Periodontal Repair in Dogs: Space Provision by Reinforced ePTFE Membranes Enhances Bone and Cementum Regeneration in Large Supraalveolar Defects

Abstract

Regeneration of alveolar bone and cementum following reconstructive therapy with reinforced space providing expanded polytetrafluorethylene (ePTFE) membranes was evaluated in supraalveolar mandibular premolar periodontal defects in five beagle dogs. The surgically-created defects in contralateral jaw quadrants were randomly assigned to receive the dome-shaped membrane or serve as surgical control. Flaps were positioned to completely submerge the teeth and sutured. The dogs were sacrificed 8 weeks after surgery and tissue blocks including teeth and surrounding structures processed for histology. Membrane treated defects in two animals became exposed and infected leaving intact quadrants in three dogs for histometric analysis. Parameters evaluated included defect height, height and area of regenerated alveolar bone, height of regenerated cementum, root resorption, and ankylosis. Mean defect height approximated 4.1 mm. Mean height (+/- s.d.) of regenerated alveolar bone amounted to 2.9 +/- 0.6 and 0.6 +/- 0.2 mm for membrane and control defects, respectively (P = 0.006). Corresponding values for bone area were 1.4 +/- 0.7 and 0.4 +/- 0.4 mm2 (P = 0.02). Cementum regeneration was observed in all teeth averaging (+/- s.d.) 1.6 +/- 0.3 mm for membrane treated and 0.1 +/- 0.1 mm for control defects (P = 0.01). Small amounts of root resorption were seen in all teeth with no significant difference between treatments. Ankylosis was noticed in three membrane treated and two control teeth. The present study provides a biologic rationale for space provision for enhanced bone and cementum regeneration in periodontal defects subject to reconstructive therapy.

Periodontal Repair in Dogs: A Bioabsorbable Calcium Carbonate Coral Implant Enhances Space Provision for Alveolar Bone Regeneration in Conjunction with Guided Tissue Regeneration

“…2,3 Studies have also shown that alveolar bone and cementum regeneration is critically dependent on space provision by the GTR device. [4][5][6][7][8][9] With limited space provision by the barrier membrane, alveolar bone will fill the space provided by the device. 4,9 In presence of a larger space, the alveolar bone adopts a physiologic form along the entire root surface, the remainder of the space being filled by fibrous connective tissue.…”

“…4,9 In presence of a larger space, the alveolar bone adopts a physiologic form along the entire root surface, the remainder of the space being filled by fibrous connective tissue. 5,6,8,9 Collapse or compression of the barrier device into a periodontal defect or onto the root surface will necessarily compromise regeneration of alveolar bone and cementum following GTR procedures. [4][5][6][7][8][9] The space provided by the device at the time of surgery is lost and the device becomes a physical obstacle to bone and cementum regeneration.…”

“…Thus, structurally reinforced GTR devices have been developed to safeguard wound stability and maintain necessary space provision. 5,6,[8][9][10][11] Autogenous bone grafts, bone derivatives, and bone substitutes have been suggested to support regeneration of alveolar bone and, for some biomaterials, periodontal attachment. 12,13 Bone grafts, bone derivatives, and bone substitutes may also potentially offer advantages in supporting stability and space provision of GTR devices.…”

“…These characteristics have been shown to support alveolar bone and cementum regeneration in the supraalveolar periodontal defect model. [4][5][6][7][8] ePTFE sutures** were used for membrane fixation and wound closure.…”

Management of Two-Wall Infra-Bony Defect with Platelet Rich Fibrin and Connective Tissue Graft Combination: A Case Report

“…Many years before, the key role of space provision and wound stability in regenerative treatment was reported by some studies evaluating the guided tissue regeneration techniques and as verified, possibility of bone formation increases by providing space provision without rigorous interruption of the gingival connective tissue [21,24,25]. PRF was covered over the defect as a membrane in the first surgical step of the present case, and the role that was imputed to the PRF membrane was containing the infrabony part of the defect in the early phase of healing due to this principle.…”