Journal of Periodontal and Implant Science

Korean Academy of Periodontology (대한치주과학회)
권호 표지

Clinical and histopathological study on the effect of Nonresorbable membrane with Demineralized freeze dried bone graft for Guided Bone Regeneration in Implant Dehiscence Defects

매식체 주위 열개형 골결손부에서 차단막과 골 이식술의 사용이 골 형성에 미치는 영향에 대한 임상 및 조직병리학적 연구

  • Kwon, Chil-Sung (Department of Periodontology, College of Dentistry, Dan-Kook University) ;
  • Hong, Ki-Seok (Department of Periodontology, College of Dentistry, Dan-Kook University) ;
  • Lim, Sung-Bin (Department of Periodontology, College of Dentistry, Dan-Kook University) ;
  • Chung, Chin-Hyung (Department of Periodontology, College of Dentistry, Dan-Kook University) ;
  • Lee, Chong-Heon (Department of Pathology, College of Dentistry, Dan-Kook University)
  • 권칠성 (단국대학교 치과대학 치주과학교실) ;
  • 홍기석 (단국대학교 치과대학 치주과학교실) ;
  • 임성빈 (단국대학교 치과대학 치주과학교실) ;
  • 정진형 (단국대학교 치과대학 치주과학교실) ;
  • 이종헌 (단국대학교 치과대학 병리학교실)
  • Published : 2005.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this study is to examine the effect of non-resorbable membrane such as e-PTFE which was used with DFDB in bone regeneration on dehiscence defect in peri-implant area. Amomg the patients, who have recieved an implant surgery at the department of Periodontics in Dan Kook University Dental Hospital, 12 patients showed implant exposure due to the dehiscence defect and 15 implants of these 22 patients were the target of the treatment. Periodontists randomly applied $Gore-Tex^{(R)}$ to the patients and treated them with antibiotics for five days both preoperatively and postoperatively. Reentry period was 26 weeks on average in maxilla and 14 weeks on average in mandible. The results were as follows : 1. Dehiscence bone defect frequently appeared in premolar in mandible and anterior teeth in maxilla respectively. 2. Among 15 cases, 1 membrane exposure was observed and in this case, regenerated area was decreased. 3. In non-resorbable membrane, bone surface area $9.25{\pm}4.84$ preoperatively and significantly increased to $11.48{\pm}7.52$ postoperatively(0.05). 4. The increase of bone surface area in non-resorbable membrane was $2.23{\pm}3.38$. 5. As a result of histopathological finding, DFDB surrounded by new bone formation and lamellate bone, resorption of DFDB and bone mineralization was found. Also, fibrosis of connective tissue beneath the membrane was found. This study shows that the surgical method using DFDB and non-resorbable membrane on dehiscence defect in peri-implant area is effective in bone regeneration.

Keywords

References

  1. Adell R, Lekholm D, Branemark P-1. Surgical procedures. In : Branemark P-1, Zarb GA. Albrektsson T(eds). Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago : Quintessence 1985:211-232
  2. Adell R, Ericsson B, Lekholm D, Branemark P-1, Jemt T : A long-term follow -up study of osseointegrated implants in the treatment of the totally edentulous jaw. Int J Oral Maxillofac Implants 1990 :4:347
  3. Tallgren A: Positional changes of complete dentures : A 7-year longitudinal study: Acta Odontol Scand 1969:27:539-561 https://doi.org/10.3109/00016356908994049
  4. Tallgren A, Lang BR, Walker GF, Ash MM Jr : Roentgen cephalometric analysis of ridge resorption and changes in jaw and occlusal relationships in immediate complete denture wearers: J Oral Rehabil 1980:7:77-94 https://doi.org/10.1111/j.1365-2842.1980.tb01466.x
  5. Seibert JS : Treatment of moderate localized alveolar ridge defects. Preventive and reconstructive concepts in therapy: Dent Clin North Am 1993:37:265-280
  6. Nevins M. Melonig JT : Enhancement of the damaged edentulous ridge to receive dental implants. A combination of allograft and Gore-Tex membrane: Int J Periodontics Restorative Dent 1992; 12:96-111
  7. Brugnami F. Then PR, Moroi H. Leone CW : Histologic evaluation of human extraction sockets treated with demineralized freeze-dried bone allograft (DFD-BA) and cell occlusive membrane: J Periodontol 1996: 67: 821-825 https://doi.org/10.1902/jop.1996.67.8.821
  8. O'Brien TP. Hinrichs JE. Schaffer EM : The prevention of localized ridge deformities using guided tissue regeneration: J Periodontol 1994:65: 17-24 https://doi.org/10.1902/jop.1994.65.1.17
  9. Lekovic V. Kenney EB. Weinlaender M : A bone regenerative approach to alveolar ridge maintenance of following tooth extraction. Report of 10 cases: J periodontol 1997;68:563-570 https://doi.org/10.1902/jop.1997.68.6.563
  10. Becker W. Urist M. Becker BE. et al : Clinical and histological observations of sites implanted with intraoral autologous bone grafts or allografts. 15 human case reports: J Periodontol 1996;67:1025-1033 https://doi.org/10.1902/jop.1996.67.10.1025
  11. Stanley HR. Hall BM. Clark AE. King CJ III. Hench LL. Berte JJ : Using 45S5 Bioglass cones as endosseous ridge maintenance implants to prevent alveolar ridge resoption: A 5-year evaluation: Int J Oral Maxillofac Implants 1997; 12:95-105
  12. Bahat O. Deeb C, Golden T. Komamyckyj O : Preservation of ridges utilizing hydroxyapatite: Int J Periodontics Restorative Dent 1987:7(6): 35-41
  13. Gross J : Ridge preservation using HTR synthetic bone following tooth extraction: Gen Dent 1995:43:364-367
  14. Boyne PJ : Use of HTR in tooth extraction sockets to maintain alveolar ridge height: Gen Dent 1995:43:470-473
  15. Scheer P. Boyne PJ : Maintenance of alveolar bone through implantation of bone graft substitutes in tooth extraction socket: J Am Dent Assoc 1987: 114:594-597
  16. Nemcovsky C. Serfaty V : Alveolar ridge preservation following tooth extraction of maxillary anterior teeth. Report on 23 consecutive cases: J Periodontol 1996: 67:390-395 https://doi.org/10.1902/jop.1996.67.4.390
  17. Zvi Artzi, Calos EN : The application of deproteinized bovine bone mineral for ridge preservation prior to implantation: Clinical and histological observations in a case report: J Periodontol: 1998:69: 1062-1067 https://doi.org/10.1902/jop.1998.69.9.1062
  18. Buser D, Bragger U. Lang NP. Nyman S : Regeneration and enlargement of jaw bone using guided tissue regeneration: Clin Oral Implants Res 1990:1:22-32. https://doi.org/10.1034/j.1600-0501.1990.010104.x
  19. Dahlin C. Gottlow J. Lindhe A Nyman S : Healing of maxillary and mandibular bone defects using a membrane technique. An experimental study in monkeys: Scand J Plast Reconstr Surg Hand Surg 1990:24:13-19 https://doi.org/10.3109/02844319009004514
  20. Jovanovic SA, Nevins M : Bone formation utilizing titanium reinforced barrier membranes. Int J Periodontics Restorative Dent 1995; 15: 57-69
  21. Smukler H. Barbosa E, Burliss C : A new approach to regereration of surgically reduced alveolar ridges in dogs: A clinical and histologic study: Int J Oral Maxillofac Implants 1995; 10: 537-551
  22. Daniel Buser, Christer Dahlin, Robert K. Schenk : Guided Bone Regeneration in Implant Dentistry. Quintessence books 32. 1996
  23. Keller EE, Van Roekel NB, Desjardins RP, Tolman DE : Prosthetic-surgical reconstruction of the severely resorbed maxilla with iliac bone grafting. Int Joral Maxillofac Implants 2: 155. 1987
  24. Kahnberg K-E, Nystrom E, Bartholdsson L : Combined use of bone grafts and Bränemark fixtures in the treatment of severely resorbed maxillae. Int J Oral Maxillofac Implants 4:297, 1989
  25. Adell R, Lekholm D, Grondahl K, Branemark P-I, Lindstrom J. Jacobsson M : Reconstruction of severely resorbed edentulous maxillae using osseointegrated fixtures in immediate autogenous bone grafts. Int Oral Maxillofac Implants 5:233. 1990
  26. Jarcho M : Retrospective analysis of hydroxyapatite development for implant applications. Dent Clin North Am 36: 19, 1992
  27. Kent JN, Zide MF : Bone and biomaterials. Otolaryngol Clin North Am 17: 273, 1984
  28. Kaban LB, Glowacki J : Induced osteogenesis in the repair of mandibular defects in rats. J Dent Res 60: 1356. 1981
  29. Glowacki J. Kaban LB. Murray JE. Folkman J. Mulliken JB : Application of the biological principle of induced osteogenesis for craniofacial defects. Lancet 200:322. 1981
  30. Prolo DJ. Rodrigo JJ : Contemporary bone graft physiology and surgery. Clin Orthop 200:322. 1985
  31. Melcher AH : On the repair potentials of the periodontal tissues. J Periodontol 47 : 256-260. 1976 https://doi.org/10.1902/jop.1976.47.5.256
  32. Karring T. Nyman S. Lindhe J : Healing following implantation of periodontitis affected roots into bone tissue. J Clin Periodontol 7:96-105. 1980 https://doi.org/10.1111/j.1600-051X.1980.tb01952.x
  33. Nyman S. Karring T. Lindhe J. Platen S : Healing following implantation of periodontitis affected roots into gingival connective tissue. J Clin Periodontol 7: 394-401. 1980 https://doi.org/10.1111/j.1600-051X.1980.tb02012.x
  34. Nyman S. Gottlow J. Karring T. Lindhe J : The regenerative potential of the periodontal ligament. An experimental study in the monkey. J Clin Periodontol 9:257-265. 1982 https://doi.org/10.1111/j.1600-051X.1982.tb02065.x
  35. Nyman S. Lindhe J. Karring T. Rylander H : New attachment following surgical treatment of human periodontal disease. J Clin Periodontol 9:290-296. 1982 https://doi.org/10.1111/j.1600-051X.1982.tb02095.x
  36. Nyman S. Gottlow J. Lindhe J. Karring T. Wennstrom J : New attachment following guided tissue regeneration. J Periodont Res 22:252-254. 1987 https://doi.org/10.1111/j.1600-0765.1987.tb01581.x
  37. Becker W. Becker BE. Prichard J. Caffesse RG. Rosenberg E. GianGrasso J : Root isolation for new attachment procedures : A surgical and suturing method three case reports. J Periodontol 58: 819-823. 1987 https://doi.org/10.1902/jop.1987.58.12.819
  38. Becker W. Becker BE. Berg L. Prichard J. Caffesse RG. Rosenberg E : New attachment after tretment with root isolation procedures : Report of treatrd class III and class II furcations and vertical osseous defects. Int J Periodontics Restorative Dent 8:9-23. 1988
  39. Gottlow J. Nyman S. Lindhe J. Karring T. Wennstrom J : New attachment formation in the human periodontium by guided tissue regeneration. Case reports. J Clin Periodontol 13:604-616. 1986 https://doi.org/10.1111/j.1600-051X.1986.tb00854.x
  40. Pontoriero R. Lindhe J. Nyman S. Karring T. Rosenberg E. Sanavi F : Guided tissue regeneration in degree II furcation-involved mandibular molars. A clinical study. J Nlin Periodontol 15:247-254. 1988 https://doi.org/10.1111/j.1600-051X.1988.tb01578.x
  41. Caffesse RG. Smith BA, Duff B. Morrison EC. Merrill D. Becker W : Class II furcations treated by guided tissue regeneration in humans : Case reports. J Periodontol 61:510-514. 1990 https://doi.org/10.1902/jop.1990.61.8.510
  42. Pitaru S. Tal H. Soldinger M. Azaravidan O. Noff M : Collagen membrane prevent the apical migration of epithelium during periodontal wound healing. J Periodont Res 22:331-333. 1987 https://doi.org/10.1111/j.1600-0765.1987.tb01594.x
  43. Pitaru S. Tal H. Soldinger M. Grosskopf A Noff M : Partial regeneration of periodontal tissue using collagen barriers. Initial obserbvations in the canine. J Periodontol 59:380-386. 1988 https://doi.org/10.1902/jop.1988.59.6.380
  44. Pitaru S. Solinger M. Noff m : Collagen membrane prevent apical migration of epithelium and support new connective tissue attachment during periodontal wound healing in dogs. J Periodont Res 24:247-253. 1989 https://doi.org/10.1111/j.1600-0765.1989.tb01789.x
  45. Blumenthal NM : The use of collagen membranes to guided tissue regeneration of new connective attachment in dogs. J Periodontol 59: 830-836, 1988 https://doi.org/10.1902/jop.1988.59.12.830
  46. Black BC, Gher ME, Sandifer JB, Fucini SE. Rechardson AC : Comparative study of collagen and Eptfe membranes in the treatment of human class II furcation defects. J Periodontol 65: 598-604, 1994 https://doi.org/10.1902/jop.1994.65.6.598
  47. Blumenthal NM : A clinical comparison of collagen membranes with ePTFE membranes in the treatment of human mandibular buccal class II furcation defects. J Periodontol 64: 925-933, 1993 https://doi.org/10.1902/jop.1993.64.10.925
  48. Kodama T : The histopathological study of periodontal regeneration using atelocollagen membranes. J Jpn Assoc Periodontol 32:1-25, 1990 https://doi.org/10.2329/perio.32.1
  49. Magnusson I. Batich C, Collins BR : New attachment formation following controlled tissue regeneration using biodegradable membranes. J Periodontol 59: 1-7, 1988 https://doi.org/10.1902/jop.1988.59.1.1
  50. Laurell I. Falk H, Fornell J. Johard G, Gottlow j : Clinical use of bioresorbable matrix barrier in guided tissue regeneration therapy : Case series. J Periodontol 65: 967-975, 1994 https://doi.org/10.1902/jop.1994.65.10.967
  51. Fleisher N, Waal HD, Bloom J : Regeneration of lost attachment apparatus in the dog using Vicryl absorbable mesh (polyglactin 910). Int J Periodontics Restorative Dent 8:45-55. 1988
  52. Kon S, Ruben MP, Bloom A, Bey WH, Boffa J : Regeneration of periodontal ligament using resorbable and nonresorbable membranes : Clinical. histological, and histometric study in dogs. Int J Periodontics Restorative Dent 11: 59-71, 1991
  53. Caton J. Greenstein G. Zappa U : Synthetic bioabsorbable barrier for regeneration in human periodontal defects. J Periodontol 65: 1037-1045. 1994 https://doi.org/10.1902/jop.1994.65.11.1037
  54. Greenstein G. Caton J : Biodegradable barriers and guided tissue regeneration. J Periodontol 2000 1: 36-45. 1993 https://doi.org/10.1111/j.1600-0757.1993.tb00205.x
  55. Caffesse RG. Nasjleti CE. Morrison EC. Sanchez R : Guided tissue regeneration : Comparison of bioabsorbable and nonbioabsorbable membranes. Histologic and histometric stugy in dogs. J Periodontol 65: 583-591, 1994 https://doi.org/10.1902/jop.1994.65.6.583
  56. Nyman S. Lindhe J. Karring T. Rylander H : New attachment following surgical treatment of human periodontal disease. J Clin Periodontol 9:290-296. 1982 https://doi.org/10.1111/j.1600-051X.1982.tb02095.x
  57. Bragger U. Hammerle C. Mombell A, Burgin W. Lang N : Remodeling of periodontal tissues adjacent to sites treated according to the principles of guided tissue regeneration(GTR). J Clin Periodontol 1992: 19:615-624 https://doi.org/10.1111/j.1600-051X.1992.tb01708.x
  58. Dahlin C. Senner by L. Lekholm U. Linde A Nyman S : Generation of new bone around titanium implants using a membrane technique : An experimental study in rabbits. Int J Oral Maxillofac Implants 4: 19-25. 1989
  59. Becker W. Becker B. Handelsman M. Celleti R. Ochsenbein C. Hardwick R. Langer B : Bone formation at dehisced dental implant sites treated with implant augmentation material : A pilot study in dogs. Int J Periodont Rest Dent 10:93-101, 1990
  60. Becker W, Becker B : Guided tissue regeneration for implants placed into extraction sockets and for implant dehiscences : Surgical techniques and case reports. Int J Periodont Rest Dent 10: 377-392, 1990
  61. Buser D, Dula K : Localized ridge augmentation using guided bone regeneration. I. Surgical procedure in the maxilla. Int J Periodont Rest DENT 13: 29-45, 1993
  62. Simion M, Baldoni M, Zaffe D : Jaw bone enlargement using immediate implant placement associated with a splitcrest technique and guided regeneration. Int J Periodont Rest Dent 12:463-473, 1992
  63. Nyman S. Lang N, Buser D, Bragger U : Bone regeneration adjacent to titanium dental implants using guided tissue regeneration: A report of two cases. Int J Oral Maxillofac Implants 5:9-14, 1990
  64. Sottosanti J, Bierly J : The storage of marrow and its relation to periodontal grafting procedures. J Periodontol 46: 162-170, 1975 https://doi.org/10.1902/jop.1975.46.3.162
  65. Wachtel H, Langford A Bernimoulin J, Reichart P : Guided bone regeneration next to osseointegrated implants in humans. Int J Oral Maxillofac Implants 6: 127-134, 1991
  66. Vlassis J, Caffess R : Guided bone regeneration at a fenestrated dental implant : Histologic assessment of a case report. Int J Oral Maxillofac Implants 8 :447-451, 1993
  67. Simion M, Dahlin C, Trisi P, Biatelli A : Qualitative and quantitative comparative study of different filling materials used in bone tissue regeneration: Acontrolled clinical study. Int J Periodont Rest Dent 14: 189-215, 1994
  68. Zablotsky H. Meffert R. Caudill R. Evans G : Histological and clinical conparisons of guided tissue regeneration on dehisced hydroxyapatite coated and titanium endosseous implant surfaces : A pilot study. Int J Oral Maxillofac Implants 6: 294-302, 1991
  69. Mellonig J, Triplett R : Guided tissue regeneration and endosseous dental implants. Int J Periodont Rest Dent 13: 109-119, 1993
  70. Sobolik CF : Alveolar bone resorption: J Prosthet Dent: 1960: 10:612-619 https://doi.org/10.1016/0022-3913(60)90240-7
  71. Atwood DA : Some clinical factors related to rate of resorption of residual ridge: J Prosthet Dent: 1962: 12: 441-450 https://doi.org/10.1016/0022-3913(62)90125-7
  72. Atwood DA : Postextraction changes in the adult mandible as illustrated by microradiographs of midsagittal sections and serial cephalometric roentgenograms: J Prosthet Dent: 1963; 13: 810-824 https://doi.org/10.1016/0022-3913(63)90225-7
  73. Atwood DA: Reduction of residual ridges: A major oral disease entity: J Prosthet Dent: 1971:26:266-279 https://doi.org/10.1016/0022-3913(71)90069-2
  74. Atwood DA, Coy WA: Clinical, cephalometric and densitometric study of reduction of residual ridges: J Prosthet Dent 1971:26:280-291 https://doi.org/10.1016/0022-3913(71)90070-9
  75. Calsson GE. Bergman B. Hedegard B: Changes in contour of the maxillary alveolar process under immediate denture: Acta Odontol Scand. 1967;25:45-75 https://doi.org/10.3109/00016356709072522
  76. Mecall RA, Rosenfeld AL: The influence of residual ridge resorpion patterns on implant fixture placement and tooth position. Part I: Int J Periodontics Restorative Dent: 1991: 11: 9-23
  77. Godfredsen K. Nimb L. Hjorting-Hansen E : Immediate implant placement using a biodegradable barrier. polyhydroxybutyrate-hydroxyvalerate reinforced with polyglactin 910. Clin Oral Implants Res 5 : 83-91, 1994. https://doi.org/10.1034/j.1600-0501.1994.050204.x
  78. Sevor JJ. Meffert RM. Cassingham RJ : Regenerntion of dehisced aoveolat bone adjacent to endosseous dental implants utilizing resorbable collagen membrane : Clinical and histological results. Int J Periodont Rest Dent 13:71-83. 1993
  79. Pajarola GF. Sailer HF. Haers PE. Meyenberg K : Guided bone regeneration around titanium screw implants using a resorbable membrane. Oral Maxillofac Surg Clin North Am 6:699-706. 1994
  80. Zitzman. N. Naef R. Scharer S : Resorbable versus Nonresorbable Membranes in Combination with Bio-oss for Guided Bone Regeneration : Int. J Oral & Maxillofacial Implants 12: 844-852. 1997