A technique is presented for treating periodontal osseous defects. Medical grade calcium sulfate hemihydrate is used as both a component of a composite graft with demineralized freeze-dried bone allograft (DFDBA) and a barrier over the graft to contain it and to exclude unwanted soft tissue. A case report is presented demonstrating clinical and radiographic success using the technique in the resolution of a severe osseous defect on a maxillary lateral incisor.
Clinical effects of root surface demineralization during flap surgery were evaluated in ten patients with rapidly progressive periodontitis. Following initial periodontal therapy, flap surgery was conducted on the anterior segments. Test sites received conditioning with tetracycline solution for 5 minutes, whereas control sites were only rinsed with sterile saline solution. Following either treatment, improvement was observed on all clinical measures. However, apart from gingival index assessments, there was not a statistically significant difference in the improvement observed between test and control groups; the only significant difference was observed in gingival index scores at the second and fourth weeks. These differences in gingival index, which are not reflected in plaque index scores, imply that tetracycline has been absorbed on root surfaces and released in biologically active form for up to 4 weeks; but attachment level measurements demonstrate that tetracycline conditioning of the root surfaces during flap surgery has no additional regenerative benefit, or at least none detectable by clinical means.
The principle of guided tissue regeneration using barrier membranes has become an accepted method for the treatment of teeth with severe osseous defects and furcation involvement. A technique was developed using an expanded polytetrafluoroethylene soft-tissue patch, 1 mm thick (W.L. Core and Assoc., Flagstaff, AZ), in conjunction with an alloplast hydroxyapatite bone substitute (HA-500, 40-60 mesh) (Orthomatrix, Minneapolis, MN), for space maintenance in severe osseous defects. A case report is presented which demonstrates the successful use of this method, and includes a fourth-year re-entry procedure that illustrates the complete bone fill and obturation of a severe vertical defect and Class II furcation of a mandibular first molar.
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