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PubMed1993

Guided tissue regeneration and anti-infective therapy in the treatment of class II furcation defects.

The purpose of the present study was to evaluate the effect of anti-infective therapy on the success of periodontal regeneration in mandibular Class II furcation defects. Eighteen patients with mandibular bilateral Class II furcation defects were enrolled. Following an initial hygienic phase, guided tissue regeneration (GTR) was performed using an expanded polytetrafluoroethylene (e-PTFE) membrane barrier. The area was surgically exposed, thoroughly root planed, and irrigated with either tetracycline (100 mg/ml) or 0.9% saline. Post-operative care included systemic tetracycline (250 mg q.i.d.) and chlorhexidine 0.12% mouthwash twice daily. Patients were maintained on a prophylaxis schedule of every 2 weeks for the first 3 months, and monthly thereafter. Clinical parameters of probing depth (PD), probing attachment level - vertical (PAL-v), probing attachment level - horizontal (PAL-h), and target periodontal pathogens were monitored at baseline and quarterly for one year. An overall improvement in all clinical parameters was observed in both groups: probing reduction (3.1 mm), PAL-h gain (2.3 mm), and PAL-v gain (1.2 mm) were all statistically significant compared to baseline measurements. Vertical measurements were performed parallel to the long axis of the tooth with no attempt to angulate the probe into the furcation. There was no significant difference in sites receiving tetracycline. A strong positive correlation was noted between initial PD and pocket reduction (r = 0.77, P < 0.0001) and between initial PD and PAL-h gain (r = 0.54) and PAL-v gain (r = 0.45) suggesting that initial probing depth might be used to assess the regenerative potential of a given site.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Gingival recession and exposure of barrier membrane: effect on guided tissue regeneration of Class II furcation defects.

The purpose of the present study was to evaluate the effect of barrier membrane exposure on the success of guided tissue regeneration in Class II furcation defects. Twenty-six subjects with mandibular Class II furcation defects received initial periodontal therapy followed by guided tissue regeneration surgery. The membrane was placed and the flaps were repositioned so that the membrane was totally submerged. Membranes were removed 4 to 6 weeks later, at which time the extent of their exposure was recorded. An overall improvement in all clinical parameters was observed for all subjects 1 year after surgery. Half of the patients had experienced no membrane exposure, while the other 13 subjects had experienced mild to pronounced exposure; both groups showed similar improvement in all clinical and surgical parameters. In light of the comparable results obtained in exposed sites, and the anatomic difficulties sometimes encountered in covering a membrane completely, in some of these cases the membrane may be left only partially submerged. This approach will allow for tighter occlusal "seal" of the tooth-membrane interface and preservation of the keratinized gingiva.

Adult↗
PubMed1991

The use of a synthetic skin substitute as a physical barrier to enhance healing in human periodontal furcation defects: a follow-up report.

The purpose of this investigation is to compare the clinical response of guided tissue regeneration using a synthetic wound dressing with open flap debridement versus open flap debridement alone in the treatment of human furcation defects. The study group was composed of 19 patients with moderate to advanced adult periodontitis and at least one bilateral pair of Class II molar furcation defects. After the hygiene phase of therapy was completed, measurements were made with calibrated periodontal probes of the clinical attachment levels, probing depths, and soft tissue recession. Paired sites were randomly selected for treatment with either open flap debridement alone (control) or open flap debridement and placement of the synthetic wound dressing over the furcation (experimental). At the time of surgery, measurements of vertical and horizontal open probing attachment were recorded. The dressing was removed 5 to 6 weeks post-surgery. The sites were reentered at 6 months to evaluate healing and to repeat all measurements. Statistical comparisons using the Wilcoxon Sign Rank Test were made between the control and experimental sites. The results of 19 pairs of Class II molar furcation defects reveal statistically significant differences between the experimental and control sites in attachment levels, probing depths, and horizontal open probing attachment. These differences were of such small magnitude that they may not be clinically relevant. There were no other significant differences for any other clinical parameter, and none of the furcations in either group was completely closed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

The measurement of molar furcation defect fill using digital computer technology--report on a new technique.

Recent advances in digital imaging technology have opened up new horizons for dental researchers. This study demonstrates the efficacy of a new technique for measuring regeneration in surgically created molar furcal defects. The investigators evaluated histologic material from a recently completed animal study using five adult baboons. In the animal study, surgically created molar furcation defects were treated using the principles of guided tissue regeneration. From the histologic data of one animal a computer calculated the volume of new bone, connective tissue, epithelium, and cementum as a percentage of the original defect size. The results of this study indicated that digital imaging technology is a useful research tool for determining the volume of defect fill in surgically treated Grade II molar furcation defects in the baboon animal model.

Animals↗
PubMed1993

A clinical comparison of collagen membranes with e-PTFE membranes in the treatment of human mandibular buccal class II furcation defects.

Guided tissue regeneration procedures using non-resorbable expanded polytetrafluoroethylene (e-PTFE) membranes have become accepted therapy in treating moderate furcation defects. Resorbable collagen membranes have also been found to support regeneration and preclude the need for surgical removal. The present study compares their effectiveness with e-PTFE membranes in treating human mandibular Class II buccal furcation defects over a 12-month healing interval. Twelve patients were treated with collagen membrane in one defect and e-PTFE in another. Vertical and horizontal defect repair was evaluated through soft tissue probings and hard tissue measurements. Gingival indices and crevicular fluid flow measurements were used to evaluate site inflammation. Intragroup comparisons were made from baseline to 12 months for each type of membrane (sign test) and for differences between treatment groups with collagen versus e-PTFE membranes (Wilcoxon signed rank test). Both materials were effective in gaining vertical open probing new attachment and horizontal open and closed probing new attachment. Collagen membrane was statistically superior to e-PTFE in gaining horizontal open new probing attachment and in reduced levels of inflammation at the surgical site from baseline to 4 weeks. However, clinical differences were negligible. The intrinsic properties and ease of handling make collagen membranes a feasible alternative in guided tissue regeneration procedures.

Adult↗
PubMed1996

The periodontal tissues in healed degree III furcation defects. An experimental study in dogs.

The aim of the present study was (i) to describe the periodontal tissue that formed in degree III furcation defects in mandibular molars of dogs following GTR therapy and (ii) to compare this healed periodontium to the corresponding tissue of pristine furcations. The study was performed in 10 mongrels dogs. In 6 of the dogs (group A), the 2nd and 4th premolars in both sides of the mandible were extracted 2 months prior to the start of the study. The 4 remaining dogs (group B) were used as normal untreated controls. In the dogs of group A, a furcation defect was produced in the 3rd mandibular premolars and reconstructive surgery was later performed in accordance with the GTR technique. 5 months after reconstructive surgery, all 10 animals (groups A+B) were sacrificed and perfused with a solution of 10% neutral, buffered formalin through the carotid arteries. Tissue blocks containing the experimental teeth were excised, demineralized in EDTA, embedded in paraffin. Serial sections were cut in the mesiodistal plane and parallel with the long axis of the roots. The microtome was set at 7 microns. The sections were stained in hematoxyline and eosin or Van Gieson's connective tissue staining. From each biopsy, 3 sections, 14 microns apart, and representing the central part of the furcation, were selected for light microscopic examination. In the healed furcation sites, histometric and morphometric measurements were performed at different levels (zones), either at the mesial or distal root surfaces; (zone 1) immediately apical of the notch; (zone 2) coronal to the notch where the newly formed alveolar bone was in continuity with the reduced bone crest; (zone 3) coronal to the notch; representing the most coronally positioned area of new bone formation; (zone 4) coronal to the notch; representing areas with no alveolar bone present. In the pristine furcation sites, the measurements were made at zones which corresponded to the location of the zones in the healed furcations. The present data demonstrated that all furcation sites in group A after 5 months of healing exhibited comprehensive de novo cementum formation in the previously exposed parts of the intraradicular root surfaces, and that collagen fibers invested in the newly formed cementum. Comparisons between the pristine and the healed furcations disclosed that the periodontal ligament of the healed furcations was poorly organised, and that bone formation was frequently incomplete.

Alveolar Process↗
PubMed1998

Periodontal healing of canine experimental grade-III furcation defects treated with autologous fibrinogen and absorbable barrier membrane.

OBJECTIVE: To determine the effects of autologous fibrinogen (AF) and absorbable barrier membrane (ABM) on periodontal healing of canine experimental grade-III furcation defects. ANIMALS: 18 conditioned, laboratory-source, adult Beagles. PROCEDURE: Defects were developed bilaterally at the second and fourth premolars and maintained for 12 weeks. Defects were treated with AF, ABM, AF and ABM, or debridement. Digital subtraction radiography, histologic evaluation, and histomorphometric analysis of defect healing was done at 1, 3, and 6 months after treatment to determine percentage increases in bone volume, height, area, and length of periodontal regeneration along the perimeter of the defect. RESULTS: Comparison of defects at post-treatment intervals indicated significantly greater healing of debridement and AF-treated defects, compared with ABM-treated defects at 3 months; however, by 6 months, there were no significant differences in defect healing for all histomorphometric variables. Defects treated with ABM were associated with significantly less root ankylosis than other treatments. Defects treated with debridement had significantly greater increases in bone volume at 6 months after treatment, compared with groups treated with ABM. There was a significant correlation between regenerated bone area, bone volume, and periodontal regeneration for all treatments at 3 and 6 months after treatment. CONCLUSION AND CLINICAL RELEVANCE: Use of AF and ABM did not enhance the amount of periodontal healing, compared with debridement only. The ABM-treated defects were essentially devoid of root ankylosis. Grade-III furcation defects may respond equally well to conservative periodontal surgery or guided tissue regenerative techniques. The prevention of root ankylosis is a substantial benefit favoring this latter method of treatment.

Absorption↗
PubMed2000

[Periodontal regeneration by application of the porous beta-TCP/BMP artificial bone to Class II furcation defects].

OBJECTIVE: To study the regeneration of periodontal tissue after the application of beta-TCP/BMP artificial bone to class II furcation defects. METHODS: Periodontal defects were produced surgically around premolar teeth in 4 dogs. The flap surgery was performed and the root surfaces were curetted to remove the periodontal ligament and the cementum. A synthetic bioabsorble barrier manufactured from poly DL-lactide was used. The defects were divided into 3 groups (beta-TCP/BMP + PDLLA, PDLLA, control). 12 weeks after surgery, the animals were sacrificed and the teeth with their supporting periodontium were processed for light microscopic evaluation. RESULTS: The definitive evidences of regeneration were founded both in BMP/GTR group and GTR group, but the BMP/GTR group exhibited more new bone formation, cementum deposition occupying the majority of the furcation defects than the other two groups. CONCLUSION: It was concluded that the beta-TCP/BMP artificial bone can be used in GTR technique to promote periodontal regeneration.

Animals↗
PubMed2003

Long-term results of guided tissue regeneration therapy in the treatment of class II furcation defects: a randomized clinical trial.

BACKGROUND: The purpose of this study was to evaluate the results after guided tissue regeneration (GTR) using a bioabsorbable membrane in Class II furcation defects in mandibular molars over a 24-month period. METHODS: Nine patients with 2 comparable Class II furcation defects were included. The defects in each patient were randomly assigned to either test (GTR) or control (open flap debridement) group. Clinical measurements and standardized radiographs were taken at baseline, and at 6, 12, 18, and 24 months. The radiographs were analyzed by subtraction radiography. RESULTS: There were significant probing depth reductions for both test and control groups (P < 0.007, P < 0.0005, respectively); however the differences between groups were not significant at any examination. The intra-group and inter-group differences in the vertical clinical attachment level gain were not significant (P > 0.05). Over 24 months, a significant horizontal clinical attachment level gain was observed in the test group compared to control (P<0.03). In the test group, 2 sites showed complete closure, one was converted to Class I, and one tooth was lost due to root resorption. In the control group, 2 defects progressed to Class III over 24 months. At 6 months, the test group showed 0.14 mm of bone loss while the control group showed 0.86 mm of bone gain (P = 0.035). The inter-group differences were not significant at 12, 18, and 24 months. A significant bone height gain was observed in the test group at 24 months when compared to the values obtained after 6 months (P = 0.015). CONCLUSION: GTR may provide a greater horizontal clinical attachment level gain with the possibility of complete closure of some defects and stability over time.

Absorbable Implants↗
PubMed1988

Repair of periodontal furcation defects in beagle dogs following reconstructive surgery including root surface demineralization with tetracycline hydrochloride and topical fibronectin application.

This study examines the effects of root surface demineralization and topical fibronectin as adjuncts to reconstructive periodontal surgery. In 14 beagle dogs, horizontal periodontal defects were surgically induced around the mandibular premolars followed by a 6-week period without plaque control. Reconstructive surgery of the defects was subsequently carried out. The root surfaces were debrided and superficially demineralized with citric acid or tetracycline hydrochloride, with or without subsequent application of fibronectin. Mucoperiosteal flaps were raised to cover most of the crowns and sutured. The animals were sacrificed 12 weeks after surgery and block sections of the teeth and surrounding tissues were processed for histology. Analysis included incidence of furcation defects presenting with an epithelial lining, quantification of connective tissue repair relative to the furcation circumference, and regeneration of alveolar bone relative to the furcation defect height. The incidence of root resorption and ankylosis was also analyzed. Within the limitations of this study it was concluded that: (1) citric acid conditioning of the root surface frequently resulted in complete connective tissue repair of the furcation defect; (2) root resorption and ankylosis were prevalent features of the healing response; (3) citric acid and tetracycline treatment had similar potential to induce connective tissue repair and resulted in corresponding incidences of root resorption and ankylosis; (4) application of fibronectin to demineralized root surfaces did not enhance the amount of connective tissue repair and did not alter the pattern of root resorption and ankylosis.

Administration, Topical↗
PubMed1998

Use of biodegradable polylactic acid barrier materials in the treatment of grade II periodontal furcation defects in humans--Part I: A multicenter investigative clinical study.

This study evaluated two bioresorbable polylactic acid barriers (Epi-Guide and Guidor) to determine if design differences were of therapeutic significance in the treatment of Grade II furcation defects in humans. Forty patients with bilaterally matched, Grade II furcation defects in maxillary or mandibular first or second molars were treated in a multicenter study. Comprehensive initial periodontal therapy, followed by defect debridement and root preparation, preceded randomized membrane placement. Data collected from all three investigative centers were pooled and analyzed using an analysis of variance appropriate for a counterbalancing design. Both barrier types produced measurable improvements of clinical probing values. Barrier exposure scores taken through the eighth week postoperative revealed that Epi-Guide was less likely to become exposed than Guidor. The findings of this study, which was conducted over a 12-month period, demonstrated that Epi-Guide and Guidor were comparable as measured by clinical probing determinations.

Absorbable Implants↗
PubMed2002

Comparison of three methods using calcium sulfate as a graft/barrier material for the treatment of Class II mandibular molar furcation defects.

The purpose of this study was to compare the effectiveness of three methods using calcium sulfate as a graft/barrier for the treatment of Class II mandibular furcation defects. Thirty-six defects in 17 patients were treated with a graft/barrier of pure calcium sulfate, calcium sulfate plus doxycycline, or demineralized freeze-dried bone allograft (DFDBA) in a 2:1 ratio by volume. Defects were randomly selected for treatment, and all measurement parameters were standardized to a light-cured acrylic resin stent at baseline and 6, 9, and 12 months. Linear regression, ANOVA, and chi-squared analysis revealed that all three groups showed significant bone fill (P < .05), vertical and horizontal probing depth reduction, defect volume reduction, and a gain in vertical clinical attachment. Furthermore, the addition of either doxycycline or DFDBA to calcium sulfate significantly enhanced the clinical outcome more than did the calcium sulfate alone, and the addition of DFDBA was more effective in the treatment of Class II mandibular furcation defects than doxycycline.

Adult↗
PubMed1994

Evaluation of an absorbable collagen membrane in treating Class II furcation defects.

Recent research has focused upon the utilization of an absorbable collagen membrane in guided tissue regeneration (GTR). Concern exists as to whether this type of membrane is beneficial in the treatment of periodontal defects. The purpose of this study was to evaluate the effect of a type I bovine collagen membrane on treatment of Class II furcation defects. Twelve systemically healthy patients (six male and six female, ages 32 to 68) were treated. Each had bilateral mandibular furcation defects with attachment loss > or = 6 mm. Prior to surgery all patients completed initial therapy including scaling and root planing. At the time of the surgery, teeth were randomly assigned to either a control (flap debridement alone) or test (flap debridement plus collagen membrane) group. Data were collected on the day of surgery, and 2, 4, and 6 months post-surgery and at the 12 month re-entry surgery. Clinical measurements included probing depth (PD), clinical attachment level (CAL), gingival recession (GR), stent to base of defect (SB), crestal bone to base of defect (CB), width of defect, and mobility. Statistical analysis was performed utilizing the paired t test. Both control and test groups demonstrated significant (P < 0.05) improvement at 12 months re-entry in PD, CAL, SB, and CB when compared to the presurgery status. While there is no significant difference in PD, CAL, GR, width of defect, and mobility between control and test groups, sites treated with the collagen membrane had significantly higher bone fill (SB and CB) at re-entry.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Treatment of furcation defects with DFDBA combined with GTR: human histologic evaluation of a case.

The purpose of this study was to evaluate whether regeneration is possible in human furcation defects. Three molars with Class II furcation involvement were included in this study. A notch was placed in calculus in the furcation to serve as a reference point for histologic evaluation. The defects were treated with a demineralized freeze-dried bone allograft combined with a bioabsorbable membrane. At 6 months postoperative, the teeth were extracted with a small piece of tissue from the furcation area. The samples were then processed for histologic evaluation. Regeneration was found in 2 of the 3 samples. This study demonstrated that regeneration is possible in human furcation defects.

Absorbable Implants↗
PubMed1994

Treatment of mandibular class III periodontal furcation defects. Coronally positioned flaps with and without expanded polytetrafluoroethylene membranes.

Twenty-six mandibular class III furcation defects were treated in 26 subjects using a regenerative therapy that included citric acid root conditioning, placement of freeze-dried decalcified bone allograft and coronally positioned flaps secured by crown-attached sutures. In addition to this therapy, expanded polytetrafluoroethylene (ePTFE) membranes were placed in 14 of the 26 defects. The effect of these therapies was evaluated after 52 to 60 weeks through a series of soft and hard tissue probing measurements including residual furcation classification. For both treatments, mean improvements were observed for furcal probing attachment levels, furcal bone levels, and defect volumes. However, only a few of these through-and-through defects had become closed as judged by a panel of 3 independent examiners. Four defects in each of the 2 treatment groups had changed from Class III to Class I/II or Class II/II evaluated with the soft tissue in place. One defect treated without membrane and 3 defects treated with membranes had changed from Class III to Class II as recorded after reflection of the soft tissues at re-entry. Little difference was observed between defects treated with and without membranes. Further studies with larger sample sizes and longer observation times are needed to fully evaluate these regenerative procedures and their potential for healing Class III furcation defects.

Adult↗
PubMed2001

A clinical evaluation of hydroxyapatite cement in the treatment of Class III furcation defects.

BACKGROUND: Calcium hydroxyapatite cement (HAC) has been demonstrated in both animal models and human craniofacial defects to be safe, absorbable, osteoconductive, and possibly osteoinductive. This pilot study evaluated a novel technique using HAC to surgically obturate Class III mandibular molar furcation defects. METHODS: Following flap reflection, affected teeth in 6 patients were root planed and etched with citric acid. Experimental sites were grafted with HAC and coronally positioned flaps (CPF), while controls were treated by CPF only. A variety of clinical parameters were recorded initially, and at re-entry surgery 9 months later. RESULTS: At re-entry, all experimental sites exhibited granulation tissue interposed between the HAC and the alveolar bone, and clinical findings were unsatisfactory. Mean probing depth, clinical attachment loss, and recession increased by 0.8 mm, 1.9 mm, and 1.2 mm, respectively, in experimental sites. In controls, mean probing depth decreased by 0.8 mm, and clinical attachment loss and recession increased by 0.3 mm and 1.2 mm, respectively. There was a mean 1.6 mm loss in osseous crest height and a mean 2.2 mm worsening in osseous defect depth for experimental sites, but only a 0.5 mm loss in osseous crest and 0.5 mm increase in osseous defect depth in control sites. CONCLUSIONS: Experimental sites lost 1.0 to 1.5 mm in bone and attachment compared to controls, without any significant clinical benefit. While the concept of surgically obturating Class III furcation defects with a safe, osteoconductive material remains attractive, HAC did not promote repair or regeneration in this technique.

Acid Etching, Dental↗
PubMed1995

The origin of fibroblasts and their role in the early stages of horizontal furcation defect healing in the beagle dog.

The origin of fibroblasts, their proliferative activity and roles in the early stages of periodontal repair were investigated in order to better understand the periodontal healing process in furcation defects of the beagle dog after guided tissue regenerative therapy. Newly divided cells were identified by immunolocalization of bromodeoxyuridine (BrdU) injected 1 hour prior to sacrificing the animals. At 1 and 2 weeks after creation of the defects, the lesions were occupied primarily by granulation tissue. Under this condition, periodontal ligaments (PDL) fibroblasts in a coronal portion of the remaining PDL close to wounds proliferated actively, migrated along the root surface and formed fibrous connective tissue on the surface. Similarly, the fibroblasts adjacent to the bone surface also showed proliferative activity and engaged in active formation of fibrous connective tissue on the bone surface. The majority of labeled cells in both areas were located in the extravascular area. At 3 and 4 weeks, the defects were filled with an increased amount of new connective tissue and bone. The labeled fibroblasts were preferentially found in the most coronal portion of connective tissue formed on the root surface that was in direct contact with inflamed tissue, and the collagen fibers projected into granulation tissue. In areas of active bone formation, numerous labeled fibroblasts were located in connective tissue adjacent to the newly-formed bone. However, fibroblasts in the endosteum of new bone were rarely labeled These results indicate that fibroblasts involved in periodontal repair originate primarily from both the remaining PDL and alveolar bone, and actively engage in fibrous connective tissue formation in the early stages of periodontal repair The ability of PDL fibroblasts to proliferate, migrate, and form connective tissue on the root surfaces in the early repair stages appears to play a crucial role in the formation of the PDL and cementum, and consequently, in periodontal regeneration in the absence of root resorption and ankylosis. As the formation of new connective tissue and bone continues, the precursor cells for fibroblasts and osteoblasts are supplied locally through the continued divisions of the fibroblastic cells in association with the newly-formed connective tissue. Paravascular and endosteal cells appear to be minor contributors to new cell population during furcation defect repair in the beagle dog.

Alveolar Process↗
PubMed2003

Guided tissue regeneration in smokers: effect of aggressive anti-infective therapy in Class II furcation defects.

BACKGROUND: Guided tissue regeneration (GTR) using membrane barriers is still the reconstructive treatment of choice for a variety of periodontal defects. Smokers, however, present a reduced regenerative response to GTR. The purpose of the present study was to design and examine a new protocol with emphasis on anti-infective therapy for patients who are cigarette smokers and who require GTR procedures for the treatment of Class II furcation defects. METHODS: Chronic periodontitis patients who were smokers and who exhibited mandibular Class II furcations were initially pooled for further assessment. Patients were randomly assigned to either the experimental group (EG) or a control group (CG). Clinical measurements and indices were recorded at baseline and at 6, 9, and 12 months, and included: plaque assessment index; gingival assessment index; probing depth; and probing attachment level (vertical [PAL-V] and horizontal [PAL-H]) using a prefabricated acrylic stent as a reproducible reference point. All patients underwent hygienic phase periodontal therapy. Next, GTR was performed, and the furcation dimensions (height, width, and depth) were measured. A membrane was placed, and a 25% metronidazole gel was then applied over the outer surface of the membrane (EG only) and the flaps repositioned so that the membrane was completely submerged. Instructions included twice daily rinses with chlorhexidine gluconate 0.2% for 1 week (CG) or as long as the membrane was in place (EG), doxycycline 100 mg x 1/day for 1 week (CG) or 6 to 8 weeks (EG), and ibuprofen 3 x 400 mg/day for 7 days. Patients were initially seen for prophylaxis weekly (EG) or biweekly (CG). Metronidazole was applied to the free gingival margins and/or over the exposed membrane at every prophylactic visit (EG). Six to 8 weeks after surgery, the membrane was removed surgically, and the amount of new tissue growth (NTG) from the cemento-enamel junction (CEJ) to the most coronal extension of the new tissue was recorded. Following membrane retrieval, patients were seen for prophylaxis and oral hygiene reinforcement every month (EG) or quarterly (CG). At 12 months postoperatively, the area was surgically reentered and the surgical measurements repeated. RESULTS: Thirty-eight subjects, 21 females and 17 males, aged 35 to 61 were accepted in this study. Baseline clinical parameters were similar for both groups. One year postoperatively, there was no statistically significant difference in probing depth reduction or in horizontal PAL between EG and CG, but vertical PAL gain was significantly greater in EG. As for alveolar parameters 1 year postoperatively, the mid CEJ-crest distance and furcation width decreased in EG but increased in CG. A similar trend was observed for furcation height. Furcation depth reduction in both groups was similar. A comparison between new tissue growth at retrieval and eventual bone formation 1 year postoperatively demonstrated a smaller change in EG patients compared to CG patients, which was statistically significant for both the distal and the mid-tooth area, as well as for the tooth mean. CONCLUSIONS: While smoking prevented tissue maturation and mineralization, the anti-infective protocol enhanced these processes, resulting in a more favorable outcome. It is therefore suggested that when GTR is performed for Class II furcation defects in smokers, anti-infective therapy should be incorporated into the treatment protocol to enhance the regenerative outcome in these patients.

Adult↗