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In periodontal disease, the bacterial film known as plaque invades the space between the tooth and surrounding gum, leading in time to deterioration of the gum tissue and bone that support the root of the tooth. The bone tissue is gradually broken down until the teeth become loose and may fall out or require extraction. One method of treating advanced periodontal disease is grafting, or transplantation, of bone tissue to the tooth socket; the goal is to fill the gaps created by destruction of the original bone. If this is successful, the tooth root will reattach to the socket, and the tooth will be saved. There are three possible sources of grafts used for this purpose. Autografting uses bone taken from the patient, often from another location in the mouth. Allografting is done when the patient does not have adequate bone tissue available; bone is taken from a cadaver. These specimens are freeze-dried and, consequently, they can be stored indefinitely. Freeze-drying also reduces the chance that the transplant recipient's immune system will reject the graft as a ''foreign'' substance. The risk of contracting a disease from donated bone tissue is slim if the tissue bank follows careful screening and testing protocols. The freezing process further lowers the risk of acquiring disease to 1 in 8 million. A third source of tissue for treating gaps caused by periodontal disease is alloplastics, which are synthetic materials that serve as non-irritating fillers. Since this material is not human tissue, the bony attachment between tooth and socket will not actually regenerate, or grow together again, as it does with autografts and allografts. These various techniques are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This study histologically evaluated recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in combination with beta-tricalcium phosphate (β-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 + β-TCP, and complete wound closure. One tooth in each patient was treated with 0.3 mg/mL of rhPDGF-BB + β-TCP, and the other tooth was treated with 1.0 mg/mL of rhPDGF-BB + β-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 β-TCP can promote periodontal regeneration in human intraosseous periodontal defects. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the potential of an allogeneic bone matrix (Grafton, Osteotech) to regenerate now 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 phasetwo 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This study evaluated a bovine-derived bone xenograft (Bio-Oss) in the treatment of human periodontal osseous defects. Four patients with at least one tooth that had been recommended for extraction because of interproximal advanced periodontal disease volunteered to participate. The surgical procedure consisted of flap reflection, soft tissue debridement, placing a notch in calculus as a histologic reference point, root planing, placement of the bovine-derived xenograft and a bioresorbable physical barrier, and flap closure. Patients were seen every 2 weeks for plaque control and any necessary adjunctive treatment. At 4 to 6 months postsurgery, 6 teeth, along with the adjacent graft site, were removed en bloc. Histologic observations demonstrated new bone, new cementum, and new periodontal ligament coronal to the reference notch in 3 of the 4 specimens. This study indicates that periodontal regeneration is possible following grafting with a bovine-derived xenograft. [ABSTRACT FROM AUTHOR]

Following endodontic treatment, a large periapical lesion (9.0 mm × 9.0 mm) at a maxillary central incisor was treated with demineralized freeze-dried bone allograft (DFDBA) using the principles of guided tissue regeneration. The physical barrier was removed 6 months postsurgical. The cortical alveolar plate was observed to be completely reconstructed. Histologic evaluation demonstrated lamellar bone surrounding DFDBA particles. Radiographic follow-up 1 year posttreatment demonstrated complete resolution of the periapical radiolucency. [ABSTRACT FROM AUTHOR]

This paper describes a step-by-step technique for The application of Emdogain. a new enamel matrix derivative (EMD) graft material, for periodontal reconstructive surgery. A case report is presented with a 1-year follow-up. The rationale for use and advantages and d,!advantages of EMD are discussed. An additional human histologic case report demonstrates that the formation of new bone, cementum, and periodontal ligament is possible following the use of EMD. [ABSTRACT FROM AUTHOR]

Guided bone regeneration is a new technique that evolved following the guided tis-sue regeneration procedure for regeneration of lost periodontium. The objective of guided bone regeneration is to promote bone formation in osseous deformities either before or in conjunction with endosseous implant placement. Osseous defects consist mainly of extraction sites, dehiscences or fenestrations, and localized ridge deformities. In addition, bane defects may either provide natural spacemaking or be nonspacemaking. A plethora of publications indicate that the guided bone regeneration technique can be used successfully in all types of defects. Nonspacemaking defects usually require bone graft materials to assist in space maintenance and enhance bone formation. Fixation pins are also used, either with or without graft materials, in this regard, the scientific literature on guided bone regeneration was reviewed by a task force to determine techniques proven to increase predictability relative to successful patient outcomes and to develop specific evidence based diagnostic and treatment decision trees. [ABSTRACT FROM AUTHOR]

This paper evaluates the use of guided tissue regeneration for treating 19 pairs of molar grade II furcation defects. Presurgical measurements were taken for the determination of aveolar crestal resorption, vertical open probing attachment and horizontal open probing attachment. The surgical procedure consisted of sulcular incision, full-Thickness facial and lingual flaps soft tissue debridement. and root planing. One defect from each pair of furcas was treated with on expanded polytetrafluoroethylene membrane, which was left in place for 4 to 6 weeks. Postsurgery soft tissue measurements showed a reduction in probing depth and a gain hi vertical and horizontal open probing attachment. [ABSTRACT FROM AUTHOR]

This paper demonstrates the successful reconstruction of alveolar bone destroyed by advanced periodontitis and endodontic failure. It offers a staged approach that is predictable and is superior to extracting the tooth and simultaneously placing an implant fixture, or to extracting the tooth and not performing a ridge enhancement procedure. Four cases using guided tissue regeneration in combination with bone grafts prior to the placement of endosseous dental implants are discussed. [ABSTRACT FROM AUTHOR]

This paper presents an evaluation of the use of the principles of guided tissue regeneration to correct the osseous defects associated with the placement of dental implants. The biologic rationale for the use of supplemental materials, such as decalcified. freeze-dried bone allograft, is discussed. The results of this investigation suggest that the use of a physical barrier in combination with a bone allograft can produce successful results in 97% of the defects treated. [ABSTRACT FROM AUTHOR]

A study was conducted to evaluate the potential of guided tissue regeneration in the treatment of human molar Class II furcation defects using BioBrane temporary wound dressing as a barrier membrane and to compare the results to those with open debridement. Eight patients, with a total of nine pairs of Class II buccal furcation molar defects, were studied. Prior to surgery, soft tissue measurements, attachment levels, and hard tissue measurements were recorded. These measurements were repeated 4 to 6 weeks after membrane removal. The study revealed no significant difference between results of treatment using the BioBrane membrane and those obtained using open debridement alone, except in the measurement of horizontal open probing attachment, in which BioBrane-treated sites had a significant gain of soft tissue. [ABSTRACT FROM AUTHOR]

Guided tissue regeneration procedures are intended to selectively favor healing by the periodontal ligament tissues. However, in most studies of the efficacy of guided tissue regeneration, nonresorbable barriers and membranes have been used, necessitating their surgical removal after a time. The present study employed a resorbable collagen barrier to treat Class II furcation invasions. The results of this treatment were compared with the results of conventional therapy. For most clinical parameters, there was no statistically significant difference in the results of treatment with or without collagen membranes. Sites treated with a collagen barrier did exhibit statistically significant improvement in probing depth and horizontal osseous support; however, these findings cannot be attributed entirely to the placement of the collagen membrane. [ABSTRACT FROM AUTHOR]

A severely damaged edentulous ridge frequently obviates the placement of dental implants or results in placing them at an angle that compromises the prosthetic restoration. This paper demonstrates the repair of severely resorbed edentulous ridges by a combination of bone allografting and the placement of a barrier membrane. The damaged edentulous ridge is treated first in this two-stage process. The implants are then installed at a second surgery. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 46-year-old man whose periodontal intraosseous defect was treated with porous particulate hydroxyapatite. Histologic evaluation was undertaken because of the discovery of an adherent connective tissue to the root with its encapsulated hydroxyapatite particles. A greater reduction in probing depth, improved fill of the osseus defect and enhanced levels of attachment gain were indicated through clinical comparisons of porous hydroxyapatite with open flap debridement.

The article presents information on periodontal bone graft technique. It notes that the objectives of bone graft therapy, which include bone reduction, bone repair, and regeneration of the attachment apparatus composed of new bone, cementum and periodontal ligament. It explains the use of local anesthetic for the procedure. Information is also provided on postoperative management for periodontal bone grafting, such as soft tissue debridement, intramarrow penetration, root planing, and graft procurement.

The article presents the case study of a 63-year old healthy woman presented for routine maintenance dental care. Prior to prophylaxis, an examination revealed two periodontal lesions involving abutments with a maxillary fixed prosthesis. The study reports on the clinical and histologic responses of a biopsy taken from a composite freeze-dried bone allograft, hydroxyapatite graft. The assessment reflects that the allograft possesses osteogenic potential and also induces fibroblastic activity.

The article presents an investigation on the use of decalcified freeze-dried bone allograft (DFDBA) as an implant material in periodontal defects. Cortical bone for the investigation was procured under sterile conditions from a human donor within 24 hours after death, which was then frozen to -179°C for four weeks and freeze-dried. This graft material was defatted, demineralized, and sterilized, and was then used in the treatment of 47 defects in 11 patients. It was concluded that DFDBA has potential as a graft in periodontal therapy. Detailed results of the study, including bone measurements and bone repair in defects, are presented.

This study evaluates a prototype bioabsorbable physical barrier material for guided bone regeneration. Nonspacemaking dehiscence-type defects were surgically created in the right and left mandibles of six adult dogs. Each animal received six root-form threaded titanium implants. The osseous defects were randomized to receive treatment by either the prototype bioabsorbable barrier composed of a copolymer of lactide and glycolide, an expanded polytetrafluoroethylene nonresorbable barrier, or no barrier (control). Clinical and histologic results after 3.5 months of wound healing indicated that exposed threads were covered when treated with the expanded polytetrafluoroethylene barrier. Minimal thread coverage was evident with the bioabsorbable barrier and the control. [ABSTRACT FROM AUTHOR]

The retrospective multicenter study analyzed 526 implants placed and loaded in regenerated bone. Both autogenous and allogeneic bone grafts were used in combination with a barrier membrane to reconstruct bone using either a simultaneous or staged approach. Implants were followed from 6 to more than 74 months postloading. Eight of the implants were lost, for a success rate of 97.5%. The type of graft material did not affect the clinical success of the implants, nor did the use of submerged versus nonsubmerged implants or a staged versus a simultaneous approach. In conclusion, regenerated bone reacted to implant placement in a manner that was clinically similar to native bone. [ABSTRACT FROM AUTHOR]

Three case reports of treatment of the failing implant are presented. The implants were immobile but had lost a significant amount of osseous support. The cause of failure was determined to be a combination of bacterial and occlusal traumatogenic insult. The defects were debrided and the implant surface was detoxified with tetracycline. Decalcified freeze-dried bone allograft was implanted into the osseous defects and covered with expanded polytetrafluoroethylene material in accordance with principles of guided tissue regeneration. The barrier membrane was removed 6 to 8 weeks after placement. Eight months to 1 year posttreatment, all sites demonstrated a substantial reduction in probing depth, a gain in clinical attachment, and bone if! of the defects adjacent to the implant. [ABSTRACT FROM AUTHOR]