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PubMed2003

Periodontal regeneration in humans using recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and allogenic bone.

BACKGROUND: Purified recombinant human platelet-derived growth factor BB (rhPDGF-BB) is a potent wound healing growth factor and stimulator of the proliferation and recruitment of both periodontal ligament (PDL) and bone cells. The hypothesis tested in this study was that application of rhPDGF-BB incorporated in bone allograft would induce regeneration of a complete new attachment apparatus, including bone, periodontal ligament, and cementum in human interproximal intrabony defects and molar Class II furcation lesions. METHODS: Nine adult patients (15 sites) with advanced periodontitis exhibiting at least one tooth requiring extraction due to an extensive interproximal intrabony and/or molar Class II furcation defect were entered into the study. Eleven defects were randomly selected to receive rhPDGF-BB. Following full-thickness flap reflection and initial debridement, the tooth roots were notched at the apical extent of the calculus, the osseous defects were thoroughly debrided, and the tooth root(s) were planed/prepared. The osseous defects were then filled with demineralized freeze-dried bone allograft (DFDBA) saturated with one of three concentrations of rhPDGF-BB (0.5 mg/ml, 1.0 mg/ml, or 5.0 mg/ml). Concurrently, four interproximal defects were treated with a well accepted commercially available graft (anorganic bovine bone in collagen, ABB-C) and a bilayer collagen membrane. Radiographs, clinical probing depths, and attachment levels were obtained preoperatively (at baseline) and 9 months later. At 9 months postoperatively, the study tooth and surrounding tissues were removed en bloc. Clinical and radiographic data were analyzed for change from baseline by defect type and PDGF concentration. The histologic specimens were analyzed for the presence of regeneration of a complete new attachment apparatus coronal to the reference notch. RESULTS: The post-surgical wound rapidly healed and was characterized by firm, pink gingivae within 7 to 10 days of surgery. There were no unfavorable tissue reactions or other safety concerns associated with the treatments throughout the course of the study. In rhPDGF/allograft sites, the vertical probing depth (vPD) reduction for interproximal defects was 6.42 +/- 1.69 mm (mean +/- SD) and clinical attachment level (CAL) gain was 6.17 +/- 1.94 mm (both P < 0.01). Radiographic fill was 2.14 +/- 0.85 mm. Sites filled with ABB-C had a PD reduction and CAL gain of 5.75 +/- 0.5 and 5.25 +/- 1.71, respectively. Furcation defects treated with rhPDGF/allograft exhibited a mean horizontal and vertical PD reduction of 3.40 +/- 0.55 mm (P < 0.001) and 4.00 +/- 1.58 mm (P < 0.005), respectively. The CAL gain for furcation defects was 3.2 +/- 2.17 mm (P < 0.030). Histologic evaluation revealed regeneration of a complete periodontal attachment apparatus, including new cementum, PDL, and bone coronal to the root notch in four of the six interproximal defects and all evaluable (four of four) furcation defects treated with PDGF. Two of the four interproximal intrabony defects treated with ABB-C and membrane exhibited regeneration. CONCLUSIONS: Use of purified rhPDGF-BB mixed with bone allograft results in robust periodontal regeneration in both Class II furcations and interproximal intrabony defects. This is the first report of periodontal regeneration demonstrated histologically in human Class II furcation defects.

Adult↗
PubMed2000

The influence of sulfate-reducing bacteria colonization of 2 different bioresorbable barrier membranes for GTR. An 18-month case-controlled microbiologic and clinical study.

The purpose of the present microbiologic and case-controlled clinical study was to examine the colonization of 2 different resorbable barrier membranes by sulfate-reducing bacteria (SRB). The barrier membranes tested were Guidor matrix barrier and Resolut regenerative material. Ten patients exhibiting 3 Class II furcation defects and 7 intrabony defects were included in the study. The probing depth and the clinical attachment level at 4 surfaces per tooth were taken at the beginning of the study. Microbiologic samples were taken from the experimental sites and from the approximal sites of the adjacent teeth. Both types of resorbable membranes were positive for SRB colonization. The detection of SRB in 2 of 7 intrabony defects and in all defects with furcation involvement before the membrane placement indicated that these organisms are a common inhabitant of sites showing periodontal destruction and are associated with guided tissue regeneration (GTR). According to the clinical criteria for healing tendencies used in this study, the GTR procedures were less successful in the presence of SRB. There were no significant clinical effects of different resorbable membrane materials or membrane layout on attachment level changes for either the intrabony defect or furcation groups after 18 months. There were no statistical differences for sites that became exposed to SRB when compared to sites that remained unexposed after 18 months. The numeric significance of SRB in relation to the total microbial count needs to be determined to gain insight into the ecologic role of membrane resorption rates.

Absorbable Implants↗
PubMed2003

Growth and amelogenin-like factors in periodontal wound healing. A systematic review.

BACKGROUND: Regeneration of tooth-supporting structures destroyed by periodontitis is a major goal of periodontal therapy. Periodontal tissue engineering utilizing growth and amelogenin-like factors (GAFs) applies advances in materials science and biology to regenerate alveolar bone, periodontal ligament, and cementum. Amelogenin-like factors (e.g., enamel matrix derivative [EMD]) and growth factors (e.g., platelet-derived growth factor [PDGF] and bone morphogenetic proteins [BMPs, also considered morphogens]) have demonstrated pleotrophic effects on the stimulation of several key events required for tissue regeneration including DNA synthesis, chemotaxis, differentiation, and matrix synthesis. RATIONALE: GAFs have been used for the treatment of periodontal disease as shown in preclinical and clinical studies. This systematic review evaluates the evidence to support the utilization of EMD and growth factors (GFs) for periodontal repair and regeneration associated with natural teeth. FOCUSED QUESTION: In patients with periodontal osseous defects, what is the effect of GAFs compared with controls on clinical, radiographic, histologic, adverse, and patient-centered outcomes? SEARCH PROTOCOL: Two investigators searched MEDLINE, pre-MEDLINE, and the Cochrane Oral Health Group trials register for clinical and preclinical studies published in English. Hand searches were performed on the International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Dental Research, Journal of Periodontology, and Journal of Periodontal Research. Searches were performed for articles published through April 2002. In addition, investigators contacted manufacturers of GAF products for related unpublished data and studies in progress. SELECTION CRITERIA INCLUSION CRITERIA: Randomized controlled clinical trials (RCTs), cohort studies, case-control studies, case reports, and preclinical (animal) randomized controlled investigations that included a cohort population diagnosed with periodontal disease and presenting data on intrabony/interproximal defects and/or furcation defects were screened. EXCLUSION CRITERIA: In vitro studies or those that did not include quantifiable data with respect to clinical or bone measures were not included. DATA COLLECTION AND ANALYSIS: Meta-analyses were performed for studies that fulfilled the eligibility criteria for the following continuous variables: clinical attachment level (CAL), probing depth (PD), or bone level (radiographic, re-entry, or histologic). Heterogeneity was assessed to determine whether the differences among therapies were due to systematic confounding factors (as noted in study quality assessments). MAIN RESULTS: 1. Eight studies, representing 7 RCTs and 1 quasi-experimental study, representing a total population of 511 subjects were analyzed with respect to EMD. 2. The majority of the remaining papers had a low evidence rating. 3. Most reports were case studies or case series without controls. 4. There were insufficient data to conduct a meta-analysis on the effect of growth factors used in periodontal repair around teeth. REVIEWERS' CONCLUSIONS: 1. There is evidence supporting the use of EMD for periodontal osseous defects to improve CAL and reduce PD, although long-term benefits have not been established. 2. EMD has demonstrated notable consistency among the studies investigated in terms of superiority to controls (in general compared to open flap debridement [OFD]). 3. EMD appears to be safe for single and multiple administrations in terms of lack of elicitation of antibody responses or other local/systemic inflammatory events. 4. Preclinical and initial clinical data for growth factors appear promising but are insufficient to draw definitive conclusions at this time.

Alveolar Bone Loss↗
PubMed1998

Distribution of periodontal disease in a Swedish adult population 1973, 1983 and 1993.

The aim of this study was to compare changes in periodontal status in a Swedish population over a period of 20 years. Cross-sectional studies were carried out in Jönköping County in 1973, 1983, and 1993. Individuals were randomly selected from the following age groups: 20, 30, 40, 50, 60, and 70 years. A total of 600 individuals were examined in 1973, 597 in 1983, and 584 in 1993. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. Based on clinical data and full mouth intra-oral radiographs, all individuals were classified into 5 groups according to the severity of the periodontal disease experience. Individuals were classified as having a healthy periodontium (group 1), gingivitis without signs of alveolar bone loss (group 2), moderate alveolar bone loss not exceeding 1/3 of the normal alveolar bone height (group 3), severe alveolar bone loss ranging between 1/3 and 2/3 of the normal alveolar bone height (group 4), or alveolar bone loss exceeding 2/3 of the normal bone height and angular bony defects and/or furcation defects (group 5). During these 20 years, the number of individuals in groups 1 and 2 increased from 49% in 1973 to 60% in 1993. In addition, there was a decrease in the number of individuals in group 3, the group with moderate periodontal bone loss. Groups 4 and 5 comprised 13% of the population and showed no change in general between 1983 and 1993. The individuals comprising these groups in 1993, however, had more teeth than those who comprised these groups in 1983; on the average, the individuals in disease group 4 had 4 more teeth and those in disease group 5, 2 more teeth per subject. In 1973, these 2 groups were considerably smaller, probably because of wider indications for tooth extractions and fewer possibilities for periodontal care which meant that many of these individuals had become edentulous and were not placed in a group. Individuals in groups 3, 4, and 5 were subdivided according to the number of surfaces (%) with gingivitis and periodontal pockets (> or =4 mm). In 1993, 20%, 42%. and 67% of the individuals in groups 3, 4, and 5 respectively were classified as diseased and in need of periodontal therapy with >20% bleeding sites and >10% sites with periodontal pockets > or =4 mm. In conclusion, an increase in the number of individuals with no marginal bone loss and a decrease in the number of individuals with moderate alveolar bone loss can be seen. The prevalence of individuals in the severe periodontal disease groups (4, 5) was unchanged during the last 10 years; however, the number of teeth per subject increased.

Adult↗
PubMed2002

Evidence for healing of periodontal defects 5 years after conventional and regenerative therapy: digital subtraction and bone level measurements.

OBJECTIVE: The aim of the present study was to compare radiographic assessment of bony fill by digital subtraction analyses (DSA) after periodontal surgery of infrabony and furcation defects with bone level measurements. METHODS: For 19 patients with 19 infrabony lesions and 20 degree II furcation defects, five defects were treated conventionally and 34 defects were treated by regenerative periodontal surgery. At baseline and 60 +/- 3 months after surgery, clinical measurements (GI, PPD, PAL-V, PAL-H, PlI) and standardized radiographs were obtained. Furthermore, intrasurgically after reflection of a mucoperiosteal flap and 60 months after surgery after local anesthesia without flap reflection, the distance from the cementoenamel junction (CEJ) to bottom of the bony defect (BD) was measured vertically (PBL-V) and, in furcation defects, horizontally (PBL-H). Pre- and postsurgical radiographs were analyzed by digital subtraction. Bone level gain and DSA results were compared by simple regression analysis. RESULTS: Surgical treatment revealed significant PPD reduction (- 3.45 +/- 1.56 mm; P < 0.001), PAL-V gain (2.84 +/- 1.36 mm; P < 0.001), and PBL-V gain (1.68 +/- 1.20 mm; P < 0.001) in infrabony defects, as well as PPD reduction (- 1.68 +/- 1.73 mm; P = 0.001) and PAL-H gain [1.43 +/- 1.70 mm (P = 0.001)] in furcation defects after 5 years. A correlation could be found in furcation defects between PBL-H gain and DSA (R2 = 0.34, P = 0.003), whereas the study failed to demonstrate a consistent correlation between PBL-V and DSA in infrabony defects (R2 = 0.12, P = 0.149). CONCLUSIONS: DSA correlates significantly with PBL-H measurements in furcation defects. Thus, either method is a sufficient tool to evaluate bony fill within furcation defects. On the other hand, DSA did not correlate significantly with PBL-V measurements in infrabony defects. This discrepant contribution of DSA in the evaluation of these two types of defects may be explained by the fact that DSA primarily evaluates change in a buccolingual direction.

Adult↗
PubMed1996

Quantitative digital subtraction radiography for assessment of bone density changes following periodontal guided tissue regeneration.

OBJECTIVES: The quantitative assessment of alveolar bone density changes in periodontal defects following guided tissue regeneration (GTR). METHODS: Twelve patients with 30 intrabony lesions and 16 furcation defects took part. Standardized radiographic and clinical examinations were carried out immediately before and then 5 and 13 months after surgery. Intra-oral radiographs were evaluated by means of digital subtraction radiography (DSR). Within the subtraction images, a window ('experimental region') was defined covering the visible density changes in the defect area. Background noise was measured by using a similarly sized window ('control region') located in an area not affected by GTR. Bone density changes were quantitatively evaluated by calculation of the mean, standard deviation and maximum and minimum values of the grey-level histogram within these windows. RESULTS: DSR revealed significant bone density gain after GTR in intrabony and furcation defects. While a continuous increase was observed over the 13 month period in intrabony defects, changes in furcation defects occurred mostly in the 5-13 month period. Clinically, a distinct vertical and horizontal attachment gain was found. The correlation coefficients between changes in radiographic density and clinical parameters were low, indicating a difference in the information obtained by the two diagnostic methods. CONCLUSION: Quantitative DSR is a valuable, non-invasive, objective method to obtain information on density changes in intrabony and furcation defects treated by GTR. However, a full assessment of soft and hard tissue changes requires both clinical evaluation and DSR.

Alveolar Bone Loss↗
PubMed2003

Periodontal regeneration in human Class II furcations using purified recombinant human platelet-derived growth factor-BB (rhPDGF-BB) with bone allograft.

This human clinical trial evaluated the clinical and histologic response to recombinant human platelet-derived growth factor-BB (rhPDGF-BB) delivered in bone allograft for the treatment of advanced Class II furcation defects. Three mandibular and one maxillary molar furcation defects were treated: Two received 0.5 mg/mL and two received 1.0 mg/mL rhPDGF-BB, in all cases mixed with DFDBA. Clinical probing depths and attachment levels were obtained presurgically and 9 months postsurgical, after which the teeth and surrounding tissues were removed en bloc. Both concentrations of rhPDGF-BB resulted in substantially improved horizontal (mean 3.5 mm) and vertical (mean 4.25 mm) probing depths and attachment levels (mean 3.75 mm). Histologic evaluation revealed periodontal regeneration, including new bone, cementum, and periodontal ligament coronal to the reference notch. Regeneration was also present coronal to the original osseous crest In one case where an enamel projection extended into the fornix of the furcation, new calcified tissue with new inserting connective tissue fibers was observed over the enamel. This study documented the favorable tissue response to rhPDGF-BB treatment at both the clinical and microscopic levels, provided the first human histologic evidence that new calcified tissue with inserting collagen fibers can occur over enamel projections within furcations, and demonstrated for the first time that complete periodontal regeneration can be achieved in advanced Class II furcation defects using a combination of purified recombinant growth factor and bone allograft.

Adult↗
PubMed1995

A clinical evaluation of guided tissue regeneration in the treatment of class II and class III furcation bony defects.

This investigation was designed to compare the clinical efficacy of open flap/expanded polytetrafluoroethylene (e-PTFE) membrane combination therapy to open flap therapy alone in the treatment of class II and class III furcation bony defects. The efficacy was evaluated by statistical analysis of the change in values for probing pocket depth, gingival recession, and relative (probing) attachment level. The statistical analysis indicated that the guided tissue regeneration (GTR)-applied group had better efficacy than the non-applied group in the treatment of furcation bony defects. Moreover, the GTR-applied maxillary group had better efficacy than the GTR-applied mandibular group, and the GTR-applied class III group was better than the GTR-applied class II group. These results were diametrically opposed to the results from the non-applied class II group. These results were diametrically opposed to the results from the non-applied group. By histological examination, new attachment of newly formed cementum with inserting of oriented collagen fibers was noted. We also found new bone formation and partial bone repair in the former furcation bony defect.

Adult↗
PubMed1998

[An aid to decision making in the treatment of furcation diseases. Part 2: New classifications and reasoning methods].

Periodontal diseases combined with furcation defects are more difficult to treat; it's evidence. Furcation defects occur still very frequently. GTR treatments have shown some efficacy in those lesions, but, the success of those treatments is still uncertain and, therefore, indications are limited. Root amputations are, at this time, frequently chosen to treat furcation defects. The goal of this work was to evaluate the success rate of root amputations, to discuss the origin of the failures and to propose a new design for a better decision making.

Alveolar Bone Loss↗
PubMed1998

[An aid to decision making in the treatment of furcation diseases. Part 1: Results of surgical treatment of furcation diseases].

Periodontal diseases combined with furcation defects are more difficult to treat; it's evidence. Furcation defects occur still very frequently. GTR treatments have shown some efficacy in those lesions, but, the success of those treatments is still uncertain and, therefore, indications are limited. Root amputations are, at this time, frequently chosen to treat furcation defects. The goal of this work was to evaluate the success rate of root amputations, to discuss the origin of the failures and to propose a new design for a better decision making.

Decision Making↗
PubMed2002

Connective tissue and bacterial deposits on rubber dam sheet and ePTFE barrier membranes in guided periodontal tissue regeneration.

The aim of this study was to compare the connective tissue and bacterial deposits on rubber dam sheets and expanded polytetrafluoroethylene membranes used as barrier membranes in guided tissue regeneration for periodontal treatment. Twenty patients having intrabony defects and/or furcation defects were surgically treated by guided tissue regeneration employing either rubber dam sheets (10 patients) or expanded polytetrafluoroethylene membranes (10 patients) as barrier membranes. Four to six weeks after the first operation, membranes were retrieved from the lesion sites and processed for scanning electron microscopy. The lesion-facing surfaces of membranes were examined for the presence of connective tissue and bacterial deposits. The differences between the numbers of fields and the distributions of connective tissue and bacteria on both types of membranes were analysed by the Chi-square test at the level of 0.05 significance. The results showed a lot of fibroblasts with their secreted extracellular matrices, known as components of the connective tissue on rubber dam sheets and expanded polytetrafluoroethylene membranes. There was no significant difference in the total number of connective tissue on both types of membranes (P = 0.456). Many bacterial forms including cocci, bacilli, filaments and spirochetes with the interbacterial matrices were identified. The total number of bacteria on rubber dam sheets was statistically less than that on expanded polytetrafluoroethylene membranes (P < 0.001). The comparable number of connective tissue on both types of membranes suggests that the healing process under both types of membranes was also comparable. Therefore, the rubber dam sheet might be used as a barrier membrane in guided tissue regeneration.

Alveolar Bone Loss↗
PubMed2002

Interradicular root proximity/fusion: a possible determining factor in regenerating molar furcations.

Both conventional and regenerative approaches have their limitations in correcting furcation defects. Cases of furcation that involve particular anatomical configurations, i.e., interradicular root proximity/fusion, have long been considered relative contraindications for treatments such as root amputation or hemisection. However, there has been little discussion of the role of interradicular root proximity in regenerative procedures. The purpose of this article was to report the clinical significance of the interradicular root relationship in regenerating intrabony defects associated with furcations.

Furcation Defects↗
PubMed1998

A comparison of stereological and computer-assisted histomorphometric analysis as tools for histological quantification in regenerative studies.

This study was designed to compare computer-assisted histomorphometric analysis (CAHA) and stereology (STER) as measurement tools for evaluating the repair response during periodontal wound healing. Thirty-six histological sections derived from 4 surgically created defects in the furcation of mandibular second premolars of sheep were measured by each technique to determine the furcation area and volume, and the percentage of new bone formation at 7 wk postoperatively. Slides were viewed in random order with the source unknown to the examiner (JL). One section from each of the 4 specimens was flagged for triplicate measurement by each technique. Intraexaminer error was determined to be low as the coefficient of variation in each of the 2 techniques was between 1% and 4%. A consistently higher percentage of bone was identified using stereology. The coefficient of agreement was plotted to determine how closely these 2 techniques were matched in their respective estimations of bone fill in a furcation defect. This analysis revealed statistical bias between the 2-techniques and a low degree of agreement between them. This study demonstrates that the 2 techniques are not interchangeable. It also emphasizes that the reader must be cautious when comparing results from studies in which different systems of measurement and analysis have been used. Stereology was determined to be the measurement tool of choice due to its high degree of reproducibility, ease of use and efficient use of time.

Animals↗
PubMed1994

Clinical, microbiological, and histological factors which influence the success of regenerative periodontal therapy.

The primary objectives of this double-blind, controlled clinical trial were to assess factor(s) which affect the success of guided tissue regeneration (GTR) procedures in mandibular Class II buccal furcation defects. Thirty subjects, with mandibular Class II furcation defects, were randomly assigned to one of two treatment groups; patients in Group A received oral hygiene instructions with scaling and root planing, while subjects in Group B received similar treatment but without subgingival scaling and root planing at the affected site. After initial oral hygiene instructions and scaling and root planing, GTR surgery was performed using ePTFE barrier membranes. Membranes were retrieved at 6 weeks and subjected to histological examination. Twelve months after regenerative therapy, clinical measurements and re-entry surgical measurements were repeated. Probing reduction (2.61 mm), horizontal probing attachment gain (2.59 mm), and vertical probing attachment gain (0.95 mm) were all significantly better compared to baseline. Likewise, significant improvements in furcation volume (8.0 microliters) and in bone measurements were observed at re-entry. There was no discernible difference between subjects for whom complete anti-infective therapy was deferred to the time of the surgery (Group B) compared to subjects in whom complete anti-infective therapy was performed as part of the hygienic phase of therapy (Group A). Pre-operative pocket depth was directly correlated with the magnitude of attachment gain as well as the amount of new bone formation in the furcation area. Subjects who maintained good oral hygiene and who had minimal gingival inflammation throughout the study demonstrated consistently better regenerative response.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Periodontal tissue regeneration in beagle dogs after laser therapy.

BACKGROUND AND OBJECTIVE: Class III periodontal furcations still represent a challenge for the periodontist. Aim of this study was to test the effect of CO2 laser on the treatment of class III furcation defects. STUDY DESIGN/MATERIALS AND METHOD: Class III furcation defects 3 mm deep were surgically induced on mandibular premolars on six male Beagle dogs, for a total of 36 defects. After 6-8 weeks of plaque accumulation, the mean depth was 6.8 mm. Quadrants were randomly assigned to a) CO2 laser therapy (laser), b) Guided Tissue Regeneration (GTR) procedure using Gore-Tex Membranes, (Gore Tex, Flagstaff, Arizona, USA) and c) Scaling and Root planing (Sc/Rp). CO2 laser beam (El.En, Florence, Italy) was applied to the root surfaces in defocused pulsed mode at 2W, 1 Hz and a duty cycle of 6%, and on periodontal soft tissues at 13W, 40 Hz, and a duty cycle of 40%. Control quadrants received either GTR procedure or Sc/Rp. Mechanical oral hygiene was provided. At 6 months the animals were sacrificed. RESULTS: The laser group showed new attachment formation averaging 1.9 mm (sd +/- 0.5), whereas GTR and Sc/Rp showed 0.2 mm (sd +/- 0.4) and 0.2 mm (sd +/- 0.5) respectively, being the differences statistically significant between the laser group and both GTR and Sc/Rp groups (p < 0.005). CONCLUSION: CO2 laser treatment of class III furcation induced formation of new periodontal ligament, cementum and bone.

Alveolar Bone Loss↗
PubMed2002

Furcation therapy with bioabsorbable collagen membrane: a clinical trial.

This study compared the effectiveness of 2 barrier membranes, expanded polytetrafluoroethylene (e-PTFE) and collagen, in treating Class II furcation defects of mandibular molars in humans. Seventeen nonsmoking subjects with no history of systemic disease each presenting with Class II furcation defects in 2 mandibular molars were selected and underwent initial therapy. At the time of the surgery and at 8-month follow-up, soft-tissue measurements consisting of the gingival index, vertical and horizontal probing depth, recession and clinical attachment level were obtained at the midfurcation level. At the time of membrane placement and at 12-month re-entry, horizontal midfurcation probing depth and hard-tissue measurement of vertical fill (from the crown to the depth of the pocket) were also obtained. According to the surgical protocol, both membranes were completely covered with a coronally positioned flap, and in all cases healing was uneventful. Data were analyzed first by comparing baseline measurements (at surgery) with measurements at 8-month follow-up and 12-month re-entry for both e-PTFE and collagen membranes according to repeated-measures analysis of variance. The changes from surgery to follow-up and re-entry were then compared between the 2 treatment modalities with paired Wilcoxon rank-sum tests. No statistically significant differences were found between e-PTFE and collagen membranes with respect to gingival index, reduction in probing depth, gain in clinical attachment or filling of the horizontal defect. However, the improvement in vertical fill at 12-month re-entry was more substantial for the teeth treated with collagen membrane than those treated with e-PTFE (p < 0.05). Within the limits of this study, it appears that collagen is a beneficial material for regenerative therapy of Class II furcation defects in humans, yielding results that are similar to or better than (vertical fill) those for e-PTFE membrane.

Absorbable Implants↗
PubMed1993

Healing patterns associated with an Atrisorb barrier in guided tissue regeneration.

The current guided tissue regeneration clinical technique uses synthetic membranes at the time of the surgical procedure to separate the gingival and periodontal tissue components. These membranes are tied to the tooth surface and have to be ++removed during a second surgical procedure. The material Atrisorb is currently under development as a guided tissue regeneration barrier in Class II furcation defects. This material is applied directly over the furcation defect and is not tied to the tooth surface. Because of its biodegradability, Atrisorb does not have to be removed. A case study is presented.

Aged↗
PubMed1995

Guided tissue regeneration in the treatment of degree II furcations in maxillary molars.

he present clinical trial was designed to evaluate the clinical effect of GTR in the treatment of degree II furcation defects in maxillary molars. 28 patients, 21 to 59 years of age, referred for treatment of advanced periodontal disease were included. They presented with similar periodontal lesions in the right and the left maxillary molar regions, but had only one surface which exhibited furcation involvement. A total of 28 pairs of contralateral furcation defects of degree II including 18 interproximal pairs (10 mesial, 8 distal) and 10 buccal pairs, were available for the study. After the completion of basic therapy, the furcation involved molars in the right and left quadrants in each patient were randomly assigned to either a test or a control treatment procedure. Following flap elevation, scaling, root planing and granulation tissue removal, an e-PTFE membrane at the test site was adjusted to cover the entrance to the furcation defect and adjacent bone and was retained in this position with sling sutures. The mucoperiostal flaps were subsequently adjusted and positioned to cover the entire surface of the membrane and were secured in this position. An identical surgical procedure was performed in the control tooth regions with the exception of the placement of a teflon membrane. No periodontal dressing was used. Starting the day before surgery and continuing for 7 days, the patients received 1 + 1 g of Amoxicillin per day; morning and evening. The sutures were removed after 10 days. At the test sites, the membranes were removed after 6 weeks of healing. The treated sites were examined and re-entry procedures performed 6 months after reconstructive surgery. Open flap debridement at maxillary furcations of degree II resulted in some gingival recession and probing depth reduction, but no change occurred in parameters describing probing attachment or bone levels. The addition of GTR at buccal furcations enhanced the treatment result by promoting probing attachment and bone gain and reduced the amount of soft tissue recession above what was accomplished by flap debridement alone. No such benefit of membrane therapy was observed at mesial and distal furcations.

Adult↗