This study was designed to evaluate the potential for regeneration of a new attachment (alveolar bone, cementum and a functional periodontal ligament) in patients whose attachment apparatus had been destroyed by periodontal disease. In each of the three parts of the investigation, the most apical level of calculus on the root served as a histologic reference point to measure regeneration. In Part I, attempts were made to initiate the formation of a new attachment by surgical debridement, crown removal (coronectomy) and submersion of the vital root below the mucosa. Nonsubmerged, surgically debrided defects served as controls. In Part II, debrided intrabony defects were treated with and without demineralized freeze-dried bone allograft and the associated vital roots were submerged. Part III evaluated potential for regeneration of a new attachment in nonsubmerged roots with and without the use of demineralized freeze-dried bone allograft. Gingival grafts were placed over the experimental and control sites in an attempt to retard epithelial migration. Biopsies were obtained in 6 months and regeneration was evaluated histometrically. Preliminary results in 7 patients and 24 intrabony defects indicate that new attachment is possible on pathologically exposed root surfaces in a submerged environment with and without the incorporation of demineralized freeze-dried bone allografts. New attachment was observed on pathologically exposed root surfaces in a nonsubmerged environment when intrabony defects were grafted with demineralized freeze-dried bone allograft. New attachment was not observed on nongrafted, nonsubmerged, defects with and without the placement of gingival grafts over the defects.
To determine the sensitivity and specificity of the radiographic detection of calculus, 275 proximal tooth surfaces from 18 patients were evaluated. Standardized periapical radiographs obtained before extraction were coded, batch processed, and evaluated independently by two investigators under optimum viewing conditions. After extraction, the teeth were photographed and evaluated both microscopically and by planimetry on 40 X linear projections. Evaluation of calculus by conventional radiography showed low sensitivity: radiographic deposits were detected on only 44% of surfaces that demonstrated calculus microscopically. Specificity was high and the rate of false positives was only 7.5%. Detection of calculus was influenced by the thickness of calculus, the percentage of root surface occupied by calculus, and by tooth type; but not by attachment loss, probing depth, proximal surface, or arch location. These results show that present radiographic techniques are not appropriate for detecting calculus on root surfaces.
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