Comparison of clinical, radiographic, and histometric measurements following treatment with guided tissue regeneration or enamel matrix proteins in human periodontal defects. Healing of human intrabony defects following treatment with enamel matrix proteins or guided tissue regeneration. Periodontal surgery of vertical bony defects with or without synthetic bioabsorbable barriers. 12-month results. Treatment of intrabony defects with enamel matrix proteins or bioabsorbable membranes. A 4-year follow-up split-mouth study. Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. I. Class II furcations. Long-term results of guided tissue regeneration therapy with non-resorbable and bioabsorbable barriers. III. Class II furcations after 10 years. Comparison of treatments of infrabony defects with enamel matrix derivative, guided tissue regeneration with a nonresorbable membrane and Widman modified flap. A pilot study. Guided tissue regeneration in human Class II furcations and interproximal infrabony defects after using a bioabsorbable membrane barrier. Combination use of bovine porous bone mineral, enamel matrix proteins, and a bioabsorbable membrane in intrabony periodontal defects in humans. Enamel matrix proteins and guided tissue regeneration with titanium-reinforced expanded polytetrafluoroethylene membranes in the treatment of infrabony defects: a comparative controlled clinical trial. Comparison of infrabony defects treated with enamel matrix derivative versus guided tissue regeneration with a nonresorbable membrane. Radiographic evaluation of bone regeneration following periodontal surgery with or without expanded polytetrafluoroethylene barriers. Treatment of interproximal angular defects by guided tissue regeneration: 1 year follow-up. Treatment of wide, shallow, and predominantly 1-wall intrabony defects with a bioabsorbable membrane: a randomized controlled clinical trial. Healing response of apicomarginal defects to two guided tissue regeneration techniques in periradicular surgery: a double-blind, randomized-clinical trial. Assessment of guided tissue regeneration procedures in intrabony defects with bioabsorbable and non-resorbable barriers. Guided bone regeneration around endosseous implants with anorganic bovine bone mineral. A randomized controlled trial comparing bioabsorbable versus non-resorbable barriers. The use of autogenous periosteal grafts as barriers for the treatment of intrabony defects in humans. Topical and systemic antimicrobial therapy in guided tissue regeneration. A comparison between enamel matrix derivative and a bioabsorbable membrane to enhance healing around transmucosal immediate post-extraction implants. The simplified papilla preservation flap in the regenerative treatment of deep intrabony defects: clinical outcomes and postoperative morbidity. Guided tissue regeneration for the treatment of intraosseous defects using a biabsorbable membrane. A controlled clinical study. Combined use of platelet-rich plasma and bone grafting with or without guided tissue regeneration in the treatment of anterior interproximal defects. Periodontal regeneration of human intrabony defects with titanium reinforced membranes. A controlled clinical trial. The use of 2 bioabsorbable barrier membranes in the treatment of interproximal intrabony periodontal defects. Platelet-rich plasma and bovine porous bone mineral combined with guided tissue regeneration in the treatment of intrabony defects in humans. Treatment of intrabony defects with enamel matrix proteins and guided tissue regeneration. A prospective controlled clinical study. Guided tissue regeneration in the treatment of human infrabony defects. Clinical, radiographical and microbiological results: a pilot study. Expanded polytetrafluoroethylene and dental rubber dam barrier membranes in the treatment of periodontal intrabony defects. A comparative clinical trial. Factors affecting the healing response of intrabony defects following guided tissue regeneration and access flap surgery. Five years clinical results following treatment of human intra-bony defects with an enamel matrix derivative: A randomized controlled trial Enamel matrix proteins in the treatment of intra-bony defects. A prospective 24-month clinical trial. Microsurgical access flap and enamel matrix derivative for the treatment of periodontal intrabony defects: a controlled clinical study. A systematic review of marginal soft tissue at implants subjected to immediate loading or immediate restoration. Guided tissue regeneration in intrabony periodontal defects following treatment with two bioabsorbable membranes in combination with bovine bone mineral graft. A clinical and radiographic study. Comparison of platelet-rich plasma, bovine porous bone mineral, and guided tissue regeneration versus platelet-rich plasma and bovine porous bone mineral in the treatment of intrabony defects: a reentry study. Guided tissue regeneration may modulate gene expression in periodontal intrabony defects: a human study. Histologic evaluation of human intrabony defects following non-surgical periodontal therapy with and without application of an enamel matrix protein derivative. Healing of intra-bony defects following treatment with a composite bovine-derived xenograft (Bio-Oss Collagen) in combination with a collagen membrane (Bio-Gide PERIO). Guided tissue regeneration procedure with bioresorbable membranes versus conventional flap surgery in the treatment of infrabony periodontal defects. Influence of autologous platelet concentrate on healing in intra-bony defects following guided tissue regeneration therapy: a randomized prospective clinical split-mouth study. Enamel matrix derivative and low-level laser therapy in the treatment of intra-bony defects: a randomized placebo-controlled clinical trial. Periodontal tissue alterations following Emdogain treatment of periodontal sites with angular bone defects. A series of case reports. Comparative evaluation of platelet-rich plasma and guided tissue regeneration membrane in the healing of apicomarginal defects: a clinical study. Issues in psychopharmacology. Impact of PubMed search filters on the retrieval of evidence by physicians Connective tissue-cementum regeneration: a new histologic regeneration following the use of enamel matrix derivative in dehiscence-type defects. A dog model. GTR with bioresorbable membranes in the treatment of intrabony defects: a clinical and histologic study. Efficacy of guided tissue regeneration in the management of through-and-through lesions following surgical endodontics: a preliminary study. Microsurgical access flap in conjunction with enamel matrix derivative for the treatment of intra-bony defects: a controlled clinical trial. How to write an evidence-based clinical review article. A prospective multi-center study evaluating periodontal regeneration for Class II furcation invasions and intrabony defects after treatment with a bioabsorbable barrier membrane: 1-year results. Preservation of alveolar bone in extraction sockets using bioabsorbable membranes. Robustness of empirical search strategies for clinical content in MEDLINE
BACKGROUND The purpose of this study was to compare the clinical and radiographic parameters with the histometric findings following 2 different regenerative procedures in humans . METHODS Fourteen advanced intrabony defects at teeth scheduled for extraction were r and omly treated as follows : 8 with guided tissue regeneration ( GTR ) using bioabsorbable barriers and 6 with an enamel matrix protein derivative ( EMD ) .  St and ardized radiographs , probing depths ( PD ) , and attachment levels ( CAL ) at baseline and 6 months after therapy were evaluated and compared to the histometric measurements made following the removal of teeth and surrounding tissues 6 months after the surgery . RESULTS Significant PD reductions ( GTR : -5.62 mm ; EMD : -5.00 mm ) and CAL gains ( GTR : 3.87 mm ; EMD : 2.67 mm ) were observed in both groups . Six months after surgery , minor resorptions of the alveolar crest ( AC ) ( GTR : 0.40 mm ; EMD : 0.33 mm ) and bony gain at the bottom of the defects ( GTR : 0.47 mm ; EMD : 1.05 mm ) were observed radiographically . No statistically significant differences in the change of clinical and radiographic parameters between the GTR and EMD groups were found . Histometrically , significant amounts of new connective tissue attachment ( i.e. , cementum with inserting collagen fibers ) were observed in both groups ( GTR : 2.29 mm ; EMD : 1.81 mm ) . Bone regeneration was found to be significant only in the GTR group ( GTR : 1.93 mm ; EMD : 0.78 mm ) . However , the study lacked statistical power for determining equivalence between the groups . CONCLUSIONS Within the limitations of the present study , it may be concluded that at 6 months after GTR or enamel matrix protein derivative therapy , formation of new cementum and bone may be histometrically demonstrated . Except for the formation of new bone , no statistically significant differences between both therapies could be seen for clinical , radiographic , and histometric results 6 months after surgery The aim of the present study was to evaluate histologically in humans the healing of advanced intrabony defects following treatment with enamel matrix proteins ( EMD ) or guided tissue regeneration ( GTR ) .  Fourteen patients , each of them displaying 1 advanced intrabony defect around teeth scheduled for extraction were included in the study . The defects were treated r and omly either with an enamel matrix protein derivative ( Emdogain , BIORA AB , Malmö , Sweden ) or with a bioabsorbable membrane ( Resolut , Regenerative Material , W.L. Gore & Assoc . , Flagstaff , Arizona , USA ) . At baseline the mean probing pocket depth ( PPD ) in the EMD group was 11.3 + /- 1.8 mm and the mean clinical attachment level ( CAL ) 12.1 + /- 2.0 mm , whereas in the GTR group the mean PPD was 11.4 + /- 2.2 mm and the mean CAL 13.3 + /- 2.3 mm . Healing was uneventful in all cases . Neither allergic reactions against EMD or the bioabsorbable membrane , nor suppuration or abscesses were observed . The clinical results revealed at 6 months in the EMD group a mean PPD of 5.6 + /- 1.3 mm and a mean CAL of 9.1 + /- 1.5 mm . In the GTR group the mean PPD was 5.6 + /- 1.3 mm and the mean CAL 10.1 + /- 1.5 mm . The histological analysis showed in the EMD group a mean 2.6 + /- 1.0 mm of new attachment ( i.e. new cementum with inserting collagen fibers ) and a mean 0.9 + /- 1.0 mm of new bone . In this group , the formation of new attachment was not always followed by bone regeneration . In the GTR group , the mean new attachment was 2.4 + /- 1.0 mm and the mean new bone 2.1 + /- 1.0 mm . In every case treated with GTR , the formation of new attachment was followed by a varying amount of new bone . After both types of regenerative treatment the newly formed cementum displayed a predominantly cellular character . The findings of the present study indicate that the treatment of intrabony defects with enamel matrix proteins or with bioabsorbable membranes enhances the formation of a new connective tissue attachment in humans The aim of the present study was to clinical ly and radiographically compare guided tissue regeneration ( GTR ) therapy with bioabsorbable polyglactin 910 barriers and conventional periodontal surgery in intrabony defects . In 26 patients with advanced periodontitis , 29 teeth exhibiting interproximal intrabony defects were treated ; 15 by conventional periodontal surgery ( control ) and 14 by GTR ( test ) . Before and 12 months after surgery , clinical parameters were assessed and st and ardized radiographs were taken . On the radiographs the distances from the cemento-enamel junction ( CEJ ) to the alveolar crest ( AC ) , and the CEJ to the most apical extension of the bony defect ( BD ) were measured using a computer-assisted analyzing device ( LMSRT ) . Twelve months after surgery , 24 patients with 27 lesions were available for examination . For both methods statistically significant ( P < 0.001 ) probing depth ( PD ) reduction ( mean + /- st and ard deviation ) of -4.49 + /- 1.94 mm ( n = 13 , test ) and -3.22 + /- 1.48 mm ( n = 14 , control ) , as well as clinical attachment gain ( CAL-V ) of 3.41 + /- 1.59 mm ( test ) and 2.07 + /- 1.10 mm ( control ) , was observed . Radiographic changes of the distance CEJ to AC of -0.95 + /- 1.72 mm ( n = 9 , test ) , and -0.98 + /- 1.53 mm ( n = 11 , control ) were not significant . A significant bony fill ( distance CEJ-BD ) of 1.05 + /- 1.22 mm was observed for the test group ( P < 0.01 ) ; the 0.68 + /- 2.04 mm bony gain for the control group was not statistically significant . The PD reduction ( P < 0.05 ) and attachment gain ( P < 0.01 ) in the test group was statistically significantly more favorable than in the control group . Twelve months after surgery , statistically more favorable PD reduction and attachment gain was observed using polyglactin 910 barriers than compared to conventional flap surgery . Hence , the use of bioabsorbable barriers for therapy of intrabony defects may be recommended BACKGROUND Treatment with enamel matrix proteins ( EMD ) and guided tissue regeneration ( GTR ) with bioabsorbable membranes has been shown to promote periodontal regeneration ; however , until now , there were only limited data on the long-term clinical results following these regenerative techniques . Therefore , the aim of the present study was to present the 4-year results following treatment of intrabony defects with EMD or guided tissue regeneration ( GTR ) . METHODS Twelve patients , each displaying one pair of intrabony defects located contralaterally in the same jaw , were r and omly treated with EMD or with GTR by means of bioabsorbable membranes . The following clinical parameters were evaluated at baseline , at 1 year , and at 4 years after treatment : plaque index ( P1 ) , gingival index ( G1 ) , bleeding on probing ( BOP ) , probing depth ( PD ) , gingival recession ( GR ) , and clinical attachment level ( CAL ) . The primary outcome variable was CAL . No statistically significant differences between the groups were found at baseline . Power analysis to determine superiority of EMD treatment showed that the available sample size would yield 70 % power to detect a 1 mm difference . RESULTS The sites treated with EMD demonstrated mean CAL change from 9.8 + /- 2.0 mm to 6.4 + /- 1.6 mm ( P<0.001 ) and to 6.8 + /- 1.8 mm ( P<0.001 ) at 1 and 4 years , respectively . No statistically significant differences were found between the CAL mean at 1 and 4 years postoperatively . The sites treated with GTR showed a mean CAL change from 9.8 + /- 2.3 mm to 6.6 + /- 1.7 mm ( P<0.001 ) at 1 year and to 6.9 + /- 1.8 mm ( P<0.001 ) at 4 years . The CAL change between I and 4 years did not present statistically significant differences . No statistically significant differences in any of the investigated parameters were observed at 1 and 4 years between the treatment groups . CONCLUSIONS It was concluded that the CAL gain obtained following treatment with EMD or GTR can be maintained over a 4-year period BACKGROUND The aim of this 5-year follow-up study was to clinical ly and radiographically evaluate the long-term results after guided tissue regeneration ( GTR ) therapy of Class II furcation defects using non-resorbable and bioabsorbable barriers . METHODS Nine pairs of contralateral Class II furcation defects were treated in 9 patients with advanced periodontitis . Within each patient , one defect received a non-resorbable ( exp and ed polytetrafluoroethylene [ ePTFE ] ; control , C ) barrier and the other a bioabsorbable ( polyglactin 910 ; test , T ) barrier by r and om assignment . At baseline , 6 , and 60 + /- 3 months after surgery , clinical parameters and st and ardized radiographs were obtained . Gain of bone density within furcation areas was assessed using subtraction radiography . RESULTS Six and 60 months after GTR therapy , statistically significant ( P < 0.05 ) horizontal attachment ( CAL-H ) gain was observed in both groups ( C6 : 1.7 + /- 0.8 mm ; C60 : 1.6 + /- 1.2 mm ; T6 : 2.0 + /- 0.7 mm ; T60 : 2.2 + /- 0.9 mm ) . However , 1 furcation assessed as Class I six months after GTR therapy with a bioabsorbable barrier had progressed to Class III after 5 years , and in another patient , 5 years after placement of an ePTFE barrier , 1 furcation had lost all the CAL-H gain that had been observed at 6 months . Subtraction analysis revealed similar area gain in both groups 6 and 60 months postsurgically ( C6 : 0.3 + /- 0.5 ; C60 1.0 + /- 1.7 ; T6 : 0.4 + /- 0.4 ; T60 : 1.1 + /- 1.7 ) . CONCLUSIONS CAL-H gain achieved after GTR therapy in Class II furcations was stable after 5 years in 16 of 18 defects . The study failed to show a statistically significant difference in stability of CAL-H gain between control and test groups 5 years after GTR therapy BACKGROUND The aim of this 10-year follow-up was to evaluate the long-term results after guided tissue regeneration ( GTR ) therapy of Class II furcation defects using non-resorbable and bioabsorbable barriers clinical ly . METHODS In nine patients with advanced periodontitis , nine pairs of contralateral Class II furcation defects were treated . Within each patient , one defect received a non-resorbable exp and ed polytetrafluoroethylene barrier ( ePTFE ; C ) and the other a bioabsorbable ( polyglactin 910 ; T ) barrier by r and om assignment . At baseline and 12 and 120 + /- 6 months after surgery , clinical parameters were obtained . RESULTS Twelve and 120 months after GTR therapy , statistically significant ( P < 0.05 ) horizontal clinical attachment level ( CAL-H ) gain was observed in both groups ( C12 : 1.9 + /- 0.5 mm ; C120 : 1.1 + /- 1.3 mm ; T12 : 1.9 + /- 0.8 mm ; T120 : 1.7 + /- 1.4 mm ) . However , one patient with furcations that had been assessed as Class I 12 months after GTR therapy had lost two teeth after 10 years , and another patient had lost more than 2 mm CAL-H at one furcation from 12 to 120 + /- 6 months post-surgery 10 years after implantation of an ePTFE barrier . Horizontal bone sounding revealed similar bone gain in both groups 120 + /- 6 months post-surgery ( C120 : 0.8 + /- 1.0 mm ; T120 : 1.1 + /- 1.1 mm ) . CONCLUSIONS CAL-H gain achieved after GTR therapy in Class II furcations was stable after 10 years in 15 of 18 defects ( 83 % ) . The study failed to show a statistically significant difference in stability of CAL-H gain between group C and T 10 years after GTR therapy BACKGROUND , AIMS The purpose of the present study was to compare the efficacy of 3 different surgical procedures in the treatment of infrabony defects :  guided tissue regeneration ( GTR ) with non-resorbable membranes , Widman modified flap ( WMF ) and enamel matrix derivative ( EMD ) . METHOD 30 patients with an infrabony component > or = 4 mm were selected . 10 were treated with exp and ed polytetrafluorethylene ( ePTFE ( Gore - Tex W. L. Gore and Associates , Flagstaff , AZ , USA ) ) membranes , 10 with WMF and 10 with enamel matrix derivatives ( Emdogain ( U Biora AB Malm , Sweden ) ) . The efficacy of each treatment modality was investigated through regression analysis . Probing attachment level ( PAL ) gain , probing depth ( PD ) reduction and gingival recession ( REC ) variation were analyzed . RESULTS Both Emdogain ( enamel matrix derivative ) and ePTFE treatment show significant better results as compared to the WMF procedure in which there were no significant changes in PAL gain and PD reduction at baseline and 1 year after surgery . CONCLUSIONS Results from our analysis suggest that there is no statistically significant difference in PAL gain between GTR and EMD . The clinical outcomes of this pilot study may be of little significance , considering the small number of patients , but it has provided an important base for a controlled clinical trial ( with a larger number of patients ) which is currently in progress This study clinical ly evaluated a bioabsorbable barrier membrane design ed for periodontal regeneration . Ten Class II furcations and 12 interproximal infrabony defects were treated by flap debridement and placement of a bioabsorbable barrier membrane using the principles of guided tissue regeneration . Treatment was evaluated in terms of changes in vertical probing depth , horizontal attachment level , clinical attachment level , and recession . Baseline data were collected on the day of surgery , and outcome measurements were performed at the 1-year appointment . The mean initial probing depth for Class II furcations was 6.5 mm . At 1 year , the mean probing depth was reduced to 2.9 mm , a 3.6 mm change . These differences were clinical ly and statistically significant ( P < 0.01 ) . There was a mean gain of 2.4 mm in clinical attachment level ( P < 0.01 ) and a mean 3.4-mm change in horizontal attachment level ( P < 0.01 ) . Recession increased 1.2 mm . For interproximal infrabony defects , there was a mean probing depth reduction of 5.0 mm ( P < 0.01 ) , a mean gain of clinical attachment level of 3.8 mm ( P < 0.02 ) , and a mean increase of 1.2 mm in recession ( P < 0.04 ) . The results indicate that significant improvements occurred after treatment of Class II furcations and interproximal infrabony defects with the use of a bioabsorbable barrier membrane and guided tissue regeneration BACKGROUND The purpose of this study was to evaluate the effectiveness of a combination of enamel matrix proteins ( EMP ) , bovine porous bone mineral ( BPBM ) , and a bioabsorbable membrane for guided tissue regeneration ( GTR ) as regenerative therapy for intrabony defects in humans and compare it to an open flap debridement ( OFD ) technique . METHODS Using a split-mouth design , 18 pairs of intrabony defects were treated and surgically reentered 6 months after the initial surgery . Experimental sites were treated with EMP , grafted with BPBM , and received a collagen/polylactic acid membrane for GTR . Control sites were treated with OFD . The primary outcomes evaluated in the study included probing depth resolution , clinical attachment gain , and bony defect fill . RESULTS Preoperative probing depths , attachment levels , and intraoperative bone measurements were similar for the experimental and control groups . Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the experimental group ( 4.95+/-1.52 mm on buccal sites and 4.74+/-1.47 mm on lingual sites ) when compared to the control group ( 2.83+/-0.83 mm on buccal sites and 2.90+/-0.91 mm on lingual sites ) . The experimental sites also presented with significantly more attachment gain ( 3.89+/-1.16 mm on buccal sites and 3.78+/-1.14 mm on lingual sites ) than the control sites ( 1.52+/-0.83 mm on buccal sites and 1.48+/-0.78 mm on lingual sites ) . Surgical reentry of the treated defects revealed a significantly greater amount of defect fill in favor of the experimental group ( 4.76+/-1.36 mm on buccal sites and 4.81+/-1.37 mm on lingual sites ) as compared to the control group ( 1.78+/-0.92 mm on buccal sites and 1.67+/-0.90 mm on lingual sites ) . CONCLUSIONS The results of this study indicate that a combination technique including BPBM , EMP , and GTR results in better clinical resolution of intrabony defects than treatment with OFD . Differences observed were both statistically and clinical ly significant . The exact role of each of the 3 technique components in achieving the clinical improvement observed in this study remains to be determined BACKGROUND Several studies have documented the clinical efficacy of guided tissue regeneration ( GTR ) with non-resorbable exp and ed polytetrafluoroethylene ( ePTFE ) membranes and enamel matrix proteins ( EMP ) in the treatment of infrabony defects . The objective of this controlled clinical study was to compare the clinical outcomes of 3 surgical modalities in the treatment of deep interproximal infrabony defects . METHODS Ninety ( 90 ) defects in 90 healthy subjects affected by chronic periodontitis were assigned to 1 of 3 treatment groups by blocking to prognostic variables . The test group was treated with the application of EMP and the simplified papilla preservation ( SPP ) technique ; the second group was treated with titanium-reinforced ePFTE membranes and the SPP technique ; and the third group was treated with the SPP technique used as access flap control procedure . No differences were observed in terms of baseline oral hygiene and defect characteristics among the 3 groups , indicating that the blocking approach was effective . A stringent infection control program was adopted for 1 year . RESULTS The 1-year results indicated that : 1 ) all treatment modalities result ed in clinical ly significant improvements in clinical attachment levels ( CAL ) and reduction in probing depth ( PD ) ; 2 ) a statistically significant treatment effect was demonstrated comparing the EMP test , the membrane control , and the flap control groups in terms of CAL gains ; 3 ) both the EMP test and the membrane control groups showed significant CAL gains compared to the flap control group ; 4 ) a statistically significantly greater amount of CAL gain was demonstrated in GTR-treated compared to EMP-treated patients ; 5 ) deeper residual probing depths but smaller increases in gingival recession were demonstrated following EMP therapy ; and 6 ) smoking habits reduced the clinical outcomes of both regenerative procedures . CONCLUSIONS The use of a regenerative procedure is indicated in the treatment of deep vertical bony defects since both the regenerative techniques ( GTR and EMD ) in the present study result ed in clinical ly and statistically significant improvements in clinical parameters compared to the access flap procedure . The use of EMP can be helpful in esthetically-sensitive sites and in reducing patient morbidity 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 ) > or = 6 mm with an infrabony component > or = 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 ( U 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 > or = 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 In 16 patients with advanced periodontitis , 23 teeth exhibiting interproximal intrabony defects were treated by conventional periodontal surgery ( n = 10 , control ) or guided tissue regeneration ( GTR ) technique using exp and ed polytetrafluoroethylene ( ePTFE ) barriers ( n = 13 , test ) , respectively . Clinical parameters were assessed before and 6 months after surgery . Presurgically and 3 and 6 months postsurgically st and ardized bite-wing radiographs were taken . Using a loupe and a computer-assisted system , respectively , the distances from the cemento-enamel junction ( CEJ ) to alveolar crest ( AC ) and CEJ to the most apical extension of bony defect ( BD ) were measured . The average gain of attachment was assessed 2.33 mm in the control group and 3.17 mm in the test group . The bony fill was measured 0.97 mm and 0.97 mm in the control group and 0.93 mm and 1.68 mm in the test group after 3 and 6 months , respectively , using a loupe . Using a computer-assisted system 0.83 mm and 1.82 mm of bone fill could be measured ( control ) and 0.76 mm and 1.79 mm ( test ) after 3 and 6 months , respectively . Compared to the gold st and ard of surgical measurements , the computer-assisted analysis of radiographs underestimated bone loss significantly less than evaluation with a loupe ( P < 0.002 ) . Compared to conventional periodontal surgery , the GTR technique result ed in higher attachment gain and bony fill . However , the high variation of surgical results in the test group prevented the calculation of a statistically significant difference The periodontal regeneration of interproximal bone defects of the posterior teeth produced by guided tissue regeneration ( GTR ) , with exp and ed Polytetrafluoroethylene barrier membranes and conventional therapy , was clinical ly evaluated in 20 intrabony periodontal defects in 10 patients . The material included the presence of at least two proximal angular lesions for the same patient , probing pocket depth > or = 6 mm , bone defect depth > or = 3 mm , and 2-wall defects with crestal involvement relative to the tooth circumference ranging from 90 to 270 degrees . Healing was clinical ly evaluated by surgical re-entry of GTR-treated sites ( 10 sites ) and debridement only sites ( 10 sites ) 1 year after initial surgery following a strict plaque control regimen . A significant correlation was observed between probing depth reduction , attachment gain and defect depth ( test sites ) ; there was increased bone fill in GTR-treated lesions of 2.95 + /- 1.3 mm corresponding to a 69.4 % improvement compared to control sites , and 1.3 + /- 1.0 mm corresponding to a 32 % improvement ( P < 0.0039 ) . The results demonstrated that bone regeneration is highly reliable , as compared to conventional therapy , in cases of severe periodontal bone loss from posterior teeth provided that the principles of GTR are applied BACKGROUND The regenerative therapy of non-contained intrabony defects achieves better results when bioabsorbable membranes are combined with a filling material . The purpose of the present study was to analyze clinical and radiographic effectiveness of a space-making bioabsorbable membrane in the treatment of wide and shallow intrabony defects characterized by a relevant 1-wall component . METHODS Eighteen pairs of angular bone defects were selected in 18 healthy , non-smoking patients ( age range 30 to 66 years ) . Prior to the surgical phase , patients were enrolled in a strict periodontal program including oral hygiene instructions and scaling and root planing ( presurgical full-mouth plaque score < 10 % ) . Using a split-mouth design , 18 sites were r and omly assigned to receive guided tissue regeneration ( GTR ) using a bioabsorbable membrane ( test group ) and 18 to receive open flap debridement alone ( control group ) . Clinical treatment outcome was evaluated 12 months postoperatively for changes in probing depth ( PD ) , clinical attachment level ( CAL ) , and position of gingival margin ( REC ) and radiographically for bone changes . RESULTS Open flap debridement and GTR yielded statistically significant ( P<0.0001 ) PD reduction ( 2.39+/- 0.92 mm and 3.44+/- 0.78 mm ) , CAL gain ( 1.50+/- 0.99 mm and 2.89 + /- 0.90 mm ) , increased REC ( -0.89 + /- 0.58 mm and -0.56 + /- 0.92 mm ) and bone fill ( 1.05+/- 0.94 mm and 2.13+/- 1.21 mm ) when 12-month data were compared to baseline . The differences between test and control groups were statistically significant for all parameters ( P<0.007 ) except for REC ( P=0.25 ) . CONCLUSION The use of this bioabsorbable membrane would seem to be effective in the treatment of intrabony defects with unfavorable architecture without the use of filling material AIM To compare healing responses to periosteal sliding grafts and polyglactin 910 periodontal mesh used as guided tissue regeneration ( GTR ) material s/techniques when both periapical and periradicular bone loss are present . METHODOLOGY Thirty patients with suppurative chronic apical periodontitis with apicomarginal communication were selected and allocated r and omly into two groups according to the barrier technique to be used during periradicular surgery : periosteal graft group ( n = 15 ) and bioabsorbable membrane group ( n = 15 ) . Clinical and radiological evaluations were completed prior to surgery , a week later and every 3 months after surgery up to 12 months to measure the periodontal pocket depth ( PD ) , clinical attachment level ( CAL ) , gingival margin position ( GMP ) , size of periapical lesion , percentage reduction of the periapical rarefaction , and periapical healing . RESULTS Both groups showed highly significant ( P < 0.001 ) reductions in periodontal PD , CAL and size of periapical lesion at 12 months whilst GMP was unaltered . No significant difference between the experimental groups was evident for these parameters , or for the percentage reduction of size of the periapical lesion and clinical -radiographic healing . CONCLUSION Guided tissue regeneration applied to apicomarginal defects using sliding periosteal grafts and use of bioabsorbable membranes led to similar enhancements of the clinical outcome of periradicular surgery in terms of periapical healing , gain of periodontal support , PD reduction and minimal recession of the gingival margin THE PURPOSE OF THIS STUDY was to assess periodontal regenerative techniques in intrabony defects utilizing a bioabsorbable , polylactic acid ( PLA ) barrier or the non-resorbable , exp and ed polytetrafluoroethylene ( ePTFE ) barrier .  Thirty patients ( 26 to 64 years old ) each with one radiographically evident intrabony periodontal lesion of probing depth > or = 6 mm participated in a 12-month controlled clinical trial . The subjects were r and omly divided into two independent groups . The test group ( n = 16 ) received a PLA barrier . The control group ( n = 14 ) received an ePTFE barrier .  Plaque index ( PI ) , gingival index ( GI ) , probing depth ( PD ) , clinical attachment level ( CAL ) , and bone fill were recorded by a single calibrated examiner not involved with the surgical treatment prior to surgery , and at 6 , 9 , and 12 months postsurgery . The treatment results were statistically analyzed utilizing two sets of data . The " averaged-site " data set consisted of values computed from the averaging of measurements from all sites encompassing the defect . The second data set was comprised of only the deepest measurement of the defect . Statistical tests used to analyze these data sets included the t-test and paired t-test for parametric data and the Wilcoxon rank sum test and the Wilcoxon signed rank test for non-parametric data . Analyses with both the averaged-site data and deepest-site data result ed in significant improvements in PD reductions , CAL , and bone fill , after 12 months of healing with both the PLA and ePTFE barrier devices . Comparisons of healing response between treatments found no significant differences when the averaged-site data were analyzed . When only the deepest site of the defect was considered , the control group result ed in significantly more attachment gain ( ePTFE , 3.36 mm ; PLA , 1.75 mm ; P < 0.02 ) and shallower probing depths ( ePTFE , 3.29 mm ; PLA , 4.69 mm ; P < 0.01 ) than the test group . In intrabony defects , the use of PLA or ePTFE barriers in GTR procedures yielded comparable clinical results ; however , in this study , data analysis using the deepest site of the defect found , after 12 months of healing , significantly more attachment gain and shallower probing depths with ePTFE BACKGROUND Guided bone regeneration ( GBR ) is a viable treatment for osseous defects surrounding dental implants . Controversy exists regarding the choice of barrier membrane used and the method of membrane fixation to achieve GBR . METHODS This study compared the efficacy of a porcine-derived bioabsorbable collagen membrane and an exp and ed polytetrafluoroethylene ( ePTFE ) membrane ( non-resorbable ) for GBR using a bovine bone xenograft/autograft bone composite in defects surrounding dental implants . The study also examined the effect of primary barrier fixation on GBR . Defect size was recorded at Stage 1 and 2 surgeries ( performed 6 months apart ) . Forty-eight subjects ( 41 % males , 59 % females ) requiring GBR were treated with either collagen ( 23 ) or ePTFE ( 25 ) barriers , respectively . Implants were titanium self-tapping screw-type . In 34 GBR sites , barrier fixation was achieved with polylactic acid resorbable pins . The remaining barriers were secured with the implant cover screw and /or embedded beneath the flaps . RESULTS At 6 months , a decrease in defect width  ( collagen barrier 1.95 + /- 0.60 mm , ePTFE barrier 2.65 + /- 0.56 mm ) , length  ( collagen barrier 2.65 + /- 0.61 mm , ePTFE barrier 2.26 + /- 0.66 mm ) , and circumference ( degrees ) ( collagen barrier 57.7 + /- 18.7 , ePTFE barrier 80.2 + /- 19.9 ) was observed for both membranes . A significant number ( chi2 , P = 0.041 ) of postoperative complications occurred when barrier fixation was lacking at initial surgery . Furthermore , a significant difference ( P < 0.05 ) in the success of GBR with respect to defect size was observed when barrier fixation was taken into account . CONCLUSIONS In conclusion , both collagen and ePTFE barriers proved suitable for achieving GBR of osseous defects surrounding dental implants . The results of this study stress the importance of barrier fixation at the time of initial surgery The purpose of this study was to evaluate the clinical effectiveness of a connective tissue graft including periosteum used as a barrier for guided periodontal tissue regeneration in interproximal bony defects . An open flap debridement of a comparable interproximal bony defect in the same patient was used as a control . This study was performed at 2 different clinical centers . Six paired defects were treated at one center , and 16 paired defects at the other .  Reentry surgeries were performed at 6 months . Preoperative comparisons of control and experimental sites with respect to clinical parameters and osseous measurements were similar . Post-surgical experimental sites produced more gain in clinical attachment ( 1.25 mm on buccal and 1.25 mm on lingual sites at center A and 1.26 mm on buccal and 1.18 mm on lingual sites at center B ) and osseous defect fill ( 1.84 mm on buccal and 2.00 mm on lingual sites at center A and 1.66 mm on buccal and 2.04 mm on lingual sites at center B ) when compared to control sites . The results of this trial indicate that clinical resolution of interproximal periodontal defects can be obtained with periosteal grafts used as barriers BACKGROUND Bacterial contamination of membrane material negatively affects healing after guided tissue regeneration ( GTR ) procedures ; conversely , flap connective tissue integration on barrier material improves the clinical outcomes . The objective of this study was to evaluate the effect of topical application of antibiotics on : 1 ) clinical outcomes of  GTR surgical procedures using titanium reinforced exp and ed polytetrafluoroethylene ( ePTFE ) periodontal membrane ; 2 ) bacterial colonization of membrane material ; and 3 ) flap connective tissue-membrane integration . METHODS Fifty-six deep interproximal bony defects were treated with  GTR surgical procedures  using titanium reinforced ePTFE periodontal membranes . Patients were r and omly assigned to 1 of the 2 antimicrobial treatment groups : the test group received weekly topical application of 25 % metronidazole gel and the control group received systemic antibiotics ( amoxicillin plus clavulanic acid 1 g/day for 14 days ) . Clinical outcomes were assessed at 1 year ; the amount of bacterial contamination and connective tissue integration on membrane material was evaluated at time of membrane removal by means of a morphological ( SEM ) method . RESULTS No statistically significant difference was found between test and control groups in terms of clinical attachment ( CAL ) gain ( baseline CAL - 12 months CAL ; P = 0.2 ) and probing depth ( PD ) reduction ( baseline PD - 12 months PD ; P = 0.6 ) . A greater increase in gingival recession ( REC ) ( 12 months REC - baseline REC ) was found in the test group compared to the control group ( P = 0.003 ) . The SEM analysis revealed no statistically significant ( t test ) difference between test and control groups in the number of fields positive to integrated connective tissue ( P = 0.82 ) , while the number of fields positive to bacteria was statistically higher ( P < 0.001 ) in the control group . CONCLUSIONS Local antibiotic administration is more effective than systemic use in preventing membrane contamination , but it does not improve clinical outcomes due to an interference of the vehicle ( gel ) with gingival tissues which may reduce the potential benefits derived from better control of the bacterial load BACKGROUND This clinical report compares the use of an enamel matrix derivative ( EMD ) and bioabsorbable barrier membrane to enhance healing following the immediate placement of transmucosal implants into extraction sockets . METHODS Thirty-two adult patients scheduled for tooth replacement with dental implants agreed to participate . Following the insertion of a transmucosal implant into the extraction site , the subjects were assigned to one of two treatment alternatives of the remaining bone defects around the implants : 1 ) the residual bone defects were filled with EMD ( EMD group ) or 2 ) the residual bone defects were covered with a bioabsorbable membrane ( membrane group ) . Flaps were then coronally positioned around implant cover screws . Patients followed weekly maintenance recalls for the first 6 weeks and then monthly recalls until the final prosthetic restoration was completed ( after 6 months ) . The treatment outcome was evaluated after 12 months by the use of clinical variables . The null hypothesis of no treatment group differences was tested by the use of analysis of variance ( ANOVA ) . RESULTS At a 12-month follow-up , all of the implants were completely osseointegrated and successfully functioning , showing a success rate of 100 % . The membrane group showed a significantly lower mean probing attachment level than the EMD group at proximal ( 0.60 mm , st and ard deviation ( SD ) 0.37 versus 1.19 mm , SD 1.10 ) , buccal ( 0.80 mm , SD 0.79 versus 1.77 mm , SD 1.16 ) , and lingual sites ( 0.44 mm , SD 0.52 versus 1.48 mm , SD 1.46 ) . The difference was statistically significant at all sites ( P < 0.05 ) . With respect to the position of the soft tissue margin around the implant shoulder , the membrane group showed a consistently higher value than the EMD group at , respectively , proximal ( 1.30 mm , SD 2.37 versus 1.16 mm , SD 1.0 ) , buccal ( 0.90 mm , SD 1.29 versus 0.22 mm , SD 1.47 ) , and lingual sites ( 1.12 mm , SD 1.10 versus 0.55 mm , SD 1.42 ) . CONCLUSIONS The membrane group obtained more favorable results in terms of both the probing attachment level and peri-implant position of soft tissues compared to the EMD group . The use of a bioabsorbable membrane around immediately placed transmucosal implants enhanced soft and hard tissue healing and might be an advisable treatment choice particularly in areas with high esthetic dem and BACKGROUND The aims of the present multi-center , r and omized , controlled clinical trial were : 1 ) to compare the efficacy of the simplified papilla preservation flap with and without a barrier membrane in deep intrabony defects ; 2 ) to evaluate the postoperative morbidity and surgical complications ; and 3 ) to preliminarily test the impact of baseline tooth mobility on clinical outcomes . METHODS This parallel group , r and omized , multi-center , controlled clinical trial involved 112 patients in 8 periodontal practice s in 4 countries . A deep intrabony defect in each patient was accessed with the simplified papilla preservation flap . In the test defects , a bioabsorbable membrane was positioned . Patients ' experiences with the surgical procedure and postoperative period were evaluated with a question naire . Clinical outcomes included clinical attachment level ( CAL ) and probing depth ( PD ) changes . RESULTS Complete observations were available for 55 test and 54 control defects . CAL gains at 1 year were 3.5 + /- 2.1 mm in the guided tissue regeneration ( GTR ) group and 2.6 + /- 1.8 mm in the control group ( P = 0.0117 ) . CAL gains > or = 4 mm were observed in 50.9 % of GTR sites and 33.3 % of control sites . A significant center effect of 2.1 mm was observed ( P= 0.01 ) . Initial PD ( P= 0.01 ) and baseline tooth mobility ( P= 0.036 ) were significant covariates . During the procedure , 30.4 % of test and 28.6 % of controls reported feeling moderate pain , and subjects estimated the hardship of the procedure at 24 + /- 25 visual analog scale ( VAS ) units in the test group , and at 22 + /- 23 VAS in controls . In terms of the investigated outcomes , differences between test and control groups were not statistically significant . Among the postoperative complications , edema was most prevalent at week 1 , and more frequently associated with the test treatment ( P= 0.01 ) . In the test group , 53.6 % of membranes were exposed at week 3 . CONCLUSIONS The present study further supports the added benefits of guided tissue regeneration with respect to access flap alone in the treatment of deep intrabony defects , as well as the general efficacy of GTR in different clinical setting s. Furthermore , our study indicates a possible influence of baseline tooth mobility on clinical outcomes The aim of this controlled , clinical study was to evaluate guided tissue regeneration using a bioabsorbable membrane in periodontal intraosseous defects . Forty patients , each contributing one defect > or = 4 mm in depth participated . The control group ( 18 individuals ) received conventional flap therapy , while the test group ( 22 individuals ) was treated using the bioabsorbable membrane , Guidor . Clinical assessment s were made by one examiner , blinded with respect to treatment group , at baseline , 6 and 12 months following surgery . Baseline probing pocket depths of 7.7+/-1.4 mm in the membrane group and 7.6+/-1.9 mm in the control group were measured . Twelve month results showed a significant clinical attachment level gain in both control ( 1.1+/-1.8 mm ) , and membrane group ( 1.3+/-2.1 mm ) . Probing pocket depth reduction of 2.6+/-1.9 mm and 2.7+/-1.9 mm was observed in the respective groups . Bone sounding showed a non-significant gain of 0.4+/-1.8 mm and 0.6+/-1.4 mm at membrane and control sites , respectively . Radiographic evaluation confirmed these results . There were no significant differences found between treatment groups for any of the tested variables . Smoking had a negative effect on healing in both groups . In conclusion , clinical and radiographic results indicate that guided tissue regeneration using a bioabsorbable membrane at intraosseous defects did not predictably achieve greater clinical attachment level gain nor bone gain when compared to conventional flap therapy BACKGROUND The aim of periodontal therapy is to prevent tissue destruction while achieving the regeneration of damaged tissues . Platelet-rich plasma ( PRP ) is used to generate new bone , periodontal ligament , and new attachment with a strategy based on the modulation and enhancement of wound healing through an autologous source for growth factors obtained from the patient 's own blood . The purpose of the present study was to evaluate the efficacy of PRP when used in combination with beta-tricalcium phosphate ( beta-TCP ) alloplastic graft material and collagen barrier membrane in the treatment of anterior interproximal intrabony defects . METHODS Thirty interproximal intrabony defects in 25 systemically healthy patients were selected for the study . Defects were distributed r and omly and equally into three groups : graft alone ( beta-TCP ) , graft + PRP , and graft + PRP + membrane . The plaque index , gingival index , periodontal probing depth , relative attachment level , transgingival probing measurement , and radiographic analyses were performed at baseline and repeated after 6 , 9 , and 12 months . RESULTS At the end of 12 months , relative attachment gain was 2.4 , 2.1 , and 2.5 mm in the three treatment groups , respectively . No statistically significant differences in clinical and radiographic measurements were observed among the groups . CONCLUSIONS All options were effective in the treatment of anterior interproximal intrabony defects . The results also suggested that PRP added no clinical benefit to beta-TCP alloplastic graft material used alone or in combination with GTR The purpose of this controlled clinical trial was to compare the clinical efficacy of 3 treatment modalities in the treatment of deep interproximal intrabony defects . Forty-five ( 45 ) defects in 45 patients were r and omly assigned to 1 of 3 treatment groups by blocking to prognostic variables . The test group was treated with titanium reinforced membranes positioned just apical to the cemento-enamel junction and the modified papilla preservation technique ; the second group received conventional exp and ed polytetrafluoroethylene ( ePTFE ) barrier membranes applied at the alveolar crest ; the third group was treated with an access flap procedure . The groups were well balanced with respect to all prognostic variables . During the 1-year observation period , patients were subjected to a stringent infection control program including : professional tooth cleaning every week for the first 6 weeks ( all groups ) and in the 4 weeks following membrane removal ( guided tissue regeneration groups ) , then at monthly intervals ( all groups ) . The results indicated that : 1 ) all treatment modalities result ed in clinical and statistically significant improvements in clinical attachment level ( CAL ) and probing depths ( PD ) at 1 year ; 2 ) a significantly greater amount of CAL gain ( P = 0.0003 , analysis of variance ) was observed in the test group ( 5.3 + /- 2.2 mm ) with respect to both the ePTFE group ( 4.1 + /- 1.8 mm ) and the flap control group 2.5 + /- 0.8 ; 3 ) in the test group the 1 year CAL ( 4.7 + /- 1.8 mm ) was located more coronally than the baseline position of the interproximal alveolar crest ( 5.9 + /- 2 mm ; P = 0.003 , t test ) . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND The use of barrier membranes in the treatment of periodontal defects is well documented . There has been an increase in the use of bioabsorbable material s which do not require a second surgical procedure for removal . However , there are little data evaluating the efficacy of bioabsorbable membranes in the treatment of intrabony defects . The purpose of this investigation was to evaluate the regenerative potential of 2 bioabsorbable barrier membranes without the use of grafting material s in the treatment of interdental intrabony defects . METHODS Twenty-three 2- or 3-walled intrabony defects were treated in 19 patients with a mean age of 50.4 years . All had completed nonsurgical treatment and a period of supportive periodontal therapy . The sites were r and omly chosen to receive a barrier membrane composed of type I bovine collagen ( 11 ) or a copolymer of polylactic acid ( PGA/PLA;12 ) . A pressure sensitive disc probe was used to evaluate the following criteria at baseline and re-entry : 1 ) occlusal surface to the apical depth of probe penetration ( OS-DP ) ; 2 ) occlusal surface to the gingival margin ( OS-GM ) ; 3 ) occlusal surface to the alveolar crest ( OS-AC ) ; and 4 ) occlusal surface to the base of the osseous defect ( OS-BD ) . Full thickness mucoperiosteal flaps were reflected to expose the surgical sites . The defects were debrided of the granulomatous tissue , the root surfaces instrumented and conditioned with 4 one-minute applications of 50 mg/ml of tetracycline . The barrier membranes were adapted to cover the defects and the flaps replaced . The postsurgical healing was uneventful and similar in both treatment modalities . RESULTS Twenty-three sites were surgically re-entered 6 months from the time of the initial surgery . The deepest probe depth for each site was used for statistical analysis . There was a mean relative attachment gain of 2.58+/-1.90 mm for the collagen , and 2.77+/-2.13 mm for the copolymer . There was a decrease in probing depth of 3.27+/-1.91 mm and 0.69+/-1.35 mm of recession for the collagen . The PGA/PLA copolymer had 3.55+/-2.47 mm reduction in probe depth and 0.78+/-1.14 mm of recession . CONCLUSIONS The data indicated the bioabsorbable collagen and copolymer membranes result ed in comparable results . A larger sample size would be necessary to determine if one membrane was superior to the other BACKGROUND A combination of platelet-rich plasma ( PRP ) , bovine porous bone mineral ( BPBM ) and guided tissue regeneration ( GTR ) has been shown to be effective in promoting clinical signs of periodontal regeneration in intrabony defects . As an initial attempt to clarify the role played by each of the three treatment components , this study was performed to compare the clinical effectiveness of two regenerative techniques for intrabony defects in humans : a combination of PRP/BPBM/GTR vs. GTR . MATERIAL AND METHODS Eighteen patients participated in the study . Using a split-mouth design , interproximal bony defects were surgically treated with either an absorbable membrane made of polylactic acid for GTR or a combination of PRP/BPBM/GTR . Changes in pocket depth , attachment level and defect fill as revealed by 6-month reentry surgeries were evaluated . RESULTS Both treatment modalities result ed in significant pocket depth reduction and clinical attachment gain as compared to baseline values . Pocket depth reduction was 4.98 + /- 0.96 mm on buccal and 4.93 + /- 0.92 mm on lingual sites of the PRP/BPBM/GTR group and 3.62 + /- 0.81 mm on buccal and 3.54 + /- 0.88 mm on lingual sites of the GTR group . The gain in clinical attachment observed was 4.37 + /- 1.31 mm on buccal and 4.28 + /- 1.33 mm on lingual sites of the PRP/BPBM/GTR group and 2.62 + /- 1.23 mm on buccal and 2.44 + /- 1.21 mm on lingual sites of the GTR group . The amount of defect fill observed was 4.78 + /- 1.26 mm on buccal and 4.66 + /- 1.32 mm on lingual sites of the PRP/BPBM/GTR group and 2.31 + /- 0.76 mm on buccal and 2.26 + /- 0.81 mm on lingual sites of the GTR group . All differences between the two groups were statistically significant in favor of the PRP/BPBM/GTR group . CONCLUSIONS The results of this study suggest that PRP and BPBM provide an added regenerative effect to GTR in promoting the clinical resolution of intrabony defects on patients with severe periodontitis BACKGROUND Utilisation of enamel matrix proteins ( EMD ) and application of the guided tissue regeneration principle ( GTR ) are treatment modalities which both have been shown to result in periodontal regeneration . However , it is yet unknown whether the combination of EMD and GTR may additionally favor the regeneration process . AIM The aim of the present controlled study was to evaluate clinical ly the treatment effect of EMD , GTR , combination of EMD and GTR , and flap surgery ( control ) on intrabony defects . MATERIAL AND METHODS 56 patients each of whom displaying one intrabony defect of a depth of at least 6 mm were r and omly treated with one of the treatment modalities . Prior to surgery and at one year after , the following parameters were evaluated by a blinded examiner : Plaque index ( PlI ) , gingival index ( GI ) , bleeding on probing ( BOP ) , probing pocket depth ( PPD ) , gingival recession ( GR ) and clinical attachment level ( CAL ) . No statistical significant differences between the four groups were observed at baseline for any of the investigated parameters . RESULTS At 1 year after therapy , the sites treated with EMD demonstrated a mean PPD reduction of 4.1 + /- 1.7 mm and a mean CAL gain of 3.4 + /- 1.5 mm ( p<0.001 ) . The sites treated with GTR showed a mean PPD reduction of 4.2 + /- 1.9 mm and a mean CAL gain of 3.1 + /- 1.5 mm ( p<0.001 ) . The sites treated with the combined treatment showed a mean PPD reduction of 4.3 + /- 1.4 mm and a mean CAL gain of 3.4 + /- 1.1 mm ( p<0.001 ) . In the control group , the mean PPD reduction was 3.7 + /- 1.4 mm ( p<0.001 ) and the mean CAL gain measured 1.7 + /- 1.5 mm ( p<0.01 ) . All 4 treatments led to statistically significant PPD reduction and CAL gain . All three regenerative treatments led to higher CAL gain than the control treatment ( p<0.05 ) . No statistical significant differences in PPD reduction and CAL gain were observed between the three regenerative treatments . CONCLUSION It may be concluded that ( a ) all 3 regenerative treatment modalities may lead to higher CAL gain than the control one , and ( b ) the combined treatment does not seem to improve the outcome of the regenerative procedure The aim of the study was to evaluate the clinical , radiographical and microbiological outcome after using guided tissue regeneration ( GTR ) with a bioabsorbable membrane , Resolut . Subjects with bilateral infrabony defects at single rooted teeth were selected . A total of 22 teeth , 2 in each 1 of 7 patients and 4 in 2 patients , with probing pocket depth > or = 5 mm , 3 months after scaling , participated . At baseline , assessment s of plaque and gingival indices , bleeding on probing , probing pocket depth and probing attachment level were recorded and reproducible radiographs for computer-based bone level measurements were taken . Bacterial sample s were collected to investigate the presence of periodontitis-associated bacteria , e.g. , Porphyromonas/Prevotella- and Fusobactrium-like micro-organisms . One tooth was r and omly treated with GTR and the contralateral with an open debridement procedure as a control . Clinical , radiographical and microbiological examinations were repeated 6 and 12 months postoperatively . Both procedures demonstrated a statistically significant improvement of gingival conditions , reduction of pocket depths and gain of attachment . When evaluating the differences between test and control teeth , none of the clinical parameters yielded statistical difference . Computer-based bone-level measurements showed only small differences in the majority of both test and control sites . The differences were not significant . Periodontitis-associated bacteria were present at baseline , but the appearance was not related to any specific site or patient and did not demonstrate any unwanted change in the 6- and 12-month sample s. The findings suggest that the clinical , radiographical and microbiological improvements were not significantly enhanced with the GTR therapy As observed in previous case reports , dental rubber dam ( DRD ) can be utilized as a barrier membrane in the guided tissue regeneration ( GTR ) technique for the treatment of periodontal intrabony defects . The purpose of the present study was ( 1 ) to confirm the validity of DRD as a suitable material in regenerative procedures and ( 2 ) to compare , in a split-mouth clinical trial , the effectiveness of DRD-made membranes in the treatment of periodontal intrabony defects versus that of exp and ed polytetrafluoroethylene ( e-PTFE ) barriers .  22 systemically healthy non-smoker adult periodontitis patients ( 7 male , 15 female ) aged between 35 to 58 years were selected for the study . In each patient , a couple of 2 - 3 wall intrabony defects , located in different quadrants , were treated by a GTR technique using DRD ( test sites ) and e-PTFE ( control sites ) , respectively . Performing a strict control of the oral hygiene level and of the marginal gingival health during the whole period of study , clinical ( pocket probing depth , PPD ; probing attachment level , PAL ; gingival recession , GR ) and intrasurgical ( depth of the defect 's intraosseous component , IOC ; level of the alveolar crest , ACL ) parameters were recorded at baseline and at the 1-year re-entry procedure in each experimental site . Furthermore , the coronal level of the newly formed tissue from the base of the defect ( NFTL ) and the vertical bone gain ( VBG ) were calculated at the time of membrane removal and after the re-entry procedure respectively . Membranes were removed from both test and control sites after 5 weeks ; however , exposure of the membrane always occurred in test sites whereas it was observed in only 6 out of 22 control sites , this fact leading to an incomplete coverage of the regenerated tissue by the gingival flap in 18 out of 22 test sites . In both test and control sites , a statistically significant improvement of clinical and intrasurgical parameters occurred at the end of the study period ; however , a significantly greater improvement was observed in control sites for PAL ( + 4.0 mm versus + 3.0 mm ; p<0.05 ) and VBG ( 3.9 mm versus 2.9 mm ; p<0.05 ) although at the time of membrane removal , NFTL was similar between the experimental sites ( test : 5.8 ; control : 5.6 ; p>0.05 ) . Conversely , test sites exhibited a statistically significant greater increase in gingival recession ( + 1.9 versus + 1.2 ; p<0.05 ) and alveolar crest resorption ( -1.1 versus -0.3 , p<0.01 ) in comparison to controls . It was concluded that ( 1 ) DRD is a suitable material to be used as a barrier membrane in GTR procedures although ( 2 ) e-PTFE membranes can provide a greater improvement in PAL and VBG , probably because of the difficulty in completely covering the regenerated tissue due to the fact that the gingival tissues have undergone a consistent recession in DRD-treated sites . Further studies are needed to demonstrate if an adequate coverage of the regenerated tissue in DRD-treated sites can eliminate these differences Identification and control of significant factors determining clinical outcomes is of paramount importance to improve expected results of a variety of therapeutic procedures . The aim of this investigation was to identify , with a multivariate approach , factors associated with healing outcomes of 3 periodontal surgical procedures in deep intrabony defects . 45 patients with evidence of deep intrabony defects were r and omly assigned to 3 treatment groups : access flap ( group C ) , conventional guided tissue regeneration ( GTR ) with non-resorbable exp and ed polytetrafluoroethilene ( ePTFE ) membranes ( group B ) , and GTR with self supporting membranes combined with the modified papilla preservation technique ( group A ) . In both GTR procedures , membranes were positioned coronal to the interproxymal alveolar crest . Primary outcome variables ( i.e. , probing attachment level gains at 1 year and the amount of newly formed tissue present at membrane removal ) were explained in terms of a series of patient , defect morphology and surgical factors , using a multivariate approach . Highly significant treatment effects were observed , indicating that the 3 tested therapeutic modalities result ed in significant differences in primary outcome variables . Detailed analysis assessing the significance of the tested factors in determining the healing outcomes following each procedure was performed with a stepwise elimination approach of non-significant factors . The results indicated that : ( i ) the need to create and maintain space should be a key objective of regenerative approaches based upon the principles of guided tissue regeneration ; ( ii ) control of patient 's oral hygiene and residual periodontal infection in the oral cavity are strongly associated with clinical outcomes of both regenerative and conventional surgical procedures and should receive proper attention Abstract Introduction . Emdogain ® represents an extracellular matrix derivative that controls and promotes periodontal regeneration . Several studies have demonstrated that the treatment of periodontal defects with Emdogain ® leads to improvements in clinical parameters . However , long-time clinical trials establishing clinical usefulness of Emdogain ® are scarce . Therefore , the present r and omized split mouth , controlled study was undertaken to evaluate the effectiveness of Emdogain ® as an adjunct to open flap debridement for the treatment of intra-bony defects over a period of 5 years . Material s and methods . The study population consisted of 15 chronic periodontitis patients with bilateral interproximal osseous defects . The test group was treated by open flap debridement with EDTA 24 % ( PrefGel ® ) followed by enamel matrix derivative ( Emdogain ® ) . The control group was treated by open flap debridement with EDTA 24 % ( PrefGel ® ) . Results . After 1 and 5 years , both the test and control groups showed significant mean PPD reduction . A greater reduction in mean Probing Pocket Depth ( PPD ) was observed in the test group ( 3.84 ± 1.05 ) as compared to the control group ( 1.92 ± 0.35 ) . The mean Clinical Attachment Level ( CAL ) gain of 3.18 ± 0.87 mm was observed in the test group , while the control group displayed mean CAL gain of 1.60 ± 0.54 mm . The observed differences were found to be statistically significant in both the groups ( p < 0.05 ) . Percentage bone fill was significantly increased at 12 months post-surgery in test group ( 66.66 ± 7.8 % ) as compared to control group ( 31.71 ± 4.1 % ) . Conclusion . The treatment with Emdogain result ed in a significantly higher CAL gain and PPD reduction in comparison with OFD and PrefGel ® BACKGROUND A growing flow of recent evidence indicates enamel matrix derivative ( EMD , Emdogain ) as a useful tool for the regeneration of periodontal tissues . This prospect i ve clinical study aim ed to evaluate the efficacy of EMD combined with surgical treatment of periodontal intra-bony defects , as compared with surgery alone , up to 24 months of follow-up . METHODS Twenty-four intra-bony defects were treated in 24 patients in a single clinical centre . Each defect had intra-bony depth ( IBD ) > or = 4 mm and probing pocket depth ( PPD ) > or = 6 mm . Patients were r and omly assigned to either test or control group . Plaque index ( PI ) , gingival index ( GI ) , PPD and periodontal attachment level ( PAL ) were assessed at baseline pre-surgical examination at the site to be treated . Full mouth plaque score ( FMPS ) and full mouth bleeding score ( FMBS ) were also evaluated . Twelve patients were treated by simplified papilla preservation flap technique ( control group ) , while 12 patients were treated with the same surgical technique plus EMD after ethylenediamine tetraacetic acid root conditioning ( test group ) . Any probing at the involved sites was avoided in the first year post-surgery . Radiographs were taken at baseline , 12 and 24 months after surgery using customized bite blocks . Intra-bony defect depth ( IBD ) and angle ( IBA ) were measured from X-rays by a computer-aided technique . At 12 and 24 months post-surgery , FMPS , FMBS , PI , GI , PPD , PAL and radiographic IBD and IBA were assessed . The difference between each follow-up and baseline , and between groups at each follow-up was evaluated for the above parameters by st and ard statistical methods . RESULTS In both groups , clinical and radiographic parameters were improved at either 12 or 24 months when compared with baseline . The test group displayed better outcomes when compared with the control group for IBD , PPD , and PAL gain at 12 months , and only for PAL and IBD gain at 24 months . No adverse event related to the use of EMD was reported . CONCLUSIONS The surgical procedure used in the present study , aim ing for maximum preservation of the regenerative potential of periodontal tissues , showed per se excellent results . The use of EMD as an adjunct to periodontal surgery in the treatment of angular defects possibly enhances periodontal regeneration rate OBJECTIVES Application of the guided tissue regeneration ( GTR ) principle and utilization of enamel matrix derivative ( EMD ) have both been shown to result in periodontal regeneration . While clinical investigations have demonstrated that the use of a microsurgical concept in combination with the GTR technique positively affects the percentage of primary closure and the amount of tissue preservation , no such information is available for EMD-treated periodontal defects . It was the aim of the present investigation to assess the clinical effect of the microsurgical access flap and EMD treatment with an emphasis on the evaluation of early wound healing . MATERIAL AND METHODS Eleven patients displaying at least one pair of intrabony periodontal defects with an intrabony component of > or =3 mm participated in the study . At baseline and at 6 and 12 months after surgery , the following clinical parameters were assessed by a blinded examiner : oral hygiene status ( API ) , gingival inflammation ( BOP ) , probing pocket depth ( PPD ) , clinical attachment level ( CAL ) and gingival recession ( GR ) . Defects were r and omly assigned to test or control treatment , which both consisted of a microsurgical access flap procedure design ed for maximum tissue preservation . The exposed root surfaces of the test sites were conditioned with a 24 % EDTA gel followed by EMD ( Emdogain(R ) ) application . Primary flap closure was achieved by a 2-layered suturing technique . Postoperative healing was evaluated by a newly introduced early wound-healing index ( EHI ) at 1 and 2 weeks after surgery . RESULTS Both test and control treatment result ed in a statistically significant mean CAL gain of 2.8 and 2.0 mm at 6 months , and 3.6 and 1.7 mm at 12 months , respectively ( p<0.05 ) . Differences in CAL gain between the two treatment modalities were statistically significant at both time points ( p<0.05 ) . Additional GR values after 12 months averaged 0.3 and 0.4 mm for test and control sites , respectively , and did not reach statistical significance ( p > or = 0.05 ) . Two weeks after surgery , primary closure was maintained in 89 % of the test sites and in 96 % of the control sites . CONCLUSION Both treatment modalities using the microsurgical flap procedure result ed in a high percentage of primary flap closure and maximum tissue preservation . In terms of PPD reduction and CAL gain , the combination with EMD application appeared to be superior to the microsurgical access flap alone OBJECTIVES The objective of this systematic review was to critically evaluate marginal soft-tissue aspects at implants subjected to immediate loading or immediate restoration . METHODS An electronic Medline search from 1966 up to August 2005 was conducted to identify prospect i ve and retrospective studies on immediate implant loading . The search strategy was complemented by h and search ing in peer- review ed journals . Studies reporting on soft-tissue aspects at implants subjected to immediate loading or immediate restoration and with a follow-up time of at least 1 year were included . Assessment of identified studies and data extraction was performed independently by two review ers . An attempt was made to isolate and categorize studies with similar protocol s in order to identify trends and relevant factors . Variables that were considered included marginal and interproximal soft-tissue stability , marginal plaque accumulation , probing depth , bleeding on probing , peri-implant mucositis and peri-implantitis . RESULTS From an initial yield of 581 titles , 240 articles were selected for text analysis , finally result ing in 17 studies that met the inclusion criteria . Six studies on immediate implant loading or restoration were controlled studies , whereas the remainder was prospect i ve case series . Seven studies reported on a 1-year data , and the longest follow-up within the included studies was 4 years . The total number of patients treated within the 17 studies was 432 including a total 706 implants studied . Overall , the articles reported on many different procedures and follow-up times , time points and evaluated soft-tissue parameters varied considerably between the different articles . CONCLUSION Within the limits of the evaluated data it can be cautiously concluded that once immediately loaded or restored implants integrate successfully , they appear to show a soft-tissue reaction with regard to periodontal as well as morphologic aspects comparable with those of conventionally loaded implants . However , follow-up periods are generally short , number of patients and /or implants per study are few , and most studies present only limited data on peri-implant soft-tissue evaluation . More accurate long-term studies with a stronger study design ( i.e. , RCT ) reporting more detailed on treatment and follow-up protocol s are required to allow for proper comparisons and conclusions AIM Comparison of two bioabsorbable barriers ( collagen and polylactic acid ( PLA ) membranes ) combined with a bovine bone mineral ( BBM ) graft , with an access flap procedure ( AFP ) alone for treating intrabony defects . MATERIAL AND METHODS Thirty-four subjects participated in this prospect i ve , controlled clinical trial . Baseline clinical examination ( probing depth ( PD ) , clinical attachment level ( CAL ) ) of selected sites was performed 2 months after completion of conservative treatment in conjunction with hard-tissue measurements to ascertain the depth of the defect ( cementoenamel junction to the bottom of the defects ) . After r and omly dividing patients into three groups ( two membrane groups , one control group ) , full thickness flaps were elevated and exposed root surfaces planed before filling defects with bone graft and positioning a barrier membrane covering the defect . The control group was treated identically except for the barrier and bone graft placement . Clinical treatment outcomes were finally evaluated 12 months after surgery for changes of PD and CAL . Radiographs at baseline and 12 months were compared using non-st and ardized digital radiography . RESULTS A mean reduction in PD value of 5.08 mm and mean CAL gain of 4.39 mm occurred in the collagen-BBM group . Corresponding values for the PLA-BBM group were 4.72 and 3.71 mm , while access flap procedure ( AFP ) sites produced values of 2.50 and 2.43 mm . All improvements in clinical parameters were statistically significant ( p<0.001 ) within groups for all variables . Both membranes produced statistically greater PD reduction and CAL gain compared with AFP treatment ( p<0.05 ) . Comparison between barrier groups failed to reveal any statistically significant difference in probing pocket depth reduction ( p=0.56 ) or in CAL gain ( p=0.34 ) . CONCLUSION Placement of the two barrier membranes used in the present study in combination with BBM graft significantly improved clinical and radiographic parameters of deep intrabony pockets and proved superior to access flap alone BACKGROUND A combination of platelet-rich plasma ( PRP ) , bovine porous bone mineral ( BPBM ) , and guided tissue regeneration ( GTR ) has been shown to be effective in promoting reduction in probing depth , gain in clinical attachment , and defect fill in intrabony periodontal lesions . The individual role played by PRP , BPBM , and GTR in this combined therapy is unclear and needs to be eluci date d. The purpose of this study was to compare the clinical effectiveness of 2 regenerative techniques for intrabony defects in humans : a combination of PRP/BPBM/GTR versus a combination of PRP/BPBM . METHODS Twenty-one patients participated in the study . Using a split-mouth design , interproximal bony defects were surgically treated with either a combination of PRP/BPBM/GTR or PRP/BPBM . The primary outcomes of the study included changes in probing depth , attachment level , and defect fill as revealed by reentry surgeries at 6 months post-treatment . RESULTS At 6 months postoperatively , clinical examination of the treated defects revealed that both treatment modalities result ed in significant probing depth reduction and clinical attachment gain compared to baseline values . Probing depth improvement was 3.98 + /- 1.02 mm on buccal and 3.94 + /- 0.94 mm on lingual sites for the PRP/BPBM group and 4.19 + /- 0.88 mm on buccal and 4.21 + /- 0.92 mm on lingual sites for the PRP/BPBM/GTR group . Gain in clinical attachment was 3.78 + /- 0.72 mm on buccal and 3.84 + /- 0.76 mm on lingual sites for the PRP/BPBM group and 4.12 + /- 0.78 mm on buccal and 4.16 + /- 0.83 mm on lingual sites for the PRP/BPBM/GTR group . Reentry surgeries revealed similar defect fill for both treatment groups ( PRP/BPBM group : 4.82 + /- 1.34 mm on buccal and 4.74 + /- 1.30 mm on lingual sites ; PRP/BPBM/GTR group : 4.96 + /- 1.28 mm on buccal and 4.78 + /- 1.32 mm on lingual sites ) . None of the differences between the 2 treatment groups was statistically significant . CONCLUSIONS The results of this study show that both combinations of PRP/BPBM/GTR and PRP/BPBM are effective in the treatment of intrabony defects present in patients with advanced chronic periodontitis . The results also suggest that GTR adds no clinical benefit to PRP/BPBM . Further studies are necessary to assess the individual role played by PRP and BPBM in the clinical outcome achieved with their combination BACKGROUND AND OBJECTIVE Guided tissue regeneration has been shown to lead to periodontal regeneration , however , the mechanisms involved remain to be clarified . The present study was carried out to assess the expression of genes involved in the healing process of periodontal tissues in membrane-protected vs. nonprotected intrabony defects in humans . MATERIAL AND METHODS Thirty patients with deep intrabony defects ( > or = 5 mm , two or three walls ) around teeth that were scheduled for extraction were selected and r and omly assigned to receive one of the following treatments : flap surgery alone ( control group ) or flap surgery plus guided tissue regeneration ( exp and ed polytetrafluorethylene ( e-PTFE ) membrane ) ( test group ) . Twenty-one days later , the newly formed tissue was harvested and quantitatively assessed using the polymerase chain reaction assay for the expression of the following genes : alkaline phosphatase , receptor activator of nuclear factor-kappa B lig and , osteoprotegerin , osteopontin , osteocalcin , bone sialoprotein , basic fibroblast growth factor , interleukin-1 , interleukin-4 , interleukin-6 , matrix metalloproteinase-2 and matrix metalloproteinase-9 . RESULTS Data analysis demonstrated that mRNA levels for alkaline phosphatase , receptor activator of nuclear factor-kappa B lig and , osteoprotegerin , osteopontin , bone sialoprotein , basic fibroblast growth factor , interleukin-1 , interleukin-6 , matrix metalloproteinase-2 and matrix metalloproteinase -9 were higher in the sites where guided tissue regeneration was applied compared with the control sites ( p < 0.05 ) , whereas osteocalcin mRNA levels were lower ( p < 0.05 ) . No difference was observed in interleukin-4 mRNA levels between control and test groups . CONCLUSION Within the limits of this study , it can be concluded that genes are differentially expressed in membrane barrier-led periodontal healing when compared with flap surgery alone , and this may account for the clinical outcome achieved by guided tissue regeneration BACKGROUND Surgical periodontal treatment with enamel matrix protein derivative ( EMD ) has been shown to promote periodontal regeneration . However , it is not known whether nonsurgical periodontal therapy with additional subgingival application of EMD may also enhance periodontal regeneration . The purpose of this study was to clinical ly and histologically evaluate healing of human intrabony defects following non-surgical periodontal treatment with and without application of EMD . METHODS Sixteen patients , each of whom displayed one advanced intrabony defect around teeth or roots scheduled for extraction , were included in the study . The defects were treated as follows : 1 ) scaling and root planing with h and instruments and application of EMD ; 2 ) scaling with an ultrasonic instrument and application of EMD ; or 3 ) scaling with an ultrasonic instrument alone .  Healing was uneventful in all cases . Six months after surgery , the teeth or roots were extracted together with some of their surrounding soft and hard tissues and processed for histologic evaluation . RESULTS Clinical examination revealed a probing depth reduction and a gain of clinical attachment after all 3 treatment modalities . The histological evaluation , however , revealed that healing in all 3 procedures was predominantly characterized by formation of a long junctional epithelium along the instrumented root surface and no predictable regeneration of attachment apparatus . CONCLUSION Within its limits , the present study failed to show periodontal regeneration in advanced human intrabony defects following non-surgical treatment with subgingival application of EMD AIM The purpose of the present study was to compare clinical ly the treatment of deep intra-bony defects with a combination of a composite bovine-derived xenograft ( BDX Coll ) and a bioresorbable collagen membrane [ guided tissue regeneration ( GTR ) ] to access flap surgery only . METHODS Thirty-two patients , each of whom displayed one intra-bony defect , were treated either with BDX Coll+GTR ( test ) or with access flap surgery ( control ) . The results were evaluated at 1 year following therapy . RESULTS No differences in any of the investigated parameters were observed at baseline between the two groups . Healing was uneventful in all patients . At 1 year after therapy , the test group showed a reduction in the mean probing depth ( PD ) from 8.3+/-1.5 to 2.9+/-1.3 mm ( p<0.001 ) and a change in the mean clinical attachment level ( CAL ) from 9.4+/-1.3 to 5.3+/-1.5 mm ( p<0.0001 ) . In the control group , the mean PD was reduced from 8.0+/-1.2 to 4.4+/-1.7 mm ( p<0.001 ) and the mean CAL changed from 9.6+/-1.3 to 7.9+/-1.6 mm ( p<0.01 ) . The test treatment result ed in statistically higher PD reductions ( p < or = 0.05 ) and CAL gains ( p<0.001 ) than the control one . In the test group , all sites ( 100 % ) gained at least 3 mm of CAL . In this group , a CAL gain of 3 or 4 mm was measured at 10 sites ( 62 % ) , whereas at six sites ( 38 % ) , the CAL gain was 5 or 6 mm . In the control group , no CAL gain occurred at three sites ( 19 % ) , whereas at 10 sites ( 62 % ) , the CAL gain was only 1 or 2 mm . A CAL gain of 3 mm was measured in three defects ( 19 % ) . CONCLUSIONS Within the limits of the present study , it can be concluded that the combination of BDX Coll+GTR result ed in significantly higher CAL gains than treatment with access flap surgery alone , and thus appears to be a suitable alternative for treating intra-bony periodontal defects AIM Cl aims are being made that clinical results of periodontal flap surgery are enhanced when membranes are employed to aid GTR in intrabony pockets . It was the aim of our study to determine whether this assumption was true for a certain bioresorbable membrane ( Guidor Matrix Barrier ) . METHOD 44 intrabony defects were treated in 16 patients . In 21 lesions , conventional flap surgery only was performed , while in 23 , similar lesion membranes were placed as an additional treatment task . Results were evaluated over a time span of 12 months . RESULTS In all surgical areas , treatment result ed in significant improvement of parameters such as attachment levels and probing depths , as well as index values for plaque and bleeding on probing . This occurred whether membranes had been used or not , without any significant differences when comparing the collective results of both treatment groups . CONCLUSIONS Placement of membranes during periodontal surgery for the enhancement of tissue regeneration in intrabony pockets is often both difficult and time consuming . In the light of our clinical results with resorbable membranes , such extra effort seems hardly warranted OBJECTIVES To investigate the influence of autologous platelet concentrate ( APC ) on early wound healing and regeneration outcomes following guided tissue regeneration ( GTR ) therapy . MATERIAL AND METHODS In 25 patients , two contralateral deep intra-bony defects were treated with beta-TCP and a bioresorbable GTR membrane . They were r and omly assigned to test and control procedure . In test defects , APC was additionally applied . After 3 , 6 , and 12 months , healing results were assessed by clinical parameters and quantitative digital subtraction radiography . RESULTS Post-operative membrane exposures occurred in 48 % of the test sites and 80 % of the control sites . Both groups revealed a significant clinical attachment level ( CAL ) gain of 5 mm after 12 months . Eighty-eight per cent of test and control sites showed a CAL gain of > or = 4 mm . No clinical parameter revealed significant differences between test and control sites . A significant bone density gain was found in both groups after 3 , 6 , and 12 months . Only after 6 months , the bone density gain was significantly greater in the test defects . CONCLUSION Within the limits of this study , autologous platelet concentrate did not seem to have a noticeable influence on the clinical and most of the radiographic outcomes following GTR . However , APC might reduce the occurrence of post-operative membrane exposures and accelerate bone density gain AIM The aim of this study was to evaluate the immediate post-operative pain , wound healing and clinical results after the application of an enamel matrix protein derivative ( EMD ) alone or combined with a low-level laser therapy ( LLLT ) for the treatment of deep intra-bony defects . MATERIAL AND METHODS This study was an intra-individual longitudinal test of 12 months ' duration conducted using a blinded , split-mouth , placebo-controlled and r and omized design . In 22 periodontitis patients , one intra-bony defect was r and omly treated with EMD+LLLT , while EMD alone was applied to the contra-lateral defect site . LLLT was used both intra- and post-operatively . Clinical measurements were performed by a blinded periodontist at the time of surgery , in the first week and in the first , second , sixth and 12th month . Visual analogue scale ( VAS ) scores were recorded for pain assessment . RESULTS The results have shown that the treatment of intra-bony defects with EMD alone or EMD+LLLT leads to probing depth reduction and attachment-level gain . In addition , EMD+LLLT had result ed in less gingival recession ( p<0.05 ) , less swelling ( p<0.001 ) and less VAS scores ( p<0.02 ) compared with EMD alone . CONCLUSION This study shows that EMD is an effective , safe and predictable bio material for periodontal regeneration and LLLT may improve the effects of EMD by reducing post-operative complications UNLABELLED The aim of the present study was to assess the predictability of probing attachment gain and probing pocket depth reduction following Emdogain treatment at sites with deep angular bone defects . MATERIAL AND METHODS 108 consecutively-treated periodontal patients ( mean age 55.8 years ) were included . Each subject exhibited at least 1 deep interproximal intrabony defect that could be identified as an experimental site based on the inclusion criteria : ( i ) probing pocket depth > or = 5 mm , ( ii ) probing attachment loss > or = 6 mm , ( iii ) radiographic evidence of an interproximal bone defect with a > or = 3 mm intrabony component . A total of 145 defects met the criteria for inclusion . All subjects received non-surgical periodontal therapy .  This included subgingival instrumentation in all parts of the dentition . At least 6 months after the completion of this treatment , a baseline examination was performed to characterise the experimental site . Reconstructive therapy was subsequently performed . Full-thickness periodontal flaps were elevated , and the root surface scaled and planed . No bone recontouring was performed . A gel containing 24 % EDTA was applied on the exposed root and was kept in place for 2 min . A preparation of enamel matrix proteins was applied to the root surface and adjacent defect space . The flaps were replaced and closed with sutures . The experimental sites were re-examined 12 months after reconstructive surgery . RESULTS The re-examination demonstrated that a treatment including the application of enamel matrix proteins at periodontal sites with angular defects result ed in a mean probing attachment level gain of 4.6 mm and a probing pocket depth reduction of 5.2 mm . 87 % of all sites treated exhibited a probing attachment gain of > 2 mm . One site suffered probing attachment loss . The radiographic assessment s revealed that the bone defect had been reduced in depth by 2.9 mm on average . The reduction in defect size corresponded to an average bone fill of 69 % of the original defect . In 43 % of the defects , the bone fill amounted to > or = 80 % . CONCLUSION The overall probing pocket depth reduction , probing attachment level gain , and soft tissue recession , that results following Emdogain therapy , is similar to the corresponding outcome variables following GTR INTRODUCTION The aim of the study was to compare the healing responses of platelet-rich plasma ( PRP ) , PRP + a collagen sponge , and a collagen membrane used as guided tissue regeneration ( GTR ) material s for the treatment of apicomarginal defects . METHODS Thirty patients with suppurative chronic apical periodontitis and apicomarginal communication were selected and allocated r and omly into three groups according to the barrier technique to be used during periradicular surgery : the collagen membrane group , the PRP group , and the PRP + collagen sponge group .  Clinical and radiographic measurements were determined at baseline and every 3 months after surgery up to 1 year . Cases were defined as healed when no clinical signs or symptoms were present , and radiographs showed complete or incomplete ( scar tissue ) healing of previous radiolucencies . RESULTS The PRP and PRP + collagen sponge groups depicted 83.33 % and 88.89 % healing , respectively , in terms of combined clinical -radiographic healing as compared with 80 % in the collagen membrane group . All the three treatments showed highly significant ( P < .05 ) reductions in the periodontal pocket depth ( PD ) , the clinical attachment level ( CAL ) , the gingival margin position ( GMP ) , the size of the periapical lesion , the percentage reduction of the periapical rarefactions , and periapical healing . No significant differences between the three groups were evident for these parameters ( P > .05 ) . CONCLUSIONS GTR applied to apicomarginal defects using PRP or PRP + collagen sponge lead to similar enhancements of the clinical outcome of periradicular surgery in terms of periapical healing , gain of periodontal support , PD reduction , and PRP may be an alternative treatment for GTR membrane in the treatment of apicomarginal defects Although pharmacologic treatment remains a critical element in the short- and long-term management of schizophrenia  , the past decade has been a challenging time in terms of real progress . Despite the introduction of several new medications as well as the conduct of larger and more diverse clinical trials , there remains considerable debate as to how far we have progressed in addressing some of the fundamental unmet needs in treating this disorder . A theme in this issue of Schizophrenia Bulletin addresses a number of topics in this context . Although the notion of careful , systematic , and critical summaries of all relevant r and omized controlled trials is not a new one , the Cochrane Schizophrenia Group is relatively young . Clive Adams , one of its founders , and colleagues provide the rationale and history of the group as well as review ing its methods and contributions . The Bulletin also carries a “ Cochrane Corner ” in each issue to alert the field to schizophrenia-related review s. Systematic meta-analyses are playing an increasingly important role in informing both the research agenda and clinical practice . The work of the Cochrane collaboration has been enormously valuable in this process . In recent years , the field of schizophrenia research has benefited from the application of various clinical trial method ologies to enhance the study of treatment outcomes and determine generalizability . Large effectiveness trials have provided data to exp and our knowledge base beyond that which is provided by traditional efficacy trials . Stroup and Geddes provide examples of each type of trial to illustrate their relative advantages and disadvantages . Within the context of different trial design s , Leucht et al provide an overview addressing critical aspects of trial design , potential population sampling bias , endpoint choices and definitions , quality of assessment s , data analysis and reporting , as well as , other potential sources of bias or confounds relevant to the interpretation of clinical trials data in schizophrenia . One of the most difficult challenges in the design , conduct , analysis , and interpretation of clinical trials is the problem of dropouts — those individuals who do not complete the trial , often for unknown reasons . A variety of statistical techniques have been developed and applied in order to address this issue ; however , none is entirely satisfactory . Rabinowitz and Davidov discuss the association of dropout and outcome in trials of antipsychotic medication and its implication s for strategies to address missing data . Another strategy to minimize dropouts in acute treatment trials would be to shorten the length of the trial , particularly when placebo control groups are included . Addressing this issue and drawing on recent meta- analysis suggesting that a substantial proportion of antipsychotic drug response occurs within the first 2 weeks , McMahon and colleagues present an exploratory analysis from short-term placebo controlled clinical trial data suggesting the potential feasibility of reducing the duration of such trials . Much more work needs to be done to determine the benefits and risks of such an approach , but this is a very valuable first step . In the final article , we provide a review of unanswered questions in the pharmacologic treatment of schizophrenia .  Despite numerous trials being conducted with antipsychotic medication , there are many clinical decisions that must be made on a day-to-day basis for which sufficient data are not available to provide an adequate evidence base . We hope that these articles will provide a snapshot of current challenges and opportunities for further progress in the design , conduct , and interpretation of psychopharmacologic trials in schizophrenia Background : Physicians face challenges when search ing PubMed for research evidence , and they may miss relevant articles while retrieving too many nonrelevant articles . We investigated whether the use of search filters in PubMed improves search ing by physicians . Methods : We asked a r and om sample of Canadian nephrologists to answer unique clinical questions derived from 100 systematic review s of renal therapy . Physicians provided the search terms that they would type into PubMed to locate articles to answer these questions . We entered the physician-provided search terms into PubMed and applied two types of search filters alone or in combination : a methods -based filter design ed to identify high- quality studies about treatment ( clinical queries “ therapy ” ) and a topic-based filter design ed to identify studies with renal content . We evaluated the comprehensiveness ( proportion of relevant articles found ) and efficiency ( ratio of relevant to nonrelevant articles ) of the filtered and nonfiltered search es . Primary studies included in the systematic review s served as the reference st and ard for relevant articles . Results : The average physician-provided search terms retrieved 46 % of the relevant articles , while 6 % of the retrieved articles were nonrelevant ( the ratio of relevant to nonrelevant articles was 1:16 ) . The use of both filters together produced a marked improvement in efficiency , result ing in a ratio of relevant to nonrelevant articles of 1:5 ( 16 percentage point improvement ; 99 % confidence interval 9 % to 22 % ; p < 0.003 ) with no substantive change in comprehensiveness ( 44 % of relevant articles found ; p = 0.55 ) . Interpretation : The use of PubMed search filters improves the efficiency of physician search es . Improved search performance may enhance the transfer of research into practice and improve patient care The goal of this investigation was to evaluate histologically and histometrically the healing process in dehiscence-type defects treated by enamel matrix derivative ( EMD ) .  Five adult female beagle dogs were used . Buccal osseous dehiscences were surgically created on the maxillary canines and the second and fourth premolars . Thirty defect sites were r and omly assigned to treatment and control groups ( 15 defect sites for each group ) . The treatment group received EMD application , while the control groups received no EMD . After 4 months of healing , the dogs were sacrificed and tissue blocks were prepared . Histometric parameters were employed to evaluate the type of periodontal tissues that formed in the defects . All created dehiscence defects in the test sites treated by EMD had formed functional connective tissue fibers inserted into regenerated cellular cementum . The mean amount of apicocoronal regenerated cementum was 3.74 + /- 0.43 mm in EMD- treated sites , whereas the control sites had not formed cementum in the created dehiscence defects ( P < .000 ) . Statistically significant differences were found between treatment and control sites . Within the limits of this study , it can be concluded that EMD alone effectively promoted new cementum and functionally oriented connective tissue formation The aim of the present study was to evaluate clinical ly and histologically the treatment of intrabony periodontal defects with a bioresorbable membrane barrier .  Fifty-two intrabony periodontal defects were treated according to the principles of guided tissue regeneration ( GTR ) with a bioresorbable membrane . Results were evaluated by assessing probing pocket depth , recession of the gingival margin , and clinical attachment level at baseline and at 1 and 2 years after therapy . Bone level changes were evaluated radiographically . The postoperative phase was uneventful in all cases . There was a mean probing pocket depth reduction from 8.4 to 3.6 mm , a mean increase of gingival margin recession from 1.5 to 3.0 mm , and a mean clinical attachment level change from 9.9 to 6.5 mm . Mean attachment gain was 3.4 mm . Two teeth scheduled for extraction were also treated with the same bioresorbable membrane . The histologic analysis 6 months after treatment revealed the formation of new connective tissue attachment and new alveolar bone in both cases . Based on the histologic findings it can be concluded that the clinical improvements following GTR with this type of bioresorbable membrane may represent , at least in part , true periodontal regeneration The purpose of this prospect i ve study was to assess the outcome of periradicular surgery with or without guided tissue regeneration ( GTR ) for the treatment of through- and -through lesions . Thirty-four teeth were included according to specific selection criteria . In the test group ( using GTR ) , after root-end filling , the defects were filled with anorganic bovine bone and covered with a resorbable collagen membrane .  Healing was assessed according to specific criteria and grade d as successful , doubtful , or failed . In the control group , neither grafts nor membranes were used . After 1 year , 31 teeth were evaluated . Of these , 22 ( 71 % ) healed successfully , 6 ( 19 % ) showed doubtful healing , and 2 were recorded as failures . The outcomes of the defects treated with  GTR  ( 88 % successful ) were significantly better than those of the control group ( 57 % successful ) . The present study showed that the use of GTR associated with anorganic bovine bone in the treatment of through- and -through lesions may positively affect the healing process OBJECTIVES The aims of this controlled study were to clinical ly and radiographically evaluate the effect of a microsurgical approach for the treatment of intra-bony defects with and without an enamel matrix derivative ( EMD ) . Parts of this study population were already published by Wachtel and colleagues in 2003 . MATERIAL AND METHODS Seventy intra-bony defects were r and omly assigned to a microsurgical access flap with application of EMD ( test group ) and on the contra-lateral side to a microsurgical access flap alone ( control group ) . Clinical and radiographic parameters were assessed at baseline and after 6 and 12 months . RESULTS Both test and control treatments result ed in a statistically significant mean clinical attachment level ( CAL ) gain , probing pocket depth ( PPD ) reduction and radiographic bone fill . The test group yielded statistically significantly more CAL gain , PPD reduction and radiographic bone fill than the control group . Gingival recession increase after 12 months averaged 0.5 and 0.7 mm for the test and control groups , and did not reach statistical significance . Two weeks after surgery , primary wound closure was maintained in 91 % of the test sites and 97 % of the control sites . CONCLUSION The combination of a microsurgical access flap with EMD seems to be superior to open flap debridement in terms of PPD reduction , CAL gain and radiographic bone fill . In the test as well as the control group , primary wound closure was successfully achieved Traditional clinical review articles , also known as up date s , differ from systematic review s and meta-analyses . Up date s selectively review the medical literature while discussing a topic broadly . Non-quantitative systematic review s comprehensively examine the medical literature , seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment . Meta-analyses ( quantitative systematic review s ) seek to answer a focused clinical question , using rigorous statistical analysis of pooled research studies . This article presents guidelines for writing an evidence -based clinical review article for American Family Physician . First , the topic should be of common interest and relevance to family practice . Include a table of the continuing medical education objectives of the review . State how the literature search was done and include several sources of evidence -based review s , such as the Cochrane Collaboration , BMJ 's Clinical Evidence , or the InfoRetriever Web site . Where possible , use evidence based on clinical outcomes relating to morbidity , mortality , or quality of life , and studies of primary care population s. In articles su bmi tted to American Family Physician , rate the level of evidence for key recommendations according to the following scale : level A ( r and omized controlled trial [ RCT ] , meta- analysis ) ; level B ( other evidence ) ; level C ( consensus/expert opinion ) . Finally , provide a table of key summary points The purpose of this prospect i ve multi-center study was to evaluate a resorbable barrier membrane design ed for periodontal regeneration . Thirty-one Class II furcations and 30 two- and three-wall intrabony defects were treated by flap debridement and bioabsorbable barrier membrane augmentation . The efficacy of treatment was evaluated in terms of changes in vertical probing depth ( PD ) , horizontal probing depth ( HPD ) , clinical attachment levels ( CAL ) , and recession .  Five centers participated in the study . Changes in clinical parameters are reported by individual center and by the average of the centers . All patients had either one molar with a Class II furcation or an intrabony defect . Baseline data were taken on the day of surgery . Post-treatment data were collected at 6 months and 1 year . This report is based on the 1-year findings . The average initial PD for Class II furcations was 6.1 mm . At 1 year the average PD was reduced to 3.6 mm , a 2.5 mm change . These differences were clinical ly and statistically significant ( P < 0.0001 ) . There was an average gain of 2.1 mm of clinical attachment ( P < 0.0001 ) and 0.4 mm of recession ( P < 0.04 ) . There was a mean of 1.8 mm change in HPD ( P < 0.0001 ) . For intrabony defects , at 1 year there was an average PD reduction of 4.1 mm ( P < 0.0001 ) and a mean gain of CAL of 2.9 mm ( P < 0.0001 ) . At 1 year the average recession was 0.9 mm which was statistically significant . When treatment outcomes were compared between centers there were no differences for either group of treated defects . There were differences between centers when baseline PD for furcations and intrabony sites were compared . The results of this study indicate that clinical ly and statistically significant improvements in PD , CAL , and HPD occurred after treatment of Class II furcations and 2- to 3-wall intrabony defects with the bioabsorbable periodontal membrane The purpose of this study was to evaluate the clinical effectiveness of a bioabsorbable membrane made of glycolide and lactide polymers in preserving alveolar ridges following tooth extraction using a surgical technique based on the principles of guided bone regeneration . Sixteen patients requiring extraction s of 2 anterior teeth or bicuspids participated in the study ( split-mouth design ) . Following elevation of buccal and lingual full-thickness flaps and extraction of teeth , experimental sites were covered with bioabsorbable membranes ; control sites did not receive any membrane . Titanium pins served as fixed reference points for measurements . Flaps were advanced in order to achieve primary closure of the surgical wound . No membrane became exposed in the course of healing . Reentry surgeries were performed at 6 months . Results showed that experimental sites presented with significantly less loss of alveolar bone height , more internal socket bone fill , and less horizontal resorption of the alveolar bone ridge . This study suggests that treatment of extraction sockets with membranes made of glycolide and lactide polymers is valuable in preserving alveolar bone in extraction sockets and preventing alveolar ridge defects BACKGROUND It is important for clinical end users of MEDLINE to be able to retrieve articles that are both scientifically sound and directly relevant to clinical practice . The use of method ologic search filters ( such as " r and om allocation " for sound studies of medical interventions ) has been advocated to improve the accuracy of search ing for such studies . Method ologic search filters have been tested in previous MEDLINE files but indexing continues to evolve and the operating characteristics of these search filters in current MEDLINE files are unknown . OBJECTIVE To determine the robustness of empirical search strategies developed in 1991 for detecting clinical content in MEDLINE in the year 2000 . DESIGN A survey based on a h and search of 171 core health care journals using predetermined quality indicators for scientific merit and clinical relevance . METHODS 6 trained , experienced research assistants read all issues of 171 journals for the publishing year 2000 . Each article was rated using purpose and quality indicators and categorized into clinical ly relevant original studies , review articles , general papers , or case reports . The original and review articles were then categorized as ' pass ' or ' fail ' for method ologic rigor in the areas of therapy/ quality improvement , diagnosis , prognosis , causation , economics , clinical prediction , and qualitative and review articles . Search strategies developed in 1991 were tested in the 2000 data base . MAIN OUTCOME MEASURES Sensitivity , specificity , precision , and accuracy of the search strategies . RESULTS Search strategies developed in 1991 generally performed at least as well in 2000 for both best single terms and combinations of terms for high-sensitivity MEDLINE search es for studies of treatment , prognosis , etiology and diagnosis . For example , the accuracy of " clinical trial ( pt ) " rose from 91.6 % to 94.4 % ( P<0.05 ) for retrieving high- quality studies of treatments . CONCLUSION Most MEDLINE search strategies developed in 1991 are robust when search ing in the publishing year 2000
In most respects , all membranes and enamel matrix derivative ( EMD ) delivered better outcomes , in the range of 1 to 2 mm , than open flap debridement .
The use of any barrier type or EMD configuration was found to yield more Clinical Attachment Level ( CAL ) gain than any open flap configuration .
GTR was confirmed to be superior to open flap debridement
In a 1998 review article , Laurell and colleagues performed a meta- analysis of relevant guided tissue regeneration ( GTR ) articles over the previous 20 years ( 1 ) .
The purpose of the present research was to exp and on that work , particularly search ing for trends discriminating between bioabsorbable and non-bioabsorbable barriers , as well as the use of enamel matrix derivative , with respect to interproximal bony defects .