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Longitudinal evaluation of durapatite ceramic as an alloplastic implant in periodontal osseous defects after 3 years.

Seven patients who participated in a clinical study comparing the response of periodontal osseous defects to either grafting with Durapatite ceramic or debridement alone were followed under an active maintenance program for 3 years. Comparison of mean values showed that gingival recession, attachment levels and probeable pocket depths remained essentially stable for Durapatite sites over the 3 years. Attachment levels for debridement sites also remained constant, but these areas showed significant coronal migration of the free gingival margin and increases in probeable pocket depths. These latter changes became apparent and significant only after 3 years. Intrapatient comparisons showed that recession and attachment gain were most frequently greater and pocket depths most frequently less for Durapatite sites. These findings suggest that the Durapatite-treated sites were stable for 3 years following surgery, while areas treated with debridement alone regressed.

Ceramics↗

Ultrastructure of durapatite-periodontal tissue interface in human intrabony defects.

The ultrastructure of the interface between Durapatite (hydroxylapatite) and human periodontal tissues was examined. Durapatite was implanted into the intrabony periodontal defects during periodontal surgery. Reentry procedures were performed after 1 year and the tissues in the defects were biopsied and processed for transmission electron microscopy. Nineteen tissue blocks from four patients were examined, 17 contained Durapatite particles embedded in fibrous tissue and two contained particles encased in bone, all without inflammation. The fibrous connective tissue consisted of densely packed collagen fibrils surrounding the implant particles. The bone surrounding the Durapatite consisted in one case of relatively mature bone, and in the other of osteoid tissue. A granular, amorphous, collagen-free, electron-dense layer was routinely observed between implant and tissue. This layer was thicker in the bone-encased samples than in those surrounded by fibrous connective tissue. Except for the particle surrounded by mature bone, this layer was continuous with an organic meshwork located on the periphery of the implant spaces. The ultrastructural features of the interface are consistent with the existence of a mucopolysaccharide "bonding zone" described by other investigators. The organic meshwork appears to outline areas similar in size and shape to the individual crystallites of hydroxylapatite. This may indicate that the reactive surface of hydroxylapatite is much larger than merely the exterior surface of the implant, a finding which may explain the apparently good tissue adhesion to the implant.

Alveolar Process↗

Use of durapatite for the rehabilitation of resorbed alveolar ridges.

These investigations were undertaken to evaluate durapatite, a particulate, ceramic, nonresorbable bone-grafting material for augmentation of deficient alveolar ridges. A total of 207 augmentations were reported among 198 patients over 24 months. Subjective and objective data showed that durapatite alone was successful for all classes of ridges augmented; height, bulk, contour, and ridge form generally improved and soft tissue overlying the augmented ridges was firm and immobile. Impressions for dentures usually began 4 to 6 weeks after surgery and these dentures remained stable, retentive, and esthetically pleasing throughout the study. Other than transiently altered sensations resulting from mental nerve manipulation during surgery, no other important procedural complications were noted. No infection or bone resorption beneath the implant was observed throughout these studies. Durapatite used in an outpatient setting provides a less costly and more permanent method for alveolar ridge augmentation than do augmentation procedures using autogenous or banked bone.

Adult↗

Evaluation of durapatite ceramic as an alloplastic implant in periodontal osseous defects. I. Initial six-month results.

Eight patients received a new polycrystalline ceramic form of pure hydroxylapatite (Durapatite) as a bone implant material in various types of infrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the CEJ using a standardized periodontal probe. Similarly debrided defects that were not implanted served as controls. Defect selection as either experimental or control site was based on either split-mouth or alternating defects design. Periodontal dressing and systemic tetracycline were used for 10 days. Results for documentation and plaque control were at 10, 20, and 30 days, and 3 and 6 months. Measurements relating to defect changes were made at the 6-months surgical re-entry. For evaluation purposes original defect depths were divided into three groups. In Group I (less than 3 mm) defect fill was 1.2 mm (60%) for the implanted defects and 0.6 mm (40.5%) for the control sites (significantly different at P less than 0.05). In Group II (3--6 mm) defect fill of 1.7 mm (48.5%) for implanted sites was significantly better than the 0.1 mm (11.1%) for the control sites. In the deepest group (Group III greater than or equal to 6 mm) Durapatite placement yielded 2.6 mm (39.9%) of defect fill while debridement alone resulted in 1.3 mm (14.8%) of fill. Hard tissue changes demonstrated a substantial advantage for use of Durapatite over controls, while soft tissue changes were similar for both. The clinical impression at re-entry and the numerical data indicate that pure hydroxylapatite ceramic has a definite potential as an alloplastic implant in the treatment of periodontal osseous defects.

Adult↗

Evaluation of durapatite ceramic as an alloplastic implant in periodontal osseous defects. II. Twelve month reentry results.

Thirteen patients received Durapatite, a hydroxylapatite ceramic (Periograf), as a bone implant material in various types of intrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the cemento-enamel junction (CEJ) at specific locations using a standardized periodontal probe. Similarly debrided, nonimplanted defects served as controls. Defect selection as either experimental or control site was based on an alternating defects design after local therapy was completed. Periodontal dressing and systemic tetracycline were used for 10 days. Postsurgical visits for documentation and plaque control were at 10, 20 and 30 days, and 3, 6, 9 and 12 months. Measurements relating to defect changes were made at the 12-month surgical reentry. For evaluation purposes original defect depths were divided into three groups. In Group I (less than 3 mm) defect fill was 1.0 mm (47%) for the implanted defects and 0.3 mm (33%) for the control sites (significantly different at P less than 0.05). In Group II (3-6 mm) defect fill of 1.7 mm (44%) for implanted sites was significantly better (P less than 0.05) than the 0.8 mm (29%) found in control sites. In the deepest group (Group III, greater than 6 mm) Durapatite placement yielded 2.1 mm (32%) of defect fill while debridement alone resulted in 1.8 mm (26%) of fill (P greater than 0.05). Hard tissue responses demonstrated a substantial advantage for use of Durapatite over controls, while soft tissue changes were similar for both.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Human clinical and histologic responses to Durapatite implants in intraosseous lesions. Case reports.

The healing response following implantation of a nonresorbable ceramic (durapatite) into human periodontal osseous defects was evaluated clinically and histologically. Four tooth-containing blocks were obtained from four patients who had received durapatite implants in osseous defects, each exceeding 4 mm in depth. Each patient was seen for 5 to 13 postsurgical maintenance visits. Teeth in block section were removed between 8 weeks and 8 months postgraft surgery. Clinical evaluation of the repair process demonstrated that pocket depth decreased in all four cases. Histological evaluation of the repair process showed no indication of new periodontal attachment, osteogenesis or cementogenesis, in the host tissues adjacent to the graft particles. Pocket closure appeared to occur by means of a long junctional epithelium and connective tissue adhesions. There was minimal or no evidence of inflammation in all sections associated with the implant. The graft material therefore acted as a biocompatible foreign body within the gingival tissue.

Adult↗

Histological assessment of human periodontal defect after durapatite ceramic implant. Report of a case.

Durapatite particles were employed along with autogenous bone chips to treat an extensive periodontal defect on a mandibular first molar which involved the bifurcation area and the distal root. Nine weeks after treatment the tooth was found to be cracked and was extracted along with tissue containing the grafted sites. The histologic specimen demonstrated that the ceramic graft particles were compatible with the periodontal tissues and showed no evidence of rejection or extrusion. They appeared completely encapsulated by connective tissue fibers while active osteogenesis was noted on the bone fragments implanted with them. Cementogenesis and connective tissue attachment to the root were seen adjacent to the durapatite particles. This healing was believed to be related to the earlier surgical denudation of this portion of the root during treatment and was unrelated to the placement of the graft.

Adult↗

Clinical evaluation of Durapatite submerged-root implants for alveolar bone preservation.

A study was undertaken to evaluate the safety and efficacy of Durapatite cones as an immediate submerged-root implant in the mandibular symphysis region. The study involved 30 patients of which 15 received 96 implants and the other 15 served as controls. The clinical and radiographic results revealed the implants to be well-accepted by alveolar bone. No evidence of rejection or major complications were observed. The principal problem which occurred was dehiscence of mucosa over some implants. This problem was attributed to operative technique. There was significantly less vertical bone loss and contour change in the anterior part of mandible in the implant group than in the control group.

Adult↗

Repair of anterior gingival deformity with durapatite. A case report.

After the extraction of a maxillary anterior tooth, a gingival deformity may occur due to the loss of the labial plate of bone. This often creates an esthetic problem in the construction of a fixed partial denture. In the past, various surgical techniques have been devised to eliminate this gingival defect. A technique using durapatite is discussed.

Dental Implantation↗

5-year evaluation of durapatite ceramic alloplastic implants in periodontal osseous defects.

Six patients who participated in a clinical study comparing the response of periodontal osseous defects to either grafting with Periograf (durapatite) hydroxylapatite (HA) ceramic or debridement alone (DEBR) were followed under an active maintenance program for 5 years. Mean values for gingival recession and attachment levels remained essentially stable following either treatment over the 5 year period. However, mean probeable pocket depths shifted from being significantly (P less than 0.05) shallower for DEBR sites at 6 months and 1 year to being significantly shallower for HA sites at 5 years. The probing pocket depth change for grafted sites was steady and the change from presurgical values was significantly greater than the change for DEBR areas, which became about 1.5 mm deeper over the 5 year postsurgical period. Intrapatient comparisons showed that recession, attachment gain, and pocket depth decrease were most frequently greater for the Periograf-treated sites. Assessment of the pattern of clinical changes during the 5 year postsurgical period demonstrated that the attachment level of grafted sites improved or stayed the same 86% of the time compared to only 62% stability or improvement in the DEBR only sites. In fact, 38% of the DEBR sites were worse at 5 years than at the time of surgery, a 3 times greater failure rate than that found in the HA-grafted sites. Pocket depth measurements showed that 98% of the Periograf-treated sites were better or the same as presurgically (2% worse), while only 80% of DEBR sites showed positive results and 20% had deeper pockets than at the time of surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveoloplasty↗