国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (2): 161-168.doi: 10.7518/gjkq.2025043
摘要:
牙周再生手术中微创理念的提出,在减小创伤的同时,更大程度上保证了软组织的完整性,为牙周再生手术提供了良好的软组织条件,从而可以更好地关闭创口,以获得更好的牙周组织再生效果。微创术式多种多样,如龈乳头保存技术、改良龈乳头保存技术等,不同学者术式选择各不相同,同时微创再生术中是否使用屏障膜、是否使用釉质基质衍生物和骨替代材料,以及使用的骨替代材料的类型,各个学者的报道不一。本文就上述问题在近年来的研究进展进行综述,总结了实行微创手术时再生材料的选择及不同类型材料的再生效果,以期为临床医生实施牙周微创手术提供一定的参考。
中图分类号:
1 | Sanz M, Herrera D, Kebschull M, et al. Treatment of stage Ⅰ-Ⅲ periodontitis-the EFP S3 level clinical practice guideline[J]. J Clin Periodontol, 2020, 47(): 4-60. |
2 | Nibali L, Koidou VP, Nieri M, et al. Regenerative surgery versus access flap for the treatment of intra-bony periodontal defects: a systematic review and meta-analysis[J]. J Clin Periodontol, 2020, 47(): 320-351. |
3 | Harrel SK, Rees TD. Granulation tissue removal in routine and minimally invasive procedures[J]. Compend Contin Educ Dent, 1995, 16(9): 960, 962, 964. |
4 | Cortellini P, Tonetti MS. A minimally invasive surgical technique with an enamel matrix derivative in the regenerative treatment of intra-bony defects: a novel approach to limit morbidity[J]. J Clin Perio-dontol, 2007, 34(1): 87-93. |
5 | Cortellini P, Prato GP, Tonetti MS. The modified papilla preservation technique. A new surgical approach for interproximal regenerative procedures[J]. J Periodontol, 1995, 66(4): 261-266. |
6 | Cortellini P, Prato GP, Tonetti MS. The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures[J]. Int J Periodontics Restorative Dent, 1999, 19(6): 589-599. |
7 | Cortellini P, Tonetti MS. Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects[J]. J Clin Periodontol, 2009, 36(2): 157-163. |
8 | Harrel SK, Abraham CM, Rivera-Hidalgo F, et al. Videoscope-assisted minimally invasive periodontal surgery (V-MIS)[J]. J Clin Periodontol, 2014, 41(9): 900-907. |
9 | Trombelli L, Farina R, Franceschetti G, et al. Single-flap approach with buccal access in periodontal reconstructive procedures[J]. J Periodontol, 2009, 80(2): 353-360. |
10 | Najafi B, Kheirieh P, Torabi A, et al. Periodontal regenerative treatment of intrabony defects in the esthetic zone using modified vestibular incision subperiosteal tunnel access (M-VISTA) [J]. Int J Perio-dontics Restorative Dent, 2018, 38(): e9-e16. |
11 | Aslan S, Buduneli N, Cortellini P. Entire papilla preservation technique in the regenerative treatment of deep intrabony defects: 1-year results[J]. J Clin Periodontol, 2017, 44(9): 926-932. |
12 | 李熠, 王琪, 邱立新. 半月-隧道瓣技术在引导组织再生术中的临床应用[J]. 中华口腔医学杂志, 2021, 56(12): 1237-1243. |
Li Y, Wang Q, Qiu LX. Clinical effect of semilunar-tunnel technique in guided tissue regeneration[J]. Chin J Stomatol, 2021, 56(12): 1237-1243. | |
13 | Cortellini P, Tonetti MS. Microsurgical approach to periodontal regeneration. Initial evaluation in a case cohort[J]. J Periodontol, 2001, 72(4): 559-569. |
14 | Clementini M, Ambrosi A, Cicciarelli V, et al. Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: systematic review and meta-analysis[J]. J Clin Perio-dontol, 2019, 46(12): 1236-1253. |
15 | Zanetta-Barbosa D, Klinge B, Svensson H. Laser doppler flowmetry of blood perfusion in mucoperio-steal flaps covering membranes in bone augmentation and implant procedures. A pilot study in dogs[J]. Clin Oral Implants Res, 1993, 4(1): 35-38. |
16 | Pasqualini E, Castro F, Curado D, et al. Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies[J]. Evid Based Dent, 2024, 25(1): 54. |
17 | Harrel SK, Nunn ME, Abraham CM, et al. Videoscope assisted minimally invasive surgery (VMIS): 36-month results[J]. J Periodontol, 2017, 88(6): 528-535. |
18 | Shaikh MS, Zafar MS, Alnazzawi A. Comparing nanohydroxyapatite graft and other bone grafts in the repair of periodontal infrabony lesions: a systema-tic review and meta-analysis[J]. Int J Mol Sci, 2021, 22(21): 12021. |
19 | Tavelli L, Chen CJ, Barootchi S, et al. Efficacy of biologics for the treatment of periodontal infrabony defects: an American Academy of Periodontology best evidence systematic review and network meta-analysis[J]. J Periodontol, 2022, 93(12): 1803-1826. |
20 | Nibali L, Sultan D, Arena C, et al. Periodontal infrabony defects: systematic review of healing by defect morphology following regenerative surgery[J]. J Clin Periodontol, 2021, 48(1): 100-113. |
21 | De Bruyckere T, Eghbali A, Younes F, et al. A 5-year prospective study on regenerative periodontal therapy of infrabony defects using minimally invasive surgery and a collagen-enriched bovine-derived xenograft[J]. Clin Oral Investig, 2018, 22(3): 1235-1242. |
22 | Venezia E, Goldstein M, Boyan BD, et al. The use of enamel matrix derivative in the treatment of perio-dontal defects: a literature review and meta-analysis[J]. Crit Rev Oral Biol Med, 2004, 15(6): 382-402. |
23 | 庄齐翔, 董家辰, 束蓉. 釉基质蛋白衍生物对牙周组织再生相关细胞的生物学作用及其成血管作用的研究进展[J]. 上海交通大学学报(医学版), 2021, 41(8): 1099-1102. |
Zhuang QX, Dong JC, Shu R. Biological and angiogenic effects of enamel matrix derivative on perio-dontal regeneration-related cells[J]. J Shanghai Jiaotong Univ Med Sci, 2021, 41(8): 1099-1102. | |
24 | Bosshardt DD. Biological mediators and periodontal regeneration: a review of enamel matrix proteins at the cellular and molecular levels[J]. J Clin Perio-dontol, 2008, 35(8 ): 87-105. |
25 | Miron RJ, Dard M, Weinreb M. Enamel matrix derivative, inflammation and soft tissue wound healing[J]. J Periodontal Res, 2015, 50(5): 555-569. |
26 | Windisch P, Iorio-Siciliano V, Palkovics D, et al. The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial[J]. Clin Oral Investig, 2022, 26(2): 1811-1821. |
27 | Estrin NE, Moraschini V, Zhang YF, et al. Use of enamel matrix derivative in minimally invasive/flapless approaches: a systematic review with meta-ana-lysis[J]. Oral Health Prev Dent, 2022, 20: 233-242. |
28 | Oneto P, Zubiry PR, Schattner M, et al. Anticoagulants interfere with the angiogenic and regenerative responses mediated by platelets[J]. Front Bioeng Biotechnol, 2020, 8: 223. |
29 | Lourenço ES, Mourão CFAB, Leite PEC, et al. The in vitro release of cytokines and growth factors from fibrin membranes produced through horizontal centrifugation[J]. J Biomed Mater Res A, 2018, 106(5): 1373-1380. |
30 | Miron RJ, Moraschini V, Fujioka-Kobayashi M, et al. Use of platelet-rich fibrin for the treatment of periodontal intrabony defects: a systematic review and meta-analysis[J]. Clin Oral Investig, 2021, 25(5): 2461-2478. |
31 | Fujioka-Kobayashi M, Miron RJ, Hernandez M, et al. Optimized platelet-rich fibrin with the low-speed concept: growth factor release, biocompatibility, and cellular response[J]. J Periodontol, 2017, 88(1): 112-121. |
32 | 文超举, 刘春影, 裴婷婷, 等. 3种不同压膜方法对浓缩生长因子膜细胞因子释放及降解的影响[J]. 口腔医学, 2019, 39(10): 889-894. |
Wen CJ, Liu CY, Pei TT, et al. A comparative study of CGF membranes made by three different compression methods on the effect of the releasing of growth factorsin in vitro and degradability in vivo [J]. Stomatology, 2019, 39(10): 889-894. | |
33 | Ahmad N, Tewari S, Narula SC, et al. Platelet-rich fibrin along with a modified minimally invasive surgical technique for the treatment of intrabony defects: a randomized clinical trial[J]. J Periodontal Implant Sci, 2019, 49(6): 355-365. |
34 | 周占豪, 笪海芹, 傅俊博, 等. 牙周微创外科技术联合CGF屏障膜应用于组织再生中的临床效果评价[J]. 临床口腔医学杂志, 2023, 39(2): 107-111. |
Zhou ZH, Da HQ, Fu JB, et al. Clinical effect eva-luation of minimally invasive periodontal surgery combined with CGF barrier membrane in tissue regeneration[J]. J Clin Stomatol, 2023, 39(2): 107-111. | |
35 | Korkmaz B, Balli U. Clinical evaluation of the treatment of multiple gingival recessions with connective tissue graft or concentrated growth factor using tunnel technique: a randomized controlled clinical trial[J]. Clin Oral Investig, 2021, 25(11): 6347-6356. |
36 | Miron RJ, Fujioka-Kobayashi M, Bishara M, et al. Platelet-rich fibrin and soft tissue wound healing: a systematic review[J]. Tissue Eng Part B Rev, 2017, 23(1): 83-99. |
37 | Mijiritsky E, Assaf HD, Peleg O, et al. Use of PRP, PRF and CGF in periodontal regeneration and facial rejuvenation-a narrative review[J]. Biology, 2021, 10(4): 317. |
38 | Kavyamala D, Vs Sruthima GN, Dwarakanath CD, et al. Evaluation of the efficacy of a 1∶1 mixture of β-TCP and rhPDGF-BB in the surgical management of two- and three-wall intraosseous defects: a prospective clinical trial[J]. Int J Periodontics Restora-tive Dent, 2019, 39(1): 107-113. |
39 | Jayakumar A, Rajababu P, Rohini S, et al. Multi-centre, randomized clinical trial on the efficacy and safety of recombinant human platelet-derived grow-th factor with β-tricalcium phosphate in human intra-osseous periodontal defects[J]. J Clin Periodontol, 2011, 38(2): 163-172. |
40 | Mishra A, Avula H, Pathakota KR, et al. Efficacy of modified minimally invasive surgical technique in the treatment of human intrabony defects with or without use of rhPDGF-BB gel: a randomized controlled trial[J]. J Clin Periodontol, 2013, 40(2): 172-179. |
41 | Sampath TK, Vukicevic S. Biology of bone morphogenetic protein in bone repair and regeneration: a role for autologous blood coagulum as carrier[J]. Bone, 2020, 141: 115602. |
42 | Garg S, Kapoor R, Tyagi P, et al. Treatment of human intraosseous periodontal defects using recombinant human bone morphogenetic protein-2: a randomized controlled clinical trial[J]. Cureus, 2023, 15(6): e40395. |
43 | Pouliou MM, Fragkioudakis I, Doufexi AE, et al. The role of rhFGF-2 in periodontal defect bone fill: a systematic review of the literature[J]. J Periodontal Res, 2023, 58(4): 733-744. |
44 | Pagni G, Tavelli L, Rasperini G. The evolution of surgical techniques and biomaterials for periodontal regeneration[J]. Dent Clin North Am, 2022, 66(1): 75-85. |
45 | Avila-Ortiz G, Ambruster J, Barootchi S, et al. American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice[J]. J Periodontol, 2022, 93(12): 1763-1770. |
46 | Simonelli A, Minenna L, Trombelli L, et al. Single flap approach with or without enamel matrix derivative in the treatment of severe supraosseous defects: a retrospective study[J]. Clin Oral Investig, 2021, 25(11): 6385-6392. |
47 | Liu B, Ouyang XY, Kang J, et al. Efficacy of perio-dontal minimally invasive surgery with and without regenerative materials for treatment of intrabony defect: a randomized clinical trial[J]. Clin Oral Investig, 2022, 26(2): 1613-1623. |
48 | Cortellini P, Tonetti MS. Clinical and radiographic outcomes of the modified minimally invasive surgical technique with and without regenerative mate-rials: a randomized-controlled trial in intra-bony defects[J]. J Clin Periodontol, 2011, 38(4): 365-373. |
49 | Cortellini P, Cortellini S, Bonaccini D, et al. Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence, and costs[J]. J Clin Periodontol, 2022, 49(6): 528-536. |
50 | de Sanctis M, Zucchelli G, Clauser C. Bacterial colo-nization of barrier material and periodontal regene-ration[J]. J Clin Periodontol, 1996, 23(11): 1039-1046. |
51 | Kitaori T, Ito H, Schwarz EM, et al. Stromal cell-derived factor 1/CXCR4 signaling is critical for the recruitment of mesenchymal stem cells to the fracture site during skeletal repair in a mouse model[J]. Arthritis Rheum, 2009, 60(3): 813-823. |
52 | Teare JA, Ramoshebi LN, Ripamonti U. Periodontal tissue regeneration by recombinant human transforming growth factor-beta 3 in Papio ursinus[J]. J Periodontal Res, 2008, 43(1): 1-8. |
53 | Nobuto T, Suwa F, Kono T, et al. Microvascular response in the periosteum following mucoperiosteal flap surgery in dogs: angiogenesis and bone resorption and formation[J]. J Periodontol, 2005, 76(8): 1346-1353. |
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