Clinical evaluation of anorganic bovine bone xenograft with a bioabsorbable collagen barrier in the treatment of molar furcation defects.

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.

Clinical evaluation of wound healing following multiple exposures to enamel matrix protein derivative in the treatment of intrabony periodontal defects.

BACKGROUND: Multiple exposures to enamel matrix protein derivative (EMD) during periodontal therapy have been shown to be safe for the patient. The purpose of this study was to clinically determine if an altered course of wound healing would occur after multiple exposures to EMD in the treatment of intrabony defects. A secondary aim was to assess the efficacy of EMD in probing depth reduction and clinical attachment level gain. METHODS: Thirty-two systemically healthy patients (18 females, 14 males, 33 to 69 years old) who were being treated for moderate to advanced periodontal disease were selected for the study. Surgical procedures involving 2 sites were separated by at least 8 weeks, and wound healing comparisons were made between the first and second procedure. Patients were given a diary card the day of surgery, which consisted of questions concerning the presence and severity of headaches, root hypersensitivity, tooth pain, swelling, and itching. Patients were also examined at postoperative visits to clinically assess wound healing and discuss responses to the questionnaire. Soft tissue measurements were taken the day of surgery and 6 months postoperatively to ascertain probing depth reduction (PD) and gains in clinical attachment levels (CAL). RESULTS: The results revealed no clinically detectable reaction that could not be attributed to normal postoperative sequelae. There were no differences in reported symptoms between patient gender, first and second procedures, or intrabony and non-intrabony defects. Smokers were found to have a statistically significantly higher incidence of severe symptoms in root hypersensitivity, tooth pain, and swelling compared to non-smokers (n = 21). The mean probing depth reduction was 3.8 +/- 1.5 mm (2 to 9 mm), while the mean clinical attachment level gain was 2.8 +/- 1.7 mm (0 to 8 mm). CONCLUSIONS: The findings of this study demonstrate that EMD is a clinically safe product to use in the treatment of periodontal defects and that multiple uses do not have a negative impact on periodontal wound healing. In addition, a statistically significant gain in clinical attachment and reduction in probing depth were demonstrated.

Clinical evaluation of Bio-Oss: a bovine-derived xenograft for the treatment of periodontal osseous defects in humans.

The purpose of this study was to compare the bovine derived xenograft (BDX) Bio-Oss to demineralized freeze dried bone allograft (DFDBA) in human intrabony defects. 17 healthy patients with no systemic disease with moderate-severe periodontitis (7 males, 10 females; aged 34-67), were treated. Surgically, defects were included only if the intraosseous defect depth was >3.0 mm. Final selection included 30 defects. The sites were randomly assigned treatment with DFDBA or BDX. Soft tissue and osseous defect measurements were taken the day of surgery and 6 months post-operatively at re-entry. Average baseline PD, CAL, and surgical defect depth for the DFDBA group were not statistically different from the BDX group. No adverse healing response occurred. The results showed a statistically significant improvement in PD and AL for both materials at 6 months in 26 defects (4 defects did not respond to therapy). Soft tissue measurements for the DFDBA group included PD reduction of 2.0+/-1.3 mm, and AL gain of 2.6+/-1.6 mm, while the BDX group showed a PD reduction of 3.0+/-1.7 mm, and AL gain of 3.6+/-1.8 mm. Osseous measurements showed bone fill of 2.4 mm (46.8%) for the DFDBA group and 3.0 mm (55.8%) for the BDX group. Defect resolution was 59.4% for the DFDBA group and 77.6% for the BDX group. Statistical analysis revealed there was no statistical difference between the 2 materials in all measurements.

Chief complaints of patients seeking treatment for periodontitis.

BACKGROUND: Hardly any data are available concerning the chief complaints, or CCs, of patients with periodontitis. The authors conducted a study to determine the most common CCs among a group of subjects with periodontitis. METHODS: The authors examined the dental records of 191 patients with periodontitis to determine what CCs they orally reported having at an initial examination. Patients were referred mainly by other members of the dental health team. Eighty percent of the patients were diagnosed with moderate or moderate-to-severe periodontitis. The authors recorded the frequency of different CCs to determine the most common complaints. RESULTS: The authors recorded 336 CCs from the records of 191 subjects with periodontitis. There were 21 different CCs. The most common CC reported was, "I was told I have gum disease." The second most common CC reported was, "I would like to save my teeth." Neither of these CCs are true periodontitis symptoms. Bleeding gums--a true periodontitis symptom--was the third most common CC. Only 6.2 percent of the subjects reported having painful gingiva, and only 29.3 percent of the subjects reported having dental-emergency-related CCs. CONCLUSIONS: The authors found that the motivation to seek periodontal treatment was most commonly based on information given to the subjects by a member of the dental health team, rather than a periodontitis symptom. CLINICAL IMPLICATIONS: Renewed efforts and increased responsibility of the dental health team members to inform patients about the presence of periodontitis are needed, as well as emphasizing to the public the risk of losing teeth as a result of periodontitis.

The accuracy of radiographic methods in assessing the outcome of periodontal regenerative therapy.

BACKGROUND: The study of regenerative therapy in the periodontal intrabony defect has relied upon surgical re-entry as the gold standard of outcome assessment. The search for a non-invasive method has led to the application of various radiographic techniques in evaluating post-treatment bone fill. METHODS: The purpose of this study was to determine the ability of 2 forms of radiographic analyses (linear measurement and computer assisted densitometric image analysis, CADIA) to assess postsurgical bone fill as measured at a re-entry procedure. A method that incorporates linear measurements and CADIA (linear-CADIA) was developed and tested as well. Forty-five intrabony defects in 15 patients were treated with open flap debridement, demineralized freeze-dried bone allograft (DFDBA), or a combination of DFDBA and tetracycline. Standardized radiographs were obtained at baseline and at 1-year postsurgery. RESULTS: A 12-month surgical re-entry provided clinical measurements for post-treatment bone fill. All radiographs were digitally scanned and analyzed on a computer. Fifty-three percent of the defects were excluded from the study due to poor standardization or poor defect quality. Forty percent of all pairs of radiographs were judged to have poor standardization. In the first analysis, standardized images were subtracted and quantitatively analyzed utilizing CADIA. It was found that CADIA had the highest correlation with clinical bone fill when a region of interest (ROI) was examined in the middle portion of the defect. This quantitative evaluation provided very little clinically relevant information regarding actual bone fill. For the second analysis, pre- and post-treatment linear radiographic measurements were obtained. In only 43% of the sites, did linear radiographic measurements determine post-treatment bone fill within 1.0 mm of the clinical measurements. Overall, linear measurements underestimated bone fill by 0.96 mm (+/-1.2). These differences were statistically significant (paired Student t-test, P = 0.0023). A method, which incorporates the use of both CADIA and linear radiographic measurements (linear-CADIA), was tested. The linear-CADIA method underestimated bone fill by 0.26 mm (+/-1.4), but these differences were not statistically significant (paired Student t-test, P = 0.41). CONCLUSION: Linear radiographic measurements significantly underestimate post-treatment bone fill when compared to re-entry data. The linear-CADIA method provided the highest level of accuracy of the 3 methods tested. This study also emphasizes the importance of developing a consistent method of radiographic standardization.

Pathologic migration of anterior teeth in patients with moderate to severe periodontitis.

The purpose of this study was to determine the prevalence of pathologic migration of anterior teeth in patients with moderate to severe periodontitis. The correlation between pathologic migration of anterior teeth and attachment loss (AL) was investigated, and an attempt was made to identify the most common early form of pathologic migration. Prevalence of tooth migration was studied in a group of 343 patients with moderate to severe periodontitis before treatment. The presence of pathologic migration was determined from the chief complaint and patient awareness o tooth movement in the last 5 years. Forty-four patients (age range 18 to 69; mean = 48.75) with 75 pairs of migrated and non-migrated teeth were studied further to determine if there is a correlation between severity of periodontal AL and pathologic migration. Migrated teeth were compared to control contralateral teeth that did not have migration. In addition, tooth mobility of the anterior teeth on 36 of the 44 patients was measured using the mobility meter. It was anticipated that tooth mobility would follow the same pattern as AL in relation to pathologic migration. The type and severity of displacement was recorded for each tooth affected by migration. The types of pathologic migration recorded were diastema, extrusion, rotation, facial flaring, and drifting into edentulous spaces. Pathologic migration prevalence was 30.03% +/- 2.5 (103/343 subjects). The mean AL of migrated teeth (4.79 +/- 0.28 mm) was significantly greater (P < 0.0001) than control teeth (3.21 +/- 0.18 mm). The numeric values (called PTV) of migrated teeth (17.6 +/- 1.5) were significantly greater (P < 0.0001) than control teeth (9.4 +/- 1.1). It was difficult to identify a primary form of displacement, as most patients demonstrated a combination of movements. The percentage of the 44 patients who presented with a specific type of movement was: facial flaring (90.9 +/- 4.4%), diastema (88.6 +/- 4.8%), rotation (72.7 +/- 6.8%), extrusion (68.2 +/- 7.1%), and tipping (13.6 +/- 5.2%). The results of this study confirms clinical impressions that periodontal disease destruction of the attachment apparatus plays a major role in the etiology of pathologic migration.

A clinical evaluation of a bioresorbable barrier with and without decalcified freeze-dried bone allograft in the treatment of molar furcations.

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.

Spontaneous correction of pathologic migration following periodontal therapy.

Two case reports illustrate spontaneous correction of pathologic migration following periodontal therapy. In one case, the displaced teeth were repositioned without orthodontic appliances after nonsurgical and surgical periodontal treatment. In the other case, closure of a diastema occurred following only nonsurgical therapy. The predictability of these findings needs further investigation. A discussion of possible reasons for this type of tooth movement is included.

A clinical evaluation of demineralized freeze-dried bone allograft in combination with tetracycline in the treatment of periodontal osseous defects.

The purpose was to evaluate the use of demineralized freeze-dried bone allograft reconstituted with 50 mg/ml tetracycline hydrochloride in the treatment of intrabony periodontal defects. Fifteen systemically healthy patients (12 females, 3 males; aged 35 to 61) with moderate-advanced periodontitis were treated. Patients had 3 osseous defects with probing depths (PD) > 5 mm after initial therapy. Each site in each subject was randomly assigned to one of the following groups: 1) demineralized freeze-dried bone allograft reconstituted with 50 mg/ml tetracycline (DFDBA + TCN); 2) demineralized freeze-dried bone allograft alone (DFDBA); or 3) debridement only (D). Clinical measurements were taken the day of surgery, 6 months, and 1 year. Standardized radiographs were taken at baseline and 1 year and were evaluated by computer assisted densitometric image analysis (CADIA). Clinical measurements included gingival recession, PD, clinical attachment level, and mobility. Osseous defect measurements were taken at baseline and at the 1 year reentry. No adverse healing responses occurred. The results showed that all patients had a statistically significant improvement in probing depth and attachment level at 1 year. Osseous measurements showed bone fill of 2.27 mm (51.6%) for the DFDBA + TCN group, 2.20 mm (52.4%) for the DFDBA group, and 1.27 mm (32.8%) for the D group. Defect resolution was 77.3% for the DFDBA + TCN group, 77.9% for the DFDBA group, and 63.8% for the D group. The mean CADIA values were 5.04 for the DFDBA + TCN group, 6.79 for the DFDBA group and 2.78 for the D group. The CADIA values did not correlate with the clinical parameters. Although the grafted groups showed greater bone fill and defect resolution, there was no statistically significant difference in any of the clinical parameters between the treatment groups. This study suggests that there is no significant benefit from reconstituting the allograft with 50 mg/ml of tetracycline hydrochloride.

Periodontitis in the baboon: a potential model for human disease.

Advances in periodontics with respect to disease activity, microbiology and immunology have demonstrated the multifactorial nature of periodontal diseases. This serves to underscore the need for an ideal animal model for periodontal research. Non-human primates are most similar to man in comparison to other animal models. The baboon is an Old World monkey that has infrequently been used in periodontal research. Periodontal exams were accomplished on 116 baboons (Papio anubis, P. cynocephalus) ages 5 to 30 years with one baboon year being roughly equivalent to 3 to 4 human years. The study population consisted of 29 males and 87 females. Clinical parameters including probing depth, attachment level, mobility, plaque index and gingival index were collected. Radiographs were taken on 25 animals and correlated to clinical findings. Results showed a significant increase in mean probing depth and mean attachment level with age (p = 0.0001). Disease prevalence and severity were not significantly different between genders. Mobility was uncommon; however, the prevalence and severity of furcation involvement increased with age. Radiographs suggested horizontal and isolated vertical bone loss. Plaque and gingival indices were at sustained high levels for all age groups and showed a statistically significant increase with age. Some baboons were found to develop a naturally-occurring periodontitis that increased in severity with age. This primate may be a suitable model for studies in human periodontal disease.

Recurrence of mandibular tori after surgical removal: two case reports.

Mandibular tori are sometimes removed to enhance periodontal and prosthodontic treatment. The exact cause of these benign bony overgrowths is not well understood, and therefore, their potential to recur after removal is also uncertain. Two case reports are presented in this article that provide evidence that at least some mandibular tori recur after surgical removal. One patient was followed-up for 11 years, and the other patient was followed-up for 14 years.

Osteoporosis and periodontal disease: a review.

A review of the literature on the relationship between osteoporosis and periodontal disease is presented. Osteoporosis, a metabolic disease, and periodontal disease, which is infectious, are both major health problems with multifactorial etiologies. There is histologic and radiographic evidence from animals and humans that osteoporosis does affect alveolar bone by decreasing bone mass and trabeculation. The literature reviewed in this paper suggests, but does not yet provide conclusive evidence for, a direct relationship between osteoporosis and periodontal disease.

Healing in periodontal defects treated by decalcified freeze-dried bone allografts in combination with ePTFE membranes. Assessment by computerized densitometric analysis.

This study quantitatively assessed radiographic changes in alveolar bone density by computer-assisted densitometric image analysis (CADIA) in periodontal defects that were treated with decalcified freeze dried bone allograft (DFDBA) alone or in combination with interproximal expanded polytetrafluroethylene membranes (ePTFE). The radiographic changes where then analyzed for correlation with the clinically assessed changes. The radiographic changes were evaluated on standardized radiographs of treated sites treated prior to, 1 week after surgery, and 6 months post-operatively. 15 patients with one pair of bilateral interproximal periodontal defects of similar morphology and > or = 6 mm in pocket depth participated. Analysis of the changes 6 months after treatment showed that the increases in density in the defect areas that received the graft were significantly greater than the adjacent areas (p < 0.001). These adjacent areas, in contrast, demonstrated significantly larger loss in radiographic density than the defect area (p < 0.001). The placement of DFDBA into the defects produced in itself significant increases in radiographic density, as illustrated by the results of one week which remained at six months. Utilization of ePTFE addition to DFDBA did not lead to additional radiographic gains in the defect area. While at one week the analysis suggested increased resorption by the combined treatment over grafting alone, such differences did not persist at 6 months post-surgery. Analysis comparing CADIA derived values for change with those of the clinical assessment revealed some associations.(ABSTRACT TRUNCATED AT 250 WORDS)

Healing in periodontal defects treated by decalcified freeze-dried bone allografts in combination with ePTFE membranes (I). Clinical and scanning electron microscope analysis.

This study clinically evaluates the use of decalcified freeze-dried bone allograft (DFDBA) in conjunction with an expanded polytetrafluoroethylene (ePTFE) membrane specifically designed for the treatment of interproximal intraosseous defects. It also examines by SEM, plaque contaminated membranes retrieved from patients. 15 advanced periodontitis patients with two bilateral interproximal probing depths of > or = 6 mm participated. After hygiene phase, measurements were made to determined soft tissue recession, pocket depth, clinical attachment levels and amount of keratinized tissue. Defects from each pair were randomly treated with ePTFE plus DFDBA (experimental) or DFDBA alone (control). Measurements were made during the surgery to determine crestal resorption, defect resolution and defect fill. Membranes were removed at 4 to 6 weeks and analyzed by SEM. Each site was surgically reentered and measurements repeated at six months. Both groups showed clinical and statistically significant changes when compared to baseline (P < 0.01), but no difference between groups. The experimental group showed increased soft tissue recession vs control group, 0.9 versus 0.4 mm, and loss of keratinized tissue 1.6 versus 0.1 mm (P < 0.0001). Control sites showed a 58% bone fill while experimental sites had 70% bone fill. There were no clear patterns of microbial colonization or cell adherences in either side of the membrane. It was concluded that the presence of plaque on the membranes did not compromise the initial clinical healing during the first 4-6 weeks. Results suggest a beneficial effect with the use of either technique for the treatment of intraosseous defects.

Effects of a bisphosphonate on experimental periodontitis in monkeys.

Bisphosphonates have been shown to increase bone mass in estrogen-deficient patients by inhibiting osteoclast activity. The purpose of this study was to measure clinical and radiographic effects of a bisphosphonate on periodontitis development in monkeys. Twenty-seven (27) adult cynomolgus monkeys were studied. After quarantine, baseline data were obtained including plaque index, gingival index, clinical probing depth measurements, and intraoral radiographs. Standardized radiographs were analyzed for quantitative changes in bone density using a computer assisted densitometric (CADIA) system. Animals were divided into 3 groups to receive 1 of the 3 treatment agents; these agents consisted of two levels of the test drug (alendronate) and a saline placebo. Agents were injected in the saphenous vein of the lower leg every 2 weeks for 16 weeks. One week after the initiation of treatment agent injections, mandibular right molars and premolars were ligated with 3-0 silk sutures to induce periodontitis. Ligated teeth were also inoculated with Porphyromonas gingivalis to insure a significant etiologic challenge. Nonligated homologous teeth served as controls. Clinical measurements and radiographs were repeated at 8 and 16 weeks after ligation. The bisphosphonate at a concentration of 0.05 mg/kg significantly retarded the progression of periodontitis as measured by bone density changes. The higher level dose of the test drug did not differ from placebo with respect to loss of bone density. Clinical indices were not affected significantly by the test drugs. Drugs that alter bone metabolism may offer a new approach to the treatment of periodontal disease.

A retrospective evaluation of endosseous titanium implants in the partially edentulous patient.

Partial edentulism in 34 patients was consecutively treated using the Brånemark osseointegration technique. A total of 102 implants was tested for mobility, signs and symptoms of infection, and radiographic bone levels. All patients had at least a 6-month follow-up of prosthesis function (mean 22.5 months). An overall success rate of 88.2% was observed. Twenty-five of 28 maxillary implants and 65 of 74 mandibular implants were successfully placed and restored. Twelve failures were observed; 7 were not integrated at the time of stage 2 surgery while 5 occurred after prosthetic reconstruction. The results of this study suggest that the Brånemark osseointegration procedure can be used to treat partially edentulous patients with a high degree of success.

The effects of erythrosine on alveolar bone and gingival connective tissue in dogs.

This study was conducted to determine if erythrosine had any effect when placed in contact with alveolar bone and gingival connective tissue in dogs in conjunction with a periodontal surgical procedure. Periodontal surgery was performed on 15 dogs, with a mucoperiosteal flap affording access for introduction of erythrosine (test) or saline (control) solutions, and subsequent flap replacement. The dogs were sacrificed at 2, 7, 10, 14, 21, and 28 days. Autopsy specimens were prepared, stained, sectioned, and examined by light microscopy. The general amount, degree, and type of inflammatory infiltrate was evaluated and recorded. Erythrosine had no apparent effect on the clinical healing time, alveolar bone, or gingival connective tissue in regard to the general degree, type, and location of the inflammation infiltrate based on postsurgical observations.