Publication: Rejeneratif periodontal tedavide mine matriksi proteininin kullanımının klinik ve radyografik olarak incelenmesi
Abstract
Rejeneratif periodontal tedavide mine matriks proteininin kullanımının klinik ve radyografik olarak incelenmesi Bu çalışmada, yatay kemik harabiyetlerinin tedavisinde mine matriks proteini (EmdogainÒ- EMD) uygulamasının etkinliği, klinik ve radyografik olarak incelenmiştir. Araştırma kapsamına, erişkin periodontitisli 20 hastanın üst çene ön bölgesindeki 6'şar dişleri olmak üzere, toplam 120 diş alınmıştır. Başlangıç tedavileri tamamlandıktan sonra, iki farklı ensizyon şekline göre planlanan iki ayrı kontrol işlemi nedeniyle, rastgele 10'ar hastalık iki grup ayrılmış ve orta hattın iki tarafındaki üçer dişi kapsayan, deney ve kontrol bölgeleri oluşturulmuştur. Deney bölgelerinde flep operasyonu sırasında kök yüzeylerine EMD uygulanmış, kontrol bölgelerinde ise herhangi bir materyal uygulanmaksızın sulkular veya klasik ensizyonlu flep operasyonları gerçekleştirilmiştir. Operasyonlarda kemik cerrahisi uygulanmamıştır. Tedaviden 8 ay sonra yapılan istatistiksel değerlendirmede, hastaların tedavi süresi boyunca gerekli ağız hijyeni seviyesini ve dişeti sağlıklarını korudukları gözlenmiş, tüm tedavi gruplarında CD'de azalma meydana gelmiştir. Başlangıç CDý4 mm olan bölgelerde, mine matriks proteini uygulanan deney grubunda, sulkular ensizyonlu flep operasyonu yapılan kontrol grubuna kıyasla çok ileri derecede anlamlı cep derinliği azalması ve ataşman kazancı saptanmıştır (p<0,001). Ataşman kazancı açısından, CDý4 mm olan bölgelerde, deney grubu ile klasik ve sulkular ensizyonlu flep operasyonu yapılan kontrol grupları arasında da anlamlı fark gözlenmiştir (p<0,01, p<0,001). Başlangıç CD£3 mm olan bölgelerde, deney grubunda sulkular ensizyonun kullanıldığı kontrol grubuna kıyasla anlamlı ataşman kazancı (p<0,05), kontrol gruplarında ise kendi içlerinde istatistiksel olarak anlamlı olmamakla birlikte, ataşman kaybı bulunmuştur. Dişeti çekilmesinin başlangıç CDý4 mm olan bölgelerde, deney gruplarında kontrol gruplarına kıyasla daha az olduğu saptanmıştır (p<0,05). Kemik ölçümleri ve radyografik değerlendirmede, gruplar arasında anlamlı fark tespit edilmemiştir. Yatay kemik harabiyetlerinin tedavisinde periodontal flep operasyonlarına destekleyici EMD uygulamasının, klasik yöntemlere bir alternatif olarak, periodontal ataşman sisteminin rejenerasyonu ile sonuçlandığı görülmüştür.
ABSTARCT Clinical and radiographic evaluation of enamel matrix proteins in regenerative periodontal therapy In this study, the efficacy of enamel matrix protein (EmdogainÒ-EMD) used with periodontal flap surgery was evaluated clinically and radiographically in a split-mouth design, and compared with periodontal flap surgery performed by using two different incision methods. Twenty adult periodontitis patients who received non-surgical periodontal therapy including oral hygiene instructions and subgingival instrumentation in all parts of dentition were included. Each subject exhibited horizontal bone loss and periodontal pocketing at the maxillary anterior teeth, that could be identified as experimental segment to receive two separate treatments. One side of the anterior segment was treated with an intracrevicular incision as a part of EMD treatment whereas the other side was treated either with a similar intracrevicular incision or with a classical incision placed approximately 2 mm from the gingival margin as a part of mucoperiostal flap debridement. The clinical and radiographic assessments were made preoperatively and 8 months postoperatively. All patients maintained a good oral hygiene and gingival health status throughout the study. The initially deep periodontal sites treated with EMD showed statistically significant reduction in probing pocket depth and gain in attachment level compared with the sites treated with flap surgery using sulcular incision (p<0,001). Significant differences in attachment gain was observed between the EMD group and the control groups (p<0,01, p<0,001). The initially shallow periodontal sites treated with EMD exhibited significantly more attachment gain compared to the sites treated with flap surgery using sulcular incision (p<0,05) whereas insignificant attachment loss was observed within the control groups. Deep periodontal pockets treated with EMD showed significantly less gingival recession compared to control groups (p<0,05). There was no statistical difference in clinical and radiographic bone mesurements between the groups. It was concluded that EMD treatment in horizontal bone loss as an adjunct to periodontal surgery leads to significant improvements of clinical parameters and regeneration of attachment apparatus in adult periodontitis patients.
ABSTARCT Clinical and radiographic evaluation of enamel matrix proteins in regenerative periodontal therapy In this study, the efficacy of enamel matrix protein (EmdogainÒ-EMD) used with periodontal flap surgery was evaluated clinically and radiographically in a split-mouth design, and compared with periodontal flap surgery performed by using two different incision methods. Twenty adult periodontitis patients who received non-surgical periodontal therapy including oral hygiene instructions and subgingival instrumentation in all parts of dentition were included. Each subject exhibited horizontal bone loss and periodontal pocketing at the maxillary anterior teeth, that could be identified as experimental segment to receive two separate treatments. One side of the anterior segment was treated with an intracrevicular incision as a part of EMD treatment whereas the other side was treated either with a similar intracrevicular incision or with a classical incision placed approximately 2 mm from the gingival margin as a part of mucoperiostal flap debridement. The clinical and radiographic assessments were made preoperatively and 8 months postoperatively. All patients maintained a good oral hygiene and gingival health status throughout the study. The initially deep periodontal sites treated with EMD showed statistically significant reduction in probing pocket depth and gain in attachment level compared with the sites treated with flap surgery using sulcular incision (p<0,001). Significant differences in attachment gain was observed between the EMD group and the control groups (p<0,01, p<0,001). The initially shallow periodontal sites treated with EMD exhibited significantly more attachment gain compared to the sites treated with flap surgery using sulcular incision (p<0,05) whereas insignificant attachment loss was observed within the control groups. Deep periodontal pockets treated with EMD showed significantly less gingival recession compared to control groups (p<0,05). There was no statistical difference in clinical and radiographic bone mesurements between the groups. It was concluded that EMD treatment in horizontal bone loss as an adjunct to periodontal surgery leads to significant improvements of clinical parameters and regeneration of attachment apparatus in adult periodontitis patients.