中国实用口腔科杂志

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牙周再生性手术的临床诊疗策略

徐莉李熠   

  1. 作者单位:北京大学口腔医学院·口腔医院牙周科,北京100081
  • 出版日期:2013-04-15 发布日期:2013-04-24
  • 作者简介:徐莉,医学博士,北京大学口腔医学院牙周科主任医师、副教授。荷兰阿姆斯特丹牙科中心访问学者。兼任中华口腔医学会牙周病学专业委员会常务委员、中央保健会诊专家、《中国口腔医学继续教育杂志》编委。从事牙周临床、教学和科研工作20余年,对复杂牙周病患者的综合诊治(如牙周手术治疗)有丰富的临床经验。发表中、英文文章近60篇。
  • 基金资助:

    国家临床重点专科建设项目

Clinical diagnosis and treatment strategy in periodontal regenerative surgery

XU LiLI yi   

  1. Department of Periodontics,Peking University School and Hospital of Stomatology,Beijing 100081,China
  • Online:2013-04-15 Published:2013-04-24

摘要:

牙周再生性手术主要包括引导性组织再生术(guided tissue regeneration,GTR)、植骨术和与生长因子有关的促进再生的方法等。GTR原理是在术区放置生物膜形成膜屏障,阻断上皮和纤维组织贴附根面,确保牙周膜细胞占据根面,形成新附着,即真正意义上的牙周组织再生。GTR适应证包括骨下袋、根分叉病变及局限性牙龈退缩。GTR需遵循一定的治疗策略,窄而深的2壁和3壁骨下袋、Ⅱ度根分叉病变以及MillerⅠ度和Ⅱ度龈退缩的治疗效果更具可预测性。再生性手术前控制牙周炎症,术中尽量采用微创手术、保证血供、创造并维持再生空间、严密关闭创口,术后维持创面及血凝块稳定、保持良好的口腔卫生等,都与获得较好的手术(特别是远期)疗效有关。

关键词: 牙周再生性手术, 引导性组织再生术

Abstract:

Abstract:Periodontal regenerative surgery can be subdivided into guided tissue regeneration (GTR),bone graft procedures and procedures associated with various growth factors. GTR is periodontal surgical procedures that utilize barrier membranes to ensure periodontal ligament cells to capture the root surface first and to direct the achievement of new attachment. The indications of GTR include intrabony defects,furcation involvements and localized gingival recessions. Some treatment strategies should be followed to reach the predictable objective of the treatment,which includes deep and narrow two/three-wall intrabony defects,classⅡfurcation involvements and Miller classⅠ/Ⅱ recessions. Removal of periodontal plaque and elimination of periodontal infection before GTR surgery are necessary. Minimal invasive technique, blood supply protection,space creation and maintenance,primary closure of the wound,wound protection and clot stabilization and plaque control can make the clinical results more predictable.

Key words: periodontal regenerative surgery, guided tissue regeneration(GTR)

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