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Results for “Furcation Defects”

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PubMed1991

[Preliminary results in periodontal treatment with guided tissue regeneration].

The objective of the present clinical study was to evaluate the predictability of a treatment procedure (GTR) aimed at regenerating periodontal tissue. 34 patients and 103 teeth were selected for the investigation. All teeth included in the study exhibited advanced loss of periodontal attachment. The periodontal defects were associated with even and/or angular bone defects or, in the case of multirooted teeth, advanced loss of periodontal tissue support in the furcation area. The probing bone level (PBL) and the probing tissue level (PTL) of the diseased sites were recorded using a standardized procedure. Treatment included placement of a barrier membrane (e-PTFE, Gore-Tex) according to the GTR method. After a healing period of 4-6 weeks the membrane was removed in a second surgical procedure. The result of healing was evaluated immediately after membrane removal. A further measurement was carried out during a re-entry operation 9 months later. The measurements of the treated sites revealed that GTR therapy had resulted in a marked tissue gain of more than 60% (p less than 0.001). In 33 of a total of 34 furcation-involved molars treatment had resulted in complete closure of the furcation defect. In the light of the findings of the present clinical trial it may be suggested that GTR therapy is an effective and predictable means of improving prognosis for both single- and multirooted teeth. A definite evaluation, of course, will be possible with the results of the re-entry procedure.

Adult↗

PubMed1998

Regeneration of periodontal ligament and cementum by BMP-applied tissue engineering.

Previously, we demonstrated that the inductive properties of bone morphogenetic protein (BMP) highly depend on the nature of the carrier material used for implantation. In this paper, we show that administration of BMP incorporated in a fibrous collagen membrane can help to regenerate periodontal ligament and cementum both in cat canines and in monkey molars. The partially purified bovine BMP was combined with one or two layers of a fibrous collagen membrane. Although the single layer approach showed partial regeneration of periodontal defects, it also quite often led to ankylosis. The double layer technique in artificially prepared class III furcation defects in monkey molars gave favorable results. After 12 wk, not only the alveolar process but also the periodontal ligament and cementum had regenerated along the entire treated dentin surface. Collagen fibers were arranged more or less perpendicular to the surface of the new cementum. Ankylosis was not seen. It is concluded that the double-layer approach is superior to the single-layer technique in regenerating cementum.

Animals↗

PubMed1978

Clinical evaluation of freeze-dried bone allografts in periodontal osseous defects--part II.

Freeze-dried crushed cortical bone allografts were implanted into widemouthed three-wall, two-wall, one-wall, combination, and furcation defects. One hundred eighty-nine sites were reentered in 97 patients and of these 60% had osseous regeneration of greater than 50%. A total of 231 sites were evaluated for pocket elimination, of which 63% demonstrated greater than 50% pocket reduction. This study presented additional evidence indicating that freeze-dried bone allografts have definite potential as grafting material in certain periodontal osseous defects. Information from additional cases is being tabulated as it becomes available and will supplement the current data.

Adult↗

PubMed1984

Alloplastic implants of tricalcium phosphate ceramic in human periodontal osseous defects.

Initial pilot studies using tricalcium phosphate ceramic placed into human periodontal osseous defects demonstrated osseous repair. Therefore, further evaluation of this material was undertaken on 17 carefully selected patients with 1-wall, 2-wall, crestal and furcation defects using standardized preoperative and postoperative radiographs, clinical measurements and clinical photographs. Inverse bevel, full-thickness flaps were raised, the areas debrided, root surfaces planed with ultrasonic and hand instrumentation, osseous penetrations made with curet point and the flaps sutured after the defects were filled. Eighteen-month reentry surgical procedures were performed on 10 of the 17 patients, with a resultant average of 2.8 mm of new bone. Controls were not used in this study since a protocol describing a sham procedure with other than 3-wall osseous defects was not acceptable in 1973 to the Clinical Human Use Committee. Although the tricalcium phosphate ceramic material was not found to be totally predictable in this study, it may nevertheless become a useful graft material because of its potential for osseous repair in combination with its availability, host acceptability, ease of manipulation and storage advantages.

Alveoloplasty↗

PubMed1992

Clinical human comparison of expanded polytetrafluoroethylene barrier membrane and freeze-dried dura mater allografts for guided tissue regeneration of lost periodontal support. I. Mandibular molar Class II furcations.

The response of mandibular Class II facial furcations to guided tissue regeneration treatment with expanded polytetrafluoroethylene barrier membrane (e-PTFE) or freeze-dried dura mater allograft (FDDMA) barriers was evaluated in 11 pairs of molars in 11 patients. Following initial preparation, full thickness flaps were raised in the area being treated, the bone and furcation defects debrided of granulomatous tissue, and the involved root surfaces mechanically and chemically prepared. By random allocation, e-PTFE or FDDMA barriers were fitted over the furcations, secured in place, and the host flap repositioned or coronally positioned. Postsurgical deplaquing was performed every 10 days leading up to e-PTFE removal at about 6 weeks (the resorbable FDDMA did not require removal). Continuing supportive periodontal therapy was provided until surgical re-entry at one year for documentation and any further necessary treatment. Direct clinical measurements demonstrated essentially similar clinical results with both barrier materials for bone and soft tissue changes (few statistically or clinically significant differences). Exceptions were the amount of horizontal furcation fill and the change in the width of the keratinized gingiva, both of which were better with FDDMA (P less than 0.05). Improvements in open probing attachment levels observed at the time of e-PTFE removal were lost over the intervening months, more so for the vertical than the horizontal component of the furcation lesion. Intrapatient comparisons suggested better horizontal furcation responses with FDDMA. The findings of this study suggest equal clinical results with e-PTFE and FDDMA barriers utilizing the GTR technique. These results in Class II mandibular furcations are less favorable than those reported by others. Barrier techniques to handicap the race between different tissues of the periodontal complex appear to be of some clinical benefit and deserve further evaluation.

Adult↗

PubMed1993

Histologic and histometric responses to polymeric composite grafts.

The present study was designed to determine whether a polymeric composite promotes new attachment in artificially-induced bony defects in the dog model. HTR, hard tissue replacement, is a non-resorbable calcium-layered polymer of polymethyl-methacrylate and hydroxyethyl-methacrylate. It has been reported to be clinically non-inflammatory, osteophilic, and osteoconductive. For the study, 4 beagle dogs, 4 to 6 years old with no periodontal disease were used. Mucoperiosteal flaps were raised including the 2nd, 3rd, and 4th maxillary premolars. Buccal Class II furcation defects were created on these premolars. Reference notches were placed in the roots at the level of the bony defects. Test quadrants were selected by the toss of a coin, and furcations were filled with the polymeric composite particles wetted with sterile saline. Following grafting, the flaps were approximated and sutured. The contralateral side, serving as control, was treated by flap debridement only. Sutures were removed 7 days after surgery. Dogs were sacrificed 4 months following surgery. Mesio-distal histological sections were evaluated by descriptive histology. In addition, surface area determinations (in mm2) of the furcal tissues were carried out using the microscope attached to a digitizer and a computer. In 8 mesio-distal serial sections cut 30 microns apart in both experimental and control teeth, surface area determinations relative to the furcations were made evaluating: 1) the total fill of the furcation; 2) the area filled with alveolar bone; 3) the area occupied by connective tissue; 4) the area occupied by new deposited cementum; and 5) the area filled by epithelium.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Bone Loss↗

PubMed2006

A novel approach to regenerating periodontal tissue by grafting autologous cultured periosteum.

In the field of oral and maxillofacial surgery, tissue-engineering techniques have been found useful in regenerating lost tissues. Periodontal disease causes severe destruction of periodontal tissue, including the alveolar bone. In this study we attempted to regenerate canine periodontal tissue defects by grafting autologous cultured membrane derived from the periosteum. Under appropriate culture conditions, periosteal cells produce enough extracellular matrix to form sheets. Periosteum specimens were peeled from the mandibular body of adult hybrid dogs and were cultured until cells formed membrane. ALP activity was measured to determine an optimal time for grafting. The cultured periosteum (CP) was grafted and sutured on a mechanically made Class III furcation defect in the 4th mandibular premolars. After 3 months, the samples were harvested and observed radiologically and histologically. In cases of CP, the bone defects were regenerated and filled with newly formed hard tissue, whereas in the controls the defects remained. These results show that our novel treatment is effective in regenerating alveolar bone for the treatment of periodontal disease.

Animals↗

PubMed1988

Guided tissue regeneration in degree II furcation-involved mandibular molars. A clinical study.

The present clinical trial was designed to evaluate the regenerative potential of the periodontal tissues in degree II furcation defects at mandibular molars using a surgical treatment technique based on the principles of guided tissue regeneration. The patient sample included 21 subjects, 22-65 years of age. The patients selected had periodontal lesions in the right and left molar regions including advanced periodontal tissue destruction within the interradicular area. After an initial examination, each patient received a series of full-mouth scalings and root planings. 2-3 months later, they were recalled for a baseline examination including assessment of plaque, gingivitis, probing depths and probing attachment levels. The furcation involved molars were randomly assigned in each patient to either a test or a control treatment procedure. The test procedure included the elevation of mucoperiosteal flaps at the buccal and lingual aspect of the alveolar process. The inner surface of each flap was carefully curetted to remove epithelium and granulation tissue. The root surfaces were scaled and planed. A teflon membrane was adjusted to cover the entrance of the furcation area and the adjacent root surfaces as well as a portion of the alveolar bone apical to the crest. The flaps were repositioned and placed on the outer surface of the membrane and secured with interdental sutures which were removed after 10 days of healing. Following surgery, the patients were instructed to rinse the mouth twice daily with chlorhexidine gluconate. A second surgical procedure was performed after a healing period of 1-2 months to remove the teflon membrane.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2001

Guided tissue regeneration for periodontal infra-bony defects.

BACKGROUND: Conventional treatment of destructive periodontal (gum) disease arrests the disease but does not regain the bone support or connective tissue lost in the disease process. Guided tissue regeneration (GTR) is a surgical procedure that aims to regenerate the periodontal tissues when the disease is advanced and could overcome some of the limitations of conventional therapy. OBJECTIVES: To assess the efficacy of GTR in the treatment of periodontal infra-bony defects measured against the current standard of surgical periodontal treatment, open flap debridement. SEARCH STRATEGY: We conducted an electronic search of the Cochrane Oral Health Group specialised trials register and MEDLINE up to October 2000. Hand searching included Journal of Periodontology, Journal of Clinical Periodontology, Journal of Periodontal Research and bibliographies of all relevant papers and review articles up to October 2000. In addition, we contacted experts/groups/companies involved in surgical research to find other trials or unpublished material or to clarify ambiguous or missing data and posted requests for data on two periodontal electronic discussion groups. SELECTION CRITERIA: Randomised, controlled trials of at least 12 months duration comparing guided tissue regeneration (with or without graft materials) with open flap debridement for the treatment of periodontal infra-bony defects. Furcation involvements and studies specifically treating early onset diseases were excluded. DATA COLLECTION AND ANALYSIS: Screening of possible studies was conducted independently by two reviewers (RT & IN) and data abstraction by three reviewers (RT, IN & EGL). The methodological quality of studies was assessed in duplicate (RT & IN) using both individual components and a quality scale (Jadad 1998) and agreement determined by Kappa scores. Methodological quality was used in sensitivity analyses to test the robustness of the conclusions. The Cochrane Oral Health Group statistical guidelines were followed (HW) and the results expressed as weighted mean differences (WMD and 95% CI) for continuous outcomes and relative risk (RR and 95% CI) for dichotomous outcomes calculated using random effects models where significant heterogeneity was detected (P < 0.1). The final analysis was conducted using STATA 6 in order to combine both parallel group studies and intra-individual (split-mouth) studies. The primary outcome measure was gain in clinical attachment. Any heterogeneity was investigated. MAIN RESULTS: We initially included 23 trial reports. Twelve were subsequently excluded. Of these, seven presented six-months data only, three were not fully randomised controlled trials, one used a non-comparable radiographic technique. Eleven studies were finally included in the review, ten testing GTR alone and two testing GTR+bone substitutes (one study had both test treatment arms). For attachment level change, the weighted mean difference between GTR alone and open flap debridement was 1.11 mm (95% CI: 0.63 to 1.59), chi-square for heterogeneity 31.4 (df = 9), p<0.001) and for GTR+bone substitutes was 1.25 mm (95% CI: 0.89 to 1.61, chi-square for heterogeneity 0.01 (df = 1), p=0.91). GTR showed a significant benefit when comparing the numbers of sites failing to gain 2 mm attachment, with relative risk 0.58 (95% CI: 0.38, 0.88, chi-square for heterogeneity 5.72 (df = 3), p=0.13). The number needed to treat (NNT) for GTR to achieve one extra site gaining 2 mm or more attachment over open flap debridement was 8 (95% CI: 4, 33), based on an incidence of 32% of sites in the control group failing to gain 2 mm or more of attachment. For baseline incidences in the range of the control groups of 10% and 55% the NNTs are 24 and 3. Probing depth reduction demonstrated a small but statistically significant benefit for GTR, weighted mean difference 0.80 mm (95% CI: 0.14,1.46, chi-square for heterogeneity 10.0 (df = 4), p=0.04) or GTR+bone substitutes, weighted mean difference 1.24 mm (95% CI: 0.89, 1.59, chi-square for heterogeneity 0.03 (df = 1), p=0.85). No significant difference was noted for gingival recession between GTR and open flap debridement. Regarding hard tissue probing at surgical re-entry, a statistically significant greater gain was found for GTR compared with open flap debridement. This amounted to a weighted mean difference of 1.39 mm (95% CI: 1.08, 1.71, chi-square for heterogeneity 0.85 (df = 2), p=0.65). For GTR+bone substitutes the difference was greater, with mean difference 3.37 mm (95% CI: 3.14, 3.61). Heterogeneity between studies was highly statistically significant for all principal comparisons and could not be explained satisfactorily by sensitivity analyses. The quality of study reporting was poor with seven out of 11 studies graded as poor using the Jadad score. (ABSTRACT TRUNCATED)

Alveolar Bone Loss↗

PubMed2006

Guided tissue regeneration for periodontal infra-bony defects.

BACKGROUND: Conventional treatment of destructive periodontal (gum) disease arrests the disease but does not usually regain the bone support or connective tissue lost in the disease process. Guided tissue regeneration (GTR) is a surgical procedure that specifically aims to regenerate the periodontal tissues when the disease is advanced and could overcome some of the limitations of conventional therapy. OBJECTIVES: To assess the efficacy of GTR in the treatment of periodontal infra-bony defects measured against conventional surgery (open flap debridement (OFD)) and factors affecting outcomes. SEARCH STRATEGY: We conducted an electronic search of the Cochrane Oral Health Group Trials Register, MEDLINE and EMBASE up to April 2004. Handsearching included Journal of Periodontology, Journal of Clinical Periodontology, Journal of Periodontal Research and bibliographies of all relevant papers and review articles up to April 2004. In addition, we contacted experts/groups/companies involved in surgical research to find other trials or unpublished material or to clarify ambiguous or missing data and posted requests for data on two periodontal electronic discussion groups. SELECTION CRITERIA: Randomised, controlled trials (RCTs) of at least 12 months duration comparing guided tissue regeneration (with or without graft materials) with open flap debridement for the treatment of periodontal infra-bony defects. Furcation involvements and studies specifically treating aggressive periodontitis were excluded. DATA COLLECTION AND ANALYSIS: Screening of possible studies and data extraction was conducted independently. The methodological quality of studies was assessed in duplicate using individual components and agreement determined by Kappa scores. Methodological quality was used in sensitivity analyses to test the robustness of the conclusions. The Cochrane Oral Health Group statistical guidelines were followed and the results expressed as mean differences (MD and 95% CI) for continuous outcomes and risk ratios (RR and 95% CI) for dichotomous outcomes calculated using random-effects models. Any heterogeneity was investigated. The primary outcome measure was change in clinical attachment. MAIN RESULTS: The search produced 626 titles, of these 596 were clearly not relevant to the review. The full text of 32 studies of possible relevance was obtained and 15 studies were excluded. Therefore 17 RCTs were included in this review, 16 studies testing GTR alone and two testing GTR+bone substitutes (one study had both test treatment arms).No tooth loss was reported in any study although these data are incomplete where patient follow up was not complete. For attachment level change, the mean difference between GTR and OFD was 1.22 mm (95% CI Random Effects: 0.80 to 1.64, chi squared for heterogeneity 69.1 (df = 15), P < 0.001, I(2) = 78%) and for GTR + bone substitutes was 1.25 mm (95% CI 0.89 to 1.61, chi squared for heterogeneity 0.01 (df = 1), P = 0.91). GTR showed a significant benefit when comparing the numbers of sites failing to gain 2 mm attachment with risk ratio 0.54 (95% CI Random Effects: 0.31 to 0.96, chi squared for heterogeneity 8.9 (df = 5), P = 0.11). The number needed to treat (NNT) for GTR to achieve one extra site gaining 2 mm or more attachment over open flap debridement was therefore 8 (95% CI 5 to 33), based on an incidence of 28% of sites in the control group failing to gain 2 mm or more of attachment. For baseline incidences in the range of the control groups of 3% and 55% the NNTs are 71 and 4. Probing depth reduction was greater for GTR than OFD: 1.21 mm (95% CI 0.53 to 1.88, chi squared for heterogeneity 62.9 (df = 10), P < 0.001, I(2) = 84%) or GTR + bone substitutes, weighted mean difference 1.24 mm (95% CI 0.89 to 1.59, chi squared for heterogeneity 0.03 (df = 1), P = 0.85). For gingival recession, a statistically significant difference between GTR and open flap debridement controls was evident (mean difference 0.26 mm (95% CI Random Effects: 0.08, 0.43, chi squared for heterogeneity 2.7 (df = 8), P = 0.95), with a greater change in recession from baseline for the control group. Regarding hard tissue probing at surgical re-entry, a statistically significant greater gain was found for GTR compared with open flap debridement. This amounted to a weighted mean difference of 1.39 mm (95% CI 1.08 to 1.71, chi squared for heterogeneity 0.85 (df = 2), P = 0.65). For GTR + bone substitutes the difference was greater, with mean difference 3.37 mm (95% CI 3.14 to 3.61). Adverse effects were generally minor although with an increased treatment time for GTR. Exposure of the barrier membrane was frequently reported with a lack of evidence of an effect on healing. AUTHORS' CONCLUSIONS: GTR has a greater effect on probing measures of periodontal treatment than open flap debridement, including improved attachment gain, reduced pocket depth, less increase in gingival recession and more gain in hard tissue probing at re-entry surgery. However there is marked variability between studies and the clinical relevance of these changes is unknown. As a result, it is difficult to draw general conclusions about the clinical benefit of GTR. Whilst there is evidence that GTR can demonstrate a significant improvement over conventional open flap surgery, the factors affecting outcomes are unclear from the literature and these might include study conduct issues such as bias. Therefore, patients and health professionals need to consider the predictability of the technique compared with other methods of treatment before making final decisions on use. Since trial reports were often incomplete, we recommend that future trials should follow the CONSORT statement both in their conduct and reporting. There is therefore little value in future research repeating simple, small efficacy studies. The priority should be to identify factors associated with improved outcomes as well as investigating outcomes relevant to patients. Types of research might include large observational studies to generate hypotheses for testing in clinical trials, qualitative studies on patient-centred outcomes and trials exploring innovative analytic methods such as multilevel modelling. Open flap surgery should remain the control comparison in these studies.

Alveolar Bone Loss↗

PubMed2000

The usefulness of radiographs in diagnosis and management of periodontal diseases: a review.

OBJECTIVES: To review the periodontally significant diagnostic information obtainable from radiographs and the stages during periodontal therapy when the information may influence patient management and treatment outcomes. DATA: Confined to studies involving conventional radiography, as this remains the commonest imaging method in clinical dental practice and primary dental care setting. SOURCES: Literature was reviewed using Medline and manual tracing of references cited in key papers not otherwise elicited. STUDY SELECTION: Studies were selected in order to (i) define the role of radiographs in periodontal diagnosis and management at the initial, corrective and supportive (maintenance) phases of periodontal therapy and (ii) critically review the evidence for the value added by radiographs. CONCLUSIONS: Radiographs provide diagnostic information on alveolar bone levels, plaque retention factors, caries, furcation defects, subgingival calculus and additional pathology. Features visualised are dependent on the radiographic view. A relationship exists between probing attachment loss and radiographic bone height, with a range in level of correlation; clinical attachment may correspond more closely to surgical measurements of bone height. Radiographs can be used in planning initial, corrective and supportive phases of therapy, though some decisions may be made on clinical assessments alone. Evidence in the literature on benefit gained from radiographs taken for periodontal patients is sparse; the extent to which they influence the treatment provided and treatment outcomes is poorly addressed. Further research is indicated to define the role of radiographs when managing the periodontal patient to maximise the potential gain for the patient.

Evidence-Based Medicine↗

PubMed1999

Controlled delivery of inductive proteins, plasmid DNA and cells from tissue engineering matrices.

It has been estimated that half the annual health care budget in the United States is spent on patients suffering from tissue loss and late stage organ failure. Critical limitations inherent in traditional therapies call for novel tissue and organ replacement strategies. This paper discusses development of biomaterials for conductive, inductive and cell-based tissue replacement strategies. Biodegradable polymer scaffolds can be used as space-filling matrices for tissue development and barriers to migration of epithelial cells in tissue conductive approaches. Inductive approaches involve sustained delivery of bioactive factors, such as protein growth factors and DNA, to alter cell function in localized regions. Factors can be released from highly porous polymer scaffolds to allow factor delivery and tissue development to occur in concert. Cell-based approaches involve seeding of cells onto polymeric scaffolds in vitro and subsequent transplantation of the scaffold. New scaffold materials are being developed that address specific tissue engineering design requirements, and in some cases attempt to mimic natural extracellular matrices. These strategies together offer the possibility of predictably forming specific tissue structures, and may provide solutions to problems such as periodontal ligament detachment, alveolar bone resorption and furcation defects.

Absorbable Implants↗

PubMed1989

The prognosis of tunnel preparations in treatment of class III furcations. A follow-up study.

The present study evaluated the long-term prognosis of tunnel preparations performed in a large number of teeth with advanced periodontal furcation defects. One hundred seven (107) patients, in which 156 teeth had been treated by tunnel preparations, were recalled for an evaluation, which was based on a questionnaire, a clinical examination, and radiographs; 102 patients attended (149 teeth = 95%). The mean observation time per tooth was 37.5 months (range 10 to 107 months). The results showed that 10 teeth (6.7%) had been extracted and 7 teeth (4.7%) hemisected. The indication for 12 of these extractions or hemisections was root caries. Among the remaining 132 teeth, 23 (15.4%) showed initial or established caries. There was no relationship between caries development and length of the observation time. Thus, approximately 75% of the teeth were still caries-free and in function. The findings demonstrated that tunnel preparations have a considerably better prognosis than previously reported and should be considered a valid treatment alternative.

Adult↗

PubMed1992

Topographical characteristics of root trunk length related to guided tissue regeneration.

Thirty-seven molars with 94 furcations were selected for a topographical study of root trunks to clarify the possible factors which may affect the clinical application of guided tissue regeneration technique. A pre-determined plane was marked on the root trunk of each tooth 1 or 2 mm below the cemento-enamel junction (CEJ). The plane followed the presumed position of the occlusal border of the Teflon membrane. Cross sectioning of the root was then performed following the plane, and the width of the gap between the membrane and root surface was measured with the aid of a stereomicroscope. The results revealed, within the limited samples of this study, 94% of the furcations possessed variant depth of developmental concavities on the root trunks. These superficial irregularities at the entrances of furcations may prevent complete adaptation of the coronal microstructure of the Teflon membrane along their root surfaces. The width of the gaps between root surfaces and membranes ranged from 0.000 mm to 2.250 mm for all tooth samples. The study implied that the subgingival application of guided tissue membranes 1 to 2 mm below CEJ cannot ensure complete adaptation of furcation defects with their coronal microstructures in the majority of molars.

Adult↗

PubMed1994

Guided tissue regeneration: comparison of bioabsorbable and non-bioabsorbable membranes. Histologic and histometric study in dogs.

This study examined histologic and histometric responses to 2 bioabsorbable membranes made from a synthetic copolymer of glycolide and lactide. They were tested for their biocompatibility, resorption characteristics, and ability to support periodontal regeneration. Expanded polytetrafluoroethylene (ePTFE) was used as control. Nine fox hound dogs with no periodontal disease were used. They were sedated and their teeth thoroughly scaled and root planed. Plaque control was maintained. Two weeks later, each dog was anesthetized using gas anesthesia. Buccal and lingual mucoperiosteal flaps were reflected in the mandibular premolar areas. Randomly selected, buccal alveolar bone was reduced on the 2nd and 4th premolars to a level 5 to 8 mm apical to the cemento-enamel junction creating a Class II buccal furcation defect on one quadrant, while the other quadrant received a Class II buccal defect only on the 4th premolar. Root surfaces were denuded of periodontal ligament and cementum, and notches were placed at the bone level of each root. In one quadrant, one site received Type I membrane and the other site received Type II. The contralateral quadrant received ePTFE. Flaps were positioned slightly coronally and sutured. Sutures were removed 1 week later. One month after surgery, 3 dogs were sacrificed and ePTFE barriers were removed from the remaining 6 dogs. Of these, 3 were sacrificed 3 months after surgery and the other 3 at 6 months. Undemineralized experimental tissues were embedded in methylmethacrylate and 8 to 10 microns thick sections were cut in a bucco-lingual direction throughout the mesiodistal extension of the tooth.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorption↗

PubMed1989

[Effect of hydroxylapatite particles during healing of experimental furcation involvement in beagle dogs].

The present study was performed to evaluate the effects of hydroxylapatite (HAP) on tissue regeneration in various types of furcation involvement. Upper premolar tooth sites of 9 beagle dogs (3-6 years old) were used. HAP particles were implanted into three types of furcation defects: Class III lesion (by Glickman) in 2nd premolar sites, artificially caused by intrafurcal suturing or spontaneously developed about 3 months after extraction of the 1st premolar; Class IV lesion in 4th premolar sites artificially produced 2 months before implantation; and through-and-through furcal bony defects in 3rd premolar sites at the time of HAP implantation. Macroscopic, radiographic and microscopical investigations of the postoperative status were carried out at intervals of 1, 2, 3 and 6 months. The appearance of the gingiva in bony defect sites was almost the same as that in the presurgical status 2 weeks after implantation, although gingival inflammation was persistent in Class III and IV lesions. Most particles in Class III and IV lesions exfoliated until 2 weeks after implantation, and the junctional space between recipient bone and particles could not be distinguished, probably as a result of incorporation of HAP and osseous tissue. Histological observation revealed that HAP particles were surrounded by new bone located at the top of the alveolar crest in all defects. However, there were no obvious signs of coronal bone formation or connective tissue attachment in Class III and IV lesions up to 3 months after the operation. At 6 months there was evidence of new bone formation over the presurgical crests in Class III and IV lesions. On the other hand, there were obvious signs of connective tissue attachment and bone formation in bony defect sites, probably induced by the tissue of the periodontal ligament remaining after the surgical procedure, and nonphysiological ankylosis between root and bone was frequently observed. There were notable findings, such as newly formed osteoid tissue intervening with the adhesive particles, calcified tissue intervening between HAP particles and root surface showing ankylosis, and peripheral osteoid formation in the HAP particles. It is postulated that HAP has no apparent role in induction of bone formation, although there is chemical affinity to calcified tissue, and it is effective in yielding a volume of bone-like tissue where osseous repair could be performed. However, HAP did not enhance regeneration of lost periodontal structures including connective tissue attachment.

Animals↗

PubMed1999

The need for GTR therapy.

Guided tissue regeneration (GTR) affords the clinician the ability to successfully manage a variety of severe periodontal problems, without engendering the prosthetic commitment necessary for the use of root resective techniques. However, such therapy is highly diagnostic- and technique-sensitive. This article provides a clinical basis for using GTR and maximizing therapeutic outcomes, and discusses the challenges posed by deep infrabony defects and furcation involvements. The discussion also focuses on the need for GTR therapy to treat such lesions comprehensively.

Alveolar Bone Loss↗

PubMed1991

[Surgical treatment methods in furcation involvement and their long-term prognosis].

Multi-rooted teeth showing severe furcation defects can be treated by either of the following techniques: Tunnel preparation, hemisection and root resection. The aim of these approaches is to reestablish the anatomical features making it possible to carry out proper homecare in the future. In hemisection and root resection this is achieved by separating and/or removal of roots. An assessment of prognosis is made on the basic of long-term follow-ups. After ten years an average bone loss of 9.5% was recorded. When bridgework was correctly designed loading did not have a detrimental influence on further bone loss. Roots restored by using gold dowels showed the same technical durability as roots restored with root screws/composite cores. The total failure rate after ten years varied between 32 and 38%. Nonperiodontal failures were predominating. This leads to the conclusion that prognosis may not be judged on the basis of periodontal aspects alone.

Alveolar Bone Loss↗