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Decision Tree for Vertical Ridge Augmentation
垂直山脊增高决策树

Alexandra B. Plonka, DDS, MS
亚历山德拉-普隆卡（Alexandra B. Plonka），牙科博士，医学硕士
Istvan A. Urban, DMD, MD, PhD
Hom-Lay Wang, DDS, MS, PhD
Hom-Lay Wang，牙科医生、医学硕士、博士
Vertical ridge augmentation (VRA) procedures before or during dental implant placement are technically challenging and often encounter procedure-related complications. To minimize complications and promote success, a literature search was conducted to validate procedures used for VRA. A decision tree based on the amount of additional ridge height needed ( to 6 , or ) was then developed to improve the procedure-selection process. At each junction, the clinician is urged to consider anatomical, clinical, and patientrelated factors influencing treatment outcomes. This decision tree guides selection of the most appropriate treatment modality and sequence for safe, predictable management of the vertically deficient ridge in implant therapy. Int J Periodontics Restorative Dent 2018;38:269-275. doi: 10.11607/prd. 3280
在牙种植体植入前或植入过程中进行垂直牙脊增高（VRA）手术在技术上具有挑战性，而且经常会遇到与手术相关的并发症。为了尽量减少并发症并提高成功率，我们进行了文献检索，以验证用于 VRA 的程序。然后根据所需的额外牙脊高度（ 至 6，或 ）开发了一个决策树，以改进手术选择过程。在每个交界处，临床医生都要考虑影响治疗效果的解剖、临床和患者相关因素。这棵决策树可以指导选择最合适的治疗方式和顺序，以便在种植治疗中安全、可预测地处理垂直缺损的牙脊。Doi: 10.11607/prd.3280
Adjunct Clinical Lecturer, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA. Adjunct Clinical Professor, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA; Private Practice in Periodontics and Implant Dentistry, Budapest, Hungary. Professor and Director of Graduate Periodontics, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.
美国密歇根州安阿伯市密歇根大学牙科学院牙周病学和口腔医学系兼职临床讲师。 美国密歇根州安阿伯市密歇根大学牙科学院牙周病学和口腔医学系兼职临床教授；匈牙利布达佩斯牙周病学和种植牙私人诊所。 美国密歇根州安阿伯市密歇根大学牙科学院牙周病学和口腔医学系教授兼牙周病学研究生主任。
Correspondence to: Dr Hom-Lay Wang, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 North University Avenue, Ann Arbor, MI 48109-1078, USA. Fax: (734) 936-0374.
通讯地址美国密歇根大学牙科学院牙周病学和口腔医学系，Hom-Lay Wang 博士，地址：1011 North University Avenue, Ann Arbor, MI 48109-1078, USA。传真：(734) 936-0374。
Email: homlay@umich.edu 电子邮件： homlay@umich.edu
©2018 by Quintessence Publishing Co Inc.
©2018 由 Quintessence Publishing Co Inc.
After extraction, the alveolar ridge undergoes significant resorption. The estimated loss of ridge height presents a significant challenge to implant placement. Over the long term, the prevalence of peri-implantitis is high, affecting up to half of all implants. Both implant position and history of regeneration increase peri-implantitis risk, so careful treatment planning is key. Options include rebuilding height using vertical ridge augmentation (VRA) or placing a short implant. This article introduces a guide for successfully managing the vertically deficient ridge.
拔牙后，牙槽嵴会发生明显的吸收。据估计， ，牙槽嵴高度的丧失对种植体的植入是一个巨大的挑战。 从长远来看，种植体周围炎的发病率很高，多达一半的种植体会受到影响。 种植体位置和再生史都会增加种植体周围炎的风险，因此谨慎的治疗规划是关键。 可供选择的方案包括使用垂直脊增高术（VRA）重建高度或植入短种植体。本文将介绍成功处理垂直缺损牙脊的指南。

Vertical Ridge Augmentation Techniques
垂直山脊隆起技术

Strategies in this guideline for VRA include distraction osteogenesis (DO), onlay grafting (OG), and guided bone regeneration (GBR).
本指南中针对 VRA 的策略包括牵张成骨（DO）、嵌体移植（OG）和引导骨再生（GBR）。

Distraction Osteogenesis
牵引性成骨

DO consists of surgical delineation of a bone segment followed by slow separation from basal bone, allowing new bone fill. is limited to vertical augmentation. Due to the complexity of , the authors do not recommend this procedure except for severe vertical deficiencies.
，仅限于垂直增量。 由于 的复杂性，除了严重的垂直缺损，作者不建议采用这种手术。
Onlay Grafting 嵌体嫁接
An onlay graft is a bone block. Complications include incision dehiscence, graft exposure, graft loss, and sensory changes. 7,8 Due to these complications, short implants should be considered as an alternative." The greatest surgical challenge in is maintenance of soft tissue closure. Allogeneic and xenogenic block grafts are an alternative to autogenous blocks, but evidence is limited.
嵌体移植是一种骨块。并发症包括切口开裂、移植物暴露、移植物丢失和感觉改变。7,8由于这些并发症，应考虑使用短种植体作为替代"。 中最大的手术挑战是保持软组织闭合。 异体和异种块状移植物可替代自体块状移植物，但证据有限。

Guided Bone Regeneration
引导骨再生

GBR has advantages over OG due to avoidance of a second surgical site and reduced complications. GBR uses barrier membranes for space maintenance and exclusion of nonbone-forming cells. GBR can be applied at the time of implant placement or staged 4 to 9 months prior. Adherence to the principles of primary closure, angiogenesis, stability, and space maintenance (PASS) maximizes GBR success. Absorbable and nonresorbable barrier membranes are available. Collagen (CM) is a common absorbable membrane. Nonresorbable barriers include titanium (Ti) mesh (Ti-mesh), expanded and density polytetrafluoroethylene (PTFE), and Ti-reinforced PTFE (PTFE-TR). The most common complication for GBR is membrane exposure, which compromises the amount of regeneration.
GBR 与 OG 相比，优势在于避免了第二个手术部位，减少了并发症。GBR 使用屏障膜来维持空间和排除非骨形成细胞。 GBR 可以在植入时使用，也可以在植入前 4 到 9 个月分阶段使用。 坚持初级封闭、血管生成、稳定性和空间维持（PASS）的原则可最大限度地提高 GBR 的成功率。 有可吸收和不可吸收的屏障膜可供选择。胶原蛋白（CM）是一种常见的可吸收膜。非吸收屏障包括钛（Ti）网（Ti-mesh）、膨体和高密度聚四氟乙烯（PTFE）以及钛增强聚四氟乙烯（PTFE-TR）。GBR 最常见的并发症是膜暴露，这会影响再生量。
Survival is high for implants placed after vertical GBR to , and stability has been maintained over 4 to 5 years. The limited data on VRA, heterogeneity, and small sample sizes hinders decision making. More data exists on nonresorbable versus resorbable membranes, but both types are comparable. nonresorbable, Ti-reinforced membrane (PTFE-TR) may improve space maintenance and eliminate the need for tenting screws used with absorbable membranes. Extrapolating from the literature, GBR is a preferred technique because it allows for simultaneous horizontal augmentation (not possible with DO), and has fewer complications than OG. GBR with PTFE-TR can yield close to success for VRA in all three (small, medium, and large) elevation height groups.
垂直 GBR 至 后植入的种植体存活率很高，稳定性可维持 4 至 5 年。 有关 VRA 的数据有限、异质性大、样本量小，这些都阻碍了决策的制定。 非吸收性钛强化膜（PTFE-TR）可改善空间维持，并消除可吸收膜使用的帐篷螺钉的需要。 根据文献推断，GBR 是一种首选技术，因为它可以同时进行水平增量（DO 无法实现），而且并发症少于 OG。 在所有三个（小、中、大）抬高高度组中，使用 PTFE-TR 的 GBR 均可获得接近 的 VRA 成功率。

Short Implants 短种植体

A short implant ( ) may be preferred over VRA due to their lower rates of complications and implant failures. Short implants show similar marginal bone levels and survival rates to implants, but the peak failure rate occurred at an earlier point ( 4 to 6 versus 6 to 8 years). Short implants decrease treatment time (by an average of 4 months), and patients prefer them over grafting. This guide defines a short implant as . Short implants are an option for all stages of vertical deficiency if the remaining bone is sufficient.
与 VRA 相比，短种植体（ ）的并发症和种植体失败率较低，因此可能更受青睐。 短种植体的边缘骨水平和存活率与 种植体相似，但失败率峰值出现的时间更早（4 到 6 年对 6 到 8 年）。 短种植体缩短了治疗时间（平均缩短 4 个月），与植骨相比，患者更喜欢短种植体 。 本指南将短种植体定义为 。如果剩余骨量充足，短种植体可用于所有阶段的垂直缺损。

Systemic and Local Factors
系统和地方因素

Prior to surgery, it is critical to ensure good oral and systemic health of the patient. A more conservative surgi- cal approach such as short or tilted implants should be considered for medically compromised patients. A thorough clinical and radiographic examination should be performed to evaluate the local anatomical factors.
手术前，确保患者口腔和全身健康至关重要。对于有内科疾病的患者，应考虑采用更保守的手术方法，如短种植体或倾斜种植体。应进行全面的临床和放射检查，以评估局部解剖因素。
Important soft tissue-related factors include keratinized mucosa (KM) width and vestibular depth. If soft tissue is deficient, its augmentation should be performed after VRA to prevent scar tissue development, which can limit flap extension and passive primary closure. Soft tissue augmentation after VRA helps reestablish lost vestibular depth. combination approach of an apically placed free gingival graft with coronally positioned free connective tissue graft can increase KM width while maximizing esthetics.
与软组织相关的重要因素包括角化粘膜（KM）宽度和前庭深度。如果软组织不足，则应在 VRA 后进行软组织增量，以防止瘢痕组织的形成，因为瘢痕组织会限制皮瓣的延伸和被动初次闭合。 在 VRA 后进行软组织增量有助于重建丧失的前庭深度。 ，将根尖位置的游离龈移植物与冠状位置的游离结缔组织移植物相结合的方法可以增加 KM 宽度，同时最大限度地提高美观度。

The Decision Tree 决策树

This decision tree (Fig 1) is based on the amount of apicocoronal elevation needed for standard-length implant placement ( ). Strategies for small , medium to , and large vertical ridge augmentation are proposed.
该决策树（图 1）基于标准长度种植体植入所需的根尖冠抬高量 ( )。提出了小型 、中型 到 以及大型 垂直嵴增量的策略。

Small Apicocoronal Elevation
表冠小隆起

GBR may be used to predictably treat small vertical defects. Simultaneous implant placement and GBR can be considered for 3-mm mean vertical gain. Both resorbable and nonresorbable membranes may be used. CM performed similarly to PTFE membranes at buccal implant
GBR 可用来对小的垂直缺损进行可预测的治疗。对于平均垂直度增加 3 毫米的情况，可以考虑同时植入种植体和 GBR。 可吸收膜和不可吸收膜均可使用。CM 在颊侧种植体上的应用与 PTFE 膜相似
Fig 1 Decision tree for vertical ridge augmentation (VRA). The decision tree suggests procedures for managing the vertically deficient ridge based on amount of apicocoronal elevation needed for standard ( ) length implant placement. Strategies for small ( ), medium (4 to ), and large (> ) degrees of VRA are proposed. GBR = guided bone regeneration; PTFE-TR = titanium-reinforced polytetrafluoroethylene; titanium.)
图 1 垂直嵴增量术（VRA）的决策树。该决策树根据标准长度（ ）种植体植入所需的根尖冠抬高量，提出了处理垂直缺损牙嵴的程序。针对 VRA 的小( )、中(4 到 )和大(> )程度，提出了相应的策略。GBR = 引导骨再生；PTFE-TR = 钛增强聚四氟乙烯； 钛)。
dehiscence defects. A combination of autogenous and DBBM bone may be ideal for long-term graft stability due to autogenous graft shrinkage. When absorbable membranes are used, periosteal vertical mattress suturing with absorbable sutures are an alternative to fixation screws. Nonresorbable membranes have also shown success for VRA. Stable mem- brane devices, such as PTFE-TR or Ti-mesh, provide enhanced stability and space. Figure 2 shows a small defect treated with GBR using a , tenting screws, and sandwich bone augmentation using a combination of autogenous and allogenic grafting (enCore, Osteogenics Biomedical).
开裂缺损。 由于自体移植物会收缩，因此将自体骨和 DBBM 骨结合使用可能是获得长期移植物稳定性的理想方法。 使用可吸收膜时，使用可吸收缝线进行骨膜垂直褥式缝合是固定螺钉的替代方法。 非吸收膜在 VRA 上也取得了成功。 稳定的膜装置，如 PTFE-TR 或钛网，可提供更高的稳定性和空间。图 2 显示了使用 、固定螺钉和自体与异体移植（enCore，Osteogenics Biomedical）相结合的夹层骨增量术治疗 GBR 的一个小缺损。
OG may be considered for an average vertical height gain; however, complication rates are higher than with GBR. While autogenous grafts are considered the gold standard, allogeneic blocks show high success rates in case series. This strategy is recommended for mild maxillary VRA to avoid a mandibular harvest site. Xenogeneic grafts show promising early reports, but more evidence is needed to validate the findings.
对于平均 的垂直高度增加，可以考虑使用 OG；但并发症发生率高于 GBR。 虽然自体移植物被认为是黄金标准，但在病例系列中，异体移植块的成功率也很高。 对于轻度的上颌 VRA，建议采用这种策略，以避免下颌取材部位。 异种基因移植物的早期报告显示前景良好，但还需要更多证据来验证研究结果。
Fig 2 Sandwich guided bone regeneration for small vertical ridge augmentation. (a) Initial defect with intrabony marrow penetration. (b) Sandwich guided bone augmentation using cancellous and cortical particulate allograft (Puros Allograft Particulate, Zimmer/Biomet 3i) and tenting screws (Neo GBR kit, Neobiotech). (c) Pericardium membrane placement (CopiOs Pericardium Membrane, Zimmer Biomet). (d) Suturing with modified horizontal vertical mattress and simple interrupted sutures using 4-0 polyglactin 910 (Vicryl, Ethicon, Johnson & Johnson). (e) Radiograph after 5 months of healing. (f) Radiograph of final restoration 2 months after implant restoration (Zimmer TSV system, Zimmer/Biomet 3i).
图 2 用三明治引导的骨再生技术进行小型垂直脊增量术。(a）骨内骨髓渗透的初始缺损。(b）使用松质和皮质颗粒状同种异体材料（Puros Allograft Particulate，Zimmer/Biomet 3i）和固定螺钉（Neo GBR kit，Neobiotech）在三明治引导下进行骨增量。(c) 植入心包膜（CopiOs 心包膜，Zimmer Biomet）。(d) 使用 4-0 polyglactin 910（Vicryl，Ethicon，强生公司）进行改良水平垂直褥式缝合和简单间断缝合。(e) 5 个月愈合后的 X 光片。(f) 种植体修复 2 个月后的最终修复照片（Zimmer TSV 系统，Zimmer/Biomet 3i）。
Fig 3 Guided bone regeneration using nonresorbable fixed membrane for medium vertical ridge augmentation (VRA). (a) Initial defect. (b) Intrabony marrow penetration and placement of titanium-reinforced polytetrafluoroethylene (PTFE-TR) membrane (Cytoplast Ti-250 Titanium-Reinforced, Osteogenics Biomedical) on the lingual aspect, secured with fixation screws (Profix, Osteogenics Biomedical). (c) Grafting with combination of autogenous bone and deproteinized bovine bone mineral (DBBM) (Geistlich). (d) Fixation of PTFE-TR membrane on buccal aspect (Profix Osteogenics Biomedical). (e) Suturing with horizontal mattress and simple interrupted 3-0 and 4-0 PTFE sutures (Osteogenics Biomedical). (f) Radiographic bone gain at 9 months. Approximately VRA was achieved.
图 3 使用不可吸收固定膜引导骨再生，用于中度垂直脊增量术（VRA）。(a) 初始缺损。(b）骨内骨髓穿透，在舌侧放置钛增强聚四氟乙烯（PTFE-TR）膜（Cytoplast Ti-250 钛增强型，Osteogenics Biomedical），用固定螺钉（Profix，Osteogenics Biomedical）固定。(c) 移植自体骨和脱蛋白牛骨矿物质（DBBM）（Geistlich）。(d) 在颊侧固定 PTFE-TR 膜（Profix Osteogenics Biomedical）。(e）使用水平褥式缝合线和 3-0 和 4-0 PTFE 简单间断缝合线（Osteogenics Biomedical）。(f) 9 个月时的骨增量X光片。达到约 VRA。
Fig 4 Guided bone regeneration (GBR) for large vertical ridge augmentation (VRA). (a) Initial defect exceeds . (b) Grafting with combination of autogenous graft and deproteinized bovine bone mineral (DBBM) (Geistlich). (c) Fixed (Master-Pin-Control Bone Management System, Meisinger) nonresorbable high density titanium-reinforced polytetrafluoroethylene (PTFE-TR) membrane (Cytoplast Ti-250 TitaniumReinforced, Osteogenics Biomedical) PTFE-TR membrane overlaid by collagen membrane to improve tissue tolerance of fixation screws. (d) Vertical ridge height gain months after VRA. (e) Radiograph at 8 years after final implant-supported restoration (Brånemark System, Nobel Biocare).
图 4 引导骨再生（GBR）用于大型垂直脊增量术（VRA）。(a) 初始缺损超过 。 (b) 结合使用自体移植物和去蛋白牛骨矿物质（DBBM）（Geistlich）。(c) 固定（Master-Pin-Control 骨管理系统，Meisinger）不可吸收的高密度钛增强聚四氟乙烯（PTFE-TR）膜（Cytoplast Ti-250 TitaniumReinforced，Osteogenics Biomedical）PTFE-TR 膜上覆盖胶原蛋白膜，以提高固定螺钉的组织耐受性。(d) VRA 后 个月的垂直嵴高度增加。(e）最终种植体支撑修复（Brånemark 系统，Nobel Biocare）后 8 年的 X 光片。
Medium Apicocoronal Elevation
中高海拔
GBR may be used predictably for medium defects (4 to ) with adherence to the PASS principles. Implant placement should be staged after 6 to 9 months to allow graft maturation. Nonresorbable stable membrane devices are preferred. The combination of PTFE-TR, DBBM, and particulate autogenous graft was used for a mean vertical gain of with no complications.
对于中等程度的缺损（4 到 ），在遵循 PASS 原则的前提下，GBR 的应用是可以预见的。 种植体植入应在 6 至 9 个月后分期进行，以便移植体成熟。 首选不可吸收的稳定膜装置。将 PTFE-TR、DBBM 和微粒自体移植物结合使用，平均垂直增高 ，且无并发症。
Cases with a thin gingival biotype may consider use of an absorbable CM alone or layered over a nonresorbable barrier to improve tissue tolerance. Since CM are nonrigid, tenting screws may enhance space maintenance. However, screws can create pressure spots, leading to flap or screw exposure, so it may be preferable to use PTFE-TR (Fig 3). For absorbable and nonresorbable barriers, rigid fixation maximizes stability. While VRA requires significant flap advancement to obtain passive closure, free soft tissue grafting after VRA may be used to reestablish vestibular depth and KM width.
牙龈生物型较薄的病例可以考虑单独使用可吸收中药或在非可吸收屏障上分层使用，以提高组织的耐受性。由于中药是非刚性的，帐篷螺钉可以加强空间的维持。但是，螺钉可能会产生压力点，导致翻瓣或螺钉暴露，因此最好使用聚四氟乙烯-TR（图 3）。对于可吸收和不可吸收屏障，刚性固定可最大限度地提高稳定性。虽然 VRA 需要大量皮瓣推进以获得被动闭合，但 VRA 后的游离软组织移植可用于重建前庭深度和 KM 宽度。
Autogenous OG is another option for medium VRA. Overall, OG has a high complication rate, second to DO (8.1%), although the average implant survival rate is high (96.32%). Clinician skill is key when considering this technique.
自体 OG 是中度 VRA 的另一种选择。总体而言，OG 的并发症发生率较高，仅次于 DO（8.1%），但植入物的平均存活率较高（96.32%）。 临床医生在考虑这种技术时，技术是关键。

Large Apicocoronal Elevation
表冠大隆起

VRA in large ( ) cases may require extensive soft and hard tissue augmentation procedures over 1 to 2 years, so short implants should be considered.
大型病例（ ）的 VRA 可能需要在 1 到 2 年的时间内进行大量的软组织和硬组织增量手术，因此应考虑短时间植入。
GBR using a nonresorbable membrane with a Ti-reinforced framework (Fig 4) may be the preferred choice for large VRA. A challenging area for primary closure is the maxillary anterior. A classification based on amount of VRA, presence of horizontal ridge deficiency, history of regeneration performed, periosteum status (native versus scarred), and vestibular depth guides flap management to maximize success of GBR.
使用非吸收膜和钛加固框架（图 4）的 GBR 可能是大型 VRA 的首选。 上颌前牙是一个具有挑战性的初次封闭区域。根据 VRA 的大小、是否存在水平嵴缺损、进行过再生的历史、骨膜状态（原生还是瘢痕）以及前庭深度进行分类，指导皮瓣管理，以最大限度地提高 GBR 的成功率。
DO is another option for severe defects, with the largest height gain (mean ) but the highest complication rate (22.4%).8,13 Complications include fracture,
DO 是严重缺损的另一种选择，其增高幅度最大（平均 ），但并发症发生率最高（22.4%）。8,13 并发症包括骨折、
mechanical problems, hypoesthesia, and implant failure. Despite these challenges, the implant survival rate is high and there may be less resorption than OG. This procedure should be reserved for the most severe cases.
机械问题、麻醉不足和植入失败。 尽管存在这些问题，但种植体的存活率还是很高的，而且吸收可能比 OG 少。这种手术应保留给最严重的病例。
Finally, OG may be considered for large VRA. Due to donor site morbidity, short implants should be considered. Long-term implant survival after OG was over a mean of 39.9 months. Based on the drawbacks associated with OG, GBR is a preferred choice in managing this specific clinical situation.
最后，对于大的 VRA，可以考虑使用 OG。 由于供体部位的发病率较高，应考虑短植入物。 OG 后的长期植入存活率为 ，平均为 39.9 个月。 基于 OG 的相关缺点，GBR 是处理这种特殊临床情况的首选。

Conclusions 结论

Limited evidence is present regarding vertical ridge augmentation.
关于垂直山脊隆起的证据有限。
When considering vertical ridge augmentation, the authors urge the clinician to evaluate pertinent anatomical (KM width, tissue thickness, anatomical structures), clinical (surgeon skill and experience), and patient-related (local and systemic health, preferences) factors. GBR is generally preferred due to its high predictability and low incidence of complications. OG should be reserved for patients resistant to allogeneic and xenogenic graft sources. Due to its high complication rate, DO should only be used in cases of extreme vertical ridge deficiency and with high operator experience and skill.
作者建议临床医生在考虑垂直嵴增量术时，应评估相关的解剖（KM 宽度、组织厚度、解剖结构）、临床（外科医生的技术和经验）以及患者相关因素（局部和全身健康状况、偏好）。由于 GBR 的可预测性高、并发症发生率低，因此一般首选 GBR。OG 应保留给对异体和异种移植源有抵抗力的患者。由于其并发症发生率较高，DO 只能用于垂直嵴极度缺损的病例，而且操作者必须具备丰富的经验和高超的技术。
This guideline offers an approach based on available evidence and the authors' clinical experience to achieve safe, predictable management of vertically deficient ridg- es. This approach is case-specific: in addition to anatomical factors, clinicians must consider their own experience and skill level and patient preferences and health concerns. This guideline allows judicious selection of vertical augmentation techniques for successful outcomes.
本指南根据现有证据和作者的临床经验提供了一种方法，以实现安全、可预测的垂直缺损脊柱管理。该方法针对具体病例：除了解剖学因素外，临床医生还必须考虑自身的经验和技术水平以及患者的偏好和健康问题。该指南允许医生明智地选择垂直隆胸技术，以获得成功的结果。

Acknowledgments 致谢

Dr Urban and Dr Wang received honoraria for lecturing from Osteogenics Biomedical. In addition, Dr Urban received honoraria for lecturing from Geistlich Pharma. This paper was partially supported by the University of Michigan Periodontal Graduate Student Research Fund. The authors reported no conflicts of interest related to this study.
Urban 博士和 Wang 博士从 Osteogenics Biomedical 公司获得了讲课酬金。此外，Urban 博士还获得了 Geistlich Pharma 的讲课酬金。本文得到了密歇根大学牙周病研究生研究基金的部分资助。作者未报告与本研究相关的利益冲突。

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  1. The International Journal of Periodontics & Restorative Dentistry
    国际牙周病学与牙科修复杂志