Bioabsorbable membrane and bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis: results of a 12-month clinical and radiological study.
BACKGROUND
Guided tissue regeneration can be achieved using membranes. In recent years, some evidence has been provided that bioactive glass is also capable of supporting the regenerative healing of periodontal lesions. The aim of this clinical and radiological prospective study was to compare the effectiveness of a bioabsorbable membrane and a bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis.


METHODS
Twelve patients (9 females, 3 males) with generalized aggressive periodontitis were enrolled in the study. The investigations were confined to 1- to 3-walled intrabony defects with a depth > or = 4 mm and with preoperative probing depths > or = 7 mm. Teeth with furcation involvement were excluded. Fifteen of the total 30 defects were treated with the membrane (RXT group) and 15 with the bioactive glass (PG group). Allocation to the groups was randomized. The clinical parameters plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), gingival recession (GR), clinical attachment level (CAL), and mobility were recorded prior to surgery as well as 6 and 12 months after surgery. Intraoral radiographs were taken in standardized paralleling technique at baseline and 12 months after the surgery. Following digitization, changes in the distances from the alveolar crest (xCA) to the defect base (xBD) and from the CEJ (xCEJ) to the xCA were determined. Statistical analysis was based on Kolmogorov-Smirnov test, Wilcoxon signed-ranks test, analysis of covariance, and Spearman's bivariate correlation analysis.


RESULTS
After 12 months, a reduction in PD of 4.0 +/- 2.1 mm (P < 0.001) and a gain in CAL of 3.4 +/- 2.3 mm (P < 0.001) was registered in the RXT group. There was a slight increase in GR by 0.6 +/- 1.5 mm (P = 0.074). In the PG group, a reduction in PD of 3.8 +/- 1.9 mm (P < 0.001) and a gain in CAL of 2.8 +/- 1.9 mm (P < 0.001) was recorded, whereas GR increased by 1.0 +/- 1.4 mm (P = 0.007). The 6-month results did not differ significantly from the stated values. Radiographically, the defects (xCA to xBD) were found to be filled by 57.2 +/- 33.5% (P = 0.001) in the RXT group and by 50.5 +/- 22.8% (P = 0.001) in the PG group. Crestal resorption (xCEJ to xCA) was 6.1 +/- 34.5% (P = 0.910) in the RXT group and 15.1 +/- 39.7% (P = 0.433) in the PG group. Only the change in gingival recession after 12 months was significantly greater (P = 0.031) in the PG group, with -1.0 +/- 1.4 mm, compared to the RXT group, with -0.6 +/- 1.5 mm. Changes in the other clinical and radiological parameters showed no significant differences. The attachment gain correlated negatively with the preoperative PI (r = -0.574; P = 0.004) and with BOP after 6 months (r = -0.315; P = 0.021).


CONCLUSIONS
Highly significant improvements in the parameters PD, CAL, and xCA-xBD were recorded after 6 and 12 months, respectively, with both regenerative materials. A good standard of oral hygiene and inflammation-free periodontal tissue in the postoperative phase improved the treatment outcome.
Mengel
Reiner
R
Department of Periodontology, School of Dentistry, Philipps University, Marburg, Germany. mengel@mailer.uni-marburg.de
Soffner
Martin
M
Flores-de-Jacoby
Lavin
L
D020341:Absorbable Implants; D000328:Adult; D016301:Alveolar Bone Loss / Q000601:surgery*; D000704:Analysis of Variance; D001672:Biocompatible Materials / Q000627:therapeutic use*; D018786:Bone Substitutes / Q000627:therapeutic use*; D002516:Ceramics / Q000627:therapeutic use*; D003774:Dental Plaque Index; D005260:Female; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000601:surgery; D016557:Guided Tissue Regeneration, Periodontal; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000601:surgery; D010514:Periodontal Pocket / Q000601:surgery; D010518:Periodontitis / Q000601:surgery*; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D001672:Biocompatible Materials; C022107:Bioglass; D018786:Bone Substitutes; D008567:Membranes, Artificial