Probing Attachment Level Gain Research Articles

Clinical efficacy of Lactobacillus reuteri-containing lozenges in the supportive therapy of generalized periodontitis stage III and IV, grade C: 1-year results of a double-blind randomized placebo-controlled pilot study.

The aim of this 12-month mono-centre double-blind randomized placebo-controlled clinical study was to evaluate the efficacy of Lactobacillus reuteri-containing lozenges during the supportive therapy of generalized periodontitis stage III and IV, grade C (GPIII-IVC) patients. Twenty treated GPIII-IVC patients were randomly divided into 2 groups. The test group received two 3-month-long administrations of L. reuteri (2 lozenges/day after brushing) with a 3-month washout period, while the control one received a placebo. Outcome measures were tooth survival, complications and adverse events, change in probing pockets depth (PPD), change in probing attachment level (PAL), presence of bleeding on probing (BOP) and patient's evaluation of treatment. Measurements were collected at 3, 6, 9 and 12months. At 1year, no dropout, tooth loss, complications or adverse event were recorded. Mean PPD and mean PAL and percentages of sites with BOP were statistically improved (p < 0.05) compared with baseline in both groups, while more PPD reduction at all time points (p < 0.05) and more PAL gain at 6months and more BOP reduction at 6 and 9months were found in the probiotic group (p < 0.05). Within the limitation of the study, the use of L. reuteri probiotics lozenges improved some clinical outcomes in treated GPIII-IVC patients during maintenance therapy. Studies with a larger number of patients are needed to confirm these data. The use of L. reuteri probiotic lozenges could be considered as an adjunct in the maintenance therapy of GPIII-IVC patients.

Efficacy of adjunctive Er,Cr:YSGG laser application to scaling and root planing in periodontal maintenance patients with residual periodontal pockets

The aim of this study was to evaluate the efficacy of using Er,Cr:YSGG laser in an adjunct to scaling and root planing (SRP + Er,Cr:YSGG) in periodontal maintenance patients with residual periodontal pockets. This study is a double-blind randomized controlled clinical trial and a split-mouth design. Fifteen periodontal maintenance patients with two single-rooted teeth with probing depth (PD) ≥ 5 mm in two different quadrants were randomly assigned to scaling and root planing (SRP) as a control group or SRP + Er,Cr:YSGG as test group. Plaque index (PI), bleeding on probing (BOP), PD, relative probing attachment level (RPAL), and relative gingival recession (RGR) were evaluated at baseline, 3 months and 6 months after treatment by one calibrated examiner. At 6 months after treatment, PDs were statistically significantly reduced in both SRP (0.9 ± 0.6 mm) and SRP + Er,Cr:YSGG (1.1 ± 0.7 mm) compared with pretreatment PD (p < 0.05). Only SRP + Er,Cr:YSGG demonstrated statistically significant probing attachment level (PAL) gained at 6 months after treatment (0.8 ± 0.6 mm; p < 0.05). Gingival recession (GR) statistically significantly increased in SRP + Er,Cr:YSGG 3 months after the treatment (0.5 ± 0.5 mm; p < 0.05). Nevertheless, there were no statistically significant differences between the 2 treatment modalities regarding PD reduction, PAL gain, or GR at 6 months after treatment. Only SRP + Er,Cr:YSGG demonstrated statistically significant PAL gained at 6 months after treatment (0.8 ± 0.6 mm; p < 0.05); however, there were no statistically significant differences between the 2 treatment modalities regarding PD reduction, PAL gain, or GR at 6 months after treatment in maintenance patients with residual periodontal pockets.

Clinical results after nonsurgical therapy in aggressive and chronic periodontitis

This study aims to analyze factors influencing treatment results in aggressive (AgP) and chronic (ChP) periodontitis. ChP [probing pocket depth (PPD) ≥ 3.5 mm, attachment loss ≥ 5 mm at >30 % of sites; age > 35 years] and AgP (clinically healthy; PPD ≥ 3.5 mm at >30 % of sites, radiographic bone loss ≥ 50 % at 2 teeth; age ≤ 35 years) were examined prior and 3 months after nonsurgical therapy according to the full-mouth disinfection concept. Adjunctive systemic antibiotics were used if Aggregatibacter actinomycetemcomitans had been detected at baseline. In 31 ChP (12 female, 10 smokers; 4,808 sites) and 28 AgP (16 female, 9 smokers; 4,769 sites), overall mean PPD reductions were less favorable in AgP (0.9 ± 0.5 mm) than in ChP (1.3 ± 0.4 mm; p = 0.033). PPD reductions and relative vertical probing attachment level gain were more favorable at sites with initial PPD ≥ 6 mm, bleeding on probing, and for adjunctive systemic antibiotics. Furthermore, PPD reductions were more favorable for increased baseline tooth mobility and maxillary teeth, whereas AgP, female sex, and multirooted teeth were associated with less favorable PPD reduction. Regarding PPD reduction, AgP responded less favorably to nonsurgical treatment than ChP.

Use of periosteal membrane as a barrier membrane for the treatment of buccal Grade II furcation defects in lower molars: A novel technique

To use the periosteum as a barrier in treatment of buccal Grade II furcation defects of lower molars. This technique was performed on 12 patients with bilateral buccal Grade II furcation defects of lower molars. On a random basis, one furcation defect of each pair was selected for the control group and other for the experimental group. Debridement was done in the defect area in both groups. In the control group, after debridement, mucoperiosteal flap was sutured back. In the experimental group, after reflection of the mucoperiosteal flap, a portion of the periosteum along with a layer of connective tissue (periosteal membrane) was incised and mobilized in the defect area for defect coverage as a barrier, and then the periosteal membrane and mucoperiosteal flap were fixed with suture, respectively. Horizontal dimension of the furcation defect was the primary outcome measure. Gingival index, probing attachment level (PAL), and vertical dimension of furcation defect were the secondary outcome measures. Clinical parameters were registered at baseline and at 6 months. Every clinical parameter was improved by surgery. Significant gain in PAL as well as horizontal and vertical dimensions of the furcation defects was found. This periosteum displacement technique is effective for the treatment of buccal Grade II furcation defects of lower molars.

Periodontal Regeneration With or Without Limited Orthodontics for the Treatment of 2‐ or 3‐Wall Infrabony Defects

Limited orthodontics are shown to be effective in the correction of infrabony defects. Studies have also demonstrated the efficacy of using enamel matrix derivative (EMD) with demineralized freeze-dried bone allograft (DFDBA) to treat infrabony defects. This study aims to compare the clinical efficacy of limited orthodontics combined with EMD/DFDBA in the treatment of 2- or 3-wall infrabony defects. A randomized, parallel clinical trial was conducted in a private periodontal practice (Tokyo, Japan) between April 2004 and October 2008. Treatment period was 1 year with a 1-year follow-up. Forty-seven randomized patients, mean age of 53 ± 10.7 years, were allocated into two intervention groups: ortho/EMD/DFDBA (n = 24) and EMD/DFDBA (n = 23). Each patient had either a 2- or 3-wall infrabony defect of ≥6 mm deep. Probing depth and clinical attachment level were measured at baseline and 1 year. The primary outcome measure was absolute change in probing depth and clinical attachment level from baseline to 1-year follow-up. The secondary outcome measure was absolute change in open probing attachment level gain and percentage defect resolution from baseline to 6-month reentry surgery. Infrabony defects were surgically treated with EMD and DFDBA 4 weeks before application of orthodontic extrusive forces. Reentry surgeries were performed at 6 months after initial surgery. Forty-seven patients were analyzed. Both treatment groups showed a significant improvement from baseline with no significant difference between the groups except for the 2-wall defects. The ortho/EMD/DFDBA group had statistically significant open probing attachment level gain (95% confidence level, 3.18 to 4.36; P = 0.036) compared to the EMD/DFDBA group (95% confidence level, 2.26 to 3.24) in 2-wall defects. Although both treatment modalities were effective in managing 2- or 3-wall infrabony defects, limited orthodontics provided an additional benefit to EMD/DFDBA in 2-wall defects.

Comparison of the effects of treatment of peri‐implant infection in animal and human studies: systematic review and meta‐analysis

The main objective of this systematic review is to compare the effects of treatment of peri-implant infection between animal and human studies. A literature search was conducted using the Medline, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Health Sciences Literature databases up to and including May 2008. In addition, bibliographies of systematic reviews on peri-implant diseases were searched manually. Non-surgical and surgical treatments of peri-implantitis/mucositis in animal models or human studies were compared. Meta-analysis was conducted to investigate the difference between the reported treatment effects in animal and human studies. Changes in probing pocket depth (PPD) and probing attachment level (PAL) from baseline measurements were used as measures of outcome. Single-level and multilevel meta-regression analysis was performed by taking into account the different follow-up times of the studies included. The single-level and multilevel random-effects meta-analysis showed that the difference in PPD reduction [0.31 mm, 95% confidence interval (CI): -0.27, 0.88] and in PAL gain (0.21 mm, 95% CI: -0.47, 0.88) between animal and human studies was not statistically significant. The random-effects meta-regression suggested that studies with longer follow-up times revealed greater PPD reduction (0.25 mm per month, 95% CI: 0.14, 0.35). However, when the different follow-up times were taken into account, these differences became greater. Substantial heterogeneity between studies was found in the meta-analyses (I(2)=97.6% for animal studies and 99.9% for human studies). There was great heterogeneity between human and animal studies in terms of study designs and treatment procedures. Therefore, the results from this meta-analysis should be interpreted with caution. Heterogeneity between studies and its causes merit further investigations.

Clinical and Radiographic Investigation of the Adjunctive Effects of a Low-Power He-Ne Laser in the Treatment of Moderate to Advanced Periodontal Disease: A Pilot Study

To evaluate the adjunctive effect of a low-power He-Ne laser in the non-surgical periodontal treatment of patients with moderate to advanced chronic periodontitis. Laser applications in dental treatment are now more common in the literature. However, limited data are available on the potential effects of the low-power laser as an adjunct to non-surgical periodontal therapy for managing patients with moderate to advanced periodontal disease. Sixteen patients with probing pocket depth (PPD) > or =5 mm and comparable bone defects on both sides of the mouth were recruited. Supragingival plaque (PL), bleeding on probing (BOP), PPD, and probing attachment level (PAL) were recorded at baseline and at 3, 6, 9, and 12 mo, while gingival crevicular fluid (GCF) samples and standardized intra-oral radiographs for digital subtraction radiography were taken at baseline and at 1, 3, 6, 9, and 12 mo. After non-surgical mechanical periodontal treatment, the test sites were selected randomly and irradiated with a low-power He-Ne laser (output power 0.2 mW) for 10 min for a total of eight times in the first 3-mo period, while the control sites received no additional treatment. PL percentage (83-16%) and BOP percentage (95-34%) decreased significantly after 12 mo. Statistically significant changes in reductions of PPD and GCF volume, gain in PAL, and increase in recession were seen in both test and control sites when compared to baseline (p < 0.05). No statistically significant differences in any clinical parameters or radiographic findings were found between the test and control sites. Changes in GCF volume were significant only at 3 mo in the test sites. Within the limits of this pilot study, the use of the low-power He-Ne laser as an adjunct to non-surgical periodontal therapy in patients with moderate to advanced chronic periodontitis did not seem to provide additional clinical benefit.

Guided tissue regeneration with bioabsorbable barriers III 10‐year results in infrabony defects

Evaluation of the 10-year results after GTR-therapy of infrabony defects using two bioabsorbable barriers in a randomized-controlled clinical trial. In 15 patients with periodontitis, 15 pairs of infrabony defects were treated. For each patient, one defect received a polydioxanon (test: T) and the other received a polylactide acetyltributyl citrate (control: C) barrier by random assignment. At baseline, 12 and 120 +/- 6 months after surgery, the clinical parameters and standardized radiographs were obtained. Nine patients were available for the 120-month re-examinations. Twelve and 120 +/- 6 months after therapy statistically significant (p<or=0.004) vertical probing attachment level (PAL-V) gain was found in both groups (T12: 3.9 +/- 1.6 mm; T120: 2.4 +/- 1.8 mm; C12: 4.0 +/- 1.1 mm; C120: 2.4 +/- 1.7 mm). From 12 to 120 months both groups experienced PAL-V loss (T: 1.4 +/- 1.5 mm, p=0.021; C: 1.6 +/- 2.5 mm, p=0.09). After 120 month, two teeth were lost in the control group (one periapical lesion, and one due to unknown reason). The study failed to show statistically significant differences between both groups regarding PAL-V gain 120 months after surgery. PAL-V gain achieved after GTR therapy in infrabony defects using both bioabsorbable barriers was stable after 10 years in 15 of 22 defects (68%).

Effects of smoking on healing response to non‐surgical periodontal therapy: a multilevel modelling analysis

To investigate the factors predicting non-surgical periodontal treatment responses using multilevel multiple regression. Forty men (mean 45.6 years) were recruited; 20 were smokers. A 12-month reduction in probing pocket depth (PPD) and gain in probing attachment level (PAL) of 5814 sites were analysed, with 594 being initially diseased sites (initial PPD> or =5 mm). Variance Component models showed that site-level variations contributed about 70-90% of the total variance. About a 10% reduction of the total variations of PPD reduction in initially diseased sites was achieved with the inclusion of the 10 predictors in the multilevel multiple regression. Multilevel multiple regression showed that three predictors, subject level: non-smokers; tooth-level: anterior teeth; and site level: sites without plaque at baseline, were significantly associated with a greater reduction in PPD in initially diseased sites over the 12-month study period (p<0.05). No consistent predictor was found for PAL gain. Multilevel analysis was applied on periodontal treatment response data. Smokers showed less favourable PPD reduction at deep sites after non-surgical periodontal therapy.

Primary flap closure combined with Emdogain® alone or Emdogain® and Cerasorb® in the treatment of intra‐bony defects

To compare clinical outcomes of three different modalities of treatment for deep intra-bony defects. Fifty-six patients were paralleled for clinical parameters and randomly assigned to treatment. They displayed one angular defect each with an intra-bony component > or =3 mm, probing pocket depth (PPD) and probing attachment level (PAL) > or =7 mm, and plaque index (PI) <1. Nineteen defects were treated, respectively, with enamel matrix derivative (EMD)+tricalcium phosphate (TCP) or EMD alone and 18 defects with modified Widman flap (MWF). Primary flap closure was used in all three groups. PI, gingival index, bleeding on probing, PPD, PAL, and recession (REC) were measured before and 12 months after treatment. Treatment with EMD alone yielded a 3.9+/-1.3 mm PPD decrease and a 3.7+/-1.0 mm PAL gain (p<0.001), whereas EMD+beta-TCP produced a 4.1+/-1.2 mm PPD reduction and a 4.0+/-1.0 mm PAL gain (p<0.001). These outcome parameters did not differ between the two groups. REC increased by 0.7+/-1.3 mm. After MWF treatment, attachment gain was 2.1+/-1.4 mm (p<0.001) and PPD reduction was 3.8+/-1.8 mm, whereas REC increased by 1.5+/-0.7 mm (p=0.042 versus EMD). Both EMD treatments showed similar clinical effects, with significant PAL gain and a significantly lower REC increase in comparison with MWF treatment.

Five-year results of guided tissue regeneration in combination with deproteinized bovine bone (Bio-Oss) in the treatment of intrabony periodontal defects: a case series report

The aim of this study was to report on the clinical and radiographic results 5 years following treatment of intrabony defects with guided tissue regeneration (GTR) in combination with deproteinized bovine bone (DBB) (Bio-Oss). Fifteen patients, with at least one intrabony periodontal defect with probing pocket depth (PPD)>or=7 mm and radiographic presence of an intrabony component (IC)>or=4 mm, were treated with a PLA/PGA bioabsorbable membrane. Prior to placement of the membrane, the defect was filled with DBB impregnated with gentamicin sulfate 2 mg/ml. Standardized intraoral radiographs were taken prior to treatment and at the control examinations after 1 and 5 years. At baseline, the average PPD was 9.2+/-1.1 mm, and the average probing attachment level (PAL) was 10.1+/-1.6 mm; the radiographic bone level (RBL) was 10.4+/-2.45 mm, and an IC of 6.2+/-2.3 mm was present. One year after membrane placement, treatment had resulted in a PAL gain of 3.8+/-1.8 mm, a residual PPD of 4.2+/-1.3 mm, an RBL gain of 4.7+/-2.0 mm, and a residual IC of 2.1+/-1.2 mm. At the 5-year examination, two patients did not show up, and two patients had lost the treated tooth. However, both teeth were endodontically treated, and progressive periodontal destruction might not necessarily have been the reason for extraction. At the 5-year control (11 patients), the PAL gain was 4.1+/-1.6 mm, and the residual PPD was 4.6+/-1.2 mm; an RBL gain of 4.9+/-2.7 mm and a residual IC of 1.8+/-0.8 mm were observed. Statistically significant clinical improvements had occurred between baseline and the 1- and 5-year controls, whereas there were no significant differences between the 1- and 5-year results. The results of GTR with bioabsorbable membranes in combination with Bio-Oss in the treatment of periodontal intrabony defects are basically stable on a long-term basis.

Long‐term stability of periodontal conditions achieved following guided tissue regeneration with bioresorbable membranes: case series results after 6–7 years

To evaluate the results of guided tissue regeneration (GTR) treatment of intrabony defects with bioresorbable membranes after 6-7 years, and to disclose factors that may influence the long-term outcome of the treatment. Twenty-five defects in 19 patients were treated by means of polylactic acid/citric acid ester copolymer bioresorbable membranes. At baseline and after 1 and 6-7 years, the following parameters were recorded: (1) probing pocket depth (PPD), (2) gingival recession (REC), (3) probing attachment level (PAL)=PPD+REC, (4) presence/absence of plaque (PI), (5) presence/absence of bleeding on probing (BOP). Smoking habits and frequency of dental-control visits were also recorded. Significance of differences between categorical variables was evaluated with McNemar's test, and between numerical variables with the t-test for paired observations. Generalized linear models were constructed to evaluate the influence of various factors on PAL gain and PPD changes from 1 to 6-7 years. Association of smoking, frequency of dental controls, oral hygiene, and BOP with sites losing > or =2 mm in PAL was evaluated with Fisher's exact test. At baseline, a mean PPD of 8.7+/-1.1 mm and a mean PAL of 9.8+/-1.5 mm was recorded. Statistically significant clinical improvements were observed at 1 and 6-7 years after GTR treatment. An average residual PPD of 3.8+/-1.1 mm and a mean PAL gain of 3.8+/-1.4 mm were observed after 1 year. After 6-7 years the corresponding values were 4.7+/-1.3 and 3.6+/-1.4 mm, respectively. There were no statistically significant differences between the 1- and the 6-7-year values. At the 6-7-year control, only 16% of the sites had lost > or =2 mm (maximum 3 mm), of the PAL gain obtained 1 year after GTR treatment. None of the sites had lost all of the attachment gained 1 year after treatment. Smoking, frequency of dental controls, oral hygiene, and BOP did not seem to influence the change of PPD and PAL gain, or the stability of PAL gain (i.e. losing PAL or not) from 1 to 6-7 years from treatment. Clinical improvements achieved by GTR treatment of intrabony defects by means of bioresorbable membranes can be maintained on a long-term basis.

Smoking affects the outcome of guided tissue regeneration with bioresorbable membranes: a retrospective analysis of intrabony defects

To disclose factors that may influence the results of guided tissue regeneration (GTR) treatment in intrabony defects with bioresorbable membranes. Forty-seven intrabony defects in 32 patients were treated by means of polylactic acid/citric acid ester copolymer bioresorbable membranes. At baseline and after 1 year, the following parameters were recorded: (1) probing pocket depth (PPD), (2) gingival recession (REC), (3) probing attachment level (PAL)=PPD+REC, (4) presence/absence of plaque (PI), (5) presence/absence of bleeding on probing (BOP) and (6) intrabony component (IC) configuration (i.e. primarily presence of one, two, or three bone walls). Occurrence of membrane exposure and smoking habits were also recorded. Significance of differences between categorical variables was evaluated with McNemar's test, and between numerical variables with the t-test for paired observations. Generalized linear models were constructed to evaluate the influence of various factors on PAL gain and PPD after 1 year, including in the analysis only one defect per patient (i.e. 32 defects) chosen at random. Odds ratios were calculated using the Mantel-Haenszel method. Differences between smokers and non-smokers were evaluated by means of Pearson's chi2 and Student's t-test for non-paired observations. At baseline, a mean PPD of 8.6+/-1.1 mm and a mean PAL of 9.8+/-1.6 mm was recorded. Statistically significant clinical improvements were observed 1 year after GTR treatment. An average residual PPD of 3.7+/-1.1 mm and a mean PAL gain of 3.8+/-1.5 mm were recorded. IC configuration and exposure of the membrane did not seem to influence the results, while a negative effect of smoking on the clinical parameters was observed. Smokers gained approximately 1 mm less in PAL than non-smokers (3.2+/-1.4 versus 4.3+/-1.3, respectively; p=0.03) and had approximately seven times less chances to gain 4 mm in PAL as compared with patients who did not smoke (odds ratio: 0.15). PPD reduction was less pronounced in smokers than in non-smokers (4.5+/-0.7 versus 5.5+/-0.7, respectively; p<0.01), resulting in somewhat deeper residual PPD in smokers than in non-smokers (3.6+/-1.0 versus 3.4+/-1.1; p>0.05). Smoking impairs the healing outcome of GTR treatment of intrabony defects with bioresorbable membranes.

GTR treatment of intrabony defects with PLA/PGA copolymer or collagen bioresorbable membranes in combination with deproteinized bovine bone (Bio-Oss)

The objectives of this study were to evaluate the results of guided tissue regeneration (GTR) treatment of intrabony defects with two kinds of bioresorbable membranes, with deproteinized bovine bone (Bio-Oss) used as an adjunct. Twenty-eight patients with at least one intrabony defect with a probing pocket depth (PPD) >/=7 mm and radiographic evidence of an intrabony component (IC) >/=4 mm were randomly treated with either a polylactic/polyglycolic (PLA/PGA) acid copolymer or a collagen bioresorbable membrane combined with Bio-Oss implantation. Immediately prior to surgery (baseline) and after 1 year, the following parameters were recorded: (1) PPD, (2) gingival recession (REC), (3) probing attachment level (PAL), (4) presence/absence of plaque (PI), and (5) presence/absence of bleeding on probing (BOP). Occurrence of membrane exposure during healing and the smoking habits of the patients were also recorded. Statistical analysis was carried out using chi(2) -tests and t-tests. There were no significant differences between the two membrane groups regarding the clinical parameters at baseline. Statistically significant clinical improvements (PAL gains, reduced PPDs) were observed 1 year after treatment in both groups. There were no significant differences, however, between the PLA/PGA and the collagen membrane groups regarding any of the evaluated parameters (mean PAL gain: 2.9 mm vs 3.9 mm; mean residual PPD: 4.8 mm vs 4.1 mm, respectively). The membrane material per se does not seem to be a critical factor for the outcome of GTR treatment of intrabony defects with bioresorbable membranes.

Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects. A systematic review.

Many clinical studies have demonstrated that guided tissue regeneration (GTR) is a successful treatment modality of periodontal reconstructive surgery and it has become an accepted procedure in most periodontal practices. The purpose of this structured review was to assess the efficacy of guided tissue regeneration (GTR) procedures in patients with periodontal osseous defects compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes. It extends the scope of previous GTR systematic reviews, which were limited to randomized controlled studies, by the scope of outcome measures examined, and the duration of the study. In patients with periodontal osseous defects, what is the effect of physical barriers compared with surgical controls on clinical, radiographic, adverse, and patient-centered outcomes? An electronic search of the Cochrane Oral Health Group Trials Register and MEDLINE databases was performed. Manual searching of journals included Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research up to January 2002. This manual search also included review of relevant bibliographies. Two manufacturers of GTR devices were contacted regarding unpublished data. Studies were selected for review if the evidence level was 3B (cohort) or above, at least 6 months duration, and compared a test GTR intervention with a surgical control. Studies with experimental design problems; histologic or microbiological investigations; or those with outcome measurements, study populations, or study duration not consistent with the inclusion criteria were excluded. Primary outcome measures for intrabony defects were: clinical attachment level (CAL) gain, probing depth reduction (PD), gingival recession (REC) reduction; for furcation defects: vertical probing attachment level (VPAL) gain, vertical probing depth reduction (VPD), horizontal probing depth reduction (HPD), horizontal open probing attachment level gain (HOPA), and vertical open probing attachment level gain (VOPA). Meta-analysis was performed to compare GTR procedures to other surgical treatments and to examine the resulting clinical outcomes. 1. For the primary outcome variables, in both intrabony-defect and furcation-defect studies, GTR was favored over open flap debridement (OFD) therapies (P < 0.0001). 2. No differences were detected among barrier types, but barrier types could explain some heterogeneity in the results. 3. Augmentation of the GTR barrier with a particulate graft enhanced VPD (P < 0.05), VPAL, and HOPA, but none of the intrabony outcomes. Overall, GTR is consistently more effective than OFD in the gain of clinical attachment and probing depth reduction in the treatment of intrabony and furcation defects.

The use of PVP‐iodine as an adjunct to non‐surgical treatment of chronic periodontitis

AbstractObjective: The present study was performed to assess the effect of topically‐applied PVP‐iodine, used as an adjunct both during basic non‐surgical therapy and at re‐treatment during the long‐term maintenance of patients with advanced periodontal disease.Material and Methods: 223 patients with advanced destructive periodontitis were recruited. The participants met the following inclusion criteria: (i) a minimum of 8 non‐molar teeth, (ii) probing pocket depth of 6 mm at 2 teeth in each dentate quadrant, and radiographic bone loss exceeding 40% at the same teeth. A baseline I examination included assessment of plaque, gingivitis, probing pocket depth (PPD), probing attachment level (PAL) and radiographic bone height (R×BL). Following baseline I, the patients were stratified into 2 treatment groups; 2 subjects out of 3 were included in a control group and 1 in a test group. All participants, on an individual basis, received a case presentation and were instructed in proper self‐performed plaque control measures. Non‐surgical therapy was performed by the use of an ultrasonic device. The instrumentation in the test group was combined with the administration of 0.1% PVP‐iodine. All subjects were recalled for comprehensive examinations 3, 6 and 12 months (baseline II) after baseline I and then after 3, 5 and 13 years of maintenance therapy. PAL determinations were performed annually. Subjects (losers) who at the re‐examinations after 1, 2 and 3 years of maintenance demonstrated an annual further loss of PAL 2 mm at 4 teeth were exited from the study and referred for re‐treatment. There were 9 losers in the test and 31 in the control group. In addition, 8 subjects in the test and 25 subjects in the control group withdrew from the trial for reasons unrelated to the study. These 73 subjects were not included in the data presentation from the various examinations.Results: It was demonstrated that non‐surgical periodontal therapy resulted in (i) improved gingival conditions, (ii) reduced PPD, (iii) gain in PAL. It was also documented that the topical application of 0.1% PVP‐iodine in conjunction with the mechanical root debridement established conditions which further improved the outcome of therapy. This was evidenced by the fact that at the 3, 6, and 12 months re‐examinations after baseline I, the test group had significantly lower mean PPD values and significantly more gain of PAL than the control group. During the 12 years of SPT, it was possible for most subjects in both groups to maintain shallow pockets and to avoid marked further loss of PAL. There were, however, a larger number of losers in the control than in the test group.Conclusion: PVP‐iodine, topically applied during subgingival instrumentation, may improve the outcome of non‐surgical periodontal therapy.

Periodontal tissue alterations following Emdogain® treatment of periodontal sites with angular bone defects.

The aim of the present study was to assess the predictability of probing attachment gain and probing pocket depth reduction following Emdogain treatment at sites with deep angular bone defects. 108 consecutively-treated periodontal patients (mean age 55.8 years) were included. Each subject exhibited at least 1 deep interproximal intrabony defect that could be identified as an experimental site based on the inclusion criteria: (i) probing pocket depth > or = 5 mm, (ii) probing attachment loss > or = 6 mm, (iii) radiographic evidence of an interproximal bone defect with a > or = 3 mm intrabony component. A total of 145 defects met the criteria for inclusion. All subjects received non-surgical periodontal therapy. This included subgingival instrumentation in all parts of the dentition. At least 6 months after the completion of this treatment, a baseline examination was performed to characterise the experimental site. Reconstructive therapy was subsequently performed. Full-thickness periodontal flaps were elevated, and the root surface scaled and planed. No bone recontouring was performed. A gel containing 24% EDTA was applied on the exposed root and was kept in place for 2 min. A preparation of enamel matrix proteins was applied to the root surface and adjacent defect space. The flaps were replaced and closed with sutures. The experimental sites were re-examined 12 months after reconstructive surgery. The re-examination demonstrated that a treatment including the application of enamel matrix proteins at periodontal sites with angular defects resulted in a mean probing attachment level gain of 4.6 mm and a probing pocket depth reduction of 5.2 mm. 87% of all sites treated exhibited a probing attachment gain of > 2 mm. One site suffered probing attachment loss. The radiographic assessments revealed that the bone defect had been reduced in depth by 2.9 mm on average. The reduction in defect size corresponded to an average bone fill of 69% of the original defect. In 43% of the defects, the bone fill amounted to > or = 80%. The overall probing pocket depth reduction, probing attachment level gain, and soft tissue recession, that results following Emdogain therapy, is similar to the corresponding outcome variables following GTR.

Guided tissue regeneration using a collagen membrane in chronic adult and rapidly progressive periodontitis patients in the treatment of 3-wall intrabony defects.

This study, confined to non-smokers, evaluated guided tissue regeneration using a diphenylphosphorylazide-cross-linked bovine type I collagen membrane in deep 3-wall intrabony defects in 52 adult periodontitis (AP) and 16-rapidly progressive periodontitis (RPP) patients, previously treated for the acute phase of the disease, no more than one defect being randomly selected for each patient. Before surgery and 6 months after surgery, plaque (PI) and sulcus bleeding (SBI) indices, as well as probing pocket depths (PPD), gingival margin locations (GML) and probing attachment levels (PAL) were recorded. During the post-surgical period, the membranes were very well tolerated in all patients and PI and SBI were kept at a low level. 6 months post-surgical, there was a significant gain in PAL (3.6 mm for AP; 2.6 mm for RPP) and reduction in PPD (5.5 mm for AP; 4.1 mm for RPP) for both groups of patients (p < 0.05). However, neither the change in GML (1.9 mm for AP; 1.5 mm for RPP), nor PPD or PAL yielded a statistically significant difference between AP and RPP patients. The results of this study demonstrated that the treatment of deep 3-wall intrabony defects with a diphenylphosphorylazide-cross-linked collagen membrane in both AP and RPP patients during the quiescent phase of the disease is a treatment modality where the conquences are predictable. However, longer observation periods are necessary to evaluate the stability of the improvements obtained for the 2 groups of patients and the differences between them.

Bacterial colonization of bioabsorbable barrier material and periodontal regeneration.

The objective of the study was to evaluate bacterial colonization of the tooth-facing surface of bioabsorbable membranes and to determine its effect on the clinical outcome of membrane supported reconstructive periodontal surgery. Twenty systemically healthy subjects affected by chronic adult periodontitis were enrolled in the study. One non-furcation tooth site per patient, associated with an angular bony defect and a probing attachment loss of > 5 mm, was selected to be treated by means of a guided tissue regeneration procedure using a polyglicolactic membrane. Antibiotics (amoxicillin/clavulanate potassium 1 g per day) for 2 weeks were prescribed, in addition to the use of chlorhexidine for post-surgical plaque control. All patients were recalled once a week for 5 weeks for professional tooth cleaning. At 5 weeks sites with clinically exposed membranes underwent a second surgery to harvest residual barrier material which was analyzed by scanning electronic microscopic (SEM) for bacterial colonization. Sites with no membrane exposure at 5 weeks were allowed to heal without any other surgical intervention. Professional tooth cleaning and reinforcement of self-performed oral hygiene measures were given at 1 month intervals for the duration of the study. For each treated site the difference in probing attachment loss between baseline examination and a follow-up examination made 6 months after the second surgery was calculated. Gain of probing attachment was statistically (P < 0.001) greater in sites with no membrane exposure when compared to sites with partially exposed barrier material (4.2 +/- 0.5 vs. 3.3 +/- 0.6). The results of SEM analysis revealed that bacterial colonization was evident in all the microscopic fields of the exposed areas of the membranes. In the mid-part of the membranes 16 out of 39 microscopic fields (41%) demonstrated microbial colonization, while no bacteria-positive field was observed in the most apical portion of the membranes. Regression analysis indicated that gain in probing attachment level was negatively correlated to microbial colonization of the mid-part of the membranes. It was suggested the midportion of the tooth-facing surface of polyglicolactic membrane is a critical area for the healing process since its bacterial colonization was detrimental to the outcome of the GTR surgery.

Bacterial colonization of barrier material and periodontal regeneration.

The objective of this study was to evaluate the relationship between the presence of bacteria on the tooth-facing surface of ePTFE barriers and the clinical outcome of membrane supported reconstructive periodontal surgery. 20 systemically healthy subjects affected by chronic periodontitis were enrolled. One tooth site per patient, associated with an angular bony defect and a probing attachment loss of > 4 mm, was selected to be treated by means of a guided tissue regeneration procedure using an ePTFE barrier membrane. Antibiotics (Augmentin 1 g/day) for 2 weeks were prescribed. In addition to the use of chlorhexidine for post-surgical plaque control, all patients were recalled once a week for professional tooth cleaning. The barrier material was harvested for SEM analysis after 4-6 weeks. Professional tooth cleaning and reinforcement of sel-performed oral hygiene measures were given at 1 mouth intervals after membrane removal. For each treated site, the difference in probing attachment loss between baseline examination and a follow-up examination after 6 months of healing was calculated. The results of the SEM-analysis revealed that bacterial colonization was evident in the collar area of all the retrieved membranes. In the mid part of the membranes 30 out of 60 microscopic fields (50%) demonstrated microbial colonization, and in the most apical part 9 out of 60 fields (15%). Regression analysis indicated that gain in probing attachment level was positively correlated to initial attachement loss and negatively correlated to microbial colonization of the mid part of the membranes. It was concluded that bacterial colonization in the mid part of the ePTFE membrane reduced the potential gain in probing attachment following GTR-therapy with almost 50%.