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PubMed1999

The use of a bovine bone mineral in periodontal osseous defects: case reports.

This article reviews the clinical and radiographical results of 12 periodontal patients treated with a bovine bone graft, Bio-Oss. Thirty-two periodontal intrabony osseous defects of various sizes and morphology were surgically treated and evaluated at 6 months. The patients responded well to the use of the bovine bone mineral with good tissue response and an improvement of the intrabony defects. There was an overall mean probing pocket reduction in the deepest sites of 2.34 mm (S.D. +/- 1.59) and a mean gain in probing attachment levels of 1.84 mm (S.D. +/- 1.09). There was a difference in the sites treated with the bovine bone alone compared to sites treated with the bone mineral and barrier membranes, but these differences were not significant. These preliminary findings seem favorable for bovine bone mineral as an alternative graft material to allogenic bone grafts from human tissue banks in treating intrabony defects.

Adolescent↗
PubMed2006

A new era in periodontal and periimplant regeneration: use of growth-factor enhanced matrices incorporating rhPDGF.

A new, powerful off-the-shelf wound healing and bone regeneration technology termed growth-factor enhanced matrix (GEM) has recently become available for clinical use. This graft material consists of a concentrated solution of pure recombinant human platelet-derived growth factor (rhPDGF-BB), the synthetic form of the body's key natural wound healing stimulator PDGF-BB, and an osteoconductive (bone scaffold) matrix. This is the first available purified, recombinant (synthetic) growth factor product and is the result of over a decade of extensive research. Clinical and animal study results with this graft material demonstrate that it is capable of simultaneously promoting wound healing, regeneration of bone, and acceleration of gingival attach-plent gain in challenging periodontal and periimplant defects.

Alveolar Bone Loss↗
PubMed2006

Enhancement of periodontal tissue regeneration by locally controlled delivery of insulin-like growth factor-I from dextran-co-gelatin microspheres.

The present work focused on the design of novel hydrogel microspheres based on both dextran- and gelatin-derived biomaterials, and discussed whether locally controlled delivery of IGF-I from dextran-co-gelatin hydrogel microspheres (DG-MP) was useful for periodontal regeneration enhancement. Microspheres were synthesized when gelatin was cooperating with glycidyl methacrylate (GMA) derivatized dextrans (Dex-GMA) and the resultant DG-MP with a hydrogel character of which the cross-linking density could be controlled by the degree of substitution (DS, the number of methacrylates per 100 glucopyranose residues) of Dex-GMA. In this study, three types of DG-MP (DG-MP4.7, DG-MP6.3 and DG-MP7.8) obtained from gelatin and Dex-GMA (differing in DS: 4.7, 6.3 and 7.8 respectively) were prepared and characterized by swelling and degradation properties, drug release kinetics and biological capability in promoting tissue regeneration. By swelling in aqueous positively charged IGF-I solutions, the protein could be encapsulated in DG-MP by polyionic complexation with negatively charged acidic gelatin. No obvious influence of Dex-GMA's DS on DG-MP's configuration and size was observed, and the release and degraded properties showed no significant difference between three types of DG-MP in PBS buffer either. However, high DS of Dex-GMA could lower microsphere's swelling, prolong its degraded time and minimize IGF-I burst release markedly in dextranase-containing PBS, where IGF-I release from a slow release type of microspheres (DG-MP7.8) could be maintained more than 28 days, and an effective protein release kinetics without a significant burst but a relevantly constant release after the initial burst was achieved. IGF-I in DG-MP resulted in more new bone formation in the periodontal defects within 4 or 8 weeks than IGF-I in blood clot directly did (P < 0.01). The observed newly formation of periodontal tissues including the height and percentage of new bone and new cementum on the denuded root surfaces of the furcation area in DG-MP7.8 group were more than that in other groups (P < 0.05). The adequate width of regenerative periodontal ligament (PDL), regular Sharpey's fibers and alveolar bone reconstruction could be observed only in DG-MP7.8 group. These combined results demonstrate that effective release kinetics can be realized by adjusting the DS of Dex-GMA and followed cross-linking density of DG-MP, and that locally controlled delivery of IGF-I from slow release type of DG-MP may serve as a novel therapeutic strategy for periodontal tissue regeneration.

Animals↗
PubMed1994

Periodontal repair in dogs: space provision by reinforced ePTFE membranes enhances bone and cementum regeneration in large supraalveolar defects.

Regeneration of alveolar bone and cementum following reconstructive therapy with reinforced space providing expanded polytetrafluorethylene (ePTFE) membranes was evaluated in supraalveolar mandibular premolar periodontal defects in five beagle dogs. The surgically-created defects in contralateral jaw quadrants were randomly assigned to receive the dome-shaped membrane or serve as surgical control. Flaps were positioned to completely submerge the teeth and sutured. The dogs were sacrificed 8 weeks after surgery and tissue blocks including teeth and surrounding structures processed for histology. Membrane treated defects in two animals became exposed and infected leaving intact quadrants in three dogs for histometric analysis. Parameters evaluated included defect height, height and area of regenerated alveolar bone, height of regenerated cementum, root resorption, and ankylosis. Mean defect height approximated 4.1 mm. Mean height (+/- s.d.) of regenerated alveolar bone amounted to 2.9 +/- 0.6 and 0.6 +/- 0.2 mm for membrane and control defects, respectively (P = 0.006). Corresponding values for bone area were 1.4 +/- 0.7 and 0.4 +/- 0.4 mm2 (P = 0.02). Cementum regeneration was observed in all teeth averaging (+/- s.d.) 1.6 +/- 0.3 mm for membrane treated and 0.1 +/- 0.1 mm for control defects (P = 0.01). Small amounts of root resorption were seen in all teeth with no significant difference between treatments. Ankylosis was noticed in three membrane treated and two control teeth. The present study provides a biologic rationale for space provision for enhanced bone and cementum regeneration in periodontal defects subject to reconstructive therapy.

Alveolar Bone Loss↗
PubMed1998

Current concept of guided tissue regeneration with non-absorbable membrane.

Guided tissue regeneration has been well established as a treatment modality for periodontal disease. Proper case selection and delicate surgical skills can lead to the predictable success. Additionally, the GTR may also be used to treat marginal tissue recession, peri-implantitis, and palato-gingival grooves. Furthermore, osteopromotion with membrane techniques can be used as a means to provide ridge augmentation in ridge defects, or as an adjunct to implant placements. It does play a very important role in implant dentistry and aesthetic dentistry.

Bone Substitutes↗
PubMed2003

Favorable healing following space creation in rhBMP-2-induced periodontal regeneration of horizontal circumferential defects in dogs with experimental periodontitis.

BACKGROUND: Recombinant human bone morphogenetic protein-2 (rhBMP-2) is believed to be capable of inducing periodontal regeneration. However, the risk of aberrant healing events, such as root resorption and ankylosis, has been reported. We hypothesized that implantation of BMP-containing carriers directly on the root planed surface may be the cause of unfavorable healing. The purpose of this study was to evaluate the influence of a 1 mm spacer membrane, which separated the rhBMP-2 in polymer-coated gelatin sponge (PGS) and the root surface, on periodontal regeneration of experimentally induced horizontal defects in dogs. METHODS: Horizontal circumferential periodontal defects were surgically created, and experimental periodontitis was induced in 72 maxillary and mandibular premolars of four male beagle dogs. The recipient sites of each quadrant received: 1) rhBMP-2/PGS (B group) (rhBMP-2 at 1.0 mg/ml, total implant volume/ site approximately 7.2 microl) (n = 24); 2) rhBMP-2/PGS with a spacer membrane (PB group) (n = 24); and 3) physiological saline (PS)/PGS as a control (P group) (n = 24). One quadrant was left untreated. Dogs were sacrificed at 12 weeks post-surgery, and healing was evaluated histologically. RESULTS: Both groups treated with rhBMP-2/PGS demonstrated enhanced new bone formation and connective tissue attachment with cementum regeneration when compared to the control group. Sites treated with rhBMP-2/PGS showed a greater degree of bone formation than sites treated with rhBMP-2/PGS and spacer membrane, although the latter sites showed no ankylosis. CONCLUSIONS: Implantation of rhBMP-2/PGS enhances bone formation and connective tissue attachment in horizontal circumferential defects. In addition, the use of a spacer membrane reduces the degree of bone formation, but minimizes ankylosis.

Alveolar Bone Loss↗
PubMed2002

Calcium sulphate as a bone substitute for various osseous defects in conjunction with apicectomy.

AIM: The purpose of this study was to investigate the effect of calcium sulphate on various osseous defects when used in conjunction with apicectomy. METHODOLOGY: Mandibular third and fourth premolars of 11 beagle dogs were used. After root-canal treatment and apicectomy, three types of osseous defects were prepared on both sides of the mandible as follows: type 1, osseous defect communicating with the gingival sulcus: type 2, large osseous defect including two roots; type 3, 'through and through' osseous defect. The experimental side was allocated randomly, and the osseous defects were filled with medical grade calcium sulphate. The defects on the opposite side were left unfilled as controls. The dogs were sacrificed at 8 and 16 weeks postoperatively. Undemineralized sections were obtained and examined histomorphometrically. RESULTS: In type 1 defects, bone was not observed on the buccal side of the root on either experimental or control side at 8 and 16 weeks. In both type 2 and 3 defects, bone volume/tissue volume (BV/TV) values on the experimental side were significantly higher than those on the control side (P < 0.01), and mineral apposition rate (MAR) values on the experimental side were significantly higher than those on the control side (P < 0.01). CONCLUSIONS: The use of calcium sulphate was effective in bone regeneration on both large osseous defects and 'through and through' osseous defects. It was less effective in osseous defects communicating with the gingival sulcus.

Alveolar Bone Loss↗
PubMed1997

Histological, clinical, and digital subtraction radiographic evaluation of repair of periodontal defects resulting from mechanical perforation of the chamber floor using ePTFE membranes.

The aim of this study was to test the hypothesis that a biocompatible membrane, when placed between the gingiva and cortical bone in teeth with periodontal defects that occurred following mechanical endodontic perforation, would facilitate greater regeneration than in control sites not treated with guided tissue regeneration. One beagle dog with a healthy periodontium was used in the study. The maxillary right first and second molars and the mandibular left first and second molars acted as the experimental group in which furcation perforations were treated by guided tissue regeneration. The maxillary left and mandibular right first and second molars served as the controls in which furcation perforation lesions were only treated by open flap debridement. Clinical, histological, and standardized radiographic evaluation showed significant differences between the test and control groups. In addition, digital subtraction radiography revealed a gain in alveolar bone height and increased density at all experimental sites, and a loss at all control sites. Histological evaluation showed extensive regeneration of both alveolar bone and connective tissue at experimental sites, but none at control sites. The results of this study suggest that the use of guided tissue regeneration in furcation lesions produced by endodontic perforations will result in significant new bone and connective tissue attachment.

Animals↗
PubMed2000

Defect morphology: effects on regenerative predictability and membrane selection.

In clinical experience, guided tissue regeneration has been associated with complications, which include membrane exposure. The maintenance of a stable blood clot under the membrane is key to a successful regenerative outcome. This requires adequate membrane stabilization, tension-free suturing, and maintenance of a good vascular supply to the defect. Careful selection of defects after a thorough periodontal evaluation and modification of surgical techniques from those used for conventional resective procedures can lead to predictable outcomes for guided tissue regeneration.

Absorbable Implants↗
PubMed1995

Periodontal healing after guided tissue regeneration with Atrisorb barriers in beagle dogs.

Periodontal healing after use of Atrisorb barrier material (polylactic acid) for guided tissue regeneration was studied in the premolar and molar teeth of six beagle dogs. Defects studied were surgically induced or were caused by naturally occurring periodontitis. Barriers fragmented and became displaced in 2 to 5 weeks after application. Granulation tissue was sometimes present between the barrier and root surface at 10 days to 4 weeks. Several sites were surgically reentered at 4 months, and new bone covered 60% to 100% of the formerly exposed furcations and root surfaces. Sites obtained for histologic evaluation 9 to 12 months after the baseline surgery showed new connective tissue attachment, cementum, and alveolar bone. Histomorphometric analyses quantitated these tissue changes, and new connective tissue attachment covered 72% of surgically exposed root surfaces and 77% of periodontitis-exposed root surfaces. It was concluded that new periodontal supporting tissues became reconstituted on root and furcation surfaces after use of the Atrisorb barrier material for GTR.

Alveolar Bone Loss↗
PubMed1995

Healing of periodontal lesions in monkeys following the guided tissue regeneration procedure. A histological study.

The purpose of the present investigation was to study histologically the healing of periodontal lesions in monkeys during the first 9 weeks following periodontal reconstructive surgery according to the principle of guided tissue regeneration. Horizontal interproximal lesions and through-and-through bifurcation defects were surgically produced in 2 adult monkeys. Following removal of granulation tissue and root planing, notches indicating the level of the reduced bone level were prepared in the root surfaces. Sterile teflon membranes were then adjusted to cover the defects, and the gingival flaps were sutured in a coronally displaced position. Sacrifice of the animals was scheduled to allow for observation periods of 1, 3, 4 and 9 weeks. Evaluation of histological specimens revealed a continuous growth of new connective tissue during a period of 4 weeks. The coronal growth of new tissue did not increase significantly between 4 and 9 weeks. New cementum had formed in the most apical part of one notch after 1 week of healing, and following 3 and 4 weeks, new cementum with inserting periodontal ligament fibers were observed in all notches and to a varying degree, also more coronally on the root surfaces of both interproximal and bifurcation defects. Limited regrowth of alveolar bone was observed in the 9-week specimens. Judged from the course of the blood vessels within the newly formed connective tissue in the defects, the tissue in the central part of the defects had originated from the alveolar bone, whereas the tissue adjacent to the root surfaces seemed to have its origin in the residual periodontal ligament.

Alveolar Bone Loss↗
PubMed1997

Guided tissue regeneration with non-resorbable and biodegradable barriers: 6 months results.

The aim of the present study was to compare the effects of guided tissue regeneration (GTR) with non-resorbable (ePTFE [G]) and biodegradable barriers (Polyglactin 910 (V)). In 20 patients, providing 25 pairs of symmetrical periodontal defects (7 pairs of interproximal intrabony lesions, 12 pairs of degree II and 6 pairs of degree III furcation involvement), each defect was randomly assigned to treatment with either non-resorbable (control) or biodegradable (test) devices. At baseline and 6 months after surgery, clinical measurements (GI, PPD, PAL-V, PAL-H, P1I) and standardized radiographs were obtained. On the radiographs, the linear distances from the cemento-enamel junction (CEJ) to the alveolar crest (AC), and from the CEJ to bottom of the bony defect (BD) were measured using a computer-assisted analysing method (LMSRT). Both treatments revealed a significant (p < 0.05) PPD reduction (-2.90 +/- 1.33 mm (V), -2.71 +/- 1.41 mm (G)), PAL-V gain (1.78 +/- 1.27 mm (V), 1.46 +/- 1.35 mm (G)), PAL-H gain (2.00 +/- 0.82 mm (V), 1.60 +/- 0.59 mm (G)), and radiographic changes (CEJ-AC: 0.48 +/- 0.75 mm (V), 0.73 +/- 0.92 mm (G); CEJ-BD: -0.76 +/- 0.79 mm (V), -0.41 +/- 0.72 mm (G)) after 6 months. The mean differences between the changes for test and control were not significant for most clinical and radiographic parameters. Similar clinical and radiographic results were found 6 months after surgical treatment using either non-resorbable or biodegradable barriers. More favorable results concerning PAL-H gain could be observed with biodegradable barriers after 6 months. Therefore, based on these results, the use of biodegradable barriers in GTR may be recommended and, thereby, a surgical re-entry to remove non-resorbable barriers can be avoided.

Adult↗
PubMed2003

Periapical and periodontal healing after osseous grafting and guided tissue regeneration treatment of apicomarginal defects in periradicular surgery: results after 12 months.

OBJECTIVE: The aim of the present study was to evaluate the periapical and periodontal healing of apicomarginal defects 12 months after periradicular surgery and guided tissue regeneration in a series of consecutively treated patients. STUDY DESIGN: Patients with apicomarginal defects who were referred for periradicular surgery were included. Apicomarginal defects were grafted with Bio-Oss bone mineral and covered with a Bio-Gide membrane. Periodontal probing depths (PPDs) and relative attachment levels were measured preoperatively and 12 months postoperatively with a manual force-controlled probe. Periapical healing was assessed clinically and radiographically. RESULTS: Of the 23 defects in 22 patients for whom follow-up data were available, 19 were considered clinically and radiographically successful, 2 were doubtful, and 2 were failures. Overall, the baseline median PPD decreased from 9.0 mm to 3.0 mm, corresponding to a median relative attachment level gain of 2.8 mm. In the case of periodontic-endodontic lesions, the median baseline PPD decreased from 9.8 mm to 4.0 mm, corresponding to a median relative attachment level gain of 4.2 mm. Defects that involved a proximal root surface had a significantly higher residual PPD than did defects not involving a proximal root surface. CONCLUSIONS: Guided tissue regeneration treatment of apicomarginal defects yields good results in terms of periapical and periodontal healing after 12 months and should be considered as an adjunct to periradicular surgery in such cases.

Adolescent↗
PubMed1997

Barrier membrane techniques in endodontic microsurgery.

The ultimate goal in endodontic microsurgery is the predictable regeneration of periapical tissues. One of the main concerns in treating an endodontically treated tooth which has a through-and-through osseous defect is that incomplete bone healing may be inevitable. This article reviews the use of different barrier membranes for bone regeneration. In addition, the indications, techniques, and prognosis of calcium sulfate in guided bone regeneration are presented.

Alveolectomy↗
PubMed2006

rhPDGF-BB promotes healing of periodontal defects: 24-month clinical and radiographic observations.

A new therapeutic system using purified recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in combination with a biocompatible, osteoconductive, synthetic scaffold beta-tricalcium phosphate (beta-TCP) has recently been shown in a large-scale, prospective, blinded, randomized clinical trial to safely and effectively treat advanced periodontal osseous defects. A significant gain in clinical attachment level was observed 3 months postsurgery for sites treated with 0.3 mg/mL rhPDGF-BB + beta-TCP versus beta-TCP + buffer (active control), with this trend continuing at 6 months postsurgery. Additionally, sites treated with 0.3 mg/mL rhPDGF-BB + beta-TCP also had significantly greater radiographic linear bone gain and percent defect fill at 6 months postsurgery than sites that received bone substitute with buffer. Representative cases from the clinical trial were followed to assess their ability to maintain the initial effect of treatment observed at 6 months. At 18 or 24 months postsurgery, with the same clinical and radiographic measurement techniques used as were performed at the 6-month time point for the clinical trial, these cases demonstrated maintenance of the clinical attachment level for all but one case, with all cases demonstrating substantial increases in linear bone gain and percent bone fill versus measurements obtained at 6 months postsurgery. Substantial radiographic changes in the appearance of the defect fill were observed for both rhPDGF-BB treatment groups, consisting of increased radiopacity and bone trabeculation, indicative of increased mineralization and maturation of the bone observed 6 months postsurgery.

Adult↗
PubMed2001

Periodontal regeneration by FGF-2 (bFGF) in primate models.

We recently demonstrated that a topical application of basic fibroblast growth factor (FGF-2; bFGF) to alveolar bone defects in beagle dogs enhanced periodontal regeneration. The purpose of this study was further characterization of the biological effects of FGF-2 in non-human primates. Thirty-two inflamed furcation class II defects were surgically created in 4 male primates. The gelatinous carrier alone or the carrier containing 0.1 or 0.4% human recombinant FGF-2 was topically applied to the defects and compared with no treatment. Eight weeks after application, the periodontal regeneration in those defects was analyzed. In all FGF-2-treated sites, significant periodontal regeneration was dose-dependently observed in greater amounts than in the carrier-treated or non-treated sites. No instances of epithelial down-growth, ankylosis, or root resorption were observed in the FGF-2-treated sites. These results indicate that a topical application of FGF-2 can enhance considerable periodontal regeneration in surgically created furcation class II defects of non-human primates.

Alveolar Bone Loss↗
PubMed2002

Rothmund-Thomson syndrome: a case report.

Rothmund-Thomson syndrome (RTS) is an extremely rare genetic disorder characterized by poikilodermatous skin changes, photosensitivity, and an increased risk of developing skin and bone malignancies. In this case report, the dental and periodontal features of RTS in a 16-year-old female patient are presented. The transmission electron microscopy performed on a gingival biopsy specimen showed structural defects of connective tissue. If the unusual ultrastructural findings of this case are confirmed as being consistent with other RTS patients, it is our opinion that this syndrome can be considered among the systemic diseases associated with early-onset periodontitis.

Adolescent↗
PubMed1996

Does root surface conditioning with citric acid delay healing?

Effects of topical citric acid application on tissue maturation was studied in standardized periodontal defects in 6 beagle dogs. Following elevation of facial mucoperiosteal flaps, fenestration defects, 3 mm in diameter, were made through the cortical bone and recessed 0.5 mm into the dentin of maxillary canines. 1 defect in each dog was conditioned with a saturated solution of citric acid for 3 min and then rinsed with saline. Control defects in contralateral teeth were treated with saline only for the same length of time. The defects were covered with an expanded polytetrafluoroethylene membrane and the flaps repositioned and sutured. 14 days postsurgery, healing appeared more advanced along the defect walls and floor than in the center of the defect in all instances. Histometrically, citric acid-conditioned defects exhibited a higher density of collagen fibers along the defect walls and floor and adjacent to the barrier membrane as well as more advanced resolution of the residual blood clot than the surgical controls. Differences in fibroblast density within specimen pairs were non-significant. All control defects but none of the acid-conditioned defects showed an artifactual split between the dentin walls and the granulation tissue. This study failed to support the contention that topical application of citric acid to root surfaces may delay healing following periodontal surgery.

Administration, Topical↗