Histologic evaluation of new attachment apparatus formation in humans. Part III.
There is still controversy as to the role of bone grafting materials in the formation of a new attachment apparatus and component tissues (bone, cementum, and periodontal ligament). The purpose of this study was to compare the healing of intrabony defects with and without the placement of decalcified freeze-dried bone allograft (DFDBA) in a nonsubmerged environment in humans. The most apical level of calculus on the root served as a histologic reference point to delineate root surfaces exposed to the oral environment and to measure new attachment apparatus and new component tissue formation. Free gingival grafts were placed over grafted and nongrafted defects to retard epithelial migration. Biopsies were obtained at 6 months and regeneration was evaluated histometrically. Data from 12 patients with 32 grafted and 25 nongrafted defects were submitted for statistical analysis. Results indicate that in nongrafted defects, a long junctional epithelium formed along the entire length of exposed root surfaces and often extended apical to the calculus reference notch. Free gingival grafts did not enhance regeneration of a new attachment apparatus, new cementum, new connective tissue, or new bone in nongrafted defects. The formation of a new attachment apparatus was observed when intrabony defects were grafted with DFDBA (x1.21 mm); significantly more new attachment apparatus (P less than .005), new cementum (P less than .005), new connective tissue (P less than .05), and new bone (P less than .0001) formed in intrabony defects grafted with DFDBA than in nongrafted defects. There was a greater chance for regeneration of a new attachment apparatus and component tissues in grafted defects than in nongrafted defects. New cellular cementum formed on old cementum and dentin but more often formed over both in the same defect). The periodontal ligament was more frequently oriented perpendicular to the root; there was greater loss in alveolar crest height in nongrafted than grafted defects (P less than .05); and extensive root resorption, ankylosis, and pulp death were not observed in grafted or nongrafted defects.
Bowers
G M
GM
Department of Periodontics, Baltimore College of Dental Surgery, University of Maryland.
Chadroff
B
B
Carnevale
R
R
Mellonig
J
J
Corio
R
R
Emerson
J
J
Stevens
M
M
Romberg
E
E
D000704:Analysis of Variance; D001861:Bone Regeneration; D001862:Bone Resorption / Q000473:pathology / Q000601:surgery; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D003238:Connective Tissue / Q000473:pathology / Q000502:physiology*; D003739:Dental Cementum / Q000473:pathology / Q000502:physiology; D004846:Epithelial Attachment / Q000473:pathology / Q000502:physiology*; D005069:Evaluation Studies as Topic; D005612:Freeze Drying; D005881:Gingiva / Q000637:transplantation; D005893:Gingivoplasty; D006801:Humans; D010510:Periodontal Diseases / Q000473:pathology* / Q000601:surgery; D010513:Periodontal Ligament / Q000473:pathology / Q000502:physiology*; D010519:Periodontium / Q000502:physiology*; D012038:Regeneration; D013524:Surgical Flaps; D014092:Tooth Root / Q000473:pathology / Q000601:surgery*