Histologic Evaluation of New Attachment Apparatus Formation in Humans

Abstract

Part I of this three-part human study evaluated the formation of a new attachment apparatus (bone, cementum, and periodontal ligament) on pathologically exposed root surfaces in an open and closed environment. The most apical level of calculus on the root served as a histologic reference point to measure regeneration on root surfaces exposed to the oral environment. Attempts were made to initiate the formation of a new attachment apparatus by flap curettage, root planing, coronectomy, and submersion of vital roots beneath the mucosa. Nonsubmerged defects were treated by the same surgical technique and served as controls. Biopsies were obtained at 6 months and regeneration was evaluated histometrically by two investigators who were unaware of the treatment performed. Data from 9 patients with 25 submerged and 22 nonsubmerged defects were submitted for statistical analysis. Results indicate that a new attachment apparatus did not form in any of the 22 nonsubmerged teeth; a new attachment apparatus did form in a submerged environment (0.75 mm); significantly more new attachment apparatus (P less than 0.05), new cementum (P less than 0.01), new connective tissue (P less than 0.05), and new bone (P less than 0.02) formed in submerged defects; new cementum was cellular in nature and formed equally well on old cementum and dentin. Greater percent positive regeneration of the attachment apparatus and all component tissues occurred in submerged defects and no extensive root resorption, ankylosis, or pulp death was observed on submerged or nonsubmerged roots.

A clinical and radiological evaluation of DFDBA with amniotic membrane versus bovine derived xenograft with amniotic membrane in human periodontal grade II furcation defects

“…The study did not have non graft site as control group because numerous studies have been reported statistically significant results in favor of bone replacement grafts as compared to non-grafted site (Bowers et al 1989b;Mellonig 1992;Cortellini and Bowers 1995).…”

Periodontal and Endodontic Regeneration

“…Periodontal/endodontic regeneration has been demonstrated with both FDBA and DFDBA, although one report from Dragoo and Kaldahl showed FBDA healing by repair (33)(34)(35). In an animal study, FDBA or DFDBA was placed into surgically created infrabony defects and evaluated histologically (36).…”

Comparative study of indigenously prepared and imported, demineralized, freeze-dried, irradiated bone allograft in the treatment of periodontal infrabony defects

“…Histological evidence further demonstrates that DFDBA grafts support the formation of a new attachment apparatus in intrabony defects, (Bowers et al 1989;Reynold et al 2003). They regenerate cementum, periodontal ligament, and bone (Bowers et al 1989) as opposed to mere open flap debridement which usually results in periodontal repair characterized primarily by the formation of a long junctional epithelial attachment (Reynold et al 2003).…”

“…The bone grafts form a scaffold for the host's resident cells to grow through a process known as creeping substitution (Bodner 1995). Some grafts like demineralized freezedried bone allograft (DFDBA), in addition to osteoconduction also have osteoinductive properties due to the presence of osteogenetic factors (Bowers et al 1989).…”