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PubMed1985

Hydroxylapatite as an alloplastic graft in the treatment of human periodontal osseous defects.

Twelve patients, 32 to 60 years of age, received a polycrystalline ceramic form of pure dense hydroxylapatite as an alloplastic bone implant material in intrabony defects following reflection of full mucoperiosteal flaps, root planing and defect-curettement. The defects were measured from an acrylic stent, using an endodontic silver point which was placed to the base of the defect. Similarly, debrided and curetted defects in the same patients were not implanted and served as controls. Recalls for documentation and plaque control were at 1, 2, and 4 weeks, and at 3, 6 and 9 months. Measurements relating to changes in defect-depth were made upon reentry at 9 months. The twelve defects, serving as controls, showed very little difference between the pretherapy and 9-month measurements. The initial mean measurement from the base of the defect to the highest alveolar crest was 4.27 mm and the 9-month mean measurement after curettage only was 3.36 mm. In terms of resolution of the original defect this amounted to 19.49% reduction, but a 0.46-mm mean loss in height of the alveolar crest provided an actual percentage fill of the original defect of 9.91%. Of sixteen experimental defects, the same initial mean measurement from the base of the defect to the highest alveolar crest was 5.18 mm and the 9-month mean measurement after grafting was 2.43 mm. In terms of resolution of the original defect, this amounted to a 53.57% reduction, but in contradistinction to the curettage sites, a mean increase in height of the highest alveolar crest of 0.61 mm gave a true percentage fill of the original defect of 66.89%. At the 9-month reentry, the implanted mass seemed to be partially "calcified" and was resistant to penetration with a probe or removal with a curette. The data and clinical impression strongly suggest that hydroxylapatite has a potential as an alloplastic implant with clinically apparent acceptance by the soft and hard tissues.

Adult↗
PubMed1985

The use of a porous hydroxylapatite implant in periodontal defects. I. Clinical results after six months.

Twenty-five patients with advanced periodontal destruction were used in the study. Following initial therapy, two angular interproximal defects were selected in each patient. During flap surgery a porous hydroxylapatite implant shaped to fit the periodontal defect was placed in one defect, the other defect was used as nonimplanted control. The material used for implantation was a hydroxylapatite replicate of coral from the genus Porites, with a pore size of 190 to 220 micron. Clinical parameters were measured prior to flap surgery for each of the defects. An occlusal acrylic stent was used to give a stable reference point for pocket depth, attachment level and gingival margin height measurements. Also gingival fluid, gingival inflammation, plaque index and tooth mobility were recorded. Periapical radiographs using a standardized positioning device were also taken. At the time of surgery, the depth of the osseous defect and the height of the alveolar crest were recorded. After 6 months the clinical measurements were repeated and a re-entry surgery was carried out in 15 selected sites. Results showed that the porous implant produced statistically significant reduction in pocket depth, in the depth of osseous lesion, and a statistically significant gain in attachment level, as compared to control areas.

Adult↗
PubMed1985

Root resorption associated with placement of a ceramic implant. Report of a case.

Ceramic grafting material was used to treat a vertical osseous defect associated with a maxillary left lateral incisor tooth. The area was monitored at maintenance appointments. Root resorption was detected radiographically 12 months after grafting. At 18 months, resorption was evident clinically in the presence of moderate inflammation.

Adult↗
PubMed1985

Clinical and microbiological evaluation of therapy for juvenile periodontitis.

Eight patients (mean age 15.6 yrs) with severe molar-incisor bone loss and pocket formation characteristic of juvenile periodontitis were entered into a clinical protocol of three sequential stages: scaling and root planing (S/RP); S/RP concurrent with systemic tetracycline therapy (1 gm/day for 28 days); periodontal surgery concurrent with systemic tetracycline therapy. Clinical and microbiological examinations were scheduled at baseline, at 1 to 2 months after Stage I, at 1 to 2 months after completion of tetracycline therapy in Stages II and III, and during recall. A decision to progress to the next stage or to place the patient on a 3-month recall was based solely on clinical findings (suppuration, bleeding upon probing and pocket depth) at the deepest site in each patient. Paperpoint subgingival plaque samples from representative affected sites were analyzed for percentage of total cultivable microflora composed of black-pigmented Bacteroides species (BPB), surface translocating bacteria (STB) and Actinobacillus actinomycetemcomitans (Aa). At baseline, all sites bled to probing, seven of eight sites showed suppuration, and deepest pocket depths averaged 8.0 mm. STB were detected in one and BPB in four sites, respectively, and all sites demonstrated Aa, which constituted approximately 40% of the total cultivable flora. S/RP alone had essentially no effect on either clinical or microbiological findings, and all patients progressed to Stage II. Five went on to Stage III. S/RP with tetracycline was clinically and microbiologically more effective at sites in which Aa was predominant. Surgery was required in all sites containing high levels of both BPB and Aa. These results suggest that microbiological diagnosis may be useful in selecting and monitoring treatment for juvenile periodontitis.

Actinobacillus↗
PubMed1985

Healing of spontaneous periodontal defects in dogs treated with xenogeneic demineralized bone.

This study was undertaken to histologically, clinically and radiographically evaluate the sequence of healing following implantation of bovine demineralized bone powder (DBP) into severe, spontaneous periodontal defects in beagle dogs. Eight dogs with documented severe periodontitis were treated surgically following initial debridement. One quadrant in each arch was treated with conventional flap surgery and the others were treated with surgery followed by DBP implantation. Animals received postoperative debridement and clinical and radiographic evaluation. Two dogs were sacrificed at 1, 3, 6 or 12 months postoperatively, and the jaws were evaluated histologically. Clinically, DBP was well tolerated by recipients. No evidence of localized inflammatory response or delayed hypersensitivity reaction was noted. Significant reductions in gingival inflammation were noted in both experimental and control sites at 1 month postoperatively compared to preoperative scores. Equivalent periodontal pocket reduction was noted between test and experimental sites and remained significant at 12 months. Radiographically, no differences were noted in the rate of bone loss between control and test sites. Histologic evaluation demonstrated the presence of DBP at 1 month following implantation, but the material was replaced with new bone by the next sacrifice period. Periodontal ligament fibers of standard orientation were seen extending from DBP-induced bone to the root surface by 1 month after implantation. An intact epithelial attachment appeared to be present 1 month after the implantation of DBP. No differences in root surfaces were detected between test and control groups. Ankylosis was a rare finding, noted equally between test and control sites. DBP did not appear to predispose to external root resorption. In later stages, histologic evidence of advancing periodontitis was noted equally in both control and experimental groups. While DBP successfully induced new bone formation, the inability to adequately maintain the periodontal tissues due to bacterial accumulation in this model combined with recurrent pocket formation, precluded any conclusion regarding long-term advantage. Based on these findings, clinical trials of this or similar materials are recommended.

Alveolar Process↗
PubMed1985

Evaluation of durapatite ceramic as an alloplastic implant in periodontal osseous defects. II. Twelve month reentry results.

Thirteen patients received Durapatite, a hydroxylapatite ceramic (Periograf), as a bone implant material in various types of intrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the cemento-enamel junction (CEJ) at specific locations using a standardized periodontal probe. Similarly debrided, nonimplanted defects served as controls. Defect selection as either experimental or control site was based on an alternating defects design after local therapy was completed. Periodontal dressing and systemic tetracycline were used for 10 days. Postsurgical visits for documentation and plaque control were at 10, 20 and 30 days, and 3, 6, 9 and 12 months. Measurements relating to defect changes were made at the 12-month surgical reentry. For evaluation purposes original defect depths were divided into three groups. In Group I (less than 3 mm) defect fill was 1.0 mm (47%) for the implanted defects and 0.3 mm (33%) for the control sites (significantly different at P less than 0.05). In Group II (3-6 mm) defect fill of 1.7 mm (44%) for implanted sites was significantly better (P less than 0.05) than the 0.8 mm (29%) found in control sites. In the deepest group (Group III, greater than 6 mm) Durapatite placement yielded 2.1 mm (32%) of defect fill while debridement alone resulted in 1.8 mm (26%) of fill (P greater than 0.05). Hard tissue responses demonstrated a substantial advantage for use of Durapatite over controls, while soft tissue changes were similar for both.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

The use of Periograf in periodontal defects. Histologic findings.

Hydroxylapatite (Periograf) was placed into periodontal defects around five teeth scheduled for extraction in two young adult females with excellent plaque control. On the facial surface for one tooth the material was placed in a supracrestal position. Twelve months later the teeth were extracted in block section and were examined microscopically. Hydroxylapatite crystals were seen in the histologic sections with evidence of new bone formation in juxtaposition. The hydroxylapatite was tolerated relatively well by the surrounding tissue. A "cap' of bone was present coronal and facial to those crystals placed in the supracrestal position. In some areas bone was seen attached to the root via a periodontal ligament coronal to the Durapatite crystals. The question of accidental implantation of the material into the adjacent bone versus the actual regeneration of a true new attachment was discussed.

Adult↗
PubMed1986

Bioceramic implants in surgical periodontal defects. A comparison study.

The healing response of two commercially available bioceramics, beta tricalcium phosphate (TCP) and hydroxylapatite (HA), was compared after implantation in surgically created defects in dogs. Three 18 to 24 month old female Labrador dogs were used. Under general anesthesia 3-wall defects were created on the canines and premolars. The roots were planed, and reference notches were placed to identify the alveolar crest and the apical extent of the defects. TCP or HA was placed in alternating canine defects. The premolars received no implants and served as controls. Plaque management was accomplished by biweekly brushing with 0.2% chlorhexidine. Following healing periods of 5, 12 and 16 weeks, the dogs were sacrificed and perfused with 10% formalin. Six-mu step serial sections were evaluated by light microscopy. Healing against the root planed surface varied from a long junctional epithelium to a connective tissue reattachment in new cementum. TCP particles were actively resorbed by giant cells and macrophages and were incorporated into new bone matrix. The HA particles were encapsulated by fibrous connective tissue and rarely seen in contact with repairing bone. Bone formation was slower around HA particles at all time periods. Some evidence of HA particle resorption was seen at each time period.

Alveolar Process↗
PubMed1986

Healing responses to grafting of combined collagen-decalcified bone in periodontal defects in dogs.

The feasibility of a new combined collagen gel-autolysed antigen-extracted allogeneic bone implant was tested. Its effect on gaining new attachment in surgically created defects in four dogs was evaluated over 24 weeks. As controls, sites receiving implants of the bone implant alone, nonimplanted and untreated defects were also evaluated. The collagen gel encouraged ingrowth of regenerative tissue-fibroblasts in the early stages of wound healing while the allogeneic bone induced new bone formation. The graft materials were bicompatible, technically manageable and clinically effective. From the present preliminary study, it was evident that the combined autolysed antigen-extracted allogeneic bone-collagen gel implant may offer advantages over the present implant materials and techniques currently used in the treatment of periodontal intrabony defects.

Alveolar Process↗
PubMed1986

Ultrastructure of durapatite-periodontal tissue interface in human intrabony defects.

The ultrastructure of the interface between Durapatite (hydroxylapatite) and human periodontal tissues was examined. Durapatite was implanted into the intrabony periodontal defects during periodontal surgery. Reentry procedures were performed after 1 year and the tissues in the defects were biopsied and processed for transmission electron microscopy. Nineteen tissue blocks from four patients were examined, 17 contained Durapatite particles embedded in fibrous tissue and two contained particles encased in bone, all without inflammation. The fibrous connective tissue consisted of densely packed collagen fibrils surrounding the implant particles. The bone surrounding the Durapatite consisted in one case of relatively mature bone, and in the other of osteoid tissue. A granular, amorphous, collagen-free, electron-dense layer was routinely observed between implant and tissue. This layer was thicker in the bone-encased samples than in those surrounded by fibrous connective tissue. Except for the particle surrounded by mature bone, this layer was continuous with an organic meshwork located on the periphery of the implant spaces. The ultrastructural features of the interface are consistent with the existence of a mucopolysaccharide "bonding zone" described by other investigators. The organic meshwork appears to outline areas similar in size and shape to the individual crystallites of hydroxylapatite. This may indicate that the reactive surface of hydroxylapatite is much larger than merely the exterior surface of the implant, a finding which may explain the apparently good tissue adhesion to the implant.

Alveolar Process↗
PubMed1986

Human allografts of iliac bone and marrow in periodontal osseous defects.

The purpose of this study was to statistically compare the bone regeneration and/or remodeling that occurred in human periodontal osseous defects treated with frozen allogenic, cancellous, iliac bone and marrow grafts, to defects treated by nongrafted flap curettage using a split-mouth protocol. Six patients were selected to participate in the study. These patients exhibited bilateral intrabony periodontal defects that had been refractory to nonsurgical periodontal therapy. Twenty-three intrabony defects were treated by osseous grafting using allogenic iliac bone and marrow and 32 intrabony defects were treated by open debridement procedures. The bony regeneration in each defect treated was evaluated by probing measurements taken from a fixed reference made at the initial surgery and at reentry 1 year after transplantation. The overall results of this study demonstrated that the percentage of osseous regeneration that occurred in intrabony defects treated by allogenic bone and marrow grafting was statistically greater than that which occurred in defects treated by nongrafted flap curettage procedures.

Adult↗
PubMed1986

Clinical and volumetric analysis of three-wall intrabony defects following open flap debridement.

Fourteen defects were treated with flap debridement procedures using the Prichard principle of epithelial exclusion. Six defects were considered to be medium in width (3-4 mm), seven defects were wide (greater than 4 mm), and one defect was narrow (1-2 mm). The parameters studied were changes in gingival and plaque scores, attachment levels, and bone scores. All defects were reentered 9 to 16 months after surgery and changes between the pretreatment and posttreatment bone levels were recorded. The mean gain in probing attachment level was 2.76 mm. The mean amount of defect fill measured from models was 2.56 mm, while the mean defect fill from direct measurements was 3.26 mm. The percentage defect fill measured from study models was 61%. Crestal resorption was 9.7%. The average change in defect volume unadjusted for crestal resorption was 61.8 cu mm. Seven defects had a 50% or greater decrease in defect volume, while seven defects had less than a 50% change. Intrabony defects where calculus is present on the involved tooth surface prior to therapy will repair with substantial amounts of bone as a result of open debridement.

Alveolar Process↗
PubMed1986

Root coverage and ridge augmentation in Class IV recession using a coronally positioned free gingival graft.

Although root coverage is not anticipated in Class IV recession, occasionally this can be accomplished if there is an edentulous area adjacent to the tooth to be grafted. This edentulous area allows the surgeon to more intimately adapt the graft to the interproximal surface of the root. A second procedure to coronally position the healed graft may be required. A case demonstrating this technique is presented.

Alveoloplasty↗
PubMed1987

Histologic study of healing of human periodontal defects after placement of porous hydroxylapatite implants.

Two intrabony pockets on teeth that were to be extracted for prosthetic reasons, in two patients, were treated by means of papilla preservation flaps and implantation with porous hydroxylapatite. The teeth, with a portion of their periodontium, were extracted 5 and 6 months after treatment and processed histologically. Both cases showed the implants invaded by connective tissue, which was actively forming bone. There was no inflammatory reaction triggered by the implant material, although there was some recurrence of inflammation in the vicinity of the pocket wall. The junctional epithelium in both cases extended slightly beyond the coronal level of the implant. One of the cases had an abundant new cementum formation with fibrous tissue next to the implant, that appeared to be a rebuilt attachment of collagen fibers. Although some multinucleated giant cells were found in the pores and next to the newly formed bone, the implanted material did not appear to be resorbed in the period of time studied.

Adult↗
PubMed1987

Histologic and clinical responses to porous hydroxylapatite implants in human periodontal defects. Three to twelve months postimplantation.

Twelve intrabony periodontal lesions in three volunteers received surgical debridement followed by site implantation of porous hydroxylapatite implants. These patients were followed over a total of a 1-year observation period. Blocks of treated sites were surgically removed at 3 months, 6 months and 12 months after implantation. Clinical observation indicated a reduction in pocket depth consisting of both recession and clinical gain of attachment. No ill effects were observed. Histologic examination of the treated sites showed ossification of the implant pores and the implant periphery as early as 3 months after implantation, which became pronounced 12 months after placement. At times, peripheral ossification linked with crestal osseous seams. This ossification occurred in the presence of an adjacent root covering, long junctional epithelium, and thus there was no new attachment. On the other hand, this graft material offers the potential of increasing new bone mass within a human intrabony lesion.

Adult↗
PubMed1987

Treatment of a patient with Papillon-Lefèvre syndrome. A case report.

A vital root submersion procedure was performed in a rare case of Papillon-Lefèvre syndrome (PLS). Although the etiology and pathogenesis are obscure, possible host genetic defects and known or unknown periodontal pathogens may play important roles in the progression of PLS. Since this patient did not respond to conventional periodontal therapy, a submersion procedure was employed to maintain the alveolar ridge and resulted in controlling the progression of the patient's severe periodontitis. The following is a report of the treatment and the rationale for therapy.

Alveoloplasty↗
PubMed1987

Clinical evaluation of porous and nonporous hydroxyapatite in the treatment of human periodontal bony defects.

The purpose of this study was to investigate the effectiveness of a synthetic nonporous hydroxyapatite graft material (OrthoMatrix HA-500), a porous replamineform hydroxyapatite graft material (Interpore 200), and a debrided control with respect to defect fill. Twelve adult patients having periodontitis and three similar angular osseous defects as verified by radiographic analysis and clinical probe depths greater than or equal to 5 mm were selected. Clinical parameters gathered prior to surgical intervention and at identified postoperative visits included plaque index, probing depth, and standardized radiographic examination. Customized acrylic stents were used as fixed reference guides for the insertion of endodontic silver points to the base of each defect during both initial and 6-month reentry surgeries. A total of 36 defects were randomly assigned to one of three treatment modalities such that 12 defects received OrthoMatrix HA-500, 12 received Interpore 200, and 12 served as debrided controls. Comparison of nonporous hydroxyapatite, porous replamineform hydroxyapatite, and debrided control treatment modalities revealed a statistically significant improvement (P less than 0.05) in the mean per cent of defect resolved in only those sites treated with nonporous hydroxyapatite. Similar positive trends were seen in the sites treated with nonporous hydroxyapatite for mean reentry defect depth and mean defect fill although these were not statistically significant (P greater than 0.05). No other significant differences were noted.

Adult↗