Repair of an intrabony defect from an adenomatoid odontogenic tumor.

This case report describes the occurrence and treatment of an adenomatoid odontogenic tumor (AOT) presenting as a periodontal intrabony defect on a upper lateral incisor. Following incision and flap reflection, a solid, rubbery specimen was enucleated in one piece leaving a wide moat-like intrabony defect. A bioabsorbable membrane of glycolide and lactide copolymer was sutured over the defect to maximize regeneration and the flaps then sutured over the membrane. Microscopic analysis of the biopsied specimen revealed dental hard tissue interspersed in a field of odontogenic epithelium in a glandular configuration, consistent with a diagnosis of AOT. AOT is a rare odontogenic tumor usually associated with unerupted teeth or dentigerous cysts, not periodontal defects. Clinical evaluation 6 months postoperatively revealed restoration of clinical attachment and periodontal health.

The use of demineralized freeze-dried bone-glycoprotein matrix grafts in treating baboon periodontal infrabony defects.

In an effort to improve regenerative capacity and establish higher levels of predictability, the use of a new graft material was investigated in baboon infrabony periodontal defects. A graft matrix composed of human demineralized freeze-dried bone combined with human connective tissue glycoprotein was implanted in 20 defects in 9 baboons. Control, debrided-only sites in the same animal served as a comparison. Grafted sites achieved a 1.8-mm greater reduction in probing depth and attachment gain compared to controls. In addition, 25.3% greater defect fill was found in grafted sites. Histologic analyses provided evidence of bone induction by the graft matrix and regeneration of new cementum, periodontal ligament, and bone in the grafted sites.

A clinical comparison of collagen membranes with e-PTFE membranes in the treatment of human mandibular buccal class II furcation defects.

Guided tissue regeneration procedures using non-resorbable expanded polytetrafluoroethylene (e-PTFE) membranes have become accepted therapy in treating moderate furcation defects. Resorbable collagen membranes have also been found to support regeneration and preclude the need for surgical removal. The present study compares their effectiveness with e-PTFE membranes in treating human mandibular Class II buccal furcation defects over a 12-month healing interval. Twelve patients were treated with collagen membrane in one defect and e-PTFE in another. Vertical and horizontal defect repair was evaluated through soft tissue probings and hard tissue measurements. Gingival indices and crevicular fluid flow measurements were used to evaluate site inflammation. Intragroup comparisons were made from baseline to 12 months for each type of membrane (sign test) and for differences between treatment groups with collagen versus e-PTFE membranes (Wilcoxon signed rank test). Both materials were effective in gaining vertical open probing new attachment and horizontal open and closed probing new attachment. Collagen membrane was statistically superior to e-PTFE in gaining horizontal open new probing attachment and in reduced levels of inflammation at the surgical site from baseline to 4 weeks. However, clinical differences were negligible. The intrinsic properties and ease of handling make collagen membranes a feasible alternative in guided tissue regeneration procedures.

The enhancement of guided tissue regeneration by altering root surface topography.

The periodontal fenestration model was used in four young mongrel dogs to evaluate the ability of vertical root surface grooving to enhance and direct cell outgrowth and subsequent formation of new attachment at 2- and 6-week healing intervals. In each dog, three fenestration wounds were made on each side of the mandible. On the control side, the roots were planed to dentin, a barrier membrane was sutured over the wound, and the flaps were replaced over the membrane. The experimental side received three vertical grooves followed by membrane placement and flap replacement. Histologic and histometric analyses were performed to determine the amount of new bone, cementum, and ankylosis and maturation of wound healing. Grooved wounds demonstrated greater cementum and bone formation, primarily in the early wounds, in addition to a more mature attachment at 6 weeks. Grooving the root surface may enhance initial cell adhesion and proliferation, thereby accelerating new attachment formation.

Controlled tissue expansion with guided bone regeneration.

Guided tissue regeneration techniques are used to create new bone around implant defects and to augment edentulous ridges prior to implant placement. A new technique, tested successfully in baboons, utilizes soft tissue expanders prior to implant placement and tissue regeneration procedures.

The use of collagen membranes to guide regeneration of new connective tissue attachment in dogs.

The aim of the present investigation was to evaluate the effectiveness of collagen membrane placement in excluding gingival epithelium and connective tissue cells and guiding new attachment in surgical treatment of created defects in dogs. Sixty defects were chosen at random and balanced in regard to receiving the following treatments: 1) untreated control, 2) debrided control, and 3) collagen membrane placement over the defect (along the root surface and under the replaced flap). Histologic and histometric evaluation at 2-12 weeks post-operatively determined the healing responses of each treatment modality. Epithelium migration with no new attachment occurred in the untreated and debrided areas. Collagen membrane placement was effective in inhibiting epithelial migration and encouraging formation of new connective tissue attachment to root surface previously altered by plaque.

The effect of supracrestal tricalcium phosphate ceramic-microfibrillar collagen grafting on postsurgical soft tissue levels.

In this clinical study, a combined tricalcium phosphate ceramic (TCP) microfibrillar collagen supracrestal graft was used in conjunction with pocket elimination surgery as a soft tissue space filler to maintain marginal and interproximal tissue heights. Fifteen volunteer adult patients (8 male, 7 female) aged 37 to 48 years were selected. Standardized clinical probing measurements were used to evaluate soft tissue recession, clinical attachment, and probing pocket depths. Intraoral photographs and radiographs supplemented documentation. Twenty-five paired test and control sites were evaluated. Following flap surgery and minor osteoplasty, test defects received supracrestal grafts of TCP microfibrillar collagen prior to flap closure. Intrabony defects were excluded. Treatment modalities were compared by analyzing changes in clinical probing measurements over four months using the students t test for paired samples at the 0.01 level of significance. Supracrestal grafting resulted in 16.74% less soft tissue recession than the control sites. In addition, there was a significant gain in clinical attachment levels compared with the controls. All implanted sites demonstrated an advantage in the use of supracrestal TCP-collagen grafts compared with the controls. This treatment modality may have value in reducing esthetic deformities, food impaction areas, and root exposure that often occur following periodontal surgery.