GTR therapy of intrabony defects using 2 different bioresorbable membranes: 12‐month results

Abstract

This prospective split-mouth study was designed to compare the clinical and radiographic healing results in intrabony periodontal defects 12 months after GTR therapy with 2 different bioresorbable barriers. The study comprised 25 healthy patients with one pair of contralaterally located intrabony defects with a probing pocket depth of > or = 6 mm and radiographic evidence of angular bone loss of > or = 4 mm. The 2 defects of each patient were randomized for treatment either with polylactic acid (PLA) membranes or with polyglactin-910 (PG-910) membranes. The patients received systemic doxycycline (100 mg/d) for 11 days postoperatively. One blinded examiner recorded the following clinical parameters using a pressure calibrated probe at baseline and after 12 months: papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), and probing attachment level (PAL). The vertical relative attachment gain (V-rAG) was calculated as a % of the PAL gain related to the maximum possible attachment gain (expressed by the intraoperatively measured depth of the osseous defect). Geometrically standardized intraoral radiographs were quantitatively evaluated for bone changes (density, area) in the defect region using digital subtraction radiography (DSR). Clinical and radiographic data were statistically analyzed using the Wilcoxon-signed-rank test (alpha=0.05). Postoperative membrane exposures occurred in 9 PLA and 13 PG-910 treated sites. After 12 months of healing, both barrier types provided significant PPD reductions and PAL gain [median (25/75 percentile)]: deltaPPD [PLA: 3.0 (2.0/4.0) mm; PG-910: 3.0 (2.0/4.5) mm]; deltaPAL [PLA: 3.0 (2.5/4.0) mm; PG-910: 2.0 (1.0/4.0) mm]. V-rAG amounted to 60% in PLA sites and 54% in PG-910 sites. DSR revealed significant bone density gain after 12 months. 58.3% of the initial defect area in PLA sites and 54.0% of the initial defect area in PG-910 sites showed bone density gain. Neither clinical nor radiographic data revealed any significant difference between the 2 barrier types after 12 months. In conclusion, this 12-month study demonstrated that PLA and PG-910 membranes provided similar favorable regeneration results in deep intrabony periodontal defects.

Digital subtraction radiographic analysis of the combination of bioabsorbable membrane and bovine morphogenetic protein pool in human periodontal infrabony defects

“…In both test and controls sites, the clinical attachment gain was accompanied by significant gain in bone density. The radiographic alterations were higher than those of previous studies 3,5,6,8 . Nevertheless, these results must be interpreted with caution because b-TCP is radiopaque and by radiographic methods, one does not distinguish whether it was replaced by vital bone.…”

“…These results were lower than those of other studies in which subtraction analysis was used 5,6,12,18 to evaluate the results of regenerative therapy. Nevertheless, the time factor must be considered, since the alterations in the degree of bone tissue mineralization are directly related to the alterations in the calcium and phosphate levels, which may require a considerable time to become evident due to biomaterial incorporation and bone remodeling 19 .…”

“…Nevertheless, these results must be interpreted with caution because b-TCP is radiopaque and by radiographic methods, one does not distinguish whether it was replaced by vital bone. Other authors have reported that the clinical attachment gain was accompanied by increase in bone density 5,6 . eickholz and Hausmann 12 (1998) did not find any correlation between attachment gain and bone filling when using digital radiographic analysis.…”

“…There are few studies involving the treatment of infra-osseous defects by means of RTG with an absorbable barrier, associated or not with other regenerative procedures, which included radiographic subtraction analyses 5,6,8,12,18 . Although the digitized image offers more resources than conventional analysis, such as the possibility of manipulating the image to adjust the gray levels and calculating the quantification of the area of density, as is the case with the conventional method, it consists of subjective analysis.…”

Treatment of intrabony defects with guided tissue regeneration in aggressive periodontitis: clinical outcomes at 6 and 12 months

“…Moreover, the ΔCAL was also found to be reduced at the sites with membrane exposure, compared to those with the nonexposed membrane. Such exposure has previously been reported in several GTR studies using various types of nonresorbable and resorbable membranes [29,30,31,32,33,34]. A meta-analysis of the effect of membrane exposure on the clinical outcome, analysing five studies where either resorbable or non-resorbable membranes were used, demonstrated that the sites with exposed membrane had a significantly lower ΔCAL (4.22 [0.15] mm) than the sites without membrane exposure (4.69 [0.13] mm) (p < 0.05) [35].…”