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PubMed1994

Periodontal repair in dogs: supraalveolar defect models for evaluation of safety and efficacy of periodontal reconstructive therapy.

It is increasingly evident that controlled preclinical models with reproducible defect characteristics and biologic reaction are critical for evaluation of safety and efficacy of periodontal reconstructive protocols. Our investigations have characterized a supraalveolar periodontal defect in the mandibular premolar region in the beagle dog. This surgically-created critical size defect heals with almost complete connective tissue attachment following immediate reconstructive surgery. When the defect is exposed to periodontitis-simulating conditions prior to surgery the new connective tissue attachment is reduced. Bone and cementum regeneration is limited for both defect variations. Critical aspects relative to animal selection and management, surgical protocol, histologic and statistical analysis are discussed. This preclinical model has proven effective for evaluation of safety and efficacy of devices and biologics used adjunctive to periodontal reconstructive therapy.

Alveolar Bone Loss↗
PubMed2000

Ridge preservation utilizing an alloplast prior to implant placement--clinical and histological case reports.

A calcified copolymer alloplast (Bioplant HTR, Bioplant Inc., South Norwalk, CT) was utilized to fill osseous defects in five patients. Hard tissue cores were obtained from the grafted sites and prepared for biopsy. In one patient, the lining of a soft tissue flap was biopsied 8 months postgrafting. Histological evaluation of the specimens revealed that the copolymer particles placed adjacent to the bony defect walls served as an osteoconductive material in which vital remodeling bone and marrow formed and fused to the surface of the particles. This process of bone deposition and remodeling was present 11 years following grafting.

Adult↗
PubMed1995

No detrimental effect of fibrin glue on the regeneration of intrabony defects. A controlled clinical trial.

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.

Adult↗
PubMed1995

New attachment and bone formation in periodontal defects following treatment of submerged roots with guided tissue regeneration.

The purpose of the present study was to examine the effect on periodontal regeneration of preventing bacterial contamination of the membrane material following the guided tissue regeneration procedure (GTR). Periodontal dehiscence defects were surgically produced in 2 monkeys. In each monkey, 8 of these defects were submerged after resection of the crowns of the teeth and a teflon (Gore-Tex Periodontal Material) or a polyglactin (Vicryl Mesh) membrane was adjusted to cover the defect and the exposed root surface. 4 defects on non-crown resected teeth were treated with either a teflon or a polyglactin membrane positioned with the coronal border approximately 2 mm below the margin of the covering tissue flap. Following 6 months of healing, the animals were sacrificed. Histological evaluation of the specimens revealed that roots which were kept completely covered during the healing period demonstrated new connective tissue attachment and bone formation corresponding to 67-100% of the length of the initial defect depth, whereas the amount of new connective tissue attachment and bone on non-submerged roots ranged between 30-59% and 11-31%, respectively. It seems reasonable to anticipate that it is bacterial contamination of the membrane material which jeopardizes the formation of new connective tissue attachment but in particular bone formation following the GTR-procedure.

Alveolar Bone Loss↗
PubMed2004

The healing potential of periodontal-endodontic lesions.

Osseous lesions involving the periodontium, and which are sometimes associated with discomfort and pathologic changes such as swelling or the development of a sinus tract, are not always due to periodontal disease. Thus, it is not uncommon to find a dentition with generally good periodontal health but with one tooth having a severe isolated bony periodontal defect. In other cases, periodontal treatment may result in a general improvement, except in relation to one tooth which does not respond to the therapy. Very often these cases are instances of combined periodontal-endodontic lesions, but which are solely of pulpal origin. This paper serves to help the dental practitioner recognise the disease process underlying the condition and appreciate its effective management with non-surgical root canal treatment.

Dental Fistula↗
PubMed2002

Treatment of intrabony defects associated with interradicular root proximity/fusion in molar furcations.

To treat furcation involvement is a crucial challenge to periodontists, not only because of the limitation in pocket reduction by osteoplasty and apically positioned flap, but also because of the unpredictability in regenerative approaches. Therefore, if the first molar is absent and the second molar has to be retained strategically for prosthetic reasons, very few alternatives besides nonsurgical/surgical debridement can be taken in treating the furcation of the second molar, where the interradicular root proximity and fusion frequently occur. On the other hand, root amputation/hemisection has long been considered a contraindication in treating furcations with two close roots; however, this impression is only empirical. A series of clinical cases involved in the treatment of intrabony defects associated with interradicular root proximity and fusion by root amputation/hemisection has been reported. Without any help of regenerative material, thorough root debridement and pocket reduction were attained. Based on these cases, we suggested that the cut surface created by odontoplasty during root amputation was compatible for periodontal healing and the extraction socket provided striking potential for defect repair. We re-examined the clinical feasibility and benefit of treating intrabony defects associated with interradicular root proximity and fusion in molar furcations by root amputation/hemisection, and suggested that its role should be favorably reconsidered on case basis. The short-term success in periodontal and prosthetic aspects needed to be further evaluated at long-term follow-up.

Adult↗
PubMedDate not supplied

Regenerative treatment of periodontal defects utilizing a bioresorbable collagen membrane.

Barrier membranes composed of resorbable collagen have demonstrated potential for use in guided tissue regeneration (GTR) procedures for repair and regeneration of periodontal defects. This article reviews the rationale for use of a collagen membrane in GTR therapy and related clinical procedures. Characteristics of the material are outlined, and indications and contraindications for utilization are discussed. Two cases are presented to demonstrate details of these principles and techniques. The learning objective of this article is to familiarize the reader with a new absorbable collagen membrane and its application in the periodontal area.

Adult↗
PubMed2006

Healing response of apicomarginal defects to two guided tissue regeneration techniques in periradicular surgery: a double-blind, randomized-clinical trial.

AIM: To compare healing responses to periosteal sliding grafts and polyglactin 910 periodontal mesh used as guided tissue regeneration (GTR) materials/techniques when both periapical and periradicular bone loss are present. METHODOLOGY: Thirty patients with suppurative chronic apical periodontitis with apicomarginal communication were selected and allocated randomly into two groups according to the barrier technique to be used during periradicular surgery: periosteal graft group (n = 15) and bioabsorbable membrane group (n = 15). Clinical and radiological evaluations were completed prior to surgery, a week later and every 3 months after surgery up to 12 months to measure the periodontal pocket depth (PD), clinical attachment level (CAL), gingival margin position (GMP), size of periapical lesion, percentage reduction of the periapical rarefaction, and periapical healing. RESULTS: Both groups showed highly significant (P < 0.001) reductions in periodontal PD, CAL and size of periapical lesion at 12 months whilst GMP was unaltered. No significant difference between the experimental groups was evident for these parameters, or for the percentage reduction of size of the periapical lesion and clinical-radiographic healing. CONCLUSION: Guided tissue regeneration applied to apicomarginal defects using sliding periosteal grafts and use of bioabsorbable membranes led to similar enhancements of the clinical outcome of periradicular surgery in terms of periapical healing, gain of periodontal support, PD reduction and minimal recession of the gingival margin.

Absorbable Implants↗
PubMed1995

Periodontal repair in dogs: evaluation of the natural disease model.

Animal models are frequently consulted for histometric analysis of periodontal reconstructive therapy. Such models include surgical, periodontitis-simulating and natural disease defects in canines or non-human primates. Our studies suggest that homogeneity in defect height is critical for sensitivity of surgical and periodontitis-simulating supraalevolar defect models in discriminating treatment effects. We herein evaluate this model aspect for natural disease defects. Buccal-lingual histologic sections from the 2nd, 3rd, and 4th mandibular premolar teeth (P2, P3, P4) from 6 aged beagle dogs with advanced natural periodontal disease were used. Defect heights from the reduced alveolar bone to the cemento-enamel junction were recorded in central step-serial sections at the buccal and lingual surfaces of the mesial and distal roots for the premolar teeth. Mean defect height, standard deviation and coefficient of variation were calculated for tooth types and jaw quadrants, separately, and for all teeth. Confidence intervals were calculated for teeth in left and right jaw quadrants. Mean defect height and standard deviation for left and right jaw quadrants was 3.6 +/- 0.9 and 3.3 +/- 0.6 mm for P2, 3.3 +/- 0.9 and 2.3 +/- 0.9 mm for P3, and 3.3 +/- 1.0 and 4.5 +/- 1.6 mm for P4, respectively. Coefficient of variation for defects for left and right jaw quadrants was 26 and 40%, respectively. Using confidence intervals for mean differences between jaw quadrants, it was determined that a mean treatment effect may be as large as 0.8, 1.1 and 1.9 mm for P2, P3 and P4, respectively, before being detected as statistically significant (p < or = 0.05; N = 6).(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Bone Loss↗
PubMed2001

Naturally occurring periodontal bone loss in the wild deer mouse, genus Peromyscus.

BACKGROUND: Historically, animal models for the study of periodontal diseases have incorporated surgically created defects, plaque retentive ligatures, as well as soft and high-sucrose diets which may not accurately reflect progression of the natural disease. Spontaneous periodontal disease is seen in a few animal species, but these are often expensive to maintain and are unsuitable for manipulation using advanced molecular biology techniques. Mice are inexpensive, easy to maintain, and are routinely used for transgenic experiments and are therefore an optimal animal for research purposes. However, it is commonly accepted that mice do not spontaneously develop periodontal disease. The purpose of this study was to determine if a mouse population that exhibits periodontal breakdown in the wild could be found, allowing for genetic manipulation of naturally occurring periodontal disease. METHODS: We examined over 2,500 dry skulls of several Peromyscus species from various locations and habitats on the west coast of North America for periodontal bone loss in the molars, using furcation involvement as an indicator of disease severity. Alveolar bone loss was classified as Grade I) horizontal component of bone loss in the furcations; II) through-and-through furcations; and III) through-and-through furcations with alveolar bone loss into the apical third of the root. RESULTS: The proportions of individual mice experiencing bone loss were 3.8% for Class I-III involvement, 1.3% for Class II-III involvement, and 0.5% for Class III alone. Three subspecies of P. keeni and one subspecies of P. maniculatus had periodontal disease prevalences in 7% to 13.5% of their samples. Mice from isolated islands had 1.8- to 4.7-fold higher disease prevalence than those located on the mainland, with even greater prevalence on small islands. No statistically significant differences between genders were found. CONCLUSIONS: It appears that periodontal disease is far more common in this mouse genus than previously believed. Some of the subspecies demonstrated severe periodontal disease at a prevalence comparable to that found in humans.

Alveolar Bone Loss↗
PubMed1994

Clinical and radiographic healing pattern observations with combined regenerative techniques.

Clinical and radiographic healing observations were categorized into four patterns: rapid, typical, delayed, and adverse. While considerable overlap of characteristics was noted between the categories, singular factors or combinations of factors enabled pattern identification. The factor primarily associated with the rapid healing pattern was the appearance of bone in the former defect adjacent to the membrane at removal. In contrast, the adverse healing pattern depicted surface necrosis or loss of tissue height at membrane removal. One hundred random sites were evaluated, revealing 13% rapid healing patterns, 76% typical healing patterns, 8% delayed healing patterns, and 3% adverse healing patterns. With favorable patient compliance with oral hygiene and follow-up care, the rapid and typical healing patterns became clinically successful cases. The level of clinical success varied with the delayed healing pattern; the adverse pattern failed to achieve the therapeutic objective.

Alveolar Bone Loss↗
PubMed1989

Comparison between panoramic and periapical radiography in the diagnosis of periodontal bone loss.

Panoramic and periapical radiography was performed on 100 patients. Five observers each registered the scores for marginal bone level, presence of bone defects and furcation involvement in the radiographs of 20 patients and the results were compared. The overall concordance in scoring the marginal bone level was high when panoramic and periapical radiography was compared. In the upper arch, 66% of the sites showed concordant scores, 31% deviated by one and 3% by two score-points. In the lower arch, 74% of sites had concordant scores, 25% deviated by one and 1% by two score-points. The panoramic radiographs more often indicated a more severe bone loss than the periapical radiographs. The concordance was related to the degree of bone loss. In sites with no bone loss the concordance was high whereas it was lower in those with severe bone loss. The concordance of the two radiographic methods for the mandibular canine, premolars and first molar was equally as high as the intra-observer overall agreement, but lowest for the mandibular central incisors and the maxillary molars. Bone defects were more easily identified by periapical radiography.

Bone Resorption↗
PubMed1998

Periodontal repair in dogs: effect of recombinant human transforming growth factor-beta1 on guided tissue regeneration.

This study evaluated alveolar bone and cementum regeneration following surgical implantation of recombinant human transforming growth factor-beta1 (rhTGF-beta1) in conjunction with guided tissue regeneration (GTR). Supraalveolar, critical size, periodontal defects were surgically created around the 3rd and 4th mandibular premolar teeth in right and left jaw quadrants in 5 beagle dogs. Alternate jaw quadrants in consecutive animals received rhTGF-beta1, in a CaCO3/hydroxyethyl starch carrier with GTR, or carrier with GTR alone (control). 20 microg of rhTGF-beta1 in buffer solution was incorporated into approximately 0.8 ml of carrier for each defect scheduled to receive rhTGF-beta1. Animals were sacrificed at week 4 postsurgery and tissue blocks were harvested and processed for histometric analysis. Clinical healing was generally uneventful. Minor membrane exposures were observed. Defects with membrane exposure displayed an inflammatory infiltrate underneath the membrane. Bone regeneration of trabecular nature, apparent in all animals, was generally limited to the very apical aspect of the defects. Cementum regeneration was limited without obvious differences between experimental conditions. Comparing rhTGF-beta1, to control defects, statistically significant differences were found for area (1.8+/-0.4 and 1.3+/-0.6 mm2, respectively; p<0.05) and density (0.3+/-0.1 and 0.2+/-0.03, respectively; p<0.05) of alveolar bone regeneration. Observed differences are small and represent a clinically insignificant potential for enhanced regeneration in this preclinical model. Within the limitations of study, it may be concluded that rhTGF-beta1 has a restricted potential to enhance alveolar bone regeneration in conjunction with GTR.

Alveolar Bone Loss↗
PubMed1998

Periodontal repair in dogs: effect of allogenic freeze-dried demineralized bone matrix implants on alveolar bone and cementum regeneration.

The objective of this study was to evaluate alveolar bone and cementum regeneration following surgical placement of an allogenic, freeze-dried, demineralized bone matrix (DBM) cortical strip implant. Critical size, supraalveolar periodontal defects were surgically created around the second, third, and fourth mandibular premolar teeth in eight mongrel dogs. Contralateral jaw quadrants in six animals were randomly assigned to receive the DBM implant, or serve as surgical control. Two additional animals received bilateral DBM implants. Flaps were coronally advanced to submerge teeth and implants, and sutured. Three animals were exited from the study due to extensive early wound failure. Remaining animals were sacrificed at 8 weeks postsurgery. Histometric recordings included defect height, bone regeneration/DBM implant height, cementum regeneration height, root resorption, and ankylosis. Large areas of unresorbed DBM exhibiting fragmentation and empty osteocyte lacunae were observed adjacent to new bone formation, or bone formation was observed adjacent to or within the implant, often exhibiting ankylosis. Cementum regeneration appeared enhanced in shelter of the DBM implant. Histometric recordings (mean+/-SD) for DBM and control defects, respectively, were: defect height, 4.8+/-0.2 mm and 4.4+/-0.2 mm; bone regeneration/DBM implant height, 4.0+/-1.3 mm and 1.2+/-0.6 mm; cementum regeneration height, 1.4+/-0.4 mm and 0.7+/-0.2 mm; root resorption, 0.5+/-0.3 mm and 1.2+/-0.3 mm; and ankylosis, 0.5+/-0.2 mm and 0.1+/-0.1 mm without statistically significant differences between experimental conditions (N=3). Within the limitations of this study, the histologic observations suggest that surgical implantation of allogenic, freeze-dried DBM cortical strip implants may have a potential to support cementum regeneration, possibly by providing conditions for guided tissue regeneration, however, alveolar regeneration appears unpredictable.

Alveolar Bone Loss↗
PubMed2005

Prospective assessment of the use of enamel matrix proteins with minimally invasive surgery.

BACKGROUND: Minimally invasive surgery (MIS) is a surgical technique using very small incisions, indicated for performing regenerative therapy in periodontal defects. Enamel matrix proteins (EMP) have been shown to enhance periodontal regeneration. This study was undertaken to determine the effect of using EMP in combination with an MIS approach. METHODS: Patients from two private periodontal practices with chronic periodontitis who, following non-surgical therapy, had one or more sites with probing depths (PD) of > or =6 mm were included in the study. An MIS approach was utilized for surgical access. Following surgical debridement, EMP was placed into the bony defect. The surgical sites were reevaluated after at least 11 months. RESULTS: Surgical treatment was performed at 160 sites in 16 patients. No significant differences were noted in the results between the two offices and the data were combined. Mean PD reduction (P = 0.002) and attachment level improvements (P = 0.012) were significantly greater than 3 mm with mean post-surgical PD of 3.17 mm and attachment levels of 4.05 mm, based on subject means. Mean change in recession following surgery was negligible (0.01 mm). All sites were considered to be clinically successful. CONCLUSION: The combination of MIS and EMP yields significant reductions in probing depths and improvements in attachment levels while producing little or no increase in recession.

Acid Etching, Dental↗
PubMed2001

A multidisciplinary approach to the diagnosis and treatment of early-onset periodontitis: a case report.

BACKGROUND: The diagnosis and treatment of early-onset forms of periodontitis (EOP) represent a major challenge to periodontists. In this case report, we describe a multidisciplinary approach for the treatment of a patient with severe generalized juvenile periodontitis (GJP). Our approach incorporates clinical laboratory evaluation with conventional concepts of periodontal pathogenesis and therapeutics to diagnose and effectively treat EOP. METHODS: The 17-year-old female patient presented with clinical and radiographic evidence of severe attachment loss. Microbiological testing showed the presence of known periodontal pathogens including Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Routine immunological tests did not reveal any of the functional defects thought to play a role in the pathogenesis of EOP After initiation of therapy, which consisted of scaling and root planing, supplemented with administration of systemic antibiotics, a reduction in probing depth and gain in clinical attachment could be demonstrated. Microbiological testing was used to monitor the composition of the periodontal microbiota and to adjust antimicrobial therapy accordingly. RESULTS: Using a non-surgical approach to treatment, except for 2 root amputations performed without flap reflection, we have been able to stabilize this patient's periodontal condition over the course of a 2-year follow-up period. CONCLUSIONS: This treatment strategy provides an efficacious alternative to more aggressive forms of therapy and should therefore be considered for the treatment of patients with severe EOP.

Adolescent↗
PubMed2004

Periodontal repair in dogs: evaluation of a bioresorbable calcium phosphate cement (Ceredex) as a carrier for rhBMP-2.

BACKGROUND: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been shown to induce clinically relevant bone formation for orthopedic, craniofacial, and oral indications. It appears critical, in particular for onlay indications, that the associated carrier technology exhibits structural integrity to offset compressive forces in support of rhBMP-2-induced bone formation. The objective of this study was to evaluate a calcium phosphate (CP) cement, Ceredex, as a candidate carrier for rhBMP-2 in a defect model with limited osteogenic potential. MATERIALS: Bilateral, critical size, 6-mm, supra-alveolar, periodontal defects were created in six, adult, male, Hound Labrador mongrels. Three animals received rhBMP-2/Ceredex (rhBMP-2 at 0.20 and 0.40 mg/ml) in contralateral defect sites (implant volume/defect approximately 1 ml). One defect site in each of the three remaining animals received Ceredex without rhBMP-2 (control). The animals were euthanized at 12 weeks postsurgery for histologic and histometric analysis. RESULTS: Mean induced bone height exceeded 80% of the defect height for supra-alveolar periodontal defects receiving rhBMP-2/Ceredex without major differences between rhBMP-2 concentrations compared with approximately 40% for the control. The newly formed bone, a mixture of lamellar and woven bone in fibrovascular tissue, circumscribed relatively large portions of the residual Ceredex biomaterial. Inflammatory lesions were associated with limited bone formation in some sites. From a periodontal perspective, sites receiving rhBMP-2/Ceredex exhibited increased cementum formation compared with control, but without a functionally oriented periodontal ligament, and increased ankylosis and root resorption. Control sites exhibited early wound failure and exposure, loss of the Ceredex biomaterial, and limited bone formation. CONCLUSIONS: The Ceredex CP cement appears a potentially promising carrier technology for rhBMP-2 onlay indications. However, a slow resorption rate may prevent its wider use. This study does not support use of the rhBMP-2/Ceredex combination for periodontal indications.

Absorbable Implants↗
PubMed1995

Treatment of intrabony defects with collagen membrane barriers. Case reports.

Two separate investigations were undertaken to assess the clinical characteristics and the safety, and to determine whether an absorbable type 1 bovine collagen barrier membrane would result in the improvement of clinical parameters during guided tissue regeneration in humans. The collagen membrane barrier was placed over a total of 21 interdental intrabony periodontal defects in 18 patients. The surgical procedures and postsurgical regimen were similar in both components of the investigation. Sulcular incisions were used and the sites were surgically exposed by reflection of full thickness mucoperiosteal flaps. The intrabony defects were debrided and the root surfaces prepared with automatic scalers and curets. Four 1-minute applications of tetracycline HCl 50 mg/ml were applied to the root surface. The collagen membrane barrier was hydrated in sterile saline until pliable, then trimmed so it covered the osseous defect and extended 2 to 3 mm beyond the defect. In both investigations, the collagen barrier membrane was not sutured, but retained by "pouching" or undermining the flap. Healing occurred without complications. There were no untoward or adverse reactions to the material in either phase of the study. In the initial investigation, 13 intrabony defects with probing depths of > or = 5 mm were treated in 9 patients having a mean age of 50.6 years. No controls defects were treated. Soft and hard tissue measurements were taken at the time of initial surgery and at 2, 4, and 6 months. In the second phase, 9 patients were enrolled with a mean age of 49.7 years. They had similar bilateral interdental intrabony defects with probing depths > or = 6 mm. One defect received the collagen membrane barrier, while the other was treated by flap debridement alone. The collagen membrane had undergone modification since the initial investigation, and was more highly cross-linked to retard absorption. After initial therapy, and prior to the surgical procedure, a series of 3 dermal patch tests were used to determine whether the patient would elicit a reaction to the collagen. Venous blood was drawn at baseline, 7 to 10 days, 18 to 21 days and at 8 weeks for analysis by ELISA for comparison of test and control sites relative to baseline. There were no allergic response to the dermal tests, and the ELISA tests indicated no significant differences between test and control sites. An automated probe was used to record soft and hard tissue measurements. These included the probing depths and clinical attachment levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗