Present status of osseous grafting procedures

Particle size of periodontal bone grafting materials

Samples of autogenous bone obtained by high speed burs, low speed burs, hand chisels and bone blending; freeze-dried bone purchased from a tissue bank and alloplastic materials, such as Calcitite, Durapatite, Periograf and Synthograft used as donor material for periodontal bone grafting procedures, were evaluated histometrically. Particle sizes ranged from a mean of 210 X 105 mu for bone blend to 1559 X 783 mu for hand-chisel samples. Except for those two materials, all of the others were in the 300 to 500 microns (0.3-0.5 mm) range that seems to be preferred for use in periodontal defects.

Human clinical and histologic responses to Durapatite implants in intraosseous lesions. Case reports

The healing response following implantation of a nonresorbable ceramic (durapatite) into human periodontal osseous defects was evaluated clinically and histologically. Four tooth-containing blocks were obtained from four patients who had received durapatite implants in osseous defects, each exceeding 4 mm in depth. Each patient was seen for 5 to 13 postsurgical maintenance visits. Teeth in block section were removed between 8 weeks and 8 months postgraft surgery. Clinical evaluation of the repair process demonstrated that pocket depth decreased in all four cases. Histological evaluation of the repair process showed no indication of new periodontal attachment, osteogenesis or cementogenesis, in the host tissues adjacent to the graft particles. Pocket closure appeared to occur by means of a long junctional epithelium and connective tissue adhesions. There was minimal or no evidence of inflammation in all sections associated with the implant. The graft material therefore acted as a biocompatible foreign body within the gingival tissue.

Kielbone in new attachment attempts in Humans

The purpose of this investigation was to evaluate, in humans, the use of Kielbone as a substitute for fresh autogenous bone in treating periodontal intrabony defects. A total of 92 intrabony defects were treated with a previously described new attachment procedure utilizing free mucosal grafts to cover the intrabony defects following bone grafting. Kielbone was placed in 46 of these defects, while the remaining 46 defects were treated with autogenous bone grafts. The results were evaluated after 6 months by periodontal probing and assessment of the bone level as seen on periodical, identical radiographs. No differences were observed between the amount of clinical gain of attachment obtained in defects treated with Kielbone and those treated with autogenous jaw bone. This indicates that in surgical procedures attempting to restore lost connective tissue attachment, Kielbone constitutes a suitable replacement for fresh autogenous bone. The results are discussed in th light of recent studies that challenge the beneficial effect of bone grafts in the treatment of intrabony defects.

Evaluation of durapatite ceramic as an alloplastic implant in periodontal osseous defects. I. Initial six-month results

Eight patients received a new polycrystalline ceramic form of pure hydroxylapatite (Durapatite) as a bone implant material in various types of infrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the CEJ using a standardized periodontal probe. Similarly debrided defects that were not implanted served as controls. Defect selection as either experimental or control site was based on either split-mouth or alternating defects design. Periodontal dressing and systemic tetracycline were used for 10 days. Results for documentation and plaque control were at 10, 20, and 30 days, and 3 and 6 months. Measurements relating to defect changes were made at the 6-months surgical re-entry. For evaluation purposes original defect depths were divided into three groups. In Group I (less than 3 mm) defect fill was 1.2 mm (60%) for the implanted defects and 0.6 mm (40.5%) for the control sites (significantly different at P less than 0.05). In Group II (3--6 mm) defect fill of 1.7 mm (48.5%) for implanted sites was significantly better than the 0.1 mm (11.1%) for the control sites. In the deepest group (Group III greater than or equal to 6 mm) Durapatite placement yielded 2.6 mm (39.9%) of defect fill while debridement alone resulted in 1.3 mm (14.8%) of fill. Hard tissue changes demonstrated a substantial advantage for use of Durapatite over controls, while soft tissue changes were similar for both. The clinical impression at re-entry and the numerical data indicate that pure hydroxylapatite ceramic has a definite potential as an alloplastic implant in the treatment of periodontal osseous defects.

Success of overdentures and prevention of failure

Placement of dentures over selected retained teeth has become a commonly used treatment in dentistry. The relationship between the overdenture and the areas of periodontal, endodontic, restorative, and prosthodontic diagnosis and treatment has been discussed. Within each area, aspects of treatment that are crucial to success of the overdenture have been identified. It is suggested that the two most important concerns are adequate diagnosis and maintenance. The combination of a properly diagnosed case and a motivated patient, along with extreme attention to detail during treatment, will enhance the prospect of success.

Histometric evaluation of periodontal surgery. II. Connective tissue attachment levels after four regenerative procedures

The present study was undertaken to determine the effect of four periodontal regenerative procedures on the connective tissue attachment level. The procedures tested were: 1) the modified Widman flap procedure, 2) the modified Widman flap procedure combined with transplantation of previously frozen autogenous red marrow and cancellous bone, 3) the modified Widman flap procedure in combination with implantation of beta tricalcium phosphate, and 4) periodic root planing and soft tissue curettage. Eight adult Rhesus monkeys, divided into four equal groups, were used. Periodontal pockets were produced around contralateral teeth in a standardized manner. In each group of animals, the pockets on one side of the jaws were subjected to one of the above-mentioned surgical treatments, while the contralateral pockets remained as unoperated controls. Three weeks before surgery, a carefully designed plaque control program was instituted and continued until the animals were sacrificed 12 months after surgery. In histologic sections, linear measurements along the root surfaces were made from the cemento-enamel junction (CEJ) to the most apical cells of the junctional epithelium (JE). These measurements from operated and unoperated sites were then compared. The data revealed that healing following the four different regenerative procedures resulted in the reformation of an epithelial lining (long junctional epithelium) along the treated root surfaces, with no new connective tissue attachment.