Comparison of clinical, periapical radiograph, and cone-beam volume tomography measurement techniques for assessing bone level changes following regenerative periodontal therapy.

BACKGROUND: Intraoral radiographs (IRs) provide a two-dimensional view of osseous structures, whereas cone-beam volumetric tomography (CBVT) images are viewable in three dimensions. The aim of this investigation was to compare the measurements from digital IR and CBVT images to direct surgical measurements for the evaluation of regenerative treatment outcomes. METHODS: Digital IR and CBVT images were taken prior to initial bone grafting and at the 6-month reentry surgery for 35 intrabony defects. After defect debridement, direct bony defect measurements were made with a periodontal probe. These same measurements were made on the IR and CBVT images and then compared to the direct surgical values. RESULTS: CBVT correlated strongly with surgical measurements (r = 0.89 to 0.95), whereas IRs correlated less favorably (r = 0.53 to 0.67). IR measurements were significantly less accurate compared to CBVT for all parameters investigated and underestimated surgical measurements from 0.6 +/- 2.3 mm to 1.5 +/- 2.3 mm. No significant difference for the distance from the cemento-enamel junction (CEJ) to the alveolar crest (P = 0.66 for initial measurement and P = 0.92 for reentry), defect fill (P = 0.14), or defect resolution (P = 0.09) was seen between CBVT and surgical measurements; however, there was a significant difference for the distance from the CEJ to the base of the defect, with CBVT measurements underestimating the surgical measurements by 0.5 +/- 1.1 mm for reentry (P <0.01) and 0.9 +/- 0.8 mm for the initial measurement (P <0.01). CONCLUSIONS: Overall, compared to direct surgical measurements, CBVT was significantly more precise and accurate than IRs. If supported by further research, CBVT may obviate surgical reentry as a technique for assessing regenerative therapy outcomes.

Clinical evaluation of demineralized freeze-dried bone allograft with and without enamel matrix derivative for the treatment of periodontal osseous defects in humans.

BACKGROUND: Beneficial clinical effects have been demonstrated with the addition of enamel matrix derivative (EMD) to demineralized freeze-dried bone allograft (DFDBA) compared to EMD alone. The purpose of this study was to evaluate the effectiveness of DFDBA combined with EMD compared to DFDBA alone in the treatment of intraosseous defects of chronic periodontitis. METHODS: Thirty-two patients with 41 intrabony defects > or = 3 mm were randomly assigned to one of two treatment groups. Intrabony defects were treated with DFDBA alone or in combination with EMD. Soft tissue measurements included probing depth (PD), gingival recession, and clinical attachment level (CAL). Hard tissue measurements included height of the alveolar crest, defect depth, and defect morphology. Following 6 months of healing, all measurements were repeated with the use of a surgical reentry procedure on 29 patients. Data were analyzed to determine PD reduction, CAL gain, change in recession, crestal resorption, defect fill, defect resolution, percentage of defect fill, and percentage of defect resolution. RESULTS: Analysis of soft and hard tissue measurements demonstrated a statistically significant difference from baseline within each group (P <0.001); however, there was no statistically significant difference between the groups. CONCLUSION: Both treatments were shown to be safe and effective therapy for periodontal defects; however, the addition of EMD to DFDBA provided no statistically significant improvement to the soft and hard tissue parameters measured.