Does periodontal tissue regeneration really work?
Does periodontal tissue regeneration really work?
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DOI：
10.1111/j.1600-0757.2009.00317.x
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发表时间：
2009-01-01
影响因子：
18.6
通讯作者：
Sculean, Anton
中科院分区：
文献类型：
--
作者：
Bosshardt, Dieter D.;Sculean, Anton
牙周炎是一种导致牙齿附着装置破坏的传染病。未经治疗的牙周炎会导致进行性附着丧失，最终可能导致牙齿早期脱落。幸运的是，研究提供的证据表明，在大多数情况下，慢性牙周病是可以治疗的[参见参考文献(29)]。还有证据表明，只要治疗、患者依从性和维护护理适当，受牙周影响的牙齿就有很大的生存机会[参见参考文献(29)]。有多种治疗方案可供选择，但只有少数可以被视为真正的再生手术。根据美国牙周病学会的一份立场文件 (29)，牙周再生手术包括软组织移植、骨替代移植、牙根生物修饰、引导组织再生及其组合，用于治疗骨缺损、分叉缺损和退缩缺损。再生被定义为身体丢失或受伤部分的复制或重建，从而使丢失或受伤组织的结构和功能完全恢复。牙周再生治疗的目的是恢复牙周组织的结构和功能。这意味着牙龈、牙槽骨、牙骨质和牙周膜的结构和功能必须恢复（图1和图2）。相比之下，牙周修复意味着无需修复牙齿附着装置即可愈合，并且通常与长连接上皮的形成有关（图3-5）。牙周炎的标志是交界上皮从牙齿表面脱离（即形成牙周袋）、通过牙骨质附着到牙根表面的牙周韧带纤维断开以及骨质流失。交界上皮与牙齿表面的新附着以及结缔组织纤维与牙根表面的新附着是真正的牙周再生的非常关键的组成部分。新的结缔组织附着需要在牙周治疗后修改的先前患病的牙根表面形成新的牙骨质。不用说，为了增加牙齿的附着功能，牙周结缔组织纤维也必须插入新形成的骨中（图6）。虽然对新上皮附着的关注较少，但新结缔组织附着更为重要。问题包括可预测性和新结缔组织附着的数量，以及治疗后的牙根表面和新牙骨质之间再生界面的强度。由于牙骨质的形成对于牙周膜纤维附着到牙根表面至关重要，因此许多研究致力于了解牙骨质形成（有关评论，请参阅参考文献 3、7、9、26、30、61、62、81）。并非所有声称已实现牙周再生的研究都利用了组织学技术。评估牙周再生的方法之前已进行过综述（56）。临床上，再生牙周治疗的结果是通过临床参数（牙周探诊、X光片和再进入评估）来评估的。然而，这些方法不适合证明真正的依恋增益。组织学仍然是评估牙周再生治疗效果的唯一可靠方法。根据美国牙周病学会世界牙周病研讨会（1996），牙周治疗被视为再生手术的要求如下：（i）人体组织学证明新的牙骨质、牙周韧带和骨......
Periodontitis is an infectious disease that causes destruction of the tooth-attachment apparatus. Untreated periodontitis results in progressive attachment loss that may eventually lead to early tooth loss. Fortunately, research has provided evidence that in most situations chronic periodontal diseases can be treated [reviewed in Ref.(29)]. There is also evidence that periodontally involved teeth have a good chance of survival, provided that therapy, patient compliance and maintenance care are appropriate [reviewed in Ref.(29)]. There are a broad range of treatment options available, but only a few may be regarded as truly regenerative procedures. According to a position paper from the American Academy of Periodontology (29), periodontal regenerative procedures include soft tissue grafts, bone replacement grafts, root biomodifications, guided tissue regeneration, and combinations thereof, for osseous, furcation and recession defects. Regeneration is defined as the reproduction or reconstitution of a lost or injured part of the body in such a way that the architecture and function of the lost or injured tissues are completely restored. The aim of regenerative periodontal therapy is to restore the structure and function of the periodontium. This means that the structure and function of the gingiva, alveolar bone, root cementum and periodontal ligament must be restored (Figs 1 and 2). By contrast, periodontal repair implies healing without restoration of the tooth-attachment apparatus and is often associated with the formation of a long junctional epithelium (Figs 3–5). Detachment of the junctional epithelium from the tooth surface (ie the formation of a periodontal pocket), disconnection of periodontal ligament fiber attachment to the root surface via cementum, and bone loss, are hallmarks of periodontitis. New attachment of junctional epithelium to the tooth surface and of connective tissue fibers to the root surface are very critical components of true periodontal regeneration. New connective tissue attachment requires the formation of new cementum to a previously diseased root surface that was modified following periodontal therapy. Needless to say, in order to increase the attachment function of a tooth, the periodontal connective tissue fibers also have to insert into newly formed bone (Fig. 6). While less concern exists about the new epithelial attachment, new connective tissue attachment is much more critical. Concerns include predictability and the amount of new connective tissue attachment, as well as the strength of the regenerated interface between the treated root surface and the new cementum. As formation of cementum is essential for the attachment of periodontal ligament fibers to the root surface, much research has been devoted to understanding cementogenesis (for reviews, see Refs 3, 7, 9, 26, 30, 61, 62, 81).Not all studies that claim to have achieved periodontal regeneration have utilized histological techniques. Methods of assessing periodontal regeneration have been reviewed previously (56). Clinically, the outcome of a regenerative periodontal treatment is assessed by clinical parameters (periodontal probing, radiographs and re-entry evaluations). These methods are, however, inappropriate for demonstrating true attachment gain. Histology continues to be the only reliable method of evaluating the efficacy of a therapy aimed at achieving periodontal regeneration. According to the World Workshop in Periodontics of the American Academy of Periodontology (1996), the requirements for a periodontal treatment to be considered a regenerative procedure are as follows:(i) human histology demonstrating new cementum, periodontal ligament and bone …