EVALUATION OF CLINICAL AND RADIOGRAPHIC EFFECTS OF A GRAFT MATERIAL INCLUDING DEMINERALIZED BONE MATRIX AND CALCIUM SULFATE COMBINATION IN THE TREATMENT OF PERIODONTAL INTRABONY DEFECTS OF CHRONIC PERIODONTITIS PATIENTS: CASE SERIES

Abstract

The present study aims to assess the clinical and radiographic effects of a graft material including demineralized bone matrix (DBM) and calcium sulfate (CS) combination in the treatment of the periodontal intrabony defects of chronic periodontitis patients. Thirty-one intrabony defects with an associated probing depth (PD) of ≥6 mm and an intrabony component of ≥4 mm were surgically treated in 13 patients with the mean age of 43.6 ± 3.18 after completion of non-surgical periodontal therapy. Prior to surgical treatment and at 12 months, plaque index, sulcus bleeding index, marginal recession, PD, relative attachment level, relative bone level and radiographic bone level were assessed. At 12 months postoperatively, favourable clinic outcomes in soft and hard tissue measurements were achieved when compared to baseline (p<0,001). Considering the deepest site of the defects, 3.84 ± 1.19 mm of PD reduction, 1.06 ± 0.51 mm of recession, 2.81 ± 0.98 mm of attachment gain, 2.58 ± 0.76 mm of clinical bone gain and 2.35 ± 1.05 mm of radiographic bone gain were obtained. These results suggest that this combination is promising for clinical and radiographic improvements and may be an alternative in the periodontal regenerative treatment of intrabony defects in chronic periodontitis patients. 

Keywords

• Demineralized bone matrix
• Calcium sulfate
• Intrabony defect
• Chronic periodontitis

DEMİNERALİZE KEMİK MATRİKSİ VE KALSİYUM SÜLFAT KOMBİNASYONUNUN KRONİK PERİODONTİTİSLİ HASTALARDAKİ KEMİK İÇİ DEFEKTLERİN TEDAVİSİNDE KULLANIMININ KLİNİK VE RADYOGRAFİK OLARAK İNCELENMESİ: OLGU SERİSİ

Abstract

Bu çalışmada demineralize kemik matriksi (DKM) ve kalsiyum sülfat (KS) içeren bir greft materyalinin kronik periodontitisli bireylerdeki kemik içi defektlerin tedavisinde kullanımının klinik ve radyografik olarak incelenmesi amaçlanmıştır. Çalışmaya, başlangıç periodontal tedavisi tamamlanmış, yaş ortalaması 43.6 ± 3.18 olan 13 hastaya ait sondalanabilir cep derinliği (SCD) ≥ 6 mm ve kemik içi defekt derinliği ≥ 4 mm olan toplam 31 kemik içi defekt dahil edildi. Defektlere DKM ve KS karışımı içeren macun kıvamında bir greft materyali uygulandı. Operasyondan önce ve operasyondan 12 ay sonra plak indeksi, dişeti oluğu kanama indeksi, rölatif dişeti kenarı konum seviyesi, SCD rölatif kemik seviyesi ve radyografik kemik seviyesi ölçümleri yapıldı. Onikinci ayda yapılan değerlendirmelerde defektin en derin noktası gözönüne alındığında, 3.84 ± 1.19 mm SCD azalması, 1.06 ± 0.51 mm dişeti çekilmesi, 2.81 ± 0.98 mm ataşman kazancı, 2.58 ± 0.76 mm klinik kemik kazancı ve 2.35 ± 1.05 mm radyografik kemik kazancı ile başlangıca göre anlamlı klinik iyileşme saptandı (p < 0,001). Bu bulgular uygulanan greft materyalinin klinik ve radyografik olarak anlamlı düzeyde ataşman ve kemik kazancı sağladığını ve kronik periodontitisli bireylerdeki kemik içi defektlerin tedavisinde kullanılabileceğini düşündürmektedir.

Keywords

• Demineralize kemik matriksi
• Kalsiyum sülfat
• Kemik içi defekt
• Kronik periodontitis

References

1. 1. Cortellini P, Bowers GM. Periodontal regeneration of intrabony defects: An evidencebased treatment approach. Int J Periodontics Restorative Dent, 1995; 15: 128-45.
2. 2. Garrett JS. Periodontal regeneration around natural teeth. Ann Periodontol, 1996; 1: 621-66.
3. 3. Aichelmann-Reidy ME, Reynolds MA. Predictability of clinical outcomes following regenerative therapy in intrabony defects. J Periodontol, 2008; 79: 387-93.
4. 4. Urist MR, Sato K, Brownell TI. Human bone morphogenetic protein (h BMP). Proc Soc Exp Biol Med, 1983; 173: 194-7.
5. 5. Yamazaki Y, Oida S, Akimoto Y. Response of mouse femoral muscle to an implant of a composite of bone morphogenetic protein and plaster of Paris. Clin Orthop, 1988; 234: 240-9.
6. 6. Sottosanti JS. Calcium sulfate aided bone regeneration: A case report. J Clin Invest, 1995; 2: 10-5.
7. 7. Kim CK, Chai JK, Cho KS, Moon IS, Choi SH, Sottosanti JS. Wikesjö UM. Periodontal repair in intrabony defects treated with a calcium sulfate implant and calcium sulfate barrier. J Periodontol, 1998; 12: 1317-24.
8. 8. Faizal A, Halim AS, Najihah ZS, Ibrahim M, Jafri A. Combination of vascularized outertable calvarial bone graft based on the superficial temporal vessels and allomatrix for the repair of an orbito-frontal blow-out fracture in child. J Cranio-Maxillofac Surg, 2005; 33: 326-30.

9. 9. Turner MT, Urban RM, Hall DJ, Cheema N, Lim TH. Restoration of large bone defects using a hard-setting, injectable putty containing demineralized bone particles compared to cancellous autograft bone. Orthopedics, 2003; 26: 561-5.
10. 10. Wilkins MR, Kelly CM. The effect of allomatrix injectable putty on the outcome of long bone applications. Orthopedics, 2003; 26: 567-70.
11. 11. Armitage GC. Development of classification system for periodontal diseases and conditions. Ann Periodontol, 1999; 4: 1-6.
12. 12. Boyan DB, Ranly MD, McMillan J, Sunwoo M, Roche K, Schwartz Z. Osteoinductive ability of human allograft formulations. J Periodontol, 2006; 77: 1555-63.
13. 13. Urist MR, Strates B. Bone formation in implants of partially and wholly demineralized bone matrix. Clin Orthop, 1970; 71: 271-3.
14. 14. Francis RM, Brunsvold MA, Prewett AB, Mellonig JT. Clinical evaluation of an allogenic bone matrix in the treatment of periodontal osseous defects. J Periodontol, 1995; 66: 1074- 9.
15. 15. Mellonig JT. Decalcified freeze-dried bone allografts as an implant material in human periodontal defects. Int J Periodontics Restorative Dent, 1984; 4: 41-55.
16. 16. Pearson GE, Rosen S, Deporter DA. Preliminary observations on the usefulness of a decalcified, freeze-dried cancellous bone allograft material in periodontal surgery. J Oral Surg, 1981; 52: 55-9.
17. 17. Quintero G, Melloning JT, Gambill VM, Pelleu GB. A six-month clinical evaluation of decalcified freeze-dried bone allografts in periodontal osseous defects. J Periodontol, 1982; 53: 726-30.
18. 18. Marby TW, Yukna RA, Sepe WW. Freezedried bone allografts combined with tetracyline in the treatment of juvenile periodontitis. J Periodontol, 1985; 56: 74-81.
19. 19. Sanders JJ, Sepe WW, Bowers GM, Koch RW, Willams JE, Lekas JS, Melloning JT, Pellen GS, Gambill V. Clinical evaluation of freezedried bone allografts in periodontal osseous defects. Part III. Composite freeze-dried bone allografts with and without autogenous bone grafts. J Periodontol, 1983; 54: 1-8.
20. 20. Yukna RA, Sepe WW. Clinical evaluation of localized periodontosis defects with freezedried bone allografts combined with local and systemic tetracyclines. Int J Periodontics Restorative Dent, 1982; 2: 8-21.
21. 21. Bender SA, Rogalski JB, Millis MP, Arnold RM, Cochran DL, Melloning JT. Evaluation of demineralized bone matrix paste and putty in periodontal intraosseous defects. J Periodontol, 2005; 76: 768-77.
22. 22. Bowers GM, Granet M, Stevens M, Emerson J, Corio R. Histologic evluation of new attachment in humans. A preminary report: J Periodontol, 1985; 56: 381-96.
23. 23. Mellonig JT. Histologic evaluation of an allogenic bone matrix for the treatment of periodontal osseous defects. Int J Perodontics Restorative Dent, 2006; 6: 561-9.
24. 24. Mellonig JT, Bowers GM, Bailey RC. Comparison of bone graft materials. Part I. New bone formation with autografts and allografts determined by Strontium-85. J Periodontol, 1981; 52: 291-6.
25. 25. Schwarz Z, Mellonig JT, Carnes DL. Ability of commercial demineralized freeze-dried bone allograft to induce new bone formation. J Periodontol, 1996; 67: 918-26.
26. 26. Aichelmann-Reidy ME, Heath C, Reynolds MA. Clinical evaluation of calcium sulfate in combination with demineralized freeze-dried bone allograft for the treatment of human intraosseous defects. J Periodontol, 2004; 75: 340-7.
27. 27. Harris RJ. Clinical evaluation of a composite bone graft with a calcium sulfate barrier. J Periodontol, 2004; 75: 685-92.
28. 28. Becker W, Becker BE. Periodontal regeneration: A contemporary reevaluation. Periodontol 2000, 1999; 19: 104-14.
29. 29. Trombelli L, Farina R. Clinical outcomes with bioactive agents alone or in combination with grafting or guided tissue regeneration. J Clin Periodontol, 2008; 8: 117-35.
30. 30. Yılmaz S, Çakar G, Kuru B, Dirikan S, Yıldırım B. Platelet-rich plasma in combination with bovine derived xenograft in the treatment of deep intrabony periodontal defects: a report of 20 consecutively treated patients. Platelets, 2009; 6: 432-40.
31. 31. Hoidal MJ, Grimard BA, Mills MP, Schoolfield JD, Mellonig JT, Mealey BL. Clinical evaluation of demineralized freeze-dried bone derivative for the treatment of periodontal osseous defects in humans. J Periodontol, 2008; 79: 2273-80.
32. 32. Sculean A, Chiantella GC, Arweiler NB, Becker J, Schwartz F, Stravropoulos A. Clinical and histologic evaluation of an enamel matrix derivative combined with a biphasic calcium phosphate for the treatment of human intrabony periodontal defects. Int J Periodontics Restorative Dent, 2008; 28: 153-61.