Remodelling of periodontal tissues adjacent to sites treated according to the principles of guided tissue regeneration (GTR).

Abstract

The aim of the present study was to assess the remodelling of alveolar bone adjacent to periodontal sites following therapy according to the principles of guided tissue regeneration (GTR) using computer-assisted densitometric image analysis (CADIA), and to compare the radiographic results to traditional clinical parameters. As required for digital subtraction analyses, periodically reproducible radiographs were obtained using a modification of the Rinn System and individual acrylic bite blocks for periodical identical radiographs. Ideally, a digital subtraction image from a site where absolutely no change in density had occurred would show a perfect cancellation of the structures. An average grey level value of 128 (the middle of the digitizer grey level range set by software) would show up at each pixel. Areas with grey levels < 128 in the subtraction image would indicate loss in density and grey levels > 128 would indicate increase in density. Within the subtraction images, areas were defined using the cursor to draw "regions of interest" (ROI) projected on the bony defect exposed to GTR covering the crestal bone as well as the region of potential "bonefill". The mean, median, the standard deviation and range of the grey levels of pixels within a particular ROI were calculated. Similarly sized ROI were drawn in bone areas not exposed to the GTR procedure serving as controls. The differences in the mean grey levels of all pixels within a particular ROI between the baseline, 3 and 12 months images were calculated for documentation of gain or loss in density. From 14 patients, standardized radiographs were available from baseline, 3 months and 12 months postsurgically, depicting one infraosseous defect before and after treatment according to the principles of GTR. The densitometric changes observed in these defects were compared to the clinically assessed changes measured at the site with the deepest baseline pocket depth. A mean clinical attachment gain of 2.36 mm after 3 and 3.22 mm after 12 months was measured. This was associated with a mean reduction in the PPD amounting to 3.36 mm and 3.79 mm, respectively. The changes in the level of the FGM were rather small considering the deep original mean PPD of 7.07 mm. Over the first months, a mean recession of 1.14 mm was observed which was followed by a coronal displacement of 0.43 mm. With respect to the remodelling of the alveolar bone adjacent to the defects assessed by means of CADIA, the most pronounced changes occurred when comparing the baseline to the 12 months radiographs.(ABSTRACT TRUNCATED AT 400 WORDS)