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At least 19 recordsLinked to original sources

PubMed1996

Hypothetical considerations in the regenerative treatment of molar furcation defects.

Treatment of the molar furcation defect is a challenge to the dental professional. Responses of molar furcation sites to both closed and open surgical debridement have not been shown to result in significant clinical improvement or bone fill. Regenerative techniques using grafting materials, guided tissue regeneration with resorbable and nonresorbable membranes, coronally positioned flaps, and combination techniques are more frequently used to treat class II molar furcations. The clinical responses to these surgical approaches have shown varied results. This article reviews some of the studies on regeneration in furcation defects as well as some of the uniqueness and complexities of the furcation problem. The bone morphology differences in molar bifurcation and trifurcation defects are discussed, and a bone morphologic classification is presented in an effort to standardize future regenerative studies in class II furcations.

Alveolar Bone Loss↗

PubMed1992

Guided tissue regeneration in surgically-produced furcation defects. An experimental study in the beagle dog.

The aim of the investigation was to evaluate the potential for new attachment formation at various degree III furcation involvements in the beagle dog. 3 differently shaped furcation defects were prepared; one small and one large key-hole defect, and one furcation defect which was part of "circumferential" loss of attachment and bone. 15 beagle dogs were used in the experiments. The furcation defects were surgically created at mandibular premolars in the right and left side of the jaw. Test teeth were subsequently treated according to the GTR principle, while control teeth were treated without the application of membranes. The result from the histological examination of biopsy specimens revealed that GTR treatment may result in complete new attachment at surgically produced "through and through" furcation involvements in dogs. The study, however, also revealed that the size of the furcation defect as well as the shape of the surrounding alveolar bone were factors that determined the outcome of this kind of treatment. The treatment failures were consistently associated with flap recession during healing which resulted in the exposure of the furcation defect.

Alveolar Bone Loss↗

PubMed1990

Treatment of periodontal furcation defects. Coronally positioned flaps versus dura mater membranes in class II defects.

Mandibular class II furcation defects in 19 subjects were treated using 2 different methods of wound closure. In 16 of the defects, the wound was closed with a coronally positioned surgical flap secured by crown-attached sutures. In 15 of the defects, a collagenous membrane (freeze-dried dura mater) was placed to cover the exposed defect, followed by suturing of the surgical flap at the level of the alveolar crest. After use of a coronally positioned flap, an average of 70% of the defect volume became filled with bone, with complete closure by bone fill for 9 of the 16 treated defects. After use of dura mater membrane, 38% of the defect volume was filled with bone, with complete bony closure for 3 of the 15 treated defects. The results following use of coronally positioned flaps support our previous findings and the potentials of this technique. The results following use of dura mater membranes, together with recently reported risk for spread of virus with dura implants, do not justify the use of dura mater for these regenerative purposes.

Adult↗

PubMed1998

GTR treatment of degree III furcation defects following application of enamel matrix proteins. An experimental study in dogs.

The aim of the present study was to evaluate the effect of enamel matrix proteins (EMD) on periodontal wound healing in degree III furcation defects in dogs. The experiment was performed in 5 foxhound dogs. 2 months prior to the start of the experiment, the 2nd and 4th lower premolars were extracted. Degree III furcation defects were created in the 3rd mandibular premolars (3P3). The furcation defects were subsequently exposed to reconstructive surgery. Buccal and lingual full thickness flaps were elevated in the lower premolar regions. The exposed root surfaces of the experimental teeth were planed. A notch was placed in the roots at the base of the defect. In one side of the mandible (Test group), phosphoric acid gel was applied over the root surfaces for 15 s. The acid was removed by flushing the root surfaces with sterile saline. Subsequently, a gel of EMD was applied to cover all instrumented root surfaces. Following gel application, a resorbable barrier membrane was adjusted to cover the buccal and lingual entrances of the furcation defect. The flaps were repositioned to cover the barrier and sutured. The contralateral premolar (Control group) received the same treatment, but acid etching was not performed and EMD was not applied prior to barrier installation. 4 months after reconstructive surgery, the animals were sacrificed and biopsies from the 3P3 regions harvested. The biopsies were placed in a fixative, demineralized in EDTA, dehydrated and embedded in paraffin. 3 mesiodistal sections, representing the central portion of the furcation site, were selected for histological analysis of the defect. The furcation defects of both the Test and Control groups were clinically closed and were found to harbor bone and periodontal ligament tissue which appeared to be in structural continuity with a newly formed root cementum. The relative amounts of mineralized bone, bone marrow and periodontal ligament tissue that had formed were similar in the Test and the Control group. In the Test group, however, the cementum that had formed in the apical portion of the furcation defect was different from the corresponding tissue in the coronal portion, and also different from the cementum observed in the Control group. In the apical portion of the test defect a thin (12 microm) acellular cementum had been laid down, while in the coronal portion a thick (32 microm) cellular cementum, similar to the cementum found in the Control group, could be observed. The current observation, hence, seems to confirm that EMD when applied onto an instrumented and acid etched dentine surface may create an environment conducive for the formation of acellular cementum.

Acid Etching, Dental↗

PubMed1997

Guided periodontal tissue regeneration in Class II furcation defects following treatment with a synthetic bioabsorbable barrier.

The purpose of this study was to evaluate guided periodontal tissue regeneration (GPTR) wound healing in Class II furcation defects following surgical treatment with a synthetic bioabsorbable barrier manufactured from a copolymer of glycolide and lactide. Periodonal lesions were induced in four adult male rhesus monkeys around the mandibular first, second, and third molar teeth using orthodontic elastics. After obtaining approximately 30% bone loss, the elastics were replaced by a stainless steel wire which had a projection extending into the furcation. Once similar contralateral Class II furcation defects had been created, the wires were removed, and an oral hygiene program was initiated and maintained until completion of the study. Three weeks after commencing oral hygiene, flap surgery was performed in the mandibular molar region and the root surfaces were thoroughly scaled and root planed to the apical portion of the defects. A bioabsorbable barrier was then placed to cover the furcation defects on one side of the jaw (i.e., test sites). No barriers were placed on the contralateral molars (i.e., control sites). Five months after surgery, the animals were sacrificed and the teeth with their supporting periodontium were processed for light microscopic evaluation. Clinical healing progressed normally and was similar in both groups. Histologic observations from control specimens indicated repair with epithelium and connective tissue occupying the majority of the furcation defects. Test specimens exhibited definitive evidence of regeneration with significantly greater new connective tissue attachment, cementum deposition, and bone formation than the control sites (P < 0.001). It was concluded that this bioabsorbable barrier facilitated GPTR wound healing in Class II furcation defects.

Alveolar Bone Loss↗

PubMed1998

GTR treatment of degree III furcation defects with 2 different resorbable barriers. An experimental study in dogs.

The aim of the present study was to describe the periodontal tissue that formed after GTR when different resorbable barriers were applied to degree III furcation defects. The study was performed in 5 foxhound dogs. The 2nd and 4th premolars in both sides of the mandible were extracted. Degree III furcation defects were produced in the 3rd mandibular premolars. 5 weeks later, GTR therapy using a barrier composed by a polylactide-glycolide copolymer was performed on one quadrant (group A). In the contralateral quadrant, a barrier made of polylactide and citric acid ester (group B) was used. The dogs were sacrificed 6 months after reconstructive therapy. Tissue blocks containing the experimental teeth were excised, demineralised in EDTA and embedded in paraffin. Serial sections were cut in the mesio-distal plane and parallel with the long axis of the roots. The microtome was set at 7 microm. The sections were stained in hematoxyline and eosin. From each biopsy, 3 sections representing the central part of the furcation were selected for light microscopic examination. In the healed furcation sites, descriptive histological analysis and histomorphometric measurements of the newly formed tissues were performed. In both groups the root surface of the healed furcation defects was covered by a cellular, extrinsic-intrinsic fibers type cementum. The composition of the newly formed periodontal ligament was similar in both groups. The proportions of bone, bone marrow and periodontal ligament, however, were substantially larger in group A than in group B. In Group B, an area in the previous furcation defect was consistently occupied by a granuloma. It is suggested that the presence of the granuloma in the healed furcation defect prevented bone regrowth.

Animals↗

PubMed1996

Long-term stability of Class II furcation defects treated with barrier membranes.

The present longitudinal study was designed to explore the long-term efficacy of guided tissue regeneration (GTR) in Class II furcation defects and establish the factors that might be responsible for modifying this response. Subjects with two or more mandibular molars, one of which had Class II furcation defects, received the hygienic phase of therapy followed by baseline clinical measurements and subgingival plaque sampling. GTR procedure was performed in furcation defect sites using expanded polytetrafluoroethylene (ePTFE) membranes, while the other non-furcated molars received only scaling and root planning. Twenty-eight subjects (13 females, 15 males) aged 27 to 66 were included in this longitudinal analysis. Post-surgical treatment included routine home care supplemented with daily chlohexidine rinse and systemic tetracycline. Membranes were retrieved 4 to 6 weeks after surgery. During the first year, patients were initially seen bi-weekly and subsequently monthly for professional prophylaxis. At the end of this year, clinical measurements and samples were obtained. For the next 2 years, patients were seen bi-annually for maintenance visits. Clinical measurements and microbiological samples were then repeated. Next, a tighter maintenance protocol was established and patients were seen quarterly for scaling and oral hygiene reinforcement. Final measurements and samples were taken again 1 year later (4 years postoperative). Significant probing reduction (3.00 mm) and gain in horizontal attachment (2.59 mm) were obtained 1 year postsurgery for the GTR sites. These changes were maintained over 4 years with a slight decline at the end of year 3. Changes in probing depth (PD) from year 1 to 4 served to dichotomize the sites into stable (delta PD < or = 0.9 mm), and unstable (PD increase > or = 1 mm). Of the 54 sites available for this analysis only 5 (9.3%) were unstable while 49 (90.7%) were stable or even further improved. Sites which exhibited minimal or no plaque (plaque index [PI] < or = 1) over the tight maintenance period had a further decrease in mean probing depth (0.43 mm) compared with a slight increase (-0.06 mm) in mean probing depth in sites with PI > or = 2 mm (P = 0.0235). The same phenomenon was observed for changes in relative attachment level (RAL): mean gain in RAL was 0.61 mm compared to 0.25 mm for the 2 groups, respectively (P = 0.07). Actinobacillus actinomycetemcomitans was only isolated from 2 sites at year 3, and none at year 4, compared to 21.45% of the sites at baseline. Porphyromonas gingivalis positive sites showed a continual decline over the years: 14.28% at baseline, 10.71% at year 1, and 5.1% at year 4. On the contrary, Prevotella intermedia (Pi) and Bacteroides forsythus (Bf) infected sites remained at approximately the same rate throughout the 4 years of the study (40% to 50% and 30% to 40% for Pi and Bf, respectively). Of these, Pi-infected sites exhibited less favorable clinical results compared to sites which were not infected with this microorganism. In summary, furcation defects treated with membrane barriers can be maintained in health for at least 4 years; however, good oral hygiene and frequent recall visits as part of a complete anti-infective therapy are essential. Finally, once treated, these teeth are comparable to similar molar teeth with no previous history of furcation pathosis.

Adult↗

PubMed1995

Gingiva thickness in guided tissue regeneration and associated recession at facial furcation defects.

Consistently successful regenerative therapy for furcation defects using membrane techniques remains a challenge for clinicians. The purpose of this study was to determine if the thickness of tissue used to cover the membrane influences postsurgery recession. Thirty-seven (37) moderate to advanced adult periodontitis patients presenting with at least one mandibular or maxillary molar class 1 or 2 facial furcation involvement participated in the study. Mid-facial presurgery recession was recorded from the cemento-enamel junction to the free gingival margin at a reproducible point. Mid-facial tissue thickness was measured using calipers at a point 5 mm apical to the gingival margin of the mucogingival flap reflected at the time of guided tissue regeneration surgery. Patients were divided into 2 groups based upon tissue thickness measurement. Patients were then re-evaluated for recession at 6 months postsurgery. Sixteen (16) patients with tissue thickness < or = 1 mm demonstrated a mean 2.1 mm increase in recession, while 21 patients with tissue thickness > 1 mm exhibited a mean 0.6 mm increase in recession. We conclude that there is less post-treatment recession (P < 0.01) for tissue thickness > 1 mm than tissue thickness < or = 1 mm. Hence, thickness of gingival tissue covering a membrane appears to be a factor to consider if post-treatment recession is to be minimized or avoided.

Adult↗

PubMed1994

Treatment of furcation defects. Guided tissue regeneration versus coronally positioned flap in mandibular molars; a pilot study.

The present study was designed to compare the healing results after treatment of buccal class II furcation defects in mandibular molars utilizing guided tissue regeneration (GTR) technique or coronally positioned flap (CPF) technique. The patient sample consisted of 8 subjects with 18 bilateral furcation defects in mandibular molars. At baseline, 6 and 12 months postoperatively assessments of plaque index, gingival index, probing pocket depths, probing attachment level and bleeding on probing were recorded. Radiographic assessment was performed using conventional radiographs and subtraction images at baseline and 12 months postoperatively. The furcation defects were randomly assigned in each patient to either the GTR or the CPF technique. 12 months postoperatively, there was a statistically significant reduction in probing pocket depths in the GTR treated teeth and a tendency to gain of probing attachment levels 6 months postoperatively. The CPF group showed a statistically significant reduction of probing pocket depths at 6 months and a tendency to reduction after 12 months. The radiological assessment demonstrated gain of interradicular bone tissue in 2 furcation defects of the GTR group. Gain of bone tissue could not be demonstrated in the CPF group. No statistically significant differences were observed between the 2 treatment modalities.

Adult↗

PubMed1998

Evaluation of periosteal membranes and coronally positioned flaps in the treatment of Class II furcation defects: a comparative clinical study in humans.

The purpose of this study was to compare the clinical effectiveness of connective tissue grafts including periosteum used as a mechanical barrier for guided periodontal tissue regeneration and coronally positioned flaps in the treatment of Class II furcation defects. A total of 28 furcation defects were treated; 14 received a periosteal barrier and 14 received a coronally positioned flap. Reentry surgeries were performed at 6 months. No statistically significant differences were found preoperatively between the two treatment groups with respect to clinical parameters and osseous measurements. Postsurgically, both treatment modalities resulted in a significant decrease in probing depth and a significant gain in clinical attachment, but the differences observed were not statistically significant. The periosteal barrier group presented with a significantly better gain in vertical components of the alveolar bone (1.93 +/- 0.15 mm and 0.20 +/- 0.26 mm for periosteal barrier and coronally positioned flap groups, respectively; P < or = 0.001) and horizontal components of the alveolar bone (1.60 +/- 0.21 mm and 0.13 +/- 0.90 mm for periosteal barrier and coronally positioned flap groups, respectively; P < or = 0.001). The results of this trial indicate that similar clinical resolution of Class II furcation defects can be obtained with periosteal barriers and coronally positioned flaps. Periosteal barriers, however, are a better treatment alternative in achieving bone fill of the furcation area.

Alveolar Process↗

PubMed1987

Guided tissue regeneration in the treatment of furcation defects in man.

The regenerative potential of the periodontal tissues in degree II and III furcation defects at mandibular molars was assessed in a clinical trial using a surgical treatment technique based on the principles of guided tissue regeneration. The patient sample included 37 subjects who had periodontal lesions in the right and left mandibular molar regions, including advanced periodontal destruction within the radicular area. Following a baseline examination, the furcation-involved molars were randomly assigned in each patient to either a test or a control treatment procedure. The test procedure included the elevation of mucoperiosteal flaps and the placement of a teflon membrane to cover the entrance of the furcation area and the adjacent root surfaces as well as a portion of the alveolar bone apical to the crest. The flaps were repositioned and secured with interdental sutures. A procedure identical to the one used at the test teeth was performed at the control tooth regions with the exception of the placement of the teflon membrane. Following surgery, all patients were placed on a plaque control regimen which involved daily rinsing with chlorexidine gluconate and, in addition, professional tooth cleaning once every 2 weeks for 6 months. After 6 months of healing, the test and control sites were re-examined. The findings demonstrated that the treatment of degree II furcation defects at mandibular molars using the principles of guided tissue regeneration in 19 sites out of 21 resulted in the resolution of the furcation defect. Conventional therapy reached the same goal in less than 20% of the cases treated.(ABSTRACT TRUNCATED AT 250 WORDS)

Connective Tissue↗

PubMed1997

On the dynamics of periodontal tissue formation in degree III furcation defects. An experimental study in dogs.

The aim of the experiment was to describe the formation of periodontal tissues in degree III furcation defects following GTR therapy. The study was performed in 8 foxhound dogs. The 2nd and 4th premolars in both sides of the mandible were extracted. Furcation defects were produced in the 3rd mandibular premolars. 3 weeks later, reconstructive surgery was performed. The dogs were scheduled for sacrifice 2, 4, 8, and 20 weeks after GTR therapy. Tissue blocks containing the experimental teeth were excised, demineralized in EDTA and embedded in paraffin. Serial sections were cut in the mesio-distal 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. From each biopsy, 3 sections representing the central part of the furcation, were selected for light microscopic examination. In the healed furcation sites, descriptive histological analysis of the newly-formed tissues was performed and the relative proportions of the hard and soft tissues were determined. It was demonstrated that at 2 weeks, the furcation defect contained granulation tissue and cell-rich connective tissue, while at 4 weeks the furcation was mainly occupied by connective tissue. At 8 weeks, woven bone occupied the central portion of the furcation, whereas connective tissue and cementum were observed in the lateral portions. The furcation area at 20 weeks was comprised of newly-formed cementum, periodontal ligament and bone. The onset of cementum formation had started as early as 2 weeks after GTR therapy. The cementum formation apparently occurred in 3 phases: organisation of collagen fibers adjacent and perpendicular to the root surface (phase 1), assembly of the collagen fibers and deposition of matrix (phase 2), and addition of cells and collagen fibers organised parallel to the root surface (phase 3). Bone formation took place through a process that included (1) organisation of a fibrous connective tissue, (2) differentiation of this tissue into woven bone and, (3) maturation of the woven bone into lamellar bone and bone marrow.

Alveolar Process↗

PubMed1997

Volumetric changes following barrier regeneration procedures for the surgical management of grade II molar furcation defects in baboons: I. Overall defect fill.

A computer imaging technique has been advocated for measuring the volumetric fill in furcation defects. Histologic material for this investigation was obtained from an animal study using five adult baboons (Papio anubis). The photographed histology was converted into digitized electronic information, and a computer calculated the overall volume of defect fill for the treated and the untreated control sites. All volumetric measurements were expressed as a percentage of the original surgically created defect size, with 100% indicating complete healing of the defect. The results indicate that none of the defects achieved complete healing. Teeth that had received flap debridement had the most overall defect fill (79.50%). Teeth that received a biodegradable barrier (Epi-Guide) showed a mean overall defect fill of 74.98%, while sites treated with an exclusion barrier (Gore-Tex) showed 70.75% overall fill. The untreated control teeth showed a mean overall fill of 78.70%. A variety of statistical tests revealed no significant differences among teeth within the same animal and between treatments and controls. The following conclusions were drawn: (1) digital imaging technology is a useful research tool for determining the volume of defect fill in surgically created grade II molar periodontal furcation defects in the baboon model; and (2) no significant differences were found among the treatment modalities and the untreated control sites.

Animals↗

PubMed1995

Guided tissue regeneration in human furcation defects after using a biodegradable barrier: a multi-center feasibility study.

This multi-center study evaluated guided tissue regeneration (GTR) in Class II furcation defects using a polylactic acid biodegradable barrier in 29 patients with mandibular and maxillary molar defects. Following an initial hygienic phase, surgical flaps were elevated, and the sites scaled and root planed. Furcation defect perimeter was measured and a customized barrier (thickness 600 to 750 mu) was applied to cover the defect. Barriers adhered directly to tooth and bone. At baseline, sites were measured for probing depth (PD) (6.0 +/- 0.2 [SE] mm), gingival margin location (GML) (-0.2 +/- 0.2 mm), and attachment level in both vertical (AL-V) (6.2 +/- 0.2 mm) and horizontal (AL-H) (5.4 +/- 0.2 mm) directions. After the surgical procedure, there was good compatibility between the gingival tissues and barrier material. Clinically, barriers fragmented and became displaced in 3 to 6 weeks. Substantial granulation tissue was sometimes present between barrier and root surfaces. Comprehensive periodontal examination parameters were measured 3, 4, 6, 9, and 12 months after baseline. A repeated measures ANOVA was used to evaluate changes from baseline. At 6 and 12 months postsurgery, GML was close to the presurgical level (-0.5 +/- 0.2 mm). There was clinically and statistically significant improvement in all other parameters: mean PD reduction (2.2 mm), AL-V gain (1.7 mm), and AL-H gain (2.5 mm). These results indicated favorable clinical regenerative outcomes after using this barrier material in Class II furcation defects in humans.

Adult↗

PubMed1995

Guided tissue regeneration in the treatment of degree III furcation defects in maxillary molars.

11 subjects with generalized periodontitis and advanced lesions in the maxillary molar regions, including bilateral mesial-distal, but not buccal, degree III furcation defects in the 1st and/or 2nd molars, were recruited for the present clinical trial. The patients were given oral hygiene instruction and full-mouth scaling and root planing. A re-examination was performed after 3 months of healing, after which the furcation involved molars were randomly selected for a GTR or conservative treatment modality. An informed consent form was signed by each participating patient. The GTR procedure involved the elevation of mucoperiostal flaps, root surface debridement, and the placement of an e-PFTE membrane at the 2 entrances of the furcation defect. The flaps were repositioned and secured. The contralateral molar was treated in an identical manner but without the placement of the teflon membrane. The patients received amoxicillin (1g x 2/day for 8 days), were placed on chlorhexidine mouth rinsing and were recalled for prophylaxis 1x every 2 weeks. The teflon membranes were removed at a 2nd stage procedure after 6 weeks. All subjects were re-examined 6 months after the regenerative procedure, and in addition, all sites were evaluated following a reentry procedure. The final examination and measurements made during the reentry procedure documented that, although some reduction in probing pocket depth and some gain in probing attachment had occurred at both test and control sites, none of the furcation defects had closed, but retained the characteristics of a degree-III furcation involvement.

Amoxicillin↗

PubMed1998

The effect of transforming growth factor beta one (TGF-beta 1) on wound healing, with or without barrier membranes, in a Class II furcation defect in sheep.

The purpose of this study was to analyse the effect of TFG-beta 1 on wound healing in standardized Class II furcation defects of 48 mandibular second premolar teeth in 24 sheep. The experimental design included a control group (carrier only, 25% pluronic F-127), and 2 experimental groups: group A (80 micrograms/ml TGF-beta 1 + carrier) and group B (80 micrograms/ml TGF-beta 1 + carrier covered with a barrier membrane). Sheep were killed either 2 wk or 6 wk after surgery. Mesiodistal sections of the decalcified specimens were quantified histologically using stereology. Percentage volumes of regenerated bone, fibrous connective tissue and cementum were calculated for each furcation defect. Mean values were analysed using multiple ANOVA; p values were calculated using paired and unpaired Student's t-tests. After 2 wk there was more bone in group B than either of the other 2 groups, but this was not statistically significant. By 6 wk more bone was present in group A than in the control group (p < 0.02) and also in group B when compared with both group A and the control group (p < 0.02 and p < 0.44), respectively. In the 4 wk between sampling significantly more bone had formed (group A < 0.05 and group B p < 0.003, respectively). A negative correlation existed between volumes of bone and fibrous connective tissue and no significant differences between the volumes of cementum were evident between any of the groups. This study demonstrated that TGF-beta 1 encouraged bone regeneration in Class II furcation defects in sheep, an effect enhanced by the presence of a barrier membrane. This is the first report on the use of TGF-beta 1 in conjunction with GTR in periodontal defects.

Alveolar Process↗

PubMed1995

Successful regeneration of mandibular Class II furcation defects: an evidence-based treatment approach.

The purpose of the present evidence-based critical review was to define goals and outcomes for regenerative therapy of Class II furcation defects and rank the efficacy of current regenerative procedures based on the available literature. Meta-analysis was employed to quantitate the mean overall expected changes and compare various techniques. The evidence presented in the literature was used to determine factors affecting regeneration of Class II furcation defects. These factors were used to establish decision-making trees to enhance success and highlight potential shortcomings of the technique. Guided tissue regeneration, used alone or in combination with bone replacement grafts, had the highest overall ranking. Mean reduction in probing depths and gains in vertical and horizontal attachment levels were all statistically significant at 6 months. Similar results were obtained in the 12-month studies. Compared to flap debridement, guided tissue regeneration resulted in greater reduction in probing depths and greater gains in vertical and horizontal attachment levels. Guided tissue regeneration provided almost identical results whether used with or without root conditioning, suggesting that root conditioning does not offer an adjunctive effect. A combination of guided tissue regeneration and bone replacement grafts yielded better results than did guided tissue regeneration alone in reducing probing depths and increasing vertical attachment levels. The decision-making trees derived from analysis of these results may assist the clinician in improving success and predictability of guided tissue regeneration procedures in Class II furcation defects.

Bibliographies as Topic↗

PubMed1996

Systemic antimicrobial treatment and guided tissue regeneration. Clinical and microbiological effects in furcation defects.

The purpose of this investigation was to study the microbiota associated with furcation-involved teeth before and after treatment by the guided tissue regeneration procedure (GTR) with non-resorbable ePTFE membranes, and to evaluate the benefit of additional systemic antimicrobial therapy (ornidazole). Each of 10 patients contributed 1 pair of bilateral mandibular molars with comparable furcation defects. 5 defects were treated with a membrane and the active drug, 5 were treated without a membrane but with the active drug, 5 were treated with a membrane and a placebo, and 5 were treated with neither a membrane nor the active drug. Considerable differences were found in the healing response of furcation defects treated with or without the antimicrobial agent. More horizontal attachment gain and increase in bone density was obtained in patients receiving the active drug than in patients receiving the placebo. With 1 exception, all sites with increasing horizontal probing depth were found in patients of the placebo group. Treatment with membrane plus ornidazole resulted in 0.7 mm mean recession and -1.2 mm mean decrease in horizontal probing depth. Sites treated with membranes generally tended to be positive for 15 target micro-organisms more often than sites treated without a membrane. This was particularly evident for Fusobacterium, Prevotella intermedia and Actinomyces odontolyticus. Whereas GTR-treated sites were often already positive upon removal of the membrane, re-emergence of target organisms seemed to be more delayed in the conventionally-treated sites.

Adult↗