Combined periodontal regenerative technique in human intrabony defects by collagen membranes and anorganic bovine bone. A controlled clinical study

The added benefit of L-PRF to autogenous bone grafts in the treatment of degree II furcation involvement in mandibular molars

BACKGROUND

Tissue regeneration within the periodontally involved furcation area is one of the most challenging aspects of periodontal surgery. The aim of this study was to evaluate the additional benefit of leukocyte and platelet-rich fibrin (L-PRF) to autogenous bone grafts (ABGs) in the treatment of mandibular molar degree II furcation involvement, comparing the clinical outcomes with those from open flap debridement (OFD)+ABG and OFD alone treatments.

METHODS

Fifty-four patients, exhibiting one buccal or lingual mandibular molar furcation defect, were randomly assigned to three treatment groups: OFD+ABG+L-PRF(n = 18); OFD+ABG (n = 18); and OFD (n = 18). Clinical [probing pocket depth (PPD), horizontal clinical attachment level (HCAL), vertical clinical attachment level (VCAL), gingival recession (GR)] and radiographic [vertical bone level (VBL)] parameters were evaluated at baseline and 6 months after treatment. HCAL change was the primary outcome.

RESULTS

No significant differences within each group were reported for GR changes, but statistically significant improvements in HCAL, VCAL, PPD and VBL were observed in all groups, except for VBL in the OFD group. At 6 months, the mean HCAL gain was 2.29±0.18 mm in the OFD+ABG+L-PRF group, which was significantly greater than that in the OFD+ABG (1.61±0.18 mm) and OFD (0.86±0.18 mm) groups. Both OFD+ABG+L-PRF and OFD+ABG therapies produced a significantly greater clinical and radiographic improvement than OFD.

CONCLUSION

The addition of L-PRF to ABG produces a significantly greater HCAL gain and PPD reduction as compared to OFD+ABG treatment in mandibular degree II furcation involvements. This article is protected by copyright. All rights reserved.

Efficacy of inorganic bovine bone combined with leukocyte and platelet-rich fibrin or collagen membranes for treating unfavorable periodontal infrabony defects: Randomized non-inferiority trial

BACKGROUND

Growing evidence shows the efficacy of platelet concentrates in periodontal therapy. This study aimed to demonstrate that an inorganic bovine bone graft (IBB) in combination with a leukocyte and platelet rich fibrin (L-PRF) is non-inferior to a combination with a collagen membrane (CM) when managing unfavorable infrabony defects (IBDs).

METHODS

All patients exhibited at least one unfavorable IBD; they were randomly assigned to two groups, 31 treated with L-PRF+IBB and 31 with CM+IBB. A clinical and radiographic examination was performed at baseline and 12 months later. Clinical attachment level (CAL), gingival recession (GR), probing depth (PD), and radiographic defect bone level (DBL) post-therapy changes were compared between the two treatments. A non-inferiority margin = 1 mm was set to determine the efficacy of the test treatment (-1 mm for GR); a second non-inferiority margin = 0.5 mm (-0.5 mm for GR) was chosen for clinical relevance.

RESULTS

Twelve months after surgery a significant improvement of clinical and radiographic parameters was observed at both experimental sites. The 90% confidence intervals of the CM+IBB-L-PRF+IBB mean difference for CAL gain (-0.810 mm [-1.300 to -0.319]) and DBL gain (-0.648 mm [-1.244 to -0.052]) were below the 0.5 mm non-inferiority margin; GR increase (1.284 mm [0.764 to 1.804]) remained above the -0.5 mm, while PD reduction (0.499 mm [0.145 to 0.853]) crossed its 0.5-mm margin.

CONCLUSIONS

The L-PRF+IBB treatment of unfavorable IBDs offers non-inferior efficacy for CAL gain, showing less GR and more DBL gain too, while for PD reduction it is inferior to the CM+IBB treatment.

Evaluating Change of Marginal Bone Height with Cone-Beam Computed Tomography Following Surgical Treatment with Guided Tissue Regeneration (Bone Grafting) or Access Flap Alone: A Retrospective Study

Background and Objectives: This study aimed to evaluate the change of bone height following treatment of human intrabony defects with guided tissue regeneration (GTR) with bone grafting or access flap alone by cone-beam computed tomography (CBCT) scan. Materials and methods: This study was conducted as a retrospective longitudinal study. In this study, a total of 2281 teeth sites were included: the GTR group had 1210 sites, and the Flap group had 1071 sites. In the GTR group, demineralized freeze-dried bone (DFDBA) particles in combination with resorbable collagen membrane were used. No regenerative material was applied to the Flap group. CBCT images were taken twice at baseline and at least 2.5 months postoperatively. Bone heights were measured using software on CBCT images. Results: The bony change between the GTR and Flap groups was significantly different (p = 0.00001). Both males and females in the GTR group had smaller bone loss than in the Flap group. In age groups, significant differences of bony height between the GTR and Flap groups were observed in the subgroups consisting of those 29–45 and 46–53 years old. The non-smoking subjects in the GTR group had higher bone heights than those in the Flap group. In the absence of systemic disease and medicine, bone formation was higher in the GTR group than in the Flap group. In terms of oral position, the #14–17, #34–37, and #44–47 subgroups of the GTR group showed higher levels of bone heights than those of the Flap group. Conclusions. The results of this study indicated that the GTR procedure offers the additional benefit of higher bone heights than the Flap procedure does.

Guided tissue regeneration of intrabony defects with perforated barrier membranes, simvastatin, and EDTA root surface modification: A clinical and biochemical study

BACKGROUND

Perforated barrier membranes (PBM) were suggested to enhance periodontal regeneration by allowing positive charity of wanted elements from the gingival tissue side. The present study was designed to evaluate clinically and biochemically the use of PBM combined with simvastatin (SMV) gel with and without an associated EDTA gel root surface etching as a suggested option that could improve SMV availability and clinical outcomes of PBM.

METHODS

Forty patients having moderate-to-severe chronic periodontitis with 40 intrabony defects were randomly divided into four treatment groups (10 sites each). Patients in group 1 received 1.2% SMV gel and covering the defect with occlusive membrane (OM). Patients in group 2 received 1.2% SMV gel and covering the defect with PBM. Group 3 received 24% EDTA root surface etching, 1.2% SMV gel, and defect coverage with OM (eOM). Patients in group 4 were treated as in group 3 but the defect was covered with PBM (ePBM). Clinical parameters were recorded at baseline before surgical procedures and were reassessed at 6 and 9 months after therapy. The mean concentration of SMV in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography at days 1, 7, 14, 21, and 30.

RESULTS

At 6- and 9-month observation periods, groups 3 and 4 showed a statistically significant improvement in PD reduction and CAL gain compared with groups 1 and 2. Group 4 showed a statistically significant more defect fill compared with groups 1, 2, and 3 (P ≤ .05). Group 2 showed statistically significant higher defect fill compared with group 1 and group 3 (P < .05). Bone density was significantly increased with no significant difference between the four groups at 6- and 9-month observation periods. SMV-GCF concentration in group 4 showed the highest mean concentration with no significant difference than that of group 3.

CONCLUSION

The use of perforated barrier membranes in association with SMV enhances the clinical hard tissue parameters compared with occlusive ones in treating intrabony periodontal defects. Moreover, EDTA root surface treatment could enhance SMV availability in the defect area.

Delayed bone healing by collagen membrane in early phase of 4 weeks

OBJECTIVE

Barrier membranes are important in maintaining space in guided bone regeneration process by preventing downgrowth of epithelial or connective tissue. In this study, the effects of resorbable membranes during the early stages of bone regeneration in rats with impaired bone healing capacity were investigated.

STUDY DESIGN

Twenty-eight rats were selected for this study. Half of the animals were selected for radiation therapy before surgical procedure (G3, G4). Animals were assigned into 4 groups (G1-G4). A circular defect was created in the central parietal bone. It was covered with resorbable membrane in G2 and G4. After 4 weeks, the animals were sacrificed.

RESULTS

At week 4, the new bone formation was observed around the margin of old bone in G1, G2 and G4 groups. Osteoclast was most abundant in the G1 group (18.3 ± 7.7) and least abundant in the G4 group (7.9 ± 4.7). The mean of osteocalcin levels in blood was the highest in the G2 group and lowest in the G3 group. Only G4 group showed significant difference in Runx2 levels between before-treatment and after- treatment.

CONCLUSIONS

Bone healing is adversely affected after radiation therapy. In addition, resorbable membranes can delay healing in the early stages of bone regeneration.

A randomized controlled clinical study of periodontal tissue regeneration using an extracellular matrix-based resorbable membrane in combination with a collagenated bovine bone graft in intrabony defects

Purpose

The purpose of this study was to investigate the feasibility of regenerative therapy with a collagenated bone graft and resorbable membrane in intrabony defects, and to evaluate the effects of the novel extracellular matrix (ECM)-based membrane clinically and radiologically.

Methods

Periodontal tissue regeneration procedure was performed using an ECM-based resorbable membrane in combination with a collagenated bovine bone graft in intrabony defects around the teeth and implants. A novel extracellular matrix membrane (NEM) and a widely-used membrane (WEM) were randomly applied to the test group and the control group, respectively. Cone-beam computed tomography images were obtained on the day of surgery and 6 months after the procedure. Alginate impressions were taken and plaster models were made 1 week and 6 months postoperatively.

Results

The quantity of bone tissue, the dimensional changes of the surgically treated intrabony defects, and the changes in width and height below the grafted bone substitutes showed no significant difference between the test and control groups at the 6-month examination.

Conclusions

The use of NEM for periodontal regeneration with a collagenated bovine bone graft showed similar clinical and radiologic results to those obtained using WEM.

Guided Tissue Regeneration in Four Teeth Using a Liquid Polymer Membrane

Periodontal disease is one of the most common diseases diagnosed in dogs and cats. Guided tissue regeneration (GTR) is a treatment alternative to extraction of strategically important teeth. The barrier membrane used in the GTR procedure is of key importance. The purpose of this case series was to evaluate a liquid polymer gel as a membrane for GTR. The polymer gel ( N-methyl-2-pyrrolidone and poly [DL-lactide]) combined with 8.5% doxycycline hyclate was used in place of a traditional membrane in 4 teeth. The teeth were re-examined 6 months postoperatively for radiographic evaluation. A decrease in probing depth and new alveolar bone formation was seen 6 months postoperatively. Improvement in periodontal disease stage was seen in 2 of the 4 teeth. Larger controlled trials with histopathologic evaluation are indicated to further assess the use of this polymer as a membrane in GTR. However, the clinical outcomes of all 4 treated teeth were considered successful.

Biomimetic hydroxyapatite used in the treatment of periodontal intrabony pockets: clinical and radiological analysis

AIM

Hydroxyapatite (PA) has a chemical composition and physical structure very similar to natural bone and therefore it has been considered to be the ideal biomaterial able to ensure a biomimetic scaffold to use in bone tissue engineering. The aim of this study is to clinically test hydroxyapatite used as osteoconductive biomaterial in the treatment of periodontal bone defects. Clinical and radiological evaluations were conducted at 6, 12 and 18 months after the surgery.

MATERIALS AND METHODS

Forty patients with 2- and 3-wall intrabony pockets were enrolled in this study. PPD, CAL, radiographic depth (RD) and angular defects were preoperatively measured. After surgery, patients were re-evaluated every 6 months for 18 months. Statistical analyses were also performed to investigate any differences between preoperative and postoperative measurements.

RESULTS

Paired t-test samples conducted on the data obtained at baseline and 18 months after, showed significant (p<0.01) differences in each measurement performed. The role of preoperative RD was demonstrated to be a significant key factor (p<0.01). A relevant correlation between preoperative PPD and CAL gain was also found.

CONCLUSIONS

Within the limitations of this study, the absence of anatomical variables, except the morphology of the bone defect, emphasizes the importance of the proper surgical approach and the graft material used.

Evaluation of anorganic bovine-derived hydroxyapatite matrix/cell binding peptide as a bone graft material in the treatment of human periodontal infrabony defects: A clinico-radiographic study

Background:

Various bone graft materials have been used in the treatment of periodontal defects. A synthetic bone substitute material composed of P-15 with anorganic bone mineral has been scantly studied. Hence, the present study was aimed to evaluate and compare the efficacy of anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) in human periodontal infrabony defects with that of open flap debridement (OFD) alone.

Materials and Methods:

A split-mouth, randomized controlled clinical study was designed to investigate the efficacy of ABM/P-15. In this clinical trial, 10 patients having bilateral periodontal infrabony defects were treated either with ABM/P-15 or OFD and followed for a period of 9 months. At baseline and at 9 months probing pocket depth (PPD), relative attachment level (RAL), depth of a defect, and radiographic bone level were measured; and compared between test and control sites.

Results:

A statistically significant reduction (P < 0.001) in PPD was observed in test sites compared to control sites. Both sites showed a gain in RAL without any significant difference. Similarly, the radiographic evaluation revealed significantly higher radiographic defect fill in test sites as compared to control sites (P < 0.001).

Conclusion:

ABM/P-15 bone graft material appears to be useful and beneficial in the treatment of human periodontal infrabony defects.

Clinical and biochemical comparison of guided tissue regeneration versus guided tissue regeneration plus low-level laser therapy in the treatment of class II furcation defects: A clinical study

OBJECTIVE

The present study was aimed to compare the clinical and biochemical effectiveness of guided tissue regeneration (GTR) alone and combined with low-level laser therapy (LLLT) application in the treatment of furcation II periodontal defects, over a period of 6 months.

MATERIAL AND METHODS

Thirty-three furcation defects were included in the study. Seventeen of these defects were treated with GTR plus LLLT, and sixteen of them were treated with GTR alone. Probing pocket depth (PPD), clinical attachment level (CAL), horizontal probing depth (HPD), and alkaline phosphatase (ALP) and osteocalcin (OC) levels in the gingival crevicular fluid (GCF) were recorded at baseline and at postoperative 3rd and 6th months.

RESULTS

Healing was uneventful in all cases. At the 3rd and 6th months, both treatment modalities-GTR and GTR plus LLLT--showed improved PPD, CAL, and HPD values compared to their baseline values. ALP and OC levels in GCF increased after the treatment in both groups (p < 0.05). When compared the two groups, at the 6th month, PPD, CAL, HPD, and ALP values showed significantly more improvement in laser group than non-laser group (p < 0.05).

CONCLUSIONS

The results of this study showed that both treatments led to significantly favorable clinical improvements in furcation periodontal defects. LLLT plus GTR may be a more effective treatment modality compared to GTR alone.

Combination of bone allograft, barrier membrane and doxycycline in the treatment of infrabony periodontal defects: A comparative trial

Aim

The purpose of the present study was to compare the regenerative potential of noncontained periodontal infrabony defects treated with decalcified freeze-dried bone allograft (DFDBA) and barrier membrane with or without local doxycycline.

Methods

This study included 48 one- or two-wall infrabony defects from 24 patients (age: 30–65 years) seeking treatment for chronic periodontitis. Defects were randomly divided into two groups and were treated with a combination of DFDBA and barrier membrane, either alone (combined treatment group) or with local doxycycline (combined treatment + doxycycline group). At baseline (before surgery) and 3 and 6 months after surgery, the pocket probing depth (PPD), clinical attachment level (CAL), radiological bone fill (RBF), and alveolar height reduction (AHR) were recorded. Analysis of variance and the Newman–Keuls post hoc test were used for statistical analysis. A two-tailed p-value of less than 0.05 was considered to be statistically significant.

Results

In the combined treatment group, the PPD reduction was 2.00 ± 0.38 mm (32%), CAL gain was 1.25 ± 0.31 mm (17.9%), and RBF was 0.75 ± 0.31 mm (20.7%) after 6 months. In the combined treatment + doxycycline group, these values were 2.75 ± 0.37 mm (44%), 1.5 ± 0.27 mm (21.1%), and 1.13 ± 0.23 mm (28.1%), respectively. AHR values for the groups without and with doxycycline were 12.5% and 9.4%, respectively.

Conclusion

There was no significant difference in the regeneration of noncontained periodontal infrabony defects between groups treated with DFDBA and barrier membrane with or without doxycycline.

Clinical outcomes following regenerative therapy of non-contained intrabony defects using a deproteinized bovine bone mineral combined with either enamel matrix derivative or collagen membrane

BACKGROUND

The purpose of this study is to compare clinical outcomes in the treatment of deep non-contained intrabony defects (i.e., with ≥70% 1-wall component and a residual 2- to 3-wall component in the most apical part) using deproteinized bovine bone mineral (DBBM) combined with either enamel matrix protein derivative (EMD) or collagen membrane (CM).

METHODS

Forty patients with multiple intrabony defects were enrolled. Only one non-contained defect per patient with an intrabony depth ≥3 mm located in the interproximal area of single- and multirooted teeth was randomly assigned to the treatment with either EMD + DBBM (test: n = 20) or CM + DBBM (control: n = 20). At baseline and after 12 months, clinical parameters including probing depth (PD) and clinical attachment level (CAL) were recorded. The primary outcome variable was the change in CAL between baseline and 12 months.

RESULTS

At baseline, the intrabony component of the defects amounted to 6.1 ± 1.9 mm for EMD + DBBM and 6.0 ± 1.9 mm for CM + DBBM sites (P = 0.81). The mean CAL gain at sites treated with EMD + DBBM was not statistically significantly different (P = 0.82) compared with CM + DBBM (3.8 ± 1.5 versus 3.7 ± 1.2 mm). No statistically significant difference (P = 0.62) was observed comparing the frequency of CAL gain ≥4 mm between EMD + DBBM (60%) and CM + DBBM (50%) or comparing the frequency of residual PD ≥6 mm between EMD + DBBM (5%) and CM + DBBM (15%) (P = 0.21).

CONCLUSION

Within the limitations of the present study, regenerative therapy using either EMD + DBBM or CM + DBBM yielded comparable clinical outcomes in deep non-contained intrabony defects after 12 months.

Absorbable Collagen Membranes for Periodontal Regeneration

Guided tissue regeneration (GTR) with bioabsorbable collagen membranes (CM) is commonly used for the treatment of periodontal defects. The objective of this systematic review of randomized clinical trials was to assess the clinical efficacy of GTR procedures with CM, with or without bone substitutes, in periodontal infrabony defects compared with that of open flap debridement (OFD) alone. Primary outcomes were tooth loss and gain in clinical attachment level (CAL). Screening of records, data extraction, and risk-of-bias assessments were performed by two reviewers. Weighted mean differences were estimated by random effects meta-analysis. We included 21 reports on 17 trials. Risk of bias was generally high. No data were available for the primary outcome tooth loss. The summary treatment effect for change in CAL for GTR with CM compared with OFD was 1.58 mm (95% CI, 1.27 to 1.88). Despite large between-trial heterogeneity (I2 = 75%, p < .001), all trials favored GTR over OFD. No differences in treatment effects were detected between trials of GTR with CM alone and trials of GTR with CM in combination with bone substitutes ( p for interaction, .31). GTR with CM, with or without substitutes, may result in improved clinical outcomes compared with those achieved with OFD alone. Our findings support GTR with CM for the treatment of infrabony periodontal defects.

A comparative evaluation of the effectiveness of guided tissue regeneration by using a collagen membrane with or without decalcified freeze-dried bone allograft in the treatment of infrabony defects: A clinical and radiographic study

BACKGROUND

The present, randomized, controlled clinical and radiographic study was undertaken to compare the effectiveness of guided tissue regeneration (GTR) by using a collagen membrane barrier with or without decalcified freeze-dried bone allograft (DFDBA) in the treatment of periodontal infrabony defects characterized by unfavorable architecture.

MATERIALS AND METHODS

Sixteen systemically healthy patients with 20 periodontal infrabony defects were selected for the study. Each patient had at least ≥ 5 mm clinical probing pocket depth (PPD) at the selected site and depth of intrabony component ≥ 3 mm as assessed by clinical and radiographic measurements. Baseline measurements included plaque index, papillary bleeding index, PPD, gingival recession, clinical attachment level and radiographic defect depth (DD). At the time of surgery, the defects were randomly assigned to either the test group (collagen membrane plus DFDBA) or the control group (collagen membrane only).

RESULTS

At the 6-month examination, PPPD reduction was significantly greater in the GTR + DFDBA group (4.06 ± 0.38 mm) compared with the GTR group (3.2 ± 0.74 mm). The mean gains of clinical attachment were 3.54 ± 0.36 mm in the test group and 2.50 ± 0.74 mm in the control group. Radiographic DD reduction was similarly greater in the GTR + DFDBA group (2.40 ± 0.51 mm) compared with the GTR group (1.60 ± 0.51 mm).

CONCLUSIONS

The results of the present study indicate that the use of a GTR membrane with bone graft has significantly improved all clinical parameters tested as compared with the use of bioresorbable membrane alone in the treatment of infrabony defects characterized by unfavorable architecture.

Clinical and radiographic evaluation of regenerative potential of GTR membrane (Biomesh®) along with alloplastic bone graft (Biograft®) in the treatment of periodontal intrabony defects

BACKGROUND AND OBJECTIVES

The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to compare the efficacy of combination of GTR membrane and alloplastc bone graft with open flap debridement (OFD) in treatment of periodontal intrabony defects.

METHODS

Twenty paired intrabony defects were surgically treated using split mouth design. The defects were randomly assigned to treatment with OFD, GTR membrane+bone graft (test) or OFD alone (control). The clinical efficacy of two treatment modalities was evaluated at 6 months postoperatively by clinical, radiographical parameters. The measurements included probing pocket depth (PD), clinical attachment level (CAL), gingival recession (GR), bone fill (BF), bone density (BD).

RESULTS

The mean reduction in PD at 0 to 6 months was 3.20±0.82 mm and CAL gain of 3.10±1.51 mm occurred in the GTR membrane+bone graft (test) group; corresponding values for OFD (control) were 2.10±0.63 mm and 1.90±0.57 mm. Similar pattern of improvement was observed when radiographically postoperative evaluation was made. All improvement in different parameters was statistically significant (p<0.01).

CONCLUSION

Treatment with a combination of collagen membrane and bone graft led to a significantly more favorable clinical outcome in intrabony defects as compared to open flap debridement alone.

Nano-crystalline hydroxyapatite bone graft combined with bioresorbable collagen membrane in the treatment of periodontal intrabony defects: A randomized controlled clinical trial

Aim:

To evaluate the clinical outcome of nanocrystalline hydroxyapatite (NcHA) bonegraft (Sybograf^®) in combination with collagen membrane (PerioCol^®) compared with open flap debridement (OFD) only in the treatment of intrabony periodontal defects.

Materials and Methods:

Eighteen intrabony defects in 16 systemically healthy patients aged between 25-65 years, were randomly assigned to test and control groups. The Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession were recorded at baseline, and were reevaluated at 6 months. In addition to this, radiographic bone fill was assessed using digital software. At the test site NcHA bone graft and collagen membrane was placed, whereas at the control site only, OFD was done. Recall appointments were made at 7^th day, 1^st month, 3^rd month, and 6^th month.

Results:

The data were subjected to statistical analysis using the Mann-Whitney ‘U’ Test and Wilcoxon signed rank sum test. In the control group, the mean reduction of PPD was 3.22±1.09 mm and CAL gain was 2.78±1.09 mm. In the test group, the mean PPD reduction of 4.33±0.5 mm and mean gain in CAL was 3.78±0.66 mm at 6 months. The mean increase in gingival recession was 0.55±0.72 mm in test and 0.44±0.52 mm in control group.

Conclusion:

The NcHA bone graft in combination with collagen membrane demonstrated better clinical outcomes compared with OFD alone.

Clinical and radiographic evaluation of Nano-crystalline hydroxyapatite bone graft (Sybograf) in combination with bioresorbable collagen membrane (Periocol) in periodontal intrabony defects

Background:

Nanosized ceramics may represent a promising class of bone graft substitutes due to their improved osseointegrative properties. Nanocrystalline Hydroxyapatite (NcHA) bind to bone and stimulate bone healing by stimulation of osteoblast activity. The present study aims to explore the clinical and radiographical outcome of NcHA bonegraft (Sybograf^®) with collagen membrane (Periocol^®), in comparison with open flap debridement (OFD), in the treatment of intrabony periodontal defects.

Materials and Methods:

A parallel-group, randomized, controlled clinical trial was designed to conduct the study. Eighteen intrabony defects in 14 systemically healthy patients aged between 25 to 65 years were randomly assigned to test and control group. The plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (REC) were recorded at baseline, and were reevaluated at 6 months. In addition to this, radiographic bone fill was assessed using digital software. At the test site, NcHA bone graft and collagen membrane was placed, whereas at the control site, only OFD was done. Recall appointments were made at 7 days, 30 days, and then at 3 months and 6 months.

Results:

The data were subjected to statistical analysis using the Mann-Whitney ‘U’ Test and Wilcoxon signed rank sum test. In the control group, the mean reduction of PPD was 3.22±1.09 mm (P=0.007) and CAL gain was 2.77±1.09 mm (P=0.007). In the test group, the mean PPD reduction of 4.33±0.5 mm (P=0.006) and mean gain in CAL was 3.77±0.66 mm (P=0.006) at 6 months. The mean increase in REC was 0.55±0.72 mm (P=0.025) in test, and 0.44±0.52 mm (P=0.046) in control group. The mean gain in radiographic defect fill was 2.07±0.67 mm (P=0.008) in test and 0.91±0.21 mm (P=0.007) in control group.

Conclusion:

The nanocrystalline hydroxyapatite bone graft in combination with collagen membrane demonstrated clinical advantages beyond that achieved by OFD alone.

Use of an Autogenous Cortical Graft in Combination with Guided Tissue Regeneration for Treatment of an Infrabony Defect

Infrabony periodontal defects are common findings encountered during complete oral examinations. Treatment options for infrabony lesions are aimed at meeting client demands as well as patient needs. Deciding on how to treat these lesions depends on the nature and degree of disease present as well as having the materials available to improve the chances of achieving the greatest clinical success. Bone grafting of an infrabony defect of the left mandibular first molar tooth of a dog using an autogenous cortical graft harvested with a reusable bone grafter in combination with guided tissue regeneration is described.

Clinical evaluation of guided tissue regeneration combined with autogenous bone or autogenous bone mixed with bioactive glass in intrabony defects

Conflicting data exist on the combined use of grafting materials and barrier membranes in comparison to guided tissue regeneration (GTR) with membrane alone. The aim of the present study was to compare the clinical outcomes of GTR with collagen membrane (CM) alone (control group) or CM combined with autogenous bone graft (test group 1) or autogenous bone mixed with bioactive glass (test group 2) in intrabony defects. A total of 32 intraosseous defects in 22 subjects were treated randomly. After 6 months, significant probing depth reduction, clinical attachment level gain (CAL) and defect resolution were observed in all groups with significantly greater improvements in the test groups. There was no significant difference between the two test groups in any parameter. Results of the present study suggest that autogenous bone can be mixed with bioactive glass if the amount of the harvested bone is not sufficient.

Periodontal regenerative effect of a bovine hydroxyapatite/collagen block in one-wall intrabony defects in dogs: a histometric analysis

Purpose

The aim of this study was to elucidate the effect of a bovine hydroxyapatite/collagen (BHC) block in one-wall intrabony periodontal defects in dogs.

Methods

A one-wall intrabony periodontal defect (4 mm wide and 5 mm deep) was prepared bilaterally at the mesial side of the mandibular fourth premolar in five beagle dogs. After thorough root planing, block-type BHC (4×5×5 mm) was placed on one side. The contralateral defect area did not receive any material as a sham-surgery control. Histological analysis of the sites was performed after an 8-week healing period.

Results

Two of five samples in the experimental group healed well without dissipation of the graft materials, and histological analysis revealed excellent regeneration of the periodontal tissues. However, most of the grafted materials had been displaced in the other three samples, leaving only a small portion of the graft. The measured parameters exhibited large standard deviations, and the mean values did not differ significantly between the experimental and sham-surgery control sides.

Conclusions

The application of BHC alone-without a barrier membrane-to wide, one-wall intrabony periodontal defects yielded inconsistent results regarding both periodontal regeneration and substantivity of the graft materials. Thus, the use of a barrier membrane for noncontained-type defects is recommended to improve the stability of the grafted material, and to condense it.

Clinical evaluation of the efficacy of a GTR membrane (HEALIGUIDE) and demineralised bone matrix (OSSEOGRAFT) as a space maintainer in the treatment of Miller's Class I gingival recession

Background:

Periodontal plastic surgical procedures aimed at coverage of exposed root surface have evolved into routine treatment modalities. The present study was designed to evaluate the effectiveness and predictability of using a collagen barrier along with a demineralized bone matrix in the treatment of recession defects in a single surgical procedure.

Materials and Methods:

Seventeen patients with Miller's class I recession were treated with a combination of a collagen barrier used along with a bone graft and coronally advanced flap technique. Clinical parameters were recorded at baseline, 3 months, 6 months, and 9 months.

Results:

The study showed a highly significant reduction in the recession depth (70.29 ± 21.96%) at the end of the study. This study showed that the use of this technique for recession coverage is highly predictable and highly esthetic root coverage can be obtained.

Effect of platelet-rich plasma on the healing of intrabony defects treated with an anorganic bovine bone mineral: a pilot study

BACKGROUND

Periodontal therapy using the combination of platelet-rich plasma (PRP) and different grafting materials has been suggested as a modality to enhance the outcome of regenerative surgery. In most clinical studies, a barrier membrane was used to cover the defects, and thus, the effects of PRP may have been masked by the effects of the barrier. The data from controlled clinical studies evaluating the effect of regenerative therapy using various grafting materials with or without PRP are still limited. The purpose of this study was to clinically compare the healing of intrabony defects treated with either a combination of an anorganic bovine bone mineral (ABBM) and PRP to those obtained with ABBM alone.

METHODS

Thirty patients with advanced chronic periodontal disease and displaying one intrabony defect were randomly treated with PRP + ABBM or ABBM alone. The following clinical parameters were evaluated at baseline and 1 year after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL.

RESULTS

No statistical significant differences in any of the investigated parameters between the two groups were observed at baseline. Healing was uneventful in all patients. In the PRP + ABBM group, mean PD decreased from 8.6 +/- 1.8 mm to 3.4 +/- 1.4 mm (P <0.001) and mean CAL changed from 9.9 +/- 1.7 mm to 5.3 +/- 1.8 mm (P <0.001). In the ABBM group, mean PD decreased from 8.5 +/- 2.0 mm to 3.2 +/- 1.3 mm (P <0.001) and mean CAL changed from 9.6 +/- 1.9 mm to 4.9 +/- 1.5 mm (P <0.001). CAL gains >or=3 mm were measured in 80% (12 of 15 defects) of cases treated with PRP + ABBM and in 87% (13 of 15 defects) of cases treated with ABBM alone. No statistically significant differences in any of the investigated parameters were observed between the two groups at the 1-year reevaluation.

CONCLUSIONS

Within the limits of the present study, it can be concluded that 1) at 1 year after regenerative surgery with PRP + ABBM and ABBM alone, significant PD reductions and CAL gains were found, and 2) the use of PRP failed to improve the results obtained with ABBM alone.

Regeneration of periodontal tissues: guided tissue regeneration

The concept that only fibroblasts from the periodontal ligament or undifferentiated mesenchymal cells have the potential to re-create the original periodontal attachment has been long recognized. Based on this concept, guided tissue regeneration has been applied with variable success to regenerate periodontal defects. Quantitative analysis of clinical outcomes after guided tissue regeneration suggests that this therapy is a successful and predictable procedure to treat narrow intrabony defects and class II mandibular furcations, but offers limited benefits in the treatment of other types of periodontal defects.

Clinical evaluation of regenerative potential of type I collagen membrane along with xenogenic bone graft in the treatment of periodontal intrabony defects assessed with surgical re-entry and radiographic linear and densitometric analysis

BACKGROUND AND OBJECTIVES

The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to compare the efficacy of combination of type I collagen (GTR membrane) and xenogenic bone graft with open flap debridement (OFD) in treatment of periodontal intrabony defects.

MATERIALS AND METHODS

Twenty paired intrabony defects were surgically treated using split mouth design. The defects were randomly assigned to treatment with OFD + collagen membrane + bone graft (Test) or OFD alone (Control). The clinical efficacy of two treatment modalities was evaluated at 9 month postoperatively by clinical, radiographical, and intrasurgical (re-entry) parameters. The measurements included probing pocket depth (PD), clinical attachment level (CAL), gingival recession (GR), bone fill (BF), bone density (BD) and intra bony component (INTRA).

RESULTS

The mean reduction in PD at 0-9 month was 3.3±0.82 mm and CAL gain of 3.40±1.51 mm occurred in the collagen membrane + bone graft (Test) group; corresponding values for OFD (Control) were 2.20±0.63 mm and 1.90±0.57 mm. Similar pattern of improvement was observed when radiographical and intra-surgical (re-entry) post operative evaluation was made. All improvement in different parameters was statistically significant (P< 0.01).

INTERPRETATION AND CONCLUSION

Treatment with a combination of collagen membrane and bone graft led to a significantly more favorable clinical outcome in intrabony defects as compared to OFD alone.

The management of mucosal fenestration: a report of two cases

AIM

To report on the management of two patients with mucosal fenestration of root apices.

SUMMARY

Two cases of mucosal fenestration of root apices were treated by a combination of nonsurgical root canal treatment and surgery. Root-end resection was performed to bring the root apices within the alveolus before root-end filling and packing of the bony defects with demineralized freeze-dried bone allograft. The areas were then covered with connective tissue grafts taken from the hard palate before repositioning the mucogingival flap. At 1 year follow-up, the mucosal fenestrations were completely healed by soft tissue graft coverage, and radiographs revealed bony healing.

KEY LEARNING POINTS

* Connective tissue grafts can be used to manage mucosal fenestration. * Periradicular surgery and connective tissue grafts can be used in combination.

Bone replacement grafts for the treatment of periodontal intrabony defects

Bone replacement grafts, including autogenous grafts from intraoral donor sites, allografts, xenografts, and alloplastic bone substitutes, are the most widely used treatment modalities for the regeneration of periodontal osseous defects. Studies suggest a favorable clinical outcome with the use of these materials in terms of improvements in periodontal probing depths, probing attachment gains, and bone fill. In terms of bone fill, most studies report more than 50% resolution of intrabony defects when treated with bone replacement grafts. However, histologic evidence of periodontal regeneration, including new bone, periodontal ligament, and cementum, has been reported only for autogenous bone grafts and demineralized freeze-dried bone allografts.

Surgical guided tissue regeneration treatment of advanced periodontal defects: a 5-year follow-up study

OBJECTIVES

To study the 5-year outcome of combined use of guided tissue regeneration (GTR) barriers and bovine bone in advanced periodontal defects.

MATERIAL AND METHODS

In each of 24 patients, one defect was surgically exposed, debrided, filled with bovine bone, and covered with a bioresorbable barrier. Re-examinations were made after 1, 3, and 5 years.

RESULTS

Average full-mouth plaque scores (FMPS) were 14.5% at baseline and 10.7%, 9.8%, and 18.9% after 1, 3, and 5 years, respectively. Mean probing pocket depth (PPD) was 10.0 mm at baseline. Mean PPD reduction was 5.2 mm after 1 year, 5.6 mm after 3 years, and 5.3 mm after 5 years. Mean gingival recession was 1.0 mm after 1 year, 1.6 mm after 3 years, and 1.3 mm after 5 years. Mean gain in clinical attachment level (CAL) was 4.2 mm at the 1-year, 4.1 mm at the 3-year, and 4.3 mm at the 5-year examination. Smoking significantly influenced CAL change at all re-examinations. FMPS were significantly correlated with radiographic defect depth at the 5-year examination and CAL with smoking and FMPS at the 3-year examination.

CONCLUSION

Advanced periodontal defects can be successfully treated with the combined use of GTR barriers and bovine bone to substantially reduce PPD and achieve a stable, long-term gain of CAL.

Combined use of platelet-rich plasma and bone grafting with or without guided tissue regeneration in the treatment of anterior interproximal defects

BACKGROUND

The aim of periodontal therapy is to prevent tissue destruction while achieving the regeneration of damaged tissues. Platelet-rich plasma (PRP) is used to generate new bone, periodontal ligament, and new attachment with a strategy based on the modulation and enhancement of wound healing through an autologous source for growth factors obtained from the patient's own blood. The purpose of the present study was to evaluate the efficacy of PRP when used in combination with beta-tricalcium phosphate (beta-TCP) alloplastic graft material and collagen barrier membrane in the treatment of anterior interproximal intrabony defects.

METHODS

Thirty interproximal intrabony defects in 25 systemically healthy patients were selected for the study. Defects were distributed randomly and equally into three groups: graft alone (beta-TCP), graft + PRP, and graft + PRP + membrane. The plaque index, gingival index, periodontal probing depth, relative attachment level, transgingival probing measurement, and radiographic analyses were performed at baseline and repeated after 6, 9, and 12 months.

RESULTS

At the end of 12 months, relative attachment gain was 2.4, 2.1, and 2.5 mm in the three treatment groups, respectively. No statistically significant differences in clinical and radiographic measurements were observed among the groups.

CONCLUSIONS

All options were effective in the treatment of anterior interproximal intrabony defects. The results also suggested that PRP added no clinical benefit to beta-TCP alloplastic graft material used alone or in combination with GTR.

Effect of Platelet-Rich Plasma on the Healing of Intrabony Defects Treated With an Anorganic Bovine Bone Mineral and Expanded Polytetrafluoroethylene Membranes

BACKGROUND

Regenerative periodontal therapy with a combination of platelet-rich plasma (PRP) + an anorganic bovine bone mineral (ABBM) + guided tissue regeneration (GTR) has been shown to result in significantly higher probing depth reductions and clinical attachment level gains compared to treatment with open flap debridement (OFD) alone, ABBM alone, or GTR alone. However, there are no data evaluating to what extent the use of PRP may additionally enhance the clinical outcome of the therapy compared to treatment with ABBM + GTR. This study aimed to clinically evaluate the effect of PRP on the healing of deep intrabony defects treated with ABBM and GTR by means of a non-resorbable expanded polytetrafluoroethylene (ePTFE) membrane.

METHODS

Twenty-four patients with advanced chronic periodontal disease and displaying one intrabony defect were randomly treated with a combination of either PRP + ABBM + GTR or ABBM + GTR. The following clinical parameters were evaluated at baseline and at 1 year after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL.

RESULTS

No differences in any of the studied parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with PRP + ABBM + GTR showed a reduction in mean PD from 8.6 +/- 1.7 mm to 3.1 +/- 1.3 mm (P <0.001) and a change in mean CAL from 10.3 +/- 1.4 mm to 5.7 +/- 1.6 mm (P <0.001). In the group treated with ABBM + GTR, mean PD was reduced from 8.8 +/- 1.7 mm to 3.1 +/- 1.0 mm (P <0.001), and the mean CAL changed from 10.4 +/- 2.6 mm to 5.9 +/- 1.8 mm (P <0.001). In both groups, all sites gained > or =3 mm of CAL. CAL gains > or =4 mm were measured in 83% (i.e., in 10 of 12 defects) of the cases treated with PRP + ABBM + GTR and in 92% (i.e., in 11 of 12 defects) treated with ABBM + GTR. No statistically significant differences in any of the studied parameters were observed between the two groups at 1-year reevaluation.

CONCLUSION

Within its limits, the present study has shown that, at 1 year after regenerative therapy in periodontal intrabony defects, optimal clinical results were obtained with ABBM + GTR with a non-resorbable barrier, with or without the addition of PRP.

Effectiveness of proliferating tissues in combination with bovine-derived xenografts to intrabony defects of alveolar bone in dogs

The aim of this study was to investigate the effect of proliferating tissue used in combination with bovine-derived xenograft (BDX) on the formation of new cementum and bone in dogs. Intrabony defects were treated with either BDX in conjunction with autogenous proliferating tissues (BDXplus-proliferating tissues: BDX-P group) or BDX alone (BDX-alone group). The control group received no BDX or proliferating tissues. The animals were sacrificed after 2, 4, and 8 weeks of the treatment, and tissues were histologically examined. Specimens from the control group were characterized by long junctional epithelium and little bone formation. The BDX-P group showed a statistically significant increase in new bone and cementum formation compared to the BDX-alone group (30.9% vs. 18.7, p < 0.01 and 87.8% vs. 61.8, p < 0.01). The ratio of proliferating cell nuclear antigen (PCNA)-positive cells in the newly formed connective tissue of the BDX-P group was significantly greater than that in the BDX-alone group. These findings suggest that the use of proliferating tissues in combination with BDX enhances new bone and cementum formation, offering potential as therapeutic material in periodontal regeneration.

Effect of platelet-rich plasma on the healing of intra-bony defects treated with a natural bone mineral and a collagen membrane

BACKGROUND

Regenerative periodontal therapy with a combination of platelet-rich plasma (PRP)+a natural bone mineral (NBM)+guided tissue regeneration (GTR) has been shown to result in significantly higher probing depth reductions and clinical attachment-level gains compared with treatment with open flap debridement alone. However, at present, it is unknown to what extent the use of PRP may additionally enhance the clinical outcome of the therapy compared with treatment with NBM+GTR.

AIM

To clinically compare treatment of deep intra-bony defects with NBM+PRP+GTR with NBM+GTR.

MATERIAL AND METHODS

Thirty patients suffering from advanced periodontal disease, and each of whom displayed one advanced intra-bony defect were randomly treated with a combination of either NBM+PRP+collagen membrane (GTR) or NBM+GTR. The following clinical parameters were evaluated at baseline and at 1 year after treatment: plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession and clinical attachment level (CAL). CAL changes were used as the primary outcome variable.

RESULTS

No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with NBM+PRP+GTR showed a reduction in mean PD from 8.9+/-2.3 mm to 3.4+/-2.0 mm (p<0.001) and a change in mean CAL from 10.9+/-2.2 mm to 6.4+/-1.8 mm (p<0.001). In the group treated with NBM+GTR, the mean PD was reduced from 8.9+/-2.5 mm to 3.4+/-2.3 mm (p<0.001), and the mean CAL changed from 11.1+/-2.5 mm to 6.5+/-2.3 mm (p<0.001). In both groups, all sites gained at least 3 mm of CAL. CAL gains of > or = 4 mm were measured in 80% (i.e. in 12 out of 15 defects) of the cases treated with NBM+PRP+GTR and in 87% (i.e. in 13 out of 15 defects) treated with NBM+GTR. No statistically significant differences in any of the investigated parameters were observed between the two groups.

CONCLUSIONS

Within its limits, the present study has shown that (i) at 1 year after regenerative surgery with both NBM+PRP+GTR and NBM+GTR, significant PD reductions and CAL gains were found, and (ii) the use of PRP has failed to improve the results obtained with NBM+GTR.

Five-year results of a prospective, randomized, controlled study evaluating treatment of intra-bony defects with a natural bone mineral and GTR

BACKGROUND

Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) has been shown to promote periodontal regeneration. However, until now there are only very limited data on the long-term clinical results following this regenerative technique.

AIM

To present the 5-year results of a prospective, randomized, controlled clinical study evaluating the treatment of deep intra-bony defects either with open flap debridement (OFD) and a combination of an NBM and GTR (test) or OFD alone (control).

METHODS

Nineteen patients diagnosed with advanced chronic periodontitis, and each of whom displayed one intra-bony defect, received randomly the test or the control treatment. Results were evaluated at baseline, at 1 and at 5 years following therapy.

RESULTS

No statistically significant differences in any of the investigated parameters were observed at baseline between the two groups. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) from 9.1+/-1.1 to 3.7+/-0.8 mm (p<0.001) and a change in mean clinical attachment level (CAL) from 10.4+/-1.3 to 6.4+/-1.2 mm (p<0.001). At 5 years, mean PD and CAL measured 4.3+/-0.8 and 6.7+/-1.6 mm, respectively. At 5 years, both PD and CAL were statistically significantly improved compared with baseline (p<0.001) without statistically significant differences between the 1- and 5-year results. In the control group, mean PD was reduced from 8.9+/-1.3 to 4.9+/-1.2 mm (p<0.001) and mean CAL changed from 10.6+/-1.4 to 8.8+/-1.5 mm (p<0.01). At 5 years, mean PD and CAL measured 5.6+/-1.1 and 9.1+/-1.3 mm, respectively, and were still statistically significantly improved compared with baseline (p<0.01). No statistically significant differences were found between the 1- and 5-year results. The test treatment, at both 1 and 5 years, yielded statistically significantly higher CAL gains than the control one (p<0.01). Compared with baseline, at 5 years a CAL gain of > or =3 mm was found in nine defects (90%) of the test group but in none of the defects treated with OFD alone.

CONCLUSIONS

It was concluded that (i) treatment of intra-bony defects with OFD+NBM+GTR may result in significantly higher CAL gains than treatment with OFD, and (ii) the clinical results obtained after both treatments can be maintained over a period of 5 years.

Clinical Evaluation of an Enamel Matrix Protein Derivative Combined With Either a Natural Bone Mineral or β-Tricalcium Phosphate

BACKGROUND

The purpose of the present study was to compare the healing of deep intrabony defects following treatment with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or beta-tricalcium phosphate (beta-TCP).

METHODS

Twenty-four patients with advanced periodontal disease, each of whom displayed one intrabony defect, were randomly treated with a combination of either EMD + NBM or EMD + beta-TCP. Clinical evaluation was performed at baseline and 1 year following therapy.

RESULTS

No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with EMD + NBM showed a reduction in mean probing depth (PD) from 7.9 +/- 1.0 mm to 3.2 +/- 0.6 mm and a change in mean clinical attachment level (CAL) from 8.8 +/- 1.1 mm to 4.5 +/- 0.6 mm (P < 0.001). In the group treated with EMD + beta-TCP, the mean PD was reduced from 7.8 +/- 1.2 mm to 3.2 +/- 0.9 mm, and the mean CAL changed from 8.8 +/- 1.2 mm to 4.7 +/- 1.2 mm (P < 0.001). In both groups, all sites gained at least 3 mm of CAL. CAL gains of 4 or 5 mm were measured in the majority of the cases (75%), irrespective of treatment modality. No statistically significant differences in terms of PD reductions and CAL gains were observed between the two groups.

CONCLUSION

Within the limits of the present study, both therapies resulted in significant PD reductions and CAL gains 1 year after surgery.

Position Paper: Periodontal Regeneration

Untreated periodontal disease leads to tooth loss through destruction of the attachment apparatus and tooth-supporting structures. The goals of periodontal therapy include not only the arrest of periodontal disease progression,but also the regeneration of structures lost to disease where appropriate. Conventional surgical approaches (e.g., flap debridement) continue to offer time-tested and reliable methods to access root surfaces,reduce periodontal pockets, and attain improved periodontal form/architecture. However, these techniques offer only limited potential towards recovering tissues destroyed during earlier disease phases. Recently, surgical procedures aimed at greater and more predictable regeneration of periodontal tissues and functional attachment close to their original level have been developed, analyzed, and employed in clinical practice. This paper provides a review of the current understanding of the mechanisms, cells, and factors required for regeneration of the periodontium and of procedures used to restore periodontal tissues around natural teeth. Targeted audiences for this paper are periodontists and/or researchers with an interest in improving the predictability of regenerative procedures. This paper replaces the version published in 1993.

Treatment of Wide, Shallow, and Predominantly 1-Wall Intrabony Defects With a Bioabsorbable Membrane: A Randomized Controlled Clinical Trial

BACKGROUND

The regenerative therapy of non-contained intrabony defects achieves better results when bioabsorbable membranes are combined with a filling material. The purpose of the present study was to analyze clinical and radiographic effectiveness of a space-making bioabsorbable membrane in the treatment of wide and shallow intrabony defects characterized by a relevant 1-wall component.

METHODS

Eighteen pairs of angular bone defects were selected in 18 healthy, non-smoking patients (age range 30 to 66 years). Prior to the surgical phase, patients were enrolled in a strict periodontal program including oral hygiene instructions and scaling and root planing (presurgical full-mouth plaque score <10%). Using a split-mouth design, 18 sites were randomly assigned to receive guided tissue regeneration (GTR) using a bioabsorbable membrane (test group) and 18 to receive open flap debridement alone (control group). Clinical treatment outcome was evaluated 12 months postoperatively for changes in probing depth (PD), clinical attachment level (CAL), and position of gingival margin (REC) and radiographically for bone changes.

RESULTS

Open flap debridement and GTR yielded statistically significant (P<0.0001) PD reduction (2.39+/- 0.92 mm and 3.44+/- 0.78 mm), CAL gain (1.50+/- 0.99 mm and 2.89 +/- 0.90 mm), increased REC (-0.89 +/- 0.58 mm and -0.56 +/- 0.92 mm) and bone fill (1.05+/- 0.94 mm and 2.13+/- 1.21 mm) when 12-month data were compared to baseline. The differences between test and control groups were statistically significant for all parameters (P<0.007) except for REC (P=0.25).

CONCLUSION

The use of this bioabsorbable membrane would seem to be effective in the treatment of intrabony defects with unfavorable architecture without the use of filling materials.

Five-year results of guided tissue regeneration in combination with deproteinized bovine bone (Bio-Oss) in the treatment of intrabony periodontal defects: a case series report

The aim of this study was to report on the clinical and radiographic results 5 years following treatment of intrabony defects with guided tissue regeneration (GTR) in combination with deproteinized bovine bone (DBB) (Bio-Oss). Fifteen patients, with at least one intrabony periodontal defect with probing pocket depth (PPD)>or=7 mm and radiographic presence of an intrabony component (IC)>or=4 mm, were treated with a PLA/PGA bioabsorbable membrane. Prior to placement of the membrane, the defect was filled with DBB impregnated with gentamicin sulfate 2 mg/ml. Standardized intraoral radiographs were taken prior to treatment and at the control examinations after 1 and 5 years. At baseline, the average PPD was 9.2+/-1.1 mm, and the average probing attachment level (PAL) was 10.1+/-1.6 mm; the radiographic bone level (RBL) was 10.4+/-2.45 mm, and an IC of 6.2+/-2.3 mm was present. One year after membrane placement, treatment had resulted in a PAL gain of 3.8+/-1.8 mm, a residual PPD of 4.2+/-1.3 mm, an RBL gain of 4.7+/-2.0 mm, and a residual IC of 2.1+/-1.2 mm. At the 5-year examination, two patients did not show up, and two patients had lost the treated tooth. However, both teeth were endodontically treated, and progressive periodontal destruction might not necessarily have been the reason for extraction. At the 5-year control (11 patients), the PAL gain was 4.1+/-1.6 mm, and the residual PPD was 4.6+/-1.2 mm; an RBL gain of 4.9+/-2.7 mm and a residual IC of 1.8+/-0.8 mm were observed. Statistically significant clinical improvements had occurred between baseline and the 1- and 5-year controls, whereas there were no significant differences between the 1- and 5-year results. The results of GTR with bioabsorbable membranes in combination with Bio-Oss in the treatment of periodontal intrabony defects are basically stable on a long-term basis.

Clinical outcomes following treatment of human intrabony defects with GTR/bone replacement material or access flap alone. A multicenter randomized controlled clinical trial

AIM

This prospective multicenter randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of a guided tissue regeneration (GTR)/bone replacement material.

MATERIALS AND METHODS

One hundred and twenty-four patients with advanced chronic periodontitis were recruited in 10 centers in seven countries. All patients had at least one intrabony defect of > or = 3 mm. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, the regenerative material was applied in the test subjects, and omitted in the controls. At baseline and 1 year following the interventions, clinical attachment levels (CALs), probing pocket depths (PPDs), recession, full-mouth plaque scores and full-mouth bleeding scores (FMBS) were assessed.

RESULTS

One year after treatment, the test defects gained 3.3 +/- 1.7 mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5 +/- 1.5 mm. Pocket reduction was also significantly higher in the test group (3.7 +/- 1.8 mm) when compared with the controls (3.2 +/- 1.5 mm). A multivariate analysis indicated that the treatment, the clinical centers, baseline PPD and baseline FMBS significantly influenced CAL gains. Odds ratios (ORs) of achieving above-median CAL gains were significantly improved by the test procedure (OR = 2.6, 95% CI 1.2-5.4) and by starting with deeper PPD (OR = 1.7, 1.3-2.2) but were decreased by receiving treatment at the worst-performing clinical center (OR = 0.9, 0.76-0.99).

CONCLUSIONS

The results of this trial indicated that regenerative periodontal surgery with a GTR/bone replacement material offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone.

GTR treatment of intrabony defects with PLA/PGA copolymer or collagen bioresorbable membranes in combination with deproteinized bovine bone (Bio-Oss)

The objectives of this study were to evaluate the results of guided tissue regeneration (GTR) treatment of intrabony defects with two kinds of bioresorbable membranes, with deproteinized bovine bone (Bio-Oss) used as an adjunct. Twenty-eight patients with at least one intrabony defect with a probing pocket depth (PPD) >/=7 mm and radiographic evidence of an intrabony component (IC) >/=4 mm were randomly treated with either a polylactic/polyglycolic (PLA/PGA) acid copolymer or a collagen bioresorbable membrane combined with Bio-Oss implantation. Immediately prior to surgery (baseline) and after 1 year, the following parameters were recorded: (1) PPD, (2) gingival recession (REC), (3) probing attachment level (PAL), (4) presence/absence of plaque (PI), and (5) presence/absence of bleeding on probing (BOP). Occurrence of membrane exposure during healing and the smoking habits of the patients were also recorded. Statistical analysis was carried out using chi(2) -tests and t-tests. There were no significant differences between the two membrane groups regarding the clinical parameters at baseline. Statistically significant clinical improvements (PAL gains, reduced PPDs) were observed 1 year after treatment in both groups. There were no significant differences, however, between the PLA/PGA and the collagen membrane groups regarding any of the evaluated parameters (mean PAL gain: 2.9 mm vs 3.9 mm; mean residual PPD: 4.8 mm vs 4.1 mm, respectively). The membrane material per se does not seem to be a critical factor for the outcome of GTR treatment of intrabony defects with bioresorbable membranes.

Treatment of gingival recession using a collagen membrane with or without the use of demineralized freeze-dried bone allograft for space maintenance

BACKGROUND

Studies utilizing collagen membranes for guided tissue regeneration (GTR)-based root coverage procedures have reported promising results. However, creating and maintaining space underneath the membrane remains a challenge. Therefore, the purpose of this clinical trial was to determine whether the addition of bone graft (i.e., demineralized freeze-dried bone allograft [DFDBA]) significantly affects the outcome of collagen membrane GTR-based root coverage procedures.

METHODS

Twenty patients participated. One Miller's Class I or II recession defect per patient was treated with a collagen membrane covered by a coronally positioned flap. Half of the patients also had DFDBA placed under the membrane. Clinical parameters recorded included: recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth, measured to the nearest 0.5 mm. Presurgery and postsurgery (6-month) data were compared using Student's paired t test for parametric data and the Wilcoxon matched pairs test for non-parametric data.

RESULTS

Guided tissue regeneration with collagen (COLL) and collagen + DFDBA (COBA) both resulted in statistically significant (P <0.05) reductions in recession depth (2.1 +/- 0.9 mm and 2.5 +/- 0.5 mm), recession width (1.5 +/- 1.7 mm and 2.2 +/- 1.6 mm), increase in keratinized tissue (0.7 +/- 0.8 mm and 1.2 +/- 1.0 mm), and gain of clinical attachment level (2.1 +/- 1.0 mm and 3.0 +/- 1.0 mm), when comparing 6-month data to baseline. Mean root coverage was 68.4 +/- 15.2% with COLL and 74.3 +/- 11.7% with COBA. However, there were no statistically significant differences between groups for recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth.

CONCLUSIONS

Both techniques are effective in attaining root coverage. Although root coverage tended to be better with the addition of DFDBA, the difference was not statistically significant. Further studies with a larger sample size are needed to determine whether adding DFDBA to GTR-based procedures using collagen membranes is of any benefit.