Effects of polyglactin mesh combined with resorbable calcium carbonate or replamineform hydroxyapatite on periodontal repair in dogs

Abstract This study evaluates periodontal repair and biomaterial reaction following implantation of a polyglactin mesh with or without porous resorbable calcium carbonate (RCC) or porous replamineform hydroxyapatite (RHA) in conjunction with reconstructive surgery. Ligature- and surgically-induced interproximal periodontal defects of left and right mandibular premolar teeth in 7 dogs were used. Bilaterally, mesial defects of the 2nd, 3rd and 4th premolar teeth were treated with polyglactin mesh, polyglactin mesh and RHA. or polyglactin mesh and RCC. respectively. The polyglactin mesh, shaped according to the contour of the defect, was adapted to the experimental teeth: its coronal margin positioned immediately apical to the cemento-enamel junction. Gingival flap margins were adapted and sutured to cover the polyglactin mesh completely. Clinical healing was generally uneventful. The dogs were sacrificed to provide block sections for histologic evaluation at 1, 3, 6, 12, 26, 32 and 56 weeks following wound closure. Generally, cementum regeneration was observed beginning at week 6 in all groups. Bone regeneration was observed from week 3 in polyglactin mesh-treated groups, and from week 6 in polyglactin mesh + RCC or polyglactin mesh + RHA treated groups. Bone regeneration appeared enhanced in polyglactin mesh + RCC or polyglactin mesh + RHA treated defects at week 12 and 26, with little difference between the three experimental conditions at week 56. Polyglactin mesh degradation was observed at week 3 and appeared complete at week 12. The RHA did not appear to resorb, while the RCC was gradually replaced by bone from week 3. Within limitations of the study conditions, periodontal regeneration was observed following implantation of a polyglactin mesh with or without RCC or RHA in conjunction with reconstructive surgery. As a conclusion, there seems to be no significant difference in periodontal regeneration after 12 months of healing between the group treated with the membrane only, and the group treated with the membrane and the bone substitution material. Changes in connective fiber orientation over the 1st 12 weeks of healing may suggest that “fibrous encapsulation” observed in earlier studies may only represent a transient stage in periodontal regeneration.     

Autogenous bone graft in conjunction with enamel matrix derivative in the treatment of deep periodontal intra-osseous defects: a report of 13 consecutively treated patients

AIM: The purpose of the present study was to investigate the effectiveness of a regenerative procedure based on supra-crestal soft tissue preservation in association with combined autogenous bone (AB) graft/enamel matrix derivative (EMD) application in the treatment of deep periodontal intra-osseous defects. METHODS: Thirteen consecutively treated patients, seven females and six males, aged 30-65 years, three smokers, were included. A total of 15 deep, one- to two-wall intra-osseous defects were selected. Immediately before surgery and 6 months after surgery, pocket probing depth (PPD), clinical attachment level (CAL), and gingival recession (REC) were recorded. RESULTS: PPD amounted to 9.4+/-1.8 mm before surgery, and decreased to 4.7+/-1.2 mm post-surgery (p<0.0000). CAL varied from 10.5+/-2.0 mm pre-surgery to 6.2+/-1.7 mm post-surgery (p<0.0000), with CAL gain averaging 4.3+/-1.4 mm. Fourteen (93.3%) defects presented CAL gain >/=3 mm. REC change was 0.4+/-0.7 mm. CONCLUSIONS: Results from the present study indicated that a regenerative procedure based on supra-crestal soft tissue preservation and combined AB/EMD treatment leads to a clinically and statistically significant improvement of soft tissue conditions of deep periodontal intra-osseous defects.     

Effects of EMD in combination with bone swaging and calcium phosphate bone cement on periodontal regeneration in one‐wall intrabony defects in dogs

Background and Objective: Although the application of EMD is a widely accepted periodontal‐regenerative therapy, its effects on noncontained intrabony defects are unpredictable because of the lack of a space‐making property. The combined use of EMD and autogenous bone grafts reportedly stimulates significant periodontal regeneration in intrabony defects. The aim of the present study was to evaluate the effects of EMD in combination with bone swaging (BS) and injectable calcium phosphate bone cement (CPC), which was placed into the spaces between the grafted swaged bone and the proximal host bone, on periodontal healing in one‐wall intrabony defects in dogs. Material and Methods: One‐wall intrabony defects (3 mm wide and 5 mm deep) were surgically created on the mesial and distal sides of the bilateral mandibular premolars in four dogs. The 16 defects were assigned to one of the following treatments: EMD only, BS only, EMD with BS (EMD + BS), or EMD with BS and CPC (EMD + BS + CPC). The animals were killed 8 wk after surgery for histologic evaluation. Results: The height of newly formed bone was significantly greater in the EMD + BS + CPC group (3.73 ± 0.30 mm) than in the BS‐only (2.74 ± 0.33 mm; p < 0.05) and EMD + BS (2.88 ± 0.98 mm; p < 0.05) groups. The area of newly formed bone was significantly larger in the EMD + BS + CPC group (5.68 ± 1.66 mm²) than in the EMD‐only (3.68 ± 0.33 mm²; p < 0.05), BS‐only (3.48 ± 1.26 mm²; p < 0.05) and EMD + BS (3.38 ± 1.37 mm²; p < 0.05) groups. The EMD‐only (4.63 ± 0.42 mm), EMD + BS (4.67 ± 0.30 mm) and EMD + BS + CPC (4.78 ± 0.54 mm) groups showed significantly greater cementum formation than did the BS‐only group (3.93 ± 0.56 mm; p < 0.05). Conclusion: These results indicate that treatment with EMD + BS + CPC promotes favorable periodontal healing in one‐wall intrabony defects in dogs.     

Thirty-six month follow-up of 25 patients treated with combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell-binding peptide (P-15) bone replacement grafts in human infrabony defects. I. Clinical findings

BACKGROUND: Long-term evaluation of periodontal therapy is important for clinical decision making. METHODS: A synthetic cell-binding peptide (P-15) combined with anorganic bovine-derived hydroxyapatite bone matrix (ABM) was evaluated as a bone replacement graft in human periodontal osseous defects. Following initial preparation and reevaluation, flap surgery was performed. A variety of 1-, 2-, 3-wall bony defects were curetted and root surfaces subjected to mechanical debridement only. The bone defects were grafted with ABM/P-15, and the host flaps replaced or slightly coronally positioned. Weekly, then monthly deplaquing was performed until surgical reentry at 6 to 7 months. Patients were then followed on approximate 3-month recalls for 3 years. Twenty-five of the original 31 patients qualified for long-term evaluation in that their ABM/P-15 treated sites did not receive any additional therapy at the time of reentry. RESULTS: Significant clinical changes for the overall group of bony defects included improvement in mean clinical attachment level from 5.4 mm at surgery to 4.5 mm at the 6-month reentry to 3.8 mm at 3 years. There was also a decrease in mean probing depth from 5.3 mm at surgery to 3.1 mm at the 6-month reentry to 2.9 mm at 3 years. The mean gingival recession changed from +0.1 mm at surgery to 1.4 mm at the 6-month reentry to 0.9 mm at 3 years. All of these differences were at least P <0.05 from surgery to the 6-month reentry, and surgery to 3 years, but were not significant from reentry to 3 years via repeated measures analysis of variance. CONCLUSIONS: These favorable 3-year results with ABM/P-15 suggest that it may have a beneficial effect in the long-term clinical management of infrabony defects. Further long-term randomized controlled studies are needed to better assess the role of ABM/P-15 in long-term healing of periodontal osseous defects.     

The use of enamel matrix derivative alone versus in combination with bone grafts to treat patients with periodontal intrabony defects: A meta-analysis

BackgroundThe authors performed a meta-analysis to compare the clinical outcomes of enamel matrix derivative (EMD) used in combination with various bone grafts with EMD alone in patients with intrabony defects.Types of Studies ReviewedThe authors retrieved relevant studies through Sept. 30, 2011, from MEDLINE, PubMed, Embase and Cochrane Central Register of Controlled Trials. The main clinical outcomes were probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, gingival recession (REC) increase and defect fill gain. The authors performed two separate meta-analyses, according to the length of follow-up. They also conducted subgroup analyses regarding the study designs and surgical procedures used.ResultsThe authors included 11 studies in their meta-analysis. At six to eight months' follow-up, pooled estimates showed that there was no significant difference regarding PPD reduction (P = .62) and CAL gain (P = .23) among the treatment groups, but there was a significant difference regarding defect fill gain and REC increase. At 12 months' follow-up, pooled estimates revealed no significant differences regarding PPD reduction (P = .29), CAL gain (P = .15) and REC increase (P = .30) between the groups, but the authors still detected a significant difference for defect fill gain.Clinical ImplicationsIn trials with a short-term follow-up, the combination therapies yielded better clinical outcomes regarding defect fill gain and REC increase compared with EMD alone, whereas most clinical outcomes were not significantly different between the two groups in the long run. The additional benefits from using combination therapies to promote periodontal tissue regeneration need to be confirmed.     

A comparative study on the use of a HA/collagen/chondroitin sulphate biomaterial (Biostite) and a bovine-derived HA xenograft (Bio-Oss) in the treatment of deep intra-osseous defects

OBJECTIVES: This parallel-group, randomized, clinical trial was designed to evaluate the clinical outcome of deep intra-osseous defects following reconstructive surgery with the use of a synthetic hydroxyapatite/equine Type I collagen/chondroitin sulphate biomaterial (Biostite), as compared to a bovine-derived hydroxyapatite xenograft (Bio-Oss). MATERIAL AND METHODS: Twenty-four systemically healthy subjects with moderate to advanced periodontitis, 11 females and 13 males, aged 30-64 years, seven smokers, were selected. Patients presented with one interproximal deep intra-osseous defect (intra-osseous component >or=4 mm) as clinically and radiographically evaluated. Immediately before surgery and 12 months after surgery, pocket probing depth (PPD), clinical attachment level (CAL) and radiographic depth of the defect (DEPTH) were evaluated. RESULTS: Thirteen defects were treated with Biostite (test) and 11 defects with Bio-Oss (control). In the test group, PPD amounted to 7.8+/-1.3 mm before surgery, and decreased significantly to 3.6+/-1.6 mm 12 months following surgery, while in the control group PPD significantly decreased from 7.5+/-2.0 mm pre-surgery to 3.1+/-1.0 mm post-surgery. At 1 year, CAL gain and DEPTH gain were 2.9+/-1.9 and 2.5+/-1.4 mm, respectively, in the test group, and 4.0+/-2.4 mm and 3.1+/-1.8 mm, respectively, in the control group. No statistically significant differences for PPD reduction, CAL gain and DEPTH gain were detected between the groups. CONCLUSIONS: The results of the present study indicate that both Biostite and Bio-Oss grafting biomaterials have determined a clinically and statistically significant improvement in terms of CAL gain, PPD reduction and radiographic DEPTH gain when used for the treatment of deep intra-osseous defects.     

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

AIM: This prospective multicenter randomized controlled clinical trial was designed to compare the clinical outcomes of papilla preservation flap surgery with or without the application of a guided tissue regeneration (GTR)/bone replacement material. MATERIALS AND METHODS: One hundred and twenty-four patients with advanced chronic periodontitis were recruited in 10 centers in seven countries. All patients had at least one intrabony defect of > or = 3 mm. The surgical procedures included access for root instrumentation using either the simplified or the modified papilla preservation flap in order to obtain optimal tissue adaptation and primary closure. After debridement, the regenerative material was applied in the test subjects, and omitted in the controls. At baseline and 1 year following the interventions, clinical attachment levels (CALs), probing pocket depths (PPDs), recession, full-mouth plaque scores and full-mouth bleeding scores (FMBS) were assessed. RESULTS: One year after treatment, the test defects gained 3.3 +/- 1.7 mm of CAL, while the control defects yielded a significantly lower CAL gain of 2.5 +/- 1.5 mm. Pocket reduction was also significantly higher in the test group (3.7 +/- 1.8 mm) when compared with the controls (3.2 +/- 1.5 mm). A multivariate analysis indicated that the treatment, the clinical centers, baseline PPD and baseline FMBS significantly influenced CAL gains. Odds ratios (ORs) of achieving above-median CAL gains were significantly improved by the test procedure (OR = 2.6, 95% CI 1.2-5.4) and by starting with deeper PPD (OR = 1.7, 1.3-2.2) but were decreased by receiving treatment at the worst-performing clinical center (OR = 0.9, 0.76-0.99). CONCLUSIONS: The results of this trial indicated that regenerative periodontal surgery with a GTR/bone replacement material offers an additional benefit in terms of CAL gains, PPD reductions and predictability of outcomes with respect to papilla preservation flaps alone.     

Healing of intrabony defects following treatment with an oily calcium hydroxide suspension (Osteoinductal). A controlled clinical study

The purpose of the present clinical study was to evaluate the healing of deep intrabony defects following the application of an oily calcium hydroxide suspension (OCHS). Thirty patients suffering from chronic periodontitis, each of whom displayed one intrabony defect, were randomly treated with access flap surgery (AFS) and the application of OCHS (test) or with AFS alone (control). The following clinical parameters were recorded at baseline and at 6 months after therapy: plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL). No differences in any of the investigated parameters were observed at baseline between the two groups. At 6 months after therapy, the test group showed a reduction in mean PD from 7.7±1.5 to 2.9±0.9 mm (P<0.001) and a change in mean CAL from 9.6±2.1 to 5.5±2.5 mm (P<0.001). In the control group, the mean PD was reduced from 6.9±0.9 to 3.7±0.9 mm (P<0.001) and the mean CAL changed from 8.5±2.5 to 6.4±2.7 mm (P<0.001). OCHS resulted in statistically significant higher PD reductions (P<0.01) and CAL gains (P<0.05) than AFS alone. Within the limits of the present study, it can be concluded that: (1) at 6 months after surgery both therapies resulted in statistically significant PD reductions and CAL gains and (2) treatment with OCHS resulted in statistically significant higher CAL gains than treatment with AFS alone.     

Evaluation of bone healing in patients with bone grafts and endosseous implants using single photon emission tomography (SPECT)

The aim of the present study was to evaluate the healing of onlay grafts to edentulous jaws in conjunction with osseointegrated implants using single photon emission computed tomography (SPECT). In all, 24 patients were examined who had received 26 full arch onlay grafts for augmentation of extremely atrophic edentulous jaws with secondary placement of implants 21.4 weeks after grafting. 99mTechnetium-MDP scintigrams were performed immediately after grafting. before implant placement, after implant placement and before abutment connection. Tracer accumulation was assessed semiquantitatively by calculating ratios of count densities between the up‐take over the calvarium and over the grafted jaws based on 16 regions of interest in the reconstructed tomograms corresponding to 16 possible areas of implant placement. There was a significant decrease in tracer uptake during graft healing, which was followed by a significant increase after implant placement and a subsequent decrease during implant healing. In 3 patients, infection and partial necrosis of the grafted bone occurred. In these cases, tracer uptake in areas of subsequent graft infection immediately after grafting was significantly lower compared to patients with uneventful healing as a sign of inferior graft revascularization. In 3 patients, 14 implants failed due to mobility at the time of abutment connection or loss of osseointegration within the first weeks thereafter. Significantly lower levels of tracer up‐take immediately after grafting and during graft healing were found in these areas, representing a lack of bone turnover due to decreased revascularization. These areas also showed a lower increase in tracer accumulation after implant placement due to the inferior graft quality, followed by a significant increase of periimplant bone turnover at the time of abutment connection representing inflammatory periimplant bone reaction.     

Bone healing in surgically created defects treated with either bioactive glass particles, a calcium sulfate barrier, or a combination of both materials. A histological and histometric study in rat tibias

OBJECTIVE: The purpose of this study was to histologically analyze the influence of bioactive glass and/or a calcium sulfate barrier on bone healing in surgically created defects in rat tibias. MATERIAL AND METHODS: Sixty-four rats were divided into 4 groups: C (control), CS (calcium sulfate), BG (bioactive glass), and BG/CS (bioactive glass/calcium sulfate). A surgical defect was created in the tibia of each animal. In Group CS, a calcium sulfate barrier was placed to cover the defect. In Group BG the defect was filled with bioactive glass. In Group BG/CS, it was filled with bioactive glass and protected by a barrier of calcium sulfate. Animals were sacrificed at 10 or 30 days post-operative. The formation of new bone in the cortical area of the defect was evaluated histomorphometrically. RESULTS: At 10 days post-operative, Group C presented significantly more bone formation than Groups CS, BG, or BG/CS. No statistically significant differences were found between the experimental groups. At 30 days post-operative, Group C demonstrated significantly more bone formation than the experimental groups. Groups CS and BG/CS showed significantly more bone formation than Group BG. No statistically significant differences were found between Group CS and BG/CS. CONCLUSIONS: (a) the control groups had significantly more bone formation than the experimental groups; (b) at 10 days post-operative, no significant differences were found between any of the experimental groups; and (c) at 30 days post-operative, the groups with a calcium sulfate barrier had significantly more bone formation than the group that used bioactive glass only.     

Repair of bone defects around dental implants with bone morphogenetic protein/fibroblast growth factor‐loaded porous calcium phosphate cement: a pilot study in a canine model

Objectives: To study the effects of the bone morphogenetic protein‐2 (BMP‐2)/fibroblast growth factor (bFGF)‐loaded porous calcium phosphate cement (CPC) on the repair of bone defects around dental implants. Material and methods: Thirty critical‐sized bone defects in beagle dogs were repaired with engineered bone composed of autologous bone‐marrow‐derived mesenchymal stem cells (BMSCs), BMP‐2, bFGF and CPC. Repairs were divided into six groups: BMSC/BMP‐2/bFGF/CPC, BMSC/BMP‐2/CPC, BMSC/bFGF/CPC, BMSC/CPC, CPC and no treatment. Polychrome sequential fluorescent labels were also performed post‐operatively. Fluorescence histological examinations of undecalcified sections at post‐operative week 12 were performed to clarify changes in the new bone around the dental implants. Results: The animals exhibited a perfect post‐operative course, with none experiencing any infection. Undecalcified sections showed that new bone was actively formed in the BMP‐2/bFGF group after 12 weeks. The bone mineralization apposition rate was better in the BMP‐2/bFGF group than in the other groups (P<0.05). Conclusion: BMP‐2 and bFGF together are more effective than either one alone in promoting the formation of new bone and may exert a synergistic activity at bone defects around dental implants. To cite this article:
Wang L, Zou D, Zhang S, Zhao J, K Pan, Huang Y. Repair of bone defects around dental implants with bone morphogenetic protein/fibroblast growth factor‐loaded porous calcium phosphate cement: a pilot study in a canine model.
Clin. Oral Impl. Res. 22 , 2011; 173–181.
doi: 10.1111/j.1600‐0501.2010.01976.x     

Efficacy of bone morphogenetic protein (BMP) with osteopromotive membranes – an experimental study in rat mandibular defects

The effect of bone morphogenetic protein (BMP) on healing of standardized bone defects was studied with and without the placement of osteopromotive membranes. Two different bovine BMP (bBMP) preparations were tested. These contained primarily collagen as a carrier. Standardized transosseous bone defects, 5 mro in diameter, were created in mandibles of rats. If left untreated, such "critical size defects" never heal during the lifetime of the animal, whereas covering with an osteopromotive membrane is known to cause complete healing of the defects in 6 weeks. The bBMP was implanted in defects and were either covered with an expanded polytetrafluoroethylene (e-PTFE) membrane (GORE–TEX®) or were left uncovered. Control defects did not receive any bBMP and were either covered with membrane or were left uncovered. Histological evaluation was made after 12 d and 24 d of healing, respectively. Implantation of bBMP alone was associated with formation of voluminous amounts of new bone, resulting in essentially complete defect healing at 24 d. However, the combination of membrane and bBMP was dearly less effective in stimulating bone healing, being only about as efficient as when using membranes alone. It was concluded that whereas both bBMP preparations were strongly osteoinductive, no further improvement of bone healing was seen when the membrane technique was supplemented with bBMP, compared to membrane alone. An explanation may be that the presence of an e-PTFE membrane prevents the degradation of the carrier material in the preparations, thus strongly reducing the availability of bBMP.     

A controlled re-entry study on the effectiveness of bovine porous bone mineral used in combination with a collagen membrane of porcine origin in the treatment of intrabony defects in humans

AIM: The purpose of this study was to evaluate the clinical effectiveness of a bovine porous bone mineral used in combination with a porcine derived collagen membrane as a barrier in promoting periodontal regeneration in intrabony defects in humans. MATERIAL AND METHODS: The study employed a split-mouth design. 22 paired intrabony defects were treated and surgically re-entered 6 months after treatment. Experimental sites were grafted with bovine porous bone mineral and received a collagen membrane for guided tissue regeneration. Control sites were treated with an open flap debridement. RESULTS: Preoperative pocket depths, attachment levels and trans-operative bone measurements were similar for control and experimental sites. Post surgical measurements revealed a significantly greater reduction in pocket depth (differences of 1.89 +/- 0.31 mm on buccal 0.88 +/- 0.27 mm on lingual measurements) and more gain in clinical attachment (differences of 1.51 +/- 0.33 mm on buccal and 1.50 +/- 0.35 mm on lingual measurements) in experimental sites. Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of experimental sites (differences of 2.67 +/- 0.91 mm on buccal and 2.54 +/- 0.87 mm on lingual measurements). CONCLUSIONS: The results of this study indicate that clinical resolution of intrabony defects can be achieved using a combination of bovine porous bone mineral and an absorbable, porcine derived collagen membrane when employing a technique based on the principles of guided tissue regeneration. The nature of the attachment between the newly regenerated tissue and the root surfaces needs to be evaluated histologically to confirm the presence of new attachment.     

自体块状骨结合引导骨再生技术重建前牙区骨量不足的临床研究

目的：比较自体块状骨结合引导骨再生(GBR)技术重建前牙区骨量不足术后种植位点和非种植位点骨量变化的差异。方法：2010年12月—2011年8月间,术前全景片及CT评估14例患者(73个缺牙位点)前牙区骨量不足,于颏部或下颌支处取自体块状骨结合GBR技术重建前牙牙槽骨,并延期行种植体植入术(共植入42颗种植体)。术后即刻、3、6、9个月和最长随访时间点(平均13.8个月)行CT检查。利用Simplant 11.04软件三维重建并测量牙槽嵴顶骨宽度(alveolar crestal bone width, ACBW)、牙槽骨中部骨宽度(alveolar midway bone width, AMBW)和牙槽骨高度(alveolar bone height, ABH)。测量的所有数据按照种植位点(即种植体植入的位点)和非种植位点(即未植入种植体,后期利用桥体修复的位点)分为2组。采用SAS 9.0软件包对该2组数据进行配对t检验。结果：14例患者均顺利完成植骨和种植体植入手术,术后无头晕、头痛等不适,切口均愈合良好,42颗种植体在愈合和随访期内骨结合良好。术后2组骨改建评价显示：对种植位点的ACBW和AMBW,术后即刻骨增量和术后3个月骨吸收量有显著差异(P<0.05),而对ABH术后即刻骨增量,术后3、6个月骨吸收量有显著差异(P<0.05),其他时间段则无显著差异(P>0.05);对非种植位点的ACBW和ABH,术后即刻骨增量,术后3、6和9个月骨吸收量有显著差异(P<0.05),而对AMBW术后即刻骨增量,术后3、6个月骨吸收量有显著差异(P<0.05),其他时间段则无显著差异(P>0.05)。术后2组中ACBW、AMBW和ABH的骨量变化显示：术后即刻骨增量,术后3、6个月骨吸收量无显著差异(P>0.05);术后9个月和最长随访时间点骨吸收量存在显著差异(P<0.05)。结论：非种植位点较种植位点在种植体植入后发生更多的骨吸收,其原因是二期种植体植入手术产生的创伤和种植体能保存骨量两者相互作用所致。因此,即刻或同期植入种植体,避免二次手术,对骨量保存具有重要意义。     

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

Summary 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 ≥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.     

Effect of an oily calcium hydroxide suspension (Osteoinductal) on healing of intrabony periodontal defects. A pilot study in dogs

The aim of the present study was to evaluate histologically in dogs the effect of treating intrabony defects with an oily calcium hydroxide suspension (OCHS). Intrabony defects were surgically created bilaterally at the distal aspects of the maxillary first premolars and at the mesial aspects of the third premolars in two mongrel dogs. Subsequently, the defects were randomly treated with (a) access flap surgery followed by the application of an OCHS or (b) access flap surgery alone. After 8 weeks of healing, the animals were killed. Dissected blocks containing the experimental specimens were fixed in formalin, decalcified in EDTA, and embedded in paraffin. The formation of new cementum and bone was assessed histomorphometrically. In the control group, healing was predominantly characterized by the formation of a long junctional epithelium along the root surface and limited periodontal regeneration at the most apical part of the defect. The OCHS-treated defects consistently revealed periodontal regeneration (i.e., new periodontal ligament, new cementum with inserting collagen fibers, and new bone). Within the limits of the present study, it can be concluded that OCHS may favor periodontal regeneration in acute-type intrabony periodontal defects.