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Clinical and Radiological Evaluation of an Osseous Xenograft for the Treatment of Infrabony DefectsFULL TEXT
Rajan Gupta, MDS
A b s t r a c t
The current study focused on the elimination of hard- and soft-tissue defects, and regeneration of new tissue with a xenogenic demineralized bone matrix (Osseograft) and compared its results with those for open-flap debridement. Demineralized bone matrix (Osseograft) is a bone-inductive sterile bioresorbable graft composed of type I collagen. This matrix, which is prepared from bovine cortical bone samples and results in nonimmunogenic flowable particles of about 250 ΅m, is replaced by host bone completely in 424 weeks.
Materials and Method: The 30 patients with infrabony defects selected for this study were between 33 to 81 years of age; 20 patients had at least 1 intraosseous defect, and 10 had bilateral intraosseous defects. For the patients with bilateral defects, 1 site was used as a test site and the other as a control site, and surgery was done on both test and control sites on the same day. Patients who had at least 1 intraosseous defect of = 3 mm and a pocket depth of = 6 mm, as measured with a manual periodontal probe (UNC-15), were included. The variables that were investigated at baseline, 3 months and 6 months were the plaque index, gingival index, pocket depth and level of clinical attachment. The radiographic variables included the amount and percentage of defect resolution. Probing measurements were done with a customized acrylic stent that was used as fixed reference point to minimize distortion. One site representing the same deepest point of the defect was included: namely, the fixed reference point (FRP) to the base of the pocket (BP), and the fixed reference point to the cementoenamel junction (CEJ). The pocket depth and level of clinical attachment were calculated from the clinical measurements: pocket depth = (FRP to BP) (FRP to gingival margin [GM]) and clinical attachment level = (FRP to BP) (FRP to CEJ). Measurements were made before and after surgery for both test and control sites at baseline, 3 months and 6 months. Radiographic evaluation of each defect was done at baseline, 3 months and 6 months for test sites and control sites. Intraoral periapical radiographs were taken with a millimetre grid. Defects were measured as the distance from the alveolar crest to the base of the bone defect. Amount of defect resolution was calculated as the difference between the defect depth before and after surgery, and then the percentage of the defect resolution was calculated.
Results: A statistically significant reduction in the mean values of pocket depth at baseline, 3 months and 6 months (p < 0.001) was found between test and control groups. A statistically significant gain in mean values of the level of clinical attachment at baseline, 3 months (p = 0.025) and 6 months (p < 0.001) was found between test and control groups. The statistically significant mean amount of defect resolution for test sites from baseline to 3 months was 2.02 mm and from baseline to 6 months, 3.28 mm (p < 0.001). The mean amount of defect fill for control sites from baseline to 3 months (0.82 mm) and from baseline to 6 months (1.17 mm) was also statistically significant (p < 0.001). The statistically significant mean percentage of defect resolution at 3 months and 6 months for test sites was 37.1% and 56.5%, respectively, and 20.5% and 28.6% for control sites, respectively, (p < 0.001).
Discussion: The results of the current study showed that demineralized bone matrix (Osseograft) improves healing outcomes, compared with open-flap debridement, namely, reduced probing depth, resolution of osseous defect and gain in clinical attachment. The study found no statistically significant difference between test and control groups in their mean values for the plaque and gingival indexes at baseline, 3 months and 6 months.
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