Human histologic evaluation of a bovine-derived bone xenograft in the treatment of periodontal osseous defects

This study evaluated a bovine-derived bone xenograft (Bio-Oss) in the treatment of human periodontal osseous defects. Four patients with at least one tooth that had been recommended for extraction because of interproximal advanced periodontal disease volunteered to participate. The surgical procedure consisted of flap reflection, soft tissue debridement, placing a notch in calculus as a histologic reference point, root planing, placement of the bovine-derived xenograft and a bioresorbable physical barrier, and flap closure. Patients were seen every 2 weeks for plaque control and any necessary adjunctive treatment. At 4 to 6 months postsurgery, 6 teeth, along with the adjacent graft site, were removed en bloc. Histologic observations demonstrated new bone, new cementum, and new periodontal ligament coronal to the reference notch in 3 of the 4 specimens. This study indicates that periodontal regeneration is possible following grafting with a bovine-derived xenograft.     

5-year evaluation of durapatite ceramic alloplastic implants in periodontal osseous defects

Six patients who participated in a clinical study comparing the response of periodontal osseous defects to either grafting with Periograf (durapatite) hydroxylapatite (HA) ceramic or debridement alone (DEBR) were followed under an active maintenance program for 5 years. Mean values for gingival recession and attachment levels remained essentially stable following either treatment over the 5 year period. However, mean probeable pocket depths shifted from being significantly (P less than 0.05) shallower for DEBR sites at 6 months and 1 year to being significantly shallower for HA sites at 5 years. The probing pocket depth change for grafted sites was steady and the change from presurgical values was significantly greater than the change for DEBR areas, which became about 1.5 mm deeper over the 5 year postsurgical period. Intrapatient comparisons showed that recession, attachment gain, and pocket depth decrease were most frequently greater for the Periograf-treated sites. Assessment of the pattern of clinical changes during the 5 year postsurgical period demonstrated that the attachment level of grafted sites improved or stayed the same 86% of the time compared to only 62% stability or improvement in the DEBR only sites. In fact, 38% of the DEBR sites were worse at 5 years than at the time of surgery, a 3 times greater failure rate than that found in the HA-grafted sites. Pocket depth measurements showed that 98% of the Periograf-treated sites were better or the same as presurgically (2% worse), while only 80% of DEBR sites showed positive results and 20% had deeper pockets than at the time of surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

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。     

Alloplastic implants of tricalcium phosphate ceramic in human periodontal osseous defects

Initial pilot studies using tricalcium phosphate ceramic placed into human periodontal osseous defects demonstrated osseous repair. Therefore, further evaluation of this material was undertaken on 17 carefully selected patients with 1-wall, 2-wall, crestal and furcation defects using standardized preoperative and postoperative radiographs, clinical measurements and clinical photographs. Inverse bevel, full-thickness flaps were raised, the areas debrided, root surfaces planed with ultrasonic and hand instrumentation, osseous penetrations made with curet point and the flaps sutured after the defects were filled. Eighteen-month reentry surgical procedures were performed on 10 of the 17 patients, with a resultant average of 2.8 mm of new bone. Controls were not used in this study since a protocol describing a sham procedure with other than 3-wall osseous defects was not acceptable in 1973 to the Clinical Human Use Committee. Although the tricalcium phosphate ceramic material was not found to be totally predictable in this study, it may nevertheless become a useful graft material because of its potential for osseous repair in combination with its availability, host acceptability, ease of manipulation and storage advantages.     

Longitudinal evaluation of durapatite ceramic as an alloplastic implant in periodontal osseous defects after 3 years

Seven patients who participated in a clinical study comparing the response of periodontal osseous defects to either grafting with Durapatite ceramic or debridement alone were followed under an active maintenance program for 3 years. Comparison of mean values showed that gingival recession, attachment levels and probeable pocket depths remained essentially stable for Durapatite sites over the 3 years. Attachment levels for debridement sites also remained constant, but these areas showed significant coronal migration of the free gingival margin and increases in probeable pocket depths. These latter changes became apparent and significant only after 3 years. Intrapatient comparisons showed that recession and attachment gain were most frequently greater and pocket depths most frequently less for Durapatite sites. These findings suggest that the Durapatite-treated sites were stable for 3 years following surgery, while areas treated with debridement alone regressed.     

Histologic evaluation of an allogeneic mineralized bone matrix in the treatment of periodontal osseous defects

The aim of this study was to evaluate the potential of an allogeneic bone matrix to regenerate new bone, cementum, and periodontal ligament around a previously diseased root surface. Four patients with severe chronic periodontitis and teeth with hopeless periodontal or restorative prognoses participated in this study. One tooth with a severe intraosseous defect was selected per patient. At baseline, measurements of probing depth, gingival recession, and clinical attachment level were obtained. Following flap reflection, a root notch was placed at the apical extent of the calculus; the root was debrided, and the allogeneic bone graft material was placed into the defect. After a minimum of 6 months of healing, the teeth were removed en bloc and prepared for histologic examination. Two of four teeth demonstrated regeneration of new bone, cementum, and periodontal ligament. One tooth healed by new connective tissue attachment, and another by junctional epthelium.     

Human histologic evaluation of a bone graft combined with GTR in the treatment of osseous dehiscence defects: a case report

There are many possible goals and outcomes of periodontal surgical therapy, but the ultimate goal is regeneration. Since the definition of periodontal regeneration is histologic, it is difficult to document. The purpose of this study was to evaluate a technique that combined a bone graft and guided tissue regeneration (GTR) to see if regeneration occurred. Four teeth with dehiscence-type osseous defects that were scheduled for extraction were treated with bone grafts and GTR. During the surgical procedure, a notch was placed into the root at the apical extent of the calculus. The teeth were extracted with conservative block sections 7 months after the treatment. They were processed, sectioned, stained, and evaluated histologically. The results revealed that regeneration did not occur in any of the teeth treated. In 2 of the teeth new connective tissue attachment was formed. In these 2 teeth cementum could be seen in the notch with connective tissue fibers inserting into the cementum. In one of the teeth the junctional epithelium extended apical to the notch, while in 3 cases the epithelium stopped at or coronal to the notch. In this case report, no regeneration could be documented, but new attachment could be seen in 2 of the 4 teeth treated.     

Human allografts of iliac bone and marrow in periodontal osseous defects

The purpose of this study was to statistically compare the bone regeneration and/or remodeling that occurred in human periodontal osseous defects treated with frozen allogenic, cancellous, iliac bone and marrow grafts, to defects treated by nongrafted flap curettage using a split-mouth protocol. Six patients were selected to participate in the study. These patients exhibited bilateral intrabony periodontal defects that had been refractory to nonsurgical periodontal therapy. Twenty-three intrabony defects were treated by osseous grafting using allogenic iliac bone and marrow and 32 intrabony defects were treated by open debridement procedures. The bony regeneration in each defect treated was evaluated by probing measurements taken from a fixed reference made at the initial surgery and at reentry 1 year after transplantation. The overall results of this study demonstrated that the percentage of osseous regeneration that occurred in intrabony defects treated by allogenic bone and marrow grafting was statistically greater than that which occurred in defects treated by nongrafted flap curettage procedures.     

A Veterans Administration Cooperative Study of biphasic calcium phosphate ceramic in periodontal osseous defects

One hundred thirty-seven V.A. patients were randomized to one of three treatment groups to evaluate the efficacy of biphasic calcium phosphate (BCP) ceramic in the treatment of periodontal osseous defects. This material was tested against both autogenous bone implant and open flap curettage procedures. Baseline probing attachment level, Navy plaque index, and gingival index were recorded for all patients. These parameters were monitored for 3 years. At the end of this period, 101 patients had completed the study. Although the plaque and gingival indices steadily increased with time, there were no statistically significant differences among the treatment groups. Patients in the ceramic group had a gain in attachment level of 1.0 mm; those in the curettage group, 0.9 mm; and 0.4 mm for those in the bone implant group. Although the BCP patients had a greater gain, the difference was not statistically significant. In this veteran population, not only did BCP patients fail to outperform those in the control groups, all three treatment groups were similarly ineffective.     

Clinical and histologic evaluation of an enamel matrix protein derivative combined with a bioactive glass for the treatment of intrabony periodontal defects in humans

The present study clinically and histologically evaluated healing of human intrabony defects following treatment with a combination of enamel matrix derivative (EMD) and bioactive glass (BG) or BG alone. Six patients displaying either combined one- and two-walled (five patients) or three-walled (one patient) intrabony defects around teeth scheduled for extraction were included. A notch was placed at the most apical extent of the calculus on the root surface to serve as a reference. Six months after surgery, the teeth or roots were extracted, together with some of their surrounding soft and hard tissues, and processed for histologic evaluation; a gain of clinical attachment was found in all cases. Healing in all three defects treated with EMD + BG was mainly characterized by new cementum with inserting collagen fibers and new periodontal ligament; most graft particles were surrounded by bone-like tissue, indicating ongoing mineralization. Treatment with BG resulted in epithelial down-growth and connective tissue encapsulation of the graft material in all three specimens. Reformation of cementum and periodontal ligament was observed in one of the specimens, limited to the most apical part of the defect. Formation of bone-like tissue around the graft particles was observed in only one of the three specimens treated with BG. Direct contact between the BG particles and root surface (cementum or dentin) was not observed in any of the six specimens. BG alone has low potential to facilitate periodontal regeneration. However, EMD + BG resulted in formation of new cementum with an associated periodontal ligament, as well as enhanced mineralization around the BG particles.     

Histologic and clinical evaluation of an allogeneic bone matrix for the treatment of periodontal osseous defects

The objective of this study was to evaluate the potential of an allogeneic bone matrix (Grafton, Osteotech) to regenerate new bone, new cementum, and a new periodontal ligament around teeth previously contaminated by bacterial plaque. Four patients with chronic advanced periodontitis and who were scheduled for full-mouth extraction were enrolled in the study. One patient dropped out from the study before any therapy began. One tooth with an intraosseous defect in each patient was selected for treatment. Measurements of probing depth, gingival recession, and clinical attachment level were made. After flap reflection, a root notch was placed at the apical level of calculus, the root was debrided, and allogenic bone matrix was inserted into the defect. After 6 months of healing, the teeth were removed en bloc and evaluated histologically for a new attachment apparatus. Two of the three teeth demonstrated regeneration of new bone, cementum, and periodontal ligament.     

Human histologic and clinical evaluation of recombinant human platelet-derived growth factor and beta-tricalcium phosphate for the treatment of periodontal intraosseous defects

This study histologically evaluated recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in combination with beta-tricalcium phosphate (beta-TCP) for the treatment of human intraosseous periodontal defects. Eight patients, each with two teeth treatment planned for extraction, were enrolled. Presurgical measurements included probing depth, clinical attachment level, and recession. Initial surgery consisted of flap reflection, debridement, placement of a root notch through the base of calculus, scaling and root planing, root biomodification with 50 mg/mL tetracycline, grafting with rhPDGF-BB + beta-TCP, and complete wound closure. One tooth in each patient was treated with 0.3 mg/mL of rhPDGF-BB + beta-TCP, and the other tooth was treated with 1.0 mg/mL of rhPDGF-BB + beta-TCP. After a minimum of 6 months of healing, postsurgical clinical measurements were made, and teeth were removed en bloc. Soft tissue healing was uneventful. Histologic evaluation demonstrated new bone, cementum, and periodontal ligament coronal to the reference notch in 13 of the 16 teeth. Six of the eight 0.3-mg/mL sites and seven of the eight 1.0-mg/mL sites demonstrated periodontal regeneration. This study provides proof of principle that 0.3 mg/mL and 1.0 mg/mL of rhPDGF-BB and beta-TCP can promote periodontal regeneration in human intraosseous periodontal defects.