Application of gel-integrated macroporous hydroxyapatite in the treatment of marginal periodontitis

Abstract

Marginal periodontitis is a moderate to severe chronic inflammation of the gingiva and deep connective tissue around teeth with progressive resorption of bone and formed connective tissue caused by microbial plaque accumulation on the teeth and gingiva. Marginal adult periodontitis causes loss of attachment of tooth with the formed connective tissue at a different degree. The development of angular bone defect is a typical sign of this chronic inflammation of the periodontium. These angular alveolar bone defects are different in size and morphology following different plaque accumulation on the root surfaces, and the radius of influence of plaque toxins into the connective tissues (circumference of 2.5 mm). Other factors influencing the development of angular alveolar bone defects are the macromorphology of the jaw as well as the individual cyclic progression of marginal periodontitis. Angular bone defects are bordered with one, two or three walls of residual bone or of inflammed connective tissues only. The treatment of marginal periodontitis aims to repair and, if possible, to regenerate the bone. The surgical treatment measures are designed to improve accessibility for root scaling and root planing, the excision of inflamed connective tissue, and the modulation of alveolar bone to improve postoperative morphology. The additional implantation of granular macroporous hydroxyapatite (HAP) results in an improvement of the postoperative clinical judgment [1-3]. HAP aims to stabilise alveolar bone defects [4,5] and to create the possibility of repair and sometimes of regeneration. The HAP particles will be integrated into newly formed alveolar bone during a kind of foreign body reaction [6]. The application of macroporous HAP particles into periodontal bone defects is not guaranteed because single particles are too light. Therefore, aids for application are recommended. The fixation of HAP particles in an inert basic substance, which serves as an integration material for the HAP particles, could result in improving the application during the surgical procedures. The aim of this clinical study was to test a gel-integrated macroporous hydroxyapatite (Osprogel ®, Cerasiv) clinically and to compare this new material with non gel-integrated macroporous HAP (lnterpore 200®, Interpore Int.).