Combined collagen membrane and hydroxyapatite/collagen chondroitin‐sulfate spacer placement in the treatment of 2‐wall intrabony defects in chronic adult and rapidly progressive periodontitis patients

Abstract

This study, confined to non-smokers, evaluated guided-tissue regeneration in deep 2-wall intrabony defects using a diphenylphosphorylazide-cross-linked bovine type I collagen membrane supported by a hydroxyapatite/collagen/chondroitin-sulfate spacer in 43 adult periodontitis (AP) and 14 rapidly progressive periodontitis (RPP) patients, no more than 1 defect being randomly selected for each patient. Before surgery and 6 months after surgery, plaque (PI) and sulcus bleeding (SBI) indices, probing pocket depths (PPD), gingival margin locations (GML) and probing attachment levels (PAL) were recorded. During the post-surgical period, the biomaterials were well tolerated in all patients and PI and SBI were kept at a low level. Following therapy, there was a significant gain in PAL (4.2 mm for AP; 3 mm for RPP) and reduction in PPD (6.1 mm for AP; 4.7 mm for RPP) for both groups of patients (p < 0.05). A significantly greater gain in PAL and reduction in PPD were observed for AP compared to RPP patients (p < 0.05). The change in GML was not statistically different between groups (1.8 mm for AP; 1.6 mm for RPP). It is concluded that the combined use of a diphenylphosphorylazide-cross-linked bovine type-I collagen membrane, supported by a hydroxyapatite/collagen/chondroitin-sulfate spacer, is beneficial in improving PAL and reducing PPD in 2-wall intrabony defects in both AP and RPP patients during the quiescent phase of the disease, with statistically better results for the former group. However, longer observation periods are necessary to evaluate the stability of the improvements obtained by this combined treatment approach between and for each group of patients.

Single‐Flap Approach With Buccal Access in Periodontal Reconstructive Procedures

“…The application of the SFA resulted in a mean postoperative REC increase of 0.4 mm, with eight of 10 patients exhibiting a reduced (≤1 mm) postoperative REC increase. This result is in contrast with previous studies 23,24,26 that reported substantially higher REC increases in deep intraosseous defects treated by a similar reconstructive technique. In this respect, the postoperative REC increase observed in our study was comparable to that reported in a study 27 in which intraosseous defects were accessed with a microsurgical approach for GTR.…”

“…CAL gain ranged from 1 to 11 mm, with five of 10 defects showing a CAL gain ≥5 mm. Previous studies investigating the use of the graft biomaterial employed in the present study in association with a collagen‐based membrane 23 or a non‐resorbable expanded polytetrafluoroethylene membrane 24 in the treatment of intraosseous defects reported a mean CAL gain ranging from 3.0 to 4.2 mm. Differences in CAL gain between our study and previous studies using similar reconstructive technologies may be ascribed, in part, to differences in disease status (chronic/aggressive periodontitis) of the study population, 23 protocols for postoperative maintenance, follow‐up intervals, and flap design and soft tissue management.…”

“…Previous studies investigating the use of the graft biomaterial employed in the present study in association with a collagen‐based membrane 23 or a non‐resorbable expanded polytetrafluoroethylene membrane 24 in the treatment of intraosseous defects reported a mean CAL gain ranging from 3.0 to 4.2 mm. Differences in CAL gain between our study and previous studies using similar reconstructive technologies may be ascribed, in part, to differences in disease status (chronic/aggressive periodontitis) of the study population, 23 protocols for postoperative maintenance, follow‐up intervals, and flap design and soft tissue management. Conversely, the amount of CAL gain observed in our study was comparable to that reported in previous case series in which a different minimally invasive technique was applied to single 15 or multiple 16 intraosseous defects in association with EMD.…”

Treatment of intrabony defects with guided tissue regeneration in aggressive periodontitis: clinical outcomes at 6 and 12 months

“…However, these reviews were limited to patients with the chronic periodontitis (CP) in subjects aged 21 years or older, and studies specifically treating AgP were excluded. Thus, there is only limited information regarding surgical therapy for AgP, and only few clinical trials comparing GTR and AF in AgP patients [11][12][13][14][15], mostly based on a limited number of subjects, comparing several defects within the same patient and utilising unclear randomisation procedures.…”

Combined Use of Platelet‐Rich Plasma and Bone Grafting With or Without Guided Tissue Regeneration in the Treatment of Anterior Interproximal Defects

“…However, space protection around large defects is an important concern in GTR 5 . The combined use of graft materials and GTR in the treatment of periodontal intrabony defects resulted in positive outcomes and secured the space that is crucial for new tissue regeneration 6‐8 . In a study in which four filling materials in bone defects of similar dimensions were evaluated in the mandibles of miniature pigs, defects were covered with barrier membranes and allowed to heal for 4, 12, or 24 weeks.…”