Surgical treatment of intrabony periodontal defects using expanded polytetrafluoroethylene barrier membranes: influence of defect configuration on healing response.

Twenty-six proximal, intrabony periodontal defects with probing depths equal to or exceeding 6 mm in 23 patients were treated with gingival flap surgery supported by an expanded polytetrafluoroethylene barrier membrane. The material included 1, 2, and 3-wall defects with crestal involvement relative to the root circumference ranging between 90 degrees and 270 degrees. Healing was evaluated clinically 12 months after surgery. Deep defects exhibited greater probing depth reduction and attachment gain than shallower defects. Probing depth reduction, attachment gain, and bone fill were positively correlated to the depth of the 3-wall intrabony component of the defect. The extent of crestal involvement, and wall form in the fundus of the defect did not appear to influence the healing response. The treatment also affected the proximal surface of the defect-adjacent tooth, which showed some reduction in bone level as well as gingival recession. Thus, the overall healing pattern following barrier membrane-supported flap surgery appears similar to that generally observed for conventional reconstructive flap surgery in intrabony periodontal defects.

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.