Effect of platelet-rich plasma on the healing of intrabony defects treated with Beta tricalcium phosphate and expanded polytetrafluoroethylene membranes

BACKGROUND: Regenerative periodontal therapy using platelet-rich plasma (PRP) and different types of bone substitutes with or without guided tissue regeneration (GTR) has been proposed as a modality to enhance the outcome of regenerative surgery. However, there are limited data from controlled clinical studies evaluating the effect of PRP on the healing of deep intrabony defects treated with a combination of bone substitutes and GTR. The aim of this study was to clinically evaluate the effect of PRP on the healing of deep intrabony defects treated with beta tricalcium phosphate (beta-TCP) and GTR by means of a non-bioresorbable expanded polytetrafluoroethylene membrane. METHODS: Twenty-eight subjects with advanced chronic periodontal disease and displaying one intrabony defect were treated randomly with a combination of PRP + beta-TCP + GTR or beta-TCP + GTR. Plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL) were evaluated at baseline and at 1 year after treatment. CAL was the primary outcome variable. RESULTS: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all subjects. At 1 year after therapy, the sites treated with PRP + beta-TCP + GTR showed a reduction in mean PD from 9.1 +/- 0.6 mm to 3.3 +/- 0.5 mm (P <0.001) and a change in mean CAL from 10.1 +/- 1.3 mm to 5.7 +/- 1.1 mm (P <0.001). In the group treated with beta-TCP + GTR, mean PD was reduced from 9.0 +/- 0.8 mm to 3.6 +/- 0.9 mm (P <0.001), and the mean CAL changed from 9.9 +/- 1.0 mm to 5.9 +/- 1.2 mm (P <0.001). In both groups, all sites gained > or =3 mm of CAL. CAL gains > or =4 mm were noted in 86% (12 of 14 defects) of the cases treated with PRP + beta-TCP + GTR and in 79% (11 of 14 defects) of those treated with beta-TCP + GTR. No statistically significant differences in any of the investigated parameters were observed between the two groups at the 1-year reevaluation. CONCLUSION: At 1 year after surgery, both therapies resulted in significant PD reductions and CAL gains.     

Effect of platelet-rich plasma on the healing of intrabony defects treated with an anorganic bovine bone mineral and expanded polytetrafluoroethylene membranes

BACKGROUND: Regenerative periodontal therapy with a combination of platelet-rich plasma (PRP) + an anorganic bovine bone mineral (ABBM) + guided tissue regeneration (GTR) has been shown to result in significantly higher probing depth reductions and clinical attachment level gains compared to treatment with open flap debridement (OFD) alone, ABBM alone, or GTR alone. However, there are no data evaluating to what extent the use of PRP may additionally enhance the clinical outcome of the therapy compared to treatment with ABBM + GTR. This study aimed to clinically evaluate the effect of PRP on the healing of deep intrabony defects treated with ABBM and GTR by means of a non-resorbable expanded polytetrafluoroethylene (ePTFE) membrane. METHODS: Twenty-four patients with advanced chronic periodontal disease and displaying one intrabony defect were randomly treated with a combination of either PRP + ABBM + GTR or ABBM + GTR. The following clinical parameters were evaluated at baseline and at 1 year after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS: No differences in any of the studied parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with PRP + ABBM + GTR showed a reduction in mean PD from 8.6 +/- 1.7 mm to 3.1 +/- 1.3 mm (P <0.001) and a change in mean CAL from 10.3 +/- 1.4 mm to 5.7 +/- 1.6 mm (P <0.001). In the group treated with ABBM + GTR, mean PD was reduced from 8.8 +/- 1.7 mm to 3.1 +/- 1.0 mm (P <0.001), and the mean CAL changed from 10.4 +/- 2.6 mm to 5.9 +/- 1.8 mm (P <0.001). In both groups, all sites gained > or =3 mm of CAL. CAL gains > or =4 mm were measured in 83% (i.e., in 10 of 12 defects) of the cases treated with PRP + ABBM + GTR and in 92% (i.e., in 11 of 12 defects) treated with ABBM + GTR. No statistically significant differences in any of the studied parameters were observed between the two groups at 1-year reevaluation. CONCLUSION: Within its limits, the present study has shown that, at 1 year after regenerative therapy in periodontal intrabony defects, optimal clinical results were obtained with ABBM + GTR with a non-resorbable barrier, with or without the addition of PRP.     

Evaluation of the effect of tooth vitality on regenerative outcomes in infrabony defects

BACKGROUND, AIMS: This investigation was designed to evaluate the null hypothesis of no differences in GTR outcomes in intrabony defects at vital and successfully root-canal-treated teeth. METHOD: 208 consecutive patients with one intrabony defect each were enrolled. Based on tooth vitality, the treated population was divided at baseline into 2 groups: one with 41 non-vital teeth and the other with 167 vital teeth. The 2 groups were similar in terms of patient and defect characteristics. RESULTS: A slight unbalance in terms of depth of the intrabony component was observed in the non-vital group compared to the vital group (6.9+/-2.1 mm versus 6.2+/-2.3 mm, p=0.08). All defects were treated with GTR therapy. At 1 year, the non-vital and the vital groups showed a clinical attachment level (CAL) gain of 4.9+/-2.2 mm and of 4.2+/-2 mm, respectively. The difference was statistically significant (p=0.03). To correct for the baseline unbalance in defect depth, data were expressed as a % of clinical attachment level gains with respect to the original intrabony depth of the defect. % CAL gains were 72.8+/-42.2% and 73+/-26.4% for vital and non-vital teeth, respectively: the difference was not statistically significant (p=0.48). Average residual pocket depths were 2.8+/-1 mm in the vital and 2.8+/-0.9 mm in the non-vital group. Tooth vitality was assessed at baseline, at 1-year and at follow-up (5.4+/-2.8 years after surgery): all teeth vital at baseline were still vital at follow-up with the exception of 2 teeth that received endodontic treatment for reconstructive reasons and for caries. At follow-up visit, the difference in CAL with respect to 1-year measurements was -0.9+/-0.8 mm in the vital group and -0.7+/-0.8 mm in the non-vital group, indicating stability of the regenerated attachment at the majority of sites. CONCLUSIONS: Data from this study demonstrate that root canal treatment does not negatively affect the healing response of deep intrabony defects treated with GTR therapy; furthermore GTR therapy in deep intrabony defects does not negatively influence tooth vitality.     

Clinical and histologic evaluation of a granular bovine bone biomaterial used as an adjunct to GTR with a bioresorbable bovine pericardium collagen membrane in the treatment of intrabony defects

Background: The aim of the present study is to evaluate the clinical and histologic healing of deep intrabony defects treated with guided tissue regeneration (GTR) with a collagen membrane from bovine pericardium and implantation of granular bovine bone biomaterial. Methods: Thirty patients with one deep, combined 1‐ and 2‐wall intrabony defect exhibiting a probing depth ≥6 mm and an associated intrabony defect ≥3 mm were treated with GTR with a bioresorbable collagen membrane from bovine pericardium and adjunct implantation of a granular bovine bone biomaterial. The clinical results were evaluated 1 and 3 years after surgery. In addition, five teeth fulfilling the inclusion criteria but scheduled for extraction because of advanced periodontitis or restorative considerations were treated similarly and then extracted along with a portion of their surrounding periodontal tissues for histologic evaluation 6 months after surgery. Results: Healing was uneventful in all patients. Significant clinical improvements were observed at 1 and 3 years postoperatively (P <0.01; probing depth averaged 4.4 ± 1.6 and 4.7 ± 1.4 mm and clinical attachment level gain was 3.9 ± 1.4 and 3.5 ± 1.3 mm, respectively). The histologic evaluation revealed formation of new cellular cementum and new periodontal ligament in four of the five cases. In general, the xenograft particles seemed to be mostly embedded in connective tissue without any evidence of new bone formation. Conclusion: GTR treatment of intrabony defects with the collagen membrane from bovine pericardium and adjunct implantation of the new bovine bone biomaterial may result in significant clinical improvements that can be maintained over a period of 3 years, and regeneration of cementum and periodontal ligament, but without bone formation.     

Comparison of platelet-rich plasma, bovine porous bone mineral, and guided tissue regeneration versus platelet-rich plasma and bovine porous bone mineral in the treatment of intrabony defects: a reentry study

BACKGROUND: A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM), and guided tissue regeneration (GTR) has been shown to be effective in promoting reduction in probing depth, gain in clinical attachment, and defect fill in intrabony periodontal lesions. The individual role played by PRP, BPBM, and GTR in this combined therapy is unclear and needs to be elucidated. The purpose of this study was to compare the clinical effectiveness of 2 regenerative techniques for intrabony defects in humans: a combination of PRP/BPBM/GTR versus a combination of PRP/BPBM. METHODS: Twenty-one patients participated in the study. Using a split-mouth design, interproximal bony defects were surgically treated with either a combination of PRP/BPBM/GTR or PRP/BPBM. The primary outcomes of the study included changes in probing depth, attachment level, and defect fill as revealed by reentry surgeries at 6 months post-treatment. RESULTS: At 6 months postoperatively, clinical examination of the treated defects revealed that both treatment modalities resulted in significant probing depth reduction and clinical attachment gain compared to baseline values. Probing depth improvement was 3.98 +/- 1.02 mm on buccal and 3.94 +/- 0.94 mm on lingual sites for the PRP/BPBM group and 4.19 +/- 0.88 mm on buccal and 4.21 +/- 0.92 mm on lingual sites for the PRP/BPBM/GTR group. Gain in clinical attachment was 3.78 +/- 0.72 mm on buccal and 3.84 +/- 0.76 mm on lingual sites for the PRP/BPBM group and 4.12 +/- 0.78 mm on buccal and 4.16 +/- 0.83 mm on lingual sites for the PRP/BPBM/GTR group. Reentry surgeries revealed similar defect fill for both treatment groups (PRP/BPBM group: 4.82 +/- 1.34 mm on buccal and 4.74 +/- 1.30 mm on lingual sites; PRP/BPBM/GTR group: 4.96 +/- 1.28 mm on buccal and 4.78 +/- 1.32 mm on lingual sites). None of the differences between the 2 treatment groups was statistically significant. CONCLUSIONS: The results of this study show that both combinations of PRP/BPBM/GTR and PRP/BPBM are effective in the treatment of intrabony defects present in patients with advanced chronic periodontitis. The results also suggest that GTR adds no clinical benefit to PRP/BPBM. Further studies are necessary to assess the individual role played by PRP and BPBM in the clinical outcome achieved with their combination.     

Long-term tooth survival following regenerative treatment of intrabony defects

BACKGROUND: The longevity of the clinical benefits of guided tissue regeneration (GTR) has not been fully explored. The aim of this investigation was to assess the long-term survival of GTR treated sites in terms of clinical attachment level (CAL) stability and tooth loss. METHODS: A total of 175 patients with one deep intrabony defect were selected for a retrospective investigation of tooth retention and CAL stability. All sites had been treated with GTR more than 2 years previously and had received full periodontal examinations every 2 years for up to 16 years. Definitions of events for survival analyses were tooth loss, loss of > or = 2 mm compared with the CAL observed before GTR treatment, and loss of > or = 2 mm compared with the CAL observed 1 year after completion of GTR. RESULTS: Teeth were severely compromised by the presence of CAL loss of 10.7 +/- 2.4 mm, probing depths of 8.7 +/- 2.3 mm and deep intrabony defects (average depth 6.6 +/- 2.1 mm). After GTR, CAL gains were 4.6 +/- 2 mm. Average follow up was 8 +/- 3.4 years; 66.9% of subjects strictly complied with a periodontal maintenance program. Tooth survival was greater than 96% more than 10 years after GTR. CAL was equal or coronal with respect to pretreatment in 92% of cases followed for 15 years after treatment, while loss of CAL compared to the 1-year post-GTR result was observed in 37.8% of cases. Cox proportional hazard models indicated that incidence-free survival was negatively affected by smoking and positively affected by full compliance with a periodontal maintenance program in a specialist practice. CONCLUSIONS: Within the limits of this study, data suggest that tooth retention and clinical improvements following GTR treatment of intrabony defects can be maintained long term in the great majority of cases and thus that regenerative periodontal treatment represents an important alternative for the management of severely compromised teeth.     

Interleukin-1 gene polymorphisms and long-term stability following guided tissue regeneration therapy

BACKGROUND: Specific interleukin (IL)-1 gene polymorphisms are associated with an increased susceptibility to severe periodontitis, increased inflammation, and increased likelihood of tooth loss during the maintenance phase after conventional periodontal therapy. The aim of the present study was to evaluate the impact of genotype on the maintenance of gained clinical attachment obtained after guided tissue regeneration (GTR) surgical therapy in deep intrabony defects. METHODS: Forty deep (> or =4 mm) interproximal angular bony defects with presurgical clinical attachment loss of >8 mm were treated by GTR using a non-absorbable expanded polytetrafluoroethylene (ePTFE) membrane. Membranes were surgically removed 4 to 6 weeks after surgery. Afterwards patients were placed on monthly recall for the first year and every 3 months for the following 3 years. At the 4-year re-evaluation, a IL-1 genetic susceptibility test was performed on all patients. RESULTS: Fourteen (35% of the 40 patients) were genotype-positive (+). At baseline no statistically significant differences were found between patients with different genotypes in full mouth plaque score (FMPS), full mouth bleeding score (FMBS), clinical attachment level (CAL), probing depth (PD), or gingival recession. At year 1 follow up visit, no statistically significant differences were noted between genotype + and genotype - patients in FMPS, FMBS, amount of CAL gain, decrease in PD, or increase in gingival recession. Sixteen patients had membrane exposure after the GTR procedures. In these patients, the amount of CAL gain (P <0.001) and PD reduction (P <0.01) 1 year after surgery was significantly lower than those observed in patients without membrane exposure. At the year 4 follow-up visit, no significant differences were found between genotype negative and positive patients in FMPS or FMBS and both groups showed a significant loss in CAL (P<0.001) and increase in PD (P<0.001) when compared to year 1 visit. No change in gingival recession was noted. Genotype + patients showed significantly more CAL loss (P<0.002) and increase in PD (P<0.001) between the years 1 and 4 when compared to genotype - patients. A significant association between genotype and stability of the regenerated attachment was also demonstrated. CONCLUSIONS: The results of this study demonstrate that genotype expression did not effect GTR treatment response at 1 year, but had a great impact on long-term stability (year 4). In a 3-year period, patients with positive IL-1 genotype lost about 50% of the first year gained CAL and were about 10 times more likely of experiencing > or = 2 mm CAL loss when compared to oral hygiene matched genotype-negative patients.     

Radiographic parameters for prognosis of periodontal healing of infrabony defects: two different definitions of defect depth

BACKGROUND: The aim of the present study was to evaluate defect width and two different definitions of defect depth as prognostic factors of periodontal healing in infrabony defects treated by regenerative therapy 6 and 24 months after surgery. METHODS: In 32 patients with moderate to advanced periodontitis, 50 infrabony defects were treated by the guided tissue regeneration (GTR) technique using non-resorbable or bioabsorbable barriers. Clinical parameters were assessed, and 50 triplets of standardized radiographs were taken before surgery and 6 and 24 months after surgery. Using a computer-assisted analysis, the distances cemento-enamel junction (CEJ) to alveolar crest (AC), CEJ to bony defect (BD), horizontal projection of the most coronal extension of the bony wall to the root surface to BD, width, and angle of the bony defects were measured. Depth of the bony defect was 1) calculated as CEJ-BD minus CEJ-AC (INFRA1) and 2) measured as horizontal projection of the most coronal extension of the bony wall to the root surface to BD (INFRA2). RESULTS: Whereas statistically significant vertical clinical attachment level gains (CAL-V: 3.36 +/- 1.59 mm/ 3.41 +/- 1.72 mm; P < 0.001) could be found both 6 and 24 months after surgery, bony fill (0.70 +/- 2.52 mm; P = 0.056/1.21 +/- 2.55 mm; P < 0.005) was significant 24 months post-surgically only. In a multilevel regression analysis, CAL-V gain was predicted by bioabsorbable membrane (P = 0.005), baseline probing depths (PD) (P < 0.001), and actual smoking (P < 0.05). Bony fill could be predicted by baseline depth of the infrabony component as determined by INFRA2 (P < 0.05), angulation of bony defect (P < 0.005), and gingival index at baseline (P < 0.001). In narrow (< 37 degrees) and deep (> or = 4 mm) infrabony defects, bony fill was more pronounced than in wide and shallow defects (P < 0.001). CONCLUSIONS: Improvement achieved by GTR in infrabony defects can be maintained up to 24 months after surgery. Narrow and deep infrabony defects respond radiographically and are to some extent clinically more favorable to GTR therapy than are wide and shallow defects. The infrabony component of bony defects, as determined by the distance from the most coronal extension of the lateral bony wall to BD (INFRA2), is a better predictor of bony fill than that determined by AC-BD (INFRA1).     

Stability of clinical and radiographic results after guided tissue regeneration in infrabony defects

BACKGROUND: The aim of this 5-year follow-up study was to evaluate clinically and radiographically the long-term results after guided tissue regeneration (GTR) therapy of infrabony defects using non-resorbable and bioabsorbable barriers. METHODS: Thirty-one patients with periodontitis and 50 infrabony defects that had been treated using GTR were recruited. Eleven defects were treated with non-resorbable expanded polytetrafluoroethylene membranes and 39 defects with bioabsorbable barriers. At baseline and 6 and 60 +/- 3 months after surgery, clinical parameters and standardized radiographs were obtained. During surgery and 60 +/- 3 months thereafter, the distance from the cemento-enamel junction to the base of the bony defect (vertical probing bone level [PBL-V]) was measured. Bone gain was evaluated using digital subtraction radiography. RESULTS: At 6 and 60 +/- 3 months after GTR, there was a statistically significant (P <0.001) reduction of probing depth (6 months: 4.31 +/- 1.76 mm; 60 months: 3.95 +/- 1.62 mm) and vertical clinical attachment level gains (CAL-V) (6 months: 3.34 +/- 1.66 mm; 60 months: 2.97 +/- 1.53 mm). From 6 to 60 months after GTR, three infrabony defects exhibited CAL-V loss >2 mm, and a small, statistically not significant mean CAL-V loss of 0.39 +/- 1.60 mm was observed. From baseline to 60 +/- 3 months, a significant PBL-V gain of 1.78 +/- 2.67 mm (P <0.001) and increase in bone density were observed (P = 0.003). CONCLUSION: The CAL-V gain achieved after GTR in infrabony defects using both non-resorbable and bioabsorbable barriers was stable after 5 years in 47 of 50 defects.     

Clinical Outcomes After Treatment of Non‐Contained Intrabony Defects With Enamel Matrix Derivative or Guided Tissue Regeneration: A 12‐Month Randomized Controlled Clinical Trial

Background: The purpose of this study is to compare the healing of deep, non‐contained intrabony defects (i.e., with a ≥80% 1‐wall component and a residual 2‐ to 3‐wall component in the most apical part) treated with either an enamel matrix derivative (EMD) or guided tissue regeneration (GTR) after 12 months. Methods: In this randomized, controlled clinical trial, 40 subjects with 40 defects affecting single‐rooted teeth were treated. The defects were treated with EMD alone or with a non‐resorbable titanium‐reinforced membrane. No grafting materials were used. At baseline and after 12 months, clinical parameters including probing depths (PDs) and clinical attachment levels (CAL) were recorded. The difference in CAL gain was the primary outcome. Results: At baseline, the intrabony component of the defects amounted to 8.5 ± 2.2 mm at EMD‐treated sites and 8.6 ± 1.7 mm at GTR‐treated sites (P = 0.47). The mean CAL gain at sites treated with GTR was significantly greater (P <0.001) than that at sites treated with EMD (4.1 ± 1.4 mm versus 2.4 ± 2.2 mm, respectively). GTR therapy, compared to EMD application alone, significantly (P = 0.01) increased the probability of CAL gain ≥4 mm (79.2% versus 11.3%, respectively) and significantly (P = 0.01) decreased the probability of residual PDs ≥6 mm (3% versus 79.3%, respectively). Conclusion: Although the outcomes of open‐flap debridement alone were not investigated, the application of EMD alone appeared to yield less PD reduction and CAL gain compared to GTR therapy in the treatment of deep, non‐contained intrabony defects.     

A comparative study of combined treatment with a collagen membrane and enamel matrix proteins for the regeneration of intraosseous defects

Recent clinical study shows that periodontal regeneration therapy using enamel matrix proteins (Emdogain; EMD) is expected to have the same therapeutic effect as guided tissue regeneration (GTR). However, reports on the combined effect of both therapies are limited, and the clinical significance is not definite. In this study, clinical effects were studied by comparing a combination of EMD and GTR using a collagen membrane for intrabony defects with GTR monotherapy and EMD monotherapy. Sixty-one patients with 69 intrabony defects were included. Efficacy of treatment was evaluated at 6 months and 1 year by assessment of reduction of probing depth, probing attachment gain, and radiographic bone gain. There were no statistically significant differences between presurgical soft tissue measurements and defect characteristics for the three treatment groups. The results showed no significant differences in reduction of probing depth, probing attachment gain, or radiographic bone gain between the three treatment groups at both evaluation times. The combination of GTR using a resorbable membrane for intrabony defects and EMD did not enhance the therapeutic effect compared with each monotherapy.     

The use of irradiated-crosslinked human collagen membrane in guided tissue regeneration.

Irradiated glutaraldehyde-crosslinked human collagen membrane was evaluated for its effects on new attachment formation in clinical trials, using the principle of guided tissue regeneration (GTR). 19 adult periodontitis patients with 52 matched bilateral periodontal defects received scaling and polishing with oral hygiene instruction. The bilateral periodontal defects were treated by reflecting a flap with collagen membrane (test) or flap reflection alone (control). Plaque (P1I) and gingival index (GI) scorings, probing pocket depth (PPD) and probing attachment level (PAL) along with classification of furcation involvement (FI) and bony defects were made at pre- and post surgery (6 weeks, 3 and 6 months). Improvement of P1I and GI scores was seen in both test and control sites following the surgical therapy. Reductions in PPD and PAL were significantly (p less than 0.001) more pronounced at 6 months in the test sites compared to the controls. The 2 Class I furcations in the graft-treated teeth showed complete resolution, while the corresponding furcations in the control teeth showed incomplete closure. The use of human collagen membrane based on the GTR technique for treatment of human periodontal defects provided greater gain of clinical attachment than when flap surgery alone was undertaken.     

Use of Emdogain in the treatment of deep intrabony defects: 12-month clinical results. Histologic and radiographic evaluation

The objective of this study was to evaluate the application of an enamel matrix derivative (Emdogain) in deep periodontal pocket therapy. Twenty-one patients presenting intrabony and interproximal defects that could be treated with guided tissue regeneration were selected. The intrabony defects were divided into deep (< 9 mm) and very deep (> or = 9 mm) defects. Bleeding on probing, Plaque Index, probing pocket depth, mobility index, gingival recession, probing attachment level, and surgical bone level were measured at baseline. At 12 months, cases were reexamined and indices recorded again. The mean probing depth decreased from 8.1 +/- 2.1 mm to 3.2 +/- 1.5 mm; attachment level decreased from 10.4 +/- 2.4 mm to 7.0 +/- 1.8 mm; recession increased from 2.3 +/- 1.4 mm to 3.8 +/- 1.8 mm; and surgical bone level decreased from 9.6 +/- 1.9 mm to 7.1 +/- 1.5 mm. No significant difference wa noted between bone defects with one or 2 walls, between local and generalized periodontitis, or between smokers and nonsmokers. Significant statistical difference was found, however, between deep intrabony defects and very deep defects when attachment gain was considered. No adverse reaction to the substance was noted. The good clinical results obtained were not confirmed by radiologic results; standardized and computerized radiographs at 12 months did not reveal significant improvement. The histologic examination carried out on 2 samples did not show evidence of new attachment. Further studies are necessary to clarify the action mechanism and to evaluate the long-term results of this method.     

Treatment of deep and shallow intrabony defects A multicenter randomized controlled clinical trial

Abstract. This prospective multicenter intra-individual randomized controlled clinical trial was designed to compare the efficacy of guided tissue regeneration (GTR) with bioresorbable barrier membranes versus access flap surgery, in intra-bony defects. 2 similar defects were selected in each of 23 patients and randomly assigned to 1 of the 2 treatments. Surgery consisted of an identical procedure except for the omission of the barrier membrane in the flap control sites. At 1-year. probing pocket depth reductions were 4.3±2.3 mm in GTR treated sites and 3.0±1.5 mm in the flap control sites (p=0.02. paired t-test). Clinical attachment level (CAL) gains were 3.0± 1.7 mm in the GTR sites and 1.6±1.8 mm in the control sites (p=0.009. paired t-test). A subset analysis, performed according to the initial depth of the intrabony component of the defects (INFRA), indicated that in shallow defects (INFRA ≤3 mm) treated with the access flap alone. CAL gains were 1± 1.5 mm. while in deep ones (INFRA ≥4 mm) they were consistently greater (1.9±1.9 mm). The % CAL gains, calculated as the % of the baseline intrabony component depth, however, were almost identical in the 2 subpopulations (45.8±64.7% in shallow and 43.8±37.6% in deep defects). Similarly, in the GTR sites, linear CAL gains were greater in deep (3.7±1.7 mm) than in shallow defects (2.2±1.3 mm), but no differences were observed in terms of % CAL gains (76.1±27.7% and 75.8±45%. respectively). The frequency distribution of CAL changes expressed as %s of the baseline INFRA indicates that most of the sites treated with GTR (73% in shallow and 92% in deep defects) gained 50% or more CAL. Furthermore, many defects (64% of shallow and 33% of deep defects) reached 100% of CAL gain. The present study demonstrated that: (i) GTR with bioresorbable barrier membranes resulted m a significant added benefit in comparison with access flap alone; (ii) the linear amounts of CAL gains were greater in deep than in shallow defects; (iii) CAL gains expressed as %s of the baseine depths of the intrabony component, were similar in shallow and deep defects; (iii) the regenerative procedure tested in the present study resulted in CAL gains equal to the depth of the intrabony component of the defect in some, but not in most of the instances.     

Defect-determined regenerative options for treating periodontal intrabony defects in baboons

BACKGROUND: In an effort to regenerate periodontal intrabony defects, the healing potential of the defect should determine what therapeutic modalities and materials are employed. The purpose of this study was to compare regenerative outcomes in baboon intrabony defects that were contained versus non-contained, using various regenerative therapies. METHODS: Nine adult baboons (Papio anubis) in good health were treated. Eighty-six interproximal, intrabony defects were surgically created: 43 contained by 3 walls of bone; 43 non-contained with a missing buccal wall. Chronicity and plaque accumulation were encouraged with wire ligature placement for 8 weeks. After ligature removal, scaling, and a 2- to 4-week healing period, the defects were treated with the following therapies: collagen membrane (GTR), human demineralized freeze-dried bone (DFDB) grafting (BG), combined therapy (GTR + BG) and a DFDB-glycoprotein sponge matrix (MAT). Clinical healing responses were evaluated in 58 sites by changes in soft tissue (recession, probing, clinical attachment) and hard tissue (resorption, defect fill) parameters 6 months post-treatment. Histologic evaluation (defect regeneration, connective tissue attachment, epithelial migration) was done on 26 sites. RESULTS: For contained defects, no real significant clinical (ANOVA) or histologic differences existed among treatments. However, for non-contained defects, combined therapy (GTR + BG) demonstrated clinically significant (P < or = 0.05, ANOVA) and histologically superior healing results over the other therapies tested. CONCLUSION: These results confirm a defect morphology directed rationale for periodontal intrabony therapy.     

No detrimental effect of fibrin glue on the regeneration of intrabony defects

Abstract. This controlled clinical trial evaluated the potential of fibrin glue as a biological carrier to locally deliver guided tissue regeneration (GTR) modulators. 2 controlateral, morphologically similar defects were selected in each of 11 patients and randomly assigned to the test (teflon membrane and fibrin glue) and the control treatment (teflon membrane alone). Outcomes were assessed at membrane removal as newly formed granulation tissue and at the 1-year follow-up in terms of changes in probing attachment level, probing pocket depth, recession of the gingival margin, probing bone levels and percentage of fill of the intrabony defects. Data confirmed that GTR treatment of deep intrabony defects results in clinically and statistically significant improvements of the clinical parameters. No significant differences, however, were evidenced between the test and the control treatments. It is suggested that, since fibrin glue did not show detrimental effects on GTR, it could be applied as a biological carrier for the delivery of GTR enhancers into the surgical wound.     

牙周引导组织再生术与植骨术联合应用的临床研究

目的　比较引导组织再生术 (GTR)和植骨术联合应用的方法与单纯GTR的方法在牙周骨内袋缺损中的疗效。方法　治疗 16例患者的 4 4个骨内袋缺损 ,其中 2 3个相似的病损联合应用了GTR加植骨术 ,而在 2 1个病损中进行了GTR术 ,疗效评价直至术后 12个月。结果　两组的手术区域 ,与术前基线比较 ,在术后 3、6、12个月观察到的临床参数如附着水平、探诊深度以及菌斑指数、探诊出血均有明显改善 (P <0 .0 0 1)。两组之间比较 ,结果无显著性差异 (P >0 .0 5 )。结论　在牙周手术中 ,植入骨代用品与GTR联合应用 ,比较单纯应用GTR方法的临床疗效没有显著性差异。     

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.     

Treatment of intrabony periodontal defects with enamel matrix derivative in private practice: a long-term retrospective study

The present study describes treatment of intrabony periodontal defects with enamel matrix derivative (EMD) in private practice. Ten patients with clinical diagnosis of chronic periodontitis were subjected to data analysis. A total of 18 teeth with various osseous defects received regenerative therapy with EMD, and were followed for a minimum of 2 years. Treatment of the intrabony defects with EMD led to a statistically significant improvement in the mean value of probing depth at 1-year when compared with at the baseline (p<0.01). Reduction in probing depth was achieved with minimal recession of the gingival margin, and was maintained over the 2-year observation period with no significant change. Mean values of attachment gain at 1 and 2 years were of clinical significance: 3.39+/-1.46 mm and 3.22+/-1.40 mm, respectively. Although one tooth was extracted because of subsequent loss of attachment and bone, most teeth treated have been successfully maintained for 2 to 7 years with no significant signs of disease progression. In conclusion, EMD treatment of intrabony osseous defects yielded clinically favorable responses. The gain in clinical attachment can be longitudinally maintained in a private practice setting. Further controlled studies are needed to elucidate the clinical significance of EMD treatment.     

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.