A synthetic cell-binding peptide (P-15) combined with anorganic bovine-derived hydroxyapatite bone matrix (ABM) was compared to demineralized freeze-dried bone allograft (DFDBA) and open flap debridement (DEBR) in human periodontal osseous defects in a controlled, monitored, multi-center trial. Following appropriate initial preparation procedures, flap surgery with defect and root debridement was performed. Three osseous defects per patient were treated randomly with one of three procedures after surgical preparation. Appropriate periodontal maintenance schedules were followed, and at 6 to 7 months re-entry flap surgery was performed for documentation and finalization of treatment. Analysis of variation (ANOVA) and t test analyses of patient mean values from 31 patients revealed that the combination ABM/P-15 grafts demonstrated significantly better mean defect fill of 2.8 +/- 1.2 mm (72.3%) versus a mean defect fill of 2.0 +/- 1.4 mm (51.4%) for defects treated with DFDBA (P <0.05) and a mean defect fill of 1.5 +/- 1.3 mm (40.3%) (P <0.05) for defects treated with DEBR. Other hard tissue findings showed similar clinically superior results with the use of ABM/P-15. Relative defect fill results showed 87% positive (50% to 100% defect fill) responses with ABM/P-15, 58% positive responses with DFDBA, and 41% positive responses with DEBR. There were 8 to 9 times more failures (minimal response) with DFDBA and DEBR (26% to 29% frequency) than with ABM/P-15. Soft tissue findings showed no significant differences among treatments except for greater clinical attachment level gain with ABM/P-15 compared to DEBR. These results suggest that the use of the P-15 synthetic cell-binding peptide combined with ABM yields better clinical results than either DFDBA or DEBR. Further studies are needed to determine the relative roles of the ABM and/or the P-15 in these improved results.

These results suggest that the use of the P-15 synthetic cell-binding peptide combined with ABM yields better clinical results than the ABM alone in intrabony periodontal defects.

Moderate to high levels of eight different periodontopathic microbes inhabiting the internal surfaces of the IAI of 43 two-stage implants in partially edentulous patients were identified by DNA probe analysis. The microbes colonized these surfaces within 25 days following the second stage surgery and placement of the healing abutment. In contrast, all samples obtained from screw-threads of 11 healing abutments were DNA probe negative. These findings appear to support those of other investigations demonstrating the translocation of bacteria from residual dentition to implants.

These favorable 3-year results with ABM/P-15 suggest that it may have a beneficial effect in the long-term clinical management of infrabony defects. Further long-term randomized controlled studies are needed to better assess the role of ABM/P-15 in long-term healing of periodontal osseous defects.

The advent of AIDS has created patients fears regarding human tissue transfers, including bone grafts in dental surgery. In the face of these fears, alternative allograft materials are of increasing interest to clinicians. One such alternative is naturally derived xenogeneic hydroxyapatite (HA). In this study, two patients with edentulous ridge defects received bovine-derived HA grafts in conjunction with a dental implant treatment plan. The results were evaluated histologically. Both patients showed excellent clinical results with histological confirmation of osseous formation. The outcomes suggest that further consideration of the use of bovine-derived HA is merited as a means of remediating edentulous ridge defects.