Journal of Periodontal and Implant Science

  • 제37권2호
  • /
  • Pages.181-192
  • /
  • 2007
  • /
  • 2093-2278(pISSN)
  • /
  • 2093-2286(eISSN)
대한치주과학회 (Korean Academy of Periodontology)
권호 표지

골연하 결손부에서 조직유도재생술의 장기적 방사선학적 변화 관찰

Long-term radiographic evaluation of GTR treatment in intrabony defect

  • 최미혜 (경북대학교 치의학전문대학원 치주과학교실) ;
  • 박진우 (경북대학교 치의학전문대학원 치주과학교실) ;
  • 서조영 (경북대학교 치의학전문대학원 치주과학교실) ;
  • 이재목 (경북대학교 치의학전문대학원 치주과학교실)
  • Choi, Mi-Hye (Department of Periodontology, School of Dentistry, Kyungpook National University) ;
  • Park, Jin-Woo (Department of Periodontology, School of Dentistry, Kyungpook National University) ;
  • Suh, Jo-Young (Department of Periodontology, School of Dentistry, Kyungpook National University) ;
  • Lee, Jae-Mok (Department of Periodontology, School of Dentistry, Kyungpook National University)
  • 발행 : 2007.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Periodontal surgery as part of the treatment of periodontal disease is mainly performed 1) to gain access to diseased areas for adequate cleaning; 2) to achieve pocket reduction or elimination; and 3) to restore the periodontal tissues lost through the disease; i.e., a new attachment formation of periodontal regeneration. To accomplish the latter, often referred to as the ultimate goal of periodontal therapy, a number of surgical procedures have been advocated throughout the years. Clinical studies have demonstrated that considerable gain of clinical attachment and bone can be achieved following guided tissue regeneration (GTR) therapy of intrabony defects. The aim of this study was to analyse the radiographic bone changes 2-year after GTR using a bone graft material and nonresorbable membrane. Patients attending the department of periodontics of Kyungpook National University Hospital were studied. Patients had clinical and radiographic evidence of intrabony defect(s), 33 sites of 30 patients aged 32 to 56 (mean age 45.6) were treated by GTR with a bone graft material and nonresorbable membrane. Baseline and 2-year follow-up radiographs were collected and evaluated for this study. Radiographic assessment includes a bone fill, bone crest change, defect resolution, and % of defect resolution. Pre- and post-treatment differences between variables (maxilla and mandible, defect depth, defect angle, bone graft materials) using the paired t-test were examined. We observed $2.86{\pm}1,87mm$ of bone fill, $065{\pm}0.79mm$ of crestal resorption, $3.49{\pm}2.11mm$ of defect resolution, and $44.42{\pm}19.51%$ of percentage of defect resolution. Mandible, deeper initial defect depth, narrower initial defect angle showed greater bone fill, defect resolution, and % of defect resolution. But no difference was observed between xenograft and allograft. Outcome of GTR as a therapy of intrabony defect was better than other therapy, but herein, good oral hygiene maintenance as a anti-infective treatment and periodic recall check of patients are essential.

키워드

참고문헌

  1. Glossarvior Periodontal Terms. Chicago: American Academy of Periodontology, 1992
  2. Hancock EB, Nevins M, Becker W, Korman K. Regeneration procedures. Proceedings of the World Workshop in Clinical Periodontics. Chicago : American Academy of Periodontology, 1989: IV
  3. Laurell L, Gottlow J, Zybutz M, Persson R. Treatment of ntrabonydefects by different surgical procedures. A literature review J Periodontol 1998;69:303-313
  4. Reddy MS, Jeffcoat HK. Methods of assessing periodontal regeneration. Periodontol 2000 1999;19:87-103 https://doi.org/10.1111/j.1600-0757.1999.tb00149.x
  5. Cortellini P, Prato GP, Tonetti M. Periodontal regeneration of human infrabony defects. I. Clinical Measures. J Periodontol 1993;64:254-260 https://doi.org/10.1902/jop.1993.64.4.254
  6. Becker W, Becker BE, Larry B, Prichard JP, Caffesse R, Rosenberg E, Giangrasso J. Root isolation for new attachment procedures : Surgical and suturing methods. Three case reports. J Periodontol 1987;58: 819-826 https://doi.org/10.1902/jop.1987.58.12.819
  7. Listgarten MA, Moda R, Robinson PJ, Periodontal probing and the relationship of the probe to the periodontal tissues. J Periodontol 1976;47:511-513 https://doi.org/10.1902/jop.1976.47.9.511
  8. Armitage GC, Svanberg GK, Loe H. Microscopic evaluation of clinical measurements of connective tissue attachment levels. J Clinical Periodontol 1977;4:173-190 https://doi.org/10.1111/j.1600-051X.1977.tb02271.x
  9. Camelo M, Nevins M, Schenk R, Simion M, Rasperini G, Lynch S, Nevins M. Clinical, radiographic, and histologic evaluation of human periodontal defects treated with Bio-Oss and Bio-Gide. Int J Periodontics Restorative Dent 1998;18:321-331
  10. Core RT, Crigger M. Bogle G, Egelberg J, Selvig KA. Connective tissue regeneration to periodontally diseased teeth. A histological study. J Periodontal Res 1980;15:1-9 https://doi.org/10.1111/j.1600-0765.1980.tb00256.x
  11. Bowers GM, Chadroff B, Carnevale R, Mellonig J, Corio R, Emerson J, Stevens M, Romberg E. Histologic evaluation of new attachment apparatus formation in humans. Part I. J Periodontol 1989;60:664-674 https://doi.org/10.1902/jop.1989.60.12.664
  12. Isidor F, Karring T, Nyman S, Lindhe J. New attachment-reattachment following reconstructive periodontal surgery. J Clin Periodontol 1985; 12: 728-735 https://doi.org/10.1111/j.1600-051X.1985.tb01398.x
  13. Cortelli P, Prato GP, Tonetti MS. Periodontal regeneration of human infrabony defects. II. Re-entry procedures and bone measures. J Periodontol 1993;64: 261-268 https://doi.org/10.1902/jop.1993.64.4.261
  14. Becker W, Becker BE. Treatment of mandibular 3-wall intrabony defects by flap debridement and expanded polytetrafluoroethylene barrier membranes. Long-term evaluation of 32 treated patients. J Periodontol 1993;64:1138-1144 https://doi.org/10.1902/jop.1993.64.11s.1138
  15. Caton J, Zander HA Osseous repair of an infrabony pocket without new attachment of connective tissue. J Clin Periodontol 1976;3:54-58 https://doi.org/10.1111/j.1600-051X.1976.tb01850.x
  16. Moscow BS, Karsh F, Stein SD. Histologic assessment of autogenous bone graft. A case report and critical evaluation. J Peirodontol 1979; 6: 291-300
  17. Tonetti MS, Prato GP, Williams RC, Cortellini P, Periodontal regeneration of human infrabony defects. III. Diagnostic strategies to detect bone gain. J Periodontol 1993;64:269-277 https://doi.org/10.1902/jop.1993.64.4.269
  18. Albandar JM. Validity and reliability of alveolar bone level measurements made on dry skulls. J Clin Periodontol 1989;16: 575-579 https://doi.org/10.1111/j.1600-051X.1989.tb02140.x
  19. Murphy KG, Gunsolley M. Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects. A systemic review. Annals of Periodontology 2003;8:266-302 https://doi.org/10.1902/annals.2003.8.1.266
  20. Tonetti MS, Prato GP, Cortellini P. Periodontal regeneration of human intrabony defects. IV. Determinants of healing response. J Periodontol 1993;64:934-940 https://doi.org/10.1902/jop.1993.64.10.934
  21. Steffensen B, Weber HP. Relationship between the radiographic periodontal defect angle and healing after treatment. J Periodontol 1989:60:248-254 https://doi.org/10.1902/jop.1989.60.5.248
  22. Cortellini P, Tonetti MS. Radiographic defect angle influences the outcomes of GTR therapy in intrabony defects 77th General Session of the IADR, Vancouver, Canada, March 1999:10-13
  23. Tsitoura E, Tucker R, Suvan J, Kaurell L, Cortellini P, Tonetti M. Baseline radiographic defect angle of the intrabony defect as a prognostic indicator in regenerative periodontal surgery with enamel matrix derivative. J Clin Periodontol 2004; 31: 643-647 https://doi.org/10.1111/j.1600-051X.2004.00555.x
  24. Cortellini P, Tonetti MS. Clinical performance of a regenerative strategy for intrabony defects scientific evidence and clinical experience. J Periodontol 2005;76: 341-350 https://doi.org/10.1902/jop.2005.76.3.341
  25. Bjorn H, Halling A, Thyberg H. Radiographic assessment of marginal bone loss. Odontologisk Revy 1969;20:165-179
  26. Schei O. Waerhaug J, Lovdal A. Arno A. Alveolar bone loss as related to oral hygiene and age. J Periodontol 1959;30:7-16 https://doi.org/10.1902/jop.1959.30.1.7
  27. Cortellini P, Bowers G, Periodontal regeneration of intrabony defects : An evidence-based treatment approach. Int J Periodontics Restorative Dent 1995;15:128-145
  28. Pontoriero R, Lindhe J, Guided tissue regeneration in the treatment of degree II furcations in maxillary molars. J Clin Periodontol 1995;22:756-763 https://doi.org/10.1111/j.1600-051X.1995.tb00258.x
  29. Metzler D, Seamons B, Mellonig J, Gher M, Gray J, Clinical evaluation of guided tissue regeneration in the treatment of maxillary class II molar furcation invasions. J Periodontol 1991;62:353-360 https://doi.org/10.1902/jop.1991.62.6.353
  30. Mellonig J, Seamons Bm Gray J, Towle H. Clinical evaluation of guided tissue regeneration in the treatment of grade II molar furcation invasions. lnt J Periodontics Restorative Dent 1994;14:255-271
  31. Cortellini P, Carnevale G, Sanz M, Tonetti MS. Treatment of deep and shallow intrabony defects. A multicenter randomized controlled clinical trial. J Clin Periodontol 1998;25:981-987 https://doi.org/10.1111/j.1600-051X.1998.tb02402.x
  32. Selvig KA, Kersten BG, Wikesjo UM. Surgical treatment of intrabony periodontal defects using expanded polytetrafluoroethylene barrier membranes : influence of defect configuration on healing response. J Periodontol 1993;64:730-733 https://doi.org/10.1902/jop.1993.64.8.730
  33. Kelin F, Kim TS, Hassfeld S, Staehle HJ, Reitmeir P, Holle R, Eickholz P. Radiographic defect depth and width for prognosis and description of periodontal healing of infrabony defects. J Periodontol 2001;72:1639-1646 https://doi.org/10.1902/jop.2001.72.12.1639
  34. Egelberg J. Regeneration and repair of periodontal tissues. J Periodontal Res 1987; 22:233-242 https://doi.org/10.1111/j.1600-0765.1987.tb01577.x
  35. Mellado JR, Salkin LM, Freedman AL, Stein MD. A comparative study of ePTFE periodontal membranes with and without decalcified freeze-dried bone allografts for the regeneration of interproximal intraosseous defects. J Periodontol 1995;66:751-755 https://doi.org/10.1902/jop.1995.66.9.751
  36. Chen CC, Wang HL, Smith F, Glickman GN, Shyr Y, O'Neal RB. Evaluation of a collagen membrane with and without bone grafts in treating periodontal intrabony defects. J Periodontol 1995;66:838-847 https://doi.org/10.1902/jop.1995.66.10.838
  37. Gouldin AG, Fayad S, Mellonig JT. Evaluation of guided tissue regeneration in interproximal defects. (II). Membrane and bone versus membrane alone
  38. Stavropoulos A, Karring ES, Kostopoulos L, Karring T. Deproteinized bovine bone and gentamicin as an adjunct to GTR in the treatment of intrabony defects : a randomized controlled clinical study. J Clin Periodontol 2003;30:486-495 https://doi.org/10.1034/j.1600-051X.2003.00258.x
  39. Murphy KG, Gunsolley JC. Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects. A systematic review. Ann Periodontol 2003;8: 266-302 https://doi.org/10.1902/annals.2003.8.1.266
  40. Kim TS, Holle R, Ernest H, Eickholz P. Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. II. A case series of infrabony defects. J Periodontol 2002;73:450-459 https://doi.org/10.1902/jop.2002.73.4.450
  41. Eickholz P, Kriger DM, Pretzl B, Steinbrenner H, Dorfer C, Kim TS. Guided tissue regeneration with bioabsorbable barriers. II. Long-term results in infrabony defects. J Periodontol 2004;75:957-965 https://doi.org/10.1902/jop.2004.75.7.957
  42. Cortellini P, Tonetti M. Long-term tooth survival following regenerative treatment of intrabony defects. J Periodontol 2004; 75:672-678 https://doi.org/10.1902/jop.2004.75.5.672
  43. Parashis A, Andronikaki-Faldami A, Tsilkakis K. Clinical and radiographic comparison of three regenerative procedures in the teatment of intrabony defects. Int J Periodontics Restorative Dent 2004;24: 81-90
  44. Karring T, Stavropoulos A. Long-term stability of periodontal conditions achieved following guided tissue regeneration with bioresorbable membranes: Case series results after 6-7 years. J Clin Periodontol 2004;31:939-944 https://doi.org/10.1111/j.1600-051X.2004.00586.x