Regeneration in periodontal and endosseous implant treatment

Abstract: In a series of clinical studies regenerative procedures for periodontal disease treatment were evaluated. A reproducibility study of probing measurements using a manual periodontal probe and 3 pressure-sensitive probes showed that measurements obtained using the manual probe were the most repeatable. This probe was therefore selected for treatment evaluation. The outcome following surgical treatment of intraosseous periodontal defects with and without EDTA root conditioning did not show any significant clinical advantage of EDTA application. Guided tissue regeneration at intraosseous periodontal defects, using a bioabsorbable membrane, did not result in predictably more probing attachment gain nor probing bone gain than conventional flap therapy. Radiographic analysis confirmed these results. Regenerative techniques may also be applied in conjunction with endosseous implant treatment. Bioabsorbable membranes were applied covering exposed fixture threads at peri-implant dehiscence and fenestration defects at the time of fixture installation. Following six months of healing, surgical re-entry demonstrated a significant reduction in the number of exposed fixture threads. Clinical and radiographic conditions were evaluated approximately 2 years following incorporation of fixed reconstructions at these fixtures. Radiographs revealed significantly less marginal bone at membrane treated fixtures than at control fixtures. This was evident from abutment connection radiographs indicating that optimal bone regeneration was not achieved at all defects. However, no significant difference in the rate of radiographic bone loss following loading between control and membrane treated fixtures was observed. All fixtures were clinically stable and peri-implant tissues healthy. The results of these studies demonstrate that clinical attachment gain and bone gain is possible but not predictable following EDTA root surface conditioning and guided tissue regeneration using a bioabsorbable membrane. Guided bone regeneration, using a bioabsorbable membrane, applied at the time of titanium fixture installation resulted in predictable bone regeneration.