Clinical performance of a regenerative strategy for intrabony defects: scientific evidence and clinical experience.
BACKGROUND
The aim of the present study was to evaluate the clinical performance of a regenerative strategy for the treatment of deep intrabony defects.


METHODS
This patient cohort study involved 40 patients with one deep interdental intrabony defect each. They were treated with periodontal regeneration using four different regenerative methods (expanded polytetrafluoroethylene [ePTFE] titanium reinforced membranes, bioabsorbable membranes alone, bioabsorbable membranes with a bone replacement graft [combination], or enamel matrix derivative), according to predefined criteria and decision-making algorithms. Defects were accessed with papilla preservation flaps performed with the aid of an operating microscope and microsurgical instruments. A stringent plaque control regimen was enforced in all the patients during the 1-year observation period. Outcomes included evaluation of the complete primary closure of the interdental space (CLOSURE), gains in clinical attachment (CAL), and reductions in probing depths (PD).


RESULTS
CLOSURE was achieved in all treated defects and was maintained in 90% of cases for the entire healing period. At 1 year the observed CAL gains were 6 +/- 1.8 mm on average, corresponding to a resolution of 92.1% +/- 12% of the initial intrabony (CAL%) component of the defect. Average PD reduction was 6.1 +/- 1.9 mm and was associated with minimal increase in gingival recession (-0.1 +/- 0.7 mm). The 12 sites treated with titanium reinforced ePTFE membranes resulted in a 1-year CAL gain of 6.8 +/- 2.2 mm (CAL%: 94.7 +/- 13.4); the 11 cases treated with combination therapy showed a 1-year CAL gain of 5.4 +/- 1.7 mm (CAL%: 88.2 +/- 9.6); the seven sites treated with bioabsorbable barriers resulted in 5.9 +/- 1.2 mm of CAL gain (CAL%: 88.9 +/- 11.5); and the 10 sites treated with enamel matrix gained on average 5.9 +/- 1.5 mm of CAL (CAL%: 88.9 +/- 11.5). No significant differences were observed among the four approaches.


CONCLUSIONS
The use of an evidence-based regenerative strategy resulted in clinically relevant amounts of CAL gains, shallow pockets, and minimal gingival recession with the four regenerative approaches.
Cortellini
Pierpaolo
P
Department of Periodontology, Eastman Dental Institute and Hospital, University College London, London, UK.
Tonetti
Maurizio S
MS
D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000601:surgery*; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation; D015331:Cohort Studies; D003746:Dental Enamel Proteins / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000517:prevention & control; 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; D011138:Polytetrafluoroethylene; D013524:Surgical Flaps; D014025:Titanium; D016896:Treatment Outcome
D018786:Bone Substitutes; D003746:Dental Enamel Proteins; D008567:Membranes, Artificial; C109069:enamel matrix proteins; D011138:Polytetrafluoroethylene; D014025:Titanium