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Treatment of intrabony defects with guided tissue regeneration in aggressive periodontitis: clinical outcomes at 6 and 12 months

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Abstract

Objective

The aim of this study was to compare clinical outcomes between guided tissue regeneration (GTR) and access flap (AF) surgery in patients with aggressive periodontitis (AgP).

Methods

Eighteen AgP patients with similar bilateral intrabony defects were treated in this split-mouth, single-blinded, randomised, controlled clinical trial. All patients presented with ≥3 mm intrabony defects and ≥5 mm periodontal pocket depths (PPD). In each patient, one defect was treated with a polyglycolide membrane according to the GTR principle, whereas the contralateral side was treated with AF. For both sides, a simplified papilla preservation flap was used. At baseline, 6 and 12 months post-surgery, the clinical attachment levels (CAL) and PPD were evaluated.

Results

At 6 and 12 months, at the GTR sites, the mean [95 % CI] CAL gain was 1.7 mm [1.1, 2.3] and 1.6 mm [0.9, 2.1], respectively, while the mean [95 % CI] PPD reduction was 2.3 mm [1.9, 2.8] and 2.4 mm [1.9, 2.8], respectively. Similar CAL (1.6 mm [1.0, 2.2] and 2.1 mm [1.4, 2.7]) and PPD (2.0 mm [1.5, 2.4] and 2.5 mm [2.0, 3.0]) outcomes were observed at the control sites at 6 and 12 months, respectively. Notably, at the GTR-treated sites, 13 subjects presented with various degrees of membrane exposure.

Conclusions

Both therapies were effective in the treatment of intrabony defects in AgP patients, and no statistically significant differences between them could be demonstrated, possibly as a result of the differing degrees of membrane exposure at the GTR sites.

Clinical relevance

Both periodontal regeneration and conventional periodontal surgery are effective treatments for AgP patients.

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References

  1. Garrett S (1996) Periodontal regeneration around natural teeth. Ann Periodontol/Am Acad Periodontology 1:621–666. doi:10.1902/annals.1996.1.1.621

    Article  Google Scholar 

  2. Papapanou PN, Wennstrom JL (1991) The angular bony defect as indicator of further alveolar bone loss. J Clin Periodontol 18:317–322

    Article  PubMed  Google Scholar 

  3. Caton J, Nyman S, Zander H (1980) Histometric evaluation of periodontal surgery. II Connective tissue attachment levels after four regenerative procedures. J Clin Periodontology 7:224–231

    Article  Google Scholar 

  4. Cortellini P, Prato GP, Tonetti MS (1999) The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. Int J Periodontics Restorative Dent 19:589–599

    PubMed  Google Scholar 

  5. Retzepi M, Tonetti M, Donos N (2007) Comparison of gingival blood flow during healing of simplified papilla preservation and modified Widman flap surgery: a clinical trial using laser Doppler flowmetry. J Clin Periodontol 34:903–911. doi:10.1111/j.1600-051X.2007.01119.x

    Article  PubMed  Google Scholar 

  6. Karring T, Nyman S, Gottlow J, Laurell L (1993) Development of the biological concept of guided tissue regeneration—animal and human studies. Periodontology 2000 1:26–35

    Article  Google Scholar 

  7. Cortellini P, Pini Prato G, Tonetti MS (1996) The modified papilla preservation technique with bioresorbable barrier membranes in the treatment of intrabony defects. Case reports. Int J Periodontics Restorative Dent 16:546–559

    PubMed  Google Scholar 

  8. Needleman I, Tucker R, Giedrys-Leeper E, Worthington H (2002) A systematic review of guided tissue regeneration for periodontal infrabony defects. J Periodontal Res 37:380–388

    Article  PubMed  Google Scholar 

  9. Murphy KG, Gunsolley JC (2003) Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects. A systematic review. Ann Periodontol/Am Acad Periodontology 8:266–302. doi:10.1902/annals.2003.8.1.266

    Article  Google Scholar 

  10. Needleman I, Tucker R, Giedrys-Leeper E, Worthington H (2005) Guided tissue regeneration for periodontal intrabony defects—a Cochrane systematic review. Periodontology 2000 37:106–123. doi:10.1111/j.1600-0757.2004.37101.x

    Article  PubMed  Google Scholar 

  11. DiBattista P, Bissada NF, Ricchetti PA (1995) Comparative effectiveness of various regenerative modalities for the treatment of localized juvenile periodontitis. J Periodontol 66:673–678. doi:10.1902/jop.1995.66.8.673

    Article  PubMed  Google Scholar 

  12. Sirirat M, Kasetsuwan J, Jeffcoat MK (1996) Comparison between 2 surgical techniques for the treatment of early-onset periodontitis. J Periodontol 67:603–607. doi:10.1902/jop.1996.67.6.603

    Article  PubMed  Google Scholar 

  13. Benque E, Zahedi S, Brocard D, Oscaby F, Justumus P, Brunel G (1997) Combined collagen membrane and hydroxyapatite/collagen chondroitin-sulfate spacer placement in the treatment of 2-wall intrabony defects in chronic adult and rapidly progressive periodontitis patients. J Clin Periodontol 24:550–556

    Article  PubMed  Google Scholar 

  14. Benque E, Zahedi S, Brocard D, Oscaby F, Justumus P, Brunel G (1997) Guided tissue regeneration using a collagen membrane in chronic adult and rapidly progressive periodontitis patients in the treatment of 3-wall intrabony defects. J Clin Periodontol 24:544–549

    Article  PubMed  Google Scholar 

  15. Mengel R, Soffner M, Flores-de-Jacoby L (2003) Bioabsorbable membrane and bioactive glass in the treatment of intrabony defects in patients with generalized aggressive periodontitis: results of a 12-month clinical and radiological study. J Periodontol 74:899–908. doi:10.1902/jop.2003.74.6.899

    Article  PubMed  Google Scholar 

  16. Wennstrom A, Wennstrom J, Lindhe J (1986) Healing following surgical and non-surgical treatment of juvenile periodontitis. A 5-year longitudinal study. J Clin Periodontol 13:869–882

    Article  PubMed  Google Scholar 

  17. Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol/Am Acad Periodontology 4:1–6. doi:10.1902/annals.1999.4.1.1

    Article  Google Scholar 

  18. Altman DG, Bland JM (2005) Treatment allocation by minimisation. BMJ 330:843. doi:10.1136/bmj.330.7495.843

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tonetti MS, Lang NP, Cortellini P, Suvan JE, Adriaens P, Dubravec D, Fonzar A, Fourmousis I, Mayfield L, Rossi R, Silvestri M, Tiedemann C, Topoll H, Vangsted T, Wallkamm B (2002) Enamel matrix proteins in the regenerative therapy of deep intrabony defects. J Clin Periodontol 29:317–325

    Article  PubMed  Google Scholar 

  20. Cortellini P, Tonetti MS (2000) Focus on intrabony defects: guided tissue regeneration. Periodontology 2000(22):104–132

    Article  Google Scholar 

  21. Tonetti MS, Cortellini P, Suvan JE, Adriaens P, Baldi C, Dubravec D, Fonzar A, Fourmousis I, Magnani C, Muller-Campanile V, Patroni S, Sanz M, Vangsted T, Zabalegui I, Pini Prato G, Lang NP (1998) Generalizability of the added benefits of guided tissue regeneration in the treatment of deep intrabonydefects. Evaluation in a multi-center randomized controlled clinical trial. J Periodontol 69:1183–1192. doi:10.1902/jop.1998.69.11.1183

    Article  PubMed  Google Scholar 

  22. Pritlove-Carson S, Palmer RM, Floyd PD (1995) Evaluation of guided tissue regeneration in the treatment of paired periodontal defects. Br Dent J 179:388–394

    Article  PubMed  Google Scholar 

  23. Bratthall G, Soderholm G, Neiderud AM, Kullendorff B, Edwardsson S, Attstrom R (1998) Guided tissue regeneration in the treatment of human infrabony defects. Clinical, radiographical and microbiological results: a pilot study. J Clin Periodontol 25:908–914

    Article  PubMed  Google Scholar 

  24. Ratka-Kruger P, Neukranz E, Raetzke P (2000) Guided tissue regeneration procedure with bioresorbable membranes versus conventional flap surgery in the treatment of infrabony periodontal defects. J Clin Periodontol 27:120–127

    Article  PubMed  Google Scholar 

  25. Cortellini P, Tonetti MS, Lang NP, Suvan JE, Zucchelli G, Vangsted T, Silvestri M, Rossi R, McClain P, Fonzar A, Dubravec D, Adriaens P (2001) The simplified papilla preservation flap in the regenerative treatment of deep intrabony defects: clinical outcomes and postoperative morbidity. J Periodontol 72:1702–1712. doi:10.1902/jop.2001.72.12.1702

    Article  PubMed  Google Scholar 

  26. Wikesjo UM, Selvig KA (1999) Periodontal wound healing and regeneration. Periodontology 2000(19):21–39

    Article  Google Scholar 

  27. Retzepi M, Tonetti M, Donos N (2007) Gingival blood flow changes following periodontal access flap surgery using laser Doppler flowmetry. J Clin Periodontol 34:437–443. doi:10.1111/j.1600-051X.2007.01062.x

    Article  PubMed  Google Scholar 

  28. Donos N, D’Aiuto F, Retzepi M, Tonetti M (2005) Evaluation of gingival blood flow by the use of laser Doppler flowmetry following periodontal surgery. A pilot study. J Periodontal Res 40:129–137. doi:10.1111/j.1600-0765.2005.00777.x

    Article  PubMed  Google Scholar 

  29. Lundgren D, Laurell L, Gottlow J, Rylander H, Mathisen T, Nyman S, Rask M (1995) The influence of the design of two different bioresorbable barriers on the results of guided tissue regeneration therapy. An intra-individual comparative study in the monkey. J Periodontol 66:605–612. doi:10.1902/jop.1995.66.7.605

    Article  PubMed  Google Scholar 

  30. Christgau M, Bader N, Schmalz G, Hiller KA, Wenzel A (1998) GTR therapy of intrabony defects using 2 different bioresorbable membranes: 12-month results. J Clin Periodontol 25:499–509

    Article  PubMed  Google Scholar 

  31. Dorfer CE, Kim TS, Steinbrenner H, Holle R, Eickholz P (2000) Regenerative periodontal surgery in interproximal intrabony defects with biodegradable barriers. J Clin Periodontol 27:162–168

    Article  PubMed  Google Scholar 

  32. Eickholz P, Kim TS, Steinbrenner H, Dorfer C, Holle R (2000) Guided tissue regeneration with bioabsorbable barriers: intrabony defects and class II furcations. J Periodontol 71:999–1008. doi:10.1902/jop.2000.71.6.999

    Article  PubMed  Google Scholar 

  33. Christgau M, Bader N, Felden A, Gradl J, Wenzel A, Schmalz G (2002) Guided tissue regeneration in intrabony defects using an experimental bioresorbablepolydioxanon (PDS) membrane. A 24-month split-mouth study. J Clin Periodontol 29:710–723

    Article  PubMed  Google Scholar 

  34. Ling LJ, Hung SL, Lee CF, Chen YT, Wu KM (2003) The influence of membrane exposure on the outcomes of guided tissue regeneration: clinical and microbiological aspects. J Periodontal Res 38:57–63

    Article  PubMed  Google Scholar 

  35. Machtei EE (2001) The effect of membrane exposure on the outcome of regenerative procedures in humans: a meta-analysis. J Periodontol 72:512–516. doi:10.1902/jop.2001.72.4.512

    Article  PubMed  Google Scholar 

  36. Chen YT, Wang HL, Lopatin DE, O’Neal R, MacNeil RL (1997) Bacterial adherence to guided tissue regeneration barrier membranes exposed to the oral environment. J Periodontol 68:172–179. doi:10.1902/jop.1997.68.2.172

    Article  PubMed  Google Scholar 

  37. Cortellini P, Clauser C, Prato GP (1993) Histologic assessment of new attachment following the treatment of a human buccal recession by means of a guided tissue regeneration procedure. J Periodontol 64:387–391. doi:10.1902/jop.1993.64.5.387

    Article  PubMed  Google Scholar 

  38. Cortellini P, Pini Prato G, Tonetti MS (1993) Periodontal regeneration of human infrabony defects. II Re-entry procedures and bone measures. J Periodontol 64:261–268. doi:10.1902/jop.1993.64.4.261

    Article  PubMed  Google Scholar 

  39. Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington HV (2009) Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects. A Cochrane systematic review. Eur J Oral Implantol 2:247–266

    PubMed  Google Scholar 

  40. Tonetti MS, Prato GP, Cortellini P (1996) Factors affecting the healing response of intrabony defects following guided tissue regeneration and access flap surgery. J Clin Periodontol 23:548–556

    Article  PubMed  Google Scholar 

  41. Falk H, Laurell L, Ravald N, Teiwik A, Persson R (1997) Guided tissue regeneration therapy of 203 consecutively treated intrabony defects using a bioabsorbable matrix barrier. Clinical and radiographic findings. J Periodontol 68:571–581. doi:10.1902/jop.1997.68.6.571

    Article  PubMed  Google Scholar 

  42. Trombelli L, Kim CK, Zimmerman GJ, Wikesjo UM (1997) Retrospective analysis of factors related to clinical outcome of guided tissue regeneration procedures in intrabony defects. J Clin Periodontol 24:366–371

    Article  PubMed  Google Scholar 

  43. Tonetti MS, Pini-Prato G, Cortellini P (1993) Periodontal regeneration of human intrabony defects. IV. Determinants of healing response. J Periodontol 64:934–940. doi:10.1902/jop.1993.64.10.934

    Article  PubMed  Google Scholar 

  44. Cortellini P, Carnevale G, Sanz M, Tonetti MS (1998) Treatment of deep and shallow intrabony defects. A multicenter randomized controlled clinical trial. J Clin Periodontol 25:981–987

    Article  PubMed  Google Scholar 

  45. Tonetti MS, Cortellini P, Lang NP, Suvan JE, Adriaens P, Dubravec D, Fonzar A, Fourmousis I, Rasperini G, Rossi R, Silvestri M, Topoll H, Wallkamm B, Zybutz M (2004) Clinical outcomes following treatment of human intrabony defects with GTR/bone replacement material or access flap alone. A multicenter randomized controlled clinical trial. J Clin Periodontol 31:770–776. doi:10.1111/j.1600-051X.2004.00562.x

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was partly supported by the Periodontal Research Fund of the Unit of Periodontology at the Eastman Dental Institute, University College London, UK and a Scholarship of The Royal Thai Government. The authors acknowledge support from staff of the Periodontology Unit, Dr Jean Suvan for randomisation processes, Ms Bambai Hirani for chair-side clinical assistance and Ms Donna Moskal-Fritzpatrick for trial coordination.

Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Periodontology Unit, Department of Clinical Research, UCL Eastman Dental Institute, London, UK

    Thanasak Rakmanee, Gareth S Griffiths, Gita Auplish, Ulpee Darbar, Irwin Olsen & Nikolaos Donos

  2. Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand

    Thanasak Rakmanee

  3. School of Clinical Dentistry, University of Sheffield, Sheffield, UK

    Gareth S Griffiths

  4. Biostatistics Unit, UCL Eastman Dental Institute, London, UK

    Aviva Petrie

  5. Department of Periodontology, UCL-Eastman Dental Institute, 256 Gray’s Inn Road, London, WC1X 8LD, UK

    Nikolaos Donos

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  1. Thanasak Rakmanee
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  2. Gareth S Griffiths
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  7. Nikolaos Donos
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Correspondence to Nikolaos Donos.

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Rakmanee, T., Griffiths, G.S., Auplish, G. et al. Treatment of intrabony defects with guided tissue regeneration in aggressive periodontitis: clinical outcomes at 6 and 12 months. Clin Oral Invest 20, 1217–1225 (2016). https://doi.org/10.1007/s00784-015-1608-z

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  • DOI: https://doi.org/10.1007/s00784-015-1608-z

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