Periodontal regeneration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs.
J Clin Periodontol
; 44(1): 58-66, 2017 01.
Article
em En
| MEDLINE
| ID: mdl-27736011
ABSTRACT
AIM:
Compare the long-term outcomes and costs of three treatment modalities in intra-bony defects. MATERIALS ANDMETHODS:
Forty-five intra-bony defects in 45 patients had been randomly allocated to receive modified papilla preservation technique with titanium-reinforced expanded-polytetrafluoroethylene (ePTFE) membranes (MPPT Tit, N = 15); access flap with expanded-PTFE membranes (Flap-ePTFE, N = 15) and access flap alone (Flap, N = 15). Supportive periodontal care (SPC) was provided monthly for 1 year, then every 3 months for 20 years. Periodontal therapy was delivered to sites showing recurrences.RESULTS:
Forty-one patients complied with SPC. Four subjects were lost to follow-up. Clinical attachment-level differences between 1 and 20 years were -0.1 ± 0.3 mm (p = 0.58) in the MPPT Tit; -0.5 ± 0.1 mm (p = 0.003) in the Flap-ePTFE and -1.7 ± 0.4 mm (p < 0.001) in the Flap. At 20 years, sites treated with Flap showed greater attachment loss compared to MPPT Tit (1.4 ± 0.4 mm; p = 0.008) and to Flap-ePTFE (1.1 ± 0.4 mm; p = 0.03). Flap group lost two treated teeth. Five episodes of recurrences occurred in the MPPT Tit, six in the Flap-ePTFE and fifteen in the Flap group. Residual pocket depth at 1-year was significantly correlated with the number of recurrences (p = 0.002). Sites treated with flap had greater OR for recurrences and higher costs of re-intervention than regenerated sites over a 20-year follow-up period with SPC.CONCLUSIONS:
Regeneration provided better long-term benefits than Flap no tooth loss, less periodontitis progression and less expense from re-intervention over a 20-year period. These benefits need to be interpreted in the context of higher immediate costs associated with regenerative treatment. These initial observations need to be extended to larger groups and broader clinical settings.Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Periodontite
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Politetrafluoretileno
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Retalhos Cirúrgicos
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Titânio
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Regeneração Tecidual Guiada Periodontal
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Custos e Análise de Custo
Tipo de estudo:
Clinical_trials
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Health_economic_evaluation
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Clin Periodontol
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Itália