Protection of mice against Schistosoma mansoni infection by passive transfer of sera from infected rabbits

Twelve patients with bilateral comparable gingival recessions were treated using a split mouth design, to compare the relative success of root coverage by two regenerative procedures. The areas of recession treated were Class I or II according to Miller's classification and caused either an esthetic problem and/or root sensitivity. The symmetrical defects, on the maxillary canines, 4 mm or deeper, were randomly assigned in each patient to surgical procedures with either a bioresorbable matrix barrier (test) or a non-resorbable expanded polytetrafluoroethylene membrane (control). Gingival recession, clinical attachment level, probing depth, and extension of keratinized tissue were measured at baseline and at 6 months postsurgically. Both procedures resulted in significant root coverage (P < 0.0001) and attachment gain (P < 0.0001). The gingival recession decreased from 4.75 +/- 0.22 mm to 0.83 +/- 0.24 mm and from 4.75 +/- 0.22 mm to 0.75 +/- 0.22 mm, corresponding to a mean root coverage of 82.4% and 83.2%, at the test and control sites respectively. The average clinical attachment gain was 4.33 +/- 0.44 mm at the test sites compared to 4.42 +/- 0.48 mm for the non-resorbable barrier. No significant changes were found for probing depth and keratinized tissue. Data analysis did not demonstrate any significant difference between the two procedures for any of the variables included. However, a questionnaire given to each patient revealed the single-step surgery to be the patients' choice.     

Subpedicle connective tissue graft versus guided tissue regeneration with bioabsorbable membrane in the treatment of human gingival recession defects

The purpose of the present clinical study was to evaluate the effect of guided tissue regeneration (GTR) in comparison to subpedicle connective tissue graft (SCTG) in the treatment of gingival recession defects. A total of 12 patients, each contributing a pair of Miller's Class I or II buccal gingival recessions, was treated. According to a randomization list, one defect in each patient received a polyglycolide/lactide bioabsorbable membrane, while the paired defect received a SCTG. Treatment effect was evaluated 6 months postsurgery. Clinical recordings included full-mouth and defect-specific oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT). Mean RD significantly decreased from 3.1 mm presurgery to 1.5 mm at 6 months postsurgery for the GTR group (48% root coverage), and from 3.0 mm to 0.5 mm for the SCTG group (81% root coverage). RD reduction and root coverage were significantly greater in SCTG group compared to GTR group. Mean CAL gain amounted to 1.7 mm for the GTR group, and 2.3 mm in the SCTG group. No significant differences in PD changes were observed within and between groups. KT increased significantly from presurgery for both treatment groups, however gingival augmentation was significantly greater in the SCTG group compared to GTR group. Results indicate that: 1) treatment of human gingival recession defects by means of both GTR and SCTG procedures results in clinically and statistically significant improvement of the soft tissue conditions of the defect; and 2) treatment outcome was significantly better following SCTG compared to GTR in terms of recession depth reduction, root coverage, and keratinized tissue increase.     

Quantitative flow cytometry: inter-laboratory variation

The objective of the study was to compare the clinical efficacy of 3 surgical approaches in the treatment of deep recession type defects. Fifty-four (54) gingival recessions > or = 5 mm were randomly assigned to 1 of the 3 treatment groups by blocking the prognostic variables. The first group was treated with a guided tissue regeneration (GTR) procedure using a bioabsorbable membrane, the second with non-resorbable membrane, and the third with a mucogingival surgical approach consisting of a connective tissue graft combined with a coronally advanced flap (bilaminar technique). No differences, in terms of baseline oral hygiene and defect characteristics, were observed among the 3 groups showing an effective blocking approach. The 1-year results indicated that 1) all treatment approaches resulted in clinically significant root coverage and attachment gain; 2) a statistically significant treatment effect (P = 0.012, ANOVA) was observed comparing the bioabsorbable (4.9+/-0.3 mm), the non-resorbable (4.5+/-0.8 mm), and the bilaminar (5.3+/-0.7 mm) groups, in terms of root coverage; 3) the difference in terms of root coverage between the bilaminar and the non-resorbable membrane groups was statistically significant while differences between the 2 GTR groups or between the bilaminar and the bioabsorbable membrane groups did not reach statistical value; 4) the 95% confidence intervals for the proportions of complete successes showed a similar pattern; 5) no statistical difference was demonstrated in the amount of attachment gain among the 3 groups (P=0.73, ANOVA). A regression model showed that the amount of root coverage was significantly affected by the initial recession depth, the procedure and smoking habits: a poorer root coverage result is expected in case of shallow recession type defects, when either bioabsorbable (P < 0.05) or non-resorbable (P < 0.001) membranes are used instead of a bilaminar technique and if the patient smokes (P < 0.01). It was concluded that the mucogingival bilaminar technique is at least as effective as GTR procedures in the treatment of gingival recession > or = 4 mm and thus recession depth is not the parameter which influences the selection of the surgical procedure.     

Long-term stability of the mucogingival complex following guided tissue regeneration in gingival recession defects

The purpose of the present study was to evaluate the stability of soft tissue conditions in gingival recession defects treated with guided tissue regeneration (GTR). The study population was selected among those patients who had been treated with GTR procedures for Miller's class I or II, deep (> or =3 mm), buccal gingival recession defects. Defects were included only when they had revealed recession depth reduction > or =2 mm and root coverage > or =60% at 6 months following GTR treatment. These defects were regarded as successfully treated and scheduled for further monitoring. 20 patients, 11 male and 9 female, aged 23 to 57 years (mean age: 33.2 years), each contributing 1 defect, were selected. 9 patients were smokers (> or =10 cigarette per day). Recession depth (RD), probing depth (PD), clinical attachment level (CAL), and width of keratinized gingiva (KG) were assessed immediately before surgery, at 6 months post-surgery (baseline examination), and at 4 years post-surgery (4-year examination). At baseline examination, RD reduction was 3.6+/-0.9 mm (mean root coverage: 80%). CAL gain amounted to 4.2+/-1.3 mm, 60% of the defects showing CAL gain > or =4 mm. KG increased from 1.9+/-1.2 mm at presurgery examination to 3.1+/-0.9 mm at baseline examination. At 4-year examination, no significant changes from baseline RD, CAL and KG recordings were observed. Differences in baseline-4 year changes between smokers and non-smokers were not statistically significant. The results of the present study demonstrate that clinical outcome achieved following GTR procedure in gingival recession defects can be maintained over periods up to 4 years.     

Integrated connective tissue in bioabsorbable barrier material and periodontal regeneration

The objective of this study was to evaluate the relationship between integrated connective tissue (ICT), that is, the presence of connective tissue into the membrane structure, and the clinical outcome of membrane-supported periodontal surgery. Twenty-six systemically healthy subjects affected by chronic adult periodontitis were enrolled in the study. One tooth site per patient, associated with an angular bony defect and an attachment loss of > 7 mm, was selected to be treated by means of a guided tissue regeneration procedure using a bioabsorbable membrane. Barrier material was surgically removed after 4 weeks for SEM analysis. For each treated site, the difference in clinical attachment loss, probing depth, and gingival recession between the baseline examination and follow-up 6 months after the second surgery was calculated. Gain of attachment was statistically (P < 0.001) greater in sites with no membrane exposure when compared to sites with exposed barrier material (5.5 +/- 1.0 vs. 4.0 +/- 0.6), while further gingival recession was greater (3.0 +/- 0.9 vs. 2.1 +/- 0.5) in sites with clinically exposed membranes. The results of SEM analysis revealed that when connective tissue structures were observed on membrane surfaces, no bacteria could be detected; conversely, areas heavily colonized by bacteria did not show the presence of connective tissue. Regression analysis indicated that integrated connective tissue on the external layer of the barrier material was positively correlated with the amount of attachment gain and negatively with the amount of gingival recession. Bacterial colonization of the membrane was negatively correlated with attachment gain and positively with gingival recession. It was concluded that connective tissue integration is an important biological phenomenon in preventing membrane exposure and bacterial plaque colonization and thus in enhancing the clinical outcome following guided tissue regeneration surgery.     

A 3-year experience with guided tissue regeneration procedures

The Guided Tissue Regeneration (GTR) procedures are promoting a clinically and radiologically as well as histologically verifiably periodontal attachment gain. The objective of the study was to evaluate the clinical efficacy of these GTR techniques. In the past four years different barrier membranes (Gore-tex, Resolut and Guidor) were used around 318 teeth of 196 patients. 169 periodontal defects of 140 patients were followed up at least for two years. 54 patient had chronic adult type periodontitis, 67 suffered with rapidly progressing periodontitis and 15 had different severe mucogingival lesions. 111 vertical bony defects, 43 Class II-III furcation lesions and 15 mucogingival lesions were surgically corrected. The average preoperative probing depth (PD) and the clinical attachment loss (CAL) of the vertical bony defects were 5.3 +/- 1.7 mm and 6.2 +/- 1.9 mm respectively. The PD of the deepest Class III furcation lesion was 11 mm. The average gingival recession of the mucogingival lesions was 4.5 +/- 1.1 mm. The GTR technique provided the best results in the Class II-III furcation lesions, where an average 2.4 +/- 0.9 clinical attachment gain was observed one year postoperatively. The GTR techniques provided an average 1.8 +/- 1.2 mm attachment gain in the vertical bony crater cases. In both groups of cases a marked gingival recession followed the healing and the periodontal regeneration. In this way the average reduction in the probing depth exceeded the average attachment gain by more that 1.5 mm. 1 year after the operation the average radiologic bone fill was about 0.9-1.2 mm. The resorbable barrier membranes resulted in clinically significant root coverage and an average 3.5 +/- 1.7 mm gain in the width of keratinized gingiva. The success or failure of our cases were mainly determined by the patient's compliance, the level of the postoperative professional and individual oral hygiene and the number of periodontal recalls. These findings are also underlining the importance of the high standard of oral hygiene in the postoperative periodontal regeneration.     

Clinical response of localized recurrent periodontitis treated with scaling, root planing, and tetracycline fiber

The purpose of this study was to compare the clinical efficacy of scaling and root planing alone versus tetracycline fiber therapy used adjunctively with scaling and root planing in the treatment of nonresponsive active periodontitis in patients under supportive periodontal therapy. Thirty patients who were receiving supportive treatment and had at least two nonadjacent periodontitis sites with a probing depth of between 4 and 8 mm and bleeding on probing, or had aspartate aminotransferase (AST) levels above 800 microIU in the gingival crevicular fluid in separate quadrants participated in this study. For each patient, the test sites were treated with scaling and root planing plus tetracycline fibers while the control site was treated with scaling and root planing only. Probing depths, clinical attachment levels, gingival recession, AST levels, and bleeding on probing were recorded and subgingival plaque samples were collected at baseline and 1, 3, and 6 months following treatment. At 3 months after treatment, there was a reduction of bleeding on probing and probing depth, and a gain of clinical attachment in both test and control sites. The mean reduction in probing depth of the test sites was 1.38 mm and the attachment gain was 0.8 mm after 6 months. The clinical response obtained at 3 months following therapy was maintained throughout the 6-month follow-up period. However, there were no statistically significant differences between sites treated with scaling and root planing alone and those treated with combined tetracycline therapy. Most of the reductions of probing depths in the fiber group were attributed to gingival recession. The present study did not confirm the efficacy of adjunctive tetracycline fibers in treating nonresponsive sites in maintenance subjects with regard to probing depth reduction or clinical attachment gain. Reinfection of the pockets from untreated sites and extra-crevicular regions may explain the insignificant response to local tetracycline therapy.     

Results of limited initial periodontal therapy in smokers and non-smokers

Eighty-seven adult patients (54 non-smokers and 33 smokers) with moderate to advanced periodontitis were treated with 1-hour full-mouth subgingival scaling and root planing, with no maintenance recalls, during this 9-month study. Clinical parameters assessed at target sites included probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index. Data were collected at baseline, and 3, 6, and 9 months. Baseline probing depth for non-smokers was 5.46 +/- .46 mm and for smokers 5.70 +/- 0.66 mm. Data analysis (t test) revealed that both non-smokers and smokers had a statistically significant decrease (P < 0.05) in probing depth at 3 months which was maintained throughout the study. At 9 months non-smokers maintained a mean decrease in probing depth of 0.60 mm and smokers a mean decrease of 0.65 mm. Both smokers and non-smokers displayed a significant gain (P < 0.05) in clinical attachment level after initial therapy when compared to baseline readings. At 9 months the mean gain in clinical attachment level for non-smokers was 0.47 mm and 0.59 mm for smokers. Plaque index scores remained consistent for smokers and non-smokers for the duration of the study. The gingival index at baseline was significantly (P < 0.05) lower in smokers (1.32 +/- 0.45) than non-smokers (1.45 +/- 0.40). By 9 months only the gingival index of non-smokers decreased significantly compared to baseline (1.26 +/- 0.37). Bleeding on probing was a prerequisite for target sites at baseline. At 9 months both smokers (0.67 +/- 0.39) and non-smokers (0.78 +/- 0.30) had a significant decrease in bleeding on probing compared to baseline. At 9 months there were no significant differences between smokers and non-smokers comparing probing depth, clinical attachment level, plaque index, bleeding on probing, and gingival index. The data have shown that smokers and non-smokers responded similarly after 9 months to the limited amount of initial therapy provided.     

A 2-year clinical evaluation of a diphenylphosphorylazide-cross-linked collagen membrane for the treatment of buccal gingival recession

To retard collagen membrane enzymatic degradation and to increase its mechanical strength, the diphenylphosphorylazide (DPPA) technique has been demonstrated to achieve natural cross-links between peptide chains of collagen without leaving any foreign product in the cross-linked molecule. In the present prospective clinical trial, the potential of a DPPA-cross-linked type I bovine collagen membrane was evaluated in the healing of 15 buccal soft tissue recessions in 15 patients according to the biological concept of guided tissue regeneration. The recession decreased from 3.7 mm (SD 1.4) at baseline to 0.8 mm (SD 1.2) at 2 years postsurgery, corresponding to a mean root coverage of 82.2% (P <0.0001). Concurrently, the clinical attachment level decreased from 5.4 mm (SD 1.6) at baseline to 1.9 mm (SD 1.2) 2 years postsurgery, corresponding to an average clinical attachment gain of 3.5 mm (SD 1.3) (P <0.0001). The 2-year postsurgical width of the keratinized tissue was not significantly different from baseline values. More than half (53%) of the treated sites showed complete root coverage and about two-thirds (73%) of the total cases showed a 75% to 100% disappearance of the mucogingival defect. The present investigation demonstrated that the use of DPPA-cross-linked collagen membranes in the treatment of human buccal soft tissue recessions results in predictable amounts of root coverage and clinical attachment gain. Long-term randomization controlled clinical trials of this material are needed to fully evaluate its potential for treating periodontal recession.     

Creeping attachment associated with the connective tissue with partial-thickness double pedicle graft

The occurrence of creeping attachment has been documented with epithelialized autogenous masticatory mucosa grafts (free gingival grafts) and suggested in other root coverage techniques. The purpose of this study was to examine whether or not creeping attachment occurred after a connective tissue with partial-thickness double pedicle graft had been performed. This study examined 22 defects, in 19 patients, treated where less than complete root coverage was obtained at 4 weeks postoperative. Creeping attachment occurred in 21 of the 22 defects (95.5%), in 18 of the 19 patients (94.7%). Complete root coverage occurred in 17 of the 22 defects (77.3%), in 15 of 19 patients (78.9%). The mean creeping attachment obtained was 0.8 mm. Additionally, it was the goal of this study to see if any factor could be associated with creeping attachment. This study did not find any factors that could be associated with the amount of creeping attachment seen. Creeping attachment seems to occur commonly, but complete root coverage is not predictable.     

Increased expression of endothelial cell nitric oxide synthase (ecNOS) in afferent and glomerular endothelial cells is involved in glomerular hyperfiltration of diabetic nephropathy

Root coverage procedures have become an important part of periodontal therapy. The purpose of this study was to compare 2 techniques, 1) guided tissue regeneration (GTR) with a bioabsorbable polylactic acid softened with citric acid ester membrane and 2) the connective tissue graft combined with a coronally positioned pedicle graft without vertical incisions. The GTR procedure produced a mean root coverage of 92.3% and the connective tissue graft combined with a coronally positioned pedicle graft, 95.0%. This difference was not statistically significant. Both procedures produced similar reductions in recession depth, recession width, and probing depth. The connective tissue graft combined with a coronally positioned pedicle graft resulted in a greater increase in the amount of keratinized tissue. Based on this study, both procedures can result in statistically similar amounts of mean root coverage, but the results are not identical. In most cases, the connective tissue with coronally positioned pedicle graft produced a more bulky result than guided tissue regeneration. Therefore, the procedures are not interchangeable.     

The prevalence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides forsythus in humans 1 year after 4 randomized treatment modalities

The relationship between probing attachment changes in treated periodontal pockets and the prevalence of selected periodontal pathogens was assessed in 10 patients with adult periodontitis 1 year following randomized therapy. All patients had at least 1 tooth in each quadrant with an inflamed pocket of probing depth > or =5 mm and clinical attachment loss and harbored at least one of the following 3 major periodontal pathogens: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, or Bacteroides forsythus. The number of target organisms per site was determined preoperatively; at 1 week; and at 1, 3, 6, and 12 months postoperatively utilizing DNA probes. The following clinical parameters were measured and recorded preoperatively and at 1, 3, 6, and 12 months post-treatment: gingival fluid flow, gingival index, plaque index, probing depth, probing attachment level, gingival recession, and bleeding on probing. One quadrant in each patient was randomly assigned to 1 of the following 4 treatments: 1) scaling and root planing; 2) pocket reduction through osseous surgery and apically-positioned flap; 3) modified Widman flap; and 4) modified Widman flap and topical application of saturated citric acid at pH 1 for 3 minutes. All 4 treatments were rendered in one appointment using local anesthesia. No postoperative antibiotics were used, but patients rinsed with 0.12% chlorhexidine for the first 3 months postoperatively and received a prophylaxis every 3 months. This investigation revealed: 1) 30.0% of the sites were infected by at least 1 species at 3, 6, and 12 months postoperatively. 2) Failing sites were infected by a high number of both Pg and Bf These sites had a mean of 24.2+/-9.0 x 10(3) Pg and 93.1+/-42.0 X 10(3) Bf while stable sites had a mean of 6.8+/-0.5 x 10(3) Pg and 7.2+/-1.2 x 10(3) Bf (P = 0.06 and P = 0.05, respectively). 3) The infected sites lost significantly more mean clinical attachment at 12 months (1.5+/-0.5 mm compared to a loss of 0.2+/-0.3 mm for uninfected sites, P = 0.017). 4) The infected sites had a significantly greater BOP (67+/-14% versus 25+/-8% for uninfected sites at 12 months, P = 0.012). 5) The choice of treatment modality did not affect the prevalence of the target species at 1 year post-treatment. These results suggest that prevalence of microbial pathogens negatively affects the 1 year outcome of periodontal surgical and nonsurgical therapy.     

Periodontal repair in intrabony defects treated with a calcium sulfate implant and calcium sulfate barrier

THIS RANDOMIZED, CONTROLLED, CLINICAL STUDY was designed to evaluate outcome following surgical implantation of an allogeneic, freeze-dried, demineralized bone matrix-calcium sulfate (DBM+CS) composite with a CS barrier in intrabony periodontal defects. Twenty-six patients contributing 26 deep intrabony defects completed the study. Thirteen patients received the DBM+CS implant. Thirteen patients received gingival flap surgery alone (GFS; control). Clinical outcome was assessed at 6 and 12 months postsurgery. At 12 months postsurgery, probing depth (PD) reduction (mean +/-SD) for the DBM+CS and GFS group was to 4.3+/-0.5 and 3.0+/-1.3 mm; clinical attachment gain was to 2.9+/-0.8 and 1.7+/-1.5 mm; and probing bone level gain was to 2.9+/-1.4 and 1.2+/-1.2 mm, respectively. There were no apparent differences between evaluations at 6 and 12 months postsurgery. Clinical improvements were significantly different from presurgery for both groups at both observation intervals (P < 0.01). There were no significant differences between groups in PD reduction and clinical attachment gain. Probing bone level gain was significantly greater in the DBM+CS group compared to controls (P < 0.05). In summary, surgical implantation of DBM+CS with a CS barrier resulted in reduced PD and improved attachment levels comparable to that achieved by gingival flap surgery alone. However, gain in probing bone levels in deep intrabony periodontal pockets assessed by clinical parameters was greater than that observed by gingival flap surgery alone. These changes were noted at both 6 and 12 months after surgery. This regenerative technique needs further biologic evaluation before being generally accepted.     

A clinical evaluation of guided tissue regeneration with a bioabsorbable matrix membrane combined with an allograft bone graft. A series of case reports

THE PURPOSE OF THIS STUDY was to evaluate the clinical effectiveness of a surgical technique in treating periodontal defects. The technique combined tetracycline treatment of a root planed root, grafting of the osseous defect with a demineralized freeze-dried bone allograft combined with tetracycline and the placement of a bioabsorbable matrix membrane, made of polylactic acid softened with citric acid ester. Thirty defects were treated in 27 patients. Statistically significant changes, as a result of the surgical procedure, were observed in marginal recession (mean: 0.5 mm), probing depth reductions (mean: 5.7 mm), and attachment level gain (mean: 5.2 mm). No statistically significant difference existed between the results in the furcation and non-furcation groups. The defects with probing depths > or = 10 mm had a greater mean probing depth reduction (7.4 mm) and mean attachment level improvement (7.2 mm) than the defects with < 10 mm probing depths (probing depth reduction 4.5 mm and attachment level gain 3.9 mm). The proposed surgical procedure seemed to be an effective method to treat periodontal defects.     

Immunosuppression in therapy of glomerulonephritis

This study clinically evaluated a bioabsorbable barrier membrane designed for periodontal regeneration. Ten Class II furcations and 12 interproximal infrabony defects were treated by flap debridement and placement of a bioabsorbable barrier membrane using the principles of guided tissue regeneration. Treatment was evaluated in terms of changes in vertical probing depth, horizontal attachment level, clinical attachment level, and recession. Baseline data were collected on the day of surgery, and outcome measurements were performed at the 1-year appointment. The mean initial probing depth for Class II furcations was 6.5 mm. At 1 year, the mean probing depth was reduced to 2.9 mm, a 3.6 mm change. These differences were clinically and statistically significant (P < 0.01). There was a mean gain of 2.4 mm in clinical attachment level (P < 0.01) and a mean 3.4-mm change in horizontal attachment level (P < 0.01). Recession increased 1.2 mm. For interproximal infrabony defects, there was a mean probing depth reduction of 5.0 mm (P < 0.01), a mean gain of clinical attachment level of 3.8 mm (P < 0.02), and a mean increase of 1.2 mm in recession (P < 0.04). The results indicate that significant improvements occurred after treatment of Class II furcations and interproximal infrabony defects with the use of a bioabsorbable barrier membrane and guided tissue regeneration.     

Evaluation of periosteal membranes and coronally positioned flaps in the treatment of Class II furcation defects: a comparative clinical study in humans

The purpose of this study was to compare the clinical effectiveness of connective tissue grafts including periosteum used as a mechanical barrier for guided periodontal tissue regeneration and coronally positioned flaps in the treatment of Class II furcation defects. A total of 28 furcation defects were treated; 14 received a periosteal barrier and 14 received a coronally positioned flap. Reentry surgeries were performed at 6 months. No statistically significant differences were found preoperatively between the two treatment groups with respect to clinical parameters and osseous measurements. Postsurgically, both treatment modalities resulted in a significant decrease in probing depth and a significant gain in clinical attachment, but the differences observed were not statistically significant. The periosteal barrier group presented with a significantly better gain in vertical components of the alveolar bone (1.93 +/- 0.15 mm and 0.20 +/- 0.26 mm for periosteal barrier and coronally positioned flap groups, respectively; P < or = 0.001) and horizontal components of the alveolar bone (1.60 +/- 0.21 mm and 0.13 +/- 0.90 mm for periosteal barrier and coronally positioned flap groups, respectively; P < or = 0.001). The results of this trial indicate that similar clinical resolution of Class II furcation defects can be obtained with periosteal barriers and coronally positioned flaps. Periosteal barriers, however, are a better treatment alternative in achieving bone fill of the furcation area.     

Comparison of mucogingival changes following treatment with coronally positioned flap and guided tissue regeneration procedures

This study compared the variation in anatomic width of the mucogingival unit following coronally positioned flap or guided tissue regeneration procedures in deep (greater than or equal to 4 mm) buccal maxillary gingival recession defects 12 months postsurgery. Eighteen patients, 10 treated with guided tissue regeneration procedures and eight treated with coronally positioned flap procedures, were retrospectively analyzed. The results demonstrated that both treatments led to consistent recession depth reduction and coronal shift of the mucogingival junction. A significant increase in the amount of keratinized gingiva was observed for the guided tissue regeneration procedure, but a decrease that was not statistically significant was observed for the coronally positioned flap procedure.     

Guided tissue regeneration for the treatment of intraosseous defects using a biabsorbable membrane. A controlled clinical study

The aim of this controlled, clinical study was to evaluate guided tissue regeneration using a bioabsorbable membrane in periodontal intraosseous defects. Forty patients, each contributing one defect > or =4 mm in depth participated. The control group (18 individuals) received conventional flap therapy, while the test group (22 individuals) was treated using the bioabsorbable membrane, Guidor. Clinical assessments were made by one examiner, blinded with respect to treatment group, at baseline, 6 and 12 months following surgery. Baseline probing pocket depths of 7.7+/-1.4 mm in the membrane group and 7.6+/-1.9 mm in the control group were measured. Twelve month results showed a significant clinical attachment level gain in both control (1.1+/-1.8 mm), and membrane group (1.3+/-2.1 mm). Probing pocket depth reduction of 2.6+/-1.9 mm and 2.7+/-1.9 mm was observed in the respective groups. Bone sounding showed a non-significant gain of 0.4+/-1.8 mm and 0.6+/-1.4 mm at membrane and control sites, respectively. Radiographic evaluation confirmed these results. There were no significant differences found between treatment groups for any of the tested variables. Smoking had a negative effect on healing in both groups. In conclusion, clinical and radiographic results indicate that guided tissue regeneration using a bioabsorbable membrane at intraosseous defects did not predictably achieve greater clinical attachment level gain nor bone gain when compared to conventional flap therapy.     

Clinical comparison of resorbable and non-resorbable barriers for guided periodontal tissue regeneration

The purpose of this study was to compare the clinical results of guided periodontal tissue regeneration (GPTR) using a resorbable barrier manufactured from a copolymer of polylactic and polyglycolic acids (Resolut Regenerative Material) with those of non-resorbable e-PTFE barrier (Gore-Tex Periodontal Material). 12 subjects participated, 6 with similarly paired class II furcations and 6 with 2 similar 2, 3-wall periodontal lesions. The resorbable and non-resorbable barriers were randomly assigned to 1 defect in each subject. Non-resorbable barriers were removed in six weeks. Plaque index (PlI), gingival index (GI), probing depth (PD), clinical attachment level (CAL) and gingival recession (R) were recorded at baseline, (i.e., immediately prior to surgery) and at 12 months postsurgically. The clinical healing was similar and uneventful in both groups. Intrabony pockets depicted significant changes from baseline (p < 0.05) for probing depth reduction and gain in clinical attachment levels. No differences were found between treatments. Class II furcations showed significant improvements from baseline (p < or = 0.05) for probing depth reduction and clinical attachment gain. No differences were detected between treatments. It is concluded that the resorbable barrier tested is as effective as the nonresorbable e-PTFE barrier for the treatment of class II furcations and intrabony defects.     

Influence of free gingival grafts on the health of the marginal gingiva

In order to evaluate the effect of increasing the width of inadequate attached gingiva on the health of the marginal gingiva, 12 free gingival grafts were performed on 12 patients with less than 1.0 mm of attached gingiva on homologous contralateral pairs of mandibular teeth. A baseline examination, which included measurements of plaque, gingival exudate, sulcus bleeding, sulcus probing depth and width of attached gingiva, was done before surgery. One week after surgery, plaque was eliminated mechanically on the test and control sides. All measurements were repeated 7 and 14 weeks after surgery. During the week following the first postsurgical examination, individual oral hygiene instruction was given until the patient could show plaque-free test and control sites. The width of the attached gingiva increased significantly on the side where the grafting was performed (test side). The only other significant changes observed during the experiment were a decrease of the mid-buccal plaque index on the test side during the first 7 weeks following surgery and a decrease of the buccoproximal plaque index on the test and control sides during the total experimental period (14 weeks). None of the other clinical parameters measured showed significant differences when test and control sites were compared or when the same sites were compared longitudinally.