This study evaluated bone regeneration and osseointegration of hydroxyapatite (HA) coated and titanium plasma sprayed (TPS) implants placed in sockets immediately after extraction in 36 adults, mean age 55.2 years (range 26 to 81 years). Twelve TPS and 10 HA‐coated implants in 20 patients were grafted with demineralized freeze‐dried bone allograft (DFDBA), covered with a barrier material, and the facial flap coronally positioned to attain primary closure (experimental). The remaining 11 TPS and 10 HAcoated implants were placed similarly, except that no DFDBA was used (control). Osseous structures were measured at the initial placement and 6‐month re‐entry surgeries. At the 6‐month re‐entry, all implants placed were clinically osseointegrated. Bone resorption at the most coronal socket crest was −1.53 mm for the grafted group and −1.59 mm for the control group. Crestal bone apposition of 1.39 mm was noted at the most apical socket crest (ASC) for the grafted group, whereas crestal resorption of −0.11 mm was noted in the ungrafted control group (P < 0.02). Bone fill from the base of the deepest osseous defect was 5.68 mm for the grafted group and 3.18 mm for the control group (P < 0.04). Complete resolution of osseous defects occurred at 15 of 22 sites in the grafted group and at 9 of 21 sites in the control group. Clinical exposure of the barrier material and a subsequent inflammatory response at 27 of 43 sites, required removal of the material prior to the 6‐month re‐entry and was associated with significantly more bone loss at the ASC sites (P < 0.01). There was no significant difference for any of the parameters when comparing the TPS with the HA‐coated implants. J Periodontol 1994;65:881–891.

The osteogenic potential of decalcified freeze-dried bone allografts in the treatment of human periodontal osseous defects was evaluated over a 6 month period. Cortical bone, obtained under sterile conditions from a human donor within 24 hours after death, was decalcified, freeze-dried and ground to a particle size of 250 to 500 microns. Twenty-seven osseous defects with one-, two- and wide three-wall morphology were treated. Clinical measurements were made with a stent and a calibrated periodontal probe before surgery, at the time of surgery, and at re-entry. The combined mean osseous regeneration for all defects was 2.4 mm. This represented a 65% mean bone-fill of the original defect. The findings demonstrate that decalcified freeze-dried bone allograft has potential as an osseous grafting material in periodontal therapy.

The purpose of this study was to compare the effectiveness of polylactic acid (PLA) granules as an alloplastic grafting material to that of decalcified freeze-dried bone allograft (DFDBA) and a flap procedure for debridement without graft (FPD) when treating periodontal intrabony defects. Ten patients presenting with advanced adult periodontitis, including at least 3 similar periodontal osseous defects (2- and 3-walled), comprised the study group. After completion of a hygienic phase of treatment, measurements were made with calibrated periodontal probes and stents to determine soft tissue recession, probing pocket depths, and probing attachment levels. Each defect was surgically exposed and hard tissue measurements were obtained. Defects were treated with one of the 3 methods above chosen randomly prior to the surgical appointment. Six months postsurgery, soft tissue measurements were repeated and all sites were surgically reentered to obtain hard tissue measurements. All surgical sites healed without clinical complication. The initial pocket depths and initial depth of osseous defects were compared between the groups using ANOVA and no significant differences were found. A mean osseous defect fill of 0.4 mm (11.2%) occurred with the flap procedure for debridement, 3.0 mm (65%) with DFDBA, and 0.1 mm (2.2%) with PLA. Mean crestal bone loss was 1.30 mm for FPD, 0.60 mm for DFDBA, and 1.55 mm for PLA. No statistically significant differences were found in soft tissue recession between groups or in the osseous defect measurement between PLA and FPD. A statistically significant improvement (P < 0.001) was found in the fill of the osseous defects when using DFDBA compared to the initial defect depth and to the other 2 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Various particle sizes of demineralized freeze-dried bone allograft (DFDBA) are currently used to treat patients with periodontal osseous defects. However, the effect of particle size on the healing of human intrabony periodontal defects is unknown since there have been no direct clinical comparisons. The purpose of this study was to compare the bony defect resolution obtained using two different particle size ranges of DFDBA. Cortical bone from a single donor was processed and ground to final particle sizes of 250 mu to 500 mu or 850 mu to 1,000 mu using an analytic mill. Paired interproximal intrabony periodontal defects in 11 patients were grafted with DFDBA. Soft and hard tissue measurements were made using an electronic constant-force probe at the initial and reentry surgeries. Treated sites in 10 patients were reevaluated by reentry approximately 6 months postoperatively. Mean bony defect fill was 1.66 mm for the large particle group and 1.32 mm for the small particle group. There was no statistically significant difference in bony fill between defects grafted with the different particle sizes of DFDBA when used in humans.

Tomography is a radiographic process that produces cross‐sectional images of bony structures within the body. The purpose of this study was to evaluate the accuracy of diagnostic measurements made by dental implant team members from linear tomograms of human cadaver mandibles. Five partially edentulous cadaver mandibles were radiographed using linear tomography (LT) and computer‐assisted tomography (CT). From the tomograms, each of four team members traced the perceived outer circumference of the mandible and the inferior alveolar canal. Tomogram tracings were compared to each other and to the equivalent CT cross‐sectional image to determine the precision of the measurements. One mandible was sectioned to verify the accuracy of the CT images. Repeated measures analysis of variance of the measurements made from the LT and CT scans showed significant statistical differences between team members. Multiple crosssectional views facilitated identification of the inferior alveolar canal in the majority of CT scans, whereas image blurring inherent to LT resulted in the inability of team members to identify the canal in 14% to 50% of the images. Volume averaging within the CT slice aperture was found capable of producing a magnification error of short dense objects. CT and LT must both be interpreted cautiously because of innate technique pecularities that can lead to measurement errors. The wide variation in interpretation of the linear tomograms and frequent inability to identify the inferior alveolar canal made this technique less valuable than the reformatted CT when planning dental surgical procedures. J Periodontol 1993;64:1243–1249.