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PubMed1997

Furcation involvement: comparison of dental radiographs and HR-CT-slices in human specimens.

In this in vitro study we compared dental radiographs and high resolution computed tomography (HR-CT) regarding identification and classification of the degree of horizontal and vertical furcation involvement. After removal of the soft tissue and metallic restorations of 18 dentate upper and lower jaws in the interradicular furcation region of 28 molars, bony defects of different dimensions were experimentally produced. The specimens were examined radiographically with standardized dental radiographs and 1.0 mm thick contiguous axial CT-scans. After identification of molars with artificial furcation involvement in the dental radiographs and axial CT-scans, the horizontal and vertical grades of furcation involvement were classified. Radiological identification and classification were compared with the macroscopic findings in the specimens. For quantitative histological-radiological comparison, corresponding microsections were prepared in the same plane as the axial CT-scans. In the dental radiographs the artificial furcation involvement in 6 of 28 (21%) molars was identified. In contrast, all 28 molars with involved furcations (100%) were identified in the axial CT-scans. The horizontal and vertical grades of furcation involvement were classified in the same way as the macroscopic findings, permitting comparison of histological sections and axial CT-scans. The HR-CT technique offers 3-dimensional assessment of the interradicular bone morphology in furcation involvement without overlying structures. The periradicular alveolar bone can be assessed on all sides of the roots. HR-CT scanning thus permits a high identification rate and classification of molars with involved furcations.

Alveolar Process↗
PubMed1994

A histomorphometric study on the healing of class III furcations utilizing bone labelling in beagle dogs.

The dynamics of bone turnover in the furcations of teeth treated with expanded polytetrafluoroethylene (ePTFE) membranes were evaluated using multiple fluorochrome labels in 6 male beagle dogs. Loss of attachment involving the furcation area was induced in the second, third, and fourth premolar teeth using silk ligatures. The resulting defects were treated with the use of mucoperiosteal flaps for access, debridement of the defects, and placement of ePTFE membranes covering the furcations of the second and fourth premolars (experimental teeth) while the third premolar received only debridement without membrane placement (control tooth). Five fluorochrome labels were administered intravenously at timed intervals to act as markers of the osseous response. Membranes were removed at 4 weeks and all animals were terminated at 12 weeks post-membrane placement. One side of the mandible was decalcified, sectioned at 7 microns, and stained with either hematoxylin and eosin or Gomori's tri-chrome. The opposite side provided non-decalcified tissue processed as 100 microns ground sections. Using fluorescent light and point-hit evaluation, tissue in the coronal half of each specimen was classified as either labelled bone, unlabelled bone, or resorption space. In addition, microradiographs were prepared of each ground section and specimens classified as either woven bone, old lamellar bone, or new lamellar bone. No significant differences in attachment levels, or level of junctional epithelium, were observed in decalcified sections although greater remodeling activity was noted in the experimental specimens. Comparison of ground sections revealed significant differences (P < 0.05) in all categories with both methods of evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

Digital volume tomography in the diagnosis of periodontal defects: an in vitro study on native pig and human mandibles.

BACKGROUND: The aim of this study of native pig and human mandibles was to investigate the accuracy and quality of the representation of periodontal defects by intraoral radiography (IR), panoramic radiography (PR), computed tomography (CT), and digital volume tomography (DVT) in comparison with histologic specimens. METHODS: Following the standardized preparation of periodontal defects (14 dehiscences, fenestrations, 2- to 3-walled intrabony defects, respectively; Class I, II, and III furcation involvement) in six pig and seven human mandibles, IR, PR, CT, and DVT were performed. The histologic specimens were produced by cutting blocks with the individual defects out of the mandibles, embedding them in acrylic, and producing sagittal and axial microsections. The intrabony defects were measured using appropriate software on the digitized IR and PR images programs. The histologic sections were measured by reflecting stereomicroscopy. The statistical comparison between the measurements of the radiographic images and those of the histologic specimens was performed with Pearson's correlation coefficient. The quality of the radiographic images was determined through the subjective perception and detectability of the intrabony defects by five independent observers. RESULTS: All intrabony defects could be measured in three planes in the CT and DVT scans. Comparison with the histologic specimens yielded a mean deviation of 0.16 +/- 0.10 mm for the CT scans and 0.19 +/- 0.11 mm for the DVT scans. On the IR and PR images, the defects could be detected only in the mesio-distal and craniocaudal planes. In comparison with the histologic specimens, the IR images revealed a mean deviation of 0.33 +/- 0.18 mm and the PR images a mean deviation of 1.07 +/- 0.62 mm. The quality rating of the radiographic images was highest for the DVT scans. CONCLUSIONS: Overall, the CT and DVT scans displayed only a slight deviation in the extent of the periodontal defects in comparison with the histologic specimens. Both radiographic imaging techniques permitted imaging of anatomic osseous structures in three planes, true to scale, and without overlay or distortion. The DVT scans showed the best imaging quality.

Animals↗
PubMed1998

Clinical comparison of cellulose and expanded polytetrafluoroethylene membranes in the treatment of class II furcations in mandibular molars with 6-month re-entry.

The present study compared two barrier membranes, ePTFE and cellulose, used to treat Class II furcations in mandibular molars. Fifteen patients with no history of systemic diseases and presenting matched pair defects were selected. The following soft tissue measurements were taken at baseline (after the hygienic phase), and 6 months after surgery: gingival recession, probing depth, clinical attachment level, and width of keratinized tissue. At the time of membrane placement, and 6 months later (re-entry), the following hard tissue parameters were recorded: cemento-enamel junction (CEJ) to alveolar crest, CEJ to base of osseous defect, alveolar crest to base of osseous defect, and horizontal defect depth. According to the surgical protocol, the ePTFE membranes were completely covered by the flaps (subgingival placement), whereas the cellulose membranes extended 1 mm coronal to the gingival margin (supragingival placement). Healing was uneventful in all cases and membranes remained in place for 4 weeks. Data were analyzed using the Wilcoxon signed-rank test at the 5% level of significance. No statistically significant differences were found between the ePTFE and cellulose membranes, respectively (in mm): probing depth reduction (2.87+/-1.0 versus 3.27+/-1.1), gain in attachment level (2.53+/-1.2 versus 2.8+/-1.3), defect fill (3.0+/-1.4 versus 4.0+/-2.3), horizontal furcation fill (2.87+/-1.1 versus 2.93+/-1.0), alveolar crest resorption (2.4+/-10 versus 2.73+/-1.2), and intrabony defect fill (0.6+/-1.2 versus 1.27+/-1.7). We conclude that both ePTFE and cellulose membranes are effective, not showing statistical differences in efficacy. A larger study may be necessary to show differences in efficacy and adverse effects.

Alveolar Bone Loss↗
PubMed2000

Clinical and radiographic findings following application of enamel matrix derivative in the treatment of intrabony defects. A series of case reports.

AIM: The purpose of this case report study was to evaluate the clinical and radiographic findings following application of enamel matrix derivative (EMD) in the treatment of 2- or 3-wall intrabony defects in a private periodontal practice one year after surgery. METHOD: 15 consecutive patients (age range 38 67 years, 9 females, 6 males, 3 smokers) with 25 intrabony defects were included in the study. The decision to use reconstructive surgery was taken at least 3 months after termination of the presurgical treatment phase. Inclusion criteria were: presence of an interproximal area with residual probing depth (PD) > or =6 mm, probing attachment level (PAL) > or =6 mm and an associated intrabony defect > or =4 mm deep and > or =2 mm wide as measured during surgery (defects were not associated with adjacent furcation lesions). Open-flap surgery was performed to expose the defects and the EMD gel was applied after proper debridement. The patients were instructed to rinse 2x daily for 6 weeks with a 0.12% solution of chlorhexidine. RESULTS: At 12 months, mean PD decreased from 8.4 mm to 4.0 mm and PAL from 10.2 mm to 6.6 mm, while recession increased from 1.8 mm to 2.6 mm. Residual PD greater than 4 mm was observed only in 7 sites. 14 sites demonstrated a PAL gain of 2-3 mm, 9 sites a gain of 4-5 mm and 2 sites a gain of 6 mm. Radiographic assessment indicated a mean crestal bone resorption of 20.7% and a mean improvement in the distance between the CEJ and the base of the defect of 22.9%. The combination of defect fill from the bottom of the defect and crestal resorption resulted in a mean defect resolution of 61%. CONCLUSION: Within the limits of this study, the application of EMD gel in 2- or 3-wall intrabony defects resulted in clinically significant gain of PAL and radiographic bone. Further controlled clinical studies are required to confirm the effectiveness of the EMD gel in the treatment of various osseous defects.

Adult↗
PubMed1996

Value of some laboratory and clinical measurements in the treatment plan for advanced periodontitis.

In our previous study, we reported that only 13 of 46 adult patients with advanced periodontitis responded well to initial non-surgical periodontal therapy. In the present follow-up study, the remaining 33 patients were randomly treated further using either modified Widman flap surgery or systemic metronidazole. The patients responding unsatisfactorily to this 2nd treatment phase, received supplementary systemic chemotherapy or surgery, respectively. By using this study design, we determined which baseline clinical variables and/or laboratory findings predicted the treatment outcome in these study patients. Clinical variables included the assessment of bleeding, suppuration, probing pocket depth, furcation lesions, relative attachment level and radiographic infrabony defects. Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were cultured from subgingival plaque samples. The specific IgG and IgA antibody levels against 5 serotypes of A. actinomycetemcomitans were determined in serum and saliva. Elastase-like, trypsin-like and general protease activities were assessed from saliva. The bivariate statistical analyses showed that the most pronounced difference between the patients responding well to initial non-surgical therapy (group MC, n = 13), to either supplementary surgery or chemotherapy (group FT1, n = 11), or those responding to the complex therapy (group FT2, n = 17), was the prior extent of periodontal destruction expressed as the proportion of > or = 6 mm deep periodontal pockets. When multiple linear regression was used to investigate the influence of clinical and laboratory findings on the variation of treatment response between the 3 groups, the most significant explanatory factor was the simultaneous presence of subgingival A. actinomycetemcomitans and multiple deep periodontal pockets. None of the immunological or biochemical variables used had any further influence in the model. Pretreatment microbiological examination, especially for the detection of A. actinomycetemcomitans, seems to be a valuable laboratory screening method for identifying complex treatment need in adult patients with advanced periodontitis. However, the evaluation of the extent and pattern of periodontal breakdown remains crucial for choosing the treatment strategy including surgery and/or chemotherapy in A. actinomycetemcomitans-infected adult periodontitis patients.

Adult↗
PubMed1992

Osteogenic capacity of collagen in repair of established periodontal defects.

Periodontal bone defects were established in four dogs, with one proximal lesion and one furcation lesion in each quadrant. These defects were treated with the implantation of collagen membranes, collagen sponge or a combination of membrane and sponge, inserted between the mucoperiosteal flaps and the bone defects. Control sites were treated in a similar surgical manner to the experimental sites, but no collagen was inserted. Substantial amounts of new bone formed in those cases treated with the collagen products, especially those treated with the membrane either with or without the sponge. The membranes limited the infiltration of small round cells, whereas in the control sites, inflammatory cells infiltrated to the bone surface. New connective tissue attachment was established in experimental situations, especially with the use of the membranes alone or in conjunction with sponge.

Animals↗
PubMed1992

Guided tissue regeneration in the treatment of infrabony defects on maxillary premolars. A pilot study.

The present study evaluated clinically and radiographically the short-term results of the healing of infrabony defects at maxillary premolars treated according to guided tissue regeneration (GTR). 9 patients with bilateral presence of infrabony defects with or without furcation involvements at maxillary premolars were selected. At baseline assessments of plaque and gingival indices, bleeding, probing pocket depth and attachment level, and furcation measurements were recorded. Conventional radiographs were obtained in a way that assured a reproducible projection geometry. One premolar was randomly treated with GTR and the contralateral with open debridement. Clinical and radiographic examinations were performed again 6 months postoperatively. The bone tissue changes were assessed by means of conventional radiographs and subtraction images. Sites treated by both procedures demonstrated an improvement of gingival conditions and a reduction of pocket depths. A statistically significant attachment gain was obtained for the test (mean 1.2 mm), but not for the control sites (mean 0.6 mm). The differences, though, were not significant between the test and control sites. Limited improvement in furcation closure was recorded. The radiographic examination demonstrated loss of bone tissue in four sites treated with GTR. The findings suggest that the regeneration of the periodontal soft and bone tissues was not significantly enhanced with the GTR therapy.

Adult↗
PubMed1995

Clinical trial of cross-linked human type I collagen as a barrier material in surgical periodontal treatment.

This study was undertaken to evaluate freeze-dried cross-linked human type I collagen when used as a barrier membrane for guided tissue regeneration (GTR) in periodontal surgery. 14 patients with radiographic evidence of bone loss and residual pocketing of > 6 mm on bilaterally matched sites were given preliminary scaling, polishing and oral hygiene instruction before undergoing contralateral flap surgery. At the experimental sites, a collagen membrane was adapted to the root surfaces, extending from 2 mm apical to the bone crest to just subgingival, before replacing the flap and closing with sutures. The control sites underwent a similar procedure but without the placement of the collagen barrier. The experimental sites were selected at random. Plaque index (PLI), gingival index (GI), bleeding index (BI), probing pocket depth (PPD) and probing attachment level (PAL) were recorded at baseline, 6, 12 and 26 weeks post-operatively. The bony defects were classified and furcation involvement noted. The clinical parameters were recorded by an examiner, previously assessed for accurate reproducibility of measurement, who was not the surgeon and unaware of the experimental sites. PPD and PAL were measured using a constant pressure probe localised by a soft stent. There was significant improvement in the PLI, GI and BI at both test and control sites at 6, 12 and 26 weeks compared to baseline (P < 0.001 for PLI; P < 0.0001 for GI and BI) but not significant difference between these sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Periodontal treatment after the method of guided periodontal tissue regeneration].

Results of studies on animal models have shown that only guided periodontal tissue regeneration (GTR) will induce growth of new connective tissue fibers attached to new zement and bone tissue when the root surface had been exposed to plaque or pocket organisms. Studies of various authors suggest that it is exclusively the progenitor cells in the still existing periodontal ligament that permit regeneration. The development of GTR is based on biological principles. In the beginning its application was limited to periodontal surgery and has meanwhile expanded to include other areas such as implantology and oral surgery. Best results can be achieved in the periodontological treatment of three-walled bone defects and class II furcation involvements according to the data of several studies.

Animals↗
PubMed1998

Root instrumentation. Power-driven versus manual scalers, which one?

The literature is clear that periodontal therapies aimed at altering the progression of inflammatory periodontal diseases must include meticulous subgingival mechanical débridement during both the nonsurgical and the surgical phases of treatment as the basis of most anti-infective therapy. In the past, infection control was achieved by the mechanical removal of subgingival deposits of plaque, calculus, and endotoxin with curets, files, and hoes. Historically, it was also generally agreed that aggressive scaling and root planing with hand instruments was necessary to remove tenacious calculus deposits to produce roots as smooth as possible for removal of the endotoxins previously thought to be deeply embedded into the root surfaces. Based on current evidence in the literature, it is now known that endotoxin is a weakly adherent surface phenomenon and that sonic and ultrasonic (power-driven) instruments can be used to accomplish definitive root detoxification and maximal wound healing without overinstrumentation of root and without extensive cementum removal. Power-driven scalers may have unique advantages because of the cavitational activity associated with ultrasonics thought to supplement removal of root surface plaques. In addition, the constant flushing activity of the lavage used to cool the tips results in disruption of the unattached and weakly attached subgingival plaques. The ability to flush the pocket during subgingival instrumentation with water or other chemical irrigating solutions is unique to ultrasonic and sonic scalers and has been shown to enhance pocket depth reduction and gain in clinical attachment beyond that achieved with hand scaling. The added benefit of chemical lavage during ultrasonic instrumentation shows great promise and may enhance the overall effect of nonsurgical anti-infective periodontal therapy. Other major advantages of power-driven scalers may include better access to difficult areas, such as deep narrow defects, root grooves, and furcations, using newly designed microultrasonic tips, which are smaller in diameter and able to penetrate the pocket approximately 1 mm farther than hand instruments. Taken together, it appears that use of ultrasonic or sonic scalers for periodontal débridement will result in improvements in clinical and microbial parameters at a level equal to or superior to hand scalers.

Anti-Infective Agents, Local↗
PubMed2004

Clinical evaluation of an enamel matrix derivative and a bioresorbable membrane in the treatment of degree III mandibular furcation involvement: a series of nine patients.

The present study evaluated the effect of combining an enamel matrix derivative (EMD) and a bioresorbable membrane (GTR) in the surgical treatment of degree III mandibular furcation involvements. Nine patients with chronic periodontitis, presenting a total of 14 degree III mandibular furcation involvements, were included in the study. Surgical treatment of the defects was randomly assigned: (1) EMD (four defects); (2) GTR (three defects); and (3) EMD and GTR (seven defects). The degree of involvement was assessed prior to surgery and after 6 and 12 months by measuring the probing attachment level in the horizontal and vertical directions at the furcation site. At 6 and 12 months, partial closure of the involvements had occurred in approximately half of the treated furcations, and the vertical probing level consistently improved following all three treatment modalities. The results suggest that all three treatment modalities may improve healing following surgical treatment of degree III mandibular furcation involvements. However, further studies are needed to examine the clinical significance of these results and the histologic characteristics of the healing following application of EMD.

Adult↗
PubMed1996

Periodontal regeneration around natural teeth.

1. Evidence is conclusive (Table 2) that periodontal regeneration in humans is possible following the use of bone grafts, guided tissue regeneration procedures, both without and in combination with bone grafts, and root demineralization procedures. 2. Clinically guided tissue regeneration procedures have demonstrated significant positive clinical change beyond that achieved with debridement alone in treating mandibular and maxillary (buccal only) Class II furcations. Similar data exist for intraosseous defects. Evidence suggests that the use of bone grafts or GTR procedures produce equal clinical benefit in treating intraosseous defects. Further research is necessary to evaluate GTR procedures compared to, or combined with, bone grafts in treating intraosseous defects. 3. Although there are some data suggesting hopeful results in Class II furcations, the clinical advantage of procedures combining present regenerative techniques remains to be demonstrated. Additional randomized controlled trials with sufficient power are needed to demonstrate the potential usefulness of these techniques. 4. Outcomes following regenerative attempts remain somewhat variable with differences in results between studies and individual subjects. Some of this variability is likely patient related in terms of compliance with plaque control and maintenance procedures, as well as personal habits; e.g., smoking. Variations in the defects selected for study may also affect predictability of outcomes along with other factors. 5. There is evidence to suggest that present regenerative techniques lead to significant amounts of regeneration at localized sites on specific teeth. However, if complete regeneration is to become a reality, additional stimuli to enhance the regenerative process are likely needed. Perhaps this will be accomplished in the future, with combined procedures that include appropriate polypeptide growth factors or tissue factors to provide additional stimulus.

Animals↗
PubMed1999

Evidence for healing of Class II and Class III furcations 24 months after guided tissue regeneration therapy: digital subtraction and clinical measurements.

BACKGROUND: The aim of this study was to compare bone regeneration as assessed by subtraction radiography with clinical attachment measurements 24 months after regenerative surgery. METHODS: In 24 patients with advanced periodontitis, 34 Class II and 10 Class III furcations were treated by guided tissue regeneration using expanded polytetrafluoroethylene (n = 18) or bioabsorbable barriers (n = 26). Clinical parameters were assessed and 40 pairs of standardized radiographs were taken before and 24 months after surgery. Bony gain within furcations was assessed using subtraction analysis. RESULTS: In Class II furcations, statistically significant (P <0.001) vertical (CAL-V: 1.06+/-1.56 mm) and horizontal (CAL-H: 2.05+/-1.24 mm) attachment gain was observed 24 months postsurgically. Within Class III defects CAL-V gain was assessed 1.78+/-1.43 mm (P <0.005). CAL-H gain in buccal and lingual Class II furcations was explained by the relative density gain, baseline CAL-H, gingival index (GI) reduction, and individual patients (P <0.001) whereas, multiple regression analysis failed to show a relation between CAL-H gain and any of the subtraction parameters for interproximal furcations. Vertical attachment gain in interproximal sites was explained by net bony area gain (subtraction), PD and GI reduction, baseline CAL-V, defect type, smoking, and individual patients (P<0.001). CONCLUSIONS: There was a statistically significant correlation between clinical and radiographic improvements within furcation defects. However, this correlation was modulated by other factors such as baseline CAL-V or CAL-H, PD and GI reduction, or smoking. The relative density gain seemed to sufficiently describe bony changes related to clinical changes within buccal and lingual furcations, whereas bone area gain suitably described bony changes in interproximal Class II and III furcations.

Absorbable Implants↗
PubMed1992

The use of irradiated-crosslinked human collagen membrane in guided tissue regeneration.

Irradiated glutaraldehyde-crosslinked human collagen membrane was evaluated for its effects on new attachment formation in clinical trials, using the principle of guided tissue regeneration (GTR). 19 adult periodontitis patients with 52 matched bilateral periodontal defects received scaling and polishing with oral hygiene instruction. The bilateral periodontal defects were treated by reflecting a flap with collagen membrane (test) or flap reflection alone (control). Plaque (P1I) and gingival index (GI) scorings, probing pocket depth (PPD) and probing attachment level (PAL) along with classification of furcation involvement (FI) and bony defects were made at pre- and post surgery (6 weeks, 3 and 6 months). Improvement of P1I and GI scores was seen in both test and control sites following the surgical therapy. Reductions in PPD and PAL were significantly (p less than 0.001) more pronounced at 6 months in the test sites compared to the controls. The 2 Class I furcations in the graft-treated teeth showed complete resolution, while the corresponding furcations in the control teeth showed incomplete closure. The use of human collagen membrane based on the GTR technique for treatment of human periodontal defects provided greater gain of clinical attachment than when flap surgery alone was undertaken.

Adult↗
PubMed1997

Particulate bioglass as a grafting material in the treatment of periodontal intrabony defects.

The present clinical trial was designed to evaluate the effects of a bioactive glass, Perioglas, in the treatment of periodontal intrabony defects. 20 patients, 23-55 years of age (44 sites), with intrabony defects completed the 1-year study. Teeth with furcation involvement were excluded. After completion of initial therapy, defects were randomly assigned to either a test or control procedure. Following flap reflection, root planing and removal of chronic inflammatory tissue in both groups, the test defects were restored with the bioactive glass particulate material. Mucoperiosteal flaps were replaced, sutured and a periodontal dressing was used. All the patients received postoperative antibiotics and analgesics and were seen at 1 week for suture removal. Follow-up was then carried out weekly and at 3 months, 6 months, 9 months and 1 year post-surgery. Plaque score, bleeding score, probing pocket depth (PPD), probing attachment level (PAL) and gingival recession were recorded at baseline, 3 months and 1 year. Standardised radiographs for computer-assisted densitometric image analysis (CADIA) were taken at baseline, immediately post-operatively and at 1 year. The CADIA data showed a significant increase (F-ratio: 15.67, p < 0.001) in radiographic density and volume between the defects treated with the Perioglas when compared to those treated with surgical debridement only. PPD and PAL showed significant improvements in both experimental and control sites, with a greater trend to improvement in the experimental sites. It was concluded that this bioactive glass is effective as an adjunct to conventional surgery in the treatment of intrabony defects.

Absorptiometry, Photon↗