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PAL Gain (pal + gain)

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Medical Sciences	100%

Selected Abstracts

Long-term stability of periodontal conditions achieved following guided tissue regeneration with bioresorbable membranes: case series results after 6,7 years

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 11 2004
Andreas Stavropoulos
Abstract Objectives: To evaluate the results of guided tissue regeneration (GTR) treatment of intrabony defects with bioresorbable membranes after 6,7 years, and to disclose factors that may influence the long-term outcome of the treatment. Methods: Twenty-five defects in 19 patients were treated by means of polylactic acid/citric acid ester copolymer bioresorbable membranes. At baseline and after 1 and 6,7 years, the following parameters were recorded: (1) probing pocket depth (PPD), (2) gingival recession (REC), (3) probing attachment level (PAL)=PPD+REC, (4) presence/absence of plaque (PI), (5) presence/absence of bleeding on probing (BOP). Smoking habits and frequency of dental-control visits were also recorded. Significance of differences between categorical variables was evaluated with McNemar's test, and between numerical variables with the t -test for paired observations. Generalized linear models were constructed to evaluate the influence of various factors on PAL gain and PPD changes from 1 to 6,7 years. Association of smoking, frequency of dental controls, oral hygiene, and BOP with sites losing 2 mm in PAL was evaluated with Fisher's exact test. Results: At baseline, a mean PPD of 8.7±1.1 mm and a mean PAL of 9.8±1.5 mm was recorded. Statistically significant clinical improvements were observed at 1 and 6,7 years after GTR treatment. An average residual PPD of 3.8±1.1 mm and a mean PAL gain of 3.8±1.4 mm were observed after 1 year. After 6,7 years the corresponding values were 4.7±1.3 and 3.6±1.4 mm, respectively. There were no statistically significant differences between the 1- and the 6,7-year values. At the 6,7-year control, only 16% of the sites had lost 2 mm (maximum 3 mm), of the PAL gain obtained 1 year after GTR treatment. None of the sites had lost all of the attachment gained 1 year after treatment. Smoking, frequency of dental controls, oral hygiene, and BOP did not seem to influence the change of PPD and PAL gain, or the stability of PAL gain (i.e. losing PAL or not) from 1 to 6,7 years from treatment. Conclusion: Clinical improvements achieved by GTR treatment of intrabony defects by means of bioresorbable membranes can be maintained on a long-term basis. [source]

Deproteinized bovine bone and gentamicin as an adjunct to GTR in the treatment of intrabony defects: a randomized controlled clinical study

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2003
A. Stavropoulos
Abstract Objectives: To evaluate whether Bio-Oss® used as an adjunct to guided tissue regeneration (GTR) improves the healing of 1- or 2-wall intrabony defects as compared with GTR alone, and to examine whether impregnation of Bio-Oss® with gentamicin may have an added effect. Material and methods: Sixty patients, with at least one interproximal intrabony defect with probing pocket depth (PPD) 7 mm and radiographic evidence of an intrabony component (IC) 4 mm, were treated at random with either a resorbable membrane (GTR), a resorbable membrane in combination with Bio-Oss® impregnated with saline (DBB,), a resorbable membrane in combination with Bio-Oss® impregnated with gentamicin (DBB+), or with flap surgery (RBF). Results: All treatment modalities resulted in statistically significant clinical improvements after 1 year. Defects treated with GTR alone presented a probing attachment level (PAL) gain of 2.9 mm, a residual PPD (PPD12) of 4.9 mm, a radiographic bone level (RBL) gain of 3.1 mm, and a residual IC (IC12) of 2.7 mm. GTR combined with Bio-Oss® did not improve the healing outcome (PAL gain: 2.5 mm; PPD12: 4.9 mm; RBL gain: 2.8 mm; IC12: 3.3 mm). Impregnation of the Bio-Oss® with gentamicin 2% mg/ml resulted in clinical improvements (PAL gain: 3.8 mm; PPD12: 4.2 mm; RBL gain: 4.7 mm; IC12: 2.1 mm), superior to those of the other treatment modalities, but the difference was not statistically significant. Defects treated with only flap surgery showed the most inferior clinical response (PAL gain: 1.5 mm; PPD12: 5.1 mm; RBL gain: 1.2 mm; IC12: 4.2 mm) of all groups. Conclusion: The results failed to demonstrate an added effect of Bio-Oss® implantation in combination with GTR on the healing of deep interproximal 1- or 2-wall, or combined 1- and 2-wall intrabony defects compared with GTR alone. Local application of gentamicin, on the other hand, improved the treatment outcome but not to an extent that it was statistically significant. Zusammenfassung Von Proteinen befreiter boviner Knochen und Gentamycin als Adjuvans der GTR bei der Behandlung von infraalveolären Knochentaschen. Eine randomisierte kontrollierte klinische Studie. Ziele: Die Evaluation ob, Bio-Oss® welches als Adjuvans zur GTR verwendet wird, die Heilung von 1- oder 2-wandigen Knochentaschen im Vergleich zu alleiniger GTR verbessert. Sowie die Untersuchung, ob die Imprägnierung von Bio-Oss® mit Gentamycin einen zusätzlichen Effekt haben könnte. Material und Methoden: 60 mit wenigstens einer approximalen Knochentasche mit Sondierungstiefe (PPD) ,7 mm und röntgenologischem Nachweis einer infraalveolären Komponente (IC) von ,4 mm, wurden randomisiert entweder mit einer resorbierbaren Membran (GTR), einer resorbierbaren Membran in Kombination mit Bio-Oss® welche mit Kochsalzlösung imprägniert war (DBB-), einer resorbierbaren Membran in Kombination mit Bio-Oss® welche mit Gentamycin imprägniert war (DBB+) oder mit Lappen-OP (RPF) behandelt. Ergebnisse: Nach einem Jahr hatten alle Behandlungsweisen eine statistisch signifikante klinische Verbesserung zum Ergebnis. Defekte, die mit alleiniger GTR behandelt wurden zeigten einen Gewinn an klinischem Attachmentniveau (PAL) von 2,9 mm, einer PPD (PPD12) von 4,9 mm, einem Gewinn an röntgenologischem Knochenniveau (RBL) von 3,1 mm und einer IC (IC12) von 2,7 mm. GTR in Kombination mit Bio-Oss® verbesserte das Ergebnis der Heilung nicht (PAL Gewinn: 2,5 mm; PPD12: 4,9; RBL Gewinn: 2,8 mm; IC12: 3,3 mm). Die Imprägnierung von Bio-Oss® mit Gentamycin 2% mg/ml hatte klinische Verbesserungen zum Ergebnis (PAL Gewinn: 3,8 mm; PPD12: 4,2 mm; RBL Gewinn: 4,7 mm; IC12: 2,1 mm), die größer waren als die der anderen Behandlungsweisen, jedoch waren die Unterschiede nicht statistisch signifikant. Defekte, die nur mit Lappen-OP behandelt wurden zeigten das schlechteste klinische Ergebnis von allen Gruppen (PAL Gewinn: 1,5 mm; PPD12: 5,1 mm; RBL Gewinn: 1,2 mm; IC12: 4,2 mm). Schlussfolgerung: Die Ergebnisse konnten im Vergleich mit alleiniger GTR keinen zusätzlichen Effekt der Bio-Oss®-Implantation in Kombination mit GTR hinsichtlich der Heilung von tiefen approximalen 1- oder 2-wandigen oder kombinierten 1- oder 2-wandigen Knochentaschen aufzeigen. Auf der anderen Seite verbessert die lokale Applikation von Gentamycin das Behandlungsergebnis, jedoch war das Ausmaß nicht statistisch signifikant. Résumé Os bovin déprotéiné et gentamicine comme adjuvant à la RTG pour le traitement des lésions intra-osseuses. Une étude clinique contrôlée et randomisée. Objectifs: Evaluer si Bio-Oss® utilisé comme adjuvant de la RTG améliore la cicatrisation des lésions intra-osseuses par rapport à la RTG seule et examiner si l'imprégnation de Bio-Oss® avec de la gentamicine pourrait avoir un effet supplémentaire. Matériels et Méthodes: 60 patients, présentant au moins une lésion intra-osseuse interproximale avec une profondeur de poche au sondage (PPD) ,7 mm et la présence avérée radiologiquement d'une composante intra-osseuse (IC) ,4 mm, ont été traités au hasard avec soit une membrane résorbable (GTR), une membrane résorbable en combinaison avec du Bio-Oss® imprégné de solution saline (DBB-), une membrane résorbable en combinaison avec du Bio-Oss® imprégné de gentamicine (DBB+), ou par chirurgie à lambeau (RBF). Résultats: Toutes les modalités de traitement entraînaient des améliorations cliniques significatives statistiquement après un an. Les lésions traitées par RTG seule présentaient un gain d'attache de 2.9 mm, une PPD résiduelle (PPD12) de 4.9 mm, un gain de niveau osseux radiographique (RBL) de 3.1 mm, et un IC résiduel (IC12) de 2.7 mm. La RTG combinée avec le Bio-Oss® n'améliorait pas le devenir de la cicatrisation. (gain de PAL: 2.5 mm; PPD12: 4.9; gain de RBL: 2.8 mm; IC12: 3.3 mm). L'imprégnation du Bio-Oss®avec la gentamicine (2% mg/ml) apportait des améliorations cliniques (gain de PAL: 3.8 mm; PPD12: 4.2 mm; gain de RBL: 4.7 mm; IC12: 2.1 mm), supérieurs à ceux des autres modalités de traitement, mais la différence n'était pas significative. Le traitement des lésions par lambeaux seulement entraînait la réponse clinique la moins bonne (gain de PAL: 1.5 mm; PPD12: 5.1 mm; gain de RBL: 1.2 mm; IC12: 4.2 mm). Conclusion: Ces résultats ne pouvaient démontrer un effet supplémentaire, sur la cicatrisation de lésions profondes interproximales avec une ou deux parois, de l'implantation de Bio-Oss® en combinaison avec la RTG par rapport à la RTG seule. L'application locale de gentamicine, par contre, améliorait le devenir du traitement mais pas suffisamment pour être statistiquement significatif. [source]

Comparison of infrabony defects treated with enamel matrix derivative versus guided tissue regeneration with a nonresorbable membrane

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2003
A multicenter controlled clinical trial
Abstract Aim: The purpose of the present multicenter clinical trial was to compare the efficacy of two different procedures in the treatment of infrabony defects: guided tissue regeneration (GTR) with nonresorbable membranes and enamel matrix derivative (EMD). Material and methods: Six centers participated in this study. Ninety-eight patients with an interproximal infrabony defect were selected. All patients were treated with an initial phase of scaling and root planing, and at the study's baseline the selected defects presented a value of probing depth (PD) ,6 mm with an infrabony component ,4 mm. Forty-nine patients were treated with GTR procedures (using ePTFE membranes (Gore-Tex W.L. Gore and Associates, Flagstaff, AZ, USA)) and forty-nine with EMDs (Emdogain® (Û Biora AB Malm, Sweden)). The efficacy of each treatment modality was investigated through covariance analysis. Results: The patients were reevaluated at one year postop. Probing attachment level (PAL) gain and PD reduction were analyzed. In the Emdogain® group the PAL before surgery (PAL 0) and the PD before surgery (PD 0) were respectively 9.9±1.4 and 8.5±1.6 mm. The PAL gain and the PD reduction at 1 year postsurgery were respectively 4.1±1.8 and 5.3±1.9 mm. The group of patients treated with membranes showed that PAL 0 and PD 0 were respectively 8.9±1.9 and 8.1±1.9. The PAL gain was 4.3±1.9 mm and the PD reduction was 5.6±1.5 mm. The mean PAL gain expressed by percentage (PAL gain/PAL 0) for the group treated with EMD was 41%, while it was 48% for the group treated with GTR. Results from our analysis suggest that there is no statistically significant difference between GTR and EMD treatments in terms of PAL gain, PD reduction and recession variation. Applying the regression model to a group of patients with a PAL 0 ,8 mm, we observed a better clinical outcome in terms of PAL gain (difference of 0.3 mm) in patients treated with the GTR procedure compared to those treated with EMD. Covariance analysis showed a strong correlation in both groups of patients between PAL gain and full mouth bleeding score, and between PAL gain and defect morphology and depth. Zusammenfassung Ziel: Der Zweck der vorliegenden klinischen Multicenterstudie war der Vergleich der Effektivität von zwei unterschiedlichen Prozeduren in der Behandlung von intraalveolären Defekten: gesteuerte Geweberegeneration (GTR) mit nicht resorbierbaren Membranen und Schmelz-Matrix-Derivaten (EMD). Material und Methoden: Sechs Zentren nahmen an der Studie teil. 98 Patienten mit approximalen intraalveolären Defekten wurden ausgesucht. Alle Patienten wurden in der initialen Phase mit Wurzelreinigung und ,glättung behandelt, und zur Basis der Studie zeigten die ausgewählten Defekte Sondierungstiefen von 6 mm mit einem intraalveolären Anteil von 4 mm. 49 Patienten wurden mit dem GTR Verfahren (unter Nutzung einer e-PTFE Membran1) und 49 Patienten mit den Schmelz-Matrix-Derivaten (Emdogain®2) behandelt. Die Effektivität von jeder Behandlungsvariante wurde mit der Kovarianzanalyse untersucht. Ergebnisse: Die Patienten wurden 1 Jahr nach der Operation reevaluiert. Die Veränderungen des Stützgewebeniveaus (PAL) und die Reduktion der Sondierungstiefen (PD) wurden analysiert. In der Emdogain® Gruppe betrugen die PAL (PAL 0) und die PD (PD 0) vor der Chirurgie 9,9±1,4 mm und 8,5±1,6 mm. Der PAL Gewinn und die PD Verringerung nach einem Jahr postoperativ waren 4,1±1,8 mm und 5,3±1,9 mm. Die Gruppe der Patienten, die mit Membranen behandelt worden waren, zeigten Werte von PAL 0 und PD 0 von 8,9±1,9 mm und 8,1±1,9 mm. Der PAL Gewinn betrug 4,3±1,9 mm und die PD Reduktion 5,6±1,5 mm. Der mittlere PAL Gewinn in Prozent (PAL Gewinn/PAL 0) für die EMD-Gruppe war 41%, während er für die GTR-Gruppe 48 % betrug. Die Ergebnisse unserer Analyse zeigen, dass keine statistisch signifikante Differenz zischen GTR und EMD Behandlungen in Bezug auf PAL Gewinn, PD Reduktion und REC Veränderung bestand. Unter Nutzung der Regressionsanalyse für eine Gruppe mit PAL 0 ,8 mm beobachteten wir ein besseres klinisches Ergebnis bezüglich des PAL Gewinns (Differenz 0,3 mm) bei GTR-Patienten verglichen mit EMD-Patienten. Die Kovarianzanalyse zeigte eine starke Korrelation in beiden Patientengruppen zwischen PAL Gewinn und dem vollständigen Blutungsindex (FMBS) sowie zwischen PAL Gewinn und Morphologie und Tiefe des Defektes. Résumé Le but de cet essai clinique multicentrique a été de comparer l'efficacité de deux processus différents dans le traitement des lésions intraosseuses : la régénération tissulaire guidée (GTR) avec des membranes non-résorbables et les dérivés de la matrice amélaire (EMD). Six centres ont participéà cette étude. Nonante-huit patients avec une lésion intraosseuse interproximale ont été sélectionnés. Tous ont été traités par une phase initiale de détartrage et surfaçage, et au début de l'étude les lésons sélectionnées avaient une profondeur de poche de 6 mm (PD) avec un composant infraosseux ,4 mm. Quarante-neuf patients ont été traités par GTR en utilisant une membrane en téflon et 49 par EMD (Emdogain®2). L'efficacité de chaque traitement a étéétudiée par l'analyse de co-variance. Les patients ont été réévalués un an après l'opération. Le gain du niveau d'attache au sondage (PAL) et la réduction de PD ont été analysés. Dans le groupe EMD, le PAL et le PD présents avant la chirurgie, (PAL 0) et (PD 0), étaient respectivement de 9,9±1,4 mm et de 8,5±1,6 mm. Le gain PAL et la réduction de PD après une année étaient respectivement de 4,1±1,8 mm et 5,3±1,9 mm. Le groupe de patients traités avec les membranes accusaient un PAL 0 et un PD 0 qui étaient respectivement de 8,9±1,9 mm et de 8,1±1,9 mm. Le gain PAL était de 4,3±1,9 mm après une année tandis que la réduction PD était de 5,6±1,5 mm. Le gain PAL moyen exprimé en pourcentage (gain PAL/PAL 0) pour le groupe traité avec EMD était de 41% tandis qu'il était de 48 % dans le groupe traité par GTR. Les résultats de cette analyse suggèrent qu'il n'y a aucune différence statistique entre les traitements GTR et EMD en terme de gain PAL, de réduction PD et dans le changement de récession. Lors de l'utilisation du modèle de régression sur un groupe de patients avec un PAL 0 ,8 mm, une guérison clinique supérieure était observée dans le gain PAL (différence de 0,3 mm) chez les patients traités avec GTR comparés à ceux traités par EMD. L'analyse de co-variance montrait une relation importante dans les deux groupes de patients entre le gain PAL et le score de saignement de l'ensemble de la bouche, et entre le gain PAL et la morphologie de la lésion et sa profondeur. [source]

Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects

AUSTRALIAN DENTAL JOURNAL, Issue 1 2010
M Esposito
Background:, Periodontitis is a chronic infective disease of the gums caused by bacteria present in dental plaque. This condition induces the breakdown of the tooth supporting apparatus until teeth are lost. Surgery may be indicated to arrest disease progression and regenerate lost tissues. Several surgical techniques have been developed to regenerate periodontal tissues including guided tissue regeneration (GTR), bone grafting (BG) and the use of enamel matrix derivative (EMD). EMD is an extract of enamel matrix and contains amelogenins of various molecular weights. Amelogenins are involved in the formation of enamel and periodontal attachment formation during tooth development. Objectives:, To test whether EMD is effective, and to compare EMD versus GTR, and various BG procedures for the treatment of intrabony defects. Search strategy:, We searched the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE and EMBASE. Several journals were handsearched. No language restrictions were applied. Authors of randomized controlled trials (RCTs) identified, personal contacts and the manufacturer were contacted to identify unpublished trials. Most recent search: February 2009. Selection criteria:, RCTs on patients affected by periodontitis having intrabony defects of at least 3 mm treated with EMD compared with open flap debridement, GTR and various BG procedures with at least 1 year follow-up. The outcome measures considered were: tooth loss, changes in probing attachment levels (PAL), pocket depths (PPD), gingival recessions (REC), bone levels from the bottom of the defects on intraoral radiographs, aesthetics and adverse events. The following time-points were to be evaluated: 1, 5 and 10 years. Data collection and analysis:, Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). It was decided not to investigate heterogeneity, but a sensitivity analysis for the risk of bias of the trials was performed. Main results:, Thirteen trials were included out of 35 potentially eligible trials. No included trial presented data after 5 years of follow-up, therefore all data refer to the 1-year time point. A meta-analysis including nine trials showed that EMD treated sites displayed statistically significant PAL improvements (mean difference 1.1 mm, 95% CI 0.61 to 1.55) and PPD reduction (0.9 mm, 95% CI 0.44 to 1.31) when compared to placebo or control treated sites, though a high degree of heterogeneity was found. Significantly more sites had <2 mm PAL gain in the control group, with RR 0.53 (95% CI 0.34 to 0.82). Approximately nine patients needed to be treated (NNT) to have one patient gaining 2 mm or more PAL over the control group, based on a prevalence in the control group of 25%. No differences in tooth loss or aesthetic appearance as judged by the patients were observed. When evaluating only trials at a low risk of bias in a sensitivity analysis (four trials), the effect size for PAL was 0.62 mm (95% CI 0.28 to 0.96), which was less than 1.1 mm for the overall result. Comparing EMD with GTR (five trials), GTR showed statistically significant more postoperative complications (three trials, RR 0.12, 95% CI 0.02 to 0.85) and more REC (0.4 mm 95% CI 0.15 to 0.66). The only trial comparing EMD with a bioactive ceramic filler found statistically significant more REC (-1.60 mm, 95% CI ,2.74 to ,0.46) at the EMG treated sites. Authors' conclusions:, One year after its application, EMD significantly improved PAL levels (1.1 mm) and PPD reduction (0.9 mm) when compared to a placebo or control, however, the high degree of heterogeneity observed among trials suggests that results have to be interpreted with great caution. In addition, a sensitivity analysis indicated that the overall treatment effect might be overestimated. The actual clinical advantages of using EMD are unknown. With the exception of significantly more postoperative complications in the GTR group, there was no evidence of clinically important differences between GTR and EMD. Bone substitutes may be associated with less REC than EMD. Plain language summary:, Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application. Bacteria in plaque can cause gum disease (periodontitis) that breaks down tissue supporting teeth. Surgical cleaning tries to stop the disease to save loose teeth. Bone grafting, guided tissue regeneration and enamel matrix derivatives (such as Emdogain) aim to regenerate support tissues. Emdogain contains proteins (derived from developing pig teeth) believed to regenerate tooth attachment. The review found that adjunctive application of Emdogain regenerates about 1 mm more tissue than surgical cleaning alone, although it is unclear to which extent such improvement is noticeable since patients did not find any difference in the aesthetic results. Emdogain showed similar clinical results to guided tissue regeneration, but is simpler to use and determines less complications. Bone substitutes may induce less gum retraction than Emdogain. No serious adverse reactions to Emdogain were reported in trials. [source]

Comparison of the effects of treatment of peri-implant infection in animal and human studies: systematic review and meta-analysis

CLINICAL ORAL IMPLANTS RESEARCH, Issue 2 2010
Clovis Mariano Faggion Jr
Abstract Objective: The main objective of this systematic review is to compare the effects of treatment of peri-implant infection between animal and human studies. Material and methods: A literature search was conducted using the Medline, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Health Sciences Literature databases up to and including May 2008. In addition, bibliographies of systematic reviews on peri-implant diseases were searched manually. Non-surgical and surgical treatments of peri-implantitis/mucositis in animal models or human studies were compared. Meta-analysis was conducted to investigate the difference between the reported treatment effects in animal and human studies. Changes in probing pocket depth (PPD) and probing attachment level (PAL) from baseline measurements were used as measures of outcome. Single-level and multilevel meta-regression analysis was performed by taking into account the different follow-up times of the studies included. Results: The single-level and multilevel random-effects meta-analysis showed that the difference in PPD reduction [0.31 mm, 95% confidence interval (CI): ,0.27, 0.88] and in PAL gain (0.21 mm, 95% CI: ,0.47, 0.88) between animal and human studies was not statistically significant. The random-effects meta-regression suggested that studies with longer follow-up times revealed greater PPD reduction (0.25 mm per month, 95% CI: 0.14, 0.35). However, when the different follow-up times were taken into account, these differences became greater. Substantial heterogeneity between studies was found in the meta-analyses (I2=97.6% for animal studies and 99.9% for human studies). Conclusion: There was great heterogeneity between human and animal studies in terms of study designs and treatment procedures. Therefore, the results from this meta-analysis should be interpreted with caution. Heterogeneity between studies and its causes merit further investigations. To cite this article: Faggion CM Jr, Chambrone L, Gondim V, Schmitter M, Tu Y-K. Comparison of the effects of treatment of peri-implant infection in animal and human studies: systematic review and meta-analysis. Clin. Oral Impl. Res. 21, 2010; 137,147. doi: 10.1111/j.1600-0501.2009.01753.x [source]