골내 결손부에서 법랑기질 유도체의 임상적 효과

Abstract

[한글]

치주질환으로 인해 상실된 치주조직의 재생에 법랑기질 유도체(Enamel Matrix Derivative : EMD)가 갖는 임상적인 효과를 알아보고자 27명의 만성 치주염 환자의 29개의 골내낭을 대상으로 치은박리수술을 시행한 15개의 골내낭을 대조군으로, 치은박리수술 시 EMD를 이식한 14개의 골내낭을 실험군으로 설정하였다. 술 전과 술 후 6개월의 치료효과를 치주낭 탐침깊이, 치은퇴축, 임상부착수준, 탐침골 깊이의 변화로 비교하여 다음과 같은 결론을 얻었다.

1. 임상부착수준의 변화는 대조군(1.67±0.72mm), 실험군(2.93±1.27mm)에서 술 후 6개월에 유의성있는 증가를 보였고 (p<0.05), 실험군의 변화가 대조군에 비해 크게 나타났다 (p<0.01).

2. 탐침골 깊이의 변화는 대조군(1.13±0.92mm), 실험군(2.71±1.14mm)에서 술 후 6개월에 유의성있는 감소를 보였고 (p<0.05), 실험군의 변화가 대조군에 비해 크게 나타났다 (p<0.05).

이상의 결과로 치주 골내낭의 치료시 치은박리수술만 시행한 대조군에 비해 EMD를 이식하는 경우에 임상부착수준의 증가, 탐침골 깊이의 감소가 통계적으로 유의한 차이를 나타내었으므로 EMD는 치주조직 재생에 효과적인 것으로 생각된다.

[영문]The purpose of this study was to evaluate the clinical effects following application of enamel matrix derivative (EMD) in the treatment of intrabony defects. For that purpose we compared sites treated with open flap debridement(OFD) alone to those treated with OFD and EMD at 6 months postsurgery. 27 generally healthy patients with chronic periodontitis were included in the study. 15 defects in 15 patients were treated with OFD alone. 14 defects in 12 patients received EMD in conjunction with OFD. Clinical and radiographic examination was carried out : before the procedure and 6 months after treatment. The following clinical parameters were evaluated : probing pocket depth(PPD), gingival recession(REC), clinical attachment level(CAL), bone probing depth(BPD), plaque index(PI), bleeding index(BI). 6 months after surgery the follow-up examination found a significant improvement of clinical parameters. In all categories, treatment with EMD(test) was superior to treatment without EMD(control). The mean clinical attachment level was changed from 8.67±1.72mm to 7.00±1.60mm(control); from 8.93±2.23mm to 6.00±1.92mm(test); and bone probing depth was decreased from 10.20±1.90mm to 9.07±1.95mm(control); from 10.14±2.14mm to 7.43±2.06mm (test).

This study indicates that treatment of periodontal intrabony defects with EMD is clinically superior to treatment without EMD(OFD alone) in every parameter evaluated. Within the limits of this study, the application of EMD in intrabony defects resulted in clinically significant gain of clinical attachment level and decrease of bone probing depth. And further controlled clinical studies are required to confirm the effectiveness of the EMD in the treatment of various osseous defects.