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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (1): 42-50. doi: 10.19723/j.issn.1671-167X.2025.01.007

• 论著 • 上一篇    下一篇

浓缩生长因子与自固化磷酸钙人工骨联合治疗牙周骨下袋缺损的疗效：临床和影像学评价

王昕莹1, 程雪原2, 张勇2, 李菲2, 段晋瑜2, 乔静2,*()   

  1. 1. 北京大学口腔医学院·口腔医院医学影像科，国家口腔医学中心，国家口腔疾 病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，北京 100081
    2. 北京大学口腔医学院·口腔医院门诊部，国家口腔医学中心，国家口腔疾 病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，北京 100081
  • 收稿日期:2024-10-09 出版日期:2025-02-18 发布日期:2025-01-25
  • 通讯作者: 乔静 E-mail:donaldshushu@aliyun.com
  • 基金资助:
    北京大学口腔医院临床新技术新疗法项目(PKUSSNCT-21G02)

Therapeutic effect of concentrated growth factors combined with self-curing calcium phosphate cement on periodontal intrabony defects: Clinical and radiographic evaluation

Xinying WANG1, Xueyuan CHENG2, Yong ZHANG2, Fei LI2, Jinyu DUAN2, Jing QIAO2,*()   

  1. 1. Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Enginee-ring Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
    2. First Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Enginee-ring Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
  • Received:2024-10-09 Online:2025-02-18 Published:2025-01-25
  • Contact: Jing QIAO E-mail:donaldshushu@aliyun.com
  • Supported by:
    the Program of New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT-21G02)

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摘要：

目的: 明确浓缩生长因子(concentrated growth factors，CGF)在自固化磷酸钙人工骨[采用磷酸钙骨水泥(calcium phosphate cement，CPC)为载体]治疗牙周骨下袋缺损中的作用。方法: 对36例骨下袋缺损进行随机分组，试验组采用CGF+CPC进行治疗(n=18)，对照组单独使用CPC进行治疗(n=18)。在基线和术后1年时评估两组的探诊深度、临床附着水平，锥形束CT(cone beam CT，CBCT)检测硬组织充填情况，比较CGF和血清中主要生长因子的水平(血小板衍生生长因子-BB、转化生长因子β1、胰岛素样生长因子1、血管内皮生长因子)。结果: 基线时两组的探诊深度、临床附着水平和CBCT硬组织充填测量值方面差异均无统计学意义(P>0.05)。术后1年时，两组在探诊深度、临床附着丧失和CBCT硬组织充填测量值方面均有显著改善(P < 0.05)。CGF+CPC在探诊深度降低[(4.5±1.3) mm vs. (3.2±1.1) mm]和临床附着获得[(3.8±0.9) mm vs. (2.0±0.5) mm]方面比单独使用CPC更有效(P < 0.05)。与单纯CPC组相比，CGF+CPC组CBCT显示硬组织充填程度明显增加[骨袋深减少(3.9±1.2) mm vs. (2.1±0.7) mm, P < 0.01]。术后1年时，CGF+CPC组CBCT显示骨下袋体积减少(0.031 8± 0.004 1) mL，显著优于单纯CPC组[(0.019 7±0.001 2) mL, P < 0.05]。此外，CGF中主要生长因子的含量高于血清(P < 0.001)。结论: 术后1年的观察结果显示，CGF可显著促进CPC治疗牙周骨下袋缺损的临床效果和影像学效果。

关键词: 浓缩生长因子, 自固化磷酸钙人工骨, 牙周组织再生, 骨下袋缺损, 锥束计算机体层摄影术

Abstract:

Objective: To clarify the role of concentrated growth factors (CGF) in the treatment of periodontal cement defects using calcium phosphate cement (CPC) with self-curing properties. Methods: Thirty-six intrabony defects were randomly divided into two groups. The experimental group received CGF+CPC treatment (n=18), while the control group received CPC treatment alone (n=18). The probing depth, clinical attachment loss, and hard tissue filling as measured by cone beam CT (CBCT) were evaluated at baseline and 1 year postoperatively in both groups, and the levels of major growth factors in CGF and serum were compared [platelet-derived growth factor-BB (PDGF-BB), transforming growth factor-β1 (TGF-β1), insulin-like growth factor-1 (IGF-1), and vascular endothelial growth factor (VEGF)]. Results: At baseline, there were no statistically significant differences in probing depth, clinical attachment loss and CBCT measurements between the two groups (P>0.05). At 1 year postoperatively, significant improvements were observed in parameters mentioned above in both groups (P < 0.05). The CGF+CPC group seemed more effective compared with the CPC group in reduction of probing depth [(4.5±1.3) mm vs. (3.2±1.1) mm] and clinical attachment gain [(3.8±0.9) mm vs. (2.0±0.5) mm, P < 0.05]. Compared with the group treated with CPC alone, the hard tissue filling degree shown by CBCT in the CGF+CPC group was significantly increased [the reduction of the depth of the intrabony defects was (3.9±1.2) mm vs. (2.1±0.7) mm, respectively, P < 0.01]. At 1 year post-operatively, the volume of the intrabony defects shown by CBCT in the CGF+CPC group was reduced by (0.031 8±0.004 1) mL, which was significantly more than that in the CPC group [(0.019 7±0.001 2) mL, P < 0.05]. In addition, the concentration of the main growth factors (PDGF-BB, TGF-β1, IGF-1, and VEGF) in CGF were higher than those in serum (P < 0.001). Conclusion: After 1 year of follow-up, the results of the present study indicated that CGF could significantly improve the clinical and radiological effects of CPC on the treatment of periodontal intrabony defects.

Key words: Concentrated growth factors, Calcium phosphate cement, Periodontal regeneration, Intrabony defect, Cone beam computed tomography

中图分类号: 

  • R781.4

图1

骨下袋CBCT测量标志点"

图2

浓缩生长因子的制备"

图3

试验组4号病例的手术情况"

表1

试验组和对照组骨下袋缺损的分布和类型"

ItemsCGF+CPC (n=18)CPC (n=18)
Maxilla89
Mandible109
Anterior teeth57
Premolars85
Molars56
2 walls54
2-3 walls87
3 walls57
AC’-BD in surgery/mm, ${\bar x}$±s5.2±1.85.3±1.6

表2

试验组和对照组基线和术后1年时的出血指数和菌斑指数"

ItemsCGF+CPC (n=18)CPC (n=18)
Plaque index, ${\bar x}$±s
   Baseline0.6±0.20.8±0.4
   1 year post-surgery0.8±0.30.9±0.3
Bleeding index, ${\bar x}$±s
   Baseline0.9±0.61.0±0.4
   1 year post-surgery1.1±0.71.3±0.5

表3

试验组与对照组基线时和术后1年时的临床指标"

ItemsCGF+CPC (n=18)CPC (n=18)P value
Probing depth/mm, ${\bar x}$±s
   Baseline7.2±1.87.6±2.00.837
   1 year post-surgery2.7±0.84.4±1.20.003
   Reduction4.5±1.33.2±1.10.012
   P value< 0.001< 0.001
Gingival recession/mm, ${\bar x}$±s
   Baseline1.1±0.30.9±0.20.612
   1 year post-surgery1.9±0.71.6±0.60.718
   Increase0.8±0.30.7±0.40.524
   P value0.0170.023
Clinical attachment loss/mm, ${\bar x}$±s
   Baseline8.3±2.08.5±2.6>0.999
   1 year post-surgery4.5±1.76.3±2.10.022
   Reduction3.8±0.92.0±0.50.019
   P value0.0380.017

表4

试验组与对照组基线时和术后1年时的CBCT影像学指标"

ItemsCGF+CPC (n=18)CPC (n=18)P value
CEJ-AC’/mm, ${\bar x}$±s
   Baseline4.3±0.84.5±1.00.965
   1 year post-surgery4.8±0.94.9±1.1>0.999
   Change0.5±0.10.4±0.2>0.999
   P value0.8760.933
CEJ-BD/mm, ${\bar x}$±s
   Baseline9.4±2.69.8±3.00.892
   1 year post-surgery6.0±1.88.1±2.70.002
   Decrease3.4±1.01.7±0.50.004
   P value< 0.001< 0.001
BD-AC’/mm, ${\bar x}$±s
   Baseline5.1±1.65.3±1.9>0.999
   1 year post-surgery1.2±0.63.2±0.90.007
   Decrease3.9±1.22.1±0.70.005
   P value< 0.001< 0.001

图4

试验组4号病例的CBCT测量"

图5

试验组4号病例基线时和术后1年时骨缺损的体积变化"

表5

CGF与血清中生长因子水平的比较"

ItemsCGFSerumP value
PDGF-BB/(μg/L), ${\bar x}$±s47.58±16.19182.65±62.37< 0.001
TGF-β1/(μg/L), ${\bar x}$±s67.89±22.38780.09±152.78< 0.001
IGF-1/(μg/L), ${\bar x}$±s88.90±25.28569.87±82.37< 0.001
VEGF/(ng/L), ${\bar x}$±s42.06±20.28264.48±52.57< 0.001
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ISSN 1671-167X
CN 11-4691/R
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