Clinical evaluation of coralline calcium carbonate as a bone replacement graft material in human periodontal osseous defects

Clinical and histological results in alveolar ridge enlargement using coralline calcium carbonate

A very important parameter during the insertion of dental implants is the amount of bone present in a site. A regenerative procedure to increase the width and the height of bone is proposed with the use of occlusive barrier membranes and biomaterials. The authors used, in six patients with deficient alveolar ridges, prior to implant insertion, Biocoral gel particles in connection with expanded polytetrafluoroethylene membranes. After 6 months it was observed that a tissue similar to mature bone had regenerated under the membrane and microscopically it was observed that the Biocoral particles were still present and almost all were completely surrounded by mature bone.

Periodontal repair in intrabony defects treated with a calcium carbonate implant and guided tissue regeneration

Clinical outcome following the concurrent use of a porous resorbable calcium carbonate (CC) implant and guided tissue regeneration (GTR) in intrabony periodontal defects was evaluated in a randomized four-treatment parallel arm study. Eighty (80) patients, each contributing one interproximal intrabony defect, were assigned to the four treatments (20 patients per treatment) including the CC implant and GTR (CC + GTR), GTR alone (GTR control), CC implant alone (CC control), and gingival flap surgery alone (GFS control). Fourteen patients treated with CC + GTR, 19 patients treated with the GTR control, 13 patients treated with the CC control, and 18 patients treated with the GFS control completed the study. Clinical healing was evaluated 6 months postsurgery and included changes in probing depth, clinical attachment level, probing bone level, and gingival recession. Postsurgery probing depth reduction was 4.5 +/- 1.7 mm (CC + GTR; P < 0.01), 4.8 +/- 1.8 mm (GTR; P < 0.01), 3.7 +/- 2.2 mm (CC; P < 0.01), and 3.3 +/- 1.6 mm (GFS; P < 0.01). Clinical attachment gain amounted to 3.3 +/- 1.4 mm (CC + GTR; P < 0.01), 4.0 +/- 2.1 mm (GTR; P < 0.01), 3.0 +/- 2.4 mm (CC; P < 0.01), and 2.0 +/- 1.7 mm (GFS; P < 0.01). The CC + GTR and GTR treatments exhibited significantly greater improvements compared to GFS (P < 0.05). Postsurgery probing bone level gain amounted to 4.0 +/- 1.7 mm (CC + GTR; P < 0.01), 4.1 +/- 1.5 mm (GTR; P < 0.01), 4.0 +/- 2.2 mm (CC; P < 0.01), and 0.5 +/- 2.0 mm (GFS; P > 0.05). The CC + GTR, GTR, and CC treatments exhibited significantly greater improvements compared to GFS (P < 0.05). Gingival recession increased significantly compared to presurgery for GTR, CC, and GFS treatments (-0.9 +/- 1.2, -0.7 +/- 0.7, and -1.2 +/- 1.4 mm, respectively; P < 0.01). The results suggest that the concurrent use of a porous resorbable CC implant and GTR has limited adjunctive effect in the treatment of intrabony periodontal defects.

Periodontal regeneration around natural teeth

1. Evidence is conclusive (Table 2) that periodontal regeneration in humans is possible following the use of bone grafts, guided tissue regeneration procedures, both without and in combination with bone grafts, and root demineralization procedures. 2. Clinically guided tissue regeneration procedures have demonstrated significant positive clinical change beyond that achieved with debridement alone in treating mandibular and maxillary (buccal only) Class II furcations. Similar data exist for intraosseous defects. Evidence suggests that the use of bone grafts or GTR procedures produce equal clinical benefit in treating intraosseous defects. Further research is necessary to evaluate GTR procedures compared to, or combined with, bone grafts in treating intraosseous defects. 3. Although there are some data suggesting hopeful results in Class II furcations, the clinical advantage of procedures combining present regenerative techniques remains to be demonstrated. Additional randomized controlled trials with sufficient power are needed to demonstrate the potential usefulness of these techniques. 4. Outcomes following regenerative attempts remain somewhat variable with differences in results between studies and individual subjects. Some of this variability is likely patient related in terms of compliance with plaque control and maintenance procedures, as well as personal habits; e.g., smoking. Variations in the defects selected for study may also affect predictability of outcomes along with other factors. 5. There is evidence to suggest that present regenerative techniques lead to significant amounts of regeneration at localized sites on specific teeth. However, if complete regeneration is to become a reality, additional stimuli to enhance the regenerative process are likely needed. Perhaps this will be accomplished in the future, with combined procedures that include appropriate polypeptide growth factors or tissue factors to provide additional stimulus.

Clinical evaluation of natural coral and porous hydroxyapatite implants in periodontal bone lesions: results of a 1-year follow-up

This study examines the suitability of 2 bone graft substitutes, natural coral skeleton (NCS) and porous hydroxyapatite (PHA) for treating periodontal bone defects in human subjects, and compares them to debridement alone (DEBR). A total of 30 sites in 10 patients were treated. Measurements were made before treatment and during surgical reexamination 12 months after treatment on lesions filled with NCS (10 sites), PHA (10 sites), or DEBR (10 sites). There was no significant difference in the use of NCS or PHA for 1, 2 wall, or combined defects for the group of parameters measured in this study (clinical probing depth, clinical attachment, gingival recession, bone fill, % bone fill, and crest remodelling). Statistical analysis (Wilcoxon non-parametric test for paired values and ANOVA for repeated measurements) revealed the beneficial effects of using each the biomaterials (57.4% for NCS, 58.1% for PHA, p < 0.86) as opposed to simple debridement (22.2%; p < 0.002; p < 0.004).