硫酸钙在牙槽骨缺损的应用课件

TARRSON FAMILY ENDOWED CHAIR IN PERIODONTICS UCLA SCHOOL OF DENTISTRY PresentsPresents Dr. E. Barrie Kenney Professor 76:2205 Eleven centers with 180 subjects 3 groups: (1) T.C.P. + 0.3 mg/ml PDGF (2) T.C.P. + 1.0 mg/ml PDGF (3) T.C.P. + buffer Included smokers up to 1 pack per day; all got tetracycline root treatment at surgery, a few got re-entry. No pocket data available. Clinical Attachment Level GainsBone Fill at 6 Months (from Radiographs) 3 months 6 months TCP + 0.3 mg/ml PDGF3.83.8 TCP + 1.0 mg/ml PDGF3.53.6 TCP alone3.33.5 TCP + 0.3 mg/ml PDGF57% TCP + 1.0 mg/ml PDGF34% TCP alone18% 6-Month Pocket Depth Changes (from package insert) TCP + 0.3 mg/ml PDGF 4.4 mm TCP + 1.0 mg/ml PDGF4.3 mm TCP alone4.2 mm Bio-Active Molecules Bone Morphogenetic Proteins (B.M.P.) Genetically engineered human Bone Morphogenetic Proteins increase the amount and purity . Osteogenin is another name for B.M. P. Most osteogenins are bound to a carrier of bovine type I collagen sponge or other carrier. First isolated in acid extracts of human bone by URIST in 1965. Are part of superfamily of 43 transforming growth factor beta group. At least 16 different proteins isolated. BMP1 not part of superfamily is a procollagen protease. BMPs secreted by osteoblasts induce formation of osteoprogenitor cells and stimulate new bone formation. Bone Morphogenetic Proteins BMPs 2, 4, 5, 6, 7 needed for regulation of osseous tissue and for repair. Some are more osteoconductive, e.g., BMP2 and BMP7 more active than BMP5. URIST at UCLA first identified BMP in 1965. This native BMP is present in minute amounts (1mg per kg of bone), so need large amounts of bone to produce. Therefore, recombinant BMPs have been developed. Recombinant BMPs require up to 10 times more than native BMPs to give the same osteogenic activity. BMPs are assayed by intramuscular injection into rodents and so initiate osteogenesis. BMPs need carrier to get effective bone initiation. Ideal carrier still not found. Carriers: Demineralized Bone Matrix Collagen Resorbable polymers Calcium phosphate materials Recombined human Bone Morphogenetic Protein-7 in maxillary sinus floor elevation surgery in 3 patients compared to autogenous bone grafts. Van den Bergh JPA. et al J. Clinical Periodontol. 2000, 27:627 -1 sinus with BMP-7 had good bone -1 sinus no bone but cyst like mass -2 sinuses had small amount of bone insufficient for implants -All 5 autogenous sinus grafts had good bone Highest concentrations of BMP gave best clinical results 25 patients with grade II furcations in lower molars. Five with BMP Group 1 0.00 control DFDBA alone. Group 2 3.13 micrograms per mg of DFDBA Group 3 6.25 micrograms per mg of DFDBA Group 4 12.50 micrograms per mg of DFDB Group 5 25.0 micrograms per mg of DFDBA Evaluated at 6 months no re-entry Control Group 1 Group 2 Group 3 Group 4 Group 5 Pocket Depth Change 1.31.01.11.81.7 Vertical Attachment Level Change 0.50.80.51.51.5 Horizontal Attachment Level Change 1.90.50.41.11.8 6 Month Clinical results using DFDBA plus Bovine Derived Protein Bio-Active Molecules Enamel Matrix Derivatives: Amelogenin Emdogain Enamel matrix derivative protein in propylene glycol alginate solution. Used in root conditioning with orthophosphoric acid or EDTA. Emdogain contains amelogenin, a matrix protein produced by ameloblasts and reduced enamel epithelium of root sheaths. Combination use of bovine porous bone, mineral enamel matrix proteins and an absorbable membrane in intrabony periodontal defects in humans Lekovic V., Camargo P.M., Weinlaender M., Kenney E.B., Vasilic N. J. Periodontol 2001, 72:583 18 paired defects 10 male, 8 female 12 smokers, 6 non-smokers Mean age: 42 years 6 months clinical and re-entry data Control: flap debridement Bio-Oss plus Emdogain and Bio-Gide composite (collagen, polylactic acid) Pocket Depth (mm) Bio-Oss + Emdogain + Biogide composite Flap Curettage Attachment Gain 3.891.52 Bone Fill4.761.78 Attachment Level (mm) Initial6 months Bio-Oss + Emdogain + Bio- Gide composite 8.463.51 Flap debridement8.345.51 Osseous Resective Surgery A Longitudinal Study of Comparing Scaling Procedures, Osseous Surgery and Modified Widman Procedures: Results After 5 Years Becker W, Becker BE, Caffesse R, Kerry G, Ochsenbein C, Morrison E, Prichard J. J. Periodontol. 2001, 72:1675 Private practice environment Experts in each technique No selection of best defects for each technique Dr. W. Becker calibrated and did all measurements. All patient got two 1-hour units of scaling and root planing by hygienist. Baseline data 3 to 4 weeks post scaling. Random assigned quadrants for root planing by Dr. W. Becker. Osseous surgery by Dr. C. Ochsenbein, Dr. W. Becker and Dr. B.E. Becker. Modified Widman by Dr. G. Kerry. Patients seen weekly for 6 weeks post-surgery for polish and oral hygiene instruction. Placed on 3-month recalls. Data collected yearly 4 to 6 weeks after last recall. 9 of 16 patients compliant with recalls Plaque IndexPocket 7mm or Greater EntryBaseline2 Months5 Years Scaling1.470.320.240.22 Osseous Surgery 1.490.240.260.38 Modified Widman 1.390.280.390.20 Baseline2 Months5 Years Scaling7.315.886.17 Osseous Surgery 7.113.314.87 Modified Widman 7.223.824.66 Attachment Levels 7mm or Greater Baseline2 Months5 Years Scaling6.155.716.00 Osseous Surgery 5.654.625.11 Modified Widman 6.124.805.77 Gingival Recession in mm (Pocket 7mm or Greater) Baseline2 Months5 Years Scaling1.150.160.18 Osseous Surgery 1.46-1.31-0.24 Modified Widman 1.07-0.98-1.11 Periostat Plus Root Planing Subantimicrobial Dose of Doxcycline Enhances the Efficacy of Scaling and Root Planing in Chronic Periodontitis: A Multicenter Trial Preshaw PM et al J. Periodontol 2004, 75:1068 210 Patients with 5 to 9 mm pockets and BOP Up to 1 hour per quadrant scaling and root planing with L.A. 9-month results Used 20mg Doxycycline b.i.d. or placebo Current smokers