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The aim of this study was to evaluate the potential of an allogeneic bone matrix to regenerate new bone, cementum, and periodontal ligament around a previously diseased root surface. Four patients with severe chronic periodontitis and teeth with hopeless periodontal or restorative prognoses participated in this study. One tooth with a severe intraosseous defect was selected per patient. At baseline, measurements of probing depth, gingival recession, and clinical attachment level were obtained. Following flap reflection, a root notch was placed at the apical extent of the calculus; the root was debrided, and the allogeneic bone graft material was placed into the defect. After a minimum of 6 months of healing, the teeth were removed en bloc and prepared for histologic examination. Two of four teeth demonstrated regeneration of new bone, cementum, and periodontal ligament. One tooth healed by new connective tissue attachment, and another by junctional epthelium.

This study evaluated the clinical and histologic results of a calcium phosphate bone cement in the treatment of human periodontal intraosseous defects. Four patients with chronic advanced periodontitis in whom treatment with complete dentures was planned were recruited. The cement was implanted in one defect per subject with a presurgical probing depth of at least 7 mm and a radiographic bone defect of 4 mm or more. Patients were seen every 2 weeks for periodontal maintenance. At 6 months, clinical measurements were repeated and the tooth was removed en bloc for histologic processing. Results demonstrated that all defects resulted in probing depth reduction and, at three of the four defects, in clinical attachment level gain. However, no site showed periodontal regeneration. There was no new bone formation. New cementum and connective tissue were limited to 0.2 mm or less. Large deposits of the bone cement were noted encapsulated in connective tissue.

Four patients with chronic advanced periodontitis participated in this study. At least one mandibular first molar had to have a hopeless periodontal and prosthetic prognosis. Clinical measurements were made, and the furcation defects were surgically exposed. A notch was placed through the calculus on both the mesial and distal roots. The furcal area was root planed with diamond-tip ultrasonic instruments. The furcations were grafted with a combination of recombinant human platelet-derived growth factor and beta tricalcium phosphate. A collagen barrier for guided tissue regeneration was used on both the facial and lingual surfaces. The flaps were coronally positioned and sutured. All patients were followed at 2-week intervals for 6 months. At 6 months, all teeth demonstrated a reduction in probing depth and a gain in clinical attachment. One tooth demonstrated a Class II furcation involvement, while through-and-through furcation involvement was still evident on the other three experimental teeth. The teeth were removed en bloc and processed for histologic evaluation. Three root surfaces demonstrated periodontal regeneration, an additional three showed new attachment, and one surface revealed junctional epithelium as measured from the base of the calculus notch. The notch area could not be identified on one surface of one specimen.

This study evaluated the effectiveness of a mineralized cancellous bone allograft (Puros) for the treatment of human periodontal osseous defects. Twenty patients with chronic periodontitis each contributed at least one intrabony defect. The surgical procedure consisted of flap reflection, debridement of the defect, root planing, and placement of the bone graft in the defect, followed by flap closure. Clinical and surgical measurements were taken at baseline and at the 6-month surgical reentry. The average probing depth reduction was 4.8 +/- 1.3 mm and average gain in clinical attachment levels was 4.2 +/- 1.5 mm; both changes were statistically significant. The average percent bone fill was 66.8% +/- 26.2% and average percent defect resolution was 71.5% +/- 25.5%. Mineralized cancellous bone allograft appears to be an effective material for the treatment of osseous defects in patients with chronic periodontitis.

This study histologically evaluated recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in combination with beta-tricalcium phosphate (beta-TCP) for the treatment of human intraosseous periodontal defects. Eight patients, each with two teeth treatment planned for extraction, were enrolled. Presurgical measurements included probing depth, clinical attachment level, and recession. Initial surgery consisted of flap reflection, debridement, placement of a root notch through the base of calculus, scaling and root planing, root biomodification with 50 mg/mL tetracycline, grafting with rhPDGF-BB + beta-TCP, and complete wound closure. One tooth in each patient was treated with 0.3 mg/mL of rhPDGF-BB + beta-TCP, and the other tooth was treated with 1.0 mg/mL of rhPDGF-BB + beta-TCP. After a minimum of 6 months of healing, postsurgical clinical measurements were made, and teeth were removed en bloc. Soft tissue healing was uneventful. Histologic evaluation demonstrated new bone, cementum, and periodontal ligament coronal to the reference notch in 13 of the 16 teeth. Six of the eight 0.3-mg/mL sites and seven of the eight 1.0-mg/mL sites demonstrated periodontal regeneration. This study provides proof of principle that 0.3 mg/mL and 1.0 mg/mL of rhPDGF-BB and beta-TCP can promote periodontal regeneration in human intraosseous periodontal defects.

The objective of this study was to evaluate the potential of an allogeneic bone matrix (Grafton, Osteotech) to regenerate new bone, new cementum, and a new periodontal ligament around teeth previously contaminated by bacterial plaque. Four patients with chronic advanced periodontitis and who were scheduled for full-mouth extraction were enrolled in the study. One patient dropped out from the study before any therapy began. One tooth with an intraosseous defect in each patient was selected for treatment. Measurements of probing depth, gingival recession, and clinical attachment level were made. After flap reflection, a root notch was placed at the apical level of calculus, the root was debrided, and allogenic bone matrix was inserted into the defect. After 6 months of healing, the teeth were removed en bloc and evaluated histologically for a new attachment apparatus. Two of the three teeth demonstrated regeneration of new bone, cementum, and periodontal ligament.

The objective of this study was to quantify new bone formation from biopsies of demineralized freeze-dried bone allograft (DFDBA) and freeze-dried bone allograft (FDBA) following ridge and sinus augmentations. Ninety-three patients who received maxillary sinus or ridge augmentation grafts agreed to core biopsies of their grafts when the implants were placed. Samples ranged from 6 to 36 months postgrafting. These samples were sectioned, stained, and examined histomorphometrically Seventy-two FDBA and 21 DFDBA samples were examined, and the mean percentages of new bone formed were 41.89% and 41.74%, respectively. There was no statistical difference, irrespective of graft site.

This study evaluated an anorganic bovine-derived xenograft (Bio-Oss Collagen) in the treatment of human periodontal defects. Four patients with intrabony defects on teeth that were treatment planned for extraction were enrolled in the study. Presurgical measurements of probing depth, attachment level, and recession were recorded. The surgical procedure consisted of flap reflection, debridement of the osseous defects and root surface, placement of a notch through calculus into the root surface, topical application of a tetracycline paste to the root surface, grafting with Bio-Oss Collagen, and flap closure. Three of the eight defects examined received a resorbable collagen barrier (Bio-Gide) in addition to the bone graft. Patients were seen every 2 weeks for plaque control and review of oral hygiene measures. Six months postsurgery, clinical parameters were rerecorded prior to en bloc resection of teeth and adjacent graft sites. The majority of sites showed a favorable clinical response with respect to probing depth reduction and clinical attachment gain. Histologic analysis demonstrated new bone, cementum, and periodontal ligament coronal to the reference notch in two of the eight specimens. Two sites demonstrated new attachment, and four showed a long junctional epithelium. Periodontal regeneration is possible following a bone-replacement graft of Bio-Oss Collagen.

Various grafting materials have been used in guided bone regeneration procedures to augment alveolar ridges deficient in horizontal or vertical dimensions or both. Autogenous block grafts from intraoral and extraoral sites have been used for ridge augmentation with encouraging results. However, the risk of vascular and neurologic injury at the donor site as well as postoperative patient morbidity have been reported following these surgical procedures. The use of a cancellous block allograft could be one alternative to avoid potential donor site complications. Five deficient alveolar ridges in three patients were each grafted with a freeze-dried cancellous block allograft and a resorbable barrier membrane. Ridge measurements taken at baseline, graft placement, and a 6-month reentry surgery demonstrated an increase in alveolar ridge width from 2 to 4 mm. These gains in ridge width compare favorably with other guided bone regeneration studies, suggesting that a freeze-dried cancellous block allograft in conjunction with a resorbable membrane may be an acceptable alternative to the autogenous block graft in the treatment of compromised alveolar ridge deficiencies.

The purpose of this study was to evaluate the feasibility of using a bioactive alloplast and a physical barrier to augment localized alveolar ridge defects for the subsequent placement of dental implants. Twelve systemically healthy patients (aged 29 to 55 years) with inadequate dental alveolar ridge widths were selected for study. All patients completed initial therapy, which included scaling, root planing, and oral hygiene instruction. All ridge defects were augmented with a bioactive glass alloplast and a titanium-reinforced e-PTFE barrier. Vertical (height) and horizontal (width) hard tissue measurements were taken the day of ridge augmentation surgery (baseline) and at the 6-month reentry surgery. The change in ridge width varied from a loss of 1 mm to a gain of 4.5 mm, with a mean gain of 1.1 mm (P < .03). Eight of the 12 sites gained 1 mm or less. The difference in mean ridge width gain between maxillary and mandibular sites was not statistically significant (P > .08). Mean ridge width gain was 1.1 mm for both maxillary and mandibular sites. There was a loss in bone height of 0.3 mm from baseline. Four implants in four patients could not be placed because of inadequate ridge width augmentation. Histologic examination of the grafted sites revealed connective tissue encapsulation of most residual graft particles. In this study, bioactive glass particulate and an e-PTFE barrier did not consistently augment localized ridge defects for dental implant placement.

The purpose of this study was to evaluate the use of mineralized freeze-dried bone allograft (FDBA) in conjunction with a titanium-reinforced expanded polytetrafluoroethylene (TR e-PTFE) barrier in the treatment of localized alveolar ridge deficiencies prior to endosseous dental implant placement. Twelve patients (aged 23 to 65 years) requiring tooth replacement with ridge augmentation were recruited to participate in this study. During ridge augmentation surgery, measurements were made prior to grafting with FDBA plus a TR e-PTFE barrier. Six months later, ridge measurements were repeated, and suitability for implant placement was assessed. At each implant site, a biopsy was taken from the grafted site. The implants were placed and allowed to osseointegrate for 13 weeks prior to phase-two surgery. Clinical data analyzed were horizontal ridge width changes and vertical ridge height changes. Histologic evaluation revealed the formation of new bone and residual particles in each graft site at the time of implant placement Ten patients completed the study. The mean alveolar ridge width increased by 3.2 +/- 1.0 mm (P < .0005). Histomorphometric analysis revealed a range of new bone from 42.9% to 70.5%, with a mean of 47.6%. Graft particles remaining ranged from 29.5% to 57.1%, with a mean of 52.4%. The clinical and histologic findings of this study demonstrate that sites grafted with FDBA in conjunction with an e-PTFE barrier can provide a predictable way to augment deficient alveolar ridges prior to implant placement.