The use of guided tissue regeneration principles in endodontic surgery for induced chronic periodontic-endodontic lesions: a clinical, radiographic, and histologic evaluation.
BACKGROUND
Chronic periodontic-endodontic lesions are not uncommon in clinical practice and their regenerative capacity has long been questioned. However, there are no published studies investigating the application of guided tissue regeneration techniques in combination with endodontic surgery using an induced perio-endo defect model. This study evaluated the clinical, radiographic, and histologic outcomes of three surgical procedures used to treat induced perio-endo lesions.


METHODS
Pulpal necrosis was induced in foxhounds along with surgical removal of radicular buccal bone. After 4 weeks, chronic lesions were clinically and radiographically assessed. Treatment surgery consisted of apicoectomy, root canal instrumentation, and retrofilling with mineral trioxide aggregate. Teeth were then assigned to one of the following treatment groups: open flap debridement only (OFD), OFD with bioabsorbable porcine-derived collagen membrane (BG), or OFD with BG and anorganic bovine bone matrix (BO/BG). Clinical parameters and standardized radiographs were assessed at defect creation; treatment surgery; and at 1, 2, 4, and 6 months. Animals were sacrificed at 6 months and specimens prepared for histometric analysis.


RESULTS
Clinical and radiographic conditions improved during the study period. Mean epithelial attachment was similar between all groups. Mean connective tissue attachment for groups OFD, BG, and BO/BG was 3.79 mm, 2.63 mm, and 1.75 mm, respectively, and mean radicular bone height was 2.16 mm, 3.24 mm, and 3.45 mm, respectively. Statistically significant increases in the amount of new cementum were observed in groups BG and BO/BG when compared with OFD (P <0.05).


CONCLUSIONS
Treatment of combined induced perio-endo lesions using bioabsorbable collagen membranes alone or in combination with anorganic bovine bone matrix resulted in increased amounts of bone, periodontal ligament, and significant increases in the amount of new cementum when compared to open flap debridement in a canine model.
Britain
Steven K
SK
Private practice, Fort Worth, TX, USA.
Arx
Thomas von
Tv
Schenk
Robert K
RK
Buser
Daniel
D
Nummikoski
Pirkka
P
Cochran
David L
DL
D020341:Absorbable Implants; D017607:Aluminum Compounds / Q000627:therapeutic use; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000539:Alveolar Process / Q000000981:diagnostic imaging / Q000473:pathology; D000818:Animals; D001047:Apicoectomy; D001857:Bone Matrix / Q000637:transplantation; D017610:Calcium Compounds / Q000627:therapeutic use; D003094:Collagen; D003739:Dental Cementum / Q000473:pathology; D003790:Dental Pulp Necrosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D004195:Disease Models, Animal; D004285:Dogs; D004338:Drug Combinations; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D008567:Membranes, Artificial; D010087:Oxides / Q000627:therapeutic use; D017622:Periodontal Attachment Loss / Q000601:surgery; D010865:Pilot Projects; D011859:Radiography; D012184:Retrograde Obturation; D012387:Root Canal Filling Materials / Q000627:therapeutic use; D018915:Root Canal Preparation; D012390:Root Canal Therapy / Q000379:methods*; D017640:Silicates / Q000627:therapeutic use; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome
D017607:Aluminum Compounds; D017610:Calcium Compounds; D004338:Drug Combinations; D008567:Membranes, Artificial; D010087:Oxides; D012387:Root Canal Filling Materials; D017640:Silicates; C086631:mineral trioxide aggregate; D003094:Collagen