Periodontal regeneration with a combination of enamel matrix proteins and autogenous bone grafting
Periodontal regeneration with a combination of enamel matrix proteins and autogenous bone grafting
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DOI：
10.1902/jop.2003.74.9.1269
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发表时间：
2003-09-01
影响因子：
4.3
通讯作者：
King, GN
中科院分区：
文献类型：
--
作者：
Cochran, DL;Jones, A;King, GN
背景：过去刺激牙周再生的尝试主要集中在用某种类型的材料填充缺陷或为宿主细胞提供空间以重新填充该部位并诱导新组织。在某些情况下，这些方法与填充材料将有助于维持宿主细胞侵入该区域所需的空间的假设相结合。生长刺激物质如生长因子和其他蛋白质也被用于促进牙周组织再生，组织学评估支持这些物质的使用。因此，一定的空间维持对牙周再生的作用和必要性还没有完全了解。此外，目前尚不清楚是否存在维持空间所需的临界尺寸，也不知道为了让宿主细胞刺激新的牙骨质、牙周韧带和骨骼，必须维持多长时间的空间。本研究的目的是评估牙釉质基质蛋白结合自体骨移植治疗不同大小骨内缺损的牙周再生效果。方法：选取狒狒下颌骨3颗牙两侧，随机选取1 ~ 6mm大小的牙周缺损。允许斑块在植入缺陷的金属丝结扎处周围积聚。2个月后，拆除金属丝结扎，对牙齿和牙根进行鳞片修剪和刨平，用凿子在缺损的底部开一个切口。采用中性乙二胺四乙酸联合牙釉质基质衍生物（EMD）治疗一侧下颌骨缺损。取同一手术部位的自体骨，在湿润皿中用牙釉质基质衍生物处理，然后加入emd处理过的缺损。另一侧下颌骨作为对照，应用中性乙二胺四乙酸和洗牙刨根术。皮瓣被缝合，动物被允许在没有口腔卫生程序的情况下愈合。5个月后处死动物，对牙齿进行组织学评价。结果：新生牙骨质、含Sharpey氏纤维的牙周韧带及与牙周组织相似的新生骨组织。在愈合后5个月，自体骨碎片的残余仍然存在。因此，所有大小的牙周缺损均可再生。一般来说，EMD +自体移植物治疗导致比对照组更大的组织形成。事实上，在许多情况下，非常戏剧性的组织形成发生在远冠状到EMD缺损的底部加上自体移植物治疗的病变。此外，在4或6 mm宽的病变中，缺损处出现水平骨填充。当评估I和2 mm的联合缺损时，EMD +接枝的新骨水泥高度为3.88 mm，而对照组为2.03 mm，差异有统计学意义(P
Background: Attempts to stimulate periodontal regeneration in the past have focused on either filling the defect with some type of material or providing a space for host cells to repopulate the site and elicit new tissue. In some cases, these approaches have been combined with the assumption that the filler material will help maintain the space necessary for the host cells to invade the area. Growth stimulating substances such as growth factors and other proteins have also been used to encourage periodontal tissue regeneration and histological evaluation supports the use of these substances. Thus, the role for and the necessity of a certain amount of space maintenance for periodontal regeneration is not exactly understood. In addition, it is not known if there is some critical size required for space maintenance or for exactly how long the space must be maintained in order for the host cells to stimulate new cementum, periodontal ligament, and bone. The goal of this study was to evaluate periodontal regeneration in intrabony defects of various sizes treated with a combination of enamel matrix proteins and autogenous bone graft.Methods: Periodontal defects ranging in size from 1 to 6 mm were randomized and created bilaterally beside three teeth in the mandibles of baboons. Plaque was allowed to accumulate around wire ligatures placed into the defects. After 2 months, the wire ligatures were removed, the teeth and roots scaled and root planed, and a notch was placed with a chisel at the base of the defect. On one side of the mandible, neutral ethylene diamine tetracetic acid and enamel matrix derivative (EMD) were first used to treat the defect. Autogenous bone taken from the same surgical site was treated with enamel matrix derivative in a dampen dish and then added to the EMD-treated defects. The other side of the mandible served as control with neutral ethylene diamine tetracetic acid and scaling and root planing. Flaps were sutured and the animals were allowed to heal without oral hygiene procedures. After 5 months, the animals were sacrificed and the teeth were processed for histological evaluation.Results: The results revealed new cementum, periodontal ligament with Sharpey's fibers, and new bone tissue similar to native periodontal tissues. Remnants of the autogenous bone chips were still present at this 5-month post-healing period. Thus periodontal regeneration occurred in all sizes of the periodontal defects. In general, EMD plus autogenous graft treatment resulted in greater tissue formation than controls. In fact, in many cases, very dramatic tissue formation occurred far coronal to the base of the defects in the EMD plus autogenous graft-treated lesions. In addition, horizontal bone fill occurred in the defects and was prominent in the 4 or 6 mm wide lesions. When evaluating the combined I and 2 mm defects, the height of new cementurn with EMD plus graft was 3.88 mm versus 2.03 mm in the controls, a statistically significant (P