Infrabony defects 20 years after open flap debridement and guided tissue regeneration

Abstract

Aim Evaluation of 20‐year results after open flap debridement (OFD) and guided tissue regeneration (GTR) of infrabony defects in a randomized controlled trial. Materials and methods In originally 16 periodontitis patients (baseline examination), periodontal surgery was performed in 44 infrabony defects. Polylactide acetyltributyl citrate barriers were randomly assigned to 23 out of these 44 defects (parallel). Ten of these patients (GTR) exhibited a second, contra‐lateral defect (OFD) each (split‐mouth). At baseline, 12, 120 and 240 ± 12 months after surgery probing depths, attachment level, bleeding on probing as well was Plaque Index, Gingival Bleeding Index and plaque control record were obtained. Results Twelve patients contributing 38 defects were available at 240 months. At 12, 120 and 240 ± 12 months, both groups showed significant (p < 0.01) attachment gain (split‐mouth: OFD: 12 months: 4.15 ± 2.93 mm; 120 months: 3.35 ± 2.37 mm, 240 months: 3.60 ± 2.55 mm; GTR: 12 months: 3.50 ± 2.47 mm; 120 months: 3.90 ± 2.76 mm, 240 months: 3.80 ± 2.69 mm; parallel: OFD: 12 months: 3.53 ± 2.04 mm; 120 months: 3.59 ± 2.54 mm, 240 months: 3.53 ± 2.50 mm; GTR: 12 months: 4.07 ± 2.88 mm; 120 months: 3.13 ± 2.22 mm, 240 months: 3.13 ± 2.22 mm). Seven teeth (3 OFD, 4 GTR) were lost. Only 1 patient out of 12 was kept in regular supportive periodontal therapy (SPT) over 20 years. The study failed to show significant attachment gain differences between both groups after 240 months. Conclusions Twenty years after OFD and GTR in infrabony defects in a population with lack of regular SPT attachment gains at 12 months after surgery were stable. About 82% of the initially included teeth were still in place.

Tooth survival and clinical outcomes up to 26 years after guided tissue regeneration therapy in deep intra‐bony defects: Follow‐up investigation of three randomized clinical trials

“…In this study, 52.9% of the initially heavily diseased teeth were still in situ at the follow‐up examination up to 26 years after GTR therapy. This stands in marked contrast to Cortellini et al who described that all teeth that had received GTR therapy were still in function after 20 years (Cortellini et al., 2017) and to Petsos et al who reported a 20‐year tooth survival of about 79% in the sites treated with GTR (Petsos et al., 2019). This difference may be attributed to several factors: as outlined above, only about half of the defects included here received SPT with at least two regular recall appointments per year over the whole study period.…”

“…Petsos et al. (2019) recently reported a mean CAL loss of 0.53 mm only between their 1‐year and their 20‐year examination. Likewise, Cortellini et al found mean new CAL losses of 0.1 mm or 0.5 mm between 1 and 20 years, depending on the surgical technique used (modified papilla preservation technique or access flap, respectively).…”

“…With regard to GTR (or combined GTR/graft therapy) in intra‐bony defects, there are only five studies with follow‐up periods of 10 years (Nickles, Ratka‐Krüger, Neukranz, Raetzke, & Eickholz, 2009; Nygaard‐Østby, Bakke, Nesdal, Susin, & Wikesjö, 2010; Pretzl, Kim, Holle, & Eickholz, 2008; Pretzl et al., 2009; Sculean et al., 2008), one study with 13‐year follow‐up evaluating additional application of autogenous platelet concentrate (Cieplik et al, 2018) and two studies with follow‐up periods of 20 years (Cortellini et al., 2017; Petsos et al., 2019). These latter two studies are prospective clinical studies comparing GTR therapy and open flap debridement (OFD) but comprise only 41 defects (in 41 patients; parallel design; Cortellini et al., 2017) or 38 defects (in 12 patients; split‐mouth design; Petsos et al., 2019), respectively. In the present study, patients from three prospective randomized clinical trials (Christgau et al., 1995, 1998, 2002), which each originally had been designed to compare clinical healing outcomes of two different types of barrier membranes in a split‐mouth approach, have been pooled to conduct a long‐term follow‐up investigation of up to 26 years (median follow‐up duration 23.3 years) after GTR therapy.…”

“…Although big efforts were made for a detailed and thorough questioning of the patients, the self‐reported data could not be controlled and thus must be interpreted with some caution. Petsos et al also described that their patients were not permanently kept in regular SPT during their 20‐year follow‐up (Petsos et al., 2019). On the contrary, Cortellini et al.…”

Bone Regeneration Assessment of Polycaprolactone Membrane on Critical-Size Defects in Rat Calvaria

“…Guided bone regeneration (GBR) [7] is commonly used to treat conditions that reduce alveolar bone defects in the jaw [8][9][10].…”