Clinical concepts for regenerative therapy in intrabony defects
Clinical concepts for regenerative therapy in intrabony defects
复制标题
DOI：
10.1111/prd.12048
复制
发表时间：
2015-06-01
影响因子：
18.6
通讯作者：
Tonetti, Maurizio S.
中科院分区：
文献类型：
--
作者：
Cortellini, Pierpaolo;Tonetti, Maurizio S.
有证据表明，牙周再生是一个有效的和可预测的程序，用于治疗孤立的和多个骨内缺损。系统综述的荟萃分析表明，除开放皮瓣清创术外，应用脱钙冻干同种异体骨、屏障膜和活性生物制品/化合物时，在临床附着水平增益方面具有额外受益。另一方面，在不同的研究中以及在每项研究的实验人群中，结果的可变性是一致的。这种可变性至少部分地由不同的患者和缺陷特征来解释。患者相关因素包括吸烟习惯、家庭口腔卫生依从性和病因相关治疗后的残留炎症。与缺损相关的因素包括缺损深度和放射学角度、残留骨壁的数量、囊袋深度和过度活动的程度。此外，与外科相关的变量，如手术技巧、临床经验和知识，以及不同再生材料的应用，对临床结果有显著影响。本文提出了一种策略，以优化牙周再生的临床结果。手术设计的皮瓣，使用不同的再生材料和应用适当的被动缝合的科学基础沿着在这篇评论中进行了讨论。
Evidence indicates that periodontal regeneration is an efficacious and predictable procedure for the treatment of isolated and multiple intrabony defects. Meta-analyses from systematic reviews indicate an added benefit, in terms of clinical attachment level gain, when demineralized freeze-dried bone allograft, barrier membranes and active biologic products/compounds are applied in addition to open flap debridement. On the other hand, a consistent amount of variability of the outcomes is evident among different studies and within the experimental population of each study. This variability is explained, at least in part, by different patient and defect characteristics. Patient-related factors include smoking habit, compliance with home oral hygiene and residual inflammation after cause-related therapy. Defect-associated factors include defect depth and radiographic angle, the number of residual bony walls, pocket depth and the degree of hypermobility. In addition, surgical-related variables, such as surgical skill, clinical experience and knowledge, and application of the different regenerative materials, have a significant impact on clinical outcomes. This paper presents a strategy to optimize the clinical outcomes of periodontal regeneration. The surgical design of the flap, the use of different regenerative materials and the application of appropriate passive sutures are discussed in this review along with the scientific foundations.