Regenerative surgery of intrabony periodontal defects using ePTFE barrier membranes: scanning electron microscopic evaluation of retrieved membranes versus clinical healing.

Sixteen intrabony defects in 12 patients were treated by gingival flap surgery including root surface debridement and placement of an expanded polytetrafluoroethylene (ePTFE) membrane. The membranes were removed after 4 to 6 weeks and examined by scanning electron microscopy (SEM) for bacterial contamination and adherent connective tissue elements. Twelve months postsurgery, the defect sites were reexamined for changes in probing attachment level and probing bone level. Comparison of ultrastructural findings and clinical observations revealed that extent of bacterial contamination of the membrane correlated inversely with clinical assessment of attachment gain. The results indicate that the extent of oral exposure and bacterial contamination of the ePTFE membrane at the time of removal may be an indicator of the long-term success or failure of the regenerative procedure.

Healing of the intrabony periodontal lesion following root conditioning with citric acid and wound closure including an expanded PTFE membrane.

The effect of citric acid conditioning of the root surface in conjunction with gingival flap surgery including barrier membranes (expanded polytetrafluoroethylene) was clinically evaluated in 26 intrabony periodontal defects in 23 patients. Control treatment included gingival flap surgery with barrier membranes alone. Twelve defects were treated with the experimental and 14 with the control protocol. Healing was evaluated 12 months after surgery. Initial probing depths approximated 6.9 mm and defect depths measured during surgery exceeded 4 mm. The patients exhibited good oral hygiene over the study interval as substantiated by low plaque and bleeding scores. Acid conditioning of the root surface did not enhance periodontal healing in this study, similar amounts of defect resolution were observed following either treatment protocol. Probing depth reduction generally approximated 1.8 mm; gain of clinical attachment, 0.8 mm; and defect bone fill, 1.2 mm. Under the prevailing conditions, the barrier membrane procedure apparently gave a healing result beyond which further improvement could not be achieved by root surface conditioning.

Healing after treatment of periodontal intraosseous defects. VI. Factors influencing the healing response.

84 periodontal intraosseous defects treated with mucoperiosteal replaced flap surgery and citric acid root conditioning were used to study the relationships between various defect characteristics and the healing response as expressed by change of probing attachment level, change of probing bone level and residual probing depth. More gains in probing attachment and probing bone levels were observed in deep defects than in shallower lesions. Other defect characteristics showed weak or no correlations to defect fill. The findings of this study seem to indicate that the outcome of treatment of intraosseous defects may be difficult to predict based upon evaluation of defect characteristics.

Significance of probing force for evaluation of healing following periodontal therapy.

The present report compares pre- and postoperative probing pocket depths and probing attachment levels in deep pockets treated non-surgically as well as surgically using probing forces at 0.25 N, 0.50 N and 0.75 N. The results demonstrated that the recorded mean pre- and postoperative probing depths were deeper with increasing probing force. In deep preoperative pockets, the difference amounted to as much as 2.0 mm comparing measurements at 0.25 N and 0.75 N. The use of 0.25 N for evaluation of therapy showed less mean pocket reduction and probing attachment gain than the use of 0.50 N or 0.75 N. Selection of a higher probing force before therapy (i.e. 0.75 N) and a lower force after therapy (i.e. 0.25 N) resulted in increased values for pocket reduction and probing attachment gain compared to use of the same probing force for both pre- and postoperative recordings. The findings emphasize the significance of using a known and standardized probing force for evaluation of results following periodontal therapy.