Kronik Periodontitisli Bir Hastada Kemik İçi Defektlerin Rejeneratif Tedavisi: Vaka Raporu

Yıl 2018, Cilt: 2 Sayı: 2, 68 - 74, 30.12.2018

Yaprak Kalkan Ömer Birkan Ağralı Leyla Kuru

Öz

Hastalıklı kök yüzeylerine erişerek plak ve endotoksinler
gibi lokal faktörleri uzaklaştırmak için uygulanan konvansiyonel periodontal
cerrahi ile elde edilen yeni ataşman genellikle uzun bağlantı epiteli
oluşumuyla sonuçlanır. Dişeti epiteli ve bağ dokusunu kök yüzeyinden uzak tutan
bariyerin kullanıldığı yönlendirilmiş doku rejenerasyonu prosedürü ile kaybedilen
periodontal dokuların kısmen rejenerasyonu sağlanmaktadır. Bu vaka raporunda
sol alt ikinci molar bölgesinde yer alan ağrısız şişlik şikayetiyle kliniğimize
başvuran 38 yaşındaki kadın hastanın rejeneratif periodontal tedavisi
sunulmaktadır. Klinik ve radyografik değerlendirme sonucunda 14, 15, 16, 25 ve
37 no’lu dişler bölgesinde kemik içi defektlerin tespit edildiği hastaya kronik
periodontitis teşhisi konuldu. Başlangıç periodontal tedavi sonrası kemik içi
defekt bölgelerinin tedavisi için flep operasyonu ile birlikte sığır kaynaklı
ksenogreft ve kolajen membran uygulandı. Yapılan 4 yıllık takip sonrasında
hastalığın tekrarlamadığı ve defekt bölgelerinde kemik dolumu saptandı. Kronik
periodontitisli hastalarda kemik içi defekt bölgelerine sığır kaynaklı kemik
ksenogrefiyle kolajen membranın kombine kullanılmasıyla uygulanan rejeneratif periodontal
tedaviyle elde edilen klinik ve radyolojik açıdan olumlu sonuçlar 4 yıl boyunca
korunmuştur.

Anahtar Kelimeler

kronik periodontitis, ksenogreft, membran, yönlendirilmiş doku rejenerasyonu

Regenerative Treatment of Intrabony Defects in a Patient with Chronic Periodontitis: Case Report

Öz

New attachment achieved by conventional periodontal
surgery performed to gain access to diseased root surfaces and to remove local factors
such as plaque and endotoxins, usually results in the formation of long
junctional epithelium. On the contrary, guided tissue regeneration procedure in
which a barrier is utilized to exclude gingival epithelium and connective
tissue from the root surface, has been shown to partially regenerate lost
periodontal tissues. This case report presents regenerative periodontal
treatment of a 38-year old female attending with a complaint of painless
swelling in the mandibular left second molar region. The patient was diagnosed
as chronic periodontitis based on clinical and radiographic findings and intrabony
defects were observed at teeth #14, #15, #16, #25 and #37. After initial
periodontal treatment, flap operation with the principles of guided tissue
regeneration was performed for treatment of intrabony defects. After 4-year
follow-up period, evidence of bone fill and no sign of recurrence were seen at
defect sites. It was concluded that regenerative treatment of intrabony
periodontal defects by the use of bovine xenograft and collagen membrane
combination provides favourable clinical and radiographic outcomes in chronic
periodontitis patients and could be maintained up to 4 years successfully.

Anahtar Kelimeler

Key words: Chronic periodontitis, guided tissue regeneration, membrane, xenograft

Kaynakça

• Kaynaklar:1. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999 4: 1-6.
• 2. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis. J Clin Periodontol. 1981 8: 57-72.
• 3. Garrett S. Periodontal regeneration around natural teeth. Ann Periodontol. 1996 1: 621-666.
• 4. Schallhorn R. Combined osseous composite grafting root conditioning and guided tissue regeneration. Int J Periodont Rest Dent. 1988 8: 13-32.
• 5. Melcher AH, McCulloch CA, Cheong T, Nemeth E, Shiga A. Cells from bone synthesize cementum-like and bone-like tissue in vitro and may migrate into periodontal ligament in vivo. J Periodontal Res. 1987 22: 246-247.
• 6. Nyman S. Bone regeneration using the principle of guided tissue regeneration. J Clin Periodontol. 1991 18: 494-498.
• 7. Buser D, Dula K, Hirt HP, Schenk RK. Lateral ridge augmentation using autografts and barrier membranes: a clinical study with 40 partially edentulous patients. J Oral Maxillofac Surg. 1996 54: 420-432.
• 8. Chen Y, Mak AF, Wang M, Li JS, Wong MS. In vitro behavior of osteoblast-like cells on PLLA films with a biomimetic apatite or apatite/collagen composite coating. J Mater Sci Mater Med. 2008 19: 2261-2268.
• 9. Camargo PM, ve ark. A controlled re-entry study on the effectiveness of bovine porous bone mineral used in combination with a collagen membrane of porcine origin in the treatment of intrabony defects in humans. J Clin Periodontol. 2000 27: 889-896.
• 10. Valentini P, Abensur D. Maxillary sinus floor elevation for implant placement with demineralized freeze-dried bone and bovine bone (Bio-Oss): a clinical study of 20 patients. Int J Periodontics Restorative Dent. 1997 17: 232-241.
• 11. Page RC, Kornman KS. The pathogenesis of human periodontitis: an introduction. Periodontol 2000. 1997 14: 9-11.
• 12. Van der Velden U, ve ark. Effect of smoking and periodontal treatment on the subgingival microflora. J Clin Periodontol. 2003 30: 603-610.
• 13. Apatzidou DA, Riggio MP, Kinane DF. Impact of smoking on the clinical, microbiological and immunological parameters of adult patients with periodontitis. J Clin Periodontol. 2005 32: 973-983.
• 14. Trombelli L, Kim CK, Zimmerman GJ, Wikesjo UM. Retrospective analysis of factors related to clinical outcome of guided tissue regeneration procedures in intrabony defects. J Clin Periodontol. 1997 24: 366-371.
• 15. Ratka-Kruger P, Neukranz E, Raetzke P. Guided tissue regeneration procedure with bioresorbable membranes versus conventional flap surgery in the treatment of infrabony periodontal defects. J Clin Periodontol. 2000 27: 120-127.
• 16. Bunyaratavej P, Wang H-L. Collagen membranes: a review. Journal of periodontology. 2001 72: 215-229.
• 17. Blank BS, Levy AR. Combined treatment of a large periodontal defect using GTR and DFDBA. Int J Periodontics Restorative Dent. 1999 19: 481-487.
• 18. Kohal RJ, Hurzeler MB. [Bioresorbable barrier membranes for guided bone regeneration around dental implants]. Schweiz Monatsschr Zahnmed. 2002 112: 1222-1229.
• 19. Reynolds MA, Aichelmann-Reidy ME, Branch-Mays GL, Gunsolley JC. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review. Ann Periodontol. 2003 8: 227-265.
• 20. Sculean A, Nikolidakis D, Schwarz F. Regeneration of periodontal tissues: combinations of barrier membranes and grafting materials - biological foundation and preclinical evidence: a systematic review. J Clin Periodontol. 2008 35: 106-116.
• 21. Cortellini P, Tonetti MS. Focus on intrabony defects: guided tissue regeneration. Periodontol 2000. 2000 22: 104-132.
• 22. Claffey N, Polyzois I, Ziaka P. An overview of nonsurgical and surgical therapy. Periodontol 2000. 2004 36: 35-44.
• 23. Socransky SS, Haffajee AD. Effect of Therapy on Periodontal Infections. J Periodontol. 1993 64 Suppl 8S: 754-759.
• 24. Becker W, Becker BE. Periodontal regeneration: a contemporary re-evaluation. Periodontol 2000. 1999 19: 104-114.
• 25. Sculean A, ve ark. Healing of intrabony defects following treatment with a bovine-derived xenograft and collagen membrane. A controlled clinical study. J Clin Periodontol. 2003 30: 73-80.
• 26. Camelo M, ve ark. Clinical, radiographic, and histologic evaluation of human periodontal defects treated with Bio-Oss and Bio-Gide. Int J Periodontics Restorative Dent. 1998 18: 321-331.
• 27. Chen CC, ve ark. Evaluation of a collagen membrane with and without bone grafts in treating periodontal intrabony defects. J Periodontol. 1995 66: 838-847.
• 28. Hutchens LH, Jr. The use of a bovine bone mineral in periodontal osseous defects: case reports. Compend Contin Educ Dent. 1999 20: 365-368.