Bioabsorbable membrane and bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis: results of a 5-year clinical and radiological study.
BACKGROUND
The aim of this clinical and radiological prospective 5-year study was to compare the long-term effectiveness of a bioabsorbable membrane and a bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis.


METHODS
Sixteen patients (11 women and five men) with generalized aggressive periodontitis were enrolled in the study. The investigations were confined to 1- to 3-walled intrabony defects with a depth >/=4 mm and with preoperative probing depths (PDs) >/=7 mm. Teeth with furcation involvement were excluded. Twenty-two of the defects were treated with the membrane (RXT group) and 20 with the bioactive glass (PG group). Allocation to the two groups was randomized. The clinical parameters plaque index (PI), gingival index (GI), PD, bleeding on probing (BOP), gingival recession (GR), clinical attachment level (CAL), and tooth mobility were recorded before surgery and at 6 months and every year for 5 years after surgery. Intraoral radiographs were taken using a standardized paralleling technique at baseline and every year for 5 years. Statistical analysis was based on Kolmogorov-Smirnov and Wilcoxon signed-rank tests, analysis of covariance, and Spearman's bivariate correlation analysis.


RESULTS
After 5 years, a reduction in PD of 3.6 +/- 0.8 mm (P = 0.016) and a gain in CAL of 3.0 +/- 2.0 mm (P = 0.01) were registered in the RXT group. There was a slight increase in GR by 0.6 +/- 1.4 mm (P = 0.334). In the PG group, a reduction in PD of 3.5 +/- 1.4 mm (P = 0.01) and a gain in CAL of 3.3 +/- 2.1 mm (P = 0.01) were recorded, whereas GR increased by 0.2 +/- 1.7 mm (P = 0.525). The 1-, 2-, 3-, and 4-year results did not differ significantly from the 5-year results. Radiographically, the defects (the point on the proximal surface of the defective tooth at which the projected alveolar crest intersected the root surface [xCA] to the most coronally located point at the proximal surface of the tooth on the defect side up to which the periodontal ligament space still displayed a uniform width [xBD]) were found to be filled by 47.5% +/- 38.3% (P = 0.001) in the RXT group and by 65.0% +/- 50.5% (P = 0.001) in the PG group. Crestal resorption (the most apical point of the enamel at the proximal surface of the tooth on the defect side [xCEJ] to the xCA) was 19.0% +/- 30.2% (P = 0.374) in the RXT group and 12.3% +/- 38.6% (P = 0.647) in the PG group. The xCEJ to the xBD was significantly more in the PG group (28.4 +/- 24.6 versus 7.3 +/- 21.8, P = 0.048). A good standard of oral hygiene and inflammation-free periodontal tissue in the postoperative phase improved the treatment outcome. No dependence of attachment gain was found on the tooth type, number of walls involved in the defects (r = 0.075; P = 0.319), or intraoperative depth (r = 0.114; P = 0.307).


CONCLUSIONS
Highly significant improvements in the parameters PD and CAL were recorded after 5 years with both regenerative materials. Radiographically, the defects (the xCED to the xBD) were found to be filled significantly more in the bioactive glass group. 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, Philipps University Marburg, Marburg, Germany. mengel@mailer.uni-marburg.de
Schreiber
Doreen
D
Flores-de-Jacoby
Lavin
L
D020341:Absorbable Implants; D000328:Adult; D016301:Alveolar Bone Loss / Q000601:surgery*; 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; D005884:Gingival Hemorrhage / Q000601:surgery; D005889:Gingival Recession / Q000601:surgery; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D017622:Periodontal Attachment Loss / Q000601:surgery; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000601:surgery; D010518:Periodontitis / Q000601:surgery*; D011446:Prospective Studies; D014086:Tooth Mobility / Q000601:surgery; D016896:Treatment Outcome
D001672:Biocompatible Materials; C022107:Bioglass; D018786:Bone Substitutes; D008567:Membranes, Artificial