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PubMed1993

A clinical comparison of collagen membranes with e-PTFE membranes in the treatment of human mandibular buccal class II furcation defects.

Guided tissue regeneration procedures using non-resorbable expanded polytetrafluoroethylene (e-PTFE) membranes have become accepted therapy in treating moderate furcation defects. Resorbable collagen membranes have also been found to support regeneration and preclude the need for surgical removal. The present study compares their effectiveness with e-PTFE membranes in treating human mandibular Class II buccal furcation defects over a 12-month healing interval. Twelve patients were treated with collagen membrane in one defect and e-PTFE in another. Vertical and horizontal defect repair was evaluated through soft tissue probings and hard tissue measurements. Gingival indices and crevicular fluid flow measurements were used to evaluate site inflammation. Intragroup comparisons were made from baseline to 12 months for each type of membrane (sign test) and for differences between treatment groups with collagen versus e-PTFE membranes (Wilcoxon signed rank test). Both materials were effective in gaining vertical open probing new attachment and horizontal open and closed probing new attachment. Collagen membrane was statistically superior to e-PTFE in gaining horizontal open new probing attachment and in reduced levels of inflammation at the surgical site from baseline to 4 weeks. However, clinical differences were negligible. The intrinsic properties and ease of handling make collagen membranes a feasible alternative in guided tissue regeneration procedures.

Adult↗
PubMed1996

The periodontal tissues in healed degree III furcation defects. An experimental study in dogs.

The aim of the present study was (i) to describe the periodontal tissue that formed in degree III furcation defects in mandibular molars of dogs following GTR therapy and (ii) to compare this healed periodontium to the corresponding tissue of pristine furcations. The study was performed in 10 mongrels dogs. In 6 of the dogs (group A), the 2nd and 4th premolars in both sides of the mandible were extracted 2 months prior to the start of the study. The 4 remaining dogs (group B) were used as normal untreated controls. In the dogs of group A, a furcation defect was produced in the 3rd mandibular premolars and reconstructive surgery was later performed in accordance with the GTR technique. 5 months after reconstructive surgery, all 10 animals (groups A+B) were sacrificed and perfused with a solution of 10% neutral, buffered formalin through the carotid arteries. Tissue blocks containing the experimental teeth were excised, demineralized in EDTA, embedded in paraffin. Serial sections were cut in the mesiodistal plane and parallel with the long axis of the roots. The microtome was set at 7 microns. The sections were stained in hematoxyline and eosin or Van Gieson's connective tissue staining. From each biopsy, 3 sections, 14 microns apart, and representing the central part of the furcation, were selected for light microscopic examination. In the healed furcation sites, histometric and morphometric measurements were performed at different levels (zones), either at the mesial or distal root surfaces; (zone 1) immediately apical of the notch; (zone 2) coronal to the notch where the newly formed alveolar bone was in continuity with the reduced bone crest; (zone 3) coronal to the notch; representing the most coronally positioned area of new bone formation; (zone 4) coronal to the notch; representing areas with no alveolar bone present. In the pristine furcation sites, the measurements were made at zones which corresponded to the location of the zones in the healed furcations. The present data demonstrated that all furcation sites in group A after 5 months of healing exhibited comprehensive de novo cementum formation in the previously exposed parts of the intraradicular root surfaces, and that collagen fibers invested in the newly formed cementum. Comparisons between the pristine and the healed furcations disclosed that the periodontal ligament of the healed furcations was poorly organised, and that bone formation was frequently incomplete.

Alveolar Process↗
PubMed1998

Periodontal healing of canine experimental grade-III furcation defects treated with autologous fibrinogen and absorbable barrier membrane.

OBJECTIVE: To determine the effects of autologous fibrinogen (AF) and absorbable barrier membrane (ABM) on periodontal healing of canine experimental grade-III furcation defects. ANIMALS: 18 conditioned, laboratory-source, adult Beagles. PROCEDURE: Defects were developed bilaterally at the second and fourth premolars and maintained for 12 weeks. Defects were treated with AF, ABM, AF and ABM, or debridement. Digital subtraction radiography, histologic evaluation, and histomorphometric analysis of defect healing was done at 1, 3, and 6 months after treatment to determine percentage increases in bone volume, height, area, and length of periodontal regeneration along the perimeter of the defect. RESULTS: Comparison of defects at post-treatment intervals indicated significantly greater healing of debridement and AF-treated defects, compared with ABM-treated defects at 3 months; however, by 6 months, there were no significant differences in defect healing for all histomorphometric variables. Defects treated with ABM were associated with significantly less root ankylosis than other treatments. Defects treated with debridement had significantly greater increases in bone volume at 6 months after treatment, compared with groups treated with ABM. There was a significant correlation between regenerated bone area, bone volume, and periodontal regeneration for all treatments at 3 and 6 months after treatment. CONCLUSION AND CLINICAL RELEVANCE: Use of AF and ABM did not enhance the amount of periodontal healing, compared with debridement only. The ABM-treated defects were essentially devoid of root ankylosis. Grade-III furcation defects may respond equally well to conservative periodontal surgery or guided tissue regenerative techniques. The prevention of root ankylosis is a substantial benefit favoring this latter method of treatment.

Absorption↗
PubMed2000

[Periodontal regeneration by application of the porous beta-TCP/BMP artificial bone to Class II furcation defects].

OBJECTIVE: To study the regeneration of periodontal tissue after the application of beta-TCP/BMP artificial bone to class II furcation defects. METHODS: Periodontal defects were produced surgically around premolar teeth in 4 dogs. The flap surgery was performed and the root surfaces were curetted to remove the periodontal ligament and the cementum. A synthetic bioabsorble barrier manufactured from poly DL-lactide was used. The defects were divided into 3 groups (beta-TCP/BMP + PDLLA, PDLLA, control). 12 weeks after surgery, the animals were sacrificed and the teeth with their supporting periodontium were processed for light microscopic evaluation. RESULTS: The definitive evidences of regeneration were founded both in BMP/GTR group and GTR group, but the BMP/GTR group exhibited more new bone formation, cementum deposition occupying the majority of the furcation defects than the other two groups. CONCLUSION: It was concluded that the beta-TCP/BMP artificial bone can be used in GTR technique to promote periodontal regeneration.

Animals↗
PubMed1988

Repair of periodontal furcation defects in beagle dogs following reconstructive surgery including root surface demineralization with tetracycline hydrochloride and topical fibronectin application.

This study examines the effects of root surface demineralization and topical fibronectin as adjuncts to reconstructive periodontal surgery. In 14 beagle dogs, horizontal periodontal defects were surgically induced around the mandibular premolars followed by a 6-week period without plaque control. Reconstructive surgery of the defects was subsequently carried out. The root surfaces were debrided and superficially demineralized with citric acid or tetracycline hydrochloride, with or without subsequent application of fibronectin. Mucoperiosteal flaps were raised to cover most of the crowns and sutured. The animals were sacrificed 12 weeks after surgery and block sections of the teeth and surrounding tissues were processed for histology. Analysis included incidence of furcation defects presenting with an epithelial lining, quantification of connective tissue repair relative to the furcation circumference, and regeneration of alveolar bone relative to the furcation defect height. The incidence of root resorption and ankylosis was also analyzed. Within the limitations of this study it was concluded that: (1) citric acid conditioning of the root surface frequently resulted in complete connective tissue repair of the furcation defect; (2) root resorption and ankylosis were prevalent features of the healing response; (3) citric acid and tetracycline treatment had similar potential to induce connective tissue repair and resulted in corresponding incidences of root resorption and ankylosis; (4) application of fibronectin to demineralized root surfaces did not enhance the amount of connective tissue repair and did not alter the pattern of root resorption and ankylosis.

Administration, Topical↗
PubMed1998

Use of biodegradable polylactic acid barrier materials in the treatment of grade II periodontal furcation defects in humans--Part I: A multicenter investigative clinical study.

This study evaluated two bioresorbable polylactic acid barriers (Epi-Guide and Guidor) to determine if design differences were of therapeutic significance in the treatment of Grade II furcation defects in humans. Forty patients with bilaterally matched, Grade II furcation defects in maxillary or mandibular first or second molars were treated in a multicenter study. Comprehensive initial periodontal therapy, followed by defect debridement and root preparation, preceded randomized membrane placement. Data collected from all three investigative centers were pooled and analyzed using an analysis of variance appropriate for a counterbalancing design. Both barrier types produced measurable improvements of clinical probing values. Barrier exposure scores taken through the eighth week postoperative revealed that Epi-Guide was less likely to become exposed than Guidor. The findings of this study, which was conducted over a 12-month period, demonstrated that Epi-Guide and Guidor were comparable as measured by clinical probing determinations.

Absorbable Implants↗
PubMed1994

Evaluation of an absorbable collagen membrane in treating Class II furcation defects.

Recent research has focused upon the utilization of an absorbable collagen membrane in guided tissue regeneration (GTR). Concern exists as to whether this type of membrane is beneficial in the treatment of periodontal defects. The purpose of this study was to evaluate the effect of a type I bovine collagen membrane on treatment of Class II furcation defects. Twelve systemically healthy patients (six male and six female, ages 32 to 68) were treated. Each had bilateral mandibular furcation defects with attachment loss > or = 6 mm. Prior to surgery all patients completed initial therapy including scaling and root planing. At the time of the surgery, teeth were randomly assigned to either a control (flap debridement alone) or test (flap debridement plus collagen membrane) group. Data were collected on the day of surgery, and 2, 4, and 6 months post-surgery and at the 12 month re-entry surgery. Clinical measurements included probing depth (PD), clinical attachment level (CAL), gingival recession (GR), stent to base of defect (SB), crestal bone to base of defect (CB), width of defect, and mobility. Statistical analysis was performed utilizing the paired t test. Both control and test groups demonstrated significant (P < 0.05) improvement at 12 months re-entry in PD, CAL, SB, and CB when compared to the presurgery status. While there is no significant difference in PD, CAL, GR, width of defect, and mobility between control and test groups, sites treated with the collagen membrane had significantly higher bone fill (SB and CB) at re-entry.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Treatment of furcation defects with DFDBA combined with GTR: human histologic evaluation of a case.

The purpose of this study was to evaluate whether regeneration is possible in human furcation defects. Three molars with Class II furcation involvement were included in this study. A notch was placed in calculus in the furcation to serve as a reference point for histologic evaluation. The defects were treated with a demineralized freeze-dried bone allograft combined with a bioabsorbable membrane. At 6 months postoperative, the teeth were extracted with a small piece of tissue from the furcation area. The samples were then processed for histologic evaluation. Regeneration was found in 2 of the 3 samples. This study demonstrated that regeneration is possible in human furcation defects.

Absorbable Implants↗
PubMed1994

Treatment of mandibular class III periodontal furcation defects. Coronally positioned flaps with and without expanded polytetrafluoroethylene membranes.

Twenty-six mandibular class III furcation defects were treated in 26 subjects using a regenerative therapy that included citric acid root conditioning, placement of freeze-dried decalcified bone allograft and coronally positioned flaps secured by crown-attached sutures. In addition to this therapy, expanded polytetrafluoroethylene (ePTFE) membranes were placed in 14 of the 26 defects. The effect of these therapies was evaluated after 52 to 60 weeks through a series of soft and hard tissue probing measurements including residual furcation classification. For both treatments, mean improvements were observed for furcal probing attachment levels, furcal bone levels, and defect volumes. However, only a few of these through-and-through defects had become closed as judged by a panel of 3 independent examiners. Four defects in each of the 2 treatment groups had changed from Class III to Class I/II or Class II/II evaluated with the soft tissue in place. One defect treated without membrane and 3 defects treated with membranes had changed from Class III to Class II as recorded after reflection of the soft tissues at re-entry. Little difference was observed between defects treated with and without membranes. Further studies with larger sample sizes and longer observation times are needed to fully evaluate these regenerative procedures and their potential for healing Class III furcation defects.

Adult↗
PubMed2001

A clinical evaluation of hydroxyapatite cement in the treatment of Class III furcation defects.

BACKGROUND: Calcium hydroxyapatite cement (HAC) has been demonstrated in both animal models and human craniofacial defects to be safe, absorbable, osteoconductive, and possibly osteoinductive. This pilot study evaluated a novel technique using HAC to surgically obturate Class III mandibular molar furcation defects. METHODS: Following flap reflection, affected teeth in 6 patients were root planed and etched with citric acid. Experimental sites were grafted with HAC and coronally positioned flaps (CPF), while controls were treated by CPF only. A variety of clinical parameters were recorded initially, and at re-entry surgery 9 months later. RESULTS: At re-entry, all experimental sites exhibited granulation tissue interposed between the HAC and the alveolar bone, and clinical findings were unsatisfactory. Mean probing depth, clinical attachment loss, and recession increased by 0.8 mm, 1.9 mm, and 1.2 mm, respectively, in experimental sites. In controls, mean probing depth decreased by 0.8 mm, and clinical attachment loss and recession increased by 0.3 mm and 1.2 mm, respectively. There was a mean 1.6 mm loss in osseous crest height and a mean 2.2 mm worsening in osseous defect depth for experimental sites, but only a 0.5 mm loss in osseous crest and 0.5 mm increase in osseous defect depth in control sites. CONCLUSIONS: Experimental sites lost 1.0 to 1.5 mm in bone and attachment compared to controls, without any significant clinical benefit. While the concept of surgically obturating Class III furcation defects with a safe, osteoconductive material remains attractive, HAC did not promote repair or regeneration in this technique.

Acid Etching, Dental↗
PubMed1995

The origin of fibroblasts and their role in the early stages of horizontal furcation defect healing in the beagle dog.

The origin of fibroblasts, their proliferative activity and roles in the early stages of periodontal repair were investigated in order to better understand the periodontal healing process in furcation defects of the beagle dog after guided tissue regenerative therapy. Newly divided cells were identified by immunolocalization of bromodeoxyuridine (BrdU) injected 1 hour prior to sacrificing the animals. At 1 and 2 weeks after creation of the defects, the lesions were occupied primarily by granulation tissue. Under this condition, periodontal ligaments (PDL) fibroblasts in a coronal portion of the remaining PDL close to wounds proliferated actively, migrated along the root surface and formed fibrous connective tissue on the surface. Similarly, the fibroblasts adjacent to the bone surface also showed proliferative activity and engaged in active formation of fibrous connective tissue on the bone surface. The majority of labeled cells in both areas were located in the extravascular area. At 3 and 4 weeks, the defects were filled with an increased amount of new connective tissue and bone. The labeled fibroblasts were preferentially found in the most coronal portion of connective tissue formed on the root surface that was in direct contact with inflamed tissue, and the collagen fibers projected into granulation tissue. In areas of active bone formation, numerous labeled fibroblasts were located in connective tissue adjacent to the newly-formed bone. However, fibroblasts in the endosteum of new bone were rarely labeled These results indicate that fibroblasts involved in periodontal repair originate primarily from both the remaining PDL and alveolar bone, and actively engage in fibrous connective tissue formation in the early stages of periodontal repair The ability of PDL fibroblasts to proliferate, migrate, and form connective tissue on the root surfaces in the early repair stages appears to play a crucial role in the formation of the PDL and cementum, and consequently, in periodontal regeneration in the absence of root resorption and ankylosis. As the formation of new connective tissue and bone continues, the precursor cells for fibroblasts and osteoblasts are supplied locally through the continued divisions of the fibroblastic cells in association with the newly-formed connective tissue. Paravascular and endosteal cells appear to be minor contributors to new cell population during furcation defect repair in the beagle dog.

Alveolar Process↗
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↗