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PubMed2006

Root cementum modulates periodontal regeneration in Class III furcation defects treated by the guided tissue regeneration technique: a histometric study in dogs.

BACKGROUND: Because the possibility of root cementum preservation as an alternative approach for the treatment of periodontal disease has been demonstrated, this study aimed to histometrically evaluate the effect of root cementum on periodontal regeneration. METHODS: Bilateral Class III furcation defects were created in dogs, and each dog was randomly assigned to receive one of the following treatments: control (group A): scaling and root planing with the removal of root cementum; or test (group B): removal of soft microbial deposits by polishing the root surface with rubber cups and polishing paste, aiming at maximum cementum preservation. Guided tissue regeneration (GTR) was applied to both groups. RESULTS: Four months after treatment, a superior length of new cementum (3.59 +/- 1.67 mm versus 6.20 +/- 2.26 mm; P = 0.008) and new bone (1.86 +/- 1.76 mm versus 4.62 +/- 3.01 mm; P = 0.002) and less soft tissue along the root surface (2.77 +/- 0.79 mm versus 1.10 +/- 1.48 mm; P = 0.020) was observed for group B. Additionally, group B presented a larger area of new bone (P = 0.004) and a smaller area of soft tissue (P = 0.008). CONCLUSION: Within the limits of this study, root cementum may modulate the healing pattern obtained by guided tissue regeneration in Class III furcation defects.

Animals↗
PubMed2005

Repair of Class II furcation defects after a reparative tissue graft obtained from extraction sockets treated with growth factors: a histologic and histometric study in dogs.

BACKGROUND: Reparative tissue of extraction sockets was proposed as grafting material in the treatment of periodontal defects. Our hypothesis was that the addition of growth factors to extraction sockets improves the regenerative potential of this tissue when used as a graft. The objective of the present study was to analyze qualitatively and quantitatively the repair of acute Class II furcation defects after they receive this grafting material. METHODS: The second and third upper premolars were extracted from four dogs. Platelet-derived growth factor (PDGF)-BB and insulin-like growth factor (IGF)-I, at concentrations of 6 microg/ml each, were applied to the resulting sockets. After 5 days, 24 acute defects (12 control and 12 test defects) were created in the second, third, and fourth lower premolars. Only the test sites received the graft. The flaps were positioned coronally on both sides and sutured. After 45 days, the specimens were collected, decalcified, and processed histologically in a buccal-lingual plane. The parameters were measured horizontally in the buccal-lingual direction. RESULTS: Repair was histologically and histometrically similar in the two groups. No significant difference was observed between the test and control groups in the parameters connective tissue, new cementum, new bone, and junctional epithelium. CONCLUSION: The use of this graft did not show beneficial effects on the repair of acute Class II furcation defects in dogs.

Animals↗
PubMed1991

Doxycycline-tricalcium phosphate composite graft facilitates osseous healing in advanced periodontal furcation defects.

The purpose of this study was to compare the effectiveness of a tricalcium phosphate, plaster of paris, and doxycycline composite graft to surgical debridement alone in the treatment of Class II and Class III furcation defects. Fifteen patients with adult periodontitis and at least two mandibular molars with Class II or III furcation defects were selected. A total of 40 sites were treated: 26 were Class II defects and 14 were Class III. Following initial therapy one site was randomly selected to receive the composite graft while the remaining site served as the surgically debrided control. Osseous healing was evaluated by direct measurements from an acrylic stent at the time of graft surgery and at the 6-month reentry. Following surgery each patient was placed on doxycycline 100mg/day for 10 days. The absence of clinical inflammation and infection during the healing process provided additional substantiation of the biocompatibility of the grafting materials. Results after 6 months indicated that sites treated with the composite graft had improved defect fill, defect resolution, probing depths, and clinical attachment levels when compared to the surgically debrided controls. Defect fill was 3.7 times greater in grafted sites and these sites were 4.0 times more likely to have 50% or greater defect fill. The effect of grafting was more pronounced in Class III defects where horizontal defect fill and gain of clinical attachment was achieved only in grafted sites. The plaster of paris functioned well as a binder, preventing particle scatter and facilitating graft retention. Additionally the plaster served as a vehicle to carry and retain the doxycycline at the treated site. These short-term results point to the potential of a composite graft containing tricalcium phosphate, plaster of paris, and doxycycline in promoting healing of furcation lesions.

Adult↗
PubMed1993

Treatment of periodontal furcation defects. Coronally positioned flap with or without citric acid root conditioning in class II defects.

A total of 27 mandibular, buccal class II furcation defects were treated in 16 subjects using a coronally positioned flap procedure, with or without citric acid conditioning of the root surfaces. The effect of the therapies was evaluated from a series of soft and hard tissue measurements. Mean improvements were slightly greater for acid treated than for non-acid treated defects. However, none of the mean differences reached statistical significance, indicating that citric acid conditioning may not be a necessary part of the regenerative, coronally positioned flap procedure in mandibular furcations.

Acid Etching, Dental↗
PubMed1992

Effects of fibrin adhesive material (Tissucol) application on furcation defects in dogs.

A histological study was conducted to evaluate the effects of fibrin adhesive material (FAM) application on periodontal healing in seven experimental dogs. Bilateral class III furcation defects were surgically created at the second and third premolars, then orthodontic wires were placed around the teeth to induce periodontitis. Six weeks later, the wires were removed and the defects were treated by either surgery alone or surgery plus FAM application. A total of 21 specimens were obtained for histological and histometrical analysis on days 7, 21 and 42. The Mann-Whitney U test showed significantly more new attachment and bone regeneration in the FAM-treated group compared to the control (p less than 0.05). Surgery plus FAM application in the treatment of class III furcation defects seemed to be effective in promoting connective tissue attachment and bone regeneration.

Alveolar Process↗
PubMed1999

The response of human buccal maxillary furcation defects to combined regenerative techniques--two controlled clinical studies.

Treatment of maxillary furcation lesions presents important clinical challenges. The aim of this study was to evaluate the response of buccal class II furcation defects in systemically healthy, non-smoking, Adult Periodontitis patients undergoing supportive periodontal therapy and surgical periodontal regenerative techniques. The treatment protocol emphasised infection control, careful soft tissue management and wound stability. Two experiments were performed. In the first experiment, a coronally positioned flap (CPF) technique was compared with surgical debridement. In the second experiment, an experimental technique (ET) was also compared with surgical debridement. The ET was a combination of a composite graft consisting of microparticulate (40-70 microns) hydroxyapatite and tetracycline (3:1), a guided tissue regeneration barrier (GTR) and CPF. Sixty patients were divided into the four (n = 15) treatment groups. The clinical variables evaluated were plaque, bleeding-on-probing scores, gingival recession, probing pocket depth (PD), vertical (VAL) and horizontal attachment levels (HAL). Reevaluation was performed 12 months after the surgical procedures and revealed that the three techniques resulted in improvements in all the clinical variables evaluated. Post-operative measurements from controls, CPF and ET showed (respectively) 1.53 +/- 1.12 mm, 1.40 +/- 0.75 mm, 2.43 +/- 1.36 mm reduction in PD; 0.63 +/- 0.1 mm, 1.17 +/- 1.12 mm and 1.57 +/- 1.32 mm VAL gains and 1.03 +/- 0.30 mm, 1.40 +/- 0.96 mm and 2.13 +/- 1.52 mm HAL gains. Five out of fifteen furcations in the ET group were closed after treatment. It was concluded that satisfactory clinical results--measured by PD reduction, VAL and HAL gains--can be obtained in advanced defects formerly considered as being non-responsive to regenerative periodontal therapy. The proposed ET showed significantly better results, with more PD reduction, HAL and VAL gains and a higher frequency of furcation closure compared with the other techniques tested, and shows promise as a new regenerative treatment technique.

Adult↗
PubMed1988

Treatment of periodontal furcation defects. (II). Bone regeneration in mandibular class II defects.

A total of 30 mandibular, buccal class II furcation defects were treated in 22 subjects using a regenerative surgical therapy that included citric acid root conditioning and coronally positioned flaps secured by crown-attached sutures. In addition, grafts of freeze-dried, decalcified allogenic bone were placed in 16 of the 30 defects. The effect of the therapies was evaluated from a series of soft and hard tissue measurements. These measurements demonstrated notable improvement 12 months following therapy. On the average, 67% of the defect volume became filled with bone. 43% of treated defects were completely closed by bone fill. No difference was observed between defects treated with and without bone grafts.

Adult↗
PubMed2002

Treatment of furcation defects with an allograft-alloplast-tetracycline composite bone graft combined with GTR: human histologic evaluation of a case report.

The purpose of this study was to histologically evaluate furcation defects in humans treated with an allograft-alloplast-tetracycline composite graft combined with an absorbable membrane for guided tissue regeneration (GTR). Three teeth with Class II furcation involvement on the buccal aspects were included in this study. A notch was placed in calculus during the procedure to serve as a reference point for histologic evaluation. The defects were then treated with an allograft-alloplast-tetracycline composite graft combined with an absorbable membrane for GTR. At 6 months postoperative, the teeth were extracted with conservative block sections and processed for histologic evaluation. Regeneration (new bone, cementum, and connective tissue attachment) coronal to a notch could be seen in one of the three defects treated. In the other two defects, a new connective tissue attachment was demonstrated (new connective tissue attachment into new cementum) in the notch placed in calculus. In this study, regeneration of a furcation defect in a human was documented with histology.

Absorbable Implants↗
PubMed1995

Initial study of guided tissue regeneration in Class II furcation defects after use of a biodegradable barrier.

This study evaluated guided tissue regeneration in Class II furcation defects after use of a polylactic acid biodegradable barrier in nine patients with mandibular molar defects. Following an initial hygienic phase, surgical flaps were elevated, and the sites were scaled and root planed. Defect perimeter was measured, and a customized barrier (600 to 750 mm thick) that adhered directly to tooth and bone was applied. At baseline, sites were measured for probing depth (6.2 +/- 0.5 mm), gingival margin location (-0.6 +/- 0.6 mm), and attachment level both vertically (6.9 +/- 0.7 mm) and horizontally (5.3 +/- 0.5 mm). Clinically, barriers fragmented and became displaced in 3 to 6 weeks. Substantial granulation tissue was sometimes present between barrier and root surfaces. Six months postsurgery, gingival margin location was close to the presurgical level (-0.4 +/- 0.8 mm). There was clinically and statistically significant improvement in all other parameters: a mean reduction of 3.1 mm in probing depth, a gain of 3.3 mm in vertical attachment level, and a gain of 3.0 mm in horizontal attachment level. These results suggested favorable regenerative outcomes.

Adult↗
PubMed1997

Periodontal regeneration in naturally occurring Class II furcation defects in beagle dogs after guided tissue regeneration with bioabsorbable barriers.

THE EFFICACY OF A BIOABSORBABLE polylactic acid based barrier was evaluated using naturally occurring buccal Class II furcation defects in beagle dogs. Sixteen furcation sites (8 control and 8 experimental) were treated in 6 adult animals. After full thickness flap reflection, exposed furcations and root surfaces were thoroughly root planed. In experimental sites a customized barrier was formed and fitted to cover the defect. Surgical flaps were replaced slightly coronal to the cemento-enamel junction. Animals were sacrificed at 6 months and specimens processed for histologic evaluation. Histologic and histometric analyses were done using 6 micrograms step serial sections in the buccal-lingual plane, corresponding to the buccal-lingual extent of the furcation. Results were: mean total defect experimental sites 1.92 mm; control sites 1.47 mm. Mean new cementum formation experimental sites 1.36 mm (71% of initial defect); control sites 0.25 mm (17% of initial defect). Mean new bone formation experimental sites 1.42 mm (74% of initial defect); control sites 0.20 mm (14% of initial defect). Mean junctional epithelium formation experimental sites 0.42 mm (22% of initial defect); control sites 1.21 mm (82% of initial defect). Statistical analysis demonstrated significant differences in all healing parameters favoring experimental (barrier-treated) sites. In this model, regeneration (new bone, cementum, and periodontal ligament) of 71% of the original defect in experimental sites and only 14% in control sites demonstrated a response that highly favored use of the barrier.

Alveolar Bone Loss↗
PubMed1992

Use of a synthetic skin substitute as a physical barrier to enhance healing in human periodontal furcation defects.

A study was conducted to evaluate the potential of guided tissue regeneration in the treatment of human molar Class II furcation defects using BioBrane temporary wound dressing as a barrier membrane and to compare the results to those with open debridement. Eight patients, with a total of nine pairs of Class II buccal furcation molar defects, were studied. Prior to surgery, soft tissue measurements, attachment levels, and hard tissue measurements were recorded. These measurements were repeated 4 to 6 weeks after membrane removal. The study revealed no significant difference between results of treatment using the BioBrane membrane and those obtained using open debridement alone, except in the measurement of horizontal open probing attachment, in which BioBrane-treated sites had a significant gain of soft tissue.

Adult↗
PubMed2001

Clinical evaluation of anorganic bovine bone xenograft with a bioabsorbable collagen barrier in the treatment of molar furcation defects.

The purpose of this study was to compare Bio-Oss (BO), an anorganic bovine bone xenograft, in combination with Bio-Gide (BG), a bioabsorbable collagen barrier, to open-flap debridement (OFD) surgery in human mandibular Class II furcation defects. A total of 31 furcations (18 treatment, 13 control) in 21 patients were treated. There was a statistically significant improvement in most clinical indices for the BO/BG group, with minimal improvement noted for the OFD group. Vertical probing depth reduction of 2.0 mm and horizontal probing depth reduction of 2.2 mm were noted for the BO/BG group, with 0.3 mm and 0.2 mm reductions, respectively, noted for OFD. Hard tissue measurements showed 2.0 mm of vertical furcation bone fill for BO/BG and 0.5 mm for OFD. The BO/BG group had 3.0 mm of horizontal furcation bone fill, and the OFD group had 0.9 mm. The BO/BG group had a defect resolution of 82.7%; 42.5% was noted for the OFD group. There was a statistically significant difference between BO/BG and OFD in all soft and hard tissue measurements with the exception of attachment level, recession, and alveolar crest resorption.

Absorbable Implants↗
PubMed2004

Guided tissue regeneration in Class II furcation defects using a resorbable polylactic acid barrier.

PURPOSE: To evaluate, clinically, the use of guided tissue regeneration (GTR) with a resorbable polylactic acid membrane (Atrisorb) in the treatment of Class II furcation defects in humans. METHODS: The study included 10 patients with two comparable Class II furcations in lower molars. The lesions were randomly assigned to one of the treatments: GTR with an Atrisorb resorbable membrane (test) or open flap debridement (control). The following clinical parameters were recorded before the surgeries (baseline) and after a healing period of 6 months: relative vertical clinical attachment level, relative horizontal clinical attachment level, probing depths, position of the gingival margin and width of the keratinized tissue. RESULTS: After the intra-group comparison (baseline versus 6 months), statistically significant differences were found for the parameters: probing depth, relative vertical clinical attachment level and relative horizontal clinical attachment level, in both groups (P < 0.05). Comparing the two groups, a statistically significant difference was found in the probing depth reduction favoring the GTR group (P < 0.05). No significant differences were found in the other parameters.

Absorbable Implants↗
PubMed1999

A clinical comparison of the new attachment obtained by guided tissue regeneration and coronally positioned flap techniques in the management of human molar furcation defects.

The present clinical trial was designed to evaluate the regenerative potential of the periodontal tissue in Class II furcation defects in mandibular molars using reconstructive surgery based on the guided tissue regeneration (GTR) technique versus the coronally positioned flap (CPF) technique. After the completion of the initial phase of therapy and four to six weeks healing period, 20 furcation-involved molars were examined for baseline data which included plaque index, gingival condition, probing depth (PD), probing attachment level (PAL-V, PAL-H) and radiographs. All parameters were reexamined after three, six and twelve months of healing, except PD, PAL-V and PAL-H which were not measured at three and six months. A nonparametric analysis was used. The study showed that there were no significant differences in the mean baseline measurements between the treatment groups. After 12 months following surgical treatment, both GTR and CPF procedures showed gains in new clinical attachment levels. When comparing parameters between the two surgical procedures, GTR molars showed significantly more improvement in probing depth as well as vertical and horizontal attachment level of the interradicular osseous defect than did the CPF molars (p < 0.05). About 80 per cent of the sites treated with the GTR technique showed complete clinical resolution of the furcation problem. CPF therapy reached the same Treatment goal in about 50 per cent of the cases which were treated. Guided tissue regeneration appeared to be more effective in promoting regeneration than the coronally positioned flap.

Adult↗
PubMed2005

Treatment of mandibular class II furcation defects by the use of amelogenins and autologous bone. Two case reports.

The aim of this preliminary study was to evaluate the clinical effectiveness of the association of amelogenins and autologous bone graft in the management of mandibular class II furcation defects. This randomized case-controlled study was conducted on 2 patients who presented 2 contralateral mandibular buccal class II furcation lesions. One defect was treated by amelogenins and autologous bone graft (test site) and the other one by open flap debridement (control site). At baseline and at 12 months postoperatively, the full-mouth plaque score (FMPS) and the full-mouth bleeding score (FMBS), the probing depth (PD), the clinical attachment level (CAL) and the recession (REC) were recorded and a periapical radiograph of the selected area was taken. In addition, at 12 months a surgical re-entry was performed. Test sites had a greater horizontal PD reduction and radiographic bone filling compared to control sites. None of the treated sites achieved complete furcation closure. At the time of re-entry, furcations treated by amelogenins were partially filled by newly formed not soundable hard tissue, while furcations treated by conventional flap surgery were filled by epithelial and connective tissue. These findings suggest that the treatment of mandibular class II furcations by amelogenins and autologous bone graft may result in a significant clinical improvement. Further long-term studies conducted on a larger sample size are therefore needed to confirm our results.

Amelogenin↗
PubMed1997

The relationship between cervical enamel projection and class II furcation defects in humans.

The purposes of the present study were to examine the frequency of cervical enamel projection in mandibular molars with class II furcation defects and to examine the response of these teeth to guided tissue regeneration procedures. Probing depth and vertical and horizontal periodontal attachment levels were recorded with a constant-force electronic periodontal probe. Following surgical exposure of the bifurcation and prior to membrane placement, the cervical enamel projection was examined and then graded clinically; photographs were taken to allow further examination of the bifurcation. An overall improvement in clinical parameters was observed in most sites. Cervical enamel projection was present in 82.1% of all molars examined. Grade II was the most prevalent (34.8%). Patients with any degree of cervical enamel projection demonstrated significantly higher mean probing depths at baseline than did patients without cervical enamel projection. Likewise, pretreatment probing attachment levels were higher in patients with some degree of cervical enamel projection. However, greater posttreatment horizontal and vertical attachment gains were observed in sites with a baseline cervical enamel projection.

Analysis of Variance↗
PubMed1995

Modified coronally positioned flap for obtaining new attachment in Class 2 and 3 furcation defects. Part I: Rationale and surgical technique.

A new technique, the modified coronally positioned flap procedure, is described for treatment of Class 2 and Class 3 molar furcation defects in conjunction with barrier membranes. This technique is designed to minimize barrier exposure during the healing phase and to cover and protect the newly formed granulation tissue following barrier removal. Examples are presented and discussed, and modifications for varying situations are described. The modified coronally positioned flap technique is applicable for use with nonresorbable and resorbable membranes.

Furcation Defects↗