Clinical and Microbiological Evaluation of a Bioabsorbable and a Nonresorbable Barrier Membrane in the Treatment of Periodontal Intraosseous Lesions

Abstract

Clinical and microbiological features of periodontal healing in barrier membrane‐treated sites were determined in a randomized clinical trial. The study included 10 patients with advanced adult periodontitis and a minimum of one set of similar 2 to 3 wall intraosseous periodontal lesions with no furcation involvement. In each patient, one periodontal lesion was treated with a biodegradable membrane and a contralateral lesion with a nonresorbable barrier membrane. Within the preceding 3 months of regenerative therapy, all patients received full mouth osseous surgery except for the sites for regeneration, were instructed in oral hygiene, and were prescribed systemic ciprofloxacin and metronidazole (250 mg of each, TID, 8 days), starting 7 days before membrane placement. At baseline and at 6 months postsurgery, probing depth and clinical attachment level were assessed in each study site. The subgingival presence of suspected periodontal pathogens was determined by non‐selective and selective culture and by DNA probe analyses, and of human cytomegalovirus (HCMV) and Epstein‐Barr virus type 1 (EBV‐1) by a nested‐polymerase chain reaction detection method. At baseline, the barrier‐treated sites did not differ significantly in clinical and microbial parameters. Mean baseline probing depth was 7.8 ± 1.1 mm for bioabsorbable and 7.9 ± 1.3 mm for nonresorbable barrier‐treated sites. At 6 months, sites treated with bioabsorbable barrier revealed 4.6 ± 1.7 mm gain of clinical attachment (range: 1 to 7 mm) and sites treated with nonresorbable barrier 4.2 ± 2.0 mm (range: 1 to 8 mm). The 11 barrier‐treated sites that harbored 10% or less bacterial pathogens and were free of HCMV and EBV‐1 averaged significantly more clinical attachment gain than the 9 sites that yielded more than 10% bacterial pathogens and/or test viruses (5.6 mm versus 3.0 mm; P = 0.005). The present data suggest bioabsorbable and nonresorbable barriers provide similar clinical healing of 2 to 3 wall intraosseous periodontal lesions, emphasize the importance of controlling bacterial pathogens prior to and during periodontal healing, and point to the possible detrimental role of HCMV and EBV‐1 in periodontal repair. J Periodontol 1998;69:445–453.

The inhibitory effects of naringin on the growth of periodontal pathogens in vitro

“…In recent years, evidence has indicated that the presence of a pathogenic flora at the regenerated site or in the oral cavity of the patient before, during or after periodontal regeneration was associated with compromised outcomes (Smith MacDonald et al, 1998;Heitz-Mayfield et al, 2006). These pathogens influence and disrupt the blood clot in the early stages of healing and affect the amount of new tissue formation.…”

Guided tissue regeneration in intrabony defects using an experimental bioresorbable polydioxanon (PDS) membrane

“…wound healing potential, immune system, oral hygiene, defect morphology, smoking habits) (Tonetti et al 1995, Kornman & Robertson 2000, Cortellini & Tonetti 2000, there is strong evidence that membrane specific problems (e.g. Although the strict plaque control regimens of previous controlled clinical studies appeared to prevent a harmful effect of postoperative membrane exposures on the attachment gain (Becker et al 1996, Christgau et al 1997b, membrane exposures dramatically increase the risk for bacterial contamination and penetration of the exposed membrane parts (Grevstad & Leknes 1993, Nowzari et al 1995, Nowzari et al 1996, Chen et al 1997, MacDonald et al 1998). Bacterial contamination of the membranes can have a detrimental effect on the periodontal regeneration (Nowzari et al 1995, Slots et al 1999.…”

Bacterial Penetration Through Antibiotic‐Loaded Guided Tissue Regeneration Membranes

“…A clinical attachment gain <3 mm or even a loss of attachment was noted when the bacterial count on the GTR membrane was >10 8 in vivo 10 . Membrane bacterial count is positively associated with gingival recession 16 and is negatively associated with clinical attachment gain 8,11,12,17‐20 . These studies indicated the importance of controlling or eliminating periodontal pathogens during GTR procedures.…”

“…Bacterial contamination of the regenerating wound represents the most significant factor leading to a compromised outcome 5–7 . Bacterial species, 8,9 bacterial count, 9,10 and the area of bacterial contamination present on the GTR membrane 11,12 are some of the factors that may affect GTR outcome. The bacteria found on GTR membranes include various Gram‐positive bacteria as well as periodontal pathogens 13 .…”