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At least 487 records · Page 27Linked to original sources
PubMed1980

A clinical evaluation of Proplast as a periodontal implant material.

Five patients received a Proplast implant in combination two- and three-wall osseous defects. In four of the cases the implant material was removed within 6 weeks due to failure to maintain primary closure over the Proplast and subsequent inflammation. One implant remained in place for 6 months with no apparent visual signs of inflammation. However, an 8 mm pocket remained, the area was reentered, and histologic sections made. The histologic sections revealed Proplast intermixed with bone, and the presence of foreign body giant cells.

Adult↗
PubMed1980

A new approach to vital root resection.

This report deals with ten cases in which periodontal surgery was performed followed by immediate resection of one of the vital buccal roots on maxillary molars. The resultant pulpal opening was treated with calcium hydroxide, zinc oxide and eugenol then sealed with an amalgam alloy. Two additional cases were treated in reverse order by first resecting the vital root followed by immediate periodontal surgery. All cases were evaluated over a 1 to 3 year period. The results indicate that vital root resection at the same time as periodontal surgery compares favorably with cases treated in which periodontal surgery was completed at a prior appointment.

Adult↗
PubMed1980

A longitudinal study of peridontal status comparing osseous recontouring with flap curettage. I. Results after 6 months.

The purpose this study was to test for short-term clinical differences in periodontal status after treatment with osseous recontouring and flap curettage in humans. Twelve systemically healthy patients with bilaterally similar marginal periodontal destruction received a standardized regime of presurgical therapy. The posterior segments of these patients were then treated with osseous recontouring and flap curettage. The investigators assigned the segments in one jaw at random to osseous recontouring and flap curettage, and then reversed the sides receiving surgical treatment in the opposing jaw. Postsurgical photographs and measurements for supragingival plaque, tooth mobility, gingival inflammation and periodontal attachment levels relative to the cemento-enamel junction were made for 6 months. Statistical analysis revealed that: (1) osseous recontouring and open flap curettage equally reduced plaque and gingival inflammation; (2) each surgical procedure equally increased attached gingiva; (3) pocket reduction achieved with osseous recontouring was maintained over 6 months, pockets recurring after open curettage; (4) open curettage did not induce bone regeneration; (5) osseous recontouring did not result in irreversible tooth mobility; (6) osseous recontouring resulted in a net loss of attachment; open curettage producing a net gain, especially in deeper pockets; and (7) both procedures improved periodontal health.

Alveoloplasty↗
PubMed1980

Alveolar bone remodeling following osseous surgery. A clinical study.

Remodeling of the alveolar bone crest was monitored following periodontal surgery including osseous recontouring at 26 sites in 17 patients, aged 23 to 60 years, with advanced periodontitis. Comparison of measurements obtained at initial surgery with those noted at re-entry showed a reduction in crest height 3 months postsurgery at all sites tested: A) At the interradicular sites a mean reduction of 0.38 mm; B) at the radicular sites a mean reduction of 0.84 min; and C) at the furcation sites a mean reduction of 0.79 mm. A reduction in crest height was also noted 6 months postsurgery at all sites tested: A) At the interradicular sites a mean reduction of 0.23 mm; B) at the radicular sites a mean reduction of 0.55 mm; and C) at the furcation sites a mean reduction of 0.88 mm. The mean bone loss different surfaces in both 3 month and 6 month groups was statistically significant when compared with zero loss, using the t test. Within the limits of this clinical study, it can be concluded that crestal resorption, albeit limited in extent, was the usual remodeling response following osseous recontouring.

Adult↗
PubMed1980

Modified distal wedge procedure.

A modified distal wedge procedure has been developed for use adjacent to edentulous areas. The purpose of this procedure is to eliminate pockets, yet retain keratinized tissue. Ease of flap design, the creation of access to the underlying osseous structures, and ease of closure are demonstrated by illustrations and Kodachromes.

Alveoloplasty↗
PubMed1981

Evaluation of durapatite ceramic as an alloplastic implant in periodontal osseous defects. I. Initial six-month results.

Eight patients received a new polycrystalline ceramic form of pure hydroxylapatite (Durapatite) as a bone implant material in various types of infrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the CEJ using a standardized periodontal probe. Similarly debrided defects that were not implanted served as controls. Defect selection as either experimental or control site was based on either split-mouth or alternating defects design. Periodontal dressing and systemic tetracycline were used for 10 days. Results for documentation and plaque control were at 10, 20, and 30 days, and 3 and 6 months. Measurements relating to defect changes were made at the 6-months surgical re-entry. For evaluation purposes original defect depths were divided into three groups. In Group I (less than 3 mm) defect fill was 1.2 mm (60%) for the implanted defects and 0.6 mm (40.5%) for the control sites (significantly different at P less than 0.05). In Group II (3--6 mm) defect fill of 1.7 mm (48.5%) for implanted sites was significantly better than the 0.1 mm (11.1%) for the control sites. In the deepest group (Group III greater than or equal to 6 mm) Durapatite placement yielded 2.6 mm (39.9%) of defect fill while debridement alone resulted in 1.3 mm (14.8%) of fill. Hard tissue changes demonstrated a substantial advantage for use of Durapatite over controls, while soft tissue changes were similar for both. The clinical impression at re-entry and the numerical data indicate that pure hydroxylapatite ceramic has a definite potential as an alloplastic implant in the treatment of periodontal osseous defects.

Adult↗
PubMed1981

Kielbone in new attachment attempts in Humans.

The purpose of this investigation was to evaluate, in humans, the use of Kielbone as a substitute for fresh autogenous bone in treating periodontal intrabony defects. A total of 92 intrabony defects were treated with a previously described new attachment procedure utilizing free mucosal grafts to cover the intrabony defects following bone grafting. Kielbone was placed in 46 of these defects, while the remaining 46 defects were treated with autogenous bone grafts. The results were evaluated after 6 months by periodontal probing and assessment of the bone level as seen on periodical, identical radiographs. No differences were observed between the amount of clinical gain of attachment obtained in defects treated with Kielbone and those treated with autogenous jaw bone. This indicates that in surgical procedures attempting to restore lost connective tissue attachment, Kielbone constitutes a suitable replacement for fresh autogenous bone. The results are discussed in th light of recent studies that challenge the beneficial effect of bone grafts in the treatment of intrabony defects.

Alveolar Process↗
PubMed1981

Early re-entry procedure. Part II. A five year histologic evaluation.

The following study was carried out to assess the histologic integrity of a bone graft which had appeared clinically successful at early re-entry some 5 years previously. The tooth required extraction due to a labial root fracture and was subsequently extracted in modified block section, demineralized, sectioned, stained and evaluated histologically. Histologic evaluation revealed the presence of a functional periodontal membrane apparatus in active stages of both bone and cemental remodeling. Necrotic bone spicules within the areas of otherwise viable periodontium suggested residue from prior graft material. Histologic evaluation presented here supports the previous clinical impression that early re-entry of autogenous grafts for evaluation and physiologic recontouring, where indicated, appears justified without apparent adverse effects on local periodontal regeneration.

Alveolar Process↗
PubMed1981

An overview of periodontal surgical procedures.

It is obvious from the foregoing that there are many technical approaches to periodontal surgery. The mere presence of a periodontal pocket of a cerain depth as the major indicator for surgery is not as steadfast as once believed. Other criteria such as hemorrhage and exudate must also be used in evaluating the need for surgery. The decision on which approach to use remains with the therapist and the individual situation which he/she is faced. However, in the past decade it has become increasingly clear that the need for so-called more advanced surgical procedures is not as important to the control of periodontal diseases as was once thought. Regardless, it is also clear that some form of surgical intervention, as defined by this paper, is still necessary to interrupt the sequence of events that make up the pathogenesis of periodontal disease that leads to eventual tooth loss. This paper has reviewed and evaluated some of the current procedures available to the therapist in the surgical approach to therapy.

Alveoloplasty↗
PubMed1982

Human clinical and histologic responses to Durapatite implants in intraosseous lesions. Case reports.

The healing response following implantation of a nonresorbable ceramic (durapatite) into human periodontal osseous defects was evaluated clinically and histologically. Four tooth-containing blocks were obtained from four patients who had received durapatite implants in osseous defects, each exceeding 4 mm in depth. Each patient was seen for 5 to 13 postsurgical maintenance visits. Teeth in block section were removed between 8 weeks and 8 months postgraft surgery. Clinical evaluation of the repair process demonstrated that pocket depth decreased in all four cases. Histological evaluation of the repair process showed no indication of new periodontal attachment, osteogenesis or cementogenesis, in the host tissues adjacent to the graft particles. Pocket closure appeared to occur by means of a long junctional epithelium and connective tissue adhesions. There was minimal or no evidence of inflammation in all sections associated with the implant. The graft material therefore acted as a biocompatible foreign body within the gingival tissue.

Adult↗
PubMed1982

A six-month clinical evaluation of decalcified freeze-dried bone allografts in periodontal osseous defects.

The osteogenic potential of decalcified freeze-dried bone allografts in the treatment of human periodontal osseous defects was evaluated over a 6 month period. Cortical bone, obtained under sterile conditions from a human donor within 24 hours after death, was decalcified, freeze-dried and ground to a particle size of 250 to 500 microns. Twenty-seven osseous defects with one-, two- and wide three-wall morphology were treated. Clinical measurements were made with a stent and a calibrated periodontal probe before surgery, at the time of surgery, and at re-entry. The combined mean osseous regeneration for all defects was 2.4 mm. This represented a 65% mean bone-fill of the original defect. The findings demonstrate that decalcified freeze-dried bone allograft has potential as an osseous grafting material in periodontal therapy.

Alveolar Process↗
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↗
PubMed1983

Healing responses of human intraosseous lesions following the use of debridement, grafting and citric acid root treatment. II. Clinical and histologic observations: one year postsurgery.

This report details histologic healing responses at intrabony sites within two patients about 1 year after surgery. Treatment consisted of open flat debridement of the lesions. At specific sites, augmenting procedures such as autogenous grafts, allografts, synthetic grafts and citric acid root treatment were utilized. In addition, notches were made through calculus prior to root planing at specific root surfaces. These notches were placed at varying distances from the base of the lesion. Patients were followed postsurgically with frequent maintenance visits. Block sections were removed at the end of the experimental period. Clinical reduction in pocket depth was noted at all treated sites. This reduction consisted of limited pocket closure, marginal gingival recession and repocketing. Histologically, all specimens showed evidence of repair. The most mature repair appeared at sites treated with debridement and autogenous grafts. "Regeneration" of lost periodontal attachment was demonstrated by evidence of cementogenesis, osteogenesis and the presence of functionally oriented ligaments. However, the coronal regeneration appeared spatially limited. Allografts showed a similar, but less mature healing response. Synthetic graft material acted essentially as a "filler" within the defect. Citric acid root treatment did not demonstrate clear evidence of augmentation of the repair process. Of particular note in these human specimens was further histologic demonstration that "regeneration" potential apparently can only take place in close proximity to histologically viable periodontal ligament cells which may act as "donor sites" for coronal "regeneration" of lost periodontal attachment. This histologic response was observed regardless of treatment modalities used.

Adult↗
PubMed1984

Alloplastic implants of tricalcium phosphate ceramic in human periodontal osseous defects.

Initial pilot studies using tricalcium phosphate ceramic placed into human periodontal osseous defects demonstrated osseous repair. Therefore, further evaluation of this material was undertaken on 17 carefully selected patients with 1-wall, 2-wall, crestal and furcation defects using standardized preoperative and postoperative radiographs, clinical measurements and clinical photographs. Inverse bevel, full-thickness flaps were raised, the areas debrided, root surfaces planed with ultrasonic and hand instrumentation, osseous penetrations made with curet point and the flaps sutured after the defects were filled. Eighteen-month reentry surgical procedures were performed on 10 of the 17 patients, with a resultant average of 2.8 mm of new bone. Controls were not used in this study since a protocol describing a sham procedure with other than 3-wall osseous defects was not acceptable in 1973 to the Clinical Human Use Committee. Although the tricalcium phosphate ceramic material was not found to be totally predictable in this study, it may nevertheless become a useful graft material because of its potential for osseous repair in combination with its availability, host acceptability, ease of manipulation and storage advantages.

Alveoloplasty↗
PubMed1985

An evaluation of tricalcium phosphate implants in human periodontal osseous defects of two patients.

This study evaluated the use of tricalcium phosphate (TCP) ceramic implant material in periodontal osseous defects. Thirteen defects in two patients were treated with mucoperiosteal flaps and placement of TCP. The defects were evaluated clinically and radiographically utilizing standardized probe placement and radiographic technique. Clinically, there was a mean probing pocket reduction of 4.5 mm as a result of a mean gain of clinical probing attachment level of 2.0 mm and a mean gingival recession of 2.5 mm. Radiographically, there was a mean "fill" of 1.8 mm. Six teeth were removed by block biopsy for histologic analysis, three at 3 months, one at 6 months and two a 9 months. The TCP particles were well tolerated and encapsulated by fibrous connective tissue, but the particles did not stimulate new bone growth. The junctional epithelium ended 1.62 mm coronal to the apical extent of a reference notch placed at the base of the defect. Although new cementum was observed, there was limited evidence of new attachment.

Adult↗
PubMed1985

The incidence and severity of complications and pain following periodontal surgery.

This study examines the incidence and severity of postoperative complications and pain in 304 consecutive periodontal surgical cases. Comparisons were made between plastic soft tissue surgery, osseous surgery and pure mucogingival procedures. Multivariable analysis was used to ascertain significant associations of numerous factors to complications and pain. Postoperative complications were rated as moderate or severe in only 5.5% of the cases. Although the total postoperative complications were minimal, regression analysis revealed osseous surgery to be three times more likely than pure mucogingival surgery to cause complications of bleeding, infection, swelling or adverse tissue changes. Minimal or no postoperative pain was reported by 51.3% of the patients. Pure mucogingival surgery was significantly related to pain and was 3.5 times more likely to cause pain than osseous surgery and 6 times more likely than plastic soft tissue surgery. The duration of surgery was statistically significant for both complications and pain. The overall results of the study indicate the risks of undergoing periodontal surgery, in terms of postoperative complications and pain, are minimal.

Adolescent↗