The use of 2 bioabsorbable barrier membranes in the treatment of interproximal intrabony periodontal defects

BACKGROUND

The use of barrier membranes in the treatment of periodontal defects is well documented. There has been an increase in the use of bioabsorbable materials which do not require a second surgical procedure for removal. However, there are little data evaluating the efficacy of bioabsorbable membranes in the treatment of intrabony defects. The purpose of this investigation was to evaluate the regenerative potential of 2 bioabsorbable barrier membranes without the use of grafting materials in the treatment of interdental intrabony defects.

METHODS

Twenty-three 2- or 3-walled intrabony defects were treated in 19 patients with a mean age of 50.4 years. All had completed nonsurgical treatment and a period of supportive periodontal therapy. The sites were randomly chosen to receive a barrier membrane composed of type I bovine collagen (11) or a copolymer of polylactic acid (PGA/PLA;12). A pressure sensitive disc probe was used to evaluate the following criteria at baseline and re-entry: 1) occlusal surface to the apical depth of probe penetration (OS-DP); 2) occlusal surface to the gingival margin (OS-GM); 3) occlusal surface to the alveolar crest (OS-AC); and 4) occlusal surface to the base of the osseous defect (OS-BD). Full thickness mucoperiosteal flaps were reflected to expose the surgical sites. The defects were debrided of the granulomatous tissue, the root surfaces instrumented and conditioned with 4 one-minute applications of 50 mg/ml of tetracycline. The barrier membranes were adapted to cover the defects and the flaps replaced. The postsurgical healing was uneventful and similar in both treatment modalities.

RESULTS

Twenty-three sites were surgically re-entered 6 months from the time of the initial surgery. The deepest probe depth for each site was used for statistical analysis. There was a mean relative attachment gain of 2.58+/-1.90 mm for the collagen, and 2.77+/-2.13 mm for the copolymer. There was a decrease in probing depth of 3.27+/-1.91 mm and 0.69+/-1.35 mm of recession for the collagen. The PGA/PLA copolymer had 3.55+/-2.47 mm reduction in probe depth and 0.78+/-1.14 mm of recession.

CONCLUSIONS

The data indicated the bioabsorbable collagen and copolymer membranes resulted in comparable results. A larger sample size would be necessary to determine if one membrane was superior to the other.

Complications associated with diabetes mellitus after guided tissue regeneration: case report

Dental practitioners need to be aware of the complications that can arise in the management and treatment of patients with diabetes mellitus. Patients with diabetes, and patients with a family history of diabetes, are at-risk dental patients. They are more likely to develop periodontal disease, and the periodontitis is more likely to be severe. Diabetes influences the progression and severity of periodontitis through changes in the small blood vessels, decreased collagen formation, and impairment of the host's defense mechanisms. Furthermore, complications associated with diabetes, such as impaired wound healing, can affect the patient's response to periodontal therapies like guided tissue regeneration (GTR). The case report in this article discusses the postsurgical complications that occurred during GTR treatment of a patient with non-insulin-dependent diabetes. The diabetic's susceptibility to periodontal disease and impaired wound healing can affect the progression of the disease and its treatment. Dental patients with diabetes require close supervision and frequent monitoring of their medical and dental health by the dental clinician.

The effects of a pulsed Nd:YAG laser on subgingival bacterial flora and on cementum: an in vivo study

The purpose of this study was to compare the effects of scaling and Nd:YAG laser treatments with that of scaling alone on cementum and levels of Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis, and Treponema denticola. Study samples consisted of 14 patients, age 30 to 75 years, 8 females and 6 males, with a total of 150 periodontally involved sites with probing depth > or = 5 mm. Group A consisted of 100 pockets that were subdivided into 4 equal groups that were treated with conventional scaling and pulsed Nd:YAG laser using an optic fiber of 300 microns and 4 different power levels as follows: Group 1: P = 0.8 W, f = 10 Hz, E = 100 mJ/pulse; Group 2: P = 1.0 W, f = 1.0 Hz, E = 100 mJ/pulse; Group 3: P = 1.2 W, f = 12 Hz, E = 100 mJ/purse; and Group 4: P = 1.5 W, f = 15 Hz, E = 100 mJ/pulse. The time of each treatment was 60 sec per pocket in all 4 groups. Group B consisted of 50 pockets that were treated by conventional scaling alone and served as a control group. Microbiological samples from group A were collected before scaling; after scaling = before laser, just after laser, 2 weeks later, 6 weeks later, and 10 weeks later. Microbiological samples from group B were collected before scaling, after scaling, 6 weeks later, and 10 weeks later. Microbiological analysis of all samples was done by the Institute Für Angewandte Immunologie (IAI) method. The effects of laser on root surfaces were assessed by SEM examination and the sample consisted of 13 teeth from 5 different patients. Four sets of 3 teeth each were treated with Nd:YAG laser using 0.8, 1.0, 1.2, and 1.5 W, respectively. One tooth was just scaled and not treated with laser to serve as a control. Microbiological analysis of Group A samples indicated posttreatment reduction in levels of all 4 bacterial types tested compared to pretreatment levels and Group B controls. SEM examination of the specimens treated with Nd:YAG laser at different levels exhibited different features of root surface alterations.

Treatment of intrabony defects with collagen membrane barriers. Case reports

Two separate investigations were undertaken to assess the clinical characteristics and the safety, and to determine whether an absorbable type 1 bovine collagen barrier membrane would result in the improvement of clinical parameters during guided tissue regeneration in humans. The collagen membrane barrier was placed over a total of 21 interdental intrabony periodontal defects in 18 patients. The surgical procedures and postsurgical regimen were similar in both components of the investigation. Sulcular incisions were used and the sites were surgically exposed by reflection of full thickness mucoperiosteal flaps. The intrabony defects were debrided and the root surfaces prepared with automatic scalers and curets. Four 1-minute applications of tetracycline HCl 50 mg/ml were applied to the root surface. The collagen membrane barrier was hydrated in sterile saline until pliable, then trimmed so it covered the osseous defect and extended 2 to 3 mm beyond the defect. In both investigations, the collagen barrier membrane was not sutured, but retained by "pouching" or undermining the flap. Healing occurred without complications. There were no untoward or adverse reactions to the material in either phase of the study. In the initial investigation, 13 intrabony defects with probing depths of > or = 5 mm were treated in 9 patients having a mean age of 50.6 years. No controls defects were treated. Soft and hard tissue measurements were taken at the time of initial surgery and at 2, 4, and 6 months. In the second phase, 9 patients were enrolled with a mean age of 49.7 years. They had similar bilateral interdental intrabony defects with probing depths > or = 6 mm. One defect received the collagen membrane barrier, while the other was treated by flap debridement alone. The collagen membrane had undergone modification since the initial investigation, and was more highly cross-linked to retard absorption. After initial therapy, and prior to the surgical procedure, a series of 3 dermal patch tests were used to determine whether the patient would elicit a reaction to the collagen. Venous blood was drawn at baseline, 7 to 10 days, 18 to 21 days and at 8 weeks for analysis by ELISA for comparison of test and control sites relative to baseline. There were no allergic response to the dermal tests, and the ELISA tests indicated no significant differences between test and control sites. An automated probe was used to record soft and hard tissue measurements. These included the probing depths and clinical attachment levels.(ABSTRACT TRUNCATED AT 400 WORDS)