Comparison of 2 Regenerative Procedures - Guided Tissue Regeneration and Demineralized Freeze-Dried Bone Allograft - In the Treatment of Intrabony Defects: A Clinical and Radiographic Study

THE PURPOSE OF THIS STUDY was to compare clinically and radiographically the effectiveness of guided tissue regeneration (GTR), using a bioabsorbable polylactic acid softened with citric acid ester barrier and commercially available demineralized freeze-dried bone allograft (DFDBA) in the treatment of 2- and 3-wall intrabony defects. Twelve patients each with one treated defect comprised each group. Conservative treatment was completed 2 to 4 months prior to surgery. Clinical measurements, plaque index, gingival index, probing depths (PD), clinical attachment levels (CAL) and recession (REC), were comparable in both groups at baseline. They were repeated at 12 months. Surgical measurements were also comparable at baseline in both groups. In the GTR group, at baseline the mean distance between the cemento-enamel junction (CEJ) and base of the defect was 12.3 ± 2.9 mm and in the DFDBA group 11.3 ± 1.8 mm. The defect depth was 6.3 ± 2.0 mm and 5.4 ± 1.3 mm, respectively. Radiographs were taken at baseline and 12 months later and compared using non-standardized digital subtraction radiography. In the GTR group, mean PD decreased from 7.9 ± 2.5 mm to 3.5 ± 1.4 mm and mean CAL from 10.8 ± 2.8 mm to 7.0 ± 1.6 mm, the differences being statistically significant (P = 0.002), while REC increased from 2.9 ± 1.2 mm to 3.5 ± 1.1 mm. In the DFDBA group, mean PD decreased from 7.1 ± 1.1 mm to 3.5 ± 1.1 mm and mean CAL from 9.8 ± 1.5 mm to 6.6 ± 1.7 mm (P = 0.002), while REC increased from 2.8 ± 1.0 mm to 3.1 ± 1.2 mm. No significant differences were found when the clinical results of the 2 groups were compared. Radiographic differences between the baseline and reconstructed images 12 months later were observed in both groups. Mean crestal bone resorption was 15.3 ± 22.5% in the GTR group and 10.4 ± 31.8% in the DFDBA group, and mean improvement in the distance between the CEJ and the base of the defect was 22.8 ± 18.1% in the GTR group and 15.3 ± 13.6% in the DFDBA group. However, the mean improvement in the intrabony depth was larger in the GTR group (71.9 ± 29.1%) than in the DFDBA group (35.4 ± 21.6%) (P = 0.007). In conclusion, within the limits of this study, both regenerative procedures were beneficial in treating intrabony defects. No statistical significant differences were observed between the 2 groups, with the exception of radiographic defect resolution which was significantly greater in the GTR group

Calculus removal from multirooted teeth with and without surgical access: (II). Comparison between external and furcation surfaces and effect of furcation entrance width

Abstract The purpose of this study was to evaluate the effect of furcation entrance width on the efficacy of calculus removal from furcation areas as well as to compare this efficacy between external and furcation surfaces after closed root planing, open root planing and use of a rotary diamond for the furcation area. 30 first and second lower molars scheduled for extraction with a calculus index 2 and a degree II or III furcation involvement were divided into 3 groups: 10 molars were scaled and root planed using a closed approach; 10 molars were scaled and root planed using an open approach; 10 molars were scaled and root planed with an open approach and rotary diamond was used for removal of deposits in the furcation area. After extraction, the width of the furcation entrance was measured buccally and lingually 2 mm apical from the bifurcation and furcations were categorized as wide (width >2.4 mm) or narrow (width <2.4 mm). The teeth were assessed in a stereomicroscope and the % of residual calculus on external and furcation surfaces was calculated. The width of the furcation entrance influenced the efficacy in root planing in the open group (p=0.0015). The use of rotary diamond was the most effective method for removing calculus both for narrow and wide furcations. The effectiveness of open root planing in the mesial root was related to the width of the furcation entrance where the % of residual calculus was significantly higher for narrow furcations (p= 0.008). Comparison between external and furcation surfaces showed that the mean values of residual calculus in the closed and open groups were lower for the external than for the furcation surfaces, but the difference was statistically significant only for the closed group (p= 0.013). When open root planing was combined with the use of rotary diamond in the furcation areas, a smaller amount of residual calculus was observed for the furcation than for the external surfaces. Copyright © 1993, Wiley Blackwell. All rights reserve

Enamel matrix derivative in intrabony defects: Prognostic parameters of clinical and radiographic treatment outcomes

Background: The purpose of this retrospective case series study is to identify possible preoperative parameters that could predict postoperative probing depth (PD), clinical attachment level (CAL) gain, or radiographic defect resolution in intrabony defects treated with enamel matrix derivative (EMD). Methods: Sixty-one chronic periodontitis patients, each contributing a 2- or 3-wall intrabony defect treated with EMD, were included. Clinical parameters recorded included the following: PD; CAL; gingival margin position; supracrestal soft tissue (SST); surgical distances of cemento-enamel junction (CEJ) to bone crest (CEJ-BC), CEJ to base of the defect (CEJ-BD), and BC to BD (BC-BD); and depth of 2- and 3-wall components. Radiographic parameters recorded included the following: CEJ-BC, CEJ-BD, BC-BD distances, and radiographic defect angle. Postoperative assessments were performed at 12 months. Results: The probability of postoperativePD>4mmincreased 1.6-fold (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.2 to 2.3) with each 1-mm baseline PD increase. Baseline PD and surgical CEJ-BD were statistically significant predictors of CAL gain; the greater the baseline PD (OR = 0.5; 95% CI = 0.3 to 0.8) and bone loss (OR = 0.6; 95% CI = 0.3 to 0.9), the less likely that postoperativeCAL gain was ≤3mm. Smoking and SST were significantly associated with defect resolution; failure to achieve ≥65% defect resolution was six-fold greater for smokers (OR = 6.5; 95% CI = 1.7 to 24.5) and almost double (OR = 1.7; 95% CI = 1.1 to 2.8) for each millimeter of SST increase. Conclusion: In EMD-treated intrabony defects, baseline PD predicts both CAL gain and postoperative PD. Smoking and SST are predictors of defect resolution. J Periodontol 2012;83:1346-1352. © 2012 American Academy of Periodontology. All rights reserved

The application of an enamel matrix protein derivative (Emdogain) in regenerative periodontal therapy: a review.

Contains fulltext : 53648.pdf (publisher's version ) (Open Access)Regenerative periodontal therapy aims at reconstitution of the lost periodontal structures such as new formation of root cementum, periodontal ligament and alveolar bone. Findings from basic research indicate that enamel matrix protein derivative (EMD) has a key role in periodontal wound healing. Histological results from animal and human studies have shown that treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. This review aims to present an overview of evidence-based clinical indications for regenerative therapy with EMD

Regeneration of the periodontium using enamel matrix derivative in combination with an injectable bone cement

Item does not contain fulltextOBJECTIVES: Enamel matrix derivative (EMD) has proven to enhance periodontal regeneration; however, its effect is mainly restricted to the soft periodontal tissues. Therefore, to stimulate not only the soft tissues, but also the hard tissues, in this study EMD is combined with an injectable calcium phosphate cement (CaP; bone graft material). The aim was to evaluate histologically the healing of a macroporous CaP in combination with EMD. MATERIALS AND METHODS: Intrabony, three-wall periodontal defects (2 x 2 x 1.7 mm) were created mesial of the first upper molar in 15 rats (30 defects). Defects were randomly treated according to one of the three following strategies: EMD, calcium phosphate cement and EMD, or left empty. The animals were killed after 12 weeks, and retrieved samples were processed for histology and histomorphometry. RESULTS: Empty defects showed a reparative type of healing without periodontal ligament or bone regeneration. As measured with on a histological grading scale for periodontal regeneration, the experimental groups (EMD and CaP/EMD) scored equally, both threefold higher compared with empty defects. However, most bone formation was measured in the CaP/EMD group; addition of CAP to EMD significantly enhanced bone formation with 50 % compared with EMD alone. CONCLUSIONS: Within the limits of this animal study, the adjunctive use of EMD in combination with an injectable cement, although it did not affect epithelial downgrowth, appeared to be a promising treatment modality for regeneration of bone and ligament tissues in the periodontium. CLINICAL RELEVANCE: The adjunctive use of EMD in combination with an injectable cement appears to be a promising treatment modality for regeneration of the bone and ligament tissues in the periodontium