多乳酸聚合物及多乳酸多甘醇酸聚合物之再生膜用於治療人體牙周炎骨缺損之比較

Comparisons of Polylactide Polymer-Assisted Regeneration Therapy with Atrisorb Barrier and Gore Resolut XT Membrane in Treating Human Periodontal Osseous Defects

本實驗目的要比較兩種可吸收再生膜——多乳酸聚合物及多乳酸多甘醇酸聚合物臨床上應用在牙周骨缺損組織工程手術治療後牙周組織再生的情形。實驗的方法是選16位病人牙齒20個部位患有中度到重度牙周炎，而且6個月內未做過牙周病治療。隨機選10個部位做多乳酸聚合物再生膜手術（A組），另外10個部位做多乳酸多甘醇酸聚合物再生膜手術（B組）。經過牙周基本治療和口腔衛教後，手術方法採取牙間乳突保留黏膜骨膜翻瓣術，瓣膜翻開的範圍超過骨缺損邊緣至少5mm。經過徹底牙根整平和清除骨內缺損的肉芽組織，這兩組的每個案例都用檸檬酸做牙根表面處理，並在骨內缺損壁做皮層骨穿刺，放入脫鈣冷凍乾燥異種骨粉和Minocin®（4:1混合）去填滿骨內缺損，最後在翻瓣膜的近根尖部位做部分層翻瓣片，使翻瓣膜可向牙冠移位而讓傷口能達到一級縫合。術後服用Minocin®兩週和兩個月內每天使用0.1% chlorhexidine漱口水。臨床上則評估術前及術後3~6個月的牙周囊袋探測深度、探測附連高度、牙齦緣位置、牙菌斑指數、牙齦炎指數，同時也觀察其同期間之X光的變化。初步結果發現2組可吸收再生膜在牙周骨內缺損治療上各自和術前比較，缺損部位的牙周囊袋探測深度、探測附連高度都有明顯改善，組內比較統計上有明顯的差異。雖然A組不同階段各項測量值改善比B組大，但兩組間統計上的差異不大。兩組手術後牙齒的搖動度、牙菌斑指數、牙齦炎指數也都有獲得改善。本研究分析結論是新的可吸收再生膜多乳酸聚合物可獲得和多乳酸多甘醇酸聚合物再生膜相類似的臨床牙周組織再生效果，兩者都能有效使牙周附連增加和降低牙周囊袋的深度。

This study compared clinical results of 20 periodontal osseous defects treated by tissue engineering technique using two types of bioabsorbable barrier materials. 16 patients suffered from moderate to advanced periodontitis were assigned to receive either 10 Atrisorb® (group A) or 10 Resolut XT® barrier (group B) therapy at random. Thorough periodontal phase I treatment and oral hygiene instruction were performed before periodontal surgery. Papillary preservation technique, supplemented partial thickness flap, citric acid root conditioning, decortication of bone defect surfaces and placement of demineralized freeze-dried bone allograft (DFDBA) were routinely applied during operation. Postoperative care included 0.10% chlorhexidine mouth rinse daily and antibiotic medication for 2 weeks. Clinical assessments including probing depth (PD), clinical attachment level (CAL), gingival recession (GR), plaque index (PlI), gingival index (GI) and radiographic examinations(RE) were taken at baseline and 0, 3, 6 months after regenerative surgery. Both A and B treatment groups achieved comparable clinical improvement of pocket reduction and attachment tissue gain. Within group comparison showed a significant attachment gain and better pocket reduction between baseline data and either 3 or 6 months postoperatively. However, there were no statistically significant differences of measured data between group A and group B. Radiographic examination also demonstrated a general bone fill in those treated osseous defects of both treatment modalities. The results of this study indicated that a comparable and favorable regeneration of periodontal osseous defects could be achieved in both Atrisorb® and Resolut XT® barriers. Further long-term study and histologic observation were needed to evaluate further clinical benefit of Atrisorb®.