International Poster Journal of Dentistry and Oral Medicine



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Int Poster J Dent Oral Med 3 (2001), No. 1     15. Mar. 2001

Int Poster J Dent Oral Med 2001, Vol 3 No 1, Poster 62

Evidence for healing of intrabony and furcation defects after periodontal therapy: digital subtraction and bone measurements

Language: English

Author(s): Peter Eickholz, Ti-Sun Kim, Ernest Hausmann
Dept. of Operative Dentistry & Periodontology, University of Heidelberg, Germany; Computer Analysis Plus, Amherst, NY & Dept. of Oral Biology, SUNY Buffalo, NY, USA

86th annual meeting of the American Academy of Periodontology
Honolulu, Hawaii, USA


Comparison of digital subtraction analysis to the gold standard of intrasurgical measurements 5 years after periodontal surgery of intrabony and furcation defects.

Material and Methods


  • 13 patients (8 female) 32 - 64 years of age.
  • Untreated advanced periodontal disease.
  • Each exhibiting at least one interproximal intrabony and/or class II/III furcation defect.

Radiographic examinations

  • Standardized bitewing radiographs of teeth with intrabony/class II/III furcation defects using modified film holders (VIP 2 Film Positioning, UpRad Corp., Fort Lauderdale, FL, USA) (Fig. 1, 2) at baseline, 6, and 60+3 months after surgery. Two orthodontic wires were placed on the mandibular side of the filmholder at a specified position (Fig. 1). Shadows of these wires were cast onto the radiographs. From the distances between the images of these wires on a radiograph, the vertical and horizontal angulation difference between the consecutive radiographs could be calculated.
  • Intraoral dental films (Ultraspeed, Eastman Kodak Co., Rochester, NY, USA) size 2.
  • x-ray source (Heliodent 70, 70 kV, 7 mA, Siemens, Bensheim, Germany).
  • Development unit (Periomat, Dürr Dental GmbH, Bietigheim-Bissingen, Germany).

Clinical examinations
At 6 sites per tooth (baseline, 6, 60+3 months after surgery):

  • Gingival Index (GI) and Plaque Index (PlI).
  • PD and CAL-V to the nearest 0.5 mm (PCPUNC 15).
  • CAL-H to the nearest 0.5 mm in class II furcations (PQ2N).

Periodontal surgery

  • Mucoperiosteal flap, thorough debridement alone in 5 defects and GTR in 25 defects using ePTFE (14 defects) and Polyglactin 910 (11 defects) barriers.
  • Removal of ePTFE barrier after 4 to 6 weeks.

Bone measurements
After reflection of a full thickness flap and under local anaesthesia 60+3 months after surgery:

  • Distance cemento-enamel junction (CEJ) to the most apical extension of the bony defect (BD): PBL-V.
  • Horizontal probing bone level in class II furcations: PBL-H.

Radiographic evaluation
Measurements using a loupe of 10 fold magnification and a 0.1 mm grid (Scale loupe 10, Peak, Tohkai Sangyo, Tokyo, Japan):

  • Distances between the projections of the orthodontic wires that had been fixed to the filmholders vertically (dv) and horizontally (dh) on every radiograph.
  • Capturing of each radiograph with a CCD camera: Cohu Solid State Camera, Cohu Inc., San Diego, CA.
  • All radiographs were analysed by one examiner blinded to the clinical and intrasurgical measurements (EH).

Statistical analysis

  • Kolmogorov-Smirnov/Lilliefors-Test for normal distribution.
  • Comparison of baseline to 6 and 60 months postsurgical measurements by paired t test.
  • Stepwise multiple linear regression analysis:
    dependent variable: PBL-V, PBL-H
    explanatory variables: baseline PBL-V/-H, subtraction parameters, GTR therapy, patient.
  • Simple regression analysis:
    relative density loss/PBL-V, net area change/PBL-H


Discussion and Conclusions

  • Improvements achieved by periodontal surgery may be maintained stable up to 5 years.
  • Subtraction parameters suitably describe bony fill after periodontal therapy as evidenced by the gold standard of PBL measurements.


GI: Gingival Index
PlI: Plaque Index
PD: probing depth
CAL-V: vertical clinical attachment level
CAL-H: horizontal clinical attachment level
PBL-V: vertical probing bone level
PBL-H: horizontal probing bone level
SD: standard deviation
SSQ: sum of squares
MSQ: mean of squares
DF: degrees of freedom

This Poster was submitted on 29.01.01 by Dr. Peter Eickholz.

Correspondence address:
Dr. Peter Eickholz
Universität Heidelberg
Im Neuenheimer Feld 400
69120 Heidelberg