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CC BY-NC-ND 4.0 · Eur J Dent 2010; 04(04): 403-411
DOI: 10.1055/s-0039-1697860
Original Article
European Journal of Dentistry

Effect of Autogenous Cortical Bone Grafting in Conjunction with Guided Tissue Regeneration in the Treatment of Intraosseous Periodontal Defects

Gonca Cayir Keles
a   Ondokuz Mayis University, Faculty of Dentistry, Department of Periodontology, Samsun, Turkey
,
Mahmut Sumer
b   Ondokuz Mayis University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Samsun, Turkey
,
Burcu Ozkan Cetinkaya
a   Ondokuz Mayis University, Faculty of Dentistry, Department of Periodontology, Samsun, Turkey
,
Ferda Tutkun
a   Ondokuz Mayis University, Faculty of Dentistry, Department of Periodontology, Samsun, Turkey
,
S. Burcak Simsek
c   Goztepe Oral and Dental Health Center, Istanbul, Turkey
› Author Affiliations
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Publication History

Publication Date:
30 September 2019 (online)

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Objectives: The aim of this clinical trial was to evaluate the additional benefit of using guided tissue regeneration (GTR) with autogenous cortical bone (ACB) grafting versus ACB grafting alone for the regenerative treatment of intraosseous periodontal defects.

Methods: Via a split-mouth design, 12 patients with chronic periodontitis (five men, seven women; mean age, 45.3±4.6 years) who had probing pocket depths (PPDs) of ≥6 mm following initial periodontal therapy were randomly assigned to two treatments in contralateral areas of the dentition: a combination of ACB grafting and GTR (with a absorbable membrane of polylactic acid) or ACB grafting alone. The compared parameters were preoperative and 6-month postoperative PPDs, clinical attachment levels (CALs), and radiographic alveolar bone heights.

Results: Both treatment modalities resulted in significant changes in the postoperative measurements from the preoperative values (P<.01). The reduction in the PPDs, gain in the CALs, and gain in the radiographic alveolar bone heights were 4.58±1.08, 4.25±1.06, and 5.50±2.24 mm in the patients treated with ACB grafting and GTR and 4.92±1.00, 4.50±0.80, and 5.92±1.83 mm in those treated with ACB grafting alone, respectively. The differences between the treatments were not statistically significant (P>.05).

Conclusions: Within the study limitations, both ACB grafting with GTR and ACB grafting alone lead to significant improvements in clinical and radiographic parameters at 6 months postoperatively. The combined approach does not provide any additional benefit for treating intraosseous periodontal defects. (Eur J Dent 2010;4:403-411)

Keywords

Autogenous bone graft - Guided tissue regeneration - Intraosseous defects - Periodontal regeneration
 

  • REFERENCES

  • 1 Socransky SS, Haffajee AD. The nature of periodontal disease. Ann Periodontol 1997; 2: 3-10
    CrossrefPubMedGoogle Scholar
  • 2 Flemmig TF. Periodontitis. Ann Periodontol 1999; 4: 32-38
    CrossrefPubMedGoogle Scholar
  • 3 Karring T, Lindhe J, Cortellini P. Regenerative periodontal therapy. In Lindhe J, Karring T, Lang NP. editors Clinical Periodontology and Implant Dentistry. 4th edn. Oxford, UK: Wiley-Blackwell Publishing Ltd; 2003: 650-704
    Google Scholar
  • 4 Kim CS, Choi SH, Cho KS, Chai JK, Wikesjö UM, Kim CK. Periodontal healing in one-wall intra-bony defects in dogs following implantation of autogenous bone or a coral-derived biomaterial. J Clin Periodontol 2005; 32: 583-589
    CrossrefPubMedGoogle Scholar
  • 5 Ivanovski S, Li H, Daley T, Bartold PM. An immunohistochemical study of matrix molecules associated with barrier membrane-mediated periodontal wound healing. J Periodontal Res 2000; 35: 115-126
    CrossrefPubMedGoogle Scholar
  • 6 Gottlow J, Nyman S, Lindhe J, Karring T, Wennström J. New attachment formation in the human periodontium by guided tissue regeneration. Case reports. J Clin Periodontol 1986; 13: 604-616
    CrossrefPubMedGoogle Scholar
  • 7 Cortellini P, Clauser C, Prato GP. Histologic assessment of new attachment following the treatment of a human buccal recession by means of a guided tissue regeneration procedure. J Periodontol 1993; 64: 387-391
    CrossrefPubMedGoogle Scholar
  • 8 Cortellini P, Carnevale G, Sanz M, Tonetti MS. Treatment of deep and shallow intrabony defects. A multicenter randomized controlled clinical trial. J Clin Periodontol 1998; 25: 981-987
    CrossrefPubMedGoogle Scholar
  • 9 Aimetti M, Romano F, Pigella E, Pranzini F, Debernardi C. Treatment of wide, shallow, and predominantly 1-wall intrabony defects with a bioabsorbable membrane: a randomized controlled clinical trial. J Periodontol 2005; 76: 1354-1361
    CrossrefPubMedGoogle Scholar
  • 10 MacNeill SR, Cobb CM, Rapley JW, Glaros AG, Spencer P. In vivo comparison of synthetic osseous graft materials. A preliminary study. J Clin Periodontol 1999; 26: 239-245
    CrossrefPubMedGoogle Scholar
  • 11 Deliberador TM, Nagata MJ, Furlaneto FA, Melo LG, Okamoto T, Sundefeld ML. et al Autogenous bone graft with or without a calcium sulfate barrier in the treatment of Class II furcation defects: a histologic and histometric study in dogs. J Periodontol 2006; 77: 780-789
    CrossrefPubMedGoogle Scholar
  • 12 Carranza FA, Takei HH, Cochran DL. Reconstructive periodontal surgery. In Newman MG, Takei HH, Klokkevold PR, Carranza FA. editors Clinical Periodontology. 10th edn. St. Louis, Missouri; USA: Saunders: 2006: 968-990
    Google Scholar
  • 13 Guida L, Annunziata M, Belardo S, Farina R, Scabbia A, Trombelli L. Effect of autogenous cortical bone particulate in conjunction with enamel matrix derivative in the treatment of periodontal intraosseous defects. J Periodontol 2007; 78: 231-238
    CrossrefPubMedGoogle Scholar
  • 14 Marx RE. Clinical application of bone biology to mandibular and maxillary reconstruction. Clin Plast Surg 1994; 21: 377-392
    CrossrefPubMedGoogle Scholar
  • 15 Chan C, Thompson I, Robinson P, Wilson J, Hench L. Evaluation of Bioglass/dextran composite as a bone graft substitute. Int J Oral Maxillofac Surg 2002; 31: 73-77
    CrossrefPubMedGoogle Scholar
  • 16 Blumenthal N, Steinberg J. The use of collagen membrane barriers in conjunction with combined demineralized bone-collagen gel implants in human infrabony defects. J Periodontol 1990; 61: 319-327
    CrossrefPubMedGoogle Scholar
  • 17 Chen CC, Wang HL, Smith F, Glickman GN, Shyr Y, O'Neal RB. Evaluation of a collagen membrane with and without bone grafts in treating periodontal intrabony defects. J Periodontol 1995; 66: 838-847
    CrossrefPubMedGoogle Scholar
  • 18 Trejo PM, Weltman R, Caffesse R. Treatment of intraosseous defects with bioabsorbable barriers alone or in combination with decalcified freeze-dried bone allograft: a randomized clinical trial. J Periodontol 2000; 71: 1852-1861
    CrossrefPubMedGoogle Scholar
  • 19 Paolantonio M. Combined periodontal regenerative technique in human intrabony defects by collagen membranes and anorganic bovine bone. A controlled clinical study. J Periodontol 2002; 73: 158-166
    CrossrefPubMedGoogle Scholar
  • 20 Donos N, Kostopoulos L, Karring T. Augmentation of the mandible with GTR and onlay cortical bone grafting. An experimental study in the rat. Clin Oral Implants Res 2002; 13: 175-184
    CrossrefPubMedGoogle Scholar
  • 21 Donos N, Kostopoulos L, Karring T. Alveolar ridge augmentation using a resorbable copolymer membrane and autogenous bone grafts. An experimental study in the rat. Clin Oral Implants Res 2002; 13: 203-213
    CrossrefPubMedGoogle Scholar
  • 22 Orsini M, Orsini G, Benlloch D, Aranda JJ, Lazaro P, Sanz M. et al Comparison of calcium sulfate and autogenous bone graft to bioabsorbable membranes plus autogenous bone graft in the treatment of intrabony periodontal defects: a split-mouth study. J Periodontol 2001; 72: 296-302
    CrossrefPubMedGoogle Scholar
  • 23 Froum SJ, Thaler R, Scopp IW, Stahl SS. Osseous autografts. I. Clinical responses to bone blend or hip marrow grafts. J Periodontol 1975; 46: 515-521
    CrossrefPubMedGoogle Scholar
  • 24 Froum SJ, Thaler R, Scopp IW, Stahl SS. Osseous autografts. II. Histological responses to osseous coagulumbone blend grafts. J Periodontol 1975; 46: 656-661
    CrossrefPubMedGoogle Scholar
  • 25 Stahl SS, Froum SJ, Kushner L. Healing responses of human intraosseous lesions following the use of debridement, grafting and citric acid root treatment. II. Clinical and histologic observations: one year postsurgery. J Periodontol 1983; 54: 325-338
    CrossrefPubMedGoogle Scholar
  • 26 Movin S, Borring-Møller G. Regeneration of infrabony periodontal defects in humans after implantation of allogenic demineralized dentin. J Clin Periodontol 1982; 9: 141-147
    CrossrefPubMedGoogle Scholar
  • 27 Silness J, Löe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22: 121-135
    CrossrefPubMedGoogle Scholar
  • 28 Löe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963; 21: 533-551
    CrossrefPubMedGoogle Scholar
  • 29 Keles GC, Cetinkaya BO, Albayrak D, Koprulu H, Acikgoz G. Comparison of platelet pellet and bioactive glass in periodontal regenerative therapy. Acta Odontol Scand 2006; 64: 327-333
    CrossrefPubMedGoogle Scholar
  • 30 Steffensen B, Webert HP. Relationship between the radiographic periodontal defect angle and healing after treatment. J Periodontol 1989; 60: 248-254
    CrossrefPubMedGoogle Scholar
  • 31 Liñares A, Cortellini P, Lang NP, Suvan J, Tonetti MS. the European Research Group on Periodontology (ErgoPerio). Guided tissue regeneration/deproteinized bovine bone mineral or papilla preservation flaps alone for treatment of intrabony defects. II: radiographic predictors and outcomes. J Clin Periodontol 2006; 33: 351-358
    CrossrefPubMedGoogle Scholar
  • 32 Sculean A, Chiantella GC, Windisch P, Arweiler NB, Brecx M, Gera I. Healing of intra-bony defects following treatment with a composite bovine-derived xenograft (Bio-Oss Collagen) in combination with a collagen membrane (Bio-Gide PERIO). J Clin Periodontol 2005; 32: 720-724
    CrossrefPubMedGoogle Scholar
  • 33 Lekovic V, Camargo PM, Weinlaender M, Vasilic N, Aleksic Z, Kenney EB. Effectiveness of a combination of plateletrich plasma, bovine porous bone mineral and guided tissue regeneration in the treatment of mandibular grade II molar furcations in humans. J Clin Periodontol 2003; 30: 746-751
    CrossrefPubMedGoogle Scholar
  • 34 Okuda K, Tai H, Tanabe K, Suzuki H, Sato T, Kawase T. et al Platelet-rich plasma combined with a porous hydroxyapatite graft for the treatment of intrabony periodontal defects in humans: a comparative controlled clinical study. J Periodontol 2005; 76: 890-898
    CrossrefPubMedGoogle Scholar
  • 35 Listgarten MA, Rosenberg MM. Histological study of repair following new attachment procedures in human periodontal lesions. J Periodontol 1979; 50: 333-344
    CrossrefPubMedGoogle Scholar
  • 36 Zybutz M, Rapoport D, Laurell L, Persson GR. Comparisons of clinical and radiographic measurements of inter-proximal vertical defects before and 1 year after surgical treatments. J Clin Periodontol 2000; 27: 179-186
    CrossrefPubMedGoogle Scholar
  • 37 Zamet JS, Darbar UR, Griffiths GS, Bulman JS, Brägger U, Bürgin W. et al Particulate bioglass as a grafting material in the treatment of periodontal intrabony defects. J Clin Periodontol 1997; 24: 410-418
    CrossrefPubMedGoogle Scholar
  • 38 Polson AM, Southard GL, Dunn RL, Polson AP. Healing patterns associated with an Atrisorb barrier in guided tissue regeneration. Compendium 1993; 14: 1162-9 1164, 1166 passim; quiz 1172
    PubMedGoogle Scholar
  • 39 Laurell L, Falk H, Fornell J, Johard G, Gottlow J. Clinical use of a bioresorbable matrix barrier in guided tissue regeneration therapy. Case series. J Periodontol 1994; 65: 967-975
    CrossrefPubMedGoogle Scholar
  • 40 Bogle G, Garrett S, Stoller NH, Swanbom DD, Fulfs JC, Rodgers PW. et al Periodontal regeneration in naturally occurring Class II furcation defects in beagle dogs after guided tissue regeneration with bioabsorbable barriers. J Periodontol 1997; 68: 536-544
    CrossrefPubMedGoogle Scholar
  • 41 Hugoson A, Ravald N, Fornell J, Johard G, Teiwik A, Gottlow J. Treatment of class II furcation involvements in humans with bioresorbable and nonresorbable guided tissue regeneration barriers. A randomized multi-center study. J Periodontol 1995; 66: 624-634
    CrossrefPubMedGoogle Scholar
  • 42 Garrett S, Polson AM, Stoller NH, Drisko CL, Caton JG, Harrold CQ. et al Comparison of a bioabsorbable GTR barrier to a non-absorbable barrier in treating human class II furcation defects. A multi-center parallel design randomized single-blind trial. J Periodontol 1997; 68: 667-675
    CrossrefPubMedGoogle Scholar
  • 43 Schallhorn RG, Hiatt WH. Human allografts of iliac cancellous bone and marrow in periodontal osseous defects. II. Clinical observations. J Periodontol 1972; 43: 67-81
    CrossrefPubMedGoogle Scholar
  • 44 Dragoo MR, Sullivan HC. A clinical and histological evaluation of autogenous iliac bone grafts in humans. II. External root resorption. J Periodontol 1973; 44: 614-625
    CrossrefPubMedGoogle Scholar
  • 45 Wikesjö UM, Lim WH, Thomson RC, Cook AD, Wozney JM, Hardwick WR. Periodontal repair in dogs: evaluation of a bioabsorbable space-providing macroporous membrane with recombinant human bone morphogenetic protein-2. J Periodontol 2003; 74: 635-647
    CrossrefPubMedGoogle Scholar
  • 46 Trombelli L, Annunziata M, Belardo S, Farina R, Scabbia A, Guida L. Autogenous bone graft in conjunction with enamel matrix derivative in the treatment of deep periodontal intra-osseous defects: a report of 13 consecutively treated patients. J Clin Periodontol 2006; 33: 69-75
    CrossrefPubMedGoogle Scholar
  • 47 Bauer TW, Muschler GF. Bone graft materials. An overview of the basic science. Clin Orthop Relat Res 2000; 371: 10-27
    CrossrefGoogle Scholar
  • 48 Nygaard-Østby P, Bakke V, Nesdal O, Nilssen HK, Susin C, Wikesjö UM. Periodontal healing following reconstructive surgery: effect of guided tissue regeneration using a bioresorbable barrier device when combined with autogenous bone grafting. A randomized controlled clinical trial. J Clin Periodontol 2008; 35: 37-43
    PubMedGoogle Scholar
  • 49 Sanz M, Tonetti MS, Zabalegui I, Sicilia A, Blanco J, Rebelo H. et al Treatment of intrabony defects with enamel matrix proteins or barrier membranes: results from a multicenter practice-based clinical trial. J Periodontol 2004; 75: 726-733
    CrossrefPubMedGoogle Scholar