Healing following GTR treatment of intrabony defects distal to mandibular 2nd molars using resorbable and non-resorbable barriers

AIMS: The objectives of the present, randomised clinical trial were (i) to evaluate the healing of periodontal intrabony defects at the distal aspect of mandibular 2nd molars using a resorbable polylactic acid (PLA) barrier and a non-resorbable polytetrafluoroethylene (e-PTFE) barrier and (ii) to compare the therapeutic effect of the bioresorbable versus the non-resorbable barrier. METHOD: 19 patients with intrabony defects distal to mandibular 2nd molars > or = 4 mm (on radiographs) were included in the study. The defects all remained 5 years after surgical removal of impacted 3rd molars. Following flap elevation and defect debridement, the defects were randomly covered with, either a resorbable PLA or a non-resorbable e-PTFE barrier. Flaps were repositioned and sutured to completely cover the barriers. Treatment was evaluated clinically after 1 year by measurements of probing depth (PD), probing attachment level (PAL), and probing bone level (PBL) and radiographically by measurements of bone levels on computer digitised images of radiographs taken immediately before and 1 year postsurgery. RESULTS: Both treatments resulted in significant PD reduction, PAL gain, and bone fill. The total PD reduction was 5.3 +/- 1.9 mm for the PLA treated sites and 3.7 +/- 1.7 mm for the e-PTFE treated sites (p<0.05). The corresponding values for PAL gain were 4.7 +/- 0.7 mm and 3.6 +/- 1.7 mm (p<0.05) and for PBL gain 5.1 +/- 1.2 and 3.3 +/- 2.0 mm (p<0.05). Radiographic bone fill averaged 3.4 +/- 1.2 for the PLA and 2.0 +/- 1.6 mm for the e-PTFE barriers (p<0.05). Radiographic bone level measurements were significantly smaller than the corresponding clinical measurements, indicating that radiographs tend to underestimate bone fill. CONCLUSIONS: GTR treatment of deep intrabony defects distal to mandibular second molars using resorbable PLA barriers resulted in significant PD reduction, PAL gain and bone fill at least equivalent to the results obtained using non-resorbable e-PTFE barriers.     

A case report study of 72 consecutive Emdogain-treated intrabony periodontal defects: clinical and radiographic findings after 1 year

This case report study examined the effect of adjunctive use of Emdogain in the treatment of intrabony periodontal defects. Seventy-two consecutively treated defects in sixty-one patients were included. Efficacy of treatment was evaluated at 12 months by assessment of probing depth reduction, probing attachment level gain, and radiographic bone gain from standardized radiographs. Initial pocket depth averaged 8.3 mm, and the mean probing attachment level was 10.0 mm. The mean radiographic defect depth was 5.3 mm. At 12 months, mean pocket depth reduction was 4.7 mm and mean probing attachment level gain was 4.2 mm. Radiographic bone level gain averaged 3.1 mm and defect fill averaged 70%. The only variables significantly affecting radiographic bone gain were bleeding on probing and smoking. It was concluded that Emdogain treatment of one- and two-walled intrabony defects in a periodontal practice will result in a clinically significant gain of probing attachment level and radiographic bone that is similar to that reported in controlled clinical trials.     

Healing after treatment of periodontal intraosseous defects

The present study compared surgical therapy to root planing alone in the treatment of periodontal intraosseous defects. 25 defects in 14 patients were subjected to root planing only and another 25 defects in the same patients were surgically exposed and citric acid treated. The healing response was evaluated 6 months after treatment. The mean gain of probing attachment level was 0.8 mm in the root-planed defects as compared to 1.3 mm for the surgically exposed and acid-treated defects. The probing bone level improved an average of 0.2 mm for the root-planed areas as compared to 0.6 mm for the acid-treated defects. The mean preoperative probing pocket depths of 6.7 mm and 6.8 mm for the 2 groups were reduced to 5.2 mm and 4.1 mm, respectively. The differences in these parameters were statistically significant between the 2 groups. However, both groups demonstrated limited regeneration.     

Four-year results following treatment of intrabony periodontal defects with an enamel matrix protein derivative: a report of 46 cases

Treatment of intrabony periodontal defects with an enamel matrix derivative (EMD) has been shown to predictably enhance periodontal regeneration. The aim of the present study was to evaluate the 4-year results following treatment of intrabony defects with EMD. Thirty-three patients with a total of 46 intrabony defects were treated. Each patient exhibited at least one intrabony defect with a probing depth > or = 6 mm as identified by probing and on radiographs. The following clinical parameters were evaluated prior to and 1 and 4 years after treatment: probing depth, recession of the gingival margin, and clinical attachment level. The primary outcome variable was clinical attachment. Mean probing depth was reduced from 8.1 +/- 1.8 mm to 3.8 - +/-.2 mm at 1 year and to 4.0 +/- 1.2 mm at 4 years. No statistically significant differences were found between the mean probing depth 1 and 4 years postoperative. At 1 year, the mean recession increased from 1.9 +/- 1.5 mm to 3.2 +/- 1.8 mm; at 4 years, it was 2.8 +/- 1.2 mm, a statistically significant improvement compared to the 1-year results, but still significantly increased compared to the baseline. The mean attachment level changed from 10.0 +/- 2.4 mm to 7.0 +/- 2.1 mm at 1 year and 6.8 +/- 1.9 mm at 4 years (no statistically significant difference). The clinical improvements obtained following treatment with EMD can be maintained over a 4-year period.     

Five-year results of guided tissue regeneration in combination with deproteinized bovine bone (Bio-Oss) in the treatment of intrabony periodontal defects: a case series report

The aim of this study was to report on the clinical and radiographic results 5 years following treatment of intrabony defects with guided tissue regeneration (GTR) in combination with deproteinized bovine bone (DBB) (Bio-Oss). Fifteen patients, with at least one intrabony periodontal defect with probing pocket depth (PPD)≥7 mm and radiographic presence of an intrabony component (IC)≥4 mm, were treated with a PLA/PGA bioabsorbable membrane. Prior to placement of the membrane, the defect was filled with DBB impregnated with gentamicin sulfate 2 mg/ml. Standardized intraoral radiographs were taken prior to treatment and at the control examinations after 1 and 5 years. At baseline, the average PPD was 9.2±1.1 mm, and the average probing attachment level (PAL) was 10.1±1.6 mm; the radiographic bone level (RBL) was 10.4±2.45 mm, and an IC of 6.2±2.3 mm was present. One year after membrane placement, treatment had resulted in a PAL gain of 3.8±1.8 mm, a residual PPD of 4.2±1.3 mm, an RBL gain of 4.7±2.0 mm, and a residual IC of 2.1±1.2 mm. At the 5-year examination, two patients did not show up, and two patients had lost the treated tooth. However, both teeth were endodontically treated, and progressive periodontal destruction might not necessarily have been the reason for extraction. At the 5-year control (11 patients), the PAL gain was 4.1±1.6 mm, and the residual PPD was 4.6±1.2 mm; an RBL gain of 4.9±2.7 mm and a residual IC of 1.8±0.8 mm were observed. Statistically significant clinical improvements had occurred between baseline and the 1- and 5-year controls, whereas there were no significant differences between the 1- and 5-year results. The results of GTR with bioabsorbable membranes in combination with Bio-Oss in the treatment of periodontal intrabony defects are basically stable on a long-term basis.     

Primary flap closure combined with Emdogain alone or Emdogain and Cerasorb in the treatment of intra-bony defects

OBJECTIVES: To compare clinical outcomes of three different modalities of treatment for deep intra-bony defects. MATERIAL AND METHODS: Fifty-six patients were paralleled for clinical parameters and randomly assigned to treatment. They displayed one angular defect each with an intra-bony component > or =3 mm, probing pocket depth (PPD) and probing attachment level (PAL) > or =7 mm, and plaque index (PI) <1. Nineteen defects were treated, respectively, with enamel matrix derivative (EMD)+tricalcium phosphate (TCP) or EMD alone and 18 defects with modified Widman flap (MWF). Primary flap closure was used in all three groups. PI, gingival index, bleeding on probing, PPD, PAL, and recession (REC) were measured before and 12 months after treatment. RESULTS: Treatment with EMD alone yielded a 3.9+/-1.3 mm PPD decrease and a 3.7+/-1.0 mm PAL gain (p<0.001), whereas EMD+beta-TCP produced a 4.1+/-1.2 mm PPD reduction and a 4.0+/-1.0 mm PAL gain (p<0.001). These outcome parameters did not differ between the two groups. REC increased by 0.7+/-1.3 mm. After MWF treatment, attachment gain was 2.1+/-1.4 mm (p<0.001) and PPD reduction was 3.8+/-1.8 mm, whereas REC increased by 1.5+/-0.7 mm (p=0.042 versus EMD). CONCLUSION: Both EMD treatments showed similar clinical effects, with significant PAL gain and a significantly lower REC increase in comparison with MWF treatment.     

Root conditioning using EDTA gel as an adjunct to surgical therapy for the treatment of intraosseous periodontal defects

Abstract. The aim of this clinical study was to compare the treatment outcome following root surface conditioning using an EDTA gel preparation in conjunction with surgical therapy with that following conventional flap surgery in periodontal intraosseous defects. 36 patients, each of them contributing one intraosseous defect ≥4 mm in depth participated. Defect sites had a probing pocket depth ≥5 mm and bled on probing following hygienic treatment phase. No furcation involvement or endodontic complications were present. In the EDTA group, 18 consecutive patients, defects were treated by root conditioning with EDTA gel for 3 minutes in combination with surgical therapy. In the control group, 18 patients, conventional flap surgery was performed without root conditioning. Chlorhexidine rinsings 0.2% were prescribed following surgery for 2–3 weeks with modified oral hygiene instruction. A strict recall program was implemented including professional prophylaxis and oral hygiene reinforcement every 4–6 weeks until 6-month re-evaluation. Baseline probing pocket depths and defect depths of 7.1 ±1.3 mm and 6.9±1.6 mm in the EDTA group and 7.6±1.9 mm and 6.6±1.7 mm, respectively, in the control group were measured, 6-month clinical results showed a significant probing attachment level gain of 1.8±1.5 mm and 1.0±l.7 mm in the EDTA and control groups respectively. A probing bone gain of 1.0±1.3 mm in the EDTA group was measured with a non-significant gain of 0.4±1.2 mm in the control group. Radiographic analysis confirmed these results. There were no statistically significant differences in treatment outcome between the group treated by root conditioning in combination with flap surgery and conventional flap surgery alone.     

Treatment of intrabony defects with resorbable materials, non-resorbable materials and flap debridement

BACKGROUND: Different types of barriers are used in guided tissue regenerative procedures. AIM: This prospective study compared resorbable citric acid ester softened polylactic acid membranes (RM) and non-resorbable expanded polytetrafluoroethylene (ePTFE) barriers (NRM) in GTR treatment of intrabony defects. METHODS: 29 subjects were randomly assigned to the RM group or NRM group. Each patient received one GTR procedure. An open flap debridement (FD) was performed at another site 2 weeks later to evaluate healing potential. Clinical treatment outcomes were finally evaluated 12 months after surgery for changes of pocket depth PD, probing attachment level PAL, and probing bone level PBL, and radiographically for bone change using standardised radiographs. RESULTS: No differences in healing patters after surgery were found between patients in the 2 study groups as evaluated from the FD surgical procedures. NRM treated sites showed less signs of post-surgical inflammation during the 1st 4 weeks of healing than did RM treated sites (p<0.05). GTR-treated defects in the RM group, initially 7.0+/-2.2 mm deep, showed PD reduction of 3.3+/-2.2 mm, PAL gain of 2.4+/-1.8 mm, PBL gain of 2.4+/-3.7 mm (28%) and a radiographic bone fill of 2.3+/-2.4 mm. Defects treated with the NRM exhibited PD reduction of 3.1+/-2.1 mm, PAL gain of 2.4+/-0.8 mm, PBL gain of 2.2+/-1.7 mm (25%) and a radiographic bone fill of 3.3+/-2.2 mm. All improvements were statistically significant (p<0.01) but there was no difference between RM and NRM treatments for any of the efficacy variables. The results of this study indicated that there was no clinically significant difference in treatment outcomes following GTR treatment of intrabony defects with citric acid ester softened polylactic acid membranes as compared to ePTFE barriers. The overall mean inter-proximal vertical bone defect fill at 12 months as assessed from intra-oral radiographs was 44% of the original mean defect depth. CONCLUSIONS: Thus, no clinically significant difference in treatment outcomes was observed following GTR treatment of intrabony defects with citric acid ester softened polylactic acid membranes or ePTFE barriers.     

Healing after treatment of periodontal intraosseous defects

2 regenerative surgical approaches using citric acid conditioning, were compared in the treatment of deep intraosseous periodontal defects. The first approach was non-resective in that no osseous tissue was removed. The second, a partially resective approach, involved reduction of the osseous defect depth by removal of some supporting bone. 16 patients and a total of 26 defects, with probing pocket depth greater than or equal to 7 mm, were included in the study. The depths of the corresponding osseous defect, as revealed during surgery were greater than or equal to 5 mm. The results demonstrated mean gains in probing attachment level of 0.7 mm for the partially resected group and 1.1 mm for the non-resected group. Corresponding gains in probing bone levels were recorded in the defect sites for each group. Probing pocket depth was reduced from 7.5 mm to 4.0 mm in the partially resected group and from 7.9 mm to 5.3 mm in the non-resected group. Both procedures caused loss of attachment and bony support from adjacent tooth surfaces involved by the surgical procedure. Slightly more loss of attachment and bone was experienced by the partially resected group (range 1.2-1.5 mm) than by the non-resective group (range 0.1-0.9 mm).     

Periodontal tissue alterations following Emdogain treatment of periodontal sites with angular bone defects. A series of case reports

The aim of the present study was to assess the predictability of probing attachment gain and probing pocket depth reduction following Emdogain treatment at sites with deep angular bone defects. MATERIAL AND METHODS: 108 consecutively-treated periodontal patients (mean age 55.8 years) were included. Each subject exhibited at least 1 deep interproximal intrabony defect that could be identified as an experimental site based on the inclusion criteria: (i) probing pocket depth > or = 5 mm, (ii) probing attachment loss > or = 6 mm, (iii) radiographic evidence of an interproximal bone defect with a > or = 3 mm intrabony component. A total of 145 defects met the criteria for inclusion. All subjects received non-surgical periodontal therapy. This included subgingival instrumentation in all parts of the dentition. At least 6 months after the completion of this treatment, a baseline examination was performed to characterise the experimental site. Reconstructive therapy was subsequently performed. Full-thickness periodontal flaps were elevated, and the root surface scaled and planed. No bone recontouring was performed. A gel containing 24% EDTA was applied on the exposed root and was kept in place for 2 min. A preparation of enamel matrix proteins was applied to the root surface and adjacent defect space. The flaps were replaced and closed with sutures. The experimental sites were re-examined 12 months after reconstructive surgery. RESULTS: The re-examination demonstrated that a treatment including the application of enamel matrix proteins at periodontal sites with angular defects resulted in a mean probing attachment level gain of 4.6 mm and a probing pocket depth reduction of 5.2 mm. 87% of all sites treated exhibited a probing attachment gain of > 2 mm. One site suffered probing attachment loss. The radiographic assessments revealed that the bone defect had been reduced in depth by 2.9 mm on average. The reduction in defect size corresponded to an average bone fill of 69% of the original defect. In 43% of the defects, the bone fill amounted to > or = 80%. CONCLUSION: The overall probing pocket depth reduction, probing attachment level gain, and soft tissue recession, that results following Emdogain therapy, is similar to the corresponding outcome variables following GTR.     

Healing after treatment of periodontal intraosseous defects I. Comparative study of clinical methods

Abstract Four clinical methods to evaluate healing after reconstructive therapy of intraosseous periodontal defects were compared: 1. probing attachment level, 2. probing bone level, 3. entry/re-entry bone height measurements, 4, radiographic bone height determinations. Thirteen patients with a total of 33 defects volunteered for the study. It was found that the depth of the lesions recorded by the various methods showed differences which seem to relate to the varying nature of the methods, On the average, the periodontal probe penetrated 0.8 mm deeper during probing for bone level than during probing for attachment level and another O.3mm deeper after denudation of the lesions during entry/re-entry. The average- gain of periodontal support following treatment was approximately 1.4mm as recorded by probing attachment level, probing bone level and entry/re-entry bone height determinations, respectively. A high degree of correlation was found between all three probing methods when the changes following therapy for the individual sites were compared (r = 0.8 5, 0.75 and 0.81, respectively), Radiographic bone height showed lower degrees of correlation with all three probing parameters (r = 0.45, 0.46 and 0,47, respectively).     

Long-term stability of periodontal conditions achieved following guided tissue regeneration with bioresorbable membranes: case series results after 6-7 years

OBJECTIVES: To evaluate the results of guided tissue regeneration (GTR) treatment of intrabony defects with bioresorbable membranes after 6-7 years, and to disclose factors that may influence the long-term outcome of the treatment. METHODS: Twenty-five defects in 19 patients were treated by means of polylactic acid/citric acid ester copolymer bioresorbable membranes. At baseline and after 1 and 6-7 years, the following parameters were recorded: (1) probing pocket depth (PPD), (2) gingival recession (REC), (3) probing attachment level (PAL)=PPD+REC, (4) presence/absence of plaque (PI), (5) presence/absence of bleeding on probing (BOP). Smoking habits and frequency of dental-control visits were also recorded. Significance of differences between categorical variables was evaluated with McNemar's test, and between numerical variables with the t-test for paired observations. Generalized linear models were constructed to evaluate the influence of various factors on PAL gain and PPD changes from 1 to 6-7 years. Association of smoking, frequency of dental controls, oral hygiene, and BOP with sites losing > or =2 mm in PAL was evaluated with Fisher's exact test. RESULTS: At baseline, a mean PPD of 8.7+/-1.1 mm and a mean PAL of 9.8+/-1.5 mm was recorded. Statistically significant clinical improvements were observed at 1 and 6-7 years after GTR treatment. An average residual PPD of 3.8+/-1.1 mm and a mean PAL gain of 3.8+/-1.4 mm were observed after 1 year. After 6-7 years the corresponding values were 4.7+/-1.3 and 3.6+/-1.4 mm, respectively. There were no statistically significant differences between the 1- and the 6-7-year values. At the 6-7-year control, only 16% of the sites had lost > or =2 mm (maximum 3 mm), of the PAL gain obtained 1 year after GTR treatment. None of the sites had lost all of the attachment gained 1 year after treatment. Smoking, frequency of dental controls, oral hygiene, and BOP did not seem to influence the change of PPD and PAL gain, or the stability of PAL gain (i.e. losing PAL or not) from 1 to 6-7 years from treatment. CONCLUSION: Clinical improvements achieved by GTR treatment of intrabony defects by means of bioresorbable membranes can be maintained on a long-term basis.     

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.     

Gingivectomy versus flap surgery: the effect of the treatment of infrabony defects. A clinical and radiographic study.

The aim of this paper was to compare the short-term results of gingivectomy (GV) and modified Widman flap (MWF) surgery in the treatment of infrabony defects. 14 patients with 68 bilateral infrabony defects were selected. At baseline, and 3 and 6 months postoperatively, assessments of oral hygiene, gingival conditions, bleeding on probing, probing pocket depth and attachment level, were recorded. Conventional radiograps were obtained in a way that assured a reproducible projection geometry. In a split-mouth design, one jaw quadrant was randomly treated with GV, while the contralateral with a MWF. The changes of the bone tissue were assessed by means of conventional and subtraction images by 2 observers. The interobserver agreement of the conventional and subtraction technique was studied. The majority of the sites demonstrated a significant improvement in gingival conditions and a reduction in bleeding. For both treatments, probing depths were reduced by an average of 3 mm, while a mean of 1.22-1.35 mm of probing attachment gain was obtained. The GV resulted in slightly more gingival recession (1.90 mm) than the MWF (1.60 mm). The radiographic examination demonstrated gain of bone in 7 defects treated with GV and in 9 defects treated with MWF. This study demonstrated that pockets associated with infrabony defects can be successfully treated by both treatment modalities. Furthermore, bone gain can occur after treatment but not in a predictable manner.     

Treatment of periodontal furcation defects. Mandibular class III defects

Twenty-seven mandibular class III furcation defects were treated in 27 subjects using a regenerative therapy that included citric acid root conditioning and coronally positioned flaps secured by crown-attached sutures. In addition to this therapy, 13 of the 27 defects received freeze-dried, decalcified allogenic bone grafts. The effect of these therapies was evaluated from soft tissue probing measurements, including furcation probings to determine soft tissue closure of the defects. At 6 months postsurgery, the mean vertical probing depth reduction and the mean probing attachment level gain in the furcation area were 2.6 mm and 2.2 mm for the non-grafted defects and 1.9 mm and 1.5 mm for the grafted defects. One of the 14 non-grafted defects and 3 of 13 grafted defects were judged to show soft tissue clinical closure by a panel of 3 independent examiners. No statistically significant differences were observed between defects treated with or without bone grafts.     

Pilot clinical studies on the effect of topical citric acid application on healing after replaced periodontal flap surgery

The effect of citric acid conditioning of the root surfaces during periodontal surgery was studied in 12 patients with residual pockets ≥ 5 mm two months following oral hygiene instruction and initial root planing. Full thickness, replaced flap procedure ("modified Widman") was performed with or without topical citric acid application using a split mouth approach. Six months post-operatively, improvement of the periodontal conditions was observed as evidenced from reduction of probing pocket depth, gain of probing attachment level and gingival recession. A mean probing attachment level gain for pooled acid treated surfaces of 2.1 mm was obtained as compared to 1.5 mm for the non-acid treated control surfaces.
Our previous dog and human studies have demonstrated new connective attachment after acid conditioning of root surfaces as contrasted to readaplation of a junctional epithelium in the non-acid treated controls. However, the results of the present study indicate that from a clinical standpoint, the use of citric acid application might only provide a small improvement in probing attachment levels.     

Deproteinized bovine bone and gentamicin as an adjunct to GTR in the treatment of intrabony defects: a randomized controlled clinical study

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.     

The combined use of enamel matrix proteins and a tetracycline-coated expanded polytetrafluoroethylene barrier membrane in the treatment of intra-osseous defects

OBJECTIVES: The purpose of this split-mouth study was to evaluate the clinical response of enamel matrix proteins (EMPs, Emdogain Gel in intra-osseous defects with or without a combined application of a tetracycline-coated expanded polytetrafluoroethylene barrier membrane (e-PTFE, Gore-Tex). METHODS: Twelve pairs of intra-osseous periodontal defects in 11 patients received the application of EMPs on the exposed root surface (EMP). One of the two defects received randomly, as an adjunct to EMP treatment, a tetracycline-coated e-PTFE membrane (MEMP). At baseline, 6- and 12-month probing pocket depth (PPD), clinical attachment level (CAL) and probing bone level (PBL) were measured. RESULTS: After 12 months, the EMP defects showed a significant mean PPD reduction of 2.86+/-0.75 mm, a mean gain in CAL of 1.28+/-2.04 mm, a mean PBL gain of 1.63+/-1.21 mm and a mean increase of recession (REC) of 1.56+/-2.30 mm. The MEMP defects showed a significant mean PPD reduction of 3.02+/-1.55 mm, a mean gain in CAL of 1.65+/-1.29 mm, a mean PBL gain of 1.58+/-1.92 mm and a mean increase of REC of 1.38+/-1.63 mm. Except for significantly more post-operative discomfort at the MEMP sites, no significant differences were found between EMP and MEMP defects. CONCLUSION: Within the limits of this study, it is concluded that in the treatment of intra-osseous defects with EMP, the adjunctive use of a tetracycline-coated e-PTFE membrane failed to show more gain of CAL and PBL.     

Impaired healing response of periodontal furcation defects following flap debridement surgery in smokers. A controlled clinical trial

OBJECTIVES: The purpose of the present parallel-design, controlled clinical trial was to evaluate the treatment outcome of periodontal furcation defects following flap debridement surgery (FDS) procedure in cigarette smokers compared to non-smokers. MATERIALS AND METHODS: After initial therapy, 31 systemically healthy subjects with moderate to advanced periodontitis, who presented at least one Class I or II molar furcation defect, were selected. Nineteen patients (mean age: 40.3 years, 15 males) were smokers (>or=10 cigarettes/day) and 12 patients (mean age: 44.8 years, 3 males) were non-smokers. Full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS), probing pocket depth (PPD), vertical clinical attachment level (v-CAL), and horizontal clinical attachment level (h-CAL) were assessed immediately before and 6 months following surgery. RESULTS: Overall, statistically significant v-CAL gain was observed in smokers (1.0 +/- 1.3 mm) and non-smokers (1.3+/-1.1 mm), the difference between groups being statistically significant (p=0.0003). In proximal furcation defects, v-CAL gain amounted to 2.3+/-0.7 mm in non-smokers as compared to 1.0+/-1.1 mm in smokers (p=0.0013). At 6 months postsurgery, non-smokers presented a greater h-CAL gain (1.3+/-1.1 mm) than smokers (0.6+/-1.0 mm), with a statistically significant difference between groups (p=0.0089). This trend was confirmed in both facial/lingual (1.4+/-1.0 versus 0.8+/-0.8 mm) and proximal furcation defects (1.2+/-1.3 versus 0.5+/-1.2 mm). The proportion of Class II furcations showing improvement to postsurgery Class I was 27.6% in smokers and 38.5% in non-smokers. After 6 months, 3.4% of presurgery Class I furcation defects in smokers showed complete closure, as compared to 27.8% in non-smokers. CONCLUSIONS: The results of the present study indicated that (1) FDS produced clinically and statistically significant PPD reduction, v-CAL gain, and h-CAL gain in Class I/II molar furcation defects, and (2) cigarette smokers exhibited a less favorable healing outcome following surgery in terms of both v-CAL and h-CAL gain.     

Evaluation of a new bioabsorbable barrier for recession therapy: a feasibility study

BACKGROUND: The objective of this study was to evaluate the feasibility of a new polylactic acid bioabsorbable barrier in the treatment of gingival recession. METHODS: Twenty patients with buccal recession defects (Miller class I, II, and III; mean recession: 4.0 +/- 1.2 mm; range: 2.0 to 6.8 mm) participated. After thorough scaling and root surface conditioning with 10% tetracycline-HCl, a trapezoidal mucoperiosteal flap was prepared. A customized barrier was applied to cover the defect. Barriers adhered directly to tooth and bone and no sutures were used. The barrier was subsequently covered by a coronally positioned flap. Assessments of probing depths were performed by means of a controlled-force electronic probe, and recession was determined on stone models with a digital caliper at baseline and 12 months following therapy. RESULTS: Eight barriers showed limited exposure (1 to 2 mm) with minimal signs of gingival inflammation between 2 and 6 weeks following surgery. Comparing baseline measurements with outcomes at 12 months, significant root coverage and probing attachment gain were observed (P <0.0001, paired t test). Mean gingival recession was reduced to 0.4 +/- 0.5 mm, corresponding to a mean root coverage of 91.9%, and overall attachment gains amounted to 4.2 mm. A significant gain of keratinized tissue was found (2.9 +/- 0.7 mm), and mean probing depths were slightly reduced from 2.2 to 1.7 mm. CONCLUSIONS: The results of this study indicate favorable outcomes after using a new bioabsorbable barrier material for root coverage in recession-type defects.