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PubMed1992

An augmented regenerative technique for severe osseous defects.

Techniques for new attachment using the principle of guided tissue regeneration with barrier membranes have become accepted as a method for treating teeth with severe osseous defects and furcation involvement. After an evaluation of existing membranes and techniques, a procedure was developed using an expanded polytetrafluoroethylene soft tissue patch, 1 mm thick (W. L. Gore and Assoc., Flagstaff, AZ), in conjunction with an alloplast hydroxylapatite bone substitute (HA-500, 40-60 mesh) (Orthomatrix, Minneapolis, MN), to maintain a space for the maturation of the blood clot. An in vitro study of microbial adherence to the soft tissue patch indicated that the number of attached Streptococcus sanguis (gordonii) G9B, and Actinomyces viscosus T14 (V) cells was significantly lower (P < .005 and P < .025, respectively) than the number of bacteria that attached to Gore-Tex Periodontal Material. Two case reports are presented to demonstrate the successful use of the soft tissue patch augmented with hydroxylapatite in patients exhibiting furcation involvement and severe vertical osseous defects.

Actinomyces viscosus↗
PubMed1998

Alveolar bone levels in AIDS and HIV seropositive patients and in control subjects.

Alveolar bone levels were studied from intraoral radiographs of 24 non-hospitalized patients with AIDS, 17 HIV seropositive subjects, and 39 matched control subjects. The AIDS/HIV subjects were seeking dental care in a faculty practice. The matched control subjects came from those non-HIV-infected patients seeking dental care at the University of Washington. Magnified intraoral radiographs were used to assess the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL). The extent of vertical defects and furcation invasions was also assessed. The mean age of the AIDS, HIV, and control subjects was 38.9 +/- 6.6 years, 37.1 +/- 7.6, and 39.9 +/- 5.6, respectively, and was not statistically different. Among the AIDS patients, 75% were smokers, while 88.2% of the HIV subjects were cigarette smokers. Therefore, the matched control subjects were also smokers to the same extent. The mean difference in distance CEJ-BL was 0.1 mm (mesial) and 0.3 mm (distal) and greater in the HIV/AIDS group than in the control group, but not statistically different. No vertical defects > or = 3.0 mm were found in 69.2% of the control subjects and in 58.5% of the combined HIV/AIDS group. None of the HIV/AIDS subjects had more than 5 defects > 3.0 mm, while 7.6% of the control subjects had such defects. Significant associations were found between smoking and extent of alveolar bone loss (distance) (P < 0.001) as well as the number and extent of vertical defects (P < 0.01), but were not associated with HIV status. The extent of furcation invasions, as read radiographically, did not differ between groups. In conclusion, smoking but not HIV status was the primary factor for alveolar bone loss.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Horizontal alveolar bone loss and vertical bone defects in an adult patient population.

The objectives of the present investigation were to analyze intraoral radiographs and to study 1) the distribution of the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL) and 2) the prevalence and severity of vertical defects, and furcation lesions in 416 individuals seeking dental care. Full mouth radiographs were enlarged 7.5 times and the mesial and distal distances between CEJ and bone level were measured. The extent of interradicular molar radiolucencies was also measured. Images of 10,282 teeth were studied. Subjects were between 15 to 94 years (mean age: 47.2, S.D.+/-15.2). On average they had 24.8 teeth (S.D.+/-5.5). The mean distance CEJ-BL increased significantly up to age 45 (r2=0.07; beta=0.29; P < 0.0001) and remained stable thereafter r2=0.09, beta=-0.02, N.S.). The mean distance CEJ-bone level was 1.4 mm (S.D.+/-0.7) in the 15 to 24 age group; 3.0 (S.D.+/-1.5) in the 45 to 54 age group; and 3.02 (S.D.+/-1.4) in the 75 to 94 age group. No vertical defects were found in 163 participants (39.3%); vertical defects > or = 3.0 mm were found in 30.2% (126). Mesial defects were significantly more common that distal defects (P < 0.001). The extent of horizontal bone loss was correlated to extent of vertical defects (r2=0.88; P < 0.0001). The number of remaining teeth was not associated with horizontal or vertical bone loss. In conclusion, the study indicated that few of the individuals had extensive horizontal bone loss. Vertical defects suitable for guided tissue regeneration procedures however, were found in many patients.

Adolescent↗
PubMed1991

Agreement between panoramic and intra-oral radiography in the assessment of marginal bone height.

Panoramic and intra-oral radiographs from 400 consecutive patients were evaluated for the assessment of the marginal bone height. Two hundred panoramic radiographs were exposed with the rotational technique and 200 with the intra-oral X-ray tube technique. Measurements of the approximal marginal bone level were independently performed by two observers. Complete agreement between panoramic and intra-oral radiographs was, on average, obtained in 55% and 49% of the sites, respectively. When the criterion for agreement was widened to include recordings with a difference of +/- 1 mm, the agreement was on average 87% irrespective of the techniques compared. The agreement varied with tooth type and severity of the marginal bone loss. Angular bony defects and furcation involvements were recorded separately. For angular bony defects there was a variation in agreement from 33% to 46% for the rotational technique and from 35% to 51% for the intra-oral X-ray tube technique depending on localization. Furcation involvements of the molars were equally recorded in 60% and 59%, respectively, but in only 12% and 28% for the upper premolars. Interobserver agreement was 58% for the intra-oral radiographs, 60% and 59% for the two panoramic techniques. Mean intra-observer agreement was 68%, 66% and 68%. It is concluded that panoramic radiography can often be used for the assessment of marginal bone loss alone, supplemented when necessary by intra-oral radiographs.

Adolescent↗
PubMed1994

Radiographic detectability of bone loss in the bifurcation of mandibular molars: an experimental study.

The aim of this study was to evaluate observer performance in the diagnosis of bone loss in the bifurcation of mandibular molars on conventional radiographs. Standardized radiographs were obtained of the first and second molars in 10 dry hemimandibles at baseline and after preparation of bony defects corresponding to degree I and degree II buccal furcation involvements. The radiographs were randomly presented to 12 observers who were asked to determine the presence or absence of bone loss. Receiver operating characteristic (ROC) curve analysis was used for evaluation. The mean AZ-value of all observers was 81% for the first molar and 80% for the second. As the degree of furcation involvement increased, the mean AZ-value of the observers also improved from 68% (furcation involvement degree I) to 86% (degree II). Multiple regression analysis revealed that lesion depth was the factor which most strongly influenced the observers' diagnostic performance.

Alveolar Bone Loss↗
PubMed1983

Clinical evaluation of freeze-dried bone allografts in periodontal osseous defects. Part III. Composite freeze-dried bone allografts with and without autogenous bone grafts.

Freeze-dried bone allografts (FDBAs) were evaluated alone and in combination with various types of autogenous bone in the treatment of periodontal osseous defects. A total of 381 defects were evaluated by surgical reentry approximately 1 year after grafting. Reentry data were compared with similar data obtained when the grafts were placed. Osseous regeneration and pocket reduction were rated as complete, greater than 50%, less than 50%, or failed. Complete or greater than 50% regeneration was considered successful. When compared with FDBAs, composite freeze-dried bone allografts/autogenous bone grafts (FDBA/ABGs) appear to offer significantly improved results in both osseous regeneration and pocket reduction. Use of composite FDBA/ABGs resulted in significant improvement in the treatment of combination one/two-wall defects and furcation involvements. A trend of improvement was seen with two-wall defects. The surgical data indicated that complete wound closure and the use of antibiotics enhanced graft success. The results also indicated that the presence of endodontically obturated teeth may be a consideration in the success or failure of the graft.

Adolescent↗
PubMed1995

Bacterial colonization of the external and internal sulci and of cellulose membranes at time of retrieval.

Membrane exposure with bacterial contamination is often considered one of the main reasons for the lack of predictability in achieving complete regeneration of periodontal defects. Ten cellulose membranes, retrieved from 7 patients treated for Class II furcation lesions in lower molars with at least 4 mm of exposure at time of retrieval were studied. Contamination of exposed membranes was studied using SEM analysis of four surfaces of the membrane, upper external, lower external, upper internal, and lower internal surfaces. DNA probe analysis of three periodontopathic bacteria, Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinmycetemcomitans, was carried out for specimens collected from the external and internal sulci. The results suggest that bacterial contamination of the membranes could be controlled if proper pre- and postoperative care is followed, since significant amounts of any of the three periodontopathogenic bacteria studied were not found. The SEM analysis corroborated the DNA probe analysis since the predominant morphotypes detected were not suggestive of periodontopathogenic bacteria. The importance of membrane contamination and of root concavities in the lack of predictability of the GTR procedure is discussed.

Adult↗
PubMed2002

Alveolar bone upper growth in furcation area using a combined orthodontic-regenerative therapy: a case report.

BACKGROUND: This case report demonstrates orthodontic and regenerative combined therapy in a 49-year-old male whose right maxillary premolar furcation had a bony defect with poor biologic width resulting from extensive subgingival caries. In these advanced interdisciplinary cases, crown lengthening with periodontal surgery alone does not solve the complex clinical problems. We believe that a combined orthodontic and periodontal regenerative combination therapy offers the best option for achieving a predictable outcome. METHODS: First, regenerative therapy by open debridement with a bioabsorbable synthetic bone graft, bioabsorbable membrane, and minocycline root conditioning was carried out. Eight weeks after initial surgery, orthodontic extrusion was initiated. RESULTS: Radiographs and reentry documentation suggest that the furcation defect associated with poor biologic width was successfully treated. CONCLUSION: This case report demonstrates that orthodontic-regenerative combined therapy can resolve complex clinical problems and enhance predictability.

Absorbable Implants↗
PubMed1995

Interproximal free gingival grafts after membrane removal in guided tissue regeneration treatment of intrabony defects. A randomized controlled clinical trial.

The purpose of this controlled clinical trial was to compare the efficacy of two surgical approaches to protect the regenerated tissue following membrane removal in guided tissue regeneration (GTR) treated intrabony defects. Twenty-eight (28) defects, one each in 28 patients were randomly assigned after placement of the membrane to one of two treatment groups by blocking to prognostic variables. The test group received free gingival grafts on the interproximal regenerated tissue. In the control group the surgical flaps were coronally positioned over the regenerated tissue. The two groups were well balanced with respect to all prognostic variables. The results indicated that: 1) similar amounts of regenerated tissue were obtained in the two groups at membrane removal (7.6 +/- 2.8 mm, test; 8.3 +/- 2.3 mm, control); 2) a significantly greater amount of probing attachment level gain was observed in the test group (5.0 +/- 2.1 mm, test; 3.7 +/- 2.1 mm, control). This study indicated that placement of free gingival grafts on the interdental regenerated tissue further improves the clinical outcome of GTR in deep intrabony defects.

Adult↗
PubMed2003

Effectiveness of a combination of platelet-rich plasma, bovine porous bone mineral and guided tissue regeneration in the treatment of mandibular grade II molar furcations in humans.

OBJECTIVE: A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM) and guided tissue regeneration (GTR) has been shown to be effective as regenerative treatment for intrabony periodontal defects. The purpose of this study was to evaluate the effectiveness of PRP, BPBM and GTR used in combination as regenerative treatment for grade II molar furcation defects in humans. MATERIAL AND METHODS: Using a split-mouth design, a total of 52 grade II mandibular molar furcation defects were treated either with PRP/BPBM/GTR (experimental group, n=26) or with an open flap debridement (control group, n=26). The primary outcomes evaluated in this study included changes in pocket depth, attachment level and re-entry bone levels (horizontal and vertical) between baseline and 6 months postoperatively. RESULTS: The results showed that the experimental group presented with significantly greater pocket reduction (4.07+/-0.33 mm for experimental and 2.49+/-0.38 mm for control sites), gain in clinical attachment (3.29 +/- 0.42 mm for experimental and 1.68+/-0.31 mm for control sites), vertical defect fill (2.56+/- 0.36 mm for experimental and -0.19+/-0.02 for control sites) and horizontal defect fill (2.28+/-0.33 mm for experimental and 0.08+/-0.02 mm for control sites) than the control group. CONCLUSIONS: It was concluded that the PRP/BPBM/GTR combined technique is an effective modality of regenerative treatment for mandibular grade II furcation defects. Further studies are necessary to elucidate the role played by each component of the combined therapy in achieving these results.

Absorbable Implants↗
PubMed1994

Microradiography of the feline marginal periodontium with a microfocal high-resolution x-ray system.

The present paper is a cross-sectional microradiographic study. Postmortem hemimandibles were radiographed with a microfocal high-resolution method. Microradiographic appearances of the feline periodontium are described and discussed. Mean relative alveolar bone support in clinically and histologically normal cats was 46.9%. Site-specific alveolar bone support (ABS) was calculated twice (blind). The 95% confidence limits of the method error for one observation were estimated. Differences between two site-specific measurements did not exceed +/- 2.72%. Microfocal radiography yielded valuable additional information about the feline periodontium and made it possible clearly to identify important dental and periodontal structures such as the CEJ (cementoenamel junction) and the bottom of infrabony defects.

Alveolar Bone Loss↗
PubMed1996

Barrier membranes in the treatment of periodontal defects.

Efficacious guided tissue regeneration for intrabony, furcation class II, and recession defects can be accomplished with both nonresorbable and bioresorbable barriers. The potential for regeneration of the periodontium is highly dependent on defect morphology and the availability of "progenitor cells." Many factors associated with surgical technique and barrier properties influence the regenerative outcome of guided tissue regeneration. Maintained flap coverage of the barrier minimizes epithelial down-growth as well as the risk of bacterial contamination of the barrier and the healing wound. Coverage of the newly regenerated tissues after removal of nonresorbable barriers is essential. The use of bioresorbable barriers eliminates a second operation for membrane removal and the associated potential trauma to the regenerating tissues. A stringent postoperative plaque control regimen is necessary during the healing period. The use of systemic antibiotics, prescribed concomitantly with insertion of the barriers has limited effect in controlling various pathogens and is therefore questionable.

Alveolar Bone Loss↗
PubMed2005

Alveolar bone levels in adults as assessed on panoramic radiographs. (I) Prevalence, extent, and severity of even and angular bone loss.

There is limited information regarding the prevalence and intraoral distribution of infrabony lesions potentially suitable for regenerative procedures in common patients seeking regular dental care in a dental practice. The aim of the present study was to investigate the prevalence and extent of alveolar bone loss and infrabony defects in randomly selected orthopantomograms of adult patients in different age groups seeking treatment at the dental service of the German Armed Forces. A total of 240 panoramic exposures were available for analysis, 60 in each of the age groups <30, 30-39, 40-49, and >or=50 years of age. At each tooth, distances between the cementoenamel junction or margin of restoration and the alveolar crest as well as the bone level were measured with a calliper to the next 0.1 mm. Whereas virtually no bone loss was present in the youngest age group, a major change in bone level frequency distributions occurred after age 30 years. At age 50 years, about 50% of subjects had considerable bone loss of more than 4 mm at 10% or more sites, and 6 mm or more at about 5% sites. Deep infrabony defects were infrequently found before age 40 years. About 20% of patients at least 50 years of age had radiographic evidence of infrabony pockets of 4 mm or more at not more than 5% of sites. Bone loss was more pronounced in the maxilla, especially at molars. In this predominantly male population, periodontal bone loss gradually increased with age. However, prevalence of infrabony defects was very low.

Adult↗
PubMed2004

Periodontal repair in dogs: analysis of histometric assessments in the supraalveolar periodontal defect model.

BACKGROUND: Traditionally, the mean value from histometric assessments of several histologic sections from the same site has been, used for the histometric characterization of the site. The histometric analysis of the supraalveolar periodontal defect model uses observations from buccal and lingual sites in three step-serial sections representing the central aspect of the mesial and distal root for the third and fourth mandibular premolar teeth. The objectives of this study were to investigate the correlations and determine whether there are significant differences in the measurement values of various histometric parameters between the three step-serial sections and to test the hypothesis that, in this animal model, histometric assessments using the most central section of each root are comparable to the mathematical means of corresponding assessments of the site using the three step-serial sections. METHODS: Histometric analysis using light microscopy, an attached digital camera system, and a personal computer-based image analysis system including a custom program for the supraalveolar periodontal defect model was performed on histologic sections acquired from one jaw quadrant in each of 12 dogs. The animals had received a protocol including placement of a coral biomaterial and guided tissue regeneration (GTR) membranes, and were evaluated following a 4-week healing interval. Twelve parameters were assessed using three central step-serial sections from each root. For each parameter, pair-wise comparisons were performed using the mixed models analysis of variance, and the correlations between measurements were assessed by the intraclass correlation coefficient (ICC). RESULTS: For all parameters assessed, there were no significant differences (P > 0.05) among the three sections. The differences between the central section and the means of the three step-serial sections were small and not statistically significant. Parameters that could be assessed on most or all specimens, such as defect height and area, membrane height, and bone regeneration area, showed high correlations among the three step-serial sections (intraclass coefficient [ICC] approximately 0.91 to 0.98), and between each of the three sections and the mean for the three step-serial sections (ICC > or = 0.95). The most central section had somewhat higher correlation with the mean than measurements made on the lateral sections. CONCLUSION: The results suggest that using the supraalveolar periodontal defect model representative histometric data can be obtained evaluating only the central section from each defect site.

Animals↗
PubMed2006

Five-year follow-up of regenerative periodontal therapy with enamel matrix derivative at sites with angular bone defects.

BACKGROUND: This prospective case series report aimed at analyzing the long-term (5 years) stability of clinical attachment level (CAL) gains following regenerative therapy with the use of enamel matrix proteins in intrabony defects. METHODS: A total of 114 consecutively treated periodontal patients (mean age: 55.8 years) were initially included. Each subject exhibited at least one deep proximal intrabony defect with the inclusion criteria of 1) probing depth (PD)>or=5 mm, 2) clinical attachment loss>or=6 mm, and 3) radiographic evidence of a >or=3-mm intrabony component. A total of 146 defects met the criteria for inclusion. At least 6 months after the completion of an initial phase of mechanical infection control, a baseline examination was performed to characterize the experimental site. Reconstructive therapy with the use of enamel matrix proteins was subsequently performed. Experimental sites were reexamined 1 and 5 years after reconstructive surgery. Primary efficacy variables were considered to be changes in PD, CAL, soft tissue recession (REC), and radiographic defect depth (RDD). Stepwise regression analysis was employed for evaluation of predicting factors of CAL change between the 1- and 5-year reexaminations. RESULTS: A total of 82 patients (102 defects) were included in the analysis. One year following the regenerative surgery, a mean CAL gain of 4.3 mm (P<0.001), a mean PD reduction of 4.9 mm (P<0.001), and a mean increase in REC of 0.6 mm (P<0.001) were recorded. At the 5-year follow-up, a further mean PD reduction of 0.3 mm (P>0.05), CAL gain of 1.1 mm (P<0.01), and reduction in recession of 0.8 mm (P<0.01) had taken place. Radiographs revealed that the bone defect had been reduced in depth with an average of 2.9 mm at 1 year (P<0.001). No statistically significant alteration in defect depth was observed between 1 and 5 years of follow-up. The stepwise regression analysis identified the degree of REC and residual PD at 1 year as significant predictors of CAL change between 1 and 5 years. CONCLUSION: Results demonstrated long-term (5 years) stability of CAL gains following regenerative therapy with the use of enamel matrix proteins in intrabony defects.

Adolescent↗