Guided Tissue Regeneration, Periodontal ; Humans ; Periodontal Attachment Loss

The major goals of periodontal therapy are the functional regeneration of periodontal supporting structures already destructed by periodontal disease as well as the reduction of signs and symptoms of progressive periodontal disease. There have been many efforts to develop materials and therapeutic methods to promote periodontal wound healing. Bone graft & guided tissue are being used for the regeneration of destroyed periodontium these days. Non-resorbable membranes were used for Guided tissue regeneration in early days, however more researches are focused on resorbable membranes these days. The aim of this study is to evaluate the osteogenesis of paradioxanone membrane on the calvarial critical size defect in Sprague Dawley rats. An 8 mm diameter surgical defect was produced with a trephine bur in the area of the midsagittal suture. The rats were divided into three groups: Untreated control group, Biomesh(R) group and paradioxanone group. The animals were sacrificed at 4, 8 and 12 weeks after surgical procedure. The specimens were examined by histologic, histomorphometric analyses. The results are as follows: 1. In histological view on Biomesh(R), no visible signs of resorption was observed at 4 weeks but progressive resorption was observed at 8 weeks through 12 weeks. Paradioxanone membrane expanded at 4 weeks, and rapid resorption was observed at 8 weeks. In both the membranes, inflammatory cells were observed around them. Inflammatory cells decreased with time but were still present at 12 weeks. More inflammatory cells were observed in paradioxanone membranes than in Biomesh(R) membrane. 2. The area of newly formed bone in the defects were 0.001+/-0.001, 0.006+/-0.005, 0.002+/-0.003 at the 4 weeks, 0.021+/-0.020, 0.133+/-0.073, 0.118+/-0.070 at the 8 weeks and 0.163+/-0.067, 0.500+/-0.197, 0.487+/-0.214 at the 12 weeks in the control group, Biomesh(R) group and experimental group respectively. Compared to the control group, Biomesh(R) group displayed significant differences at 4,8, and 12 weeks and the paradioxanone group at 8 and 12 weeks.(P<0.05) 3. The area of residual membranes were 1.143+/-0.499, 2.599+/-1.012, at the 4 weeks, 0.666+/-0.140, 0.314+/-0.131 at the 8 weeks and 0.365+/-0.110, 0.076+/-0.050 at the 12 weeks in the Biomesh(R) group and experimental group respectively. Between the two groups, significant differences were displayed at 4 weeks.(P<0.05) According to the results, when paradioxanone membrane was used in calvarial critical size defect in Sprague Dawley rat, initially the membrane expaned and regeneration of newly formed bone was small however after 8weeks new bone was formed with simultaneous resorption for the membrane. If a few problems could be solved, previously used membranes could be replaced in periodontal guided tissue regeneration.
Animals ; Guided Tissue Regeneration ; Guided Tissue Regeneration, Periodontal ; Membranes ; Osteogenesis ; Periodontal Diseases ; Periodontium ; Rats ; Rats, Sprague-Dawley* ; Regeneration ; Sutures ; Transplants ; Wound Healing

PURPOSE: The final goal of regenerative periodontal therapy is to restore the structure and function of the periodontium destroyed or lost due to periodontitis. However, the role of periosteum in periodontal regeneration was relatively neglected while bone repair in the skeleton occurs as a result of a significant contribution from the periosteum. The aim of this study is to understand the histological characteristics of periosteum and compare the native periosteum with the repaired periosteum after elevating flap or after surgical intervention with flap elevation. METHODS: Buccal and lingual mucoperiosteal flaps were reflected to surgically create critical-size, "box-type" (4 mm width, 5 mm depth), one-wall, intrabony defects at the distal aspect of the 2nd and the mesial aspect of the 4th mandibular premolars in the right and left jaw quadrants. Animals were sacrificed after 24 weeks. RESULTS: The results from this study are as follows: 1) thickness of periosteum showed difference as follows (P<0.05): control group (0.45+/-0.22 mm)>flap-elevation group (0.36+/-0.07 mm)>defect formation group (0.26+/-0.03 mm), 2) thickness of gingival tissue showed difference as follows (P<0.05): defect formation group (3.15+/-0.40 mm)>flap-elevation group (2.02+/-0.25 mm)>control group (1.88+/-0.27 mm), 3) higher cellular activity was observed in defect formation group and flap-elevation groups than control group, 4) the number of blood vessles was higher in defect formation group than control group. CONCLUSIONS: In conclusion, prolonged operation with increased surgical trauma seems to decrease the thickness of repaired periosteum and increase the thickness of gingiva. More blood vessles and high cellular activity were observed in defect formation group.
Animals ; Bicuspid ; Gingiva ; Guided Tissue Regeneration, Periodontal ; Jaw ; Models, Animal ; Periodontitis ; Periodontium ; Periosteum ; Regeneration ; Skeleton

The purpose of this study was to evaluate the extent and predictability of periodontal regeneration with barrier membranes in deep infrabony defects. 25 patients(40% smokers) were included in this study. Fourty-one deep infrabony defects treated with membranes(PPD>6mm) were evaluated 1 year postoperatively following a plaque control regimen. Probing pocket depth(PPD), gingival recession(REC), and probing attachment level(PAL) were evaluated at baseline and postoperative 1 year. Plaque score at baseline was 16.2 and plaque score at 1 year was 9.9 A PAL gain of 4.1+/-2.5mm along with a PPD reduction of 5.0+/-2.3mm were observed. A PAL gain of 4.1+/-2.5mm was observed at the smoking group and a PAL gain of 4.0+/-2.5mm was observed at the non-smoking sroup. It was concluded that periodontal regeneration with membrane represented the predictable and effective treatment modality in the deep infrabony defects.
Guided Tissue Regeneration* ; Membranes ; Periodontal Diseases ; Regeneration ; Retrospective Studies* ; Smoke ; Smoking

In periodontal regeneration treatment, access to the frucation area is very difficult. Thus complete removal of plaque, calculus and endotoxin is somewhat impossible. In this study, teeth that were extracted due to periodontal disease were used. The furcation area was treated with periodontal curette, ultrasonic scaler, roto bur and they observed using SEM. The result was follows 1. The group treatment with curette showed remaining plaque, the cementum existed in most of the surface and partial dentinal tubule orifice could be seen. 2. The group treatment with ultrasonic scaler showed less removalof plaque compared to curette and irregular surface could be seen. 3. The group treatment with roto bur showed cleaner surface and many dentinal tubule orifice could be seen compared to the curette and ultrasonic scaler groups. Thus when suing treatments such as bone grafting or guided tissue regeneration, it is considered that the furcation area should be treatment with Roto bur.
Bone Transplantation ; Calculi ; Dental Cementum ; Dentin ; Guided Tissue Regeneration ; Periodontal Diseases ; Regeneration ; Tooth ; Ultrasonics

The present study evaluated the effects of guided tissue regeneration using biodegradable membrane, with and without calcium-phosphate thin film coated deproteinated bone powder in beagle dogs. Contralateral fenestration defects(6 x 4 mm) were created 4 mm apical to the buccal alveolar crest on maxillary canine teeth in 5 beagle dogs. Ca-P thin film coated deproteinated bone powder was implanted into one randomly selected fenestration defect(experimental group). Biodegradable membranes were used to provide bilateral GTR. Tissue blocks including defects with overlying membranes and soft tissues were harvested following a four- & eight-week healing interval and prepared for histologic analysis. The results of this study were as follows. 1. The regeneration of new bone, new periodontal ligament, and new cementum was occurred in experimental group more than control group. 2. The collapse of biodegradable membranes into defects were showed in control group and the space for regeneration was diminished. In experimental group, the space was maintained without collapse by graft materials. 3. In experimental group, the graft materials were resorbed at 4 weeks after surgery and regeneration of bone surrounding graft materials was occurred at 8 weeks after surgery. 4. Biodegradable membranes were not resorbed at 4 weeks and partial resorption was occurred at 8 weeks but the framework and the shape of membranes were maintained. No inflammation was showed at resorption. In conclusion, the results of the present study suggest that Ca-P thin film coated deproteinated bone powder has adjunctive effect to GTR in periodontal fenestration defects. Because it has osteoconductive property and prohibit collapse of membrane into defect, can promote regeneration of much new attachment apparatus.
Animals ; Cuspid ; Dental Cementum ; Dogs* ; Guided Tissue Regeneration* ; Inflammation ; Membranes* ; Periodontal Ligament ; Regeneration ; Transplants

OBJECTIVETo evaluate the clinical short-term results of the acellular dermal matrix for guided bone regeneration.

METHODSSixty-four patients with bone defect in anterior maxillary area (average bone width: 3 mm) were included. Ridge-splitting technique with simultaneous placement of implants and artificial bone material implantation was performed in 21 patients (non-membrane group). Forty-three patients received the same procedure but with acellular dermal matrix covering the surgical sites (membrane group). The patients were followed up for three months and the new bone formation was checked in clinic and by X-ray.

RESULTSThree months after operation, the membrane group showed good osseointegration and high bone density over the implant cover screws. In the second operation, the membranes became thinner and the new bone fully covered the implant in the membrane group. The labial bone exhibited slight absorption and labial surface of 7 implants in 7 patients was exposed in non-membrane group. The width and the height of the ridge in the second operation were greater in membrane group than in non-membrane group (P < 0.05).

CONCLUSIONSThe acellular dermal matrix can effectively resist the growth of soft tissue to allow bone regeneration around the implant.

Acellular Dermis ; Bone Regeneration ; Bone Substitutes ; Dental Implants ; Guided Tissue Regeneration, Periodontal ; Humans

OBJECTIVETo fabricate the bio-implant supported by regenerated periodontal tissue utilizing periodontal ligament cells (PDLC)-bone marrow stromal cells (BMSC) sheet and natural root.

METHODSPremolars of 2 beagle dogs were extracted to prepare the implanted area. Autologous tooth roots were carved into cylinders. PDLC and BMSC separated from beagle dogs were cultured into cell sheets in medium. Tooth roots were wrapped by one type of cell sheets or both to fabricate bio-implant and divided into four groups, tooth roots were wrapped by PDLC sheets and BMSC sheets successively (2 samples each dog), tooth roots were wrapped by PDLC sheets alone (2 samples each dog), tooth roots were wrapped by BMSC sheet alone (2 samples each dog), tooth roots without cell sheet (1 sample each dog). The implants were implanted into the mandibles. The mandibles were dissected 12 weeks later, sliced and stained by HE and Masson dyes for histological examination.

RESULTSIn the PDLC cell sheet/root implants, histological examination revealed that new periodontal-like tissue including cementum, periodontium and alveolar bone was regenerated.In the BMSC implants, tooth ankylosis was observed.

CONCLUSIONSPDLC sheet and natural root can be used to fabricate bio-implant. PDLC sheet could promote periodontal regeneration.

Animals ; Bicuspid ; Dental Cementum ; Dogs ; Guided Tissue Regeneration, Periodontal ; Mesenchymal Stromal Cells ; Periodontal Ligament ; cytology ; Periodontium ; Regeneration ; Tooth Root

The purpose of this 6-months study was to compare the clinical and radiographic outcomes following guided tissue regeneration treating human mandibular Class II furcation defects with a bioabsorbable BioMesh barrier(test treatment) or a non-absorbable ePTFE barrier(control treatment). Fourteen defects in 14 patients(mean age 44 years) were treated with BioMesh barriers and ten defects in 10 patients(mean age 48 years) with ePTFE barriers. After initial therapy, a GTR procedure was done. Following flap elevation, root planing, and removal of granulation tissue, each device was adjusted to cover the furcation defect. The flaps were repositioned and sutured to complete coverage of the barriers. A second surgical procedure was performed at control sites after 4 to 6 weeks to remove the nonresorbable barrier. Radiographic and clinical examinations(plaque index, gingival index, tooth mobility, gingival margin position, pocket depth, clinical attachment level) were carried out under standardized conditions immediately before and 6 months after surgery. Furthermore, digital subtraction radiography was carried out. All areas healed uneventfully. Surgical treatment resulted in clinically and statistically equivalent changes when comparisons were made between test and control treatments. Changes in plaque index were 0.7 for test and 0.4 for control treatments; changes in gingival index were 0.9 and 0.5. In both group gingival margin position and pocket depth reduction was 1.0mm and 3.0mm; clinical attachment level gain was 1.9mm. There were no changes in tooth mobility and the bone in radiographic evaluation. No significant(p< or =0.05) difference between the two membranes could be detected with regard to plaque index, gingival index, gingival margin position, pocket depth, and clinical attachment level. In conclusion, a bioabsorbable BioMesh membrane is effective in human mandibular Class II furcation defects and a longer period study is needed to fully evaluate the outcomes.
Furcation Defects ; Granulation Tissue ; Guided Tissue Regeneration* ; Humans* ; Membranes ; Periodontal Index ; Radiography ; Root Planing ; Tooth Mobility

PURPOSE: The aim of this study was to identify a role for endodontic intervention in enhancing the regenerative potential of the periodontal ligament when combined with periodontal treatment in seriously involved teeth with a secondary endodontic component. METHODS: Patients who exhibited radiolucency extending to the periapical region, abnormal electric pulp testing values, and deep probing depth derived from primary periodontal disease with secondary endodontic involvement were included. Intentional root canal treatment was applied to those teeth in which the apical lesions were presumed to communicate with those of the periodontal lesion of the teeth that remained vital. In all three selected cases, regenerative periodontal therapy incorporating either bone graft or guided tissue regeneration was instituted 3 months after the endodontic intervention. RESULTS: Remarkable enhancement in radiographic density was noticeable around the affected teeth as evidenced by changes in radiopacity. There was a significant reduction in the probing pocket depth and gain in the clinical attachment level. Chewing discomfort gradually disappeared from the commencement of the combined treatment. CONCLUSIONS: An intentional endodontic intervention may be a worthwhile approach for the sophisticated management of teeth suffering from serious attachment loss and alveolar bone destruction with concomitant secondary endodontic involvement.
Dental Pulp Cavity ; Guided Tissue Regeneration ; Humans ; Periodontal Attachment Loss ; Periodontal Diseases ; Periodontal Ligament ; Root Canal Therapy ; Stress, Psychological ; Tooth