Comparison of clinical, radiographic, and histometric measurements following treatment with guided tissue regeneration or enamel matrix proteins in human periodontal defects. Healing of human intrabony defects following treatment with enamel matrix proteins or guided tissue regeneration. Periodontal surgery of vertical bony defects with or without synthetic bioabsorbable barriers. 12-month results. Treatment of intrabony defects with enamel matrix proteins or bioabsorbable membranes. A 4-year follow-up split-mouth study. Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. I. Class II furcations. Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. III. Class II furcations after 10 years. Comparison of treatments of infrabony defects with enamel matrix derivative, guided tissue regeneration with a nonresorbable membrane and Widman modified flap. A pilot study. Guided tissue regeneration in human Class II furcations and interproximal infrabony defects after using a bioabsorbable membrane barrier. Combination use of bovine porous bone mineral, enamel matrix proteins, and a bioabsorbable membrane in intrabony periodontal defects in humans. Enamel matrix proteins and guided tissue regeneration with titanium-reinforced expanded polytetrafluoroethylene membranes in the treatment of infrabony defects: a comparative controlled clinical trial. Comparison of infrabony defects treated with enamel matrix derivative versus guided tissue regeneration with a nonresorbable membrane. Radiographic evaluation of bone regeneration following periodontal surgery with or without expanded polytetrafluoroethylene barriers. Treatment of interproximal angular defects by guided tissue regeneration: 1 year follow-up. Treatment of wide, shallow, and predominantly 1-wall intrabony defects with a bioabsorbable membrane: a randomized controlled clinical trial. Healing response of apicomarginal defects to two guided tissue regeneration techniques in periradicular surgery: a double-blind, randomized-clinical trial. Assessment of guided tissue regeneration procedures in intrabony defects with bioabsorbable and non-resorbable barriers. Guided bone regeneration around endosseous implants with anorganic bovine bone mineral. A randomized controlled trial comparing bioabsorbable versus non-resorbable barriers. The use of autogenous periosteal grafts as barriers for the treatment of intrabony defects in humans. Topical and systemic antimicrobial therapy in guided tissue regeneration. A comparison between enamel matrix derivative and a bioabsorbable membrane to enhance healing around transmucosal immediate post-extraction implants. The simplified papilla preservation flap in the regenerative treatment of deep intrabony defects: clinical outcomes and postoperative morbidity. Guided tissue regeneration for the treatment of intraosseous defects using a biabsorbable membrane. A controlled clinical study. Combined use of platelet-rich plasma and bone grafting with or without guided tissue regeneration in the treatment of anterior interproximal defects.
BACKGROUND The purpose of this study was to compare the clinical and radiographic parameters with the histometric findings following 2 different regenerative procedures in humans . METHODS Fourteen advanced intrabony defects at teeth scheduled for extraction were r and omly treated as follows : 8 with guided tissue regeneration ( GTR ) using bioabsorbable barriers and 6 with an enamel matrix protein derivative ( EMD ) .  St and ardized radiographs , probing depths ( PD ) , and attachment levels ( CAL ) at baseline and 6 months after therapy were evaluated and compared to the histometric measurements made following the removal of teeth and surrounding tissues 6 months after the surgery . RESULTS Significant PD reductions ( GTR : -5.62 mm ; EMD : -5.00 mm ) and CAL gains ( GTR : 3.87 mm ; EMD : 2.67 mm ) were observed in both groups . Six months after surgery , minor resorptions of the alveolar crest ( AC ) ( GTR : 0.40 mm ; EMD : 0.33 mm ) and bony gain at the bottom of the defects ( GTR : 0.47 mm ; EMD : 1.05 mm ) were observed radiographically . No statistically significant differences in the change of clinical and radiographic parameters between the GTR and EMD groups were found . Histometrically , significant amounts of new connective tissue attachment ( i.e. , cementum with inserting collagen fibers ) were observed in both groups ( GTR : 2.29 mm ; EMD : 1.81 mm ) . Bone regeneration was found to be significant only in the GTR group ( GTR : 1.93 mm ; EMD : 0.78 mm ) . However , the study lacked statistical power for determining equivalence between the groups . CONCLUSIONS Within the limitations of the present study , it may be concluded that at 6 months after GTR or enamel matrix protein derivative therapy , formation of new cementum and bone may be histometrically demonstrated . Except for the formation of new bone , no statistically significant differences between both therapies could be seen for clinical , radiographic , and histometric results 6 months after surgery The aim of the present study was to evaluate histologically in humans the healing of advanced intrabony defects following treatment with enamel matrix proteins ( EMD ) or guided tissue regeneration ( GTR ) .  Fourteen patients , each of them displaying 1 advanced intrabony defect around teeth scheduled for extraction were included in the study . The defects were treated r and omly either with an enamel matrix protein derivative ( Emdogain , BIORA AB , Malmö , Sweden ) or with a bioabsorbable membrane ( Resolut , Regenerative Material , W.L. Gore & Assoc . , Flagstaff , Arizona , USA ) . At baseline the mean probing pocket depth ( PPD ) in the EMD group was 11.3 + /- 1.8 mm and the mean clinical attachment level ( CAL ) 12.1 + /- 2.0 mm , whereas in the GTR group the mean PPD was 11.4 + /- 2.2 mm and the mean CAL 13.3 + /- 2.3 mm . Healing was uneventful in all cases . Neither allergic reactions against EMD or the bioabsorbable membrane , nor suppuration or abscesses were observed . The clinical results revealed at 6 months in the EMD group a mean PPD of 5.6 + /- 1.3 mm and a mean CAL of 9.1 + /- 1.5 mm . In the GTR group the mean PPD was 5.6 + /- 1.3 mm and the mean CAL 10.1 + /- 1.5 mm . The histological analysis showed in the EMD group a mean 2.6 + /- 1.0 mm of new attachment ( i.e. new cementum with inserting collagen fibers ) and a mean 0.9 + /- 1.0 mm of new bone . In this group , the formation of new attachment was not always followed by bone regeneration . In the GTR group , the mean new attachment was 2.4 + /- 1.0 mm and the mean new bone 2.1 + /- 1.0 mm . In every case treated with GTR , the formation of new attachment was followed by a varying amount of new bone . After both types of regenerative treatment the newly formed cementum displayed a predominantly cellular character . The findings of the present study indicate that the treatment of intrabony defects with enamel matrix proteins or with bioabsorbable membranes enhances the formation of a new connective tissue attachment in humans The aim of the present study was to clinical ly and radiographically compare guided tissue regeneration ( GTR ) therapy with bioabsorbable polyglactin 910 barriers and conventional periodontal surgery in intrabony defects . In 26 patients with advanced periodontitis , 29 teeth exhibiting interproximal intrabony defects were treated ; 15 by conventional periodontal surgery ( control ) and 14 by GTR ( test ) . Before and 12 months after surgery , clinical parameters were assessed and st and ardized radiographs were taken . On the radiographs the distances from the cemento-enamel junction ( CEJ ) to the alveolar crest ( AC ) , and the CEJ to the most apical extension of the bony defect ( BD ) were measured using a computer-assisted analyzing device ( LMSRT ) . Twelve months after surgery , 24 patients with 27 lesions were available for examination . For both methods statistically significant ( P < 0.001 ) probing depth ( PD ) reduction ( mean + /- st and ard deviation ) of -4.49 + /- 1.94 mm ( n = 13 , test ) and -3.22 + /- 1.48 mm ( n = 14 , control ) , as well as clinical attachment gain ( CAL-V ) of 3.41 + /- 1.59 mm ( test ) and 2.07 + /- 1.10 mm ( control ) , was observed . Radiographic changes of the distance CEJ to AC of -0.95 + /- 1.72 mm ( n = 9 , test ) , and -0.98 + /- 1.53 mm ( n = 11 , control ) were not significant . A significant bony fill ( distance CEJ-BD ) of 1.05 + /- 1.22 mm was observed for the test group ( P < 0.01 ) ; the 0.68 + /- 2.04 mm bony gain for the control group was not statistically significant . The PD reduction ( P < 0.05 ) and attachment gain ( P < 0.01 ) in the test group was statistically significantly more favorable than in the control group . Twelve months after surgery , statistically more favorable PD reduction and attachment gain was observed using polyglactin 910 barriers than compared to conventional flap surgery . Hence , the use of bioabsorbable barriers for therapy of intrabony defects may be recommended BACKGROUND Treatment with enamel matrix proteins ( EMD ) and guided tissue regeneration ( GTR ) with bioabsorbable membranes has been shown to promote periodontal regeneration ; however , until now , there were only limited data on the long-term clinical results following these regenerative techniques . Therefore , the aim of the present study was to present the 4-year results following treatment of intrabony defects with EMD or guided tissue regeneration ( GTR ) . METHODS Twelve patients , each displaying one pair of intrabony defects located contralaterally in the same jaw , were r and omly treated with EMD or with GTR by means of bioabsorbable membranes . The following clinical parameters were evaluated at baseline , at 1 year , and at 4 years after treatment : plaque index ( P1 ) , gingival index ( G1 ) , bleeding on probing ( BOP ) , probing depth ( PD ) , gingival recession ( GR ) , and clinical attachment level ( CAL ) . The primary outcome variable was CAL . No statistically significant differences between the groups were found at baseline . Power analysis to determine superiority of EMD treatment showed that the available sample size would yield 70 % power to detect a 1 mm difference . RESULTS The sites treated with EMD demonstrated mean CAL change from 9.8 + /- 2.0 mm to 6.4 + /- 1.6 mm ( P<0.001 ) and to 6.8 + /- 1.8 mm ( P<0.001 ) at 1 and 4 years , respectively . No statistically significant differences were found between the CAL mean at 1 and 4 years postoperatively . The sites treated with GTR showed a mean CAL change from 9.8 + /- 2.3 mm to 6.6 + /- 1.7 mm ( P<0.001 ) at 1 year and to 6.9 + /- 1.8 mm ( P<0.001 ) at 4 years . The CAL change between I and 4 years did not present statistically significant differences . No statistically significant differences in any of the investigated parameters were observed at 1 and 4 years between the treatment groups . CONCLUSIONS It was concluded that the CAL gain obtained following treatment with EMD or GTR can be maintained over a 4-year period BACKGROUND The aim of this 5-year follow-up study was to clinical ly and radiographically evaluate the long-term results after guided tissue regeneration ( GTR ) therapy of Class II furcation defects using non-resorbable and bioabsorbable barriers . METHODS Nine pairs of contralateral Class II furcation defects were treated in 9 patients with advanced periodontitis . Within each patient , one defect received a non-resorbable ( exp and ed polytetrafluoroethylene [ ePTFE ] ; control , C ) barrier and the other a bioabsorbable ( polyglactin 910 ; test , T ) barrier by r and om assignment . At baseline , 6 , and 60 + /- 3 months after surgery , clinical parameters and st and ardized radiographs were obtained . Gain of bone density within furcation areas was assessed using subtraction radiography . RESULTS Six and 60 months after GTR therapy , statistically significant ( P < 0.05 ) horizontal attachment ( CAL-H ) gain was observed in both groups ( C6 : 1.7 + /- 0.8 mm ; C60 : 1.6 + /- 1.2 mm ; T6 : 2.0 + /- 0.7 mm ; T60 : 2.2 + /- 0.9 mm ) . However , 1 furcation assessed as Class I six months after GTR therapy with a bioabsorbable barrier had progressed to Class III after 5 years , and in another patient , 5 years after placement of an ePTFE barrier , 1 furcation had lost all the CAL-H gain that had been observed at 6 months . Subtraction analysis revealed similar area gain in both groups 6 and 60 months postsurgically ( C6 : 0.3 + /- 0.5 ; C60 1.0 + /- 1.7 ; T6 : 0.4 + /- 0.4 ; T60 : 1.1 + /- 1.7 ) . CONCLUSIONS CAL-H gain achieved after GTR therapy in Class II furcations was stable after 5 years in 16 of 18 defects . The study failed to show a statistically significant difference in stability of CAL-H gain between control and test groups 5 years after GTR therapy BACKGROUND The aim of this 10-year follow-up was to evaluate the long-term results after guided tissue regeneration ( GTR ) therapy of Class II furcation defects using non-resorbable and bioabsorbable barriers clinical ly . METHODS In nine patients with advanced periodontitis , nine pairs of contralateral Class II furcation defects were treated . Within each patient , one defect received a non-resorbable exp and ed polytetrafluoroethylene barrier ( ePTFE ; C ) and the other a bioabsorbable ( polyglactin 910 ; T ) barrier by r and om assignment . At baseline and 12 and 120 + /- 6 months after surgery , clinical parameters were obtained . RESULTS Twelve and 120 months after GTR therapy , statistically significant ( P < 0.05 ) horizontal clinical attachment level ( CAL-H ) gain was observed in both groups ( C12 : 1.9 + /- 0.5 mm ; C120 : 1.1 + /- 1.3 mm ; T12 : 1.9 + /- 0.8 mm ; T120 : 1.7 + /- 1.4 mm ) . However , one patient with furcations that had been assessed as Class I 12 months after GTR therapy had lost two teeth after 10 years , and another patient had lost more than 2 mm CAL-H at one furcation from 12 to 120 + /- 6 months post-surgery 10 years after implantation of an ePTFE barrier . Horizontal bone sounding revealed similar bone gain in both groups 120 + /- 6 months post-surgery ( C120 : 0.8 + /- 1.0 mm ; T120 : 1.1 + /- 1.1 mm ) . CONCLUSIONS CAL-H gain achieved after GTR therapy in Class II furcations was stable after 10 years in 15 of 18 defects ( 83 % ) . The study failed to show a statistically significant difference in stability of CAL-H gain between group C and T 10 years after GTR therapy BACKGROUND , AIMS The purpose of the present study was to compare the efficacy of 3 different surgical procedures in the treatment of infrabony defects :  guided tissue regeneration ( GTR ) with non-resorbable membranes , Widman modified flap ( WMF ) and enamel matrix derivative ( EMD ) . METHOD 30 patients with an infrabony component > or = 4 mm were selected . 10 were treated with exp and ed polytetrafluorethylene ( ePTFE ( Gore - Tex W. L. Gore and Associates , Flagstaff , AZ , USA ) ) membranes , 10 with WMF and 10 with enamel matrix derivatives ( Emdogain ( U Biora AB Malm , Sweden ) ) . The efficacy of each treatment modality was investigated through regression analysis . Probing attachment level ( PAL ) gain , probing depth ( PD ) reduction and gingival recession ( REC ) variation were analyzed . RESULTS Both Emdogain ( enamel matrix derivative ) and ePTFE treatment show significant better results as compared to the WMF procedure in which there were no significant changes in PAL gain and PD reduction at baseline and 1 year after surgery . CONCLUSIONS Results from our analysis suggest that there is no statistically significant difference in PAL gain between GTR and EMD . The clinical outcomes of this pilot study may be of little significance , considering the small number of patients , but it has provided an important base for a controlled clinical trial ( with a larger number of patients ) which is currently in progress This study clinical ly evaluated a bioabsorbable barrier membrane design ed for periodontal regeneration . Ten Class II furcations and 12 interproximal infrabony defects were treated by flap debridement and placement of a bioabsorbable barrier membrane using the principles of guided tissue regeneration . Treatment was evaluated in terms of changes in vertical probing depth , horizontal attachment level , clinical attachment level , and recession . Baseline data were collected on the day of surgery , and outcome measurements were performed at the 1-year appointment . The mean initial probing depth for Class II furcations was 6.5 mm . At 1 year , the mean probing depth was reduced to 2.9 mm , a 3.6 mm change . These differences were clinical ly and statistically significant ( P < 0.01 ) . There was a mean gain of 2.4 mm in clinical attachment level ( P < 0.01 ) and a mean 3.4-mm change in horizontal attachment level ( P < 0.01 ) . Recession increased 1.2 mm . For interproximal infrabony defects , there was a mean probing depth reduction of 5.0 mm ( P < 0.01 ) , a mean gain of clinical attachment level of 3.8 mm ( P < 0.02 ) , and a mean increase of 1.2 mm in recession ( P < 0.04 ) . The results indicate that significant improvements occurred after treatment of Class II furcations and interproximal infrabony defects with the use of a bioabsorbable barrier membrane and guided tissue regeneration BACKGROUND The purpose of this study was to evaluate the effectiveness of a combination of enamel matrix proteins ( EMP ) , bovine porous bone mineral ( BPBM ) , and a bioabsorbable membrane for guided tissue regeneration ( GTR ) as regenerative therapy for intrabony defects in humans and compare it to an open flap debridement ( OFD ) technique . METHODS Using a split-mouth design , 18 pairs of intrabony defects were treated and surgically reentered 6 months after the initial surgery . Experimental sites were treated with EMP , grafted with BPBM , and received a collagen/polylactic acid membrane for GTR . Control sites were treated with OFD . The primary outcomes evaluated in the study included probing depth resolution , clinical attachment gain , and bony defect fill . RESULTS Preoperative probing depths , attachment levels , and intraoperative bone measurements were similar for the experimental and control groups . Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the experimental group ( 4.95+/-1.52 mm on buccal sites and 4.74+/-1.47 mm on lingual sites ) when compared to the control group ( 2.83+/-0.83 mm on buccal sites and 2.90+/-0.91 mm on lingual sites ) . The experimental sites also presented with significantly more attachment gain ( 3.89+/-1.16 mm on buccal sites and 3.78+/-1.14 mm on lingual sites ) than the control sites ( 1.52+/-0.83 mm on buccal sites and 1.48+/-0.78 mm on lingual sites ) . Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of the experimental group ( 4.76+/-1.36 mm on buccal sites and 4.81+/-1.37 mm on lingual sites ) as compared to the control group ( 1.78+/-0.92 mm on buccal sites and 1.67+/-0.90 mm on lingual sites ) . CONCLUSIONS The results of this study indicate that a combination technique including BPBM , EMP , and GTR results in better clinical resolution of intrabony defects than treatment with OFD . Differences observed were both statistically and clinical ly significant . The exact role of each of the 3 technique components in achieving the clinical improvement observed in this study remains to be determined BACKGROUND Several studies have documented the clinical efficacy of guided tissue regeneration ( GTR ) with non-resorbable exp and ed polytetrafluoroethylene ( ePTFE ) membranes and enamel matrix proteins ( EMP ) in the treatment of infrabony defects . The objective of this controlled clinical study was to compare the clinical outcomes of 3 surgical modalities in the treatment of deep interproximal infrabony defects . METHODS Ninety ( 90 ) defects in 90 healthy subjects affected by chronic periodontitis were assigned to 1 of 3 treatment groups by blocking to prognostic variables . The test group was treated with the application of EMP and the simplified papilla preservation ( SPP ) technique ; the second group was treated with titanium-reinforced ePFTE membranes and the SPP technique ; and the third group was treated with the SPP technique used as access flap control procedure . No differences were observed in terms of baseline oral hygiene and defect characteristics among the 3 groups , indicating that the blocking approach was effective . A stringent infection control program was adopted for 1 year . RESULTS The 1-year results indicated that : 1 ) all treatment modalities result ed in clinical ly significant improvements in clinical attachment levels ( CAL ) and reduction in probing depth ( PD ) ; 2 ) a statistically significant treatment effect was demonstrated comparing the EMP test , the membrane control , and the flap control groups in terms of CAL gains ; 3 ) both the EMP test and the membrane control groups showed significant CAL gains compared to the flap control group ; 4 ) a statistically significantly greater amount of CAL gain was demonstrated in GTR-treated compared to EMP-treated patients ; 5 ) deeper residual probing depths but smaller increases in gingival recession were demonstrated following EMP therapy ; and 6 ) smoking habits reduced the clinical outcomes of both regenerative procedures . CONCLUSIONS The use of a regenerative procedure is indicated in the treatment of deep vertical bony defects since both the regenerative techniques ( GTR and EMD ) in the present study result ed in clinical ly and statistically significant improvements in clinical parameters compared to the access flap procedure . The use of EMP can be helpful in esthetically-sensitive sites and in reducing patient morbidity AIM The purpose of the present multicenter clinical trial was to compare the efficacy of two different procedures in the treatment of infrabony defects :  guided tissue regeneration ( GTR ) with nonresorbable membranes and enamel matrix derivative ( EMD ) . MATERIAL AND METHODS Six centers participated in this study . Ninety-eight patients with an interproximal infrabony defect were selected . All patients were treated with an initial phase of scaling and root planing , and at the study 's baseline the selected defects presented a value of probing depth ( PD ) > or = 6 mm with an infrabony component > or = 4 mm . Forty-nine patients were treated with GTR procedures ( using ePTFE membranes ( Gore-Tex W.L. Gore and Associates , Flagstaff , AZ , USA ) ) and forty-nine with EMDs ( Emdogain ( U Biora AB Malm , Sweden ) ) . The efficacy of each treatment modality was investigated through covariance analysis . RESULTS The patients were reevaluated at one year postop . Probing attachment level ( PAL ) gain and PD reduction were analyzed . In the Emdogain group the PAL before surgery ( PAL 0 ) and the PD before surgery ( PD 0 ) were respectively 9.9+/-1.4 and 8.5+/-1.6 mm . The PAL gain and the PD reduction at 1 year postsurgery were respectively 4.1+/-1.8 and 5.3+/-1.9 mm . The group of patients treated with membranes showed that PAL 0 and PD 0 were respectively 8.9+/-1.9 and 8.1+/-1.9 . The PAL gain was 4.3+/-1.9 mm and the PD reduction was 5.6+/-1.5 mm . The mean PAL gain expressed by percentage ( PAL gain/PAL 0 ) for the group treated with EMD was 41 % , while it was 48 % for the group treated with GTR . Results from our analysis suggest that there is no statistically significant difference between GTR and EMD treatments in terms of PAL gain , PD reduction and recession variation . Applying the regression model to a group of patients with a PAL 0 > or = 8 mm , we observed a better clinical outcome in terms of PAL gain ( difference of 0.3 mm ) in patients treated with the GTR procedure compared to those treated with EMD . Covariance analysis showed a strong correlation in both groups of patients between PAL gain and full mouth bleeding score , and between PAL gain and defect morphology and depth In 16 patients with advanced periodontitis , 23 teeth exhibiting interproximal intrabony defects were treated by conventional periodontal surgery ( n = 10 , control ) or guided tissue regeneration ( GTR ) technique using exp and ed polytetrafluoroethylene ( ePTFE ) barriers ( n = 13 , test ) , respectively . Clinical parameters were assessed before and 6 months after surgery . Presurgically and 3 and 6 months postsurgically st and ardized bite-wing radiographs were taken . Using a loupe and a computer-assisted system , respectively , the distances from the cemento-enamel junction ( CEJ ) to alveolar crest ( AC ) and CEJ to the most apical extension of bony defect ( BD ) were measured . The average gain of attachment was assessed 2.33 mm in the control group and 3.17 mm in the test group . The bony fill was measured 0.97 mm and 0.97 mm in the control group and 0.93 mm and 1.68 mm in the test group after 3 and 6 months , respectively , using a loupe . Using a computer-assisted system 0.83 mm and 1.82 mm of bone fill could be measured ( control ) and 0.76 mm and 1.79 mm ( test ) after 3 and 6 months , respectively . Compared to the gold st and ard of surgical measurements , the computer-assisted analysis of radiographs underestimated bone loss significantly less than evaluation with a loupe ( P < 0.002 ) . Compared to conventional periodontal surgery , the GTR technique result ed in higher attachment gain and bony fill . However , the high variation of surgical results in the test group prevented the calculation of a statistically significant difference The periodontal regeneration of interproximal bone defects of the posterior teeth produced by guided tissue regeneration ( GTR ) , with exp and ed Polytetrafluoroethylene barrier membranes and conventional therapy , was clinical ly evaluated in 20 intrabony periodontal defects in 10 patients . The material included the presence of at least two proximal angular lesions for the same patient , probing pocket depth > or = 6 mm , bone defect depth > or = 3 mm , and 2-wall defects with crestal involvement relative to the tooth circumference ranging from 90 to 270 degrees . Healing was clinical ly evaluated by surgical re-entry of GTR-treated sites ( 10 sites ) and debridement only sites ( 10 sites ) 1 year after initial surgery following a strict plaque control regimen . A significant correlation was observed between probing depth reduction , attachment gain and defect depth ( test sites ) ; there was increased bone fill in GTR-treated lesions of 2.95 + /- 1.3 mm corresponding to a 69.4 % improvement compared to control sites , and 1.3 + /- 1.0 mm corresponding to a 32 % improvement ( P < 0.0039 ) . The results demonstrated that bone regeneration is highly reliable , as compared to conventional therapy , in cases of severe periodontal bone loss from posterior teeth provided that the principles of GTR are applied BACKGROUND The regenerative therapy of non-contained intrabony defects achieves better results when bioabsorbable membranes are combined with a filling material . The purpose of the present study was to analyze clinical and radiographic effectiveness of a space-making bioabsorbable membrane in the treatment of wide and shallow intrabony defects characterized by a relevant 1-wall component . METHODS Eighteen pairs of angular bone defects were selected in 18 healthy , non-smoking patients ( age range 30 to 66 years ) . Prior to the surgical phase , patients were enrolled in a strict periodontal program including oral hygiene instructions and scaling and root planing ( presurgical full-mouth plaque score < 10 % ) . Using a split-mouth design , 18 sites were r and omly assigned to receive guided tissue regeneration ( GTR ) using a bioabsorbable membrane ( test group ) and 18 to receive open flap debridement alone ( control group ) . Clinical treatment outcome was evaluated 12 months postoperatively for changes in probing depth ( PD ) , clinical attachment level ( CAL ) , and position of gingival margin ( REC ) and radiographically for bone changes . RESULTS Open flap debridement and GTR yielded statistically significant ( P<0.0001 ) PD reduction ( 2.39+/- 0.92 mm and 3.44+/- 0.78 mm ) , CAL gain ( 1.50+/- 0.99 mm and 2.89 + /- 0.90 mm ) , increased REC ( -0.89 + /- 0.58 mm and -0.56 + /- 0.92 mm ) and bone fill ( 1.05+/- 0.94 mm and 2.13+/- 1.21 mm ) when 12-month data were compared to baseline . The differences between test and control groups were statistically significant for all parameters ( P<0.007 ) except for REC ( P=0.25 ) . CONCLUSION The use of this bioabsorbable membrane would seem to be effective in the treatment of intrabony defects with unfavorable architecture without the use of filling material AIM To compare healing responses to periosteal sliding grafts and polyglactin 910 periodontal mesh used as guided tissue regeneration ( GTR ) material s/techniques when both periapical and periradicular bone loss are present . METHODOLOGY Thirty patients with suppurative chronic apical periodontitis with apicomarginal communication were selected and allocated r and omly into two groups according to the barrier technique to be used during periradicular surgery : periosteal graft group ( n = 15 ) and bioabsorbable membrane group ( n = 15 ) . Clinical and radiological evaluations were completed prior to surgery , a week later and every 3 months after surgery up to 12 months to measure the periodontal pocket depth ( PD ) , clinical attachment level ( CAL ) , gingival margin position ( GMP ) , size of periapical lesion , percentage reduction of the periapical rarefaction , and periapical healing . RESULTS Both groups showed highly significant ( P < 0.001 ) reductions in periodontal PD , CAL and size of periapical lesion at 12 months whilst GMP was unaltered . No significant difference between the experimental groups was evident for these parameters , or for the percentage reduction of size of the periapical lesion and clinical -radiographic healing . CONCLUSION Guided tissue regeneration applied to apicomarginal defects using sliding periosteal grafts and use of bioabsorbable membranes led to similar enhancements of the clinical outcome of periradicular surgery in terms of periapical healing , gain of periodontal support , PD reduction and minimal recession of the gingival margin THE PURPOSE OF THIS STUDY was to assess periodontal regenerative techniques in intrabony defects utilizing a bioabsorbable , polylactic acid ( PLA ) barrier or the non-resorbable , exp and ed polytetrafluoroethylene ( ePTFE ) barrier .  Thirty patients ( 26 to 64 years old ) each with one radiographically evident intrabony periodontal lesion of probing depth > or = 6 mm participated in a 12-month controlled clinical trial . The subjects were r and omly divided into two independent groups . The test group ( n = 16 ) received a PLA barrier . The control group ( n = 14 ) received an ePTFE barrier .  Plaque index ( PI ) , gingival index ( GI ) , probing depth ( PD ) , clinical attachment level ( CAL ) , and bone fill were recorded by a single calibrated examiner not involved with the surgical treatment prior to surgery , and at 6 , 9 , and 12 months postsurgery . The treatment results were statistically analyzed utilizing two sets of data . The " averaged-site " data set consisted of values computed from the averaging of measurements from all sites encompassing the defect . The second data set was comprised of only the deepest measurement of the defect . Statistical tests used to analyze these data sets included the t-test and paired t-test for parametric data and the Wilcoxon rank sum test and the Wilcoxon signed rank test for non-parametric data . Analyses with both the averaged-site data and deepest-site data result ed in significant improvements in PD reductions , CAL , and bone fill , after 12 months of healing with both the PLA and ePTFE barrier devices . Comparisons of healing response between treatments found no significant differences when the averaged-site data were analyzed . When only the deepest site of the defect was considered , the control group result ed in significantly more attachment gain ( ePTFE , 3.36 mm ; PLA , 1.75 mm ; P < 0.02 ) and shallower probing depths ( ePTFE , 3.29 mm ; PLA , 4.69 mm ; P < 0.01 ) than the test group . In intrabony defects , the use of PLA or ePTFE barriers in GTR procedures yielded comparable clinical results ; however , in this study , data analysis using the deepest site of the defect found , after 12 months of healing , significantly more attachment gain and shallower probing depths with ePTFE BACKGROUND Guided bone regeneration ( GBR ) is a viable treatment for osseous defects surrounding dental implants . Controversy exists regarding the choice of barrier membrane used and the method of membrane fixation to achieve GBR . METHODS This study compared the efficacy of a porcine-derived bioabsorbable collagen membrane and an exp and ed polytetrafluoroethylene ( ePTFE ) membrane ( non-resorbable ) for GBR using a bovine bone xenograft/autograft bone composite in defects surrounding dental implants . The study also examined the effect of primary barrier fixation on GBR . Defect size was recorded at Stage 1 and 2 surgeries ( performed 6 months apart ) . Forty-eight subjects ( 41 % males , 59 % females ) requiring GBR were treated with either collagen ( 23 ) or ePTFE ( 25 ) barriers , respectively . Implants were titanium self-tapping screw-type . In 34 GBR sites , barrier fixation was achieved with polylactic acid resorbable pins . The remaining barriers were secured with the implant cover screw and /or embedded beneath the flaps . RESULTS At 6 months , a decrease in defect width  ( collagen barrier 1.95 + /- 0.60 mm , ePTFE barrier 2.65 + /- 0.56 mm ) , length  ( collagen barrier 2.65 + /- 0.61 mm , ePTFE barrier 2.26 + /- 0.66 mm ) , and circumference ( degrees ) ( collagen barrier 57.7 + /- 18.7 , ePTFE barrier 80.2 + /- 19.9 ) was observed for both membranes . A significant number ( chi2 , P = 0.041 ) of postoperative complications occurred when barrier fixation was lacking at initial surgery . Furthermore , a significant difference ( P < 0.05 ) in the success of GBR with respect to defect size was observed when barrier fixation was taken into account . CONCLUSIONS In conclusion , both collagen and ePTFE barriers proved suitable for achieving GBR of osseous defects surrounding dental implants . The results of this study stress the importance of barrier fixation at the time of initial surgery The purpose of this study was to evaluate the clinical effectiveness of a connective tissue graft including periosteum used as a barrier for guided periodontal tissue regeneration in interproximal bony defects . An open flap debridement of a comparable interproximal bony defect in the same patient was used as a control . This study was performed at 2 different clinical centers . Six paired defects were treated at one center , and 16 paired defects at the other .  Reentry surgeries were performed at 6 months . Preoperative comparisons of control and experimental sites with respect to clinical parameters and osseous measurements were similar . Post-surgical experimental sites produced more gain in clinical attachment ( 1.25 mm on buccal and 1.25 mm on lingual sites at center A and 1.26 mm on buccal and 1.18 mm on lingual sites at center B ) and osseous defect fill ( 1.84 mm on buccal and 2.00 mm on lingual sites at center A and 1.66 mm on buccal and 2.04 mm on lingual sites at center B ) when compared to control sites . The results of this trial indicate that clinical resolution of interproximal periodontal defects can be obtained with periosteal grafts used as barriers BACKGROUND Bacterial contamination of membrane material negatively affects healing after guided tissue regeneration ( GTR ) procedures ; conversely , flap connective tissue integration on barrier material improves the clinical outcomes . The objective of this study was to evaluate the effect of topical application of antibiotics on : 1 ) clinical outcomes of  GTR surgical procedures using titanium reinforced exp and ed polytetrafluoroethylene ( ePTFE ) periodontal membrane ; 2 ) bacterial colonization of membrane material ; and 3 ) flap connective tissue-membrane integration . METHODS Fifty-six deep interproximal bony defects were treated with  GTR surgical procedures  using titanium reinforced ePTFE periodontal membranes . Patients were r and omly assigned to 1 of the 2 antimicrobial treatment groups : the test group received weekly topical application of 25 % metronidazole gel and the control group received systemic antibiotics ( amoxicillin plus clavulanic acid 1 g/day for 14 days ) . Clinical outcomes were assessed at 1 year ; the amount of bacterial contamination and connective tissue integration on membrane material was evaluated at time of membrane removal by means of a morphological ( SEM ) method . RESULTS No statistically significant difference was found between test and control groups in terms of clinical attachment ( CAL ) gain ( baseline CAL - 12 months CAL ; P = 0.2 ) and probing depth ( PD ) reduction ( baseline PD - 12 months PD ; P = 0.6 ) . A greater increase in gingival recession ( REC ) ( 12 months REC - baseline REC ) was found in the test group compared to the control group ( P = 0.003 ) . The SEM analysis revealed no statistically significant ( t test ) difference between test and control groups in the number of fields positive to integrated connective tissue ( P = 0.82 ) , while the number of fields positive to bacteria was statistically higher ( P < 0.001 ) in the control group . CONCLUSIONS Local antibiotic administration is more effective than systemic use in preventing membrane contamination , but it does not improve clinical outcomes due to an interference of the vehicle ( gel ) with gingival tissues which may reduce the potential benefits derived from better control of the bacterial load BACKGROUND This clinical report compares the use of an enamel matrix derivative ( EMD ) and bioabsorbable barrier membrane to enhance healing following the immediate placement of transmucosal implants into extraction sockets . METHODS Thirty-two adult patients scheduled for tooth replacement with dental implants agreed to participate . Following the insertion of a transmucosal implant into the extraction site , the subjects were assigned to one of two treatment alternatives of the remaining bone defects around the implants : 1 ) the residual bone defects were filled with EMD ( EMD group ) or 2 ) the residual bone defects were covered with a bioabsorbable membrane ( membrane group ) . Flaps were then coronally positioned around implant cover screws . Patients followed weekly maintenance recalls for the first 6 weeks and then monthly recalls until the final prosthetic restoration was completed ( after 6 months ) . The treatment outcome was evaluated after 12 months by the use of clinical variables . The null hypothesis of no treatment group differences was tested by the use of analysis of variance ( ANOVA ) . RESULTS At a 12-month follow-up , all of the implants were completely osseointegrated and successfully functioning , showing a success rate of 100 % . The membrane group showed a significantly lower mean probing attachment level than the EMD group at proximal ( 0.60 mm , st and ard deviation ( SD ) 0.37 versus 1.19 mm , SD 1.10 ) , buccal ( 0.80 mm , SD 0.79 versus 1.77 mm , SD 1.16 ) , and lingual sites ( 0.44 mm , SD 0.52 versus 1.48 mm , SD 1.46 ) . The difference was statistically significant at all sites ( P < 0.05 ) . With respect to the position of the soft tissue margin around the implant shoulder , the membrane group showed a consistently higher value than the EMD group at , respectively , proximal ( 1.30 mm , SD 2.37 versus 1.16 mm , SD 1.0 ) , buccal ( 0.90 mm , SD 1.29 versus 0.22 mm , SD 1.47 ) , and lingual sites ( 1.12 mm , SD 1.10 versus 0.55 mm , SD 1.42 ) . CONCLUSIONS The membrane group obtained more favorable results in terms of both the probing attachment level and peri-implant position of soft tissues compared to the EMD group . The use of a bioabsorbable membrane around immediately placed transmucosal implants enhanced soft and hard tissue healing and might be an advisable treatment choice particularly in areas with high esthetic dem and BACKGROUND The aims of the present multi-center , r and omized , controlled clinical trial were : 1 ) to compare the efficacy of the simplified papilla preservation flap with and without a barrier membrane in deep intrabony defects ; 2 ) to evaluate the postoperative morbidity and surgical complications ; and 3 ) to preliminarily test the impact of baseline tooth mobility on clinical outcomes . METHODS This parallel group , r and omized , multi-center , controlled clinical trial involved 112 patients in 8 periodontal practice s in 4 countries . A deep intrabony defect in each patient was accessed with the simplified papilla preservation flap . In the test defects , a bioabsorbable membrane was positioned . Patients ' experiences with the surgical procedure and postoperative period were evaluated with a question naire . Clinical outcomes included clinical attachment level ( CAL ) and probing depth ( PD ) changes . RESULTS Complete observations were available for 55 test and 54 control defects . CAL gains at 1 year were 3.5 + /- 2.1 mm in the guided tissue regeneration ( GTR ) group and 2.6 + /- 1.8 mm in the control group ( P = 0.0117 ) . CAL gains > or = 4 mm were observed in 50.9 % of GTR sites and 33.3 % of control sites . A significant center effect of 2.1 mm was observed ( P= 0.01 ) . Initial PD ( P= 0.01 ) and baseline tooth mobility ( P= 0.036 ) were significant covariates . During the procedure , 30.4 % of test and 28.6 % of controls reported feeling moderate pain , and subjects estimated the hardship of the procedure at 24 + /- 25 visual analog scale ( VAS ) units in the test group , and at 22 + /- 23 VAS in controls . In terms of the investigated outcomes , differences between test and control groups were not statistically significant . Among the postoperative complications , edema was most prevalent at week 1 , and more frequently associated with the test treatment ( P= 0.01 ) . In the test group , 53.6 % of membranes were exposed at week 3 . CONCLUSIONS The present study further supports the added benefits of guided tissue regeneration with respect to access flap alone in the treatment of deep intrabony defects , as well as the general efficacy of GTR in different clinical setting s. Furthermore , our study indicates a possible influence of baseline tooth mobility on clinical outcomes The aim of this controlled , clinical study was to evaluate guided tissue regeneration using a bioabsorbable membrane in periodontal intraosseous defects . Forty patients , each contributing one defect > or = 4 mm in depth participated . The control group ( 18 individuals ) received conventional flap therapy , while the test group ( 22 individuals ) was treated using the bioabsorbable membrane , Guidor . Clinical assessment s were made by one examiner , blinded with respect to treatment group , at baseline , 6 and 12 months following surgery . Baseline probing pocket depths of 7.7+/-1.4 mm in the membrane group and 7.6+/-1.9 mm in the control group were measured . Twelve month results showed a significant clinical attachment level gain in both control ( 1.1+/-1.8 mm ) , and membrane group ( 1.3+/-2.1 mm ) . Probing pocket depth reduction of 2.6+/-1.9 mm and 2.7+/-1.9 mm was observed in the respective groups . Bone sounding showed a non-significant gain of 0.4+/-1.8 mm and 0.6+/-1.4 mm at membrane and control sites , respectively . Radiographic evaluation confirmed these results . There were no significant differences found between treatment groups for any of the tested variables . Smoking had a negative effect on healing in both groups . In conclusion , clinical and radiographic results indicate that guided tissue regeneration using a bioabsorbable membrane at intraosseous defects did not predictably achieve greater clinical attachment level gain nor bone gain when compared to conventional flap therapy BACKGROUND The aim of periodontal therapy is to prevent tissue destruction while achieving the regeneration of damaged tissues . Platelet-rich plasma ( PRP ) is used to generate new bone , periodontal ligament , and new attachment with a strategy based on the modulation and enhancement of wound healing through an autologous source for growth factors obtained from the patient 's own blood . The purpose of the present study was to evaluate the efficacy of PRP when used in combination with beta-tricalcium phosphate ( beta-TCP ) alloplastic graft material and collagen barrier membrane in the treatment of anterior interproximal intrabony defects . METHODS Thirty interproximal intrabony defects in 25 systemically healthy patients were selected for the study . Defects were distributed r and omly and equally into three groups : graft alone ( beta-TCP ) , graft + PRP , and graft + PRP + membrane . The plaque index , gingival index , periodontal probing depth , relative attachment level , transgingival probing measurement , and radiographic analyses were performed at baseline and repeated after 6 , 9 , and 12 months . RESULTS At the end of 12 months , relative attachment gain was 2.4 , 2.1 , and 2.5 mm in the three treatment groups , respectively . No statistically significant differences in clinical and radiographic measurements were observed among the groups . CONCLUSIONS All options were effective in the treatment of anterior interproximal intrabony defects . The results also suggested that PRP added no clinical benefit to beta-TCP alloplastic graft material used alone or in combination with GTR
In most respects , all membranes and enamel matrix derivative ( EMD ) delivered better outcomes , in the range of 1 to 2 mm , than open flap debridement .
The use of any barrier type or EMD configuration was found to yield more Clinical Attachment Level ( CAL ) gain than any open flap configuration .
GTR was confirmed to be superior to open flap debridement
In a 1998 review article , Laurell and colleagues performed a meta- analysis of relevant guided tissue regeneration ( GTR ) articles over the previous 20 years ( 1 ) .
The purpose of the present research was to exp and on that work , particularly search ing for trends discriminating between bioabsorbable and non-bioabsorbable barriers , as well as the use of enamel matrix derivative , with respect to interproximal bony defects .