牙周再生性手术双语- 同济口腔医学课件 * 24 牙周再生性手术Regenerative Periodontal Surgery 手术的目的在于获得牙周组织再生的手术，叫做再生性手术 the use of regenerative procedures aimed at restoring the lost periodontal support 牙周组织再生牙槽骨 牙骨质 Periodontal Regeneration? 牙周膜血管通道牙周前体细胞牙周膜 牙周组织再生的细胞生物学基础 24-1 引导组织再生术 Guided Tissue Regeneration Following flap surgery, the curetted root surface may be repopulated by (1) epithelial cells, (2) Gingival connective tissue cells, (3) bone cells, or (4) periodontal ligament cells. The exclusion of epithelial and gingival connective tissue cells from the healing area by the use of a physical barrier may allow (guide) periodontal ligament cells to repopulate the detached root surface. This observation provided the basis for the clinical application of the treatment principle termed guided tissue regeneration (GTR). 原理 Drawing illustrating the placement of the physical barrier which prevents the epithelium and gingival connective tissue from contacting the root surface during healing. At the same time the membrane allows cells from the periodontal ligament (arrow) to repopulate the previously periodontitis-involved root surface. Microphotograph of membrane (M) covered root. 用于再生性手术的屏障膜材料 Barrier Materials for Regenerative Surgery Essential design criteria: Biocompatibility: good tissue acceptance Barrier: exclude undesirable cell types from entering the secluded space adjacent to the root surface. Tissue integration : tissue may grow into the material without penetrating all the way through. Maintaining a space maintaining a space adjacent to the root surface. Easy to trim and to place. Maintaining a space Barrier materials for regenerative surgery Non-Bioabsorbable materials PTFE Bioabsorbable materials 手术要点： 1 ，膜的放置位置 2 ，瓣缝合 3 ，术后护理 4 ，膜的放置时间 Cases 24-2 植骨术Bone Graft Procedures The grafting materials in periodontal bony defects may be: 成骨osteoproliferative (osteogenetic), which means that new bone is formed by bone forming cells contained in the grafted material 骨引导 osteoconductive, which means that the grafted material does not contribute to new bone formation but serves as scaffold for bone formation originating from adjacent host bone 骨诱导 osteoinductive, which means that bone formation is induced in the surrounding soft tissue immediately adjacent to the grafted material. 植骨用材料Graft Materials The various graft and implant materials used so far can be placed into four categories: 自体骨 Autogenous grafts: Grafts transferred from one position to another within the same individual. This type of graft comprises (1) cortical bone or (2) cancellous bone and marrow, and is harvested either from intraoral or extraoral donor sites. 异体骨 Altogeneic grafts: Grafts transferred between genetically dissimilar members of the same species. (1) Frozen cancellous bone and marrow, and (2) freeze-dried bone have been used. 异种骨Xenogencic grafts: Grafts taken from a donor of another species. 骨替代品 Alloplastic materials: Synthetic or inorganic implant materials which are used as substitutes for bone grafts. BIO-OSS （牛骨） Alloplastic materials Beta-tricalcium phosphate (3-TCP) Bioactive glasses (Bio-glasses) Polymers Hydroxyapatite (HA) 牙周植骨的适应症骨下袋 II度根分叉手术要点 : 尽量保留龈组织 , 尽量少用内斜切口尽量用保留龈乳头切口充分暴露术区 , 彻底清创骨移植物不可超出缺损严密缝合覆盖 *