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Results for “Furcation Defects”

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PubMed1989

[Application of CaO-P2O5-MgO-SiO2-CaF system glass ceramics to periodontal therapy. Histopathological observation after implantation in furcation bony defect in monkeys].

This study was carried out in order to determine the efficacy of CaO-P2O5-MgO-SiO2-CaF system glass ceramics, which are made as implant materials, for treatment of furcation lesions. Glass ceramic granules were implanted in artificial class II furcation bony defects in monkeys. As controls, non-implanted sites were preserved. Radiographic and various clinical examinations were performed before surgery and at 0, 2, 4 and 8 weeks after implantation. Two, 4 and 8 weeks after implantation, two monkeys were sacrificed and the mandibles were sectioned for histopathological observation. The results obtained were as follows; 1. During the experiment, no clinical problems or abnormal response at the sites of glass ceramic implantation were observed. 2. In clinical observation, no remarkable differences were obtained between control sites and implanted sites. 3. Two and 4 weeks after surgery, remarkable regeneration of bone was shown in the implanted sites. However 8 weeks after surgery, the difference between implanted and control sites was not so clear.

Acrylic Resins↗

PubMed1988

The use of a porous hydroxylapatite implant in periodontal defects. II. Treatment of Class II furcation lesions in lower molars.

Twenty-three human subjects with two Class II furcation involvements in lower molars were treated with initial therapy following which presurgical measurements of pocket depth, gingival recession and attachment level were made. Periodontal flaps were used to expose the furcation defects, and one defect was implanted with porous hydroxylapatite while the other served as an unimplanted control. At the time of surgery, bone defects were measured obliquely and horizontally using a specially designed device to ensure reproducible probe angulation. Six months later the presurgical measurements were repeated, and reentry surgical procedures were carried out to measure the changes in the bone defects. Areas implanted with porous hydroxylapatite showed a statistically significant reduction in pocket depth and a statistically significant improvement in attachment level and fill of bone defects when compared with control defects. There was statistically less gingival recession in the implanted areas compared with the control sites. Control sites at six months showed no significant change in pocket depth, an increased loss of attachment and worsening of the bone defects.

Adult↗

PubMed2002

Medical grade calcium sulfate hemihydrate versus expanded polytetrafluoroethylene in the treatment of mandibular class II furcations.

BACKGROUND: Guided tissue regeneration (GTR) techniques have been reported to enhance bone regeneration of molar furcation defects. The current trends in therapy encourage the use of a bioabsorbable barrier. The efficacy of the bioabsorbable barrier needs to be equal to, if not better than, the non-absorbable barrier. METHODS: This clinical study compared the bone regeneration capacity of a commonly used GTR procedure (demineralized freeze-dried bone allograft [DFDBA] and an expanded polytetrafluoroethylene [ePTFE] membrane) to DFDBA and an exclusion barrier of medical grade calcium sulfate hemihydrate [MGCSH]). Thirteen pairs of mandibular molar Class II furcation defects were evaluated in 13 patients. Clinical measurements of keratinized gingival width, probing depth, and recession were recorded prior to treatment. Following flap elevation and furcation defect debridement, an occlusal reference stent and periodontal probes were used to measure vertical, horizontal, and intrabony defect dimensions to the nearest millimeter. Paired defects were randomly assigned to receive either DFDBA/ePTFE or DFDBA/MGCSH. At 6 months, study sites were surgically re-entered and the treated furcations were debrided to a firm bone surface. Intraoperative measurements were repeated. Clinical measurements were repeated at 12 months. RESULTS: The MGCSH-treated furcations demonstrated mean probing depth reduction between baseline and 6 months (1.00 +/- 0.82 mm, P<0.05) and baseline and 12 months (1.31 +/- 0.85 mm, P<0.05). There was no statistically significant change in probing depth in the ePTFE group at any time interval. The horizontal defect fill was significantly greater for ePTFE (36.7%) versus MGCSH (23.8%) (P<0.02). CONCLUSIONS: In selected defects, improved clinical measurements were achieved with DFDBA/MGCSH as well as DFDBA/ePTFE. Both treatments obtained significant horizontal defect fill at 6 months. DFDBA/ePTFE showed a significantly greater horizontal defect fill compared to DFDBA/MGCSH. Attachment level gains achieved with MGCSH held for 12 months, whereas ePTFE attachment level gains did not.

Absorbable Implants↗

PubMed2003

Factors influencing the outcome of regenerative therapy in mandibular Class II furcations: Part I.

BACKGROUND: Factors influencing the outcome of regenerative therapy of Class II furcations are incompletely and poorly understood. The purpose of this 24-month prospective study was to examine the relationship of patient-, site-, and treatment-related factors to the clinical closure of randomly selected mandibular Class II furcations. Results of therapy were evaluated at 1 and 2 years postoperatively. One-year outcome data are presented in this report. METHODS: A total of 43 otherwise healthy individuals with chronic periodontitis (26 male, 17 female), 36 to 70 years of age, completed the 12-month evaluation of the study. Entry criteria included clinical and radiographic evidence of two or more mandibular facial Class II furcation defects (> or = 3 mm horizontal probing depth). Surgical therapy was completed by four periodontists (two each) in either a university clinic or private practice. Each patient contributed two furcation defects that were treated by combination therapy using an expanded polytetrafluoroethylene (ePTFE) membrane and demineralized freeze-dried bone allograft (DFDBA). Clinical measurements included a gingival index, plaque index, mobility, and, referencing an occlusal stent, probing depth (PD), probing attachment level-vertical (PAL-V), and probing attachment level-horizontal (PAL-H). Multiple linear measurements were recorded for each site clinically and after surgical debridement to characterize defect morphology, root configuration, and barrier placement. Defect volume was computed mathematically. Postsurgical maintenance care was provided at 1 to 2, 4, 6, and 8 weeks, and then biweekly until 3 months, with subsequent supportive periodontal maintenance visits at 3-month intervals. The clinical status of the furcation (open or closed), measured by a non-treating periodontist at 1 and 2 years, was the primary outcome measure. The association of patient-related factors (e.g., smoking), site-related factors (e.g., root configuration and defect morphology), and treatment-related factors (e.g., membrane exposure) to clinical status of furcations was assessed using random effects hierarchical logistic regression analysis, controlling for design and demographic variables. Non-parametric analysis was used for specific group comparisons. RESULTS: Complete clinical closure was achieved in 74% of all sites. Of the residual furcation defects, 68% were reduced to Class I. No defects progressed to Class III. Significant improvements in mean PD and PAL-V were obtained following surgical therapy. Although the proportion of sites demonstrating complete furcation closure was comparable for smokers and non-smokers, the proportion of Class II residual defects was significantly higher among smokers than non-smokers (62.5% versus 14.3%, respectively). Increases in presurgical PAL-H were associated with monotonic decreases in the percentage of sites demonstrating complete clinical closure, with only 53% of lesions > or = 5 mm responding with complete closure. Similarly, significant reductions in the frequency of clinical closure were associated with increases in the distance between the roof of furcation and crest of bone, roof of furcation and base of defect, depth of horizontal defect, and divergence of roots at the crest of bone. CONCLUSIONS: The successful clinical closure of Class II furcations was achievable at 1 year following combination therapy with an ePTFE membrane and DFDBA. The highest frequency of clinical furcation closure was observed in early Class II defects. Furcations with vertical or horizontal bone loss of 5 mm or greater responded with the lowest frequency of complete clinical closure. Nevertheless, complete furcation closure was achievable in 50% of molars with extensive bone loss. Also, 15 out of 22 (68%) of all residual defects were reduced to Class I and only seven (8%) failed to improve, demonstrating that successful clinical resolution of advanced defects remains an attainable goal.

Adult↗

PubMed1998

The relationship between probing bone loss and standardized radiographic analysis.

This study evaluated the validity of radiographic alveolar bone defect depth measurements to direct probing measurements. The study was planned in two parts. The first part consisted of the evaluation of artificially prepared defects in dry mandibles. These consisted of 3-mm intrabony defects created at the mesial aspect of the second mandibular molar and a Class II furcation defect on the buccal aspect of the first molar. A total of six standardized periapical radiographs with grids were obtained. They were then evaluated by 10 independent examiners who recorded the distance between the alveolar crest (AC) or root junction (RJ) and base of defect (BD) in the proximal and furcation areas of the teeth. Intra- and inter-examiner differences were assessed. Radiographic results showed that these measurements overestimated the mean defect depth values within 0.12 mm in intrabony defects and underestimated within 0.40 mm in Class II furcation defects. The differences between the radiographic and direct dry mandible defect depth measurements were found to be statistically significant (P < .05) with correlation values r = .50 and r = .46, respectively. The clinical part of the study included evaluation of 64 preoperative radiographs taken from patients who underwent various types of periodontal surgery. Mean clinical bone defect depth was found to be 4.20 mm and the mean of the radiographic defect depth measurements was found to be 3.92 mm in intrabony defects. In furcation defects these values were 3.92 mm and 3.55 mm, respectively. The results revealed that (1) a strong correlation existed between the radiographic and clinical assessments in both type of defects (r = .85, P < .001), and that (2) the difference between the two types of assessment methods was generally within 1 mm (58%). It can be concluded that in both dry mandible and clinical studies radiographic interpretation of the intrabony and furcation defects showed differences from the actual bone defect depths.

Adult↗

PubMed2005

Root resorption and ankylosis associated with guided tissue regeneration.

BACKGROUND: Root resorption and ankylosis have been reported rarely as sequelae to guided tissue regeneration (GTR). The authors describe a clinical case of root resorption following GTR that involved the use of a bioabsorbable membrane. CASE DESCRIPTION: Two years after GTR was performed on a Class II furcation defect, the clinical examination revealed root resorption reaching the pulp chamber. The furcation defect was filled with epithelium and connective tissue, which contained inflammatory infiltrate and fragments of the membrane. The authors also observed areas of the tooth that exhibited points of ankylosis and root resorption. CLINICAL IMPLICATIONS: Clinical trials have reported favorable clinical and histologic results with GTR. However, this case report, along with other case reports and studies in animals, suggests a high risk of root resorption and ankylosis after GTR, which could limit the indications for this technique.

Absorbable Implants↗

PubMed1994

Synthetic bioabsorbable barrier for regeneration in human periodontal defects.

Guided tissue regeneration (GTR) may result in the formation of new bone, cementum, and periodontal ligament. The purpose of this study was to assess the efficacy of a resorbable synthetic material, which has been used extensively in general surgery for wound support, to promote GTR. Forty healthy patients with adult periodontitis, each having a Class II furcation defect, participated in the study. After initial therapy, mucoperiosteal flaps were elevated and furcations debrided with hand and rotary instruments. In 20 patients the molar Class II furcation defects were treated with a GTR procedure using the resorbable synthetic material (experimental), and 20 patients received a mucoperiosteal flap debridement procedure without barrier placement (control). Probing depth and attachment level measurements were taken immediately before surgery, at 6 weeks, and 2, 3, 4, 5, and 6 months after surgery. All areas healed uneventfully. Comparison of clinical attachment level measurements indicated significantly greater gain of attachment at sites receiving barriers. Fifteen of 20 Class II furcations in the synthetic barrier group, but only one of 20 in the control group, were converted to Class I defects. Barriers were still clinically detectable at 4 weeks, but were absent at 6 weeks. The synthetic barriers enhanced gain of clinical attachment in human Class II furcation defects.

Analysis of Variance↗

PubMed1997

A clinical evaluation of a bioresorbable barrier with and without decalcified freeze-dried bone allograft in the treatment of molar furcations.

This study evaluated a bioresorbable barrier with and without decalcified freeze-dried bone allograft (DFDBA) in the treatment of human molar furcations. 14 subjects with paired class II mandibular molar furcation defects participated in the study (8 male and 6 female). The class-II furcation defects were randomly treated with either the resorbable barrier alone or resorbable barrier in combination with decalcified freeze-dried bone allograft (DFDBA). Gingival recession, probing depth, clinical attachment, and bone fill were measured 6 months post-treatment measurements were repeated and each site was surgically re-entered. When the resorbable barrier alone was compared to resorbable barrier in combination with DFDBA, probing depth reduction was significantly (p < 0.01) in favor of the combination therapy. Vertical bone gain was significant with the combination treatment demonstrating more bone fill (p < 0.02). Smoking was also a variable examined in this study. When compared to smokers, non-smokers for both treatment groups revealed greater probing depth reduction, vertical bone gain, and horizontal bone gain. Within the non-smoking group, probing depth reduction was also significantly higher for the resorbable barrier and DFDBA group than the resorbable alone group (p < 0.02). These results illustrate that the probing depth reduction is better in the non-smoker and the best in the non-smoker with the combination therapy of resorbable barrier and DFDBA than with resorbable barrier alone.

Adult↗

PubMed1998

Equivalence and superiority testing in regeneration clinical trials.

The purpose of this report is to investigate sample size requirements for both equivalence and superiority studies investigating products used in regeneration. The goal of a superiority clinical trial is to determine if a new therapy is superior to an established therapy or placebo. In contrast to superiority trials, equivalence trials are used to determine if a new product has similar therapeutic properties to an established product. The sample sizes for the two different types of clinical trials were based on the following assumptions: an alpha of 0.05, a power of 0.80, a 2 group parallel arm study, and equal variances and sample sizes for both groups. Separate sample size calculations were done for both intrabony defects and Class II furcation defects. Sample sizes for the equivalence and superiority trials using the same criteria were the same. However, criteria for estimating sample sizes for equivalence clinical trials require much smaller differences between groups, resulting in much larger sample sizes. A criterion of a 20% difference between groups of the total therapeutic effect resulted in sample sizes which ranged from 64 to 127 in equivalence clinical trials. These samples sizes are much larger than have been generally used in clinical trials investigating periodontal regeneration.

Alveolar Bone Loss↗

PubMed2000

Retention of multi-rooted teeth with class III furcation lesions utilizing resins. Report of 17 cases.

BACKGROUND: Treatment of periodontally diseased multi-rooted posterior teeth has conventionally consisted of scaling and root planing, apically positioned flaps, tunneling, root amputation, root resection, guided tissue regeneration, osseous grafting, and combination osseous graft and barrier membrane techniques. Successful treatment has often been directed and measured by how well the clinician obtains sufficient access to facilitate patient hygiene efforts. Long-term success is predicated upon tooth retention and the arrest of further destruction within the furcation area. METHODS: Seventeen adult periodontal patients with Class III furcation defects were evaluated. Using an open flap procedure, a resin-ionomer was placed into all 3 furcation defects. The patients were placed on quarterly maintenance appointments and the teeth evaluated up to 1 year. RESULTS: The results revealed that sealing the furcations of multi-rooted teeth with hopeless prognoses seems to be a viable alternative to accessing the same intraradicular areas for maintenance using more conventional modes of therapy. Sealing further decreases the surface area of the furca and simplifies future maintenance. CONCLUSIONS: The present study showed that teeth with hopeless prognoses might be retained by decreasing probing depths, bleeding upon probing, and mobility when furcation areas are sealed with a resin-ionomer.

Adult↗

PubMed2001

Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. I. Class II furcations.

BACKGROUND: The aim of this 5-year follow-up study was to clinically and radiographically evaluate the long-term results after guided tissue regeneration (GTR) therapy of Class II furcation defects using non-resorbable and bioabsorbable barriers. METHODS: Nine pairs of contralateral Class II furcation defects were treated in 9 patients with advanced periodontitis. Within each patient, one defect received a non-resorbable (expanded polytetrafluoroethylene [ePTFE]; control, C) barrier and the other a bioabsorbable (polyglactin 910; test, T) barrier by random assignment. At baseline, 6, and 60 +/- 3 months after surgery, clinical parameters and standardized radiographs were obtained. Gain of bone density within furcation areas was assessed using subtraction radiography. RESULTS: Six and 60 months after GTR therapy, statistically significant (P <0.05) horizontal attachment (CAL-H) gain was observed in both groups (C6: 1.7 +/- 0.8 mm; C60: 1.6 +/- 1.2 mm; T6: 2.0 +/- 0.7 mm; T60: 2.2 +/- 0.9 mm). However, 1 furcation assessed as Class I six months after GTR therapy with a bioabsorbable barrier had progressed to Class III after 5 years, and in another patient, 5 years after placement of an ePTFE barrier, 1 furcation had lost all the CAL-H gain that had been observed at 6 months. Subtraction analysis revealed similar area gain in both groups 6 and 60 months postsurgically (C6: 0.3 +/- 0.5; C60 1.0 +/- 1.7; T6: 0.4 +/- 0.4; T60: 1.1 +/- 1.7). CONCLUSIONS: CAL-H gain achieved after GTR therapy in Class II furcations was stable after 5 years in 16 of 18 defects. The study failed to show a statistically significant difference in stability of CAL-H gain between control and test groups 5 years after GTR therapy.

Absorbable Implants↗

PubMed2003

The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review.

BACKGROUND: Bone replacement grafts (BRG) are widely used in the treatment of periodontal osseous defects; however, the clinical benefits of this therapeutic practice require further clarification through a systematic review of randomized controlled studies. RATIONALE: The purpose of this systematic review is to access the efficacy of bone replacement grafts in proving demonstrable clinical improvements in periodontal osseous defects compared to surgical debridement alone. FOCUSED QUESTION: What is the effect of bone replacement grafts compared to other interventions on clinical, radiographic, adverse, and patient-centered outcomes in patients with periodontal osseous defects? SEARCH PROTOCOL: The computerized bibliographical databases MEDLINE and EMBASE were searched from 1966 and 1974, respectively, to October 2002 for randomized controlled studies in which bone replacement grafts were compared to other surgical interventions in the treatment of periodontal osseous defects. The search strategy included screening of review articles and reference lists of retrieved articles as well as hand searches of selected journals. INCLUSION CRITERIA: All searches were limited to human studies in English language publications. EXCLUSION CRITERIA: Non-randomized observational studies (e.g., case reports, case series), publications providing summary statistics without variance estimates or data to permit computation, and studies without BRG intervention alone were excluded. DATA COLLECTION AND ANALYSIS: The therapeutic endpoints examined included changes in bone level, clinical attachment level, probing depth, gingival recession, and crestal resorption. For purposes of meta-analysis, change in bone level (bone fill) was used as the primary outcome measure, measured upon surgical re-entry or transgingival probing (sounding). MAIN RESULTS: 1. Forty-nine controlled studies met eligibility criteria and provided clinical outcome data on intrabony defects following grafting procedures. 2. Seventeen studies provided clinical outcome data on BRG materials for the treatment of furcation defects. REVIEWERS' CONCLUSIONS: 1. With respect to the treatment of intrabony defects, the results of meta-analysis supported the following conclusions: 1) bone grafts increase bone level, reduce crestal bone loss, increase clinical attachment level, and reduce probing depth compared to open flap debridement (OFD) procedures; 2) No differences in clinical outcome measures emerge between particulate bone allograft and calcium phosphate (hydroxyapatite) ceramic grafts; and 3) bone grafts in combination with barrier membranes increase clinical attachment level and reduce probing depth compared to graft alone. 2. With respect to the treatment of furcation defects, 15 controlled studies provided data on clinical outcomes. Insufficient studies of comparable design were available to submit data to meta-analysis. Nonetheless, outcome data from these studies generally indicated positive clinical benefits with the use of grafts in the treatment of Class II furcations. 3. With respect to histological outcome parameters, 2 randomized controlled studies provide evidence that demineralized freeze-dried bone allograft (DFDBA) supports the formation of a new attachment apparatus in intrabony defects, whereas OFD results in periodontal repair characterized primarily by the formation of a long junctional epithelial attachment. Multiple observational studies provide consistent histological evidence that autogenous and demineralized allogeneic bone grafts support the formation of new attachment. Limited data also suggest that xenogenic bone grafts can support the formation of a new attachment apparatus. In contrast, essentially all available data indicate that alloplastic grafts support periodontal repair rather than regeneration. 4. The results of this systematic review indicate that bone replacement grafts provide demonstrable clinical improvements in periodontal osseous defects compared to surgical debridement alone.

Alveolar Bone Loss↗

PubMed1997

A combined surgical and orthodontic treatment of Class III furcations. Report of a case.

Oral hygiene in furcation defects of upper molars is difficult to achieve. In this case report, a combined surgical and orthodontic treatment procedure is presented to facilitate access and plaque control in furcation areas of upper molars with class-III furcation defects. After endodontic treatment and root resection in an upper 1st molar, the remaining mesiobuccal and palatal roots were separated and aligned orthodontically within the dental arch, as one-rooted teeth. The new morphological position of the roots greatly facilitated oral hygiene and may offer a better long-term prognosis.

Dental Plaque↗

PubMed2006

Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. III. Class II furcations after 10 years.

BACKGROUND: The aim of this 10-year follow-up was to evaluate the long-term results after guided tissue regeneration (GTR) therapy of Class II furcation defects using non-resorbable and bioabsorbable barriers clinically. METHODS: In nine patients with advanced periodontitis, nine pairs of contralateral Class II furcation defects were treated. Within each patient, one defect received a non-resorbable expanded polytetrafluoroethylene barrier (ePTFE; C) and the other a bioabsorbable (polyglactin 910; T) barrier by random assignment. At baseline and 12 and 120 +/- 6 months after surgery, clinical parameters were obtained. RESULTS: Twelve and 120 months after GTR therapy, statistically significant (P <0.05) horizontal clinical attachment level (CAL-H) gain was observed in both groups (C12: 1.9 +/- 0.5 mm; C120: 1.1 +/- 1.3 mm; T12: 1.9 +/- 0.8 mm; T120: 1.7 +/- 1.4 mm). However, one patient with furcations that had been assessed as Class I 12 months after GTR therapy had lost two teeth after 10 years, and another patient had lost more than 2 mm CAL-H at one furcation from 12 to 120 +/- 6 months post-surgery 10 years after implantation of an ePTFE barrier. Horizontal bone sounding revealed similar bone gain in both groups 120 +/- 6 months post-surgery (C120: 0.8 +/- 1.0 mm; T120: 1.1 +/- 1.1 mm). CONCLUSIONS: CAL-H gain achieved after GTR therapy in Class II furcations was stable after 10 years in 15 of 18 defects (83%). The study failed to show a statistically significant difference in stability of CAL-H gain between group C and T 10 years after GTR therapy.

Absorbable Implants↗

PubMed1994

The effect of cigarette smoking on the long-term success of guided tissue regeneration: a preliminary study.

Regenerative therapy has provided the clinician with an alternative to traditional procedures such as osseous surgery. However, there is a deficiency of data and research on long-term success of guided tissue regeneration (GTR). The purpose of this paper is to report the findings of a preliminary long-term clinical study of GTR in Class II furcation defects. In a private practice setting, 38 e-PTFE barrier membranes were placed in 38 periodontal Class II furcation lesions in patients diagnosed with chronic adult periodontitis (1 defect per patient). These patients were followed from 4 to 7 years. There were 21 maxillary Class II furcation defects and 17 mandibular Class II furcation defects. All patients had a non-contributory medical history; however, in retrospective examination, many of these patients smoked at least 10 cigarettes per day for at least 5 years. In this study, results after 4 to 7 years revealed a 58 per cent success rate and a 42 per cent failure rate: 80 per cent of the failures were in smokers. In this study, GTR in furcation defects was not as successful as previously reported in the literature from a clinical point of view and the success rate was significantly lower when a patient was a smoker.

Adult↗

PubMed1990

Scanning electron microscopic observations of cell populations and bacterial contamination of membranes used for guided periodontal tissue regeneration in humans.

Fourteen intrabony periodontal defects and six furcation defects (Class II) were treated by a flap procedure which included the use of a polytetrafluoroethylene membrane to allow guided tissue regeneration. After 4 to 6 weeks of healing, the membranes were retrieved and examined by scanning electron microscopy for the presence of adherent cells and other tissue elements. The cervical open pore-structured collar of the membrane, which in most cases had become partially exposed to the oral cavity, had a deposit of bacterial plaque. Bacterial Bacterial colonies and a scatter of single cells in some instances extended into the mid-third of the membrane. Fibroblast-like cells and, in some specimens, blood vessels and fibrous structures were seen in the mid-third and deep parts of the membrane. Generally, however, the occlusive portion of the membrane was characterized by a sparseness of adherent tissue elements. There did not seem to be a systematic difference in the nature and distribution of the adherent structures on the inner and outer surfaces of the membrane. The findings suggest that, in addition to preventing flap tissues from contacting the root surface, an important function of the membrane is to protect the integrity of the underlying blood clot by diverting mechanical stress acting on the flap during early stages of healing.

Bacteria↗

PubMed1995

Treatment of class II furcation involvements in humans with bioresorbable and nonresorbable guided tissue regeneration barriers. A randomized multi-center study.

In this multi-center study 38 patients with contralateral molar Class II furcation defects were treated with GTR therapy using a bioresorbable matrix barrier (test) and a nonresorbable expanded polytetrafluoroethylene (ePTFE) barrier (control). Following flap elevation, scaling, root planing, and removal of granulation tissue, each device was adjusted to cover the furcation defect. The flaps were repositioned and sutured to complete coverage of the barriers. A second surgical procedure was performed at control sites after 4 to 6 weeks to remove the nonresorbable barrier. Before treatment and 12 months postsurgery all patients were examined and probing depths, clinical attachment levels, and position of the gingival margin were recorded. The primary response variable was the change in clinical attachment level in a horizontal direction (CAL-H change). Both treatment procedures reduced the probing depths (P < or = 0.001). Statistically significant gain of clinical attachment level in both horizontal and vertical direction was found at the test sites. At control sites gain of attachment in horizontal direction was statistically significant. The gain of CAL-H was 2.2 mm at test sites compared to 1.4 mm at control sites (P < or = 0.05). At test sites, the gingival margin was maintained close to the pre-surgical level (0.3 mm), whereas at control sites gingival recession was evident (0.9 mm), the difference being statistically significant (P < or = 0.01). Postsurgical complications, such as swelling and pain were more frequent following the control treatment (P < or = 0.05).

Adult↗

PubMed2006

The effect of fibronectin and a bone xenograft on regenerative treatment: a feasibility study.

The purpose of this study was to evaluate the ability of fibronectin to augment the regenerative effects of a bovine-derived xenograft in human periodontal defects. Using a parallel arm, randomized double-blind design, 24 patients with an intrabony defect or a Class II furcation defect were randomly assigned to either the experimental group (xenograft plus fibronectin) or the control group (xenograft without fibronectin). Probing attachment level, pocket depth, and gingival recession were measured at baseline and at 12 months after surgery. Both treatment modalities resulted in attachment gain and pocket depth reduction compared with baseline values. Changes in clinical attachment were not significantly different between the groups (gain of 1.5 mm +/- 1.1 mm in the experimental group and 1.3 mm +/- 1.4 mm in the control). Pocket depth reduction was greater in the control (2.3 mm +/- 1.2 mm) than in the experimental group (2.1 mm +/- 1.9 mm). Gingival recession also was greater in the control (0.9 mm +/- 0.6 mm) than in the experimental group (0.6 +/- 1.5 mm). Subtraction radiography revealed no significant differences between the groups when measuring changes in the distance between the cementoenamel junction and the crest of the bone or in the estimated gain in mineralized tissue mass. It was concluded that a significant difference between the regenerative treatment modalities could not be demonstrated within the limitations of the study. Fibronectin appears to have a stabilizing or proliferative effect on the gingival soft tissue by promoting less postoperative gingival recession.

Adult↗