Guided Tissue Regeneration With and Without Decalcified Freeze‐Dried Bone in Mandibular Class II Furcation Invasions

Abstract

The purpose of this study was to compare periodontal soft and hard tissue repair using expanded polytetrafluoroethylene (ePTFE) membranes with and without decalcified freeze-dried cortical bone allografts (DFDBA). Six patients with 17 mandibular Class II buccal molar furcal invasions received oral hygiene instructions followed by scaling and root planing. Baseline soft tissue measurements with periodontal probes were made to assess probing depths (PD), recession (REC), and probing attachment levels (PAL). After non-surgical therapy, 10 teeth were randomly selected as test sites (ePTFE + DFDBA) and 7 as controls (ePTFE alone). Full-thickness flaps were elevated, and open surgical measurements were made to determine alveolar crestal height (CEJ-AC) and vertical (CEJ-BDF) and horizontal (HPDF) defect depth. The ePTFE membranes were removed at 6 weeks. After 6 months, all sites were reentered and both soft tissue and open surgical measurements recorded. The following mean changes (mm) were found for ePTFE and ePTFE + DFDBA treated sites respectively: decreased PD = 1.5, 2.2; increased REC = 1.3, 1.3; loss(-)/gain PAL = -0.2, 0.8; decreased CEJ-BDF = 3.8, 5.0; increased CEJ-AC = 0.5, 0.4; and decreased HPDF = 2.3, 2.4. None of the changes were statistically significant. The addition of DFDBA to the GTR procedure did not significantly improve any of the mean soft tissue and open surgical measurements between control (ePTFE alone) and test (ePTFE+DFDBA) groups in mandibular Class II buccal furcations. Both treatment procedures resulted in significant decreases in PD, CEJ-BDF, and HPDF and a significant increase in REC. There were no differences for PAL and CEJ-AC within control and test groups seen with this sample. Larger randomized clinical trials are needed to more fully evaluate whether combined graft and GTR procedures offer an advantage over GTR alone.

Periodontitis vs. Peri-Implantitis: The Same Disease? The Same Treatment?

“…GTR with either decalcified freeze-dried bone allograft (Anderegg et al, 1991) or composite grafts of autografts and tricalcium phosphate and/or demineralized freeze-dried bone allografts (Schallhorn and McClain, 1988) showed substantially more bone fill on re-entry in comparison with other studies (Wallace et al, 1994;Becker et al, 1995) which have shown no real benefit of the combination of GTR and grafting material. Caffesse et al (1993) reported results of treatment of furcation defects in beagle dogs, with and without demineralized freeze-dried cortical bone grafts, in a GTR procedure and found that the use of the guided tissue regeneration procedure resulted in an increase in connective tissue and alveolar bone regeneration, but that adjunctive bone grafting in itself did not appear to enhance regeneration.…”

“…Caffesse et al (1993) reported results of treatment of furcation defects in beagle dogs, with and without demineralized freeze-dried cortical bone grafts, in a GTR procedure and found that the use of the guided tissue regeneration procedure resulted in an increase in connective tissue and alveolar bone regeneration, but that adjunctive bone grafting in itself did not appear to enhance regeneration. In a study of six patients with 17 Class II furcal defects, Wallace et al (1994) compared soft and hard tissue repair using e-PTFE membranes with and without decalcified freezedried cortical bone allografts (DFDBA). These investigators reported that addition of DFDBA to the GTR procedure did not improve mean closed and open probing measurements in terms of repair.…”

“…Their conclusion was that the material, which resorbed in six to seven months, was a satisfactory barrier but that a supporting grafting material should be used to prevent barrier collapse. However, other investigators (Wallace et al, 1994;Becker et al, 1990bBecker et al, , 1995 are of the opinion that an allograft is not essential or advantageous in guided tissue or guided bone regeneration.…”

Periodontal Regeneration Using the Mixture of Human Tooth-ash and Plaster of Paris in Dogs

“…Wallace et al 41) also reported that there was no difference between GTR with e-PTFE membrane and GTR with e-PTFE membrane combined with the DFDB in the bifurcation area. This present study had consistent results with the previously mentioned Bowers 42,43) and Anderegg's study 14) , in which bone graft material could support the barrier material and prevent its collapse, and eventually promote bone regeneration.…”

Furcal Obliteration for Advanced Furcation Invasions Using Glass – Ionomer Restorative Material.

“…However, predictable regeneration cannot be achieved in advanced furcation invasions due to the complexity of furcation morphology [4]. Multiple modalities have been utilized over the years ranging from non-surgical therapy [3], surgical therapy utilizing regenerative methods using grafts and membranes [5,6,7] , root resection [8 ], tunnel procedure [9] with unpredictable success. The patients are most often offered options which are unpredictable, more invasive and expensive.…”