Deproteinized bovine bone and gentamicin as an adjunct to GTR in the treatment of intrabony defects: a randomized controlled clinical study.
OBJECTIVE
To evaluate whether Bio-Oss used as an adjunct to guided tissue regeneration (GTR) improves the healing of 1- or 2-wall intrabony defects as compared with GTR alone, and to examine whether impregnation of Bio-Oss with gentamicin may have an added effect.


METHODS
Sixty patients, with at least one interproximal intrabony defect with probing pocket depth (PPD) > or =7 mm and radiographic evidence of an intrabony component (IC) > or =4 mm, were treated at random with either a resorbable membrane (GTR), a resorbable membrane in combination with Bio-Oss impregnated with saline (DBB-), a resorbable membrane in combination with Bio-Oss impregnated with gentamicin (DBB+), or with flap surgery (RBF).


RESULTS
All treatment modalities resulted in statistically significant clinical improvements after 1 year. Defects treated with GTR alone presented a probing attachment level (PAL) gain of 2.9 mm, a residual PPD (PPD12) of 4.9 mm, a radiographic bone level (RBL) gain of 3.1 mm, and a residual IC (IC12) of 2.7 mm. GTR combined with Bio-Oss did not improve the healing outcome (PAL gain: 2.5 mm; PPD12: 4.9 mm; RBL gain: 2.8 mm; IC12: 3.3 mm). Impregnation of the Bio-Oss with gentamicin 2% mg/ml resulted in clinical improvements (PAL gain: 3.8 mm; PPD12: 4.2 mm; RBL gain: 4.7 mm; IC12: 2.1 mm), superior to those of the other treatment modalities, but the difference was not statistically significant. Defects treated with only flap surgery showed the most inferior clinical response (PAL gain: 1.5 mm; PPD12: 5.1 mm; RBL gain: 1.2 mm; IC12: 4.2 mm) of all groups.


CONCLUSIONS
The results failed to demonstrate an added effect of Bio-Oss implantation in combination with GTR on the healing of deep interproximal 1- or 2-wall, or combined 1- and 2-wall intrabony defects compared with GTR alone. Local application of gentamicin, on the other hand, improved the treatment outcome but not to an extent that it was statistically significant.
Stavropoulos
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A
Department of Periodontology and Oral Gerodontology, Royal Dental College, University of Aarhus, Denmark. stavropoulos@odont.au.dk
Karring
E S
ES
Kostopoulos
L
L
Karring
T
T
D020341:Absorbable Implants; D000328:Adult; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001857:Bone Matrix / Q000637:transplantation; D001861:Bone Regeneration / Q000187:drug effects*; D018786:Bone Substitutes / Q000494:pharmacology* / Q000627:therapeutic use; D002417:Cattle; D004338:Drug Combinations; D005260:Female; D005839:Gentamicins / Q000494:pharmacology* / Q000627:therapeutic use; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D008903:Minerals / Q000494:pharmacology* / Q000627:therapeutic use; D011098:Polyglactin 910; D011859:Radiography; D013524:Surgical Flaps; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; C077540:Bio-Oss; D018786:Bone Substitutes; D004338:Drug Combinations; D005839:Gentamicins; D008567:Membranes, Artificial; D008903:Minerals; C094810:Resolut; D011098:Polyglactin 910