Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: subtraction radiography outcomes, prognostic variables, and patient morbidity

• Published in: Clinical oral investigations Vol. 23; no. 7; pp. 3005 - 3020
• Main Authors: Górski, Bartłomiej, Jalowski, Stanisław, Górska, Renata, Zaremba, Maciej
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2019; Springer Nature B.V
• Subjects: Aggressive Periodontitis - diagnostic imaging; Aggressive Periodontitis - therapy; Alveolar Bone Loss; Bone density; Bone grafts; Bone growth; Collagen; Defects; Dentistry; Edema; Follow-Up Studies; Guided Tissue Regeneration, Periodontal; Gum disease; Humans; Medicine; Membranes, Artificial; Morbidity; Morphology; Multivariate analysis; Original; Original Article; Osteogenesis; Pain; Patients; Periodontal Attachment Loss; Periodontitis; Prognosis; Radiography; Radiography - methods; Regeneration; Subtraction Technique; Treatment Outcome; Xenografts; Periodontal regeneration; Digital subtraction radiography; Intrabony defect; Aggressive periodontitis
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-018-2712-7

Objectives The main objectives of this study were (1) to evaluate bone/graft density alterations by digital subtraction radiography; (2) to determine factors associated with favorable clinical and radiographic outcomes, and (3) to report on patient morbidity after guided tissue regeneration (GTR) in aggressive periodontitis (AgP) patients. Materials and methods Adapting a split-mouth design, 30 comparative intrabony defects in 15 patients were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). The time period of observation was 12 months. Results There were significant improvements in clinical and radiographic parameters within each group, without intergroup differences. However, higher PPD reduction for three-wall defects was noted in MPM sites (5.22 versus 3.62 mm; p  = 0.033). Moreover, a significant gain in bone/graft density of 4.9% from 6 to 12 months post-operatively was observed in test sites. Multivariate analysis demonstrated that morphology of intrabony defects was a predictor of CAL gain ( p  = 0.06), while independent prognostic variables effecting changes in bone/graft density were radiographic defect depth ( p  = 0.025) and radiographic angle ( p  = 0.033). The majority of patients reported some discomfort, pain, and edema with mild intensity without any significant differences between treatment modalities. Conclusions This study demonstrated enhanced bone/graft density gain after GTR with MPM, which may indicate greater area of new bone formation. Independent variables effecting treatment outcomes were intrabony defect morphology, radiographic defect depth, and radiographic angle. Clinical relevance This study supports the regenerative treatment of intrabony defects in AgP patients and identifies some variables with prognostic value.