ارزيابي كلينيكي و راديوگرافيك درمان گرفتاري درجه IIفوركا مولرهاي فك پايين با استفاده از Demineralized Bone Matrix Dynagraft در مقايسه با روش Coronally Positioned Flap

A clinical and radiographical evaluation on the treatment of grade II furcation involvement of mandibular molars by demineralized bone matrix (Dynagraft) as compared with coronally positioned flap (CPF

بيان مساله: يكي از مشكلات درمان بيماريهاي پريودنتال، گسترش بيماري به ناحيه انشعاب ريشه ها مي باشد. روش هاي متعددي براي درمان اين ضايعات مطرح گرديده است. اين روش ها شامل درمانهاي Resective، Conservative و Regenerative مي باشد. هدف مطالعه حاضر با هدف مقايسه دو روش بازسازي شامل روش موقعيت دادن كرونالي فلپ و استفاده از ماده آلوگرفت Demineralized Bone Matrix (Dynagraft) به منظور بازسازي استخوان در درگيري فوركيشن درجه II فك پايين انجام شد. روش بررسي در اين مطالعه Randomized Controlled Clinical Trial كه به صورت دو سويه كور انجام شد، 12 نفر از مراجعه كنندگان به دانشكده دندانپزشكي دانشگاه علوم پزشكي تهران (9 زن و 3 مرد) كه در محدوده سني 25 تا 40 سال بودند، مورد بررسي قرار گرفتند؛ اين افراد داراي درگيري فوركاي درجه II مولرهاي فك پايين (طبقه بندي Glickman) به صورت Bilateral بودند. مولرهاي يك طرف توسط ماده پيوندي Dynagraft و طرف مقابل توسط روش موقعيت دادن كرونالي فلپ مورد درمان قرار گرفتند. متغيرهاي عمق پاكت (PPD)، سطح چسبندگي كلينيكي (CAL)، لثه كراتينيزه (KG) و عمق پروبينگ افقي (HPD) در زمان عمل، 3 و 6 ماه پس از جراحي اندازه گيري و ثبت شدند. همچنين به منظور بررسي تغييرات راديوگرافيك استخوان و نيز تاييد يافته هاي حاصل از اندازه گيريهاي كلينيكي در مقاطع زماني فوق، راديوگرافي RVG نيز انجام شد. تحليل اطلاعات به دست آمده با استفاده از آزمون آماري Paired t انجام شد. نتيجه گيري با توجه به نتايج اين مطالعه، مي توان استفاده از ماده پيوندي (Dynagraft) DBM را به عنوان روشي مناسب براي درمان ضايعات درجه II مولرهاي فك پايين توصيه نمود. به هر حال مطالعات بيشتر با حجم نمونه بالاتر، مشاهدات طولاني مدت تر و نيز بررسي بافت شناختي براي ارزيابي كامل اين گونه روش هاي بازسازي و پتانسيل آنها براي ترميم درگيري فوركا مورد نياز است.

Statement of Problem: One of the problems associated with the treatment of periodontal diseases is caused through the extension of disease toward furcation area. Several techniques in Conservative, Resective and Regenerative categories have been suggested for the treatment of furcation involvement. Purpose The aim of this study was to compare the results of the treatment of grade II furcation involvement in mandibular molars using an allograft material named 'Dynagraft' (a type of demineralized bone matrix) and the coronally positioned flap. Materials an‎d Methods In this randomized controlled clinical trial study, twelve patients (9 females and 3 males), aged 25 to 40, suffering from bilaterally grade II furcation involvement of mandibular molars who referred to dental faculty Tehran University of medical Sciences, were investigated. The molars of one side were treated by Dynagraft whereas those of the opposite side underwent the CPF method. Measurements of the probing pocket depth (PPD), clinical attachment level (CAL), keratinized gingiva (KG) and horizontal probing depth (HPD) were recorded at baseline, 3 and 6 months after surgery. In order to investigate the bone radiographic changes, radiovisiography at the mentioned periods in addition to clinical investigation, were performed. For statistical analysis, Paired West was used. Results The mean PPD reduction three months and six months after the operation were 1.75 mm and 2.25mm, respectively in the Dynagraft (test) group whereas 1.26mm and 1.27mm in the CPF (control) group (P<0.005). The mean attachment gain three months and six months after the operation were 1.1 mm and 1.5mm respectively in the test group, and 0.2mm and 0.3mm in the control group (P<0.005). The mean KG reduction three months and six months after the operation were 0.5mm and 0.6mm respectively in the test group and those of the control group were 1.1mm and 1.1mm. The mean HPD reduction three months and six months after the operation were 1.55mm and 2mm respectively in the test group (P<0.005) and 0.55mm and 0.55mm in the control group (PO.01). Radiovisiography of the mentioned areas three months and six months after the operation confirmed the changes obtained from clinical measurements, showing appreciable reconstructive results (Bone filling) in the test group as compared with the control group. Moreover, root resorption was not observed. Conclusion Based on the results of this study, Dynagraft can be used as an appropriate material in the treatment of grade II furcation involvement in mandibular molars. However, for a through evaluation of such regenerative techniques in furcation involvement, further studies with larger population and long term follow up in addition to histologic studies are suggested.