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

Abstract

This report details histologic healing responses at intrabony sites within two patients about 1 year after surgery. Treatment consisted of open flat debridement of the lesions. At specific sites, augmenting procedures such as autogenous grafts, allografts, synthetic grafts and citric acid root treatment were utilized. In addition, notches were made through calculus prior to root planing at specific root surfaces. These notches were placed at varying distances from the base of the lesion. Patients were followed postsurgically with frequent maintenance visits. Block sections were removed at the end of the experimental period. Clinical reduction in pocket depth was noted at all treated sites. This reduction consisted of limited pocket closure, marginal gingival recession and repocketing. Histologically, all specimens showed evidence of repair. The most mature repair appeared at sites treated with debridement and autogenous grafts. "Regeneration" of lost periodontal attachment was demonstrated by evidence of cementogenesis, osteogenesis and the presence of functionally oriented ligaments. However, the coronal regeneration appeared spatially limited. Allografts showed a similar, but less mature healing response. Synthetic graft material acted essentially as a "filler" within the defect. Citric acid root treatment did not demonstrate clear evidence of augmentation of the repair process. Of particular note in these human specimens was further histologic demonstration that "regeneration" potential apparently can only take place in close proximity to histologically viable periodontal ligament cells which may act as "donor sites" for coronal "regeneration" of lost periodontal attachment. This histologic response was observed regardless of treatment modalities used.

Clinical evaluation of a biphasic calcium phosphate grafting material in the treatment of human periodontal intrabony defects

“…Regarding bone replacement grafts, from a biologic point of view, autogenous bone grafts have been considered the gold-standard material with the most predictable outcomes [3,4], but they require a second surgical site to harvest the graft from a donor area. Alternatively, xenografts and allografts have been well documented to be suitable as bone replacement grafts [5-7].…”

Clinical Comparison of an Enamel Matrix Derivative Used Alone or in Combination With a Bovine‐Derived Xenograft for the Treatment of Periodontal Osseous Defects in Humans

“…2 This histological evidence is supported by clinical results that include bone fill of osseous defects and gain of clinical attachment levels. Currently, several materials have met these criteria in the human model: intraoral autogenous bone, [3][4][5] demineralized freeze-dried bone allograft (DFDBA), 6,7 DFDBA with bone morphogenetic protein (BMP), 8 barrier membranes, [9][10][11][12] citric acid application, 13 bovine-derived xenograft (BDX), 14,15 and enamel matrix derivative (EMD). 16,17 EMD and BDX have recently been introduced as part of the armamentarium for regenerative therapy.…”

Outcome Variables for the Study of Periodontal Regeneration

“…Caffesse et al,64 using a dog model, and Caton et al65 in a primate model have shown that the bulk of these changes are complete within 3 to 5 months postsurgery. Human histological studies of periodontal regeneration are scarce; however, Stahl et al6667 have shown significant tissue regeneration at both 6-and 12-months postsurgery. Unfortunately, no attempt was made to quantitate and compare healing berevealed a mean defect resolution of 4.72 mm, which was the combination of 4.39 mm bone fill and 0.33 mm of crestal…”