Clinical, Microbiological, and Histological Factors Which Influence the Success of Regenerative Periodontal Therapy

Abstract

The primary objectives of this double-blind, controlled clinical trial were to assess factor(s) which affect the success of guided tissue regeneration (GTR) procedures in mandibular Class II buccal furcation defects. Thirty subjects, with mandibular Class II furcation defects, were randomly assigned to one of two treatment groups; patients in Group A received oral hygiene instructions with scaling and root planing, while subjects in Group B received similar treatment but without subgingival scaling and root planing at the affected site. After initial oral hygiene instructions and scaling and root planing, GTR surgery was performed using ePTFE barrier membranes. Membranes were retrieved at 6 weeks and subjected to histological examination. Twelve months after regenerative therapy, clinical measurements and re-entry surgical measurements were repeated. Probing reduction (2.61 mm), horizontal probing attachment gain (2.59 mm), and vertical probing attachment gain (0.95 mm) were all significantly better compared to baseline. Likewise, significant improvements in furcation volume (8.0 microliters) and in bone measurements were observed at re-entry. There was no discernible difference between subjects for whom complete anti-infective therapy was deferred to the time of the surgery (Group B) compared to subjects in whom complete anti-infective therapy was performed as part of the hygienic phase of therapy (Group A). Pre-operative pocket depth was directly correlated with the magnitude of attachment gain as well as the amount of new bone formation in the furcation area. Subjects who maintained good oral hygiene and who had minimal gingival inflammation throughout the study demonstrated consistently better regenerative response.(ABSTRACT TRUNCATED AT 250 WORDS)

Regeneration of class II furcation defects: determinants of increased success

“…The patient-related factors that have a negative influence on the regeneration of these lesions include smoking, stress, diabetes mellitus, acquired immunodeficiency syndrome and other acute and debilitating diseases, and the presence of multiple deep periodontal pockets. Age, gender and type of periodontal disease do not seem to play a major role in regenerative therapy (10,16).…”

“…Bowers et al (10) demonstrated that despite comparable percentages of first and second molars with incomplete furcation closure, second molars exhibited a trend towards a higher proportion of defects with residual class II furcation. However, Machtei et al (16) showed that first and second molars responded similarly to regenerative treatment.…”

“…It could be stated that plaque-infected teeth will lose attachment after any type of surgery. Numerous reports indicate that good oral hygiene, as reflected in low plaque scores, is associated with better regenerative responses (14,16,28,43).…”

“…Patients should maintain good oral hygiene, especially in the furcation area, because sites with minimal or no gingival inflammation have consistently better regenerative responses than sites with poor plaque control (16). Thus, a regular supportive periodontal treatment (SPT) program must be established to maintain low plaque and gingival indexes and consequently to ensure that the newly-regenerated tissues are maintained.…”

Antibacterial efficacy of triple-layered poly(lactic-<i>co</i>-glycolic acid)/nanoapatite/lauric acid guided bone regeneration membrane on periodontal bacteria

“…However, excessive accumulation of acidic degradation products has been reported which will leads to unwanted inflammatory reactions 5) . One main factor that contributes to unsuccessful tissue regeneration by GBR membrane treatment is the action of periodontal bacteria such as Porphyromonas gingivalis (P. gingivalis) and Actinobacillus actinomycetemcomitans 7) . The proliferation of these bacteria should be controlled on the site of GBR membrane restoration to ensure successful tissue migration, growth and proliferation 7) .…”