MCAF is a predictable treatment for multiple adjacent Miller Class I or II recession-type defects. The addition of a PRF membrane positioned under the MCAF provided inferior root coverage but an additional gain in GTH at 6 months compared to conventional therapy.

One-year results indicate that the modified tunnel/CTG technique is predictable for the treatment of multiple class III recession-type defects. The addition of EMD does not enhance the mean clinical outcomes.

The purpose of the present study was to histologically evaluate the healing of human intrabony defects following treatment with either a bovine-derived xenograft (BDX) and guided tissue regeneration (GTR) [BDX + GTR] or a bovine-derived xenograft mixed with collagen (BDX Coll) and GTR [BDX Coll + GTR]. Eight patients with chronic periodontitis and each with one very deep intrabony defect around a tooth scheduled for extraction were treated with either a combination of BDX + GTR (five patients) or with BDX Coll + GTR (three patients). The postoperative healing was uneventful in all eight cases. After a healing period of 6 months, the teeth or roots were extracted together with some of their surrounding soft and hard tissues and subsequently fixed in 10% buffered formalin. Following decalcification in EDTA, the specimens were embedded in paraffin and 8-microm histological sections were cut in the mesio-distal direction, parallel to the long axes of the teeth. The sections were alternatively stained with hematoxylin and eosin, van Giesson's connective tissue stain or with the Ladevig's connective tissue staining method and examined under the light microscope. Generally, formation of new cementum with inserting collagen fibers was found in seven out of the eight treated cases, whereas in the remaining case (treated with BDX + GTR) the healing was characterized by formation of a long junctional epithelium along the debrided root surface and no formation of cementum or bone. In the specimens demonstrating periodontal regeneration the new cementum was always of a cellular type. In most cases, the graft particles were surrounded by bone. In some areas, the bone tissue around the graft particles was connected by perpendicularly inserting collagen fibers to the newly formed cementum on the root surface. The epithelium downgrowth stopped always at the most coronal part of the newly formed cementum. No remnants of the membrane material were observed in any of the biopsies. Connective tissue encapsulation of the graft particles was rarely observed and was limited to the most coronal part of the defects. The findings of the present study provide evidence that treatment of intrabony defects with both BDX + GTR and BDX Coll + GTR may enhance periodontal regeneration in humans.

Within its limits, the present study failed to show periodontal regeneration in advanced human intrabony defects following non-surgical treatment with subgingival application of EMD.

The aim of the study was to investigate immunohistochemically the expression of matrix molecules associated with periodontal tissues reformed after regenerative periodontal treatment. Chronic intrabony defects were treated with guided tissue regeneration, enamel matrix proteins, the combination of both, or access flap surgery. Five months after healing, the animals were killed, and the healed periodontal tissues were evaluated immunohistochemically by means of polyclonal antibodies against osteopontin, collagen I, and collagen III. The intact (nontreated) parts of the periodontium served as controls. As a general observation, the staining for all investigated matrix molecules appeared to be stronger within the regenerated tissues than in the intact ones. The results failed to reveal any differences in terms of staining intensity or distribution pattern of investigated matrix molecules between the four different treatments. Osteopontin expression was most intense at the border near the newly formed cementum and bone. In the regenerated periodontium, collagens I and III were localized throughout the entire periodontal ligament connective tissue. In the regenerated periodontal ligament, collagen III displayed more intense staining than collagen I. The present results suggest that: (1) even after a 5-month period following surgical periodontal therapy, extracellular matrix molecules associated with wound healing and/or remodelling are more strongly expressed in regenerated than in intact tissues and (2) once an environment for periodontal regeneration has been created, the expression of extracellular matrix molecules associated with the healing process seems to display the same pattern, irrespective of treatment modality.

InstituteDie Institutsangaben sind am Ende des Beitrags gelistet Zusammenfassung ▼ Hintergrund: Ziel der vorliegenden kontrollierten randomisierten Studie im Split-Mouth-Design war es zu untersuchen, ob sich das Behandlungsergebnis bei multiplen Rezessionen der Klasse III mit einer modifi zierten Tunneltechnik und einem Bindegewebstransplantat unter Verwendung von Schmelzmatrixproteinen gegenüber dem bloßen chirurgischen Verfahren verbessert. Material und Methoden: In die Studie wurden an einer Klinik für Parodontologie insgesamt 20 gesunde Probanden im durchschnittlichen Alter von 31,7 Jahren aufgenommen. Die Patienten hatten mindestens 3 benachbarte Gingivarezessionen auf beiden Seiten eines Kiefers. Sie wurden mithilfe einer modifi zierten Tunneltechnik und einem Bindegewebstransplantat behandelt. Auf der Testseite wurde zusätzlich ein Schmelzmatrixprotein verwendet. Zu Beginn der Studie, nach 28 Tagen sowie 3, 6 und 12 Monate später wurden klinische Befunde erhoben. Die Ergebnisse werden patientenbezogen vorgelegt. Ergebnisse: Die durchschnittliche Wurzeldeckung betrug nach einem Jahr in der Testgruppe 82 % und in der Kontrollgruppe 83 %. Eine vollständige Wurzeldeckung fand sich nach einem Jahr bei insgesamt 8 (38 %) der 20 Operationen (Test-und Kontrollgruppe). Schlussfolgerungen: Die Ergebnisse nach einem Jahr lassen darauf schließen, dass die modifi zierte Tunneltechnik in Verbindung mit einem Bindegewebstransplantat zu vorhersagbaren Ergebnissen bei der Behandlung von multiplen Gingivarezessionen der Klasse III führt. Die zusätzliche Verwendung von Schmelzmatrixproteinen hatte keine Auswirkungen auf die durchschnittlichen klinischen Ergebnisse. Abstract ▼ Background: The aim of this controlled randomized split-mouth study was to evaluate whether a modifi ed tunnel/connective tissue graft (CTG) technique -enamel matrix derivative (EMD) combination will improve the treatment of multiple class III recession when compared with the same technique alone. Materials and methods: 20 healthy subjects with a mean age of 31.7 years, were enrolled for the trial in a university periodontal clinic. Patients with at least 3 adjacent gingival recessions on both sides of the mouth were treated with a modifi ed tunnel/CTG technique. On the test side, an EMD was used in addition. Clinical parameters were measured at baseline, 28 days, 3, 6 and 12 months after the surgery. Results are presented at the subject level. Results: The mean root coverage from baseline to 1 year post-surgery was 82 % for the test group and 83 % for the control group. Complete root coverage was achieved at 1 year in 8 (38 %) of the 20 surgeries (experimental and control group). Conclusions: 1-year results indicate that the modifi ed tunnel/CTG technique is predictable for the treatment of multiple class III recession-type defects. The addition of EMD does not enhance the mean clinical outcomes. Bibliografi e DOI http://dx.Schlüsselwörter • ▶ Bindegewebstransplantat • ▶ Tunneltechnik in Kombination mit koronalem Verschiebelappen • ▶ Schmelzmatrixprote...