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PubMed1994

Guided tissue regeneration with and without decalcified freeze-dried bone in mandibular Class II furcation invasions.

The purpose of this study was to compare periodontal soft and hard tissue repair using expanded polytetrafluoroethylene (ePTFE) membranes with and without decalcified freeze-dried cortical bone allografts (DFDBA). Six patients with 17 mandibular Class II buccal molar furcal invasions received oral hygiene instructions followed by scaling and root planing. Baseline soft tissue measurements with periodontal probes were made to assess probing depths (PD), recession (REC), and probing attachment levels (PAL). After non-surgical therapy, 10 teeth were randomly selected as test sites (ePTFE + DFDBA) and 7 as controls (ePTFE alone). Full-thickness flaps were elevated, and open surgical measurements were made to determine alveolar crestal height (CEJ-AC) and vertical (CEJ-BDF) and horizontal (HPDF) defect depth. The ePTFE membranes were removed at 6 weeks. After 6 months, all sites were reentered and both soft tissue and open surgical measurements recorded. The following mean changes (mm) were found for ePTFE and ePTFE + DFDBA treated sites respectively: decreased PD = 1.5, 2.2; increased REC = 1.3, 1.3; loss(-)/gain PAL = -0.2, 0.8; decreased CEJ-BDF = 3.8, 5.0; increased CEJ-AC = 0.5, 0.4; and decreased HPDF = 2.3, 2.4. None of the changes were statistically significant. The addition of DFDBA to the GTR procedure did not significantly improve any of the mean soft tissue and open surgical measurements between control (ePTFE alone) and test (ePTFE+DFDBA) groups in mandibular Class II buccal furcations. Both treatment procedures resulted in significant decreases in PD, CEJ-BDF, and HPDF and a significant increase in REC. There were no differences for PAL and CEJ-AC within control and test groups seen with this sample. Larger randomized clinical trials are needed to more fully evaluate whether combined graft and GTR procedures offer an advantage over GTR alone.

Adult↗
PubMed1984

Juvenile periodontitis: healing following autogenous iliac marrow graft, long-term evaluation.

A case of juvenile periodontitis treated by autogenous bone grafting is reported. The patient, an 18-year-old female, presented with periodontal lesions around the incisors and the first lower left molar. The first molar was severely affected with bone defects at the mesial aspect and in the furcation region and, for this reason, was selected for grafting. Minced fragments of bone with its marrow, obtained from the patient's iliac crest, were implanted into the diseased periodontium. 1 year after treatment, clinical and radiological inspection revealed the presence of bone. This bone completely filled the furcation area of the tooth but only partially the mesial aspect. There was, also, significant bone fill in the supracrestal region.

Adolescent↗
PubMed1994

Microorganisms in polytetrafluoroethylene barrier membranes for guided tissue regeneration.

This study examined the microflora in 11 barrier membranes around teeth with furcation involvement or 2 to 3 wall intrabony defects and in 16 membranes around implants with various types of bony defects. Total viable counts and the occurrence of selected microbial species were determined by non-selective and selective culture and by DNA probes. Study sites were examined for probing pocket depth and attachment level. All tooth-associated membranes yielded high levels of microorganisms. 4 of 5 teeth with membranes harboring less than 10(8) organisms gained 3 mm or more in probing attachment, whereas 6 teeth with membranes with more than 10(8) organisms exhibited loss or only small gains in attachment. 3 membranes with high levels of black-pigmented anaerobic rods lost 1 to 2 mm of attachment. Ten implant-associated membranes with no cultivable microorganisms demonstrated a mean probing gain of 4.9 mm. 6 implants with infected membranes only gained an average of 2.0 mm of supportive bone. The present findings underscore the importance of controlling or eliminating periodontal pathogens on barrier membranes in order to gain new attachment.

Adult↗
PubMed1977

Present status of osseous grafting procedures.

Osseous grafting techniques represent one mode of therapy to manage combination pocket-osseous defects. They have their greatest applicability in the intrabony defect although encouraging results have been noted in furcation and suprabony sites. Like all treatment modalities, their usage is dictated by the therapeutic objectives for specific problems and whether their respective advantages and limitations outweigh other management techniques. They are neither a panacea nor an unproven experimental venture. When properly employed, they are a valuable component of currently accepted therapy. When compared with other treatment approaches, the following relative advantages and limitations have been noted with osseous grafts: Advantages 1. Reconstruct lost periodontium. 2. Idealistic therapeutic objective. 3. Reversal of disease process. 4. Increase tooth support. 5. Enhance esthetics. 6. Improve function. Limitations 1. Additional treatment time. 2. Autograft disadvantages. 3. Availability of graft material. 4. Additional postoperative care. 5. Unique postoperative problems. 6. Variations in repair. 7. Longer post-treatment evaluation interval. 8. Predictability. 9. Greater expense. 10. Multistep therapy common. 11. Vulnerability to recurrence.

Alveolar Process↗
PubMed1998

Root conditioning using EDTA gel as an adjunct to surgical therapy for the treatment of intraosseous periodontal defects.

The aim of this clinical study was to compare the treatment outcome following root surface conditioning using an EDTA gel preparation in conjunction with surgical therapy with that following conventional flap surgery in periodontal intraosseous defects. 36 patients, each of them contributing one intraosseous defect > or =4 mm in depth participated. Defect sites had a probing pocket depth > or =5 mm and bled on probing following hygienic treatment phase. No furcation involvement or endodontic complications were present. In the EDTA group, 18 consecutive patients, defects were treated by root conditioning with EDTA gel for 3 minutes in combination with surgical therapy. In the control group, 18 patients, conventional flap surgery was performed without root conditioning. Chlorhexidine rinsings 0.2% were prescribed following surgery for 2-3 weeks with modified oral hygiene instruction. A strict recall program was implemented including professional prophylaxis and oral hygiene reinforcement every 4-6 weeks until 6-month re-evaluation. Baseline probing pocket depths and defect depths of 7.1+/-1.3 mm and 6.9+/-1.6 mm in the EDTA group and 7.6+/-1.9 mm and 6.6+/-1.7 mm, respectively, in the control group were measured. 6-month clinical results showed a significant probing attachment level gain of 1.8+/-1.5 mm and 1.0+/-1.7 mm in the EDTA and control groups respectively. A probing bone gain of 1.0+/-1.3 mm in the EDTA group was measured with a non-significant gain of 0.4+/-1.2 mm in the control group. Radiographic analysis confirmed these results. There were no statistically significant differences in treatment outcome between the group treated by root conditioning in combination with flap surgery and conventional flap surgery alone.

Acid Etching, Dental↗
PubMed1996

Bacterial colonization of bioabsorbable barrier material and periodontal regeneration.

The objective of the study was to evaluate bacterial colonization of the tooth-facing surface of bioabsorbable membranes and to determine its effect on the clinical outcome of membrane supported reconstructive periodontal surgery. Twenty systemically healthy subjects affected by chronic adult periodontitis were enrolled in the study. One non-furcation tooth site per patient, associated with an angular bony defect and a probing attachment loss of > 5 mm, was selected to be treated by means of a guided tissue regeneration procedure using a polyglicolactic membrane. Antibiotics (amoxicillin/clavulanate potassium 1 g per day) for 2 weeks were prescribed, in addition to the use of chlorhexidine for post-surgical plaque control. All patients were recalled once a week for 5 weeks for professional tooth cleaning. At 5 weeks sites with clinically exposed membranes underwent a second surgery to harvest residual barrier material which was analyzed by scanning electronic microscopic (SEM) for bacterial colonization. Sites with no membrane exposure at 5 weeks were allowed to heal without any other surgical intervention. Professional tooth cleaning and reinforcement of self-performed oral hygiene measures were given at 1 month intervals for the duration of the study. For each treated site the difference in probing attachment loss between baseline examination and a follow-up examination made 6 months after the second surgery was calculated. Gain of probing attachment was statistically (P < 0.001) greater in sites with no membrane exposure when compared to sites with partially exposed barrier material (4.2 +/- 0.5 vs. 3.3 +/- 0.6). The results of SEM analysis revealed that bacterial colonization was evident in all the microscopic fields of the exposed areas of the membranes. In the mid-part of the membranes 16 out of 39 microscopic fields (41%) demonstrated microbial colonization, while no bacteria-positive field was observed in the most apical portion of the membranes. Regression analysis indicated that gain in probing attachment level was negatively correlated to microbial colonization of the mid-part of the membranes. It was suggested the midportion of the tooth-facing surface of polyglicolactic membrane is a critical area for the healing process since its bacterial colonization was detrimental to the outcome of the GTR surgery.

Adult↗
PubMed2004

Treatment of intrabony defects with bovine-derived xenograft alone and in combination with platelet-rich plasma: a randomized clinical trial.

BACKGROUND: In the treatment of periodontal intrabony defects, the benefits of adding platelet-rich plasma (PRP) to a bone replacement grafting material have not been tested. The purpose of this study was to compare the clinical outcomes obtained by the combination of PRP and a bovine derived xenograft (BDX) to those obtained from the use of the bone replacement graft alone. METHODS: Thirteen patients were enrolled in a randomized, split mouth, double-masked clinical trial. Bilateral defects were matched according to their intrasurgical measurements. Qualifying defects had loss of attachment of > or = 6 mm, a radiographically detectable defect of > or = 4 mm, at least two remaining osseous walls, and not primarily related to a furcation involvement. After the hygienic phase, at the baseline examination, probing depth (PD), clinical attachment level (CAL), and recession (REC) were measured. During open flap debridement, the defects were randomly assigned to receive either BDX mixed with PRP or BDX alone. Baseline osseous intrasurgical measurements were obtained. Post-surgical follow-up and maintenance were performed and PD, CAL, and REC were remeasured at 6 months. The mean baseline and 6-month PD, CAL, and REC of the deepest buccal and lingual measurements related to the defect for each group were computed. The change from baseline to 6 months for each parameter measured was calculated. Pre- and postoperative comparisons were made between treatment groups at 6 months. RESULTS: Randomization of the defects resulted in comparable groups (P > or = 0.05). At 6 months, paired t test comparisons within groups showed statistically significant benefits with both treatment modalities (P < or = 0.05). The mean changes (delta) at 6 months for the test and the control groups at the deepest sites were: PD reduction: 3.54 and 2.53 mm; CAL gain: 3.15 and 2.31 mm; and REC: -0.38 and -0.23 mm, respectively. Paired t test comparisons yielded significant differences between treatments for PD and CAL (P < or = 0.05). CONCLUSION: In this 6-month clinical trial, the addition of a high concentration of autologous platelets to a bovine derived xenograft to treat intrabony defects significantly improved their clinical periodontal response.

Adult↗
PubMed2004

Sealing ability of One-Up Bond and MTA with and without a secondary seal as furcation perforation repair materials.

This study investigated the ability of One-Up Bond alone and mineral trioxide aggregate (MTA), with and without a secondary seal of One-Up Bond or SuperEBA to seal saucer-shaped perforation defects in human molars. Cusps were removed, roots were amputated, and endodontic therapy completed on 40 extracted teeth. A cylindrical hole was made in each tooth from the furcation area to the chamber, into which a section of steel tubing was cemented. Intracoronal saucer-shaped defects were created over the perforation. The teeth were restored with MTA, One-Up Bond, or MTA with a secondary seal of One-Up Bond or SuperEBA. The integrity of the seal was evaluated by fluid filtration. MTA alone leaked significantly more than One-Up Bond or MTA with either secondary seal at 24 h. At 1 month, MTA, MTA plus One-Up Bond, and One-Up Bond alone were equivalent.

Aluminum Compounds↗
PubMed1994

Periodontal regeneration with bioresorbable membranes.

A critical point for the success of guided tissue regeneration is the rate of degradation of the bioresorbable membrane. An ideal bioresorbable membrane must allow selective repopulation of the root surface by cells from the periodontal ligament before it is degraded and replaced by the healing connective tissues of the periodontium. Freeze-dried dura mater, microfibrillar collagen, bovine type I collagen, human type I collagen, polylactic acid, and polyglactin 910 have been used in clinical human studies. Microfibrillar collagen did not form an effective barrier to epithelial migration. Freeze-dried dura mater has shown limited improvement in the treatment of proximal infrabony defects and equal results to expanded polytetrafluorothylene in the treatment of mandibular class II furcations. Cross-linked type I collagen and polylactic acid have shown significant improvement in the treatment of proximal infrabony lesions and class II furcations. More clinical studies done by independent investigators are needed to support the value of these bioresorbable materials in the regeneration of the periodontal tissues.

Animals↗
PubMed2000

Guided tissue regeneration with and without demineralized freeze-dried bone allografts for maxillary Class II furca invasions of rapidly progressive periodontitis.

BACKGROUND: Guided tissue regeneration (GTR) using an expanded polytetrafluorethylene (ePTFE) membrane is an established treatment modality for periodontal disease. This study was designed to compare the effects of ePTFE membranes with and without demineralized, freeze-dried bone allografts (DFDBA) for treating maxillary class II buccal furca invasions of rapidly progressive periodonitis. METHODS: Seven patients with pairs of maxillary class II buccal furca invasions comprised the study group. The clinical parameters investigated were probing depth, probing attachment level and marginal tissue recession. One defect from each pair of teeth was randomly selected for the ePTFE membrane and DFDBA group and the other tooth defect received ePTFE membrane treatment only. During the operation, horizontal probing depths at the buccal furcation areas were measured. The membrane was removed 6 weeks after insertion. All measurements were repeated 1 year later at surgical re-entry of the buccal furcation. The Wilcoxon ranked sum test was used to test the significance of the difference between the groups 1 year after treatment. RESULTS: In the ePTFE membrane and DFDBA group, the mean probing depth reduction was 2.1 +/- 0.8 mm. The probing attachment gain was 2.6 +/- 1.0 mm and the bone fill was 3.1 +/- 1.7 mm. There was no statistically significant difference between the groups for these parameters. The marginal tissue recession was reduced 0.4 +/- 0.7 mm in ePTFE membrane and DFDBA group but increased 0.9 +/- 0.6 mm in ePTFE membrane only group. This difference was statistically significant (p = 0.016). CONCLUSIONS: There was no difference in probing depth reduction, probing attachment gain or bone fill between the two treatment modalities for treating maxillary class II buccal furca invasion of rapidly progressive periodontitis. Marginal tissue recession can be significantly reduced with the treatment of combined ePTFE membrane and DFDBA.

Adult↗
PubMed1991

[Treatment of furcation involvement--implantation of alloplastic materials].

Based on the results of clinical and experimental research, the treatment of furcation-involved teeth by alloplastic implant is critically evaluated. Only materials like calcium phosphate ceramic have shown to be of therapeutic value. Clinically it was found in reentry surgeries 6 months after implantation that the vertical and horizontal components of grade II furcation-involved mandibular molars were reduced to a greater extent with hydroxyapatite implants compared to flap surgery alone. Histological studies in animals were performed only in periodontal infrabony defects; these data yielded contradictory results. However, most studies showed that the apical migration of the epithelium along the root surface was reduced and periodontal regeneration was enhanced. Because these results cannot be extrapolated to the specific situation in the furcation area, the routine treatment of furcation-involved teeth with alloplastic implants is not recommended. Possible future aspects of this treatment modality may involve a combination of the membrane technique with alloplastic implants as well as a temporary closure of the involved furcation entrance with a sterile bone cement. These techniques are based on the principle of guided tissue regeneration. Both treatment modalities demonstrate promising results.

Alveolar Bone Loss↗
PubMed1987

Relationship between periodontal furcation involvement and molar cervical enamel projections.

A total of 78 individuals ages 21 to 61 years with periodontal furcation involvement was examined for the presence of cervical enamel projections on the buccal surfaces of molar teeth. The furcal defects and cervical enamel projections (CEPs) of molars were diagnosed by probing, periapical roentgenographs, flap operation and inspection. Plaque index (PlI) and gingival index (GI) were recorded for the buccal and lingual surfaces of molars examined. The percentage of CEPs in the 78 individuals examined was 67.9%. The prevalence of CEPs in all molars examined was 45.2%. The prevalence of CEPs in molars with and without furcal involvements were 82.5% and 17.5%, respectively. The frequency of CEP in molars occurred in the following order: mandibular first molars, maxillary first molars, mandibular second molars and maxillary second molars. Statistical analyses (Chi-square test) revealed a significant difference between periodontal furcation involvements and the presence of CEPs. Results of this study also indicated that the furcal involvements with CEPs were associated with poor oral hygiene as measured by GI and PlI.

Adult↗
PubMed1987

Root isolation for new attachment procedures. A surgical and suturing method: three case reports.

A surgical and suturing method is described for the subgingival placement of Gore-tex periodontal material during new attachment procedures. The periodontal material isolates the root surface from epithelium and gingival connective tissue. Three cases were treated. Clinical new attachment was evident from clinical probings and reentry. The term "open probing new attachment" describes the type of tissue that was evident at reentry after treatment of a Class III furcation. A combination of new bone and "open probing new attachment" was evident after one-wall defects were treated adjacent to a mandibular cuspid. A two-wall defect was treated and biopsied three months later. A reference notch was placed 1 mm coronal to the apical aspect of the defect. Histologic examination of the biopsy showed new bone, cementum and periodontal fibers coronal to the notch. Clinical and histologic new attachment was achieved using the technique for root isolation. The long-term predictability and stability of this type of new attachment is not known at this time.

Connective Tissue↗
PubMed1991

Principles and techniques of guided tissue regeneration.

Guided tissue regeneration is an accepted technique to promote new attachment in periodontal therapy. It is supported by sound basic research indicating that the definitive factor in the obtainment of regeneration is the source from which the cells repopulating the exposed root surface originate. These studies have indicated that cells proliferating from the periodontal ligament have the greatest potential for achieving new attachment. The use of barriers during periodontal surgery permits the possibility of periodontal ligament proliferation toward the exposed root at the same time that epithelial and gingival connective tissue proliferation is blocked. Studies in which Gore-Tex periodontal material has been used as a barrier have shown positive results in animal and clinical studies. Histologically, the formation of new cementum, bone, and periodontal ligament has been demonstrated. Clinically, beneficial results have been documented in the treatment of intrabony defects with three-wall, two- to three-wall, or funnel-shaped topography. Also, Class II furcations with or without a vertical component have been treated successfully by guided tissue regeneration.

Animals↗
PubMed2006

Development of a new micro-endoscope for odontological application.

PURPOSE: Development and introduction of a new micro-endoscope called Visio Scope for multidiscipline use in dentistry. METHODS: During the development of the new micro-endoscope called Visio Scope testings in the following dental disciplines were performed: endodontics, periodontology, implantology, periapical surgery, prosthodontics, and laser treatment. In this first report, flexible micro-endoscopes with an external diameter of 1.0 mm as well as of 0.34 mm were used. RESULTS: There is a significant improvement in all tested disciplines concerning handling and flexibility, verification of radiologically not detectable findings. In this context, the endoscope has proved itself clearly superior to conventional optical aids, above all the surgical microscope. The working canal facilitates specific application of medication and irrigation solutions. CONCLUSIONS: The Visio Scope allows visual control of the extent of the bone defect and enables optical control after removal of concrements and granulation tissue, before possible regenerative measures. Root fractures and furcation invasion can be reliably documented. Optical control guarantees preoperative and postoperative success of treatment.

Dental Equipment↗
PubMed1995

Clinical and historical predictors of dental caries on radiographs.

This report evaluates the efficacy of the clinical predictors of caries proposed in the USA FDA guidelines for prescribing dental radiographs. The clinical findings that best associate with the presence of any caries where a history of pain, a defective restoration, unusual calcification, and an abutment tooth for a fixed or removable prosthesis. There is a group of measures of periodontal disease that were also weakly associated with the presence of caries. The best predictors of caries extending into the dentin were the presence of clinically defective restorations, a history of pain, and signs of periodontal disease. Proximal lesions are likely to appear on teeth with defective restorations, unusual calcification or large or deep restorations. The best predictors of radiographic root caries are periodontal findings such as furcation involvement, increased mobility, a history of periodontal therapy and gingival recession. While the specificities for these findings were generally high, the sensitivities and positive predictive values were usually under 50%, and often much lower. Thus these clinical findings cannot successfully be used as exclusive criteria for ordering radiographs for caries detection. Because caries is found fairly frequently, and because we are unable to identify tooth-specific criteria with clinically useful sensitivity and specificity values, these data support the FDA panel recommendation of bitewing examinations for all new patients and at periodic intervals for recall patients.

Confidence Intervals↗
PubMed1995

Effect of dentin preparation and acid etching on the sealing ability of glass ionomer and composite resin when used to repair furcation perforations over plaster of Paris barriers.

Access openings and furcation perforations were prepared in 60 human extracted teeth and randomly divided into four equal groups. Plaster of Paris barriers were created in all perforations. The defects were obturated using either glass ionomer or composite resin with or without acid etching of the dentin. The pulp chambers and access openings were filled with composite resin. After immersion in 2% methylene blue solution for 2 weeks, the teeth were sectioned longitudinally and dye penetration was measured under a stereomicroscope using the NIH Image 1.47 Macintosh program. The results indicated that light-cured glass ionomer provided a significantly better seal than did the light-cured composite resin with or without dentin preparation and acid etching. The glass ionomer allowed significantly less dye penetration when used on etched dentin than it did on nonetched dentin.

Acid Etching, Dental↗
PubMed1982

Forced eruption: principles in periodontics and restorative dentistry.

Forced orthodontic eruption is based on an understanding of the normal dental unit. The relationships between tooth, attachment apparatus, gingival unit, and force and stress demand consideration when forced eruption is used to treat carious or traumatic destruction of clinical crowns, lateral root perforations, or isolated vertical periodontal defects. Factors that must be judged acceptable prior to the initiation of therapy are (1) esthetics, (2) clinical root length, (3) root proximity, (4) root morphology, (5) furcation location, (6) individual tooth position, (7) collective tooth position, and (8) the ability to restore teeth. A correct diagnosis is essential and must precede the choice of forced eruption as a clinical solution. Correctly chosen, force eruption allows the tooth to assist in the support of a multiunit restoration or maintain its individual integrity while contributing to esthetics, speech, and function.

Dental Caries↗