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Int Poster J Dent Oral Med 5 (2003), No. 1     15. Mar. 2003

Int Poster J Dent Oral Med 2003, Vol 5 No 01, Poster 161

Long-Term Results of Guided Tissue Regeneration Therapy with Non-Resorbable and Bioabsorbable Barriers. II Infrabony Defects

Language: English

Authors: PD Dr. Peter Eickholz1, Dr. Dr. Ti-Sun Kim1, Prof. Ernest Hausmann D.M.D., Ph.D.2, PD Dr. Rolf Holle3
1Sektion Parodontologie, Poliklinik für Zahnerhaltungskunde, Universitätsklinikum Heidelberg, Deutschland
2Computer Analysis Plus, Amherst, NY & Dept. of Oral Biology, SUNY Buffalo, NY, USA
3GSF-Forschungszentrum für Umwelt und Gesundheit, Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Deutschland

Date/Event/Venue:
6.-9.03.2002
80th General Session and Exhibition of the IADR
San Diego, USA

 

Abstract

Objectives: The aim of this 5 year follow-up study was to evaluate clinically and radiographically the long-term results after GTR therapy of infrabony defects using non-resorbable and bioabsorbable barriers. Methods: In 12 patients suffering from advanced periodontitis 12 pairs of contralateral infrabony defects were treated. Within each patient one defect received a non-resorbable (ePTFE; control: C) and the other a bioabsorbable (Polyglactin 910; test: T) barrier by random assignment. At baseline, 6 and 60±3 months after surgery clinical parameters and standardized radiographs were obtained. Using digital subtraction analysis gain of bone relative density change (mean grey level change x area) within infrabony defects was assessed. Results: Eight of 12 patients were available for the 60-months re examinations. Six and 60±3 months after GTR therapy statistically significant (p < 0.05) vertical attachment (CAL-V) gain was observed in both groups (C6: 2.6±1.4 mm; C60: 1.6±1.5 mm; T6: 3.0±1.7 mm; T60: 3.0±0.7 mm). However, 60 months after GTR therapy 2 infrabony defects in the control group had lost all the attachment that had been gained 6 months after GTR therapy and a clinically relevant but statistically insignificant mean CAL-V loss of 1.0±2.1 mm was observed from 6 to 60 months. The study failed to show statistically significant differences between test and control regarding CAL-V gain 60 months after surgery. Also subtraction analysis failed to reveal statistically significant differences regarding density gain between both groups 6 and 60 months postsurgically (C6: 26.4±54.2; C60 62.8±112.7; T6: 68.7±72.8; T60: 84.1±83.6). Conclusions: CAL-V gain achieved after GTR therapy in infrabony defects using both non-resorbable and bioabsorbable barriers was quite stable after 5 years in 14 of 16 defects.

 

Objective

Comparison of the results of GTR therapy using non-resorbable and biodegradable barriers 5 years after periodontal surgery of infrabony defects.

 

Material and Methods

Patients

  • 12 patients (9 female) 32-62 years of age.
  • Untreated advanced periodontal disease.
  • Each exhibiting at least one pair of contralateral interproximal infrabony defects.

Radiographic examinations

  • Standardized bitewing radiographs of teeth with infrabony defects using modified film holders (VIP 2 Film Positioning, UpRad Corp., Fort Lauderdale, FL, USA) at baseline, 6, and 60±3 months after surgery.
  • 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, random assignment of therapies: in each patient a ePTFE barrier (Gore Tex Periodontal Membrane, W. L. Gore and Assoc., Flagstaff, AZ, USA) for one defect and a Polyglactin 910 (PG 910) barrier (Vicryl membrane, Ethicon, Norderstedt, Germany) for the other defect.
  • Removal of ePTFE barrier after 4 to 6 weeks.

Bone measurements

After reflection of a full thickness flap and bone sounding without flap mobilisation 60±3 months after surgery:

  • Distance cemento-enamel junction (CEJ) to the most apical extension of the bony defect (BD): PBL-V.

Radiographic evaluation

  • Capturing of pairs of radiographs with a CCD camera: Cohu Solid State Camera, Cohu Inc., San Diego, CA, USA.
  • Digital subtraction analysis with 512 x 480 pixels resolution and 256 gray levels (Variable Scan Frame Grabber; Imaging Tech. Inc., Woburn, MA, USA).
  • Removal of contrast differences between images by gamma correction. Assessment of change of gray levels and relative density gain
  • All radiographs were analysed by one examiner blinded to the clinical and intrasurgical measurements (EH).

Genetic examination

  • All patients available for the 60±3 months re examination were tested for interleukin-1-polymorphism (Advanced Diagnostic Systems, Nehren, Germany).

Statistical analysis

  • Kolmogorov-Smirnov/Lilliefors-Test for normal distribution.
  • Comparison of baseline to 6 and 60 months postsurgical measurements by paired t test.
  • Comparison between test (Polyglactin 910) and control (ePTFE) by paired t test.

 

Conclusions

  • CAL-V gain achieved after GTR therapy in infrabony defects using both non-resorbable and bioabsorbable barriers was quite stable after 5 years in 14 of 16 defects.
  • Beside patient charcteristics like smoking, interleukin-1-polymorphism or diabetes other perhaps site specific factors seem to influence stability of attachment gains.

 

Results

  • Of 12 patients that originally started the study 8 were available for the 5 years of re examination.
  GI PII PD/mm
    PG 910     ePTFE     PG 910     ePTFE     PG 910     ePTFE  
Baseline     2.0±0.0 2.0±0.0 0.4±1.1 0.6±0.7 7.8±2.1 7.9±1.6
6 months 0.3±0.7 0.3±0.7 0.3±0.5 0.3±0.5 3.7±0.8 3.7±1.0
Change -1.7±0.7 -1.7±0.7 -0.1±0.8 0.3±0.7 -4.1±1.7 -4.3±2.1
60 months 1.0±1.1 1.3±1.0 0.1±0.4 0.8±1.0 4.2±1.1 5.3±1.9
Change -1.0±1.1 -0.7±1.0 -0.3±1.2 0.2±1.2 -3.6±1.8 -2.7±2.0
Tab. 1: Clinical parameters (mean±SD)

    PG 910       ePTFE    *p<0.05 
    INFRA     CAL-V     INFRA     CAL-V  
Baseline     4.2±1.1 7.9±1.9 3.7±1.3 8.0±2.0
6 months   4.9±1.1*   5.4±1.5*
Change   3.0±1.7   2.6±1.4
60 months   4.9±1.8*   6.4±2.3*
Change   3.0±0.7   1.6±1.5
Tab. 2: Vertical attachment levels/mm (mean±SD)

    PG 910       ePTFE    *p<0.05 
    PBL-V  
/mm
  rel. density  
gain
  PBL-V  
/mm
  rel. density  
gain
Baseline     8.4±2.1   8.0±2.4  
6 months   68.66±72.84   26.41±54.18
60 months 6.2±1.7   6.5±2.0  
Change 2.2±1.1* 84.08±83.62 1.5±1.2 62.80±112.65
Tab. 3: Bone parameters (mean±SD)


patient# 
 age  teeth
test/control 
defect site  regular
recalls 
number
of recalls 
mean±SD 
GBI

PCR
smoking 
interleukin-1beta 
other 
1 62 24/ 14 mesial + 11 12.4±6.7 33.8±13.4 - + -
2 49 47/ 37 mesial + 11 4.0±3.0 27.6±6.1 - + -
3 46 34/ 43 mesial - 9 6.4±4.8 25.1±6.9 + - diabetes
4 57 36/ 46 dist./mes. + 14 7.8±6.6 36.6±20.4 - + diabetes
5 46 13/ 23 distal + 16 9.2±6.7 32.4±10.3 - - -
6 36 33/ 45 dist./mes. + 13 11.9±13.0 22.9±16.7 + + -
7 41 35/ 44 distal + 14 3.3±1.9 17.9±9.9 - + -
8 32 25/ 15 mesial + 13 1.9±2.6 19.6±9.2 - + -
Tab. 4: Patient characteristics

Fig. 1: CAL-V at baseline, 6, and 60 months after surgery

Fig. 2 a+b: Subtraction image of baseline and 60 months radiographics of patient #7 showing bony fill at the distal aspects of tooth 44 (a) and 35 (b)

 

This Poster was submitted by PD Dr. Peter Eickholz.

Correspondence address:
PD Dr. Peter Eickholz
Universitätsklinikum Heidelberg
Poliklinik für Zahnerhaltungskunde
Sektion Parodontologie
Im Neuenheimer Feld 400
69120 Heidelberg
Deutschland