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Int Poster J Dent Oral Med 6 (2004), No. 1     15. Mar. 2004

Int Poster J Dent Oral Med 2004, Vol 6 No 01, Poster 211

GTR with bioabsorbable barriers: Long-term results

Language: English

Authors:
Diana Krigar, Bernadette Pretzl, DDS
Dr. Dr. Ti-Sun Kim, Dr. Christof Dörfer, Dr. Harald Steinbrenner, Prof. Dr. Peter Eickholz
Departement of Operative Dentistry and Periondontology, Clinic of Dental Medicine, University Clinic of Heidelberg Germany

Date/Event/Venue:
June 18-22th, 2003
Europerio 4
Berlin/Germany

Objectives

Evaluation of the long-term results after GTR therapy of infrabony defects using 2 different bioabsorbable barriers after 5 years.

Material and Methods

Patients:

  • 15 patients (3 male, 12 female) 22 to 64 years of age.
  • untreated severe periodontitis.
  • 15 pairs of contralateral infrabony defects.

Radiographic examination

  • At baseline, 12, and 60 ± 3 months after GTR-therapy: standardized radiographs of all teeth with infrabony defects with modified film holders (VIP 2 film Positioning, UpRad Corp., Fort Lauderdale, FL, USA).
  • Intraoral dental radiographs (Ultra-speed, Eastman Kodak Co., Rochester, NY, USA), size 2 film.
  • X-ray source (Heliodent 70, 70 kV, 7 mA, Siemens, Bensheim, Germany).
  • Development unit (Periomat, Dürr Dental GmbH, Bietigheim-Bissingen, Germany).

Clinical examinations:
at baseline, 12, and 60 ± 3 months after GTR-therapy at 6 sites per tooth:

  • Gingival (GI) and Plaque Index (PlI).
  • PD and PAL-V to the nearest 0.5mm (PCPUNC 15; Hu Friedy, Chicago, USA).

Periodontal surgery:
GTR therapy:

  • 15 defects: polydioxanone barrier (Mempol, Ethicon, Norderstedt, Germany); test group.
  • 15 defects: polylactide acetyltributyl citrate barrier (Guidor, Guidor AB, Huddinge, Sweden); control group.

Radiographic measurements:

  • Digitization of all radiographs with a flatbed scanner (Linotype Saphir, Friadent AG, Mannheim, Germany) with a resolution of 600 x 1200 dpi.
  • All further measurements were made using a computer program (Friacom 2.5, Friadent AG, Mannheim, Germany): with 9.5x magnification.
  • Marking of the ends of the maxillary wire on the radiographs and entering of its actual length. All further measurements were adjusted automatically for magnification.
  • Measurement of the distances CEJ-BD (Figs. 1, 2).
Fig. 1 a, b, c: standardized radiographs of an infrabony defect mesial 45 at baseline (a), 12 (b), and 60 months (c) after GTR-therapy with a polydioxanone barrier: CEJ (cemento-enamel junction), BD (most apical extension of bony defect). Fig. 2 a, b, c: standardized radiographs of an infrabony defect distal 35 at baseline (a), 12 (b), and 60 months (c) after GTR-therapy with a polylactide acetyltributyl citrate barrier: CEJ (cemento-enamel junction), BD (most apical extension of bony defect).

Definition of landmarks: If the CEJ was destroyed by a restoration, its margin was taken as reference. BD: the most coronal point where the periodontal ligament space showed continuous width. If no periodontal ligament space was identified, the point where the projection of AC crossed the root surface was taken as the landmark. If both structures could be identified at one defect, the point defined by the periodontal ligament was used as BD. If several bony contours could be identified, the most apical point that crossed the rootsurface was defined as BD (Figs. 1, 2).

  • All radiographic measurements were performed by two examiners blinded to the clinical measurements and repeated after 7 days: DK and BP. To reduce error the means of all 4 measurements were entered into analysis.

Statistical analysis:

  • Statistical unit: patient
  • Kolmogorov-Smirnov/ Lilliefors-test for normal distribution.
  • Comparison of clinical and radiographic parameters from baseline to 12 and 60 months after surgery and between test and control with paired t tests.

Results

Results I

  • 13 of 15 patients were available for the 60-months re-examination: 1 patient did not reappear for the 60 months re-examination, 1 patient deceased after the 12 months re-examination.
  • PlI and GI at baseline, 12, and 60 months after surgery are given in Tab. 1 and 2.
  • Both groups showed a statistically significant PD reduction (P < 0.001), PAL-V gain (P ≤ 0.001), and bony fill 12 and 60 months after surgery (Tab. 4, 5, 7).
  • Both groups showed a statistically significant PAL-V loss from 12 to 60 months (P < 0.05) (Tab. 5).
  • 60 months after GTR therapy 3 defects in the control group and 1 in the test group had PAL-V loss ≥ 3 mm compared to the 12 months re-examination.
  • The study failed to show statistically significant differences between test and control group regarding PD reduction, PAL-V gain, and bony fill 12 and 60 months after surgery.

Results II

  Polylactide Polydioxanone Difference P
Baseline 0.23 ± 0.60 0.08 ± 0.28 0.15 ± 0.38 0.157
12 months 0.62 ± 0.87 0.46 ± 0.78 0.15 ± 0.99 0.516
Change 0.39 ± 0.96 0.39 ± 0.65 0.00 ± 1.23 1.000
P 0.131 0.059    
60 months 0.39 ± 0.77 0.46 ± 0.78 -0.08 ± 0.28 0.317
Change 0.15 ± 1.07 0.39 ± 0.87 -0.23 ± 0.44 0.083
P 0.581 0.129    
Tab. 1: Plaque Index (n=13).

  Polylactide Polydioxanone Difference P
Baseline 1.54 ± 0.88 1.69 ± 0.75 -0.15 ± 0.55 0.317
12 months 0.31 ± 0.75 0.39 ± 0.77 -0.08 ± 1.04 0.705
Change -1.23 ± 1.01 -1.31 ± 0.95 -0.08 ± 1.19 0.888
P 0.005 0.004    
60 months 1.15 ± 0.99 0.46 ± 0.89 0.69 ± 0.95 0.034
Change -0.39 ± 1.61 -1.23 ± 1.30 -0.85 ± 1.28 0.039
P 0.441 0.011    
Tab. 2: Gingival Index (n=13)

  Polylactide Polydioxanone Difference P
Baseline 7.35 ± 1.94 7.31 ± 1.20 0.04 ± 1.80 0.94
12 months 2.42 ± 0.91 3.15 ± 1.35 0.15 ± 0.99 0.046
Change -4.92 ± 2.01 -4.15 ± 1.56 0.00 ± 1.23 0.211
P < 0.001 < 0.001    
95% Confidence Interval -2.04 ± 0.50  
60 months 3.39 ± 1.12 3.69 ± 1.49 -0.31 ± 1.38 0.436
Change -3.96 ± 1.34 3.62 ± 1.61 -0.35 ± 1.81 0.503
P < 0.001 < 0.001    
95% Confidence Interval 0.75 ± 1.44  
Change 0.96 ± 1.16 0.54 ± 1.68 0.42 ± 2.05 0.471
12-60 months
P 0.001 0.269    
95% Confidence Interval -0.82 ± 1.66  
Tab. 4: Probing Depth (n=13).

  Polylactide Polydioxanone Difference P
Baseline 8.35 ± 1.61 8.31 ± 1.32 0.04 ± 1.20 0.910
12 months 4.35 ± 1.70 4.85 ± 1.56 -0.50 ± 1.53 0.261
Change 4.00 ± 0.91 3.46 ± 1.52 0.54 ± 1.69 0.273
P < 0.001 < 0.001    
95% Confidence Interval -1.59 ± 0.33  
60 months 5.96 ± 1.87 6.08 ± 2.17 -0.12 ± 1.70 0.811
Change 2.39 ± 1.00 2.23 ± 1.80 0.15 ± 1.85 0.770
P < 0.001 0.001    
95% Confidence Interval -0.97 ± 1.27  
Change -1.62 ± 1.06 -1.23 ± 1.93 -0.39 ± 2.24 0.547
12-60 months
P < 0.001 < 0.040    
95% Confidence Interval -1.74 ± 0.97  
Tab. 5: Vertical Probing Attachment Level (n=13).

  Polylactide Polydioxanone
PAL-V 12 months 60 months 12 months 60 months
≤ 2 mm 1 6 3 8
> 2 - ≤ 4 mm 9 7 6 3
> 4 - ≤ 6 mm 3 - 4 2
> 6 mm - - - -
Tab. 6: Distribution of Vertical Probing Attachment Gain.

  Polylactide Polydioxanone Difference P
Baseline 9.35 ± 2.99 8.86 ± 2.56 0.50 ± 2.27 0.443
12 months 8.41 ± 2.75 7.70 ± 2.80 0.71 ± 2.21 0.272
Change 0.94 ± 1.41 1.15 ± 1.31 -0.21 ± 1.89 0.697
P < 0.05 < 0.01    
60 months 8.33 ± 3.12 7.31 ± 3.18 1.01 ± 2.77 0.213
Change 1.03 ± 1.63 1.54 ± 2.19 -0.51 ± 2.83 0.527
P < 0.05 < 0.05    
Tab. 7: Distance Cemento-enamel Junction (CEJ) to Bony Defect (BD) (n=13).

Discussion and Conclusions

  • There are no statistically significant differences regarding PD reduction, PAL-V gain, and bony fill after GTR therapy using polylactide acetyltributyl citrate or polydioxanone.
  • PAL-V gain after GTR therapy in infrabony defects using both bioabsorbable barriers was stable after 5 years in 21 of 26 defects (81%).
  • PAL-V gain achieved by GTR therapy using bioabsorbable membranes may be maintained up to 5 years successfully.

This Poster was submitted by Diana Krigar.

Correspondence address:
Diana Krigar
Section of Periodontology
Departement of Operative Dentistry and Periodontology
Im Neuenheimer Feld 400
69120 Heidelberg
Germany