浓缩生长因子在下颌磨牙Ⅱ度根分叉病变再生治疗中的应用

Effect of concentrated growth factors on the treatment of degree Ⅱ furcation involvements of mandibular molars

目的:评价浓缩生长因子(concentrated growth factors,CGFs)在下颌磨牙Ⅱ度根分叉病变再生治疗中的作用。方法:纳入需进行手术的15例牙周炎患者,20颗下颌磨牙,31个下颌磨牙Ⅱ度根分叉病变,随机分为2组,试验组采用CGFs+植骨术进行治疗,对照组采用单纯植骨术进行治疗。在术前和术后1年时分别对患牙进行临床检查,并拍摄锥束CT(cone beam computed tomography,CBCT)。比较试验组和对照组手术前后临床和CBCT数据的变化。结果:基线时两组的探诊深度、垂直附着丧失和水平附着丧失差异均无统计学意义(P>0.05):探诊深度分别为试验组(7.36±2.32)mm,对照组(7.53±2.06)mm;垂直附着丧失分别为试验组(8.69±1.65)mm,对照组(8.81±1.53)mm;水平附着丧失分别为试验组(5.24±2.01)mm,对照组(5.35±2.14)mm。术后1年时,两组临床指标均有显著改善(P<0.001),其中试验组垂直附着获得为(2.78±1.66)mm,垂直附着丧失较基线时有显著改善(P<0.001);水平附着获得为(2.10±1.89)mm,水平附着丧失较基线时有显著改善(P<0.001)。对照组垂直附着获得为(1.73±1.87)mm,垂直附着丧失较基线时有显著改善(P<0.001);水平附着获得为(1.28±1.97)mm,水平附着丧失较基线时有显著改善(P<0.001)。试验组垂直和水平附着获得显著高于对照组(P<0.001)。基线时两组CBCT显示的垂直骨丧失和水平骨丧失差异均无统计学意义(P>0.05):垂直骨丧失分别为试验组(5.08±2.17)mm,对照组(5.84±2.65)mm;水平骨丧失分别为试验组(5.85±2.13)mm,对照组(6.01±2.27)mm。术后1年时,CBCT显示,两组垂直骨缺损和水平骨缺损较基线时均有显著改善(P<0.001),其中试验组垂直骨缺损减少(2.20±1.98)mm,水平骨缺损减少(2.51±2.18)mm,垂直和水平向骨吸收程度均较基线时有显著改善(P<0.001)。对照组垂直骨缺损减少(1.89±2.15)mm,水平骨缺损减少(1.30±2.47)mm,垂直和水平向骨吸收程度也较基线时有显著改善(P<0.001)。试验组垂直和水平向骨吸收改善程度显著高于对照组(P<0.001)。结论:CGFs可以促进植骨术在下颌磨牙Ⅱ度根分叉病变中的治疗效果。

Objective： Concentrated growth factors（ CGF）,a new generation of platelet concentrate products,appears to have more abundant growth factors because of its special centrifugation process.However,there are few studies supporting this. This study was designed to evaluate the effect of CGFs in the treatment of Ⅱ° furcations of mandibular molars. Methods： In the present study,thirty-one Ⅱ° furcation involvements in twenty mandiblular molars were included and randomly divided into two groups.The furcation involvements in the experimental group were treated with bone graft therapy combined with CGFs,and the furcation involvements in the control group were treated with bone graft therapy alone. The clinical examination and cone beam computed tomography（ CBCT） were performed at baseline and 1 year post-surgery for the two groups. The changes of clinical and CBCT data at baseline and 1 year postsurgery were compared between the experimental group and the control group. Results： At baseline,there were no significant differences between the two groups in the probing depth（ PD）,vertical clinical attachment loss（ CAL-V） and horizontal clinical attachment loss（ CAL-H） ： PD（ 7. 36 ± 2. 32） mm（ the experimental group） vs.（ 7. 53 ± 2. 06） mm（ the control group）; CAL-V（ 8. 69 ± 1. 65） mm（ the experimental group） vs.（ 8. 81 ± 1. 53） mm（ the control group）; CAL-H（ 5. 24 ± 2. 01） mm（ the experimental group） vs.（ 5. 35 ± 2. 14） mm（ the control group）. At the end of 1 year post-surgery,the clinical parameters of both groups were significantly improved（ P 〈0. 001）. For the experimental group,the average vertical attachment gain was（ 2. 78 ± 1. 66） mm,and the vertical attachment loss was improved significantly compared with the baseline（ P 〈0. 001）; the average horizontal attachment gain was（ 2. 10 ± 1. 89） mm,and the horizontal attachment loss were improved significantly compared with the baseline（ P 〈0. 001）. Furthermore,the improvement degree of the experimental group was significantly higher than that of the control group（ P 〈0. 001）. At baseline,there were no statistical differences in the vertical bone loss（ BL-V） or horizontal bone loss（ BL-H） between the two groups（ P 〈0. 05） ：BL-V（ 5. 08 ± 2. 17） mm（ the experimental group） vs.（ 5. 84 ± 2. 65） mm（ the control group）; BL-H（ 5. 85 ± 2. 13） mm（ the experimental group） vs.（ 6. 01 ± 2. 27） mm（ the control group）. At 1 year post-surgery,both groups showed significant radiographic bone gain at vertical and horizontal directions compared with baseline（ P 〈0. 001）. For the experimental group,the average vertical radiographic bone gain was（ 2. 20 ± 1. 98） mm,the horizontal radiographic bone gain was（ 2. 51 ± 2. 18） mm,the vertical and horizontal radiographic bone loss were both significantly reduced compared with the baseline（ P 〈0. 001）. For the control group,the average vertical radiographic bone gain was（ 1. 89 ± 2. 15） mm,the horizontal radiographic bone gain was（ 1. 30 ± 2. 47） mm,the vertical and horizontal radiographic bone losses were both significantly reduced compared with the baseline（ P 〈0. 001）. And the experimental group showed significantly higher bone gain at vertical and horizontal directions compared with the control group（ P 〈0. 001）. Conclusion： Within the limitation of the present study,CGFs showed positive role in the treatment of Ⅱ° furcation involvements of mandibular molars.