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PubMed1993

Guided tissue regeneration and bone grafts in the treatment of furcation defects.

The present study evaluated the effects of guided tissue regeneration (GTR), with and without demineralized freeze-dried cortical bone grafts, in the treatment of furcation defects in 4 female beagle dogs with naturally occurring periodontal disease. The root surfaces were thoroughly debrided. Four weeks later, full thickness facial and lingual mucoperiosteal flaps were reflected using inverse bevel incisions on both sides of the mandible involving the 2nd, 3rd, and 4th premolar, and the 1st molar teeth. Following debridement, notches were placed on the roots at the level of supporting bone. Test quadrants were randomly selected and furcations were filled with reconstituted, demineralized, freeze-dried human cortical bone grafts. Following bone grafting, all defects were covered with an expanded polytetrafluoroethylene (ePTFE) membrane, which was sutured with 4-0 sutures. Afterward, interproximal sutures were placed through the flaps, assuring the flaps covered the membranes completely. The contralateral side, serving as control, was treated by debridement only and application of ePTFE membrane. All membranes were removed 6 weeks after surgery. Dogs were sacrificed at 4 months after surgery. Both mesio-distal and bucco-lingual histologic sections were evaluated by descriptive histology. Linear measurements and surface area determination of the furcal tissues were carried out using the microscope attached to a digitizer. Twelve to 20 nonserial sections were made of the mid-buccal aspects of each root of each treated tooth. Half of these sections were stained with Harris' hematoxylin and eosin (H&E) and the other half stained with Mallory's trichrome stain.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed2001

Periodontal regeneration of a class II furcation defect utilizing a bioabsorbable barrier in a human. A case study with histology.

This case report describes human histologic data of periodontal regeneration following guided tissue regeneration therapy (GTR) with a bioabsorbable barrier composed of polylactic acid. The tooth that was examined was part of a previously published study of the clinical effects of GTR therapy without the use of bone or bone substitutes on Class II furcation defects. Twenty-five months following the surgical procedure, the tooth was extracted for non-periodontal reasons. During this extraction, the bone within the furcation that was treated in the study was luxated with the tooth. At the completion of the study (month 12), the furcation's vertical probing depth had decreased by 2 mm with a 2 mm gain in clinical attachment. The horizontal furcation measurement decreased by 3 mm. Following extraction, the tooth was prepared for light microscopy and sectioned in the mesial-distal plane. Reference notches were not placed in the tooth at the time of surgery as there were no plans to perform histologic analysis in the study. However, using the buccal root prominences and what we interpreted to be root planing marks on the cementum, we were able to demonstrate that complete periodontal regeneration occurred on the root surface that was exposed to the pocket environment prior to surgery. New alveolar bone, cementum, and periodontal ligament were consistently observed throughout the furcation in the areas that demonstrated clinical attachment gain and a decrease in horizontal probing depth. This case report adds to the accumulating evidence of histologic periodontal regeneration following guided tissue regeneration with bioabsorbable polylactic acid barriers.

Absorbable Implants↗
PubMed1998

Recombinant human osteogenic protein-1 (OP-1) stimulates periodontal wound healing in class III furcation defects.

Osteogenic protein-1 (OP-1) is a member of the transforming growth factor beta superfamily and is a potent modulator of osteogenesis and bone cell differentiation. This preclinical study in dogs sought to assess the effects of OP-1 on periodontal wound healing in surgically created critical size Class III furcation defects. Eighteen male beagle dogs were subjected to the creation of bilateral mandibular 5 mm osseous defects. A split-mouth design was utilized which randomly assigned opposing quadrants to control therapy (surgery alone or collagen vehicle) or 1 of 3 ascending concentrations of OP-1 in a collagen vehicle (0.75 mg OP-1/g collagen, 2.5 mg/g, or 7.5 mg/g). Thus, 9 quadrants per test group received OP-1, 9 quadrants per control group received surgery alone, and 9 quadrants received collagen vehicle alone. Test articles were delivered by a surgeon masked to the treatment, and fluorogenic bone labels were injected at specified intervals post-treatment. Eight weeks after defect creation and OP-1 delivery, tissue blocks of the mandibulae were taken for masked histomorphometric analysis to assess parameters of periodontal regeneration (e.g., bone height, bone area, new attachment formation, and percent of defect filled with new bone). Histomorphometry revealed limited evidence of osteogenesis, cementogenesis, and new attachment formation in either vehicle or surgery-alone sites. In contrast, sites treated with all 3 concentrations of OP-1 showed pronounced stimulation of osteogenesis, regenerative cementum, and new attachment formation. Lesions treated with 7.5 mg/g of OP-1 in collagen regenerated 3.9+/-1.7 mm and 6.1+/-3.4 mm2 (mean +/-S.D.) of linear bone height and bone area, respectively. Furthermore, these differences were statistically different from both control therapies for all wound healing parameters (P < 0.0001). No significant increase in tooth root ankylosis was found among the treatment groups when compared to the surgery-alone group. We conclude that OP-1 offers promise as an attractive candidate for treating severe periodontal lesions.

Alveolar Process↗
PubMed1990

Furcation defects in dogs treated by guided tissue regeneration (GTR).

This study evaluated the effects of guided tissue regeneration (GTR) in the treatment of Class II furcation defects in beagle dogs. Gore-Tex periodontal material was used, and the amount of furcation fill and the surface area corresponding to new connective tissue attachment and new bone were evaluated. If present, epithelium was also evaluated. Six female dogs with naturally-occurring periodontitis were given thorough root debridement. Four weeks later mucoperiosteal flaps were raised, involving the mandibular 2nd, 3rd, and 4th premolar and 1st molar teeth. After debridement, notches were placed on the roots at the level of furcal alveolar bone. Gore-Tex material was adapted to the furcation and secured with sutures on two teeth of each quadrant. The flaps were sutured tightly, making sure the margin of the material was covered. Teeth receiving only surgery acted as controls. Gore-Tex material was removed 1 month following surgery. All dogs were sacrificed by exsanguination at 3 months. Mesiodistal sections were evaluated by descriptive histology. Surface area determination of the furcal tissues was carried out using a microscope attached to a computerized digitizer. Approximately 10 serial sections per tooth were evaluated. Mean values for each dog were obtained for experimental and control teeth and analyzed using paired t-tests (N = 6) to see whether different treatments had any effect on the parameters tested. Different degrees of fill were seen with epithelium, new connective tissue, and bone. Statistically, GTR gave significantly better results in the amount of connective tissue and bone fill achieved.

Alveolar Process↗
PubMed2003

Guided tissue regeneration in human Class II furcation defects using a diphenylphosphorylazide-cross-linked collagen membrane: a consecutive case series.

BACKGROUND: Several bioabsorbable collagen membranes are either currently available or under investigation for use in guided tissue regeneration (GTR) procedures. The aim of this 12-month reentry study was to evaluate a diphenylphosphorylazide (DPPA)-cross-linked bovine type I collagen membrane in the healing of mandibular Class II furcation defects. The DPPA technique prevents the inclusion of foreign cytotoxic cross-linking substances in the reticulated molecules, thus providing a more biocompatible product. METHODS: Forty non-smoking periodontally compromised adult subjects volunteered for this study, and one defect was randomly selected in each patient. At baseline, plaque index (PI), gingival index (GI), probing depth (PD), gingival margin location (GML), clinical attachment level (CAL), and width of the attached gingiva (AG) were measured. Intrasurgical hard tissue measurements consisted of the vertical open probing attachment level (V-OPAL) and horizontal open probing attachment level (H-OPAL), as well as furcation entrance width (FW) and height (FH) and subclassification of defects according to vertical bone loss. All soft tissue measurements were repeated 12 months after membrane placement using conservative flap reentry surgeries; hard tissue parameters were also assessed at this time. RESULTS: DPPA-cross-linked collagen membranes demonstrated good handling characteristics, and no postoperative adverse tissue reactions or clinically detectable localized allergic responses were observed. GI and PI remained low during the entire study period. When the one year reentry values were compared to the baseline measurements, a significant reduction in PD (1.9 +/- 1.4), FW (2.1 +/- 1.7), FH (2.9 +/- 1.6), and gain in CAL (1.7 +/- 1.5), V-OPAL (2.1 +/- 1.9), and H-OPAL (4.7 +/- 1.4) were observed (P < or = 0.05). However, there were no significant differences in GML or AG. Hard tissue improvements resulted in the complete closure of 30% (12) of the defects, and transformation of 67.5% (27) of the defects to Class I, while one defect remained a Class II (2.5%). CONCLUSIONS: Based on this 12-month clinical reentry study, a DPPA-cross-linked collagen membrane could be beneficial in GTR treatment of Class II mandibular furcation involvements, both in terms of soft and hard tissue improvements.

Absorbable Implants↗
PubMed1985

Bone regeneration pattern and ankylosis in experimental furcation defects in dogs.

This study reports on the pattern of interradicular bone formation and the frequency and localization of ankylosis following regenerative surgery of experimentally-induced furcation defects in 12 beagle dogs. Observations were made in 39 specimens showing healing with connective tissue attachment in the full circumference of the furcation. The findings indicate that bone regeneration first occurs adjacent to the root surfaces, followed by a subsequent fill of the central portion of the interradicular area. Ankylosis, observed in 24 of the 39 specimens, was more frequent in large defects than in small defects. The incidence of ankylosis increased with increased distance from the base of the original wound. These findings suggest that coronal bone apposition may require or be facilitated by the presence of a root surface, and that undisturbed coronal regeneration may be dependent upon cellular or some other activity from the intact periodontal ligament.

Animals↗
PubMed1985

Effect of crown-attached sutures on healing of experimental furcation defects in dogs.

This study evaluates whether suturing of replaced flaps with crown-attached sutures, following reconstructive surgery, counteracts postoperative recession of the gingival margins and facilitates new attachment. Through-and-through furcation defects were created in the mandibular premolars of 5 beagle dogs. Bone was surgically removed from the furcation and around each root to a level 3 to 4 mm below the cemento-enamel junction. Steel wires were placed in the furcations for 6 weeks to enhance plaque formation. After 12 weeks, reconstructive surgery that included acid conditioning of root surfaces was performed. On 1 side of the mandible, the flaps were replaced and secured by bonding the sutures to the teeth with composite resin. On the other side, the replaced flaps were sutured interdentally with single sutures. The results demonstrated that the margins of flaps secured with interdental sutures shifted apically to the fornix of the furcations after 1 week, and histologically all 10 furcations were found to be lined with epithelium. Margins of flaps secured with crown-attached sutures remained an average of 0.5 mm coronally to the fornix, and 13 of the 14 teeth showed new attachment. The results indicate that a suturing technique which counteracts gingival recession, favours the formation of new attachment in this beagle dog model.

Animals↗
PubMed1985

Effect of periodic tooth displacement on healing of experimental furcation defects in dogs.

This study compared the healing response, following reconstructive surgery, between teeth subjected to periodic displacement and teeth which were splinted during the postoperative healing period. Through-and-through furcation defects were created in the mandibular second, third, and fourth premolars of 6 beagle dogs. Bone was surgically removed from the furcation and around each root to 3 different levels: 3, 6, and 9 mm. Reconstructive surgery included demineralization of the root surface and coronally positioned flaps. During the postoperative healing period, the premolars on one side were subjected to periodic mesio-distal displacement by orthodontic elastics attached to splints. Corresponding teeth on the contralateral side were splinted to serve as non-mobile controls. The results demonstrated that reattachment occurred in 12 of 14 displaced teeth and in 14 of 16 splinted teeth. There was no difference in the amount of interradicular bone fill or frequency of ankylosis between displaced and splinted teeth. Our findings indicate that the healing response was not affected by tooth displacement in this dog furcation model.

Alveolar Process↗
PubMed1993

Clinical evaluation of the effect of tetracycline root preparation on guided tissue regeneration in the treatment of Class II furcation defects.

The purpose of this clinical trial was to evaluate the effect of tetracycline root preparation on guided tissue regeneration in the treatment of Class II furcation defects. Nine pairs of defects with horizontal clinical attachment level value > or = 5 mm comprised the study group. Measurements were made to determine presence of plaque, gingival condition, probing depth, and vertical and horizontal clinical attachment level. Defects from each pair were randomly assigned for treatment with an expanded polytetrafluoroethylene membrane (e-PTFE) and tetracycline root conditioning (100 mg/ml) or the membrane alone. The membranes were removed 4 to 6 weeks postsurgery. Patients were then seen monthly for the duration of the study. Six months postsurgery, all clinical measurements were repeated. Following either treatment, improvement was observed in all clinical parameters, particularly in horizontal clinical attachment level. However, there was not a statistically significant difference in the improvement observed between sites treated with guided tissue regeneration in conjunction with tetracycline as compared to membrane placement alone. Further studies are needed to fully evaluate tetracycline root preparation in conjunction with regenerative therapy.

Administration, Topical↗
PubMed1988

Treatment of periodontal furcation defects. (I). Review of the literature and description of a regenerative surgical technique.

This report provides an abbreviated review of the literature on treatment and prognosis of periodontal furcation lesions. In addition, it describes a surgical technique designed to accomplish bone regeneration in class II furcation defects, together with the rationale for the development of this procedure. Results of treatment of 30 defects with this technique are presented in a subsequent report.

Bone Regeneration↗
PubMed2003

Recombinant human basic fibroblast growth factor (bFGF) stimulates periodontal regeneration in class II furcation defects created in beagle dogs.

Several growth factors (or cytokines) have been recently investigated for their use as potential therapeutics for periodontal tissue regeneration. The objective of this study was to evaluate periodontal tissue regeneration, including new bone and cementum formation, following topical application of recombinant basic fibroblast growth factor (bFGF, FGF-2) to furcation class II defects. Twelve furcation class II bone defects were surgically created in six beagle dogs, then recombinant bFGF (30 micro g/site) + gelatinous carrier was topically applied to the bony defects. Six weeks after application, periodontal regeneration was analyzed. In all sites where bFGF was applied, periodontal ligament formation with new cementum deposits and new bone formation was observed histomorphometrically, in amounts greater than in the control sites. Basic FGF-applied sites exhibited significant regeneration as represented by the new bone formation rate (NBR) (83.6 +/- 14.3%), new trabecular bone formation rate (NTBR) (44.1 +/- 9.5%), and new cementum formation rate (NCR) (97.0 +/- 7.5%). In contrast, in the carrier-only sites, the NBR, NTBR, and NCR were 35.4 +/- 8.9%, 16.6 +/- 6.2%, and 37.2 +/- 15.1%, respectively. Moreover, no instances of epithelial down growth, ankylosis, or root resorption were observed in the bFGF-applied sites examined. The present results indicate that topical application of bFGF can enhance considerable periodontal regeneration in artificially created furcation class II bone defects of beagle dogs.

Alveolar Process↗
PubMed1985

Effect of implants on healing of experimental furcation defects in dogs.

The present study was performed to find out whether implants placed around periodontally involved teeth during reconstructive surgery would support replaced flaps and prolong gingival coverage of the treated root surfaces facilitating new attachment. Through-and-through furcation defects were made in the mandibular second, third, and fourth premolars of 10 beagle dogs. Bone was surgically removed from the furcation and from the circumference of each tooth to a level 3 to 4 mm apical to the cementoenamel junction. Steel wires were passed through the furcations and ligated to enhance plaque formation. At 6 weeks, the wires were removed. At 12 weeks, during reconstructive surgery, 4 dogs received implants of autogenous intraoral cancellous bone, 2 of autogenous iliac cancellous bone and marrow, 2 of Proplast, and 2 of Avitene. The results demonstrated that none of 12 teeth implanted with Avitene or Proplast showed new attachment. Only 2 of 6 teeth implanted with autogenous iliac bone showed new attachment, combined with extensive root resorption and ankylosis. Of 12 teeth implanted with autogenous intraoral bone, 6 showed new attachment. Our findings suggest that flap support by intraoral cancellous bone implants may facilitate new attachment. A more predictable technique, however, needs to be developed.

Animals↗
PubMed1989

Autogenous, allogenic, and beta-TCP grafts: comparative effectiveness in experimental bone furcation defects in dogs.

The healing responses of three implant materials--fresh autogenous bone, allogenic decalcified freeze-dried bone, and alloplastic implant, beta-tricalcium phosphate (beta-TCP)--were evaluated and compared. Through-and-through furcational defects were surgically created in the third and fourth mandibular premolars of three dogs. Implant material was then placed individually in the surgical defects. All defects without grafting served as controls. Following grafting (ten weeks into the healing period), individual dogs were killed and prepared for light microscopy. The following results were recorded: (1) All materials were well-tolerated. No post-surgical complications occurred. (2) Graft sites showed more pronounced regeneration and the possibility of higher periodontal attachment than did control sites. (3) The defects filled with autogenous bone showed slightly more pronounced regeneration than in allogenic freeze-dried bone and beta-TCP.

Alveolar Bone Loss↗
PubMed2001

Molar root anatomy and management of furcation defects.

BACKGROUND, AIMS: Furcally-involved teeth present unique challenges to the success of periodontal therapy. Anatomical and morphological complicating factors dictate modifications in treatment approaches used for managing these areas. METHOD: Various treatment approaches are available for furcally-involved teeth, the choice of which depends on selected interdependent factors. RESULTS: These factors, along with various approaches used in the treatment of furcally compromised teeth are discussed in this review, with particular emphasis on morphology, etiology, classification and diagnosis.

Dental Restoration, Permanent↗