Evaluation of Clinical Results of Guided Tissue Regeneration Technique Applied with Two Different Barriers in 5 Years

Abstract

Thirteen subjects were participated whoseages between 20 and 45 in the study. Guided tissueregeneration GTR surgery was performed for 26interproximal intrabony defects. Two similardefects were selected for each patient. A resorbablemembrane manufactured of polylactic and polyglycolic acid Resolut and a non resorbable e-PTFEbarrier Gore-tex were randomly assigned to onedefect in each subject. Non-resorbable e-PTFE membrane wasremoved in 4 - 6 weeks. Plaque index PI , gingivalindex GI , mobility MOB , bleeding on probing BOP , probing pocked depth PD , clinical attachment level CAL , position of gingival margin wererecorded at baseline, and 3, 6, 9, 12, 24, 36., 48. and60. months.The clinical healing was similar in bothgroups. Significant probing depth reduction andgain in clinical attachment levels were observed foreach group. No differences were found between twomaterials. CAL was decreased in long term evaluation. It was concluded that a frequent maintenance protocol is essential for defects that are treated with GTR

Keywords

• periodontal surgery, guided tissueregeneration, barrier membrane, polyglygolicacids, polytetrafluroethylen, clinical trials

FARKLI İKİ YAPIDA MEMBRAN KULLANILARAK GERÇEKLEŞTİRİLEN YÖNLENDİRİLMİŞ DOKU REJENERASYONU TEKNİĞİNİN 5 YILLIK KLİNİK SONUÇLARININ DEĞERLENDİRİLMESİ

Abstract

Yaşları 20 ile 45 arasında değişen, 13 bireyeait, periodontal hastalık nedeni oluşmuş toplam 26 kemik içi defekt, yönlendirilmiş doku rejenerasyonu yöntemi ile tedavi edildi. Ayn› bireyin benzer iki kemik içi defektinden birine rezorbe olabilen glikoid ve laktid kopolimer esasl› Resolut membran, diğerine rezorbe olmayan e-PTFE esasl› Gore-tex membran rasgele seçilerek yerleştirilmiştir. Defekt bölgelerine ait plak indeksi, gingival indeks, sondlamada kanama indeksi, cep derinliği, ataçman seviyesi ve gingival marjin konumlar›n› içeren klinik ölçümler; operasyon öncesinde ve operasyonu takip eden 3., 6., 9., 12., 24., 36., 48. ve 60. aylarda kaydedildi. Resolut ve Gore-tex membran uygulanan gruplarda yap›lan grup içi değerlendirmelerde, her iki grupta da cep derinliğinde istatistiksel olarak anlaml› azalma, ataçman seviyesinde ise kazanç olduğu görüldü. Gruplar birbirleri ile karş›laşt›r›ld›klar›nda ise istatistiksel olarak fark olmad›ğ› görüldü. Çal›şman›n sonucunda, her iki membran›n rejeneratif tedavilerde benzer klinik iyileşme gösterdiğini ve 1. y›l sonunda elde edilen ataçman kazanc›n›n korunamad›ğ›n› görülmüştür. Uzun dönemde başar›l› sonuçlar elde etmek için idame dönemlerinin ve hasta motivasyonunun önemli olduğu düşünülmektedir.

Keywords

• periodontal cerrahi, yönlendirilmiş doku rejenerasyonu, bariyer membran,polilaktik ve poliglikolik asit, politetrafloroetilen,klinik çalışmalar

References

1. Cortellini P, Bowers GM. Periodontal rege- neration of intrabony defects: An evidence-based treatment approach. Int J Periodont Rest Dent 1995; 15: 128-45.
2. Anderegg CR, Metzler DG, Nicoll BK. Gingiva thickness in guided tissue regeneration and associated recession at facial furcation defects. J Periodontol 1995; 66: 397-402.
3. Melcher AH. On the repair potential of the periodontal tissues. J Periodontol 1976; 47: 256-60.
4. Gray JL, Hancock EB. Guided tissue rege- neration. Nonabsorbable barriers. Dent Clin North Am 1998; 42: 523-41.
5. Cortellini P, Pini Prato G, Tonetti MS. Periodontal regeneration of human intrabony defects. J Clin Periodontol 1993; 11: 254-60.
6. Becker W, Becker BE. Clinical applications of guided tissue regeneration: surgical considera- tions. Periodontology 2000 1993; 1: 46-53.
7. Murphy KG. Postoperative healing compli- cations associated with Gore-tex periodontal materal. Part II. Effect of complications on regeneration. Int J Periodont Rest Dent 1995; 15: 549-61.
8. Minabe M. A critical review of the biologic rationale for guided tissue regeneration. J Periodontol 1991; 62: 171-9.

9. Ponteriero R, Lindhe J, Nyman S. Guided tis- sue regeneration in treatment of furcation defects in mandibular molars. J Clin Periodontol 1989; 16: 170-4.
10. Selvig KA, Kersten BG, Wikesjo UM. Surgical treatment of intrabony periodontal defects using expanded polytetrafluoroethylene barrier membranes: influence of defect configuration on healing response. J Periodontol 1993; 64: 730-3.
11. Flores-de-Jacoby L, Zimmermann A, Tsalikis L. Experiences with guided tissue regenera- tion in the treatment of advanced periodontal disease. A clinical re-entry study. Part I. Vertical, horizontal and horizontal periodontal defects. J Clin Periodontol 1994; 21: 113-7.
12. Cortellini P, Pini Prato G, Tonetti MS. Periodontal regeneration of human intrabony defects with bioabsorbable membranes. A controlled clinical trail. J Periodontol 1996; 67: 217-23.
13. Persson GR, Falk H, Laurell L. A ret- rospective radiographic outcome assessment study of intra-bony defects treated by osseous surgery or by bone graft procedures. J Clin Periodontol 2000; 27: 104-8.
14. Mattson JS, Gallagher SJ, Jabro MH. The use of 2 bioabsorbable barrier membranes in the treatment of interproximal intrabony periodontal defects. J Periodontol 1999; 70: 510-7.
15. Caton J, Greenstein G, Zappa U. Synthetic bioabsorbable barrier for regeneration in human peri- odontal defects. J Periodontol 1994; 65: 1037-45.
16. Caffesse RG, Nasjleti CE, Morrison EC, Sanchez R. Guided tissue regeneration: comparison of bioabsorbable and non-bioabsorbable membranes. Histologic and histometric study in dogs. J Periodontol 1994; 65: 583-91.
17. Cortellini P, Paolo G, Prato P, Tonetti MS. Pini Prato G, Tonetti MS. Long term stability of cli- nical attachment following guided tissue regenera- tion and conventional therapy. J Clin Periodontol 1996; 23: 106-11.
18. Wang HL, Mac Neil L. Guided tissue regeneration. Dent Clin of North Am 1998; 3: 505- 22.
19. Reddy MS, Jeffcoat MK. Methods of assessing periodontal regeneration. Periodontol 2000. 1999; 19: 87-103.
20. Sanz M, Zabalegui I, Villa A, Sicilia A. Guided tissue regeneration in human Class II furca- tions and interproximal infrabony defects after using a bioabsorbable membrane barrier. Int J Periodontics Restorative Dent 1997; 17: 562-73.
21. Weltman R, Trejo PM, Morrison E, Caffesse R. Assessment of guided tissue regenera- tion procedures in intrabony defects with bio- absorbable and non-resorbable barriers. J Periodontol 1997; 68: 582-90.
22. Weigel C, Bragger U, Hammerle CH, Mombelli A, Lang NP. Maintenance of new attach- ment 1 and 4 years following guided tissue regene- ration (GTR). J Clin Periodontol. 1995; 22: 661-9.
23. Christgau M, Bader N, Schmalz G, Hiller KA, Wenzel A. Postoperative exposure of biore- sorbable GTR membranes: effect on healing results. Clin Oral Investig 1997; 1: 109-18.