更好的临床效果,GTR联合植骨术稍优于单纯GTR术。

Objective This randomized controlled clinical trial was designed to compare the clinical outcomes of guided tissue regeneration with hydroxyapatite（HA） bone graft substitute,or guided tissue regeneration,or open flap debridement（OFD） in periodontal intrabony defects.Methods Forty-five teeth affected by severe chronic periodontitis were recruited and randomly divided into three equal groups.Subjects were surgically treated with OFD（OFD group）,GTR（GTR group）,or GTR with HA bone graft（GTR＋HA group）.One year after surgical treatment,the pre-and post-therapy clinical parameters,including PPD,clinical attachment level（CAL） and gingival recession（GR） were compared.Results The clinical parameters showed statistically significant changes from baseline within each group for all of the evaluated parameters.The GTR＋HA and GTR groups had significantly smaller PD and CAL values than subjects treated with only OFD,while the changes of GR had no statistically significant differences.No significant differences were seen between GTR＋HA and GTR groups.Conclusions Both regenerative treatments produced additional clinical benefits over OFD alone.Moreover,the use of GTA＋HA may minimize post-surgical CAL.