Clinical management of endo-perio lesion through guided tissue regeneration: a 5 year follow-Up / Manejo clínico de una lesión endo-perio a través de la regeneración tisular guiada: control post-operatorio de 5 años

ABSTRACT: Progressive periodontal disease causes loss of supporting structures of teeth resulting in deep bony defects. In this case a report of 22-year old female patient is being presented with clinical findings of vertical bone loss in two adjacent teeth, on distal surface of 2nd upper right premolar and mesial surface of upper right 1st molar. Root canal treatment, non-surgical periodontal therapy followed by guided tissue regeneration was carried out using decalcified freeze-dried bone allograft (DFDBA) and collagen membrane. Analysis of clinical and radiographic findings showed marked reduction in pocket depth up to 12mm with hard tissue repair on 3-month, 2-year and 5- year follow ups.

RESUMEN: La enfermedad periodontal progresiva provoca la pérdida de las estructuras de soporte de los dientes, lo que resulta en defectos óseos profundos. En este caso clínico se presenta un informe de una paciente de 22 años con pérdida ósea vertical en la superficie distal del segundo premolar superior derecho y en la superficie mesial del primer molar superior derecho. El tratamiento del conducto radicular, la terapia periodontal no quirúrgica seguida de la regeneración tisular guiada se llevó a cabo utilizando aloinjerto óseo liofilizado descalcificado (DFDBA) y membrana de colágeno. El análisis de los hallazgos clínicos y radiográficos mostró una marcada reducción en la profundidad de la bolsa de hasta 12 mm con reparación de tejido duro en seguimientos de 3 meses, 2 años y 5 años.

Revealing The Treatment Plan For Endodontic Periodontic Lesions – Case Series

Introduction: An endodontic-periodontic lesion becomes a challenge for a clinician to diagnose and manage. when it comes to combined endodontic-periodontic lesion the most common treatment alternative is extraction and replacement with prosthesis. With numerous complications associated with prosthesis as well as patient's desire to retain natural teeth make it most important task for clinicians to conserve such teeth. Method: Four patients were included in this case series. Cases were treated with endodontic and periodontic treatment sequentially as per the guidelines. Results: After a follow-up period ranging from 6 months to 2 years, it was observed that all teeth remain asymptomatic and in normal function. Conclusions: This case series shows that it is possible to change the prognosis of teeth affected by combined endodontic-periodontal lesions, provides that correct diagnosis and proper oral hygiene maintenance is implemented

Evaluation of the relative efficacy of copolymerized polylactic-polyglycolic acids alone and in conjunction with polyglactin 910 membrane in the treatment of human periodontal infrabony defects: A clinical and radiological study.

Background: Absorbable synthetic biopolymers have been used as bone filler in Periodontology, proving effective stimulants to bone regeneration. Aim: Copolymerized polylactic and polyglycolic acid is used as a bone filler and polyglactin 910 as a guided tissue regeneration (GTR) membrane to achieve regeneration in periodontal infrabony defects. Materials and Methods: Forty patients with two- or three-walled infrabony defects were selected and randomly divided into two groups. Group A included patients treated with polylactic-polyglycolic acids 50:50 (Fisiograft® ,Ghimsa SPA,Via Fucini, Italy) alone and Group B included patients treated with polylactic-polyglycolic acids (PLA-PGA)50:50 in conjunction with polyglactin acid 910 (Vicryl Mesh® Johnson&Johnson , U.S.A ). Evaluation of clinical parameters probing depth and attachment level and radiographs was done preoperatively and 12 and 24 weeks postoperatively. Results: Both the groups showed statistically significant mean reduction in probing depth and gain in clinical attachment level and linear bone fill. Conclusions: Within the limit of this study, both the treatment modalities are beneficial for the treatment of infrabony defects.

Combined periodontal regenerative and prosthetic treatment of pathologic migration of anterior teeth / 대한치주과학회지

PURPOSE: Pathologic tooth migration (PTM) commonly occurs in the anterior region and is associated with periodontal disease. The treatment of PTM of anterior teeth can be complex and time consuming, and a multidisciplinary approach is often required. MATERIALS AND METHODS: The patient was a 38-year-old woman with a chief complaint of saving and realigning her elongated maxillary left central incisor. This paper describes the successful combined periodontal regenerative (guided tissue regeneration) and prosthetic treatment and a 2-year follow-up of maxillary central incisor with pathologic tooth migration, deep intrabony defect, and poor prognosis. RESULTS: The right maxillary central incisor was restored by laminate veneer and the left by all-ceramic crown. The patient had no pain and discomfort and was satisfied with the outcomes of her treatment for 2 years. She has maintained her recall program at the Department of Periodontology at 3 months interval. CONCLUSION: The key step in the successful treatment of PTM in anterior region is to obtain a high level of cooperation from the patient. Maintenance of the treatment result of PTM is dependent on the continuous preservation of periodontal health.

Effects of various membranes on periodontal tissue regeneration: a meta-analysis of the histomorphometry / 대한치주과학회지

Various periodontal barrier membranes used in many clinical and experimental fields, and many recent studies of membranes have reported good results. To improve clinical results, selection of barrier membranes is an important factor. So, we need not only to evaluate various barrier membranes, but also to understand the property of barrier membranes appropriate to defect characteristics. For this purpose, this study reviewed available literature, evaluated comparable experimental models, and compared various barrier membranes. From above mentioned methods, the following conclusions are deduced. 1. In 1-wall periodontal defect models, new bone formation showed a consistent result, almost 30% of the defect size. New cementum formations measured mostly 40% of the defect size, but showed more variations than new bone formations. This seems to be resulted form difference in experimental methods, so standardization in experimental methods is needed for future studies. 2. Application PLGA barrier membrane to periodontal defect demonstrated improved healing in new bone and new cementum. 3. There was a minimal periodontal regeneration with calcium sulfate barrier membrane only. But, there was better healing pattern in combination of calcium sulfate membrane with bone graft material, such as DFDBA. 4. There was no significant difference between the experimental group that used chitosan membrane only and the control group. But, in combination with bone graft material for space maintanence, periodontal regeneration was improved. Overall, Space maintenance is a critical factor for Guided tissue regeneration using barrier membranes. Also, a barrier membrane itself that has difficulty in maintaining space, achieved better result when used with graft material.

Long-term radiographic evaluation of GTR treatment in intrabony defect / 대한치주과학회지

Periodontal surgery as part of the treatment of periodontal disease is mainly performed 1) to gain access to diseased areas for adequate cleaning; 2) to achieve pocket reduction or elimination; and 3) to restore the periodontal tissues lost through the disease; i.e., a new attachment formation of periodontal regeneration. To accomplish the latter, often referred to as the ultimate goal of periodontal therapy, a number of surgical procedures have been advocated throughout the years. Clinical studies have demonstrated that considerable gain of clinical attachment and bone can be achieved following guided tissue regeneration (GTR) therapy of intrabony defects. The aim of this study was to analyse the radiographic bone changes 2-year after GTR using a bone graft material and nonresorbable membrane. Patients attending the department of periodontics of Kyungpook National University Hospital were studied. Patients had clinical and radiographic evidence of intrabony defect(s). 33 sites of 30 patients aged 32 to 56 (mean age 45.6) were treated by GTR with a bone graft material and nonresorbable membrane. Baseline and 2-year follow-up radiographs were collected and evaluated for this study. Radiographic assessment includes a bone fill, bone crest change, defect resolution, and % of defect resolution. Pre- and post-treatment differences between variables (maxilla and mandible, defect depth, defect angle, bone graft materials) using the paired t-test were examined. We observed 2.86+/-1.87mm of bone fill, 065+/-0.79mm of crestal resorption, 3.49+/-2.11mm of defect resolution, and 44.42+/-19.51% of percentage of defect resolution. Mandible, deeper initial defect depth, narrower initial defect angle showed greater bone fill, defect resolution, and % of defect resolution. But no difference was observed between xenograft and allograft. Outcome of GTR as a therapy of intrabony defect was better than other therapy, but herein, good oral hygiene maintenance as a anti-infective treatment and periodic recall check of patients are essential.

Membranas no reabsorbibles: Una revision de la literatura

La regeneración tisular guiada (RTG) ha sido utilizada por más de una década para regenerar el tejido periodontal perdido como consecuencia de la Enfermedad Periodontal y constituye una de las formas de tratamiento mejor documentado en la literatura. Una serie de biomateriales han sido probados clínicamente para este propósito, sin embargo, las membranas de politetrafluoretileno expandido (e-PTFE) han sido ampliamente consideradas en la literatura como las de elección para los procedimientos de RTG.

Guided tissue regeneration (GTR) has been used for more than a decade to regenerate periodontal tissue lost as a result of periodontal disease and is the best documented regenerative approach. Several biomaterials have been clinically tested for guided tissue regeneration applications; however, the expanded polytetrafluoroethylene (e-PTFE) barriers are widely regarded in the literature as the membrane of choice for GTR procedures.

Clinical study on therpeutic effects of Guided tissue regeneration by Nanogide-C(R) and Biomesh(R) in furcation defects / 대한치주과학회지

This study was designed to compare the effects of treatment using chitosan membrane (Nanogide-C(R)) resorbable barrier with control treated by polylactic acid/polylacticglycolic acid membrane(PLA/PLGA membrane, Biomesh(R)). 44 furcation defecs from 44 patients with class 2 furcation degree were used for this study, 22 sites of them were treated by chitosan membrane as experimental group and 22 site were treated by PLA/PLGA membrane as control group. Clinical parameters including probing depth, gingival recession, attachment level and radiographic examination were evlauated at base line, 1 month, 2 month and 3 month. after surgery. Statistical test used to analyze these data included paired t-test, one way ANOVA. The results are as follows : 1. Probing depth was significanlly decreased in the two group and there were significant differences between groups(p<0.05). 2. Gingival recession was not significanlly increased in the two group and there were no significant differences between groups(p<0.05). 3. Loss of attachment was statistically decreased in the two group and there were no significant differences between groups(p<0.05). 4. Horizontal bone level was significanlly increased in the two group and there were significant differences between groups(p<0.05). On the basis of these results, chitoans resorbable membrane has similar potential to PLA/PLGA membrane in GTR for furcation defect.

A Histo-Pathological Study of Effect on Bone Regeneration with Fibrin Adhesive / 대한치주과학회지

Several effective treatment methods and materials have been developed for the treatment of furcation involvement. Currently, the combination of guided tissue regeneration (GTR) and bone grafts is the most commonly prescribed method of treating furcation involved defects. But because these cases often present with poor accessibility, placement of the membrane may be difficult and consequently, clinically impractical. In this study, the alveolar bone healing patterns of adult beagle dogs presenting with alveolar bone destruction treated by one of two methods - treatment using solely bone aIlografts (BBP(R)), or treatment using bone allografts (BBP(R)) stabilized by a fibrin adhesive - were comp ared. The effects of the fibrin adhesive on the initial stabilization of the newly formed bone, subsequent regeneration of bone, and the feasibility of the clinical application of the fibrin adhesive were analyzed. The results of the study were as follows: 1. Clinical signs of inflammation at the 4-8 week interval were not observed: but signs of mild inflammation were histologically observed at the 4-week interval. 2. Allografts stabilized by fibrin adhesive showed good bone formation, whereas defects treated with only the allograft material showed incomplete alveolar bone regeneration. 3. Allografts stabilized by fibrin adhesive showed a decrease in the amount old bone with a concurrent increase in the formation of new lamellar bone four weeks post-op, whereas defects treated with only the allograft material showed no new lamellar bone formation at the same interval. 4. In detects treated with only the allograft material, the defective area was filled with connective tissue 8- weeks post-op, whereas fibrin adhesive stabilized allografts showed viable connections between the original bone and the newly formed bone, in addition to neovascularization 8-weeks post-op. The results of this study show that concurrent use of fibrin adhesive materials can stabilize the allograft material and aid in new bone formation Although the stability of fibrin adhesives fall short of the results achievable by GTR membranes, in cases presenting with poor accessibility that contraindicate the use of membranes, fibrin adhesive materials provide a viable and effective alternative to graft stabilization and new bone formation.

Resorbability and histological reaction of bioabsorbable membranes / 대한치주과학회지

The major goals of periodontal therapy are the functional regeneration of periodontal supporting structures already destructed by periodontal disease. There have been many efforts to develop materials and therapeutic methods to promote periodontal wound healing. With the development of non-resorbable membrane, GTR has proved to be the representive technique of periodontal regeneration. However, due to various clinical problems of non-resorbable membrane, resorbable membrane was developed and it showed to be clinically effective. The newly developed Para-Dioxanone membrane has a characteristic of non-woven fabric structures which is different from the generally used membranes with structure of mesh form. In addition, Chitosan membrane has been developed to apply its adventage maximally in GTR. Although a number of different types of membranes had been clinically used, researches on absorption rate of membranes were inadequate and limited to subjective opinions. However, since long term period of resorption and space maintenance are required in implant or ridge augmentation, accurate verification of resorption rate is clinically important. In this study, we had implanted Resolut(R), Biomesh(R), Para-Dioxanone membrane and Chitosan membrane (Size : 4mmx4mm) on dorsal side of Sprague Dawley rat, and sacrificed them after 4 weeks, 8 weeks, 12 weeks respectively. Histologic observation was carried out, and the following results were obtained by calculating the objective resorption rate. 1. In case of Resolut(R), external resorption took place initially, followed by internal resorption. Surface area are 5.76+/-2.37mm2, 4.91+/-1.06mm2, 4.90+/-0.98mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 31.6+/-4.5%, 52.8+/-9.4%, 56.4+/-5.1% respectively. 2. Biomesh(R) showed a pattern of folding, relatively slow resorption rate with small size of membrane. Surface area are 3.62+/-0.82mm2, 3.63+/-0.76mm2, 4.07+/-1.14mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 26.1+/-5.8%, 30.9+/-3.4%, 29.2+/-3.6%, respectively. 3. Para-Dioxanone membrane was surrounded by fibrous conncetive tissue externally, and resorption took place internally and externally. Surface area are 5.96+/-1.05mm2, 4.77+/-0.76mm2, 3.86+/-0.84mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 30.7+/-5.1%, 53.3+/-4.4%, 69.5+/-3.1%, respectively. 4. Each fiber of Chitosan membrane was surrounded by connective tissue and showed external resoption pattern. It showed little invasion of inflammatory cells and excellent biocompatability. The resorption rate was relatively slow. Surface area are 6.01+/-2.01mm2, 5.49+/-1.3mm2, 5.06+/-1.38mm2 at 4 weeks, 8 weeks, 12 weeks respectively, and invasion rate of connective tissue to membrane are 31.3+/-3.6%, 38.4+/-3.8%, 39.7+/-5.6%, respectively. Consequently, Para-Dioxanone membrane and Chitosan membrane are found to be clinically effective for their excellent tissue reaction and biocompatibility. Futhermore, the advantage of bone regenerating ability as well as the relatively long resorption period of Chitosan membrane, it might be widely used in implant or ridge augmentation.

Comparative study on tissue responses of 3 resorbable membranes in rats / 대한치주과학회지

The purpose of this study is to evaluate histologically the resorption and tissue response of various resorbable collagen membranes used for guided tissue regeneration and guided bone regeneration, using a subcutaneous model on the dorsal surface of the rat. In this study, 10 Sprague-Dawley male rats (mean BW 150gm) were used and the commercially available materials included acellular dermal matrix allograft, porcine collagen membrane, freeze-dried bovine dura mater. Animals were sacrificed at 2, 6 and 8 weeks after implantation of various resorbable collagen membranes. Specimens were prepared with Hematoxylin-Eosin stain for light microscopic evaluation. The results of this study were as follows: 1. Resorption : Inner portion of porcine collagen membrane was resorbed a lot at 6 weeks, but its function was being kept for infiltration of another tissues were not observed. Freeze-dried bovine dura mater and acellular dermal allograft were rarely resorbed and kept their structure of outer portion for 8 weeks. 2. Inflammatory reactions : Inflammatory reaction was so mild and foreign body reaction didn't happen in all of resorbable collagen membranes, which showed their biocompatibility. 3. In all of resorbable collagen membranes, multinucleated giant cells by foreign body reactions were not observed. Barrier membranes have to maintain their function for 4-6 weeks in guided tissue regeneration and at least 8 weeks in guided bone regeneration. According to present study, we can find all of the resorbable collagen membranes kept their function and structure for 8 weeks and were rarely resorbed. Foreign body reaction didn't happen and inflammatory reaction was so mild histologically. Therefore, all of collagen membranes used in this experiment were considered proper resorbable membranes for guided tissue regeneration and guided bone regeneration.

Localization of bone matrix gene mrna in regenerating bone tissue during the guided bone regeneration

An experimental study of guided bone regeneration of bone defects in rabbit using rubber dam