据报道，据报道，在美学区域进行两种严重内部缺陷的临床病例，并遵循了一年。

选择的生物材料是搪瓷基质衍生物（Emdogain^®; Straumann™) alone with a preservation papilla flap and a minimally invasive surgical technique.

手术治疗后，将患者保留在两次任命之间的支撑性牙周治疗计划中，间隔为6个月。

在任命手术后的一年中，观察到临床和放射学变化，显示牙周健康和稳定性。

牙周炎通常会导致内部缺陷，这与深牙周袋有关。这些缺陷可以被一个，两个或三个残留的骨壁甚至它们的组合包围[1]。内部缺陷与更高的牙周疾病进展风险有关，并且通常需要一种手术方法[2]。几项研究报告说，可以通过再生手术方法与开放式皮瓣手术成功治疗内部缺陷[3,4]。必威体育西汉姆联还可以通过可用的科学证据来证实，牙周再生治疗结果可以随着时间的推移而保持稳定，尤其是在不吸烟并且符合支持性牙周治疗的患者中[5-7]。

一些生物材料表现出潜在的牙周再生，例如搪瓷基质衍生物（Emdogain^®; Straumann™), demineralized bovine bone mineral, decalcified freeze-dried bone allograft and Platelet derived factors [8].

Scientific evidence is fulfilled with data that displays the predictability of the periodontal regenerative therapy [8-11], but the morphology of periodontal defects diverges vastly between studies, at this case report we have the opportunity to demonstrate the outcome of the periodontal regenerative treatment with enamel matrix derivative (Emdogain^®; Straumann™) in two rare and severe intrabony defects.

一名54岁的男子被转交给里斯本大学牙科医学学院牙科学系。该患者透露，他在私人执业中接受了将近10年的治疗，随后是一名牙科卫生师，这么长时间就接受了牙科卫生师，正是牙科卫生员将患者转诊为牙周病学任命。转介的原因是牙齿12和21中发现的I级移动性[12]。

在牙周检查时，已经确定患者患有牙周炎IV期B级，没有级别的修饰剂[13]。在牙髓检查期间，牙齿12和21对冷敏感和电测试作出负面反应。因此，建议根管治疗[4]。

The clinical examination included radiographic analysis which revealed the presence of radiographic images compatible with intrabony defects (Figure 1).

作为该临床病例的治疗计划，提出了牙周非手术疗法的初始阶段，其中包括有关牙周疾病，病因，进展及其与宿主系统状况的关系，然后进行口腔卫生指示（图2）。

Subsequently, scaling and root planing was performed on every periodontal pockets and teeth 12 and 21 were endodontically treated during the initial phase of periodontal therapy.

牙周非手术治疗结束后6周，进行了牙周重新评估，如图3,4所示，在前部扇形中显示了残留的深袋，这证明了牙齿12和21的进一步纠正疗法（表1）（表1）。

考虑到临床和放射学分析，我们决定使用搪瓷基质衍生物（Emdogain）进行再生治疗^®; Straumann™) in the intrabony defects associated with teeth 12 and 21.

Surgical procedure

为了进行手术检查，已经选择了一种保守的方法（图5），其中我们制作了一种与牙齿12相关的微创手术技术[14]和与牙齿21相关的缺陷的简化乳头保护皮瓣（15）。

手术切口后，将全厚的前庭和pa骨皮瓣升高（图6）。

All the granulation tissue was removed, and the lesion was meticulously debrided, the root surface was carefully scaled and planed (Figure 7). A defect with complex anatomy was then observed, showing 3 residual walls at apical and 2 walls at the coronal portion in tooth 12 and the same defect with circumferential involvement at the palatal portion in tooth 21.

牙周缺陷清创术后，进行60秒的根表面调节（图8），然后进行搪瓷基质衍生物（Emdogain）（图8）^®; Straumann™) was applied, filling the defect from apical to coronal (Figures 9-11).

最后，将两个皮瓣重新定位并用垂直床垫和单缝线缝合。

All post-surgery recomendations were given.

它被开处方布洛芬600毫克，每天3次，持续三天，然后是扑热息痛1 g，以控制疼痛。避免了所有卫生程序，并用0.2％的氯己定漱口水取代，每天两次1分钟，持续14天。

手术后八天将所有缝合线去除（图12-14）（表2）。

临床结果 - 1年随访

将患者引入了一个为期6个月的牙周计划中，保持符合所有口腔卫生说明，并保持最佳斑块控制。一年后，有可能看到临床和射线照相变化与基线相对。所有可见的更改均根据牙周健康状况[16]，应在适当的牙周支持护理中维护。

本临床病例报告了两个严重的内部缺陷，损害了牙齿预后。牙釉质基质衍生物（Emdogain）牙周再生治疗后一年^®; Straumann™), it was possible to realise that teeth prognosis has changed.

According to several studies, there are significant improvements when enamel matrix derivative is used to potentiate periodontal regeneration instead of open access debridement alone or other type of biomaterials [17–21].

The regenerative approach of intrabony defects with enamel matrix derivative seems to have the same clinical result as guided tissue regeneration according to the meta-analysis conducted by Esposito and colleagues [22] idea that is compatible with the guidelines purposed by the European Federation of Periodontology for the management of intrabony defects [23].

The access flaps that are designed to preserve the interdental soft tissues are related to higher degree of success. The maintenance of the interdental space, the protection of the regenerative materials and tissues seems to be the main goals of the minimally invasive techniques [4] that have been used in this clinical case.

与在没有抗生素覆盖率的搪瓷基质衍生物相比，牙釉质基质衍生物施用后的抗生素似乎在袖珍深度减少和临床附着的增益中没有任何临床相关性[24]。同样，报告治疗后的非甾体类抗炎药的使用也不会影响临床结果，而是影响患者的发病率[25]。

重建牙周设备应成为牙周矫正治疗的主要目标。该病例表明，由于遵循多学科治疗计划，因此可以成功治疗和维持与牙周健康的牙周缺陷。长期的结果将取决于患者对支持性牙周计划和牙菌斑控制的遵守。

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