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Shakya A, Li Y, Chang NW, Liu X. Supra-Alveolar Bone Regeneration: Progress, Challenges, and Future Perspectives. COMPOSITES. PART B, ENGINEERING 2024; 283:111673. [PMID: 39071449 PMCID: PMC11270636 DOI: 10.1016/j.compositesb.2024.111673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Periodontitis is a highly prevalent disease that damages the supporting tissues of a tooth, including the alveolar bone. Alveolar bone loss owing to periodontitis is broadly categorized as supra-alveolar and intra-alveolar bone loss. In intra-alveolar bone loss, the defect has an angular or oblique orientation to the long axis of the tooth in an apical direction. In contrast, the defect is perpendicular to the long axis of the tooth in supra-alveolar bone loss. Unlike intra-alveolar bone defects, supra-alveolar bone defects lack supporting adjacent space, which makes supra-alveolar bone regeneration more challenging. In addition, the limited availability of resources in terms of vascularity and underlying tissues is another obstacle to supra-alveolar bone regeneration. Currently, supra-alveolar bone loss is the least predictable periodontal defect type in regenerative periodontal therapy. In addition, supra-alveolar bone loss is much more common than other alveolar bone loss. Despite its prevalence, research on supra-alveolar bone regeneration remains sparse, indicating an unmet need for significant research efforts in this area. This review summarize recent advances, obstacles, and future directions in the field of supra-alveolar bone regeneration. We discuss the biomaterials, bioactive molecules, and cells that have been tested for supra-alveolar bone regeneration, followed by pre-clinical and clinical approaches employed in this field. Additionally, we highlight obstacles and present future directions that will propel supra-alveolar bone research forward.
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Affiliation(s)
- Ajay Shakya
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX 75246
| | - Yingzi Li
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX 75246
- Chemical and Biomedical Engineering Department, University of Missouri, Columbia, MO 65211
| | - Nai-wen Chang
- Department of Periodontology, Texas A&M University School of Dentistry, Dallas, TX 75246
| | - Xiaohua Liu
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX 75246
- Chemical and Biomedical Engineering Department, University of Missouri, Columbia, MO 65211
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Moreno Rodríguez JA, Ortiz Ruiz AJ, Caffesse RG. Supra‐alveolar attachment gain in the treatment of combined intra‐suprabony periodontal defects by non‐incised papillae surgical approach. J Clin Periodontol 2019; 46:927-936. [DOI: 10.1111/jcpe.13158] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/29/2019] [Accepted: 06/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Raúl G. Caffesse
- Postgraduate Periodontics Complutense University of Madrid Madrid Spain
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Joseph V R, Sam G, Amol NV. Clinical evaluation of autologous platelet rich fibrin in horizontal alveolar bony defects. J Clin Diagn Res 2014; 8:ZC43-7. [PMID: 25584315 DOI: 10.7860/jcdr/2014/9948.5129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/27/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Horizontal bone loss is the most common periodontal problem confronting the clinician but has received little attention. Platelet rich fibrin (PRF) is a second generation platelet concentrate. The platelets, leucocytes, growth factors and cytokines contained within PRF make it a healing biomaterial with tremendous potential for bone and soft tissue regeneration. AIM This interventional clinical trial evaluates the clinical effectiveness of Autologous Platelet Rich Fibrin (PRF) in the management of horizontal bony defects. SETTINGS AND DESIGN Department of Periodontics. Design was Non Randomized Clinical Trial with split mouth design. MATERIALS AND METHODS A total of 45 sites with horizontal bone loss in 15 patients were studied, 15 sites were treated with PRF gel (experimental group I) and 15 sites were treated with PRF gel and PRF membrane (experimental group II). Control group (15 sites) were treated with open flap debridement. STATISTICAL ANALYSIS All the parameters were assessed at baseline and after nine months which included Pocket Depth (PD), Clinical Attachment level (CAL), Gingival Recession (REC) and Relative Crest Height (RCH). The mean changes at baseline and after 9 months within each group were compared using Wilcoxon Signed Ranks Test. The mean changes for each parameter between groups were compared using Kruskal Wallis Test. RESULTS Re-evaluation at nine months revealed that all groups showed a significant reduction in probing depth (1.1±0.38 mm in control, 1.73±0.53 mm in group I, 1.7±0.45 mm in group II)(p<0.05) and clinical attachment gain (0.86±0.58 mm in control, 1.56±0.62 mm in group I, 1.7±0.52 in group II)(p<0.05) as compared to baseline. Intergroup comparisons of reduction in probing depth and clinical attachment gain showed significant differences in the experimental groups as compared to control (p<0.05), but there was no significant difference between the experimental groups (p>0.05). There was no significant difference in gingival recession and radiographic bone levels at 9 months post surgery (p>0.05) in all the three groups. CONCLUSION Within the limitations of this study, it can be concluded that, clinically the use of PRF in both gel and membrane form is more effective than open flap debridement alone in the management of horizontal periodontal defects at nine months post surgery.
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Affiliation(s)
- Rosamma Joseph V
- Professor, Department of Periodontics, Government Dental College Calicut, Kerala, India
| | - George Sam
- Senior Resident, Department of Periodontics, Government Dental College , Kottayam, Kerala, India
| | - Nagrale Vijay Amol
- Senior Resident, Department of Periodontics, Government Dental College , Calicut, Kerala, India
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Wang Y, Chai Z, Zhang Y, Deng F, Wang Z, Song J. Influence of low-intensity pulsed ultrasound on osteogenic tissue regeneration in a periodontal injury model: X-ray image alterations assessed by micro-computed tomography. ULTRASONICS 2014; 54:1581-1584. [PMID: 24815538 DOI: 10.1016/j.ultras.2014.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 03/18/2014] [Accepted: 03/26/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study was conducted to evaluate, with micro-computed tomography, the influence of low-intensity pulsed ultrasound on wound-healing in periodontal tissues. METHODS Periodontal disease with Class II furcation involvement was surgically produced at the bilateral mandibular premolars in 8 adult male beagle dogs. Twenty-four teeth were randomly assigned among 4 groups (G): G1, periodontal flap surgery; G2, periodontal flap surgery+low-intensity pulsed ultrasound (LIPUS); G3, guided tissue regeneration (GTR) surgery; G4, GTR surgery plus LIPUS. The affected area in the experimental group was exposed to LIPUS. At 6 and 8weeks, the X-ray images of regenerated teeth were referred to micro-CT scanning for 3-D measurement. RESULTS Bone volume (BV), bone surface (BS), and number of trabeculae (Tb) in G2 and G4 were higher than in G1 and G3 (p<0.05). BV, BS, and Tb.N of the GTR+LIPUS group were higher than in the GTR group. BV, BS, and Tb.N of the LIPUS group were higher than in the periodontal flap surgery group. CONCLUSION LIPUS irradiation increased the number, volume, and area of new alveolar bone trabeculae. LIPUS has the potential to promote the repair of periodontal tissue, and may work effectively if combined with GTR.
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Affiliation(s)
- Yunji Wang
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Zhaowu Chai
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Feng Deng
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China
| | - Zhibiao Wang
- Dept. of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jinlin Song
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, The Affiliated Hospital of Stomatology, Chongqing Medical University, No. 426, North Songshi Road, Chongqing 400015, China.
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Di Tullio M, Femminella B, Pilloni A, Romano L, D’Arcangelo C, De Ninis P, Paolantonio M. Treatment of Supra-Alveolar-Type Defects by a Simplified Papilla Preservation Technique for Access Flap Surgery With or Without Enamel Matrix Proteins. J Periodontol 2013; 84:1100-10. [DOI: 10.1902/jop.2012.120075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jayakumar A, Rohini S, Naveen A, Haritha A, Reddy K. Horizontal alveolar bone loss: A periodontal orphan. J Indian Soc Periodontol 2011; 14:181-5. [PMID: 21760673 PMCID: PMC3100862 DOI: 10.4103/0972-124x.75914] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 07/27/2010] [Indexed: 11/24/2022] Open
Abstract
Background: Attempts to successfully regenerate lost alveolar bone have always been a clinician’s dream. Angular defects, at least, have a fairer chance, but the same cannot be said about horizontal bone loss. The purpose of the present study was to evaluate the prevalence of horizontal alveolar bone loss and vertical bone defects in periodontal patients; and later, to correlate it with the treatment modalities available in the literature for horizontal and vertical bone defects. Materials and Methods: The study was conducted in two parts. Part I was the radiographic evaluation of 150 orthopantomographs (OPGs) (of patients diagnosed with chronic periodontitis and seeking periodontal care), which were digitized and read using the AutoCAD 2006 software. All the periodontitis-affected teeth were categorized as teeth with vertical defects (if the defect angle was ≤45° and defect depth was ≥3 mm) or as having horizontal bone loss. Part II of the study comprised search of the literature on treatment modalities for horizontal and vertical bone loss in four selected periodontal journals. Results: Out of the 150 OPGs studied, 54 (36%) OPGs showed one or more vertical defects. Totally, 3,371 teeth were studied, out of which horizontal bone loss was found in 3,107 (92.2%) teeth, and vertical defects were found only in 264 (7.8%) of the teeth, which was statistically significant (P<.001). Search of the selected journals revealed 477 papers have addressed the treatment modalities for vertical and horizontal types of bone loss specifically. Out of the 477 papers, 461 (96.3%) have addressed vertical bone loss, and 18 (3.7%) have addressed treatment options for horizontal bone loss. Two papers have addressed both types of bone loss and are included in both categories. Conclusion: Horizontal bone loss is more prevalent than vertical bone loss but has been sidelined by researchers as very few papers have been published on the subject of regenerative treatment modalities for this type of bone loss. This study should be an impetus for greater attention to an otherwise ubiquitous periodontal challenge.
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Affiliation(s)
- A Jayakumar
- Department of Periodontics, Sri Sai College of Dental Surgery, Vikarabad, Andhra Pradesh, India
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Kaya Y, Yalim M, Bahçecitapar M, Baloş K. Comparison of applying particulate demineralized bone matrix (DBM), putty DBM and open flap debridement in periodontal horizontal bone defects. A 12-month longitudinal, multi-center, triple-blind, split-mouth, randomized, controlled clinical study. Part 1 - clinical and radiographic evaluation. J Oral Rehabil 2009; 36:524-34. [PMID: 19453850 DOI: 10.1111/j.1365-2842.2009.01958.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Putty form graft materials may have additional favourable effects when compared with particulate ones in periodontal bone defects. The purpose of this study was to assess clinical and also radiographic changes following application of (i) putty form demineralized bone matrix (DBM), (ii) particulate form DBM and (iii) open flap debridement (control), using modified curtain suturing technique in the treatment of interproximal suprabony (horizontal) defects. Twenty-five chronic periodontitis patients with 125 sites (radiologically >or=4 mm horizontal bone defect) were selected to participate in this triple-blind, split mouth, randomized, controlled clinical trial. Putty and particulate form DBM grafts were placed at experimental sites. Clinical measurements included probing depth (PD), relative attachment level (RAL), gingival recession and bone probing depth (BPD) were made at baseline and repeated 12 months after the operations. Standardized digital radiographs were also taken to measure radiographic bone level (RBL) at baseline and 12 months later to be compared in a software. Probing depth reductions and RAL gains were significantly improved in all treatment groups (P < 0.001). No significant differences in soft tissue parameters were found among three groups (P > 0.05). Bone probing depth measurements indicated comparable significant bone gain in graft applied groups (P < 0.01) and a significant bone resorption in open flap debridement group (P < 0.01). Radiographic evaluation did not show any significant bone gain or resorption in all treatment groups (P > 0.05). The results of this study indicate that either putty or particulate DBM demonstrates similar enhancements in soft and hard tissue parameters. Applying putty or particulate form DBM results with slight bone formation when compared with open flap debridement in horizontal bone defects at 1-year post-operative examination according to BPD measurements.
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Affiliation(s)
- Y Kaya
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey.
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Windisch P, Szendroi-Kiss D, Horváth A, Suba Z, Gera I, Sculean A. Reconstructive periodontal therapy with simultaneous ridge augmentation. A clinical and histological case series report. Clin Oral Investig 2008; 12:257-64. [PMID: 18357474 PMCID: PMC2491434 DOI: 10.1007/s00784-008-0194-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 02/25/2008] [Indexed: 11/28/2022]
Abstract
Treatment of intrabony periodontal defects with a combination of a natural bone mineral (NBM) and guided tissue regeneration (GTR) has been shown to promote periodontal regeneration in intrabony defects. In certain clinical situations, the teeth presenting intrabony defects are located at close vicinity of the resorbed alveolar ridge. In these particular cases, it is of clinical interest to simultaneously reconstruct both the intrabony periodontal defect and the resorbed alveolar ridge, thus allowing insertion of endosseous dental implants. The aim of the present study was to present the clinical and histological results obtained with a new surgical technique designed to simultaneously reconstruct the intrabony defect and the adjacently located resorbed alveolar ridge. Eight patients with chronic advanced periodontitis displaying intrabony defects located in the close vicinity of resorbed alveolar ridges were consecutively enrolled in the study. After local anesthesia, mucoperiosteal flaps were raised, the granulation tissue removed, and the roots meticulously scaled and planed. A subepithelial connective tissue graft was harvested from the palate and sutured to the oral flap. The intrabony defect and the adjacent alveolar ridge were filled with a NBM and subsequently covered with a bioresorbable collagen membrane (GTR). At 11–20 months (mean, 13.9 ± 3.9 months) after surgery, implants were placed, core biopsies retrieved, and histologically evaluated. Mean pocket depth reduction measured 3.8 ± 1.7 mm and mean clinical attachment level gain 4.3 ± 2.2 mm, respectively. Reentry revealed in all cases a complete fill of the intrabony component and a mean additional vertical hard tissue gain of 1.8 ± 1.8 mm. The histologic evaluation indicated that most NBM particles were surrounded by bone. Mean new bone and mean graft area measured 17.8 ± 2.8% and 32.1 ± 8.3%, respectively. Within their limits, the present findings indicate that the described surgical approach may be successfully used in certain clinical cases to simultaneously treat intrabony defects and to reconstruct the resorbed alveolar ridge.
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Affiliation(s)
- Péter Windisch
- Department of Periodontology, Semmelweis University, Budapest, Hungary
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Wang HL, Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, Townsend C, Sheridan P, Genco RJ. Position Paper: Periodontal Regeneration. J Periodontol 2005; 76:1601-22. [PMID: 16171453 DOI: 10.1902/jop.2005.76.9.1601] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Murphy KG, Gunsolley JC. Guided Tissue Regeneration for the Treatment of Periodontal Intrabony and Furcation Defects.A Systematic Review. ACTA ACUST UNITED AC 2003; 8:266-302. [PMID: 14971257 DOI: 10.1902/annals.2003.8.1.266] [Citation(s) in RCA: 267] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Many clinical studies have demonstrated that guided tissue regeneration (GTR) is a successful treatment modality of periodontal reconstructive surgery and it has become an accepted procedure in most periodontal practices. RATIONALE The purpose of this structured review was to assess the efficacy of guided tissue regeneration (GTR) procedures in patients with periodontal osseous defects compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes. It extends the scope of previous GTR systematic reviews, which were limited to randomized controlled studies, by the scope of outcome measures examined, and the duration of the study. FOCUSED QUESTION In patients with periodontal osseous defects, what is the effect of physical barriers compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes? SEARCH PROTOCOL An electronic search of the Cochrane Oral Health Group Trials Register and MEDLINE databases was performed. Manual searching of journals included Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research up to January 2002. This manual search also included review of relevant bibliographies. Two manufacturers of GTR devices were contacted regarding unpublished data. SELECTION CRITERIA INCLUSION CRITERIA Studies were selected for review if the evidence level was 3B (cohort) or above, at least 6 months duration, and compared a test GTR intervention with a surgical control. EXCLUSION CRITERIA Studies with experimental design problems; histologic or microbiological investigations; or those with outcome measurements, study populations, or study duration not consistent with the inclusion criteria were excluded. Primary outcome measures for intrabony defects were: clinical attachment level (CAL) gain, probing depth reduction (PD), gingival recession (REC) reduction; for furcation defects: vertical probing attachment level (VPAL) gain, vertical probing depth reduction (VPD), horizontal probing depth reduction (HPD), horizontal open probing attachment level gain (HOPA), and vertical open probing attachment level gain (VOPA). Meta-analysis was performed to compare GTR procedures to other surgical treatments and to examine the resulting clinical outcomes. MAIN RESULTS 1. For the primary outcome variables, in both intrabony-defect and furcation-defect studies, GTR was favored over open flap debridement (OFD) therapies (P < 0.0001). 2. No differences were detected among barrier types, but barrier types could explain some heterogeneity in the results. 3. Augmentation of the GTR barrier with a particulate graft enhanced VPD (P < 0.05), VPAL, and HOPA, but none of the intrabony outcomes. REVIEWER'S CONCLUSIONS Overall, GTR is consistently more effective than OFD in the gain of clinical attachment and probing depth reduction in the treatment of intrabony and furcation defects.
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Affiliation(s)
- Kevin G Murphy
- Department of Periodontics, College of Dental Surgery, University of Maryland, Baltimore, USA.
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Stavropoulos A, Karring ES, Kostopoulos L, Karring T. Deproteinized bovine bone and gentamicin as an adjunct to GTR in the treatment of intrabony defects: a randomized controlled clinical study. J Clin Periodontol 2003; 30:486-95. [PMID: 12795786 DOI: 10.1034/j.1600-051x.2003.00258.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate whether Bio-Oss used as an adjunct to guided tissue regeneration (GTR) improves the healing of 1- or 2-wall intrabony defects as compared with GTR alone, and to examine whether impregnation of Bio-Oss with gentamicin may have an added effect. MATERIAL AND METHODS Sixty patients, with at least one interproximal intrabony defect with probing pocket depth (PPD) > or =7 mm and radiographic evidence of an intrabony component (IC) > or =4 mm, were treated at random with either a resorbable membrane (GTR), a resorbable membrane in combination with Bio-Oss impregnated with saline (DBB-), a resorbable membrane in combination with Bio-Oss impregnated with gentamicin (DBB+), or with flap surgery (RBF). RESULTS All treatment modalities resulted in statistically significant clinical improvements after 1 year. Defects treated with GTR alone presented a probing attachment level (PAL) gain of 2.9 mm, a residual PPD (PPD12) of 4.9 mm, a radiographic bone level (RBL) gain of 3.1 mm, and a residual IC (IC12) of 2.7 mm. GTR combined with Bio-Oss did not improve the healing outcome (PAL gain: 2.5 mm; PPD12: 4.9 mm; RBL gain: 2.8 mm; IC12: 3.3 mm). Impregnation of the Bio-Oss with gentamicin 2% mg/ml resulted in clinical improvements (PAL gain: 3.8 mm; PPD12: 4.2 mm; RBL gain: 4.7 mm; IC12: 2.1 mm), superior to those of the other treatment modalities, but the difference was not statistically significant. Defects treated with only flap surgery showed the most inferior clinical response (PAL gain: 1.5 mm; PPD12: 5.1 mm; RBL gain: 1.2 mm; IC12: 4.2 mm) of all groups. CONCLUSION The results failed to demonstrate an added effect of Bio-Oss implantation in combination with GTR on the healing of deep interproximal 1- or 2-wall, or combined 1- and 2-wall intrabony defects compared with GTR alone. Local application of gentamicin, on the other hand, improved the treatment outcome but not to an extent that it was statistically significant.
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Affiliation(s)
- A Stavropoulos
- Department of Periodontology and Oral Gerodontology, Royal Dental College, University of Aarhus, Denmark.
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Rosen PS, Reynolds MA. A retrospective case series comparing the use of demineralized freeze-dried bone allograft and freeze-dried bone allograft combined with enamel matrix derivative for the treatment of advanced osseous lesions. J Periodontol 2002; 73:942-9. [PMID: 12211505 DOI: 10.1902/jop.2002.73.8.942] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Combined regenerative approaches have been used for treating advanced osseous lesions around teeth. The aim of combining treatments is to enhance both clinical predictability and regenerative outcome compared to a monotherapeutic approach. This case series from a private practice reports on the clinical efficacy of an enamel matrix derivative (EMD) combined with either demineralized freeze-dried bone allograft (DFDBA) or freeze-dried bone allograft (FDBA) in the treatment of advanced infrabony lesions. The advanced lesions were veneered by a rapidly formed absorbable polymer barrier of poly(DL-lactide) to enhance graft containment. METHODS A total of 22 consecutive patients, each contributing one infrabony lesion, are reported. After patients completed presurgical preparation, the infrabony lesions were surgically treated with a combined approach that included root surface treatment with citric acid. The two groups differed in their composite graft; one received DFDBA-EMD (n = 10) and the other received FDBA-EMD (n = 12). Patients followed a stringent postoperative protocol and were evaluated 6 months postsurgery. Clinical outcomes were assessed by changes in clinical attachment level (CAL) and probing depth (PD) from pretreatment. Surgical re-entry of several sites was possible in each group. RESULTS CAL at pretreatment measured 9.2 +/- 1.3 mm and 9.1 +/- 1.9 mm for DFDBA-EMD and FDBA-EMD groups, respectively, with corresponding PD of 8.4 +/- 1.6 mm and 8.9 +/- 2.0 mm for each group. At 6 months post-treatment, CALs were reduced to 4.7 +/- 1.3 mm and 3.8 +/- 1.0 mm for DFDBA-EMD and FDBA-EMD groups, respectively; with corresponding PD decreased to 3.0 +/- 0.8 mm and 3.2 +/- 1.0 mm. Relative improvements in CAL for the DFDBA-EMD and DFDBA-EMD groups were 49.1% +/- 11.0% and 57.3% +/- 9.4%, respectively (P <0.07). CONCLUSIONS This case series demonstrates the clinical benefits of using a combined therapeutic approach in which a biologic mediator (EMD) was combined with either DFDBA or FDBA. In this limited case series, a trend was observed towards greater improvement in clinical attachment level gain in advanced infrabony defects when EMD was combined with FDBA as compared to DFDBA. Larger prospective controlled clinical trials are needed to determine if differences exist in the relative efficacy of DFDBA versus FDBA in combination with EMD.
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Affiliation(s)
- Paul S Rosen
- Department of Periodontics, Baltimore College of Dental Surgery, University of Maryland, Baltimore, USA
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Velasquez-Plata D, Scheyer ET, Mellonig JT. Clinical comparison of an enamel matrix derivative used alone or in combination with a bovine-derived xenograft for the treatment of periodontal osseous defects in humans. J Periodontol 2002; 73:433-40. [PMID: 11990445 DOI: 10.1902/jop.2002.73.4.433] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The combination of bone replacement graft materials has been suggested for the treatment of periodontal osseous defects. The purpose of this study was to evaluate the effectiveness of enamel matrix derivative (EMD) combined with a bovine-derived xenograft (BDX) as compared to EMD alone in the treatment of intraosseous defects in patients with moderate to advanced periodontitis. METHODS Sixteen adult patients with at least 2 intrabony defects were entered in this split-mouth design study. Defects were treated with EMD alone or EMD + BDX. Reentries were performed 6 to 8 months after initial surgery. The following soft and hard tissue measurements were recorded prior to initial surgery and at reentry: probing depth (PD), gingival margin location, clinical attachment level (CAL), depth of defect, and crestal bone level. Statistical analyses were performed to determine changes in PD, CAL, fill of osseous defect, and crestal resorption. Percentages of bone fill (%BF) and defect resolution (%DR) were also calculated. RESULTS The most significant results were that gingival recession was greater for the group treated with EMD alone (0.8 +/- 0.8 mm) compared to EMD + BDX (0.3 +/- 0.6 mm) (P = 0.04) and bone fill was greater for EMD + BDX (4.0 +/- 0.8 mm) compared to EMD alone (3.1 +/- 1.0 mm) (P = 0.02). The measures for PD reduction, attachment level gain, crestal resorption, %BF, and %DR did not present a statistically significant difference (P > 0.10). CONCLUSIONS This study evaluated the performance of EMD + BDX and EMD alone. The results demonstrated that a significant improvement in clinical parameters was observed. When comparing both modalities, a statistically significant difference was only found for gingival recession and bone fill, yielding a more favorable outcome towards the combined approach.
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Affiliation(s)
- Diega Velasquez-Plata
- Department of Periodontics, The University of Texas Health Science Center at San Antonio, USA
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Yukna RA, Mellonig JT. Histologic evaluation of periodontal healing in humans following regenerative therapy with enamel matrix derivative. A 10-case series. J Periodontol 2000; 71:752-9. [PMID: 10872956 DOI: 10.1902/jop.2000.71.5.752] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Enamel matrix derivative (EMD) has been developed as a stimulus of periodontal regeneration. Human histology following its use has not been evaluated on pathologically altered root surfaces. METHODS Ten intrabony defects in 8 patients were evaluated at 2 centers. Teeth with advanced adult periodontitis that were treatment planned for extraction were treated with sulcular incisions; full-thickness flap reflection; debridement of granulomatous tissue from the defect; placement of a notch in the root at the apical extent of calculus; mechanical root planing; conditioning with citric acid; application of EMD; wound closure with sutures; and placement of a periodontal dressing. Biweekly to monthly recalls were made until removal of small block section biopsies at about 6 months. The biopsies were fixed, decalcified, step-serial sectioned at 6 microns to 8 microns, and stained with hematoxylin and eosin or Masson's trichrome. RESULTS Histologic evaluation of the region coronal to the base of the calculus notch showed evidence of regeneration (new cementum, new bone, and new periodontal ligament) in 3 specimens, new attachment (connective tissue attachment/adhesion only) in 3 specimens, and a long junctional epithelium in 4 specimens. No evidence of root resorption, ankylosis, or untoward inflammation was seen. CONCLUSIONS The results of this study fulfill the proof of principle that use of EMD can result in periodontal regeneration on previously diseased root surfaces in humans, but on an inconsistent basis.
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Affiliation(s)
- R A Yukna
- Department of Periodontics, Louisiana State University School of Dentistry, New Orleans 70119, USA
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Affiliation(s)
- T Karring
- Department of Periodontology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark
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16
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Abstract
Surgical treatment of gingival recession defects aims at obtaining soft tissue coverage of exposed root surfaces and/or augmentation of gingival tissue dimensions. A variety of protocols have been developed to manage these clinical problems. Since one goal of periodontal therapy is the regeneration of the lost attachment apparatus of the tooth, full restoration of defect should be accomplished following mucogingival procedures. This implies regeneration of all periodontal structures, including formation of new cementum with inserting connective tissue fibers, alveolar bone regeneration and recreation of a functional and aesthetic morphology of the mucogingival complex. Animal and human histological studies have shown that healing at gingiva-root interface following pedicle flaps or free soft tissue grafts generally includes a long junctional epithelium with varying amounts of a new connective tissue attachment in the most apical aspect of the covered root surface. Limited bone regeneration has been observed. Adjunctive use of root conditioning agents and cell excluding, wound-stabilizing devices may amplify regenerative outcomes. Changes in the amount of keratinized tissue, which can significantly affect the aesthetic outcome of treatment, have been shown to depend on the interactions among various tissues involved in the healing process and the selected surgical procedure.
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Affiliation(s)
- L Trombelli
- Department of Periodontology, School of Dentistry, University of Ferrara, Italy
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17
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Mayfield L, Söderholm G, Hallström H, Kullendorff B, Edwardsson S, Bratthall G, Brägger U, Attström R. Guided tissue regeneration for the treatment of intraosseous defects using a biabsorbable membrane. A controlled clinical study. J Clin Periodontol 1998; 25:585-95. [PMID: 9696260 DOI: 10.1111/j.1600-051x.1998.tb02492.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this controlled, clinical study was to evaluate guided tissue regeneration using a bioabsorbable membrane in periodontal intraosseous defects. Forty patients, each contributing one defect > or =4 mm in depth participated. The control group (18 individuals) received conventional flap therapy, while the test group (22 individuals) was treated using the bioabsorbable membrane, Guidor. Clinical assessments were made by one examiner, blinded with respect to treatment group, at baseline, 6 and 12 months following surgery. Baseline probing pocket depths of 7.7+/-1.4 mm in the membrane group and 7.6+/-1.9 mm in the control group were measured. Twelve month results showed a significant clinical attachment level gain in both control (1.1+/-1.8 mm), and membrane group (1.3+/-2.1 mm). Probing pocket depth reduction of 2.6+/-1.9 mm and 2.7+/-1.9 mm was observed in the respective groups. Bone sounding showed a non-significant gain of 0.4+/-1.8 mm and 0.6+/-1.4 mm at membrane and control sites, respectively. Radiographic evaluation confirmed these results. There were no significant differences found between treatment groups for any of the tested variables. Smoking had a negative effect on healing in both groups. In conclusion, clinical and radiographic results indicate that guided tissue regeneration using a bioabsorbable membrane at intraosseous defects did not predictably achieve greater clinical attachment level gain nor bone gain when compared to conventional flap therapy.
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Affiliation(s)
- L Mayfield
- Lund University, Faculty of Odontology, Malmö, Sweden
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18
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Pellen-Mussi P, Fravalo P, Guigand M, Bonnaure-Mallet M. Evaluation of cellular proliferation on collagenous membranes. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1997; 36:331-6. [PMID: 9260104 DOI: 10.1002/(sici)1097-4636(19970905)36:3<331::aid-jbm8>3.0.co;2-f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Collagenous membranes are used in guided tissue regeneration designed to repair damage done to the periodontium by disease. The cells primarily responsible for the process are desmodontal fibroblasts. We have studied the behavior and proliferation of fibroblasts grown on collagenous membrane. Fibroblasts grown on plastic served as control. Cellular proliferation was evaluated using a colorimetric test for cytotoxicity and by flow cytometry. Scanning electron microscopy was used to observe cellular morphology. Results showed a reduction in cell number, together with a modification in cell cycle, but good preservation of cellular morphology for cultures grown on collagenous membrane. These results support the in vivo use of collagenous membrane in guided tissue regeneration.
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19
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Kiliç AR, Efeoğlu E, Yilmaz S. Guided tissue regeneration in conjunction with hydroxyapatite-collagen grafts for intrabony defects. A clinical and radiological evaluation. J Clin Periodontol 1997; 24:372-83. [PMID: 9205915 DOI: 10.1111/j.1600-051x.1997.tb00200.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This clinical and radiological study evaluated the healing of 3 + 2 + 1 wall-combined intrabony defects treated using the guided tissue regeneration technique (GTR) with and without hydroxyapatite-collagen alloplastic graft materials (HAC), in comparison to that of HAC alone and conventional flap surgery (CF). 40 interproximal defects with probing depth > 6 mm were treated in 18 adult periodontitis patients of ages 35-60 years. After non-surgical therapy, the defects were randomly grouped into 4 groups of 10 defects each. These groups were designated: (1) expanded polytetrafluoroethylene membrane (e-PTFE), (2) e-PTFE + HAC, (3) HAC alone and (4) CF. At 6 months, the following changes in parameters were recorded. Mean PPD reduction for each group was 5.83, 5.85, 3.80 and 3.17 mm respectively. PPD reduced very significantly in all groups (p < 0.01), the highest and lowest reductions in PPD being for the e-PTFE + HAC and CF group respectively. Comparison between the 4 groups showed higher PPD reduction in both membrane groups than in either of the non membrane groups (p < 0.05) with the difference between the e-PTFE and CF groups being very highly significant (p < 0.001). Mean attachment gain for the 4 groups was 3.70, 3.80, 2.60 and 2.1 mm, respectively. Similarly attachment gain for all groups was very significant (p < 0.01) and the highest and lowest attachment gains were for the e-PTFE + HAC and CF group respectively. Both membrane groups showed significantly more attachment gain than the CF group (p < 0.05). Change in probing bone level (BL) for the 4 groups was 1.60, 1.90, 1.0 and 0.65 mm respectively. Again the highest changes in BL were recorded for the e-PTFE + HAC group. Significant differences were found between both membrane groups and the CF group (p < 0.05). Radiological evaluation using standardized radiographs and millimeter grids showed change in radiographic bone level at the deepest point of the defect on the radiograph to be 1.50, 1.55, 0.85 and 0.60 mm, respectively and this was significantly higher in both membrane groups than in the CF group (p < 0.05). This study therefore found e-PTFE membranes both alone and when combined with HAC to lead to more attachment gain and bone fill than did HAC alone or CF. It found HAC combined with e-PTFE to perform better although not significantly better than e-PTFE alone.
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Affiliation(s)
- A R Kiliç
- Department of Pariodontology, Faculty of Dentistry, Marmara University, Nişantaşi, Istanbul, Turkey
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20
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Abstract
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.
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Affiliation(s)
- S Garrett
- Attrix Laboratories, Fort Collins, Colorado, USA
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21
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Froum SJ. Human histologic evaluation of HTR polymer and freeze-dried bone allograft. A case report. J Clin Periodontol 1996; 23:615-20. [PMID: 8841892 DOI: 10.1111/j.1600-051x.1996.tb00584.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This case report compares the results of placement of HTR (Hard Tissue Replacement Synthetic Bone) and freeze-dried bone allograft (FDBA) in the same patient. 2 notches were made in each of 6 teeth, 1 at the gingival margin and the other at the most apical level of calculus. Soft tissue responses with both materials included probing depth reduction, gingival shrinkage and gain in clinical attachment. Histological sections of block extraction sites 30 months after placement of either material showed no signs of new attachment. Little or no inflammation was present with both materials. There was also an absence of all FDBA particles which assumes complete resorption of this material prior to 30 months. Gingival shrinkage resulted in the exposure of the gingival and calculus notch in all FDBA treated sites. Gingival epithelium was found adjacent to the gingival notch in all HTR treated sites. The calculus notch in HTR treated sites was lined by junctional epithelium with connective tissue and bone opposing the adhesion. HTR particles were present and surrounded by connective tissue or bone. HTR appears to serve as a scaffold for new bone formation when in close contact with alveolar bone.
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Affiliation(s)
- S J Froum
- Department of Surgical Sciences (Periodontics) and Implants, New York University Dental Center, NY 10010-4099, USA
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22
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Iversen B, Albandar JM, Oydna J, Gjermo P. Bone density changes after 1 year in periodontal lesions treated surgically with or without ePTFE membrane placement. J Clin Periodontol 1996; 23:512-6. [PMID: 8811469 DOI: 10.1111/j.1600-051x.1996.tb01818.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The present study was designed to quantitatively assess radiographic changes in alveolar bone density in intrabony defects treated with expanded polytetrafluorethylene membranes (ePTFE) or by conventional flap surgery alone. 15 patients with 2 periodontal defects of comparable morphology which could be depicted on a single radiograph made up the test panel. Standardized radiographs of the periodontal defects were taken immediately prior to surgery and 12 months later. The 2 defects were treated simultaneously using the modified Widman flap procedure and prepared for membrane placement. Then one of the lesions was randomly assigned for treatment with the membrane. All radiographs and surgical procedures were managed by one person. The radiographs were assessed by another person according to a blind design. Periodontal defects treated with ePTFE membranes (test), and sites treated by conventional flap procedures (control) were then analyzed using a computerized image analysis program. In 8 patients, the test site outcome was better than the outcome in the control site. 6 of the control sites indicated increased bone density, while 7 sites showed decreased values, and 2 sites were unchanged. The corresponding values from the test sites were 5, 6 and 4, respectively. In the present controlled clinical study, the use of an ePTFE membrane to cover the opening of a vertical bone defects during periodontal surgery did not predictably increase the bone density of the defects.
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Affiliation(s)
- B Iversen
- Department of Periodontology, Dental Faculty, University of Oslo, Norway
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23
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Abstract
Bone allografts as used in dentistry have a 20-year history of safety and efficacy. Case reports and controlled clinical trials have shown the potential of both mineralized and decalcified cortical freeze-dried bone allograft to reconstruct the bone defects caused by periodontitis. Histomorphometric analysis of human biopsies following grafts of decalcified freeze-dried bone allograft have shown the ability of decalcified freeze-dried bone allograft to promote regeneration of new bone, cementum, and periodontal ligament on a tooth root surface previously exposed to bacterial plaque. The addition of mineralized freeze-dried bone allograft and decalcified freeze-dried bone allograft to the guided tissue and guided bone regeneration procedures have significantly enhanced results, especially in large osseous lesions.
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Affiliation(s)
- J T Mellonig
- Department of Periodontics, The University of Texas Health Science Center, San Antonio, TX 78284-7894, USA
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24
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Novaes AB, Gutierrez FG, Francischetto IF, Novaes AB. Bacterial colonization of the external and internal sulci and of cellulose membranes at time of retrieval. J Periodontol 1995; 66:864-9. [PMID: 8537869 DOI: 10.1902/jop.1995.66.10.864] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Membrane exposure with bacterial contamination is often considered one of the main reasons for the lack of predictability in achieving complete regeneration of periodontal defects. Ten cellulose membranes, retrieved from 7 patients treated for Class II furcation lesions in lower molars with at least 4 mm of exposure at time of retrieval were studied. Contamination of exposed membranes was studied using SEM analysis of four surfaces of the membrane, upper external, lower external, upper internal, and lower internal surfaces. DNA probe analysis of three periodontopathic bacteria, Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinmycetemcomitans, was carried out for specimens collected from the external and internal sulci. The results suggest that bacterial contamination of the membranes could be controlled if proper pre- and postoperative care is followed, since significant amounts of any of the three periodontopathogenic bacteria studied were not found. The SEM analysis corroborated the DNA probe analysis since the predominant morphotypes detected were not suggestive of periodontopathogenic bacteria. The importance of membrane contamination and of root concavities in the lack of predictability of the GTR procedure is discussed.
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Affiliation(s)
- A B Novaes
- Department of Periodontology, School of Dentistry, Federal University of Rio de Janeiro, Brazil
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25
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Cortellini P, Pini Prato GP, Tonetti MS. No detrimental effect of fibrin glue on the regeneration of intrabony defects. A controlled clinical trial. J Clin Periodontol 1995; 22:697-702. [PMID: 7593700 DOI: 10.1111/j.1600-051x.1995.tb00829.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This controlled clinical trial evaluated the potential of fibrin glue as a biological carrier to locally deliver guided tissue regeneration (GTR) modulators, 2 controlateral, morphologically similar defects were selected in each of 11 patients and randomly assigned to the test (teflon membrane and fibrin glue) and the control treatment (teflon membrane alone). Outcomes were assessed at membrane removal as newly formed granulation tissue and at the 1-year follow-up in terms of changes in probing attachment level, probing pocket depth, recession of the gingival margin, probing bone levels and percentage of fill of the intrabony defects. Data confirmed that GTR treatment of deep intrabony defects results in clinically and statistically significant improvements of the clinical parameters. No significant differences, however, were evidenced between the test and the control treatments. It is suggested that, since fibrin glue did not show detrimental effects on GTR, it could be applied as a biological carrier for the delivery of GTR enhancers into the surgical wound.
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Affiliation(s)
- P Cortellini
- Department of Periodontology, School of Dental Medicine, University of Siena, Italy
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26
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Israel M, Rossmann JA, Froum SJ. Use of the carbon dioxide laser in retarding epithelial migration: a pilot histological human study utilizing case reports. J Periodontol 1995; 66:197-204. [PMID: 7776164 DOI: 10.1902/jop.1995.66.3.197] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Predictable regeneration of tooth-supporting tissues lost to periodontal disease is the aim of periodontal therapy. Often the result of conventional treatment is healing with a long junctional epithelium along the root surface and little regeneration of the complete attachment apparatus. The purpose of this pilot study was to evaluate whether de-epithelialization with a CO2 laser at the time of flap surgery and at 10-day intervals over the first 30 days of healing has the potential to enhance the formation of a connective tissue attachment. Six mandibular incisors in two patients were selected for the study. Each patient received oral hygiene instruction and initial therapy prior to surgery. The teeth were splinted together, open flap debridement was performed on all teeth, a notch was placed on the roots at the height of the crest of the alveolar bone, and the flaps were sutured in place. The test side received controlled de-epithelialization of the outer (oral) gingiva with the carbon dioxide laser, and the inner gingival flap. The de-epithelialization was repeated on the test side at 10, 20, and 30 days postsurgically. Controls received open debridement only. Block sections were taken at 90 days and processed for histologic analysis. The results showed that for both patients, junctional epithelium (JE) was formed on both test and control teeth. In all control teeth, the JE extended the entire length of the root to the base of the reference notch.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Israel
- Department of Implantology and Surgical Sciences, New York University Dental Center, NY, USA
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27
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Florès-de-Jacoby L, Zimmermann A, Tsalikis L. Experiences with guided tissue regeneration in the treatment of advanced periodontal disease. A clinical re-entry study. Part I. Vertical, horizontal and horizontal periodontal defects. J Clin Periodontol 1994; 21:113-7. [PMID: 8144730 DOI: 10.1111/j.1600-051x.1994.tb00288.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this study was to evaluate the predictability of guided tissue regeneration (GTR), using ePTFE-membranes (Gore-Tex) in the treatment of advanced periodontal disease. The study presents long-term results for 88 teeth in 23 patients at least 9 months after membrane surgery. The periodontal lesions included severe horizontal and/or vertical bone loss. The bone level (BL and BL') and the tissue level (TL), a new parameter between cemento-enamel junction and coronal margin of the tissue in the defect, were recorded during surgery: immediately before application of the membrane (BL), after membrane removal (TL) and during a re-entry procedure (BL') 9 to 12 months later. The average tissue gain in the periodontal defect (BL-Tl) at membrane removal was 65.7% (p < 0.001) and the average gain in mineralized tissue at re-entry (BL-BL'), 30.4%, meaning more than 46% of the gained tissue at removal was mineralized at re-entry. The decreased amount of mineralized tissue at re-entry in relation to the tissue gain at membrane removal might be due to formation of a so-called long connective tissue attachment or to mineralization-induced shrinkage of the new tissue and some surgical difficulties in coverage of the newly formed tissue. Nevertheless, an absolute gain of 31% mineralized tissue after GTR can provide a marked improvement in the prognosis of a periodontally severely damaged tooth.
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Affiliation(s)
- L Florès-de-Jacoby
- Department of Periodontology, Dental School, Philipps-University Marburg, Germany
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28
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Tempro PJ, Nalbandian J. Colonization of retrieved polytetrafluoroethylene membranes: morphological and microbiological observations. J Periodontol 1993; 64:162-8. [PMID: 8463937 DOI: 10.1902/jop.1993.64.3.162] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Polytetrafluoroethylene membranes (ePTFE) used in guided tissue regeneration (GTR) are accessible to colonization by oral bacteria. The bacterial composition of the adherent biomass is unknown. We examined a total of 6 membranes that were retrieved after 4 to 6 weeks from human periodontitis sites, using optical and transmission electron microscopy (TEM) as well anaerobic cultivation. Five of the 6 membranes provided the microbiological data and microscopic data. TEM revealed an organized microbial mass covering the surfaces and also within the interstices of the open microstructure and occlusive portions of the membranes. Numerous bacterial forms including cocci, rods, and filaments with an interbacterial matrix, frequently in microcolonies, were identified. Anaerobic cultivation yielded Streptococcus and Actinomyces species with a minor component of Gram-negative facultative rods comprised mainly of Haemophilus species. Candida species was recovered from one membrane. These data show that ePTFE is heavily colonized by oral bacteria during retention. The impact of bacterial colonization of ePTFE is not known but it seems reasonable to assume that colonization of membranes may affect connective tissue regeneration. Further studies will be needed to examine the effect of systemic antimicrobials on ePTFE colonization and in turn to examine the effect on GTR.
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Affiliation(s)
- P J Tempro
- Department of Periodontology, University of Connecticut School of Dental Medicine, Farmington
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31
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Selvig KA, Kersten BG, Chamberlain AD, Wikesjö UM, Nilvéus RE. Regenerative surgery of intrabony periodontal defects using ePTFE barrier membranes: scanning electron microscopic evaluation of retrieved membranes versus clinical healing. J Periodontol 1992; 63:974-8. [PMID: 1474469 DOI: 10.1902/jop.1992.63.12.974] [Citation(s) in RCA: 144] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sixteen intrabony defects in 12 patients were treated by gingival flap surgery including root surface debridement and placement of an expanded polytetrafluoroethylene (ePTFE) membrane. The membranes were removed after 4 to 6 weeks and examined by scanning electron microscopy (SEM) for bacterial contamination and adherent connective tissue elements. Twelve months postsurgery, the defect sites were reexamined for changes in probing attachment level and probing bone level. Comparison of ultrastructural findings and clinical observations revealed that extent of bacterial contamination of the membrane correlated inversely with clinical assessment of attachment gain. The results indicate that the extent of oral exposure and bacterial contamination of the ePTFE membrane at the time of removal may be an indicator of the long-term success or failure of the regenerative procedure.
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Affiliation(s)
- K A Selvig
- Department of Dental Research, University of Bergen, School of Dentistry, Norway
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32
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Jendresen MD, Allen EP, Bayne SC, Hansson TL, Klooster J, Preston JD. Report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 1992; 68:137-90. [PMID: 1403904 DOI: 10.1016/0022-3913(92)90302-q] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The committee screened several hundred articles, citing 518 published papers. Some are present quality in research, others provide clinical interest, and some are identified as misleading. New techniques in pulp physiology and pathology are reported. Laser use and techniques in prevention, restorative dentistry, and materials use are reported. Epidemiology of selected diseases and the results of various formulations for treatment are cited. Diagnosis of craniomandibular dysfunction is well represented as well as references to literature reviews and other sophisticated scientific investigation. Research on adhesives is presented in respect to bonding agents for dentin and enamel. Several clinical studies are included, along with customary laboratory reports on several materials.
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33
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Schroeder HE. Biological problems of regenerative cementogenesis: synthesis and attachment of collagenous matrices on growing and established root surfaces. INTERNATIONAL REVIEW OF CYTOLOGY 1992; 142:1-59. [PMID: 1487394 DOI: 10.1016/s0074-7696(08)62074-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- H E Schroeder
- Department of Oral Structural Biology, University of Zurich, Switzerland
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34
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Stahl SS, Froum S. Human suprabony healing responses following root demineralization and coronal flap anchorage. Histologic responses in 7 sites. J Clin Periodontol 1991; 18:685-9. [PMID: 1960237 DOI: 10.1111/j.1600-051x.1991.tb00110.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
6 suprabony pockets in 2 adult patients were treated with debridement and citric acid root demineralization. Following these procedures, coronal positioning of the marginal flaps was performed at 2 sites. At 4 sites, the marginal flaps were sutured coronally using orthodontic brackets as anchors. At 1 additional site, root debridement only was performed and the margin was placed at about crestal level. Prior to root planing, all roots were notched both at the level of the gingival margin and the most apically positioned calculus. Blocks were harvested 7 and 18 weeks postsurgery and prepared for histologic analysis. Clinical results showed a gain in probing attachment in both coronally positioned sites (average = 1.8 mm) and coronally anchored sites (average = 4.5 mm). The additional debrided-only site showed a gain in probing attachment of 0.1 mm. Histologically, new cementum with functionally inserted fibers was seen within the calculus notch in all coronally anchored sites. This new attachment was associated with crestal osteogenesis. In the 2 coronally positioned and root demineralized sites, new attachment was seen within the calculus notch in 1 out of the 2 specimens evaluated. Within the limits of the evidence presented, coronal anchorage of flaps enhanced probing attachment and new attachment when used in conjunction with root demineralization.
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Affiliation(s)
- S S Stahl
- Department of Periodontics, College of Dentistry, New York University, New York 10010
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35
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Stahl SS, Froum S. Human intrabony lesion responses to debridement, porous hydroxyapatite implants and teflon barrier membranes. 7 histologic case reports. J Clin Periodontol 1991; 18:605-10. [PMID: 1665499 DOI: 10.1111/j.1600-051x.1991.tb00097.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
7 vertical lesions at 7 teeth in 3 adults with severe periodontitis were treated using open surgical debridement, porous hydroxyapatite grafts and placement of a barrier membrane. Roots were notched at both gingival margins and deepest visible calculus. Flaps were sutured coronally and patients were placed on 0.12% chlorohexidine gluconate twice daily for 2 weeks, post-surgery. Patients returned frequently for plaque control until block removal at 16 to 28 weeks post-surgery. 1 additional block was harvested after 28 weeks. The latter site received root planing only and closed by epithelial adhesion. In the 7 experimental sites, clinical responses were uneventful, and gain in clinical closure varied from 1.7 to 5.0 mm (average = 3.6 mm). Histologically, 2 sites exhibited closure by a long junctional epithelium. The remaining 5 sites showed gingival recession to be apical to the calculus notch or the calculus notch to be epithelialized. However, apical to the notch and within the osseous crater, cellular cementum deposition was marked as was increased bone mass. The increase in bone mass was the result of osteogenesis within the surrounding graft particles which often fused with osseous seams of the crater. A functionally-oriented PDL was seen usually at these sites.
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Affiliation(s)
- S S Stahl
- Department of Periodontics, New York University College of Dentistry, New York 10010
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36
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Stahl SS, Froum S. Histologic healing responses in human vertical lesions following the use of osseous allografts and barrier membranes. J Clin Periodontol 1991; 18:149-52. [PMID: 2005229 DOI: 10.1111/j.1600-051x.1991.tb01705.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
4 vertical lesions at 3 teeth in 2 volunteer adults with severe periodontitis were treated by open surgical debridement, osseous allografts and barrier membranes. Roots were notched at both gingival margins and the deepest visible calculus and flaps were sutured coronally. Patients were placed on 0.12% chlorhexidine gluconate 2x daily post-surgery, and blocks were harvested 5 to 6 weeks after surgery. No abnormal clinical responses were noted during the observation period. In the 4 sites, the average preoperative pocket depth was 9.4 mm; the post-operative pocket depth averaged 4.9 mm, recession averaged 0.9 mm and gain in clinical closure averaged 3.6 mm. Histologically, new cementum measured coronally-apically at the treated sites varied from 0.0 mm to 1.7 mm, with an average of 1.1 mm. Osseous remodelling and crestal osteogenesis were seen in association with cementogenesis. The newly deposited cementum showed insertion of functional oriented fibers. New attachment was present within 2 out of 4 calculus notches in this sample.
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Affiliation(s)
- S S Stahl
- Department of Periodontics, College of Dentistry, New York University, New York 10010
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