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.

Clinical application of a new bioresorbable guided tissue regeneration device: case reports.

Bioresorbable barriers have been recently introduced in clinical practice for guided tissue regeneration therapy. One of these is the Guidor matrix barrier which is made of amorphous polylactic acid softened with a citric acid ester to increase malleability and facilitate clinical handling. The advantages of the bioresorbable barrier include: the elimination of second surgery; better handling and adaptation around the tooth and over the bone; and integration of the connective tissue of the flap with the barrier preventing epithelial migration, gingival recession, and pocket formation. In the case of matrix exposure the material disappears within 6 to 8 weeks. The purpose of this report is to present the clinical application of the Guidor matrix barrier in the treatment of two- or three-wall intrabony defects that were followed up for more than 1 year. The evaluation included soft tissue changes using clinical parameters and hard tissue changes using nonstandardized digital subtraction radiography. In the authors' opinion, the incorporation of a bioresorbable barrier in guided tissue regeneration therapy represents a significant improvement in the treatment of intrabony defects.

[Diabetes mellitus and periodontium. 1. Prevalence of periodontal disease in young insulin-dependent diabetics]. / Sakcharodes diabetes kai periodontio. 1. Emphanise periodontikes nosou se nearous insoulinoexartomenous diabetikous astheneis.

The aim of this investigation was to assess the periodontal condition of two different age groups of young insulin-dependent diabetics, and to compare it with two age-matched groups of non-diabetic controls. Group A consisted of 19 diabetics 15-24 years old, group B of 21 diabetics 25-36 years old, control group CA of 16 healthy individuals 16-24 years old. Each individual was examined regarding oral hygiene status (PlI), gingival condition (GI), probing depth, and gingival recession. The interproximal marginal bone level was assessed in bitewing radiographs. Non significant differences were found between the groups A and CA regarding their oral hygiene status (PlI), gingival condition (GI), frequency of sites with probing depths of greater than 3 mm, and gingival recession. There was a slight difference in the position of the interproximal alveolar bone margin. No significant differences were found between the groups B and CB regarding their oral hygiene status (PlI) and gingival condition. Very significant differences were found between these two groups (0.01 less than p less than 0.05). It was assumed that diabetes is associated with periodontal disease in diabetics of 25-36 years old. There were no significant correlations between the periodontal variables and the duration of diabetes, insulin dosage and blood sugar.

[Gingival hyperplasia induced by nifedipine. Report of two cases]. / Yperplasia oulon apo niphedipine (Parousiase dyo periptoseon).

Two cases of gingival hyperplasia associated with the administration of nifedipine are presented in this paper. Case 1, a 66 years old woman appeared with severe gingival enlargement, which was located at the right anterior and premolar region. Both attached gingivae and interdental papillae were hyperplastic, and the enlargement was more pronounced at the labial surfaces. The patient discontinued nifedipine, and after scaling and root planning, gingivectomy was performed. One month postoperatively the gingivae were in perfect health. Case 2, a 68 years old man presented with gingival enlargement mainly of the interdental papillae of the anterior and posterior region, which was more pronounced at the labial surfaces. Gingivectomy was performed at the upper anterior region after deep scaling, but the patient did not discontinue nifedipine. Three weeks postoperatively, recurrence of hyperplasia was noticed. In both cases histologically the gingival epithelium was parakeratininized and exhibited elongated rete pegs. The underlying connective tissue comprised of dense collagen fibres and the inflammatory cells which were present in the connective tissue, were mainly plasma cells and lymphocytes.