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Background: In guided tissue regenerative surgery, membrane perforations may serve as a mechanism for the passage of cells and biologic mediators from the periosteum and overlying gingival connective tissue into the periodontal defects. To test this assumption, this study was designed to evaluate levels of bone morphogenetic protein-2 (BMP-2) in gingival crevicular fluid (GCF) during the early stages of healing for sites treated with modified perforated membranes (MPMs) as compared with occlusive membranes (OMs)., Methods: Fifteen non-smoking patients with severe chronic periodontitis participated in this prospective, randomized and single-blinded clinical trial. Each patient contributed two interproximal contralateral defects that were randomly assigned to either an experimental modified perforated membrane group (15 sites) or a control occlusive membrane group (15 sites). Plaque index, gingival index, probing depth(PD), clinical attachment level (CAL) and the relative intrabony depth of the defect (rIBD) were measured at baseline and reassessed at three, six and nine months after therapy. Gingival crevicular fluid samples were collected on day 1 and 3, 7, 14, 21, and 30 days after therapy., Results: The MPM-treated group showed a statistically significant improvement in PD reduction and clinical attachment gain compared to the OM control group. Similarly, rIBD was significantly reduced in MPM-treated sites as compared with those of the OM group. BMP-2 concentrations peaked in the MPM samples obtained during the early postoperative period (days 1, 3 and 7) with a statistically significant difference compared with OM-treated groups. BMP-2 levels decreased sharply in the samples obtained at days 14, 21 and 30 with non-significant higher levels in MPM samples as compared with those of OM sites., Conclusion: Within the limits of the present study, one can conclude that MPM coverage of periodontal defects is associated with a significant initial increase in GCF levels of BMP-2, a factor that could improve the clinical outcomes of guided tissue regenerative surgery.

After tooth extraction, varying amounts of bone resorption occur because of qualitative and quantitative changes at the edentulous site of the alveolar process. The aims of this randomized controlled clinical trial were (1) to compare the postextraction changes in residual ridge dimensions during spontaneous healing with those during socket preservation, (2) to analyze the histologic and histomorphometric aspects of the grafted sockets, and (3) to compare probing procket depth (PPD) and clinical attachment level (CAL) changes at teeth adjacent to extraction sites. Forty-eight teeth were extracted from 41 patients referred for extraction of 1 or more maxillary or mandibular premolars or molars. The edentulous sites were randomly assigned to the control (EXT, extraction alone) or experimental groups (SP, extraction and socket preservation). In the SP group, the sockets were filled with bovine bone mineral and covered with porcine collagen membrane. At baseline and after 4 months, PPD, gingival recession (REC), and CAL were measured at teeth adjacent to the edentulous sites. The changes in ridge dimensions from baseline to 4 months were assessed on dental casts. At 4 months, bone was harvested from the grafted areas in the SP group and the edentulous areas in the EXT group. PPD, REC, and CAL were comparable between groups. However, from baseline to 4 months, the SP group showed significantly less reduction in ridge width (1.04 ± 1.08 mm vs 4.48 ± 0.65 mm, P < .001) and height (0.46 ± 0.46 mm vs 1.54 ± 0.33 mm, P < .001). Histologically, the grafted sockets exhibited various stages of bone maturation and formation without inflammatory responses. No significant difference in the mineralized and nonmineralized fractions was noted between the groups. Socket preservation using bovine bone mineral and porcine collagen membrane considerably limits the amount of horizontal and vertical bone resorption when compared with extraction alone.

Background: Regenerative periodontal therapy using platelet-rich plasma (PRP) and different types of bone substitutes with or without guided tissue regeneration (GTR) has been proposed as a modality to enhance the outcome of regenerative surgery. However, there are limited data from controlled clinical studies evaluating the effect of PRP on the healing of deep intrabony defects treated with a combination of bone substitutes and GTR. The aim of this study was to clinically evaluate the effect of PRP on the healing of deep intrabony defects treated with beta tricalcium phosphate (beta-TCP) and GTR by means of a non-bioresorbable expanded polytetrafluoroethylene membrane., Methods: Twenty-eight subjects with advanced chronic periodontal disease and displaying one intrabony defect were treated randomly with a combination of PRP + beta-TCP + GTR or beta-TCP + GTR. Plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL) were evaluated at baseline and at 1 year after treatment. CAL was the primary outcome variable., Results: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all subjects. At 1 year after therapy, the sites treated with PRP + beta-TCP + GTR showed a reduction in mean PD from 9.1 +/- 0.6 mm to 3.3 +/- 0.5 mm (P <0.001) and a change in mean CAL from 10.1 +/- 1.3 mm to 5.7 +/- 1.1 mm (P <0.001). In the group treated with beta-TCP + GTR, mean PD was reduced from 9.0 +/- 0.8 mm to 3.6 +/- 0.9 mm (P <0.001), and the mean CAL changed from 9.9 +/- 1.0 mm to 5.9 +/- 1.2 mm (P <0.001). In both groups, all sites gained > or =3 mm of CAL. CAL gains > or =4 mm were noted in 86% (12 of 14 defects) of the cases treated with PRP + beta-TCP + GTR and in 79% (11 of 14 defects) of those treated with beta-TCP + GTR. No statistically significant differences in any of the investigated parameters were observed between the two groups at the 1-year reevaluation., Conclusion: At 1 year after surgery, both therapies resulted in significant PD reductions and CAL gains.

Aim: : The purpose of the present study was to compare clinically the treatment of deep intrabony defects with a combination of a bovine-derived xenograft (BDX) and a bioresorbable collagen membrane to access flap surgery., Methods: : Twenty-eight patients suffering from chronic periodontitis, and each of whom displayed one intrabony defect, were randomly treated with BDX + collagen membrane (test) or with access flap surgery (control). Soft tissue measurements were made at baseline and at 1 year following therapy., Results: : No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) from 9.2+/-1.3 to 3.9+/-0.7 mm (p<0.001) and a change in mean clinical attachment level (CAL) from 10.2+/-1.5 to 6.2+/-0.5 mm (p<0.0001). In the control group, the mean PD was reduced from 9.0+/-1.2 to 5.2+/-1.8 mm (p<0.001) and the mean CAL changed from 10.5+/-1.5 to 8.4+/-2.1 mm (p<0.01). The test treatment resulted in statistically higher PD reductions (p

The present study was planned to assess the capacity of a resorbable collagen membrane enriched with fibronectin to prevent the apical migration of epithelium and to facilitate new attachment and new bone. Experimental osseous dehiscence defects were produced on the bilateral labial aspect of mandibular 2nd, 3rd and 4th premolar teeth in six mongrel dogs. Guided tissue regeneration therapy using collagen membranes, which were rehydrated with fibronectin solution, was performed on one quadrant (group A). In the contralateral quadrant, the same collagen membranes, but rehydrated only with saline (group B), were placed over the bony defects. The third premolar teeth, which were treated by open-flap debridement, served as control (group C). Flaps were positioned slightly coronally and sutured; sutures were removed 10 days later. The dogs were killed 30 days after reconstructive therapy. Tissue blocks containing the experimental and control teeth were excised, demineralized in EDTA, and embedded in paraffin. Histological and histometric evaluation revealed that all groups demonstrated similar effects on preventing the down-growth of epithelium and formation of new cementum and new bone. Collagen membranes were tolerated well within the tissues, and membrane remnants were identified at 30 days. In summary, this study indicated that in this dog model similar healing results could be achieved with a bovine type I collagen membrane with or without fibronectin solution and open-flap debridement.

Histological and morphometric assessment of periradicular wound healing was made after the use of a bioresorbable membrane over a buccal dehiscence. The third and fourth premolar teeth of nine dogs were resected and buccal defects created. Teeth were assigned randomly to the membrane or control group. One tooth in each quadrant received a membrane, covering both roots. The other tooth received no further treatment and served as a control. The animals were killed and specimens were assessed at two time periods: 9 wk and 27 wk. The 27-wk membrane group exhibited significantly more (p = 0.004) connective tissue height than the control group or either of the 9-wk groups. The amount of regenerated alveolar bone was significantly greater for the 27-wk membrane group than for the control (p = 0.001) and 9-wk groups. Mean junctional epithelium measurements were significantly greater (p = 0.012) for the control. The use of a bioresorbable membrane enhances bone regeneration when a buccal defect exists at the time of periradicular surgery.

This study evaluated the clinical, radiographic, and histologic response to the composite use of Bio-Oss porous bone mineral and autogenous bone in combination with a Bio-Gide bilayer collagen membrane to achieve regeneration when treating human periodontal bone defects. Preoperative recordings for four treatment areas included radiographs, clinical probing depths, and attachment levels; these recordings were repeated at 9 months. Histologic evaluation revealed new cementum with inserting collagen fibers and new bone formation on the surface of both types of graft materials. This grafting combination not only compared favorably with the previous use of Bio-Oss and Bio-Gide, but exceeded that result with almost complete periodontal regeneration. This human histologic study demonstrates that autogenous bone in combination with porous bone mineral matrix, together with the Bio-Gide collagen membrane, has the capacity to stimulate substantial new bone and cementum formation with Sharpey's fiber attachment.

The purpose of this study was to compare Bio-Oss (BO), an anorganic bovine bone xenograft, in combination with Bio-Gide (BG), a bioabsorbable collagen barrier, to open-flap debridement (OFD) surgery in human mandibular Class II furcation defects. A total of 31 furcations (18 treatment, 13 control) in 21 patients were treated. There was a statistically significant improvement in most clinical indices for the BO/BG group, with minimal improvement noted for the OFD group. Vertical probing depth reduction of 2.0 mm and horizontal probing depth reduction of 2.2 mm were noted for the BO/BG group, with 0.3 mm and 0.2 mm reductions, respectively, noted for OFD. Hard tissue measurements showed 2.0 mm of vertical furcation bone fill for BO/BG and 0.5 mm for OFD. The BO/BG group had 3.0 mm of horizontal furcation bone fill, and the OFD group had 0.9 mm. The BO/BG group had a defect resolution of 82.7%; 42.5% was noted for the OFD group. There was a statistically significant difference between BO/BG and OFD in all soft and hard tissue measurements with the exception of attachment level, recession, and alveolar crest resorption.

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

Background: The use of barrier membranes in the treatment of periodontal defects is well documented. There has been an increase in the use of bioabsorbable materials which do not require a second surgical procedure for removal. However, there are little data evaluating the efficacy of bioabsorbable membranes in the treatment of intrabony defects. The purpose of this investigation was to evaluate the regenerative potential of 2 bioabsorbable barrier membranes without the use of grafting materials in the treatment of interdental intrabony defects., Methods: Twenty-three 2- or 3-walled intrabony defects were treated in 19 patients with a mean age of 50.4 years. All had completed nonsurgical treatment and a period of supportive periodontal therapy. The sites were randomly chosen to receive a barrier membrane composed of type I bovine collagen (11) or a copolymer of polylactic acid (PGA/PLA;12). A pressure sensitive disc probe was used to evaluate the following criteria at baseline and re-entry: 1) occlusal surface to the apical depth of probe penetration (OS-DP); 2) occlusal surface to the gingival margin (OS-GM); 3) occlusal surface to the alveolar crest (OS-AC); and 4) occlusal surface to the base of the osseous defect (OS-BD). Full thickness mucoperiosteal flaps were reflected to expose the surgical sites. The defects were debrided of the granulomatous tissue, the root surfaces instrumented and conditioned with 4 one-minute applications of 50 mg/ml of tetracycline. The barrier membranes were adapted to cover the defects and the flaps replaced. The postsurgical healing was uneventful and similar in both treatment modalities., Results: Twenty-three sites were surgically re-entered 6 months from the time of the initial surgery. The deepest probe depth for each site was used for statistical analysis. There was a mean relative attachment gain of 2.58+/-1.90 mm for the collagen, and 2.77+/-2.13 mm for the copolymer. There was a decrease in probing depth of 3.27+/-1.91 mm and 0.69+/-1.35 mm of recession for the collagen. The PGA/PLA copolymer had 3.55+/-2.47 mm reduction in probe depth and 0.78+/-1.14 mm of recession., Conclusions: The data indicated the bioabsorbable collagen and copolymer membranes resulted in comparable results. A larger sample size would be necessary to determine if one membrane was superior to the other.

Background: Bacterial contamination of membrane material negatively affects healing after guided tissue regeneration (GTR) procedures; conversely, flap connective tissue integration on barrier material improves the clinical outcomes. The objective of this study was to evaluate the effect of topical application of antibiotics on: 1) clinical outcomes of GTR surgical procedures using titanium reinforced expanded polytetrafluoroethylene (ePTFE) periodontal membrane; 2) bacterial colonization of membrane material; and 3) flap connective tissue-membrane integration., Methods: Fifty-six deep interproximal bony defects were treated with GTR surgical procedures using titanium reinforced ePTFE periodontal membranes. Patients were randomly assigned to 1 of the 2 antimicrobial treatment groups: the test group received weekly topical application of 25% metronidazole gel and the control group received systemic antibiotics (amoxicillin plus clavulanic acid 1 g/day for 14 days). Clinical outcomes were assessed at 1 year; the amount of bacterial contamination and connective tissue integration on membrane material was evaluated at time of membrane removal by means of a morphological (SEM) method., Results: No statistically significant difference was found between test and control groups in terms of clinical attachment (CAL) gain (baseline CAL - 12 months CAL; P = 0.2) and probing depth (PD) reduction (baseline PD - 12 months PD; P = 0.6). A greater increase in gingival recession (REC) (12 months REC - baseline REC) was found in the test group compared to the control group (P = 0.003). The SEM analysis revealed no statistically significant (t test) difference between test and control groups in the number of fields positive to integrated connective tissue (P = 0.82), while the number of fields positive to bacteria was statistically higher (P < 0.001) in the control group., Conclusions: Local antibiotic administration is more effective than systemic use in preventing membrane contamination, but it does not improve clinical outcomes due to an interference of the vehicle (gel) with gingival tissues which may reduce the potential benefits derived from better control of the bacterial load.

Background: Enamel matrix proteins (EMP) have recently been introduced as a new modality for regenerative periodontal treatment. However, limited information is available concerning the comparison of the treatment of intrabony periodontal defects with enamel matrix proteins and other regenerative treatment alternatives., Methods: The aim of the present controlled clinical trial was to compare the treatment of deep intrabony periodontal defects with EMP to that with guided tissue regeneration (GTR) with bioabsorbable membranes. Sixteen patients, each of whom displayed one pair of intrabony defects located contralaterally in the same jaw, were randomly treated with EMP or with a bioabsorbable membrane. Prior to surgery and 8 months later the following parameters were evaluated by a blinded examiner: Plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Antibiotics (amoxicillin and metronidazole) were given during the first 10 days after surgery. No statistical significant differences in any of the investigated parameters between the 2 groups were observed at baseline., Results: No serious adverse events (e.g., allergic reactions or abscesses) after any of the treatments were noted during the entire observation period. Membrane exposure occurred in 7 out of the 16 GTR treated sites. Clinical examination was performed again 8 months postoperatively. Sites treated with EMP demonstrated a reduction of PD from 8.1+/-1.7 mm to 4.3+/-1.2 mm (P <0.001) and a change in CAL from 10.3+/-1.8 mm to 7.2+/-1.2 mm (P <0.001). The sites treated with GTR showed a reduction of PD from 8.3+/-1.7 mm to 4.3+/-0.7 mm (P <0.001) and a change of CAL from 10.1+/-1.9 mm to 7.1+/-1.7 mm (P <0.001). Both treatment procedures led to significant improvements of PD and CAL. However, no statistically significant differences in any of the investigated parameters were observed between the test and control group., Conclusions: It may be concluded that both therapies led to shortterm improvements of the investigated clinical parameters. Further studies of much higher power are needed to support equivalence.

This study evaluated whether differences in design of 3-dimensional polylactic acid barriers (EPi-Guide and Guidor) would influence hard tissue results in the treatment of Grade II furcations in humans. A multicenter study was conducted, using 40 patients with moderate to advanced bilateral chronic adult periodontitis of the mandibular first or second molars. After flap access, debridement, and root preparation, surgical bone level measurements were taken and membranes were placed on a random basis. Surgical reentry occurred at 1 year. Data collected from all 3 investigative centers were pooled and analyzed using an analysis of variance appropriate for a counterbalancing design. Both barrier materials resulted in significant gains of attachment level and defect reduction. The composite reduction in the vertical component of the osseous defects was greater in the sites treated with Epi-Guide as compared to those treated with Guidor; the difference between barriers reached statistical significance (P = 0.02).

THIS RANDOMIZED, CONTROLLED, CLINICAL STUDY was designed to evaluate outcome following surgical implantation of an allogeneic, freeze-dried, demineralized bone matrix-calcium sulfate (DBM+CS) composite with a CS barrier in intrabony periodontal defects. Twenty-six patients contributing 26 deep intrabony defects completed the study. Thirteen patients received the DBM+CS implant. Thirteen patients received gingival flap surgery alone (GFS; control). Clinical outcome was assessed at 6 and 12 months postsurgery. At 12 months postsurgery, probing depth (PD) reduction (mean +/-SD) for the DBM+CS and GFS group was to 4.3+/-0.5 and 3.0+/-1.3 mm; clinical attachment gain was to 2.9+/-0.8 and 1.7+/-1.5 mm; and probing bone level gain was to 2.9+/-1.4 and 1.2+/-1.2 mm, respectively. There were no apparent differences between evaluations at 6 and 12 months postsurgery. Clinical improvements were significantly different from presurgery for both groups at both observation intervals (P < 0.01). There were no significant differences between groups in PD reduction and clinical attachment gain. Probing bone level gain was significantly greater in the DBM+CS group compared to controls (P < 0.05). In summary, surgical implantation of DBM+CS with a CS barrier resulted in reduced PD and improved attachment levels comparable to that achieved by gingival flap surgery alone. However, gain in probing bone levels in deep intrabony periodontal pockets assessed by clinical parameters was greater than that observed by gingival flap surgery alone. These changes were noted at both 6 and 12 months after surgery. This regenerative technique needs further biologic evaluation before being generally accepted.

This prospective multicenter intra-individual randomized controlled clinical trial was designed to compare the efficacy of guided tissue regeneration (GTR) with bioresorbable barrier membranes versus access flap surgery, in intrabony defects. 2 similar defects were selected in each of 23 patients and randomly assigned to 1 of the 2 treatments. Surgery consisted of an identical procedure except for the omission of the barrier membrane in the flap control sites. At 1-year, probing pocket depth reductions were 4.3+/-2.3 mm in GTR treated sites and 3.0+/-1.5 mm in the flap control sites (p=0.02, paired t-test). Clinical attachment level (CAL) gains were 3.0+/-1.7 mm in the GTR sites and 1.6+/-1.8 mm in the control sites (p=0.009, paired t-test). A subset analysis, performed according to the initial depth of the intrabony component of the defects (INFRA), indicated that in shallow defects (INFRA < or =3 mm) treated with the access flap alone, CAL gains were 1+/-1.5 mm, while in deep ones (INFRA > or =4 mm) they were consistently greater (1.9+/-1.9 mm). The % CAL gains, calculated as the % of the baseline intrabony component depth, however, were almost identical in the 2 subpopulations (45.8+/-64.7% in shallow and 43.8+/-37.6% in deep defects). Similarly, in the GTR sites, linear CAL gains were greater in deep (3.7+/-1.7 mm) than in shallow defects (2.2+/-1.3 mm), but no differences were observed in terms of % CAL gains (76.7+/-27.7% and 75.8+/-45%, respectively). The frequency distribution of CAL changes expressed as %s of the baseline INFRA indicates that most of the sites treated with GTR (73% in shallow and 92% in deep defects) gained 50% or more CAL. Furthermore, many defects (64% of shallow and 33% of deep defects) reached 100% of CAL gain. The present study demonstrated that: (i) GTR with bioresorbable barrier membranes resulted in a significant added benefit in comparison with access flap alone; (ii) the linear amounts of CAL gains were greater in deep than in shallow defects; (iii) CAL gains expressed as %s of the baseline depths of the intrabony component, were similar in shallow and deep defects; (iii) the regenerative procedure tested in the present study resulted in CAL gains equal to the depth of the intrabony component of the defect in some, but not in most of the instances.

This study evaluated the clinical, radiographic, and histologic response to Bio-Oss porous bone mineral when used alone or in combination with Bio-Gide bilayer collagen membrane in human periodontal defects. Four intrabony periodontal defects were treated: two received Bio-Oss alone and two were treated with a combination of Bio-Oss and Bio-Gide. Radiographs, clinical probing depths and attachment levels were obtained preoperatively and 6 to 9 months postoperative, and teeth and surrounding tissues were biopsied. Both treatments significantly improved clinical probing depths and attachment levels, and the radiographic appearance suggested osseous fill. Histologic evaluation revealed that both treatments produced new cementum with inserting collagen fibers and new bone formation on the surface of the graft particles; this regenerative effect was more pronounced using the Bio-Oss/Bio-Gide combination, which resulted in 7 mm of new cementum and periodontal ligament and extensive new bone incorporating the graft. The membrane was intact at 7 months and partially degraded by 9 months after treatment. This human histologic study demonstrates that the porous bone mineral matrix used has the capacity to stimulate substantial new bone and cementum formation and that this capacity is further increased when the graft is used with a slowly resorbing collagen membrane.

The aim of this controlled, clinical study was to evaluate guided tissue regeneration using a bioabsorbable membrane in periodontal intraosseous defects. Forty patients, each contributing one defect > or =4 mm in depth participated. The control group (18 individuals) received conventional flap therapy, while the test group (22 individuals) was treated using the bioabsorbable membrane, Guidor. Clinical assessments were made by one examiner, blinded with respect to treatment group, at baseline, 6 and 12 months following surgery. Baseline probing pocket depths of 7.7+/-1.4 mm in the membrane group and 7.6+/-1.9 mm in the control group were measured. Twelve month results showed a significant clinical attachment level gain in both control (1.1+/-1.8 mm), and membrane group (1.3+/-2.1 mm). Probing pocket depth reduction of 2.6+/-1.9 mm and 2.7+/-1.9 mm was observed in the respective groups. Bone sounding showed a non-significant gain of 0.4+/-1.8 mm and 0.6+/-1.4 mm at membrane and control sites, respectively. Radiographic evaluation confirmed these results. There were no significant differences found between treatment groups for any of the tested variables. Smoking had a negative effect on healing in both groups. In conclusion, clinical and radiographic results indicate that guided tissue regeneration using a bioabsorbable membrane at intraosseous defects did not predictably achieve greater clinical attachment level gain nor bone gain when compared to conventional flap therapy.

This prospective split-mouth study was designed to compare the clinical and radiographic healing results in intrabony periodontal defects 12 months after GTR therapy with 2 different bioresorbable barriers. The study comprised 25 healthy patients with one pair of contralaterally located intrabony defects with a probing pocket depth of > or = 6 mm and radiographic evidence of angular bone loss of > or = 4 mm. The 2 defects of each patient were randomized for treatment either with polylactic acid (PLA) membranes or with polyglactin-910 (PG-910) membranes. The patients received systemic doxycycline (100 mg/d) for 11 days postoperatively. One blinded examiner recorded the following clinical parameters using a pressure calibrated probe at baseline and after 12 months: papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), and probing attachment level (PAL). The vertical relative attachment gain (V-rAG) was calculated as a % of the PAL gain related to the maximum possible attachment gain (expressed by the intraoperatively measured depth of the osseous defect). Geometrically standardized intraoral radiographs were quantitatively evaluated for bone changes (density, area) in the defect region using digital subtraction radiography (DSR). Clinical and radiographic data were statistically analyzed using the Wilcoxon-signed-rank test (alpha=0.05). Postoperative membrane exposures occurred in 9 PLA and 13 PG-910 treated sites. After 12 months of healing, both barrier types provided significant PPD reductions and PAL gain [median (25/75 percentile)]: deltaPPD [PLA: 3.0 (2.0/4.0) mm; PG-910: 3.0 (2.0/4.5) mm]; deltaPAL [PLA: 3.0 (2.5/4.0) mm; PG-910: 2.0 (1.0/4.0) mm]. V-rAG amounted to 60% in PLA sites and 54% in PG-910 sites. DSR revealed significant bone density gain after 12 months. 58.3% of the initial defect area in PLA sites and 54.0% of the initial defect area in PG-910 sites showed bone density gain. Neither clinical nor radiographic data revealed any significant difference between the 2 barrier types after 12 months. In conclusion, this 12-month study demonstrated that PLA and PG-910 membranes provided similar favorable regeneration results in deep intrabony periodontal defects.

The purpose of this study was to determine the types of inflammatory cells and bacterial contamination on expanded polytetrafluoroethylene (ePTFE) membranes which might affect new tissue formed by guided tissue regeneration (GTR). Forty periodontal bony defects were treated by the flap procedure, which included the use of an ePTFE membrane. Twelve months after the second surgery, the defect sites were re-evaluated for changes in probing depth and clinical attachment level. The ePTFE membranes were retrieved after 4 to 6 weeks of healing and sectioned serially at 3 microm in a coronal-apical plane. The ePTFE membrane was divided into 3 portions: cervical, middle, and apical, each of which was subdivided into outer, central, and inner segments, providing a total of 9 fields. Cells and bacteria were analyzed by light microscopy for their types: mononuclear cell, erythrocyte, fibroblast, neutrophil, plasma cell, T lymphocyte, B lymphocyte, macrophage, and oral bacteria. Both cells and bacteria decreased in number towards the apical portion and were present even in the central part. Most cells were mononuclear cells. Erythrocytes, fibroblasts, neutrophils, and plasma cells were rarely encountered. Bacteria, most of which were Gram-positive, were observed in almost the same number in the outer and inner parts. The results indicate that numerous inflammatory cells adhered to and invaded the ePTFE membranes accompanied by bacterial contamination and that there was a tendency for a negative correlation between the increment number of bacteria and the gain of clinical attachment level.

The configuration of the barrier devices to treat interproximal defects by guided tissue regeneration (GTR) necessitates inclusion of healthy adjacent teeth to secure the barriers in place. The purpose of this study was to evaluate the effects of expanded polytetrafluoroethylene (ePTFE) and polylactic acid (PLA) barrier devices on probing depth (PD), clinical attachment level (CAL), and crestal bone height in healthy sites. The study included 30 patients who were in an earlier study which compared the effects of GTR utilizing an ePTFE or a PLA barrier in intrabony defects. Thirty defects were randomly assigned to receive either a PLA (test) or an ePTFE barrier (control) after open flap debridement. The sites in this investigation included those healthy sites in the immediately adjacent non-affected teeth covered by the barriers. CAL and PD were measured at baseline and 12 months. Intrasurgical crestal bone height was recorded at the time of barrier placement and at a 12-month re-entry. Two-sample t-test comparisons of PD and CAL measurements between barrier device covered sites at baseline (PD: ePTFE, 2.32+/-0.51; PLA, 2.59+/-0.74; CAL: ePTFE, 2.71+/-0.66; PLA, 2.59+/-0.65 mm), and at one year (PD: ePTFE, 2.14+/-0.37; PLA, 2.07+/-0.56; CAL: ePTFE, 3.14+/-1.05; PLA, 2.75+/-0.73 mm) were not statistically different (P > 0.05). Paired t-test was utilized to compare changes in PD, CAL, and crestal bone height from baseline to 12 months. A statistically significant reduction in PD was found in the PLA group (delta = -0.52, P = 0.01) while no significant change was found in the ePTFE group (delta = -0.18, P = 0.18). Change in CAL was statistically significant in the ePTFE group (delta = 0.43, P = 0.02) while no significant change was found in the PLA group (delta = 0.16, P = 0.39). Crestal bone height changes from baseline to 12 months were statistically different for both groups (ePTFE, delta = 0.8 mm, P = 0.001; PLA, delta = 0.6 mm, P = 0.001). These resorptive changes, when compared between treatment groups were not statistically different (P > 0.05). In conclusion, the placement of ePTFE or PLA barriers on healthy sites resulted in probing depth reductions and loss of attachment of 0.5 mm or less. Additionally, both groups exhibited less than 1.0 mm of crestal bone resorption.

The purpose of this study was to compare the clinical results of guided periodontal tissue regeneration (GPTR) using a resorbable barrier manufactured from a copolymer of polylactic and polyglycolic acids (Resolut Regenerative Material) with those of non-resorbable e-PTFE barrier (Gore-Tex Periodontal Material). 12 subjects participated, 6 with similarly paired class II furcations and 6 with 2 similar 2, 3-wall periodontal lesions. The resorbable and non-resorbable barriers were randomly assigned to 1 defect in each subject. Non-resorbable barriers were removed in six weeks. Plaque index (PlI), gingival index (GI), probing depth (PD), clinical attachment level (CAL) and gingival recession (R) were recorded at baseline, (i.e., immediately prior to surgery) and at 12 months postsurgically. The clinical healing was similar and uneventful in both groups. Intrabony pockets depicted significant changes from baseline (p < 0.05) for probing depth reduction and gain in clinical attachment levels. No differences were found between treatments. Class II furcations showed significant improvements from baseline (p < or = 0.05) for probing depth reduction and clinical attachment gain. No differences were detected between treatments. It is concluded that the resorbable barrier tested is as effective as the nonresorbable e-PTFE barrier for the treatment of class II furcations and intrabony defects.

The objective of this study was to evaluate the relationship between integrated connective tissue (ICT), that is, the presence of connective tissue into the membrane structure, and the clinical outcome of membrane-supported periodontal surgery. Twenty-six systemically healthy subjects affected by chronic adult periodontitis were enrolled in the study. One tooth site per patient, associated with an angular bony defect and an attachment loss of > 7 mm, was selected to be treated by means of a guided tissue regeneration procedure using a bioabsorbable membrane. Barrier material was surgically removed after 4 weeks for SEM analysis. For each treated site, the difference in clinical attachment loss, probing depth, and gingival recession between the baseline examination and follow-up 6 months after the second surgery was calculated. Gain of attachment was statistically (P < 0.001) greater in sites with no membrane exposure when compared to sites with exposed barrier material (5.5 +/- 1.0 vs. 4.0 +/- 0.6), while further gingival recession was greater (3.0 +/- 0.9 vs. 2.1 +/- 0.5) in sites with clinically exposed membranes. The results of SEM analysis revealed that when connective tissue structures were observed on membrane surfaces, no bacteria could be detected; conversely, areas heavily colonized by bacteria did not show the presence of connective tissue. Regression analysis indicated that integrated connective tissue on the external layer of the barrier material was positively correlated with the amount of attachment gain and negatively with the amount of gingival recession. Bacterial colonization of the membrane was negatively correlated with attachment gain and positively with gingival recession. It was concluded that connective tissue integration is an important biological phenomenon in preventing membrane exposure and bacterial plaque colonization and thus in enhancing the clinical outcome following guided tissue regeneration surgery.

Guided tissue regeneration (GTR) is a clinical procedure used to restore the attachment apparatus of periodontally diseased teeth. Guided bone regeneration (GBR) is a similar procedure used to augment bone of edentulous ridges. Both therapies enhance the ability of regenerative cells to repopulate wounds by using expanded polytetrafluoroethylene (ePTFE) membranes to exclude gingival fibroblasts and keratinocytes from the healing site. Cells were isolated from 12 membranes used in each procedure and screened for the ability to form mineralized nodules in vitro, a property of cells with osteogenic potential. Using zymography and reverse zymography, low-passage isolates of cells which formed nodules were examined for the expression of gelatinolytic and caseinolytic proteases as well as for proteinase inhibitors. These molecular data were then compared with clinical outcomes for each procedure. Cells isolated from regenerative membranes exhibited variable expression of 72 kDa gelatinase, fibroblast collagenase, stromelysin, tissue inhibitor of metalloproteinases (TIMP-1), and other unidentified proteases. The greatest proportion of clinical failures was associated with GTR therapy. Cells from GTR membranes which did not exhibit gains in clinical attachment often exhibited aberrant proteinase profiles. When compared with cells from GBR procedures, most cells from GTR procedures also secreted lower amounts of TIMP-1. The study shows that cells isolated from regenerative procedures produce degradative enzymes in vitro which may be related to the success or failure of the regenerative process in vivo. Generally, cells from unsuccessful GTR procedures produced low molecular weight gelatinases not associated with cells from successful cases.

The use of guided tissue regeneration (GTR) procedures in the treatment of gingival recession has shown promising results and is gaining clinical acceptance. The purpose of this study was to assess the use of a bioabsorbable collagen membrane as a barrier device in root coverage treatment of gingival recession defects. The study consisted of 10 patients with 10 defects of either Miller Class I or II description and gingival recession > or =2.5 mm. Clinical measurements taken at baseline included plaque index (PI) and gingival index (GI), clinical attachment level (CAL) measured with an automated probe and reference stent, recession depth (RD; mean = 3.19 +/- 0.26 mm), recession width (RW; 3.95 +/- 0.41 mm), probing depth (PD; 2.3 +/- 0.2 mm), and width of keratinized tissue (KT; 2.4 +/- 0.3 mm); measurements were repeated at 1, 2, and 4 weeks and 3 and 6 months post-treatment. During the surgical procedure, a mucoperiosteal flap was elevated and the respective root thoroughly planed. The collagen membrane was cut to cover the defect and surrounding bone, positioned over the root, and secured with 5-0 gut interdental sutures. The flap was coronally positioned to cover the membrane and sutured with 5-0 silk. Data were analyzed using the Student paired t-test to compare pre- and postsurgery measurements. The nonparametric Wilcoxon matched pairs test was used to analyze the significance of PI and GI at different time intervals. A statistically significant (P < 0.01) reduction in RD (-1.66 +/- 0.25 mm) was observed at 6 months, representing 51.6% total attainable root coverage. Clinically, a statistically significant mean gain of 1.34 +/- 0.47 mm CAL and 0.90 +/- 0.32 mm KT was observed at 6 months. No statistical differences were found in PD and RW between baseline and 6 months postoperatively. PI and GI remained low and showed no statistically significant change (P < 0.05) throughout the study period. Results from this study suggest that a collagen membrane can be used successfully as a barrier device in GTR-based root coverage procedures.

This study, confined to non-smokers, evaluated guided-tissue regeneration in deep 2-wall intrabony defects using a diphenylphosphorylazide-cross-linked bovine type I collagen membrane supported by a hydroxyapatite/collagen/chondroitin-sulfate spacer in 43 adult periodontitis (AP) and 14 rapidly progressive periodontitis (RPP) patients, no more than 1 defect being randomly selected for each patient. Before surgery and 6 months after surgery, plaque (PI) and sulcus bleeding (SBI) indices, probing pocket depths (PPD), gingival margin locations (GML) and probing attachment levels (PAL) were recorded. During the post-surgical period, the biomaterials were well tolerated in all patients and PI and SBI were kept at a low level. Following therapy, there was a significant gain in PAL (4.2 mm for AP; 3 mm for RPP) and reduction in PPD (6.1 mm for AP; 4.7 mm for RPP) for both groups of patients (p < 0.05). A significantly greater gain in PAL and reduction in PPD were observed for AP compared to RPP patients (p < 0.05). The change in GML was not statistically different between groups (1.8 mm for AP; 1.6 mm for RPP). It is concluded that the combined use of a diphenylphosphorylazide-cross-linked bovine type-I collagen membrane, supported by a hydroxyapatite/collagen/chondroitin-sulfate spacer, is beneficial in improving PAL and reducing PPD in 2-wall intrabony defects in both AP and RPP patients during the quiescent phase of the disease, with statistically better results for the former group. However, longer observation periods are necessary to evaluate the stability of the improvements obtained by this combined treatment approach between and for each group of patients.

This study, confined to non-smokers, evaluated guided tissue regeneration using a diphenylphosphorylazide-cross-linked bovine type I collagen membrane in deep 3-wall intrabony defects in 52 adult periodontitis (AP) and 16-rapidly progressive periodontitis (RPP) patients, previously treated for the acute phase of the disease, no more than one defect being randomly selected for each patient. Before surgery and 6 months after surgery, plaque (PI) and sulcus bleeding (SBI) indices, as well as probing pocket depths (PPD), gingival margin locations (GML) and probing attachment levels (PAL) were recorded. During the post-surgical period, the membranes were very well tolerated in all patients and PI and SBI were kept at a low level. 6 months post-surgical, there was a significant gain in PAL (3.6 mm for AP; 2.6 mm for RPP) and reduction in PPD (5.5 mm for AP; 4.1 mm for RPP) for both groups of patients (p < 0.05). However, neither the change in GML (1.9 mm for AP; 1.5 mm for RPP), nor PPD or PAL yielded a statistically significant difference between AP and RPP patients. The results of this study demonstrated that the treatment of deep 3-wall intrabony defects with a diphenylphosphorylazide-cross-linked collagen membrane in both AP and RPP patients during the quiescent phase of the disease is a treatment modality where the conquences are predictable. However, longer observation periods are necessary to evaluate the stability of the improvements obtained for the 2 groups of patients and the differences between them.

This multi-center single-blind study compared clinical outcomes following guided tissue regeneration (GTR) treating human Class II furcation defects with a new polylactic-acid-based bioabsorbable barrier (test treatment) or a non-absorbable ePTFE barrier (control treatment). Clinical parameters evaluated were change in vertical attachment level (VAL), horizontal attachment level (HAL), probing depth (PD), and gingival margin location (REC). Surgical treatment resulted in clinically and statistically equivalent changes when comparisons were made between test and control treatments. VAL gain was 2.0 mm for test and 1.6 mm for control groups; HAL gain was 2.1 mm for both test and control groups. PD reduction was 2.3 mm for the test group and 2.1 mm for the control group. Test sites experienced an additional 0.3 mm of recession beyond baseline; control sites, 0.5 mm. Within-group comparisons showed that the amount of recession was not significantly different from baseline in the test group. Recession in the control group was significantly different from baseline. All other parameters in both the test and control groups were significantly different from baseline. Evaluation of safety data indicated no significant differences between test and control treatments, although there was a strong trend for the control group to have more postoperative abscess or suppuration than test sites (control = 11; test = 4; P = 0.06).

The purpose of the study was to compare clinical parameter changes and osseous regeneration in 12 pairs of comparable Class II mandibular molar furcation invasion defects using either a bioabsorbable demineralized laminar bone allograft membrane or a non-resorbable expanded polytetrafluoroethylene (ePTFE) membrane as a barrier in guided tissue regeneration. Measurements with calibrated periodontal probes were made to determine soft tissue recession, probing depth, and attachment levels. Defects within each pair were randomly selected for treatment with either bioabsorbable demineralized bone allograft membrane or ePTFE membrane. All defects were concurrently grafted with particulate demineralized freeze-dried bone allograft (DFDBA). Additional measurements were made at surgery to determine crestal resorption and the vertical and horizontal dimensions of the osseous defects. The temporal course and extent of membrane exposures were also recorded. The non-resorbable membrane was retrieved 6 weeks following placement. Six months following initial surgical treatment, each site was surgically re-entered and all soft and hard tissue measurements repeated. Descriptive statistical analysis revealed that both treatments resulted in significant within-group mean vertical and horizontal osseous fill, but no statistical difference emerged between the groups. As based on this pilot study, laminar bone membrane may be as effective as ePTFE when used in conjunction with DFDBA for treatment of Class II mandibular molar furcation bone defects. This pilot study of low power suggests that these two materials may be equivalent when used in conjunction with DFDBA. Further studies of much higher power and of the laminar bone alone as compared to positive and negative controls are required. Laminar bone does not require a secondary surgical procedure for removal and may undergo less frequent instances and degrees of exposure during healing.

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.

This study clinically evaluates the use of expanded polytetrafluoroethylene (ePTFE) membranes with or without the addition of decalcified freezedried bone allograft (DFDBA) in the treatment of interproximal intraosseous defects. 25 patients (26 paired defects) diagnosed with advanced periodontitis and having at least 2 bilateral interproximal probing depths of > or = 6 mm participated in the study. After the hygiene phase, measurements were made to determine soft tissue recession, pocket depth, and clinical attachment levels. Defects from each pair were randomly treated with either ePTFE alone (control), or ePTFE+DFDBA (experimental). Measurements were made during the surgery to determine crestal resorption, defect resolution and defect fill. Membranes were removed at 4 to 6 weeks. At 6 months, the soft and hard tissue measurements (surgical reentry) were repeated. Both groups showed statistically significant improvement when compared to baseline (p < 0.001), but no difference was determined between groups. Control sites showed a 50% bone fill and experimental sites had 54% bone fill. The defect resolution changes were also similar between control and experimental groups, respectively (80%, 74%). For this short-term study, it was concluded that either technique was beneficial for the treatment of intraosseous defects. Other studies are needed to assess the long-term stability of the improvements rendered by these treatments.

Twelve patients with bilateral comparable gingival recessions were treated using a split mouth design, to compare the relative success of root coverage by two regenerative procedures. The areas of recession treated were Class I or II according to Miller's classification and caused either an esthetic problem and/or root sensitivity. The symmetrical defects, on the maxillary canines, 4 mm or deeper, were randomly assigned in each patient to surgical procedures with either a bioresorbable matrix barrier (test) or a non-resorbable expanded polytetrafluoroethylene membrane (control). Gingival recession, clinical attachment level, probing depth, and extension of keratinized tissue were measured at baseline and at 6 months postsurgically. Both procedures resulted in significant root coverage (P < 0.0001) and attachment gain (P < 0.0001). The gingival recession decreased from 4.75 +/- 0.22 mm to 0.83 +/- 0.24 mm and from 4.75 +/- 0.22 mm to 0.75 +/- 0.22 mm, corresponding to a mean root coverage of 82.4% and 83.2%, at the test and control sites respectively. The average clinical attachment gain was 4.33 +/- 0.44 mm at the test sites compared to 4.42 +/- 0.48 mm for the non-resorbable barrier. No significant changes were found for probing depth and keratinized tissue. Data analysis did not demonstrate any significant difference between the two procedures for any of the variables included. However, a questionnaire given to each patient revealed the single-step surgery to be the patients' choice.

The aim of this study was to compare the clinical regenerative capacity of collagen membrane with and without demineralized freeze-dried bone allografts (DFDBA) in treating periodontal intrabony defects. Ten systemically healthy patients with similar bilateral periodontal defects were scheduled for surgery. Each patient had at least > or = 6 mm clinical probing depth and loss of attachment at selected sites. Baseline measurements included gingival index (GI), plaque index (PI), gingival recession (GR), clinical attachment level (CAL), probing depth (PD), and mobility. At the time of surgery, the defects were randomly assigned to either test (collagen membrane plus DFDBA) or control group (collagen membrane only). Stent to base of the defects, stent to crest bone, crest of bone to base of the defect, and width of the defects were recorded at the time of surgery and reentry. Eight patients returned after 6 months for reentry surgery. Statistical analysis with a paired t test was used to evaluate the treatment effect and comparison between test and control groups. In addition, a McNemar test was used to analyze the significance of GI, PI, and mobility at different times. The result of this study indicated that both the collagen plus DFDBA and the collagen alone treatment groups had a significant decrease of PD (3.4 +/- 0.4 and 3.2 +/- 0.4 mm), gain of CAL (2.3 +/- 0.5 and 2.0 +/- 0.4 mm), and defect fill (1.7 +/- 0.3 and 1.9 +/- 0.9 mm) (P < 0.05) when compared to the presurgery status. However, there was no significant difference in PD, AL, GR, defect fill, crestal bone resorption, GI, PI, or mobility between the test group and control group. No adverse tissue reaction, infection, or delayed wound healing was noted throughout the treatment in either group. This study suggests that the collagen membrane is well tolerated by the human tissues. Both treatments, either collagen membrane plus DFDBA or collagen membrane alone, promoted significant resolution of periodontal intrabony defects. The addition of a bone graft (DFDBA) with a collagen membrane appears to add no extra benefit to the collagen membrane treatment.

A comparative study which evaluated two treatment modalities for regeneration of interproximal periodontal lesions was conducted. Eleven pairs of advanced periodontal lesions in 11 human subjects (6 male and 5 female) were treated in a split mouth design with expanded polytetrafluoroethylene (ePTFE) interproximal membranes alone (control) in one lesion and ePTFE interproximal membranes in combination with decalcified freeze-dried bone (test) in the other lesion. At 1 year post-treatment, both treatment modalities revealed a significant increase in clinical attachment levels from baseline (2.0 +/- 1.37 mm test, 2.0 +/- 0.88 mm control) with no significant differences between the two modalities. When the amount of new bone formed in these lesions was assessed using re-entry procedures, a significant difference in new bone formation from baseline was found only for lesions treated with ePTFE alone (0.4 +/- 0.78 mm test, 1.3 +/- 0.96 mm control). It was concluded that at 1 year post-treatment, significant clinical attachment gains could be obtained by the use of ePTFE barriers with or without DFDBA. Statistically significant results in bone fill were only found when ePTFE barriers were used alone.

The purpose of this controlled clinical trial was to compare the clinical efficacy of 3 treatment modalities in the treatment of deep interproximal intrabony defects. Forty-five (45) defects in 45 patients were randomly assigned to 1 of 3 treatment groups by blocking to prognostic variables. The test group was treated with titanium reinforced membranes positioned just apical to the cemento-enamel junction and the modified papilla preservation technique; the second group received conventional expanded polytetrafluoroethylene (ePTFE) barrier membranes applied at the alveolar crest; the third group was treated with an access flap procedure. The groups were well balanced with respect to all prognostic variables. During the 1-year observation period, patients were subjected to a stringent infection control program including: professional tooth cleaning every week for the first 6 weeks (all groups) and in the 4 weeks following membrane removal (guided tissue regeneration groups), then at monthly intervals (all groups). The results indicated that: 1) all treatment modalities resulted in clinical and statistically significant improvements in clinical attachment level (CAL) and probing depths (PD) at 1 year; 2) a significantly greater amount of CAL gain (P = 0.0003, analysis of variance) was observed in the test group (5.3 +/- 2.2 mm) with respect to both the ePTFE group (4.1 +/- 1.8 mm) and the flap control group 2.5 +/- 0.8; 3) in the test group the 1 year CAL (4.7 +/- 1.8 mm) was located more coronally than the baseline position of the interproximal alveolar crest (5.9 +/- 2 mm; P = 0.003, t test).(ABSTRACT TRUNCATED AT 250 WORDS)

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).

The purpose of this controlled clinical trial was to compare the efficacy of two surgical approaches to protect the regenerated tissue following membrane removal in guided tissue regeneration (GTR) treated intrabony defects. Twenty-eight (28) defects, one each in 28 patients were randomly assigned after placement of the membrane to one of two treatment groups by blocking to prognostic variables. The test group received free gingival grafts on the interproximal regenerated tissue. In the control group the surgical flaps were coronally positioned over the regenerated tissue. The two groups were well balanced with respect to all prognostic variables. The results indicated that: 1) similar amounts of regenerated tissue were obtained in the two groups at membrane removal (7.6 +/- 2.8 mm, test; 8.3 +/- 2.3 mm, control); 2) a significantly greater amount of probing attachment level gain was observed in the test group (5.0 +/- 2.1 mm, test; 3.7 +/- 2.1 mm, control). This study indicated that placement of free gingival grafts on the interdental regenerated tissue further improves the clinical outcome of GTR in deep intrabony defects.

This study determined the microbial composition of the apical parts of the expanded polytetrafluoroethylene membrane surfaces facing the gingiva and the tooth in guided tissue regeneration. Microbial and clinical features of 2-to-3 wall periodontal bony defects treated with membranes with and without concomitant use of systemic Augmentin therapy were also determined. 18 patients with 18 study sites participated. 9 patients received systemic 500 mg Augmentin 1 h prior to surgery, and 500 mg TID for 8 days thereafter. 9 patients received no systemic antimicrobial therapy. Microbiological examination was performed 1 h prior to surgery, at the time of membrane removal at week 6, and at 6 months post-surgery. Microbial morphotypes, total viable counts, and the occurrence of selected microbial species were determined by phase-contrast microscopy, selective and non-selective culture, and DNA probes. Study sites were examined for probing pocket depths and attachment levels. At baseline, no microbial or clinical parameter showed statistical differences between groups. At 6 months, the Augmentin group demonstrated a significantly higher (P = 0.032; Student t-test) mean probing attachment gain (36.5% of potential gain to the cemento-enamel junction) than the 9 control patients (22.4% of potential gain). At the time of removal, membranes in the Augmentin group showed significantly fewer organisms than membranes in the control group (52.2 x 10(6) versus 488.6 x 10(6)). Sites free of pathogens on the membrane surface toward the tooth gained the most clinical attachment, even in the presence of various pathogens on the gingiva-facing membrane surface.(ABSTRACT TRUNCATED AT 250 WORDS)

The present experiment on guided tissue regeneration had 2 objectives namely: (i) to study if an improved anchorage of the soft tissue flaps during the initial healing period after membrane placement would reduce the tendency for soft tissue recession and allow for healing of also large furcation defects; (ii) to determine if the use of biodegradable membranes in GTR procedures may promote new attachment formation in degree III furcation defects. 2 experiments were performed which included 5 and 8 dogs each. In each animal, the 3rd premolar of the left or right side of the mandible was selected as test site using the contralateral tooth as control. 2 months prior to the start of the experiment, the 2nd and 4th premolars in each side of the mandible were extracted. The extractions were performed to create a large edentulous space mesial and distal to the 3rd premolar. During GTR therapy the incisions prepared in this edentulous region were used to allow proper suture retention and flap stability during the initial phase of healing. In study 1, furcation defects (degree III) were prepared and subsequently treated according to GTR using e-PTFE membranes in the test and no membrane in the control site. In study 2, a bioresorbable membrane (Resolut) was installed in the test and an e-PTFE membrane in the control sites. The non-resorbable membranes were removed after 30 days. The animals were sacrificed 5 months after reconstructive surgery, biopsies were harvested, sectioned and analyzed histologically for new connective tissue attachment and bone.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this prospective split-mouth-study was to compare the 5-months-healing results after implantation of resorbable (Polyglactin-910) and non-resorbable (e-PTFE) GTR-membranes. 12 healthy patients with 41 periodontal defects were treated. Radiographical and clinical examinations (papillary bleeding index, gingival recession, probing pocket depth, probing attachment level, and furcation depth) were carried out under standardized conditions immediately before and 5 months after surgery. The vertical relative attachment gain (V-rAG) was calculated as a % of the bony defect depth (intra-operatively measured) at baseline, and the horizontal relative attachment gain (H-rAG) as a % of the furcation depth at baseline. The standardized radiographs were evaluated blind by 4 experienced examiners for changes of the alveolar bone. Furthermore, digital subtraction radiography was carried out using the standard deviation of the grey level histograms in the experimental region and in a control region as a test parameter for bone changes. Both types of membranes achieved an attachment gain. Using the split-mouth-design, no statistically significant (< or = 0.05) difference between the two membranes could be detected (number of defects/median) with regard to V-rAG (Polyglactin: 12/77.5%, e-PTFE: 12/73.2%) or to H-rAG of class-II-furcations (Polyglactin: 5/66.7%, e-PTFE: 5/66.7%), or to bone changes using conventional and subtraction radiographic evaluation. In conclusion based on this 5-months-study, the resorbable membranes provided attachment gain comparable to the e-PTFE-membranes.

In this case series study 19 Class II furcations and 47 intrabony defects in 59 patients were treated according to the principles of guided tissue regeneration using a bioresorbable matrix barrier. Gingival condition and device exposure were assessed at 2 weeks, and 1, 3, 6, and 12 months after surgery. The effect of therapy was evaluated by assessing probing depths (PD), probing attachment level (PAL), and the position of the gingival margin prior to surgery and 12 months after surgery. Mild clinical signs of inflammation in the soft tissue covering the device was found adjacent to 3 defects only and limited to the first month of healing. Device exposure occurred at 10 out of the 66 defects. At the furcation defects, the mean PD reduction amounted to 3.7 mm (P < or = 0.001). Mean gain PAL vertical was 3.4 mm and PAL horizontal 3.3 mm (P < or = 0.001), resulting in complete closure of 9 out of the 19 defects. Mean gingival recession was 0.2 mm. At the intrabony defects mean PD reduction was 5.4 mm and mean gain of PAL 4.9 mm (P < or = 0.001). Gingival recession averaged 0.5 mm (P < or = 0.05). It was concluded that the use of the matrix barrier in GTR therapy resulted in 1) reduced probing depths; 2) pronounced gain of clinical attachment; and 3) a very low incidence of gingival pathology, gingival recession, and device exposure.

The purpose of this study was to compare the changes in clinical attachment when either a non-resorbable ePTFE membrane or an absorbable collagen membrane was used as a barrier during surgical treatment of class II molar furcation defects. Thirteen patients, mean age 43.2 years, with two comparable class II molar defects were treated using a split mouth design. Pre-surgical standardized probings were made using an automated probe at a constant force of 25 grams. Four to 6 weeks after initial therapy, the furcations were surgically debrided, the membranes placed to occlude separate furcation defects in each patient, and the sites closed. The ePTFE membrane was removed 6 weeks after placement. Six months postsurgery, the clinical measurements were repeated. Student t test was used to compare the results. There were no significant differences in the mean initial measurements between the treatment groups. The mean decrease in vertical probing depth was 1.40 +/- 1.68 mm for the collagen treated sites and 1.07 +/- 0.81 mm for the ePTFE treated sites. The decrease in horizontal probing depth was 1.49 +/- 1.97 mm for the collagen treated sites and 0.79 +/- 2.16 mm for the ePTFE treated sites. No significant differences were found between any of the clinical parameters measured. Based on the results of this short-term clinical study, the absorbable collagen membrane was statistically equivalent to the non-resorbable ePTFE membrane in the clinical resolution of class II furcation defects.

Twenty-six proximal, intrabony periodontal defects with probing depths equal to or exceeding 6 mm in 23 patients were treated with gingival flap surgery supported by an expanded polytetrafluoroethylene barrier membrane. The material included 1, 2, and 3-wall defects with crestal involvement relative to the root circumference ranging between 90 degrees and 270 degrees. Healing was evaluated clinically 12 months after surgery. Deep defects exhibited greater probing depth reduction and attachment gain than shallower defects. Probing depth reduction, attachment gain, and bone fill were positively correlated to the depth of the 3-wall intrabony component of the defect. The extent of crestal involvement, and wall form in the fundus of the defect did not appear to influence the healing response. The treatment also affected the proximal surface of the defect-adjacent tooth, which showed some reduction in bone level as well as gingival recession. Thus, the overall healing pattern following barrier membrane-supported flap surgery appears similar to that generally observed for conventional reconstructive flap surgery in intrabony periodontal defects.