两种骨移植材料治疗牙周骨内缺损的3年临床回顾性观察

目的：评价牙周翻瓣刮治术联合移植生物活性玻璃（PerioGlas）或多孔无机骨（Bio-Oss）,治疗患重度牙周炎前牙的三年临床效果。方法：回顾19例前牙有深牙周袋,存在牙周骨内缺损的慢性牙周炎患者,在行牙周翻瓣刮治术后分别移植PerioGlas或Bio-Oss,记录术前,术后1年,术后3年的临床牙周指数和检查牙周X线片表现。结果：两组病例术后1年和术后3年与基线比较牙周探诊深度（PD）和临床附着丧失（CAL）显著降低,牙龈退缩水平（GR）略有增加。PerioGlas组术后1年PD减少4.94 mm;CAL减少3.94 mm;GR增加1.00 mm。Bio-Oss组术后1年PD减少5.15 mm;CAL减少3.95 mm。GR增加1.10 mm。各组病例术后1年和3年的PD、GR、CAL比较差异均无统计学意义。术后3年PerioGlas组和Bio-Oss组间各项牙周指数PD、GR、CAL比较差异无统计学意义。结论：牙周翻瓣刮治联合骨移植术治疗前牙重度牙周骨内缺损,显著改善临床牙周状态,使牙周骨内缺损再生,3年后临床效果稳定。两种骨移植材料Bio-Oss和PerioGlas均可以引导牙周骨再生,显著改善临床牙周...     

A bioactive glass particulate in the treatment of molar furcation invasions.

BACKGROUND: Procedures for the treatment of molar furcation invasion defects range from open flap debridement, apically repositioned flap, hemisection, tunneling or extraction, to regenerative therapies. METHODS: The results of surgical therapy consisting of the clinical parameters of probing depth and bleeding on probing were compared in 15 patients with moderate to advanced adult periodontitis. Each patient received surgical therapy consisting of regenerative therapy using bioactive glass compared to open flap debridement alone in human mandibular molar furcation defects. RESULTS: The results of therapy were statistically significant in the defects treated with the bioactive glass. CONCLUSIONS: This study revealed the benefits of bioactive glass in the treatment of Class II furcation defects regarding the clinical parameters of probing depth reduction and the reduction in bleeding on probing.     

A comparative study utilizing open flap debridement with and without enamel matrix derivative in the treatment of periodontal intrabony defects: a 12-month re-entry study

BACKGROUND: Previous studies have demonstrated that enamel matrix derivative (EMD) has the ability to improve clinical parameters when used to treat intraosseous defects. The purpose of the present study was to compare at 12 months postsurgery sites treated with open flap debridement (OFD) alone to those treated with OFD and EMD. METHODS: Twenty-three subjects with at least 2 intrabony defects were chosen. Fifty-three defects received EMD in conjunction with OFD. Thirty-one defects in these same 23 subjects were treated with OFD alone. Stents were fabricated to serve as fixed reference points. Re-entries were performed at least 1 year after initial surgery. Soft tissue measurements were recorded prior to initial surgery and prior to re-entry for gingival (GI) and plaque (PI) indices, probing depth (PD), gingival margin position, and clinical attachment level (CAL). Hard tissue measurements were recorded during the initial and re-entry surgery for level of crestal bone and depth of defect. Statistical analysis was conducted using the method of generalized estimating equations to determine changes in GI, PI, PD, CAL, fill of the osseous defect, and crestal resorption. Percent of defect fill was also calculated. RESULTS: In all categories, treatment with EMD (test) was superior to treatment without EMD (control). Average PI and GI were not significantly different either initially or prior to re-entry. The average PD reduction was 2.7 mm greater with EMD than controls. The average CAL gains were 1.5 mm greater, and the average fill of osseous defect 2.4 mm greater with EMD than controls. The average percent of defect fill after adjusting for crestal bone loss was more than 3 times greater for EMD versus control-treated sites (74% defect fill with EMD versus 23% defect fill for control sites). CONCLUSIONS: This study indicates that treatment of periodontal intraosseous defects with EMD is clinically superior to treatment without EMD (open flap debridement) in every parameter evaluated. Re-entry data demonstrate that percent fill of osseous defects treated with EMD compares favorably with the treatment results utilizing bone grafts or membrane barriers, according to published literature.     

Bioactive Glass Granules for Regeneration of Human Periodontal Defects

Purpose: A comparative study which evaluated the effectiveness of bioactive glass granules of uniform size (300–335 μm) for the regenerative treatment of interproximal intrabony periodontal defects was conducted.
Materials and Methods: Twelve pairs of advanced periodontal lesions in 12 patients (6 males and 6 females) were treated in a split-mouth design with open flap débridement in the control sites and open flap debridement with bioactive glass particles placed in the test sites.
Results: At 6 months post-treatment, both treatment modalities demonstrated a gain in clinical attachment level (CAL), with the test sites having a significantly ( p < .01) greater gain in CAL than the control sites. Reentry procedures were performed to assess the amount of hard tissue fill. The test sites demonstrated significantly ( p < .001) more gain in hard tissue fill than the controls.
CLINICAL SIGNIFICANCE
The use of bioactive glass granules of uniform size in human interproximal intrabony periodontal defects resulted in significantly better hard tissue fill and clinical attachment gain than surgical debridement alone.     

Comparative Evaluation of Autologous Platelet‐Rich Fibrin and Platelet‐Rich Plasma in the Treatment of 3‐Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: The topical use of platelet concentrates is recent, and its efficiency remains controversial. The present study aims to explore the clinical and radiographic effectiveness of autologous platelet‐rich fibrin (PRF) and platelet‐rich plasma (PRP) in the treatment of intrabony defects in patients with chronic periodontitis. Methods: Ninety intrabony defects were treated with either autologous PRF with open‐flap debridement or autologous PRP with open‐flap debridement or open‐flap debridement alone. Clinical and radiologic parameters, such as probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage defect fill, were recorded at baseline and 9 months postoperatively. Results: Mean PD reduction and CAL gain were greater in PRF (3.77 ± 1.19 and 3.17 ± 1.29 mm) and PRP (3.77 ± 1.07 and 2.93 ± 1.08 mm) groups than the control group (2.97 ± 0.93 and 2.83 ± 0.91 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (55.41% ± 11.39%) and PRP (56.85% ± 14.01%) groups compared with the control (1.56% ± 15.12%) group. Conclusions: Within the limit of the present study, there was similar PD reduction, CAL gain, and bone fill at sites treated with PRF or PRP with conventional open‐flap debridement. Because PRF is less time consuming and less technique sensitive, it may seem a better treatment option than PRP. However, long‐term, multicenter randomized, controlled clinical trials will be required to know their clinical and radiographic effects on bone regeneration.     

Treatment of 3-wall intrabony defects in patients with chronic periodontitis with autologous platelet-rich fibrin: a randomized controlled clinical trial

Background: Platelet‐rich fibrin (PRF) is considered a second‐generation platelet concentrate that is widely used in osseous regeneration. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF in the treatment of intrabony defects in patients with chronic periodontitis. Methods: Fifty‐six intrabony defects were treated with either autologous PRF with open‐flap debridement or open‐flap debridement alone. Clinical parameters such as the probing depth (PD) and periodontal attachment level (PAL) were recorded at baseline and 9 months postoperatively. The defect fill at baseline and 9 months was calculated on standardized radiographs by using image‐analysis software. Results: The mean PD reduction was greater in the test group (4.55 ± 1.87 mm) than in the control group (3.21 ± 1.64 mm), whereas the mean PAL gain was also greater in the test group (3.31 ± 1.76) compared to the control group (2.77 ± 1.44 mm). Furthermore, a significantly greater percentage of mean bone fill was found in the test group (48.26% ± 5.72%) compared to the control group (1.80% ± 1.56%). Conclusions: Within the limits of the present study, there was greater PD reduction, PAL gain, and bone fill at sites treated with PRF with conventional open‐flap debridement compared to conventional open‐flap debridement alone. However, a long‐term, multicentered randomized controlled clinical trial is required to know the clinical and radiographic effects of PRF on bone regeneration.     

Factors influencing treatment outcomes in mandibular Class II furcation defects

BACKGROUND: Factors influencing treatment outcomes in furcation defects remain to be studied. Therefore, the aim of the study was to evaluate the association between factors and clinical parameters that may influence treatment outcomes in mandibular Class II furcation defects. METHODS: Twenty-seven systemically healthy subjects with a Class II buccal or lingual furcation defect in lower molars were treated. Clinical measurements (probing depth [PD], clinical attachment level [CAL], recession, mobility, plaque index [PI], and bleeding on probing [BOP]) and defect (vertical and horizontal defect depths) were obtained at initial and 6-month reentry surgeries. Treatment modalities (e.g., nine each in the following three groups: open flap debridement [OFD] alone, bone graft [BG], and bone graft plus a bioabsorbable collagen membrane [BG + C]), anatomic factors (presence of cervical enamel projection, presence of cervical restorations/fixed prosthesis, and location of furcations [buccal or lingual sides; first or second molars]), clinical parameters (initial mobility, initial PD at furcation, initial CAL at furcation, mean initial PD of the tooth, mean initial CAL of the tooth, initial horizontal PD at furcation, initial horizontal/vertical defect depth, PI, and BOP), and background factors (endodontic status, smoking status, and surgeon's experience) were analyzed for associations with probability of clinical improvement. RESULTS: The anatomic factors, clinical parameters, and background information were found to have no effect in influencing treatment outcome with the exception of initial vertical defect depth. An initial vertical defect depth >or=4 mm had a borderline significance (P = 0.06) of achieving a high probability of having a 1-mm vertical bone fill. In addition, treatment modality was found to be a major influence factor. Sites treated with BG were 16x more likely to have >50% vertical bone fill than open flap surgery. Furthermore, sites treated with BG were 64x more likely to have a 1-mm vertical defect fill compared to sites treated with OFD and 16x more likely to have a 2-mm vertical defect fill compared to sites treated with OFD or BG + C. However, the additional membrane does not enhance the regenerative outcomes achieved by BG alone. CONCLUSIONS: Initial vertical defect depth (>or=4 mm) and treatment modality (e.g., BG) were found to be the clinical parameter and factor that were associated with high probability of clinical improvement. Sites treated with BG, such as mineralized human cancellous allograft, were more likely to have greater vertical furcation defect fill than the conventional OFD surgery. Additional membrane placement does not enhance the treatment outcome achieved by BG alone.     

Autologous Platelet‐Rich Fibrin in the Treatment of 3‐Wall Intrabony Defects in Aggressive Periodontitis: A Randomized Controlled Clinical Trial

Background: Platelet‐rich fibrin (PRF) has recently been applied in osseous regeneration. The aim of the present study is to explore the efficacy of PRF in treatment of intrabony defects (IBDs) in aggressive periodontitis. Methods: Fifty‐four IBDs in 17 patients were treated either with autologous PRF with open flap debridement (OFD) or OFD alone. Clinical and radiologic parameters such as probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect change were recorded at baseline and 9 months postoperatively. Results: Mean PD reduction and mean CAL gain were significantly greater in PRF compared with the control group. Furthermore, a significantly greater percentage of mean bone defect change was found in the PRF group. Conclusion: Within the limits of the present study, there is greater bone fill at sites treated with PRF with conventional OFD than conventional OFD alone.     

Clinical evaluation of anorganic bovine-derived hydroxyapatite matrix/cell-binding peptide (P-15) in the treatment of human infrabony defects

The purpose of the present study was to compare the clinical outcomes of infrabony periodontal defects following treatment with an anorganic bovine-derived hydroxyapatite matrix/cell-binding peptide (ABM/P-15) flow to open flap debridement. Twenty-six patients, each displaying one infrabony defect with probing depth >/=6 mm and vertical radiographic bone loss >/=3 mm participated in the present study. Patients were allocated randomly to be treated with ABM/P-15 flow (test group) or open flap debridement (control group). At baseline and at 12 months after surgery, the following clinical parameters were recorded by a blinded examiner: plaque index, gingival index, probing depth (PD), clinical attachment level (CAL), and gingival recession. Both treatments resulted in significant improvements between baseline and 12 months, in terms of PD reduction and CAL gain (p < 0.001). At 12 months following therapy, the test group showed a reduction in mean PD from 7.8 +/- 1.6 mm to 3.5 +/- 1.0 mm and a change in mean CAL from 8.5 +/- 2.1 mm to 4.6 +/- 1.2 mm, whereas in the control group the mean PD decreased from 7.5 +/- 0.8 mm to 4.9 +/- 0.7 mm and mean CAL from 8.2 +/- 1.2 mm to 6.4 +/- 1.4 mm. The test group demonstrated significantly greater PD reductions (p = 0.002) and CAL gains (p = 0.001) compared to the control group. In conclusion, treatment of infrabony periodontal defects with ABM/P-15 flow significantly improved clinical outcomes compared to open flap debridement.     

A randomized clinical trial of autologous platelet-rich plasma in the treatment of mandibular degree II furcation defects

Aim: A combined technique using a platelet-rich plasma (PRP)/bovine porous bone mineral/guided tissue regeneration membrane was found to be an effective modality for the treatment of mandibular grade II furcation defects. To elucidate the role played by each component, the present randomized, double-blind study is designed to evaluate the effectiveness of autologous PRP alone in the treatment of mandibular degree II furcation defects compared with open flap debridement (OFD).
Material and Methods: Using a split-mouth design, 40 mandibular degree II furcation defects were treated either with autologous PRP or OFD. Plaque index, sulcus bleeding index, vertical probing depth, relative vertical and horizontal clinical attachment level and gingival marginal level were recorded at baseline and 6 months post-operatively. Vertical and horizontal defect depths were also recorded using spiral computed tomography.
Results: A statistically significant difference was observed in all the clinical and radiographic parameters at the sites treated with PRP as compared with those with OFD. However, all the furcation defects retained their degree II status.
Conclusion: Despite a significant improvement, lack of complete closure of furcation defects implies a limited role of autologous PRP as a regenerative material in the treatment of furcation defects, necessitating further long-term studies.     

Clinical effectiveness of autologous platelet rich fibrin in the management of infrabony periodontal defects

BackgroundThis interventional controlled clinical trial with split mouth design compares the clinical effectiveness of autologous platelet rich fibrin with open flap debridement in the management of infrabony periodontal defects.MethodsFifteen patients with paired contralateral infrabony defects were treated with open flap debridement and autologous platelet rich fibrin (experimental group) or open flap debridement alone (control group). The changes in probing pocket depth, clinical attachment level, and radiographic defect depth were evaluated. Patient perception regarding pain and discomfort following the procedures and early soft tissue healing responses were assessed by visual analog scales, scored 7 days after the surgical procedures. Final reevaluation was done 1 year after surgery.ResultsBaseline clinical and radiographic measurements were comparable between the groups. Reevaluation at 1 year revealed that both treatment modalities resulted in a significant decrease in probing pocket depth, gain in clinical attachment and radiographic bone fill of the defects compared to baseline. Postoperative differences observed between the two groups were 2.27±0.29 mm (P<0.001) for probing pocket depth, 3.33±0.35 mm (P<0.001) for clinical attachment level and 1.29±0.32 mm (P<0.001) for radiographic infrabony defect depth reduction, all in favor of the experimental group. Patient preference was greater and early healing response better for the experimental group as assessed by the visual analog scores.ConclusionWithin the limitations of this study it can be concluded that use of platelet rich fibrin is more effective than open flap debridement alone in the management of infrabony periodontal defects.     

Medical grade calcium sulfate hemihydrate versus expanded polytetrafluoroethylene in the treatment of mandibular class II furcations

BACKGROUND: Guided tissue regeneration (GTR) techniques have been reported to enhance bone regeneration of molar furcation defects. The current trends in therapy encourage the use of a bioabsorbable barrier. The efficacy of the bioabsorbable barrier needs to be equal to, if not better than, the non-absorbable barrier. METHODS: This clinical study compared the bone regeneration capacity of a commonly used GTR procedure (demineralized freeze-dried bone allograft [DFDBA] and an expanded polytetrafluoroethylene [ePTFE] membrane) to DFDBA and an exclusion barrier of medical grade calcium sulfate hemihydrate [MGCSH]). Thirteen pairs of mandibular molar Class II furcation defects were evaluated in 13 patients. Clinical measurements of keratinized gingival width, probing depth, and recession were recorded prior to treatment. Following flap elevation and furcation defect debridement, an occlusal reference stent and periodontal probes were used to measure vertical, horizontal, and intrabony defect dimensions to the nearest millimeter. Paired defects were randomly assigned to receive either DFDBA/ePTFE or DFDBA/MGCSH. At 6 months, study sites were surgically re-entered and the treated furcations were debrided to a firm bone surface. Intraoperative measurements were repeated. Clinical measurements were repeated at 12 months. RESULTS: The MGCSH-treated furcations demonstrated mean probing depth reduction between baseline and 6 months (1.00 +/- 0.82 mm, P<0.05) and baseline and 12 months (1.31 +/- 0.85 mm, P<0.05). There was no statistically significant change in probing depth in the ePTFE group at any time interval. The horizontal defect fill was significantly greater for ePTFE (36.7%) versus MGCSH (23.8%) (P<0.02). CONCLUSIONS: In selected defects, improved clinical measurements were achieved with DFDBA/MGCSH as well as DFDBA/ePTFE. Both treatments obtained significant horizontal defect fill at 6 months. DFDBA/ePTFE showed a significantly greater horizontal defect fill compared to DFDBA/MGCSH. Attachment level gains achieved with MGCSH held for 12 months, whereas ePTFE attachment level gains did not.     

Efficacy of open flap debridement with and without enamel matrix derivatives in the treatment of mandibular degree II furcation involvement

The aim of the present study was the evaluation of the efficacy of open flap debridement (OFD) with and without enamel matrix derivatives (EMD) in the management of class II furcation involvement. Twenty similar bilateral class II furcation defects in ten healthy nonsmoker patients were selected. One defect in each subject was treated with OFD alone (OFD group) and the contralateral one with OFD and simultaneous application of enamel matrix derivatives (EMD group). Clinical probing depth, vertical clinical attachment level, horizontal clinical attachment level, and the location of the gingival margin, horizontal probing depth of bony defect (E-HPD), vertical depth of bone crest, vertical depth of the base of bony defect (V-DBD), and length of the intrabony defect were measured at baseline and during reentry surgery after 6 months. Wilcoxon signed-rank test and Mann-Whitney U test were used to analyze the data. Among soft tissue parameters, only horizontal attachment gain in EMD was significantly more than OFD (P = 0.002). Application of EMD significantly enhanced the horizontal (E-HPD) and vertical (V-DBD) resolution of the bony defect (P < 0.05). In conclusion, it seems that the adjunctive use of EMD enhances the efficiency of OFD in the management of mandibular class II furcation defects.     

生物活性玻璃治疗牙周骨下袋的临床研究

目的：评价生物活性玻璃（bioactive glass,BAG)治疗牙周骨下袋的临床疗效。方法：随机选择性经过牙周基础治疗的20处牙周骨缺损，其中13处进行翻瓣术加BAG移植，另外7处只做翻瓣术加以对照。通过术后3、6个月的复查，比较两组的临床疗效。结果：BAG组术前的探诊深度、附着丧失和出血指数分别为6．19mm、6．31mm和2．77，术后6个月时分别为3．23mm、3．65mm和0．65；翻瓣组术前的探诊深度、附着丧失和出血指数分别为6．86mm、7．71mm和2．93，术后6个月时分别为4.50mm、5．35mm和1．93。术后BAG组和翻瓣组的探诊深度、附着丧失及BAG组的拙血指数均比术前明显减少。BAG组的上述指标均低于翻瓣组，BAG组的出血指数减少值显著大于翻瓣组。结论：翻瓣术BAG植入和单纯翻瓣术均能明显改善下袋患牙的临床指标，而前者的临床疗效优于后者,在减轻牙周炎症方面更为突出。     

Clinical evaluation of guided tissue regeneration in the treatment of maxillary class II molar furcation invasions

This investigation assessed and compared the clinical efficacy of combined open flap debridement/occlusive membrane therapy versus open flap debridement therapy alone, in the treatment of maxillary periodontal furcation defects. Seventeen patients presenting with advanced adult periodontitis, including at least one pair of Class II maxillary furcal defects, comprised the study group. Following completion of a hygienic phase of treatment, measurements were made with calibrated periodontal probes to determine soft tissue recession, probing pocket depths, and attachment levels. Each pair of furcation defects was surgically exposed and hard tissue measurements obtained. Defects were treated with either open flap debridement and a polytetrafluoroethylene periodontal membrane or open flap debridement alone. Membranes were removed at 4 to 6 weeks. Six months postsurgery, soft tissue measurements were repeated and all sites were surgically re-entered to obtain hard tissue measurements. No statistically significant differences were found in recession, probing depth reductions, clinical attachment gains, or resorption of alveolar crest height between test and control groups. Results for these parameters were inconsistent and unpredictable. Statistically significant improvements were found, however, in horizontal open probing attachment (HOPA) and vertical open probing attachment (VOPA) between experimental and control sites. The GTR procedure as used in this study likely has limited application as a therapeutic modality for Class II furcations of maxillary molars. Modifications or improvements in the procedure may result in more predictable healing of these lesions.     

Autologous platelet-rich fibrin in the treatment of mandibular degree II furcation defects: a randomized clinical trial

Background: Platelet‐rich fibrin (PRF), an intimate assembly of cytokines, glycan chains, and structural glycoproteins enmeshed within a slowly polymerized fibrin network, has the potential to accelerate soft and hard tissue healing. This double‐masked randomized study is designed to evaluate the effectiveness of autologous PRF in the treatment of mandibular degree II furcation defects compared with open flap debridement (OFD). Methods: Using a split‐mouth design, 18 patients with 36 mandibular degree II furcation defects were randomly allotted and treated either with autologous PRF and OFD or OFD. Plaque index, sulcus bleeding index, probing depth, relative vertical and horizontal clinical attachment level, gingival marginal level, and radiographic bone defect were recorded at baseline and 9 months postoperatively. Comparison between indices between the test and control groups was performed using the paired t test except for plaque index and sulcus bleeding index data, which used the χ² test. Results: All clinical and radiographic parameters showed statistically significant improvement at the sites treated with PRF and OFD compared to those with OFD alone. Conclusion: Within the limitation of this study, significant improvement with autologous PRF implies its role as a regenerative material in the treatment of furcation defects.     

Clinical evaluation of nanocrystalline hydroxyapatite paste in the treatment of human periodontal bony defects--a randomized controlled clinical trial: 6-month results

BACKGROUND: The aim of this study was to compare the clinical outcome of intrabony periodontal defects following treatment with a novel nanocrystalline hydroxyapatite (NHA) paste to open flap debridement. METHODS: Twenty-eight subjects, each displaying one intrabony defect with probing depth (PD) > or =6 mm and radiographic evidence of an intraosseous component > or =3 mm participated in the present study. Subjects were allocated randomly to treatment with NHA paste (test group) or open flap debridement (control group). At baseline and at 6 months after surgery, the following clinical parameters were recorded by a masked examiner: plaque index, gingival index, PD, clinical attachment level (CAL), and gingival recession. RESULTS: A significant improvement in PD and CAL was observed at 6 months after surgery compared to baseline in both treatment groups (P <0.001). At 6 months following therapy, the test group showed a reduction in mean PD from 7.4 +/- 1.3 mm to 3.4 +/- 1.2 mm and a change in mean CAL from 8.0 +/- 1.3 mm to 4.4 +/- 1.7 mm, whereas in the control group the mean PD decreased from 7.4 +/- 0.8 mm to 4.9 +/- 0.9 mm, and mean CAL decreased from 8.1 +/- 1.2 mm to 6.4 +/- 1.3 mm. The intergroup comparison demonstrated significantly more PD reductions (P = 0.012) and CAL gains (P = 0.005) in the test group compared to the control group. CONCLUSION: Treatment of intrabony periodontal defects with NHA paste significantly improved clinical outcomes compared to open flap debridement.     

Clinical and volumetric analysis of three-wall intrabony defects following open flap debridement

Fourteen defects were treated with flap debridement procedures using the Prichard principle of epithelial exclusion. Six defects were considered to be medium in width (3-4 mm), seven defects were wide (greater than 4 mm), and one defect was narrow (1-2 mm). The parameters studied were changes in gingival and plaque scores, attachment levels, and bone scores. All defects were reentered 9 to 16 months after surgery and changes between the pretreatment and posttreatment bone levels were recorded. The mean gain in probing attachment level was 2.76 mm. The mean amount of defect fill measured from models was 2.56 mm, while the mean defect fill from direct measurements was 3.26 mm. The percentage defect fill measured from study models was 61%. Crestal resorption was 9.7%. The average change in defect volume unadjusted for crestal resorption was 61.8 cu mm. Seven defects had a 50% or greater decrease in defect volume, while seven defects had less than a 50% change. Intrabony defects where calculus is present on the involved tooth surface prior to therapy will repair with substantial amounts of bone as a result of open debridement.     

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.     

Combination use of bovine porous bone mineral, enamel matrix proteins, and a bioabsorbable membrane in intrabony periodontal defects in humans

BACKGROUND: The purpose of this study was to evaluate the effectiveness of a combination of enamel matrix proteins (EMP), bovine porous bone mineral (BPBM), and a bioabsorbable membrane for guided tissue regeneration (GTR) as regenerative therapy for intrabony defects in humans and compare it to an open flap debridement (OFD) technique. METHODS: Using a split-mouth design, 18 pairs of intrabony defects were treated and surgically reentered 6 months after the initial surgery. Experimental sites were treated with EMP, grafted with BPBM, and received a collagen/polylactic acid membrane for GTR. Control sites were treated with OFD. The primary outcomes evaluated in the study included probing depth resolution, clinical attachment gain, and bony defect fill. RESULTS: Preoperative probing depths, attachment levels, and intraoperative bone measurements were similar for the experimental and control groups. Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the experimental group (4.95+/-1.52 mm on buccal sites and 4.74+/-1.47 mm on lingual sites) when compared to the control group (2.83+/-0.83 mm on buccal sites and 2.90+/-0.91 mm on lingual sites). The experimental sites also presented with significantly more attachment gain (3.89+/-1.16 mm on buccal sites and 3.78+/-1.14 mm on lingual sites) than the control sites (1.52+/-0.83 mm on buccal sites and 1.48+/-0.78 mm on lingual sites). Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of the experimental group (4.76+/-1.36 mm on buccal sites and 4.81+/-1.37 mm on lingual sites) as compared to the control group (1.78+/-0.92 mm on buccal sites and 1.67+/-0.90 mm on lingual sites). CONCLUSIONS: The results of this study indicate that a combination technique including BPBM, EMP, and GTR results in better clinical resolution of intrabony defects than treatment with OFD. Differences observed were both statistically and clinically significant. The exact role of each of the 3 technique components in achieving the clinical improvement observed in this study remains to be determined.