Periodontal healing following reconstructive surgery: effect of guided tissue regeneration using a bioresorbable barrier device when combined with autogenous bone grafting. A randomized-controlled trial 10-year follow-up.
OBJECTIVE
The objective of this 10-year randomized-controlled trial follow-up was to evaluate the stability of treatment outcomes following the implantation of autogenous bone graft with or without guided tissue regeneration (GTR) in the treatment of deep intra-bony periodontal defects.


METHODS
Forty patients exhibiting deep intra-bony periodontal defects were included in a randomized-controlled trial evaluating the adjunctive effect of GTR to autogenous bone graft. Twenty-six of 39 patients completing the original study were available for follow-up 10 years post-treatment. The patients had been included in a structured maintenance programme and were evaluated using the criteria of the original study by the same investigators.


RESULTS
Significant improvements in the probing depth and clinical attachment level were observed for both groups between baseline and 9 months. Whereas the autogenous bone graft+GTR group showed significant improvements in probing bone levels and increased gingival recession at 9 months, no significant differences were observed for the autogenous bone graft group. Nine-month within-group results were maintained throughout the 10-year follow-up. Nevertheless, between-group comparisons at 10 years showed that the autogenous bone graft+GTR group exhibited significantly greater probing depth reduction (mean +/- SE: 4.2 +/- 0.5 versus 2.7 +/- 0.5 mm, p=0.023) and probing bone-level gain (3.9 +/- 0.8 versus 1.3 +/- 0.9 mm, p=0.034) than the autogenous bone graft group. Borderline significant differences between the autogenous bone graft+GTR and the autogenous bone graft groups were observed for clinical attachment level gain at 10 years (3.8 +/- 0.5 versus 2.2 +/- 0.7 mm, p=0.067), whereas no significant differences were observed for gingival recession (0.7 +/- 0.3 versus 0.6 +/- 0.5 mm, p>0.05).


CONCLUSIONS
The results of this randomized study suggest that statistically significant differences were found with the adjunct use of GTR to an autogenous bone graft at 10 years. Nevertheless, these results should be interpreted with caution in light of its clinical relevance and biological rationale. Importantly, resolution of deep intra-bony periodontal defects can be maintained in the presence of a structured maintenance programme emphasizing high oral hygiene standards.
Nygaard-Østby
Per
P
Department of Periodontology, Faculty of Dentistry, University of Oslo, Geitmyrsveien 71, 0458 Oslo, Norway. n-ostby@online.no
Bakke
Vibeke
V
Nesdal
Oddny
O
Susin
Cristiano
C
Wikesjö
Ulf M E
UM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016301:Alveolar Bone Loss / Q000150:complications / Q000601:surgery*; D001672:Biocompatible Materials / Q000627:therapeutic use; D016025:Bone Transplantation; D055113:Chronic Periodontitis / Q000150:complications / Q000601:surgery*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D009911:Oral Hygiene Index; D019647:Oral Surgical Procedures / Q000379:methods*; D017622:Periodontal Attachment Loss / Q000150:complications / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome; D014945:Wound Healing
D001672:Biocompatible Materials; D008567:Membranes, Artificial