Polymer-assisted regenerative therapy: case reports of 22 consecutively treated periodontal defects with a novel combined surgical approach.
This report describes the clinical application of an in situ formed barrier of poly(DL-lactide) used in combination with a composite graft of demineralized freeze-dried bone allograft (DFDBA) mixed with calcium sulfate and tetracycline in a ratio of 7:2:1 and citric acid root conditioning for the treatment of intrabony and furcation defects. The clinical outcome was assessed by changes in clinical attachment level (CAL) and probing depth (PD) in 18 consecutively treated patients with 17 intrabony and 5 furcation lesions. After patients demonstrated acceptable oral hygiene, the lesions were surgically treated with combination therapy using an in situ formed barrier over a DFDBA composite graft. Patients followed a stringent postoperative protocol and were evaluated at 6 months postsurgery. CAL improved for all sites from a presurgical average of 8.8+/-2.3 mm to 4.4+/-1.6 mm at 6 months postsurgery (4.4+/-1.5 mm gain), while PD was reduced from an average of 8.3+/-2.1 mm presurgery to 3.3+/-1.1 mm at 6 months postsurgery (5.0+/-1.8 mm reduction). Five furcations were treated, of which 4 were Class II and 1 was Class III. Of these furcation lesions, 3 had complete clinical closure, while 1 improved by 1 grade. The Class III furcation remained the same. Results suggest that DFDBA composite graft covered by an in situ formed barrier on root surfaces treated with citric acid can enhance the prognoses of teeth with periodontal lesions as measured by CAL gains and PD reductions. Further studies are warranted to compare this treatment to other more traditional forms of regenerative therapy to determine its comparative efficacy.
Rosen
P S
PS
Department of Periodontology, Baltimore College of Dental Surgery, University of Maryland, USA.
Reynolds
M A
MA
D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001672:Biocompatible Materials; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods; D002133:Calcium Sulfate / Q000627:therapeutic use; D002614:Chelating Agents / Q000627:therapeutic use; D019343:Citric Acid / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D017823:Furcation Defects / Q000601:surgery*; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000601:surgery; D010514:Periodontal Pocket / Q000601:surgery; D011091:Polyesters; D011379:Prognosis; D013752:Tetracycline / Q000627:therapeutic use; D014092:Tooth Root / Q000187:drug effects; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D018786:Bone Substitutes; D002614:Chelating Agents; D008567:Membranes, Artificial; D011091:Polyesters; D019343:Citric Acid; C033616:poly(lactide); D013752:Tetracycline; D002133:Calcium Sulfate