Experimental and control regenerative surgeries were performed by a periodontist (BG) in a single surgical appointment. Depending on the width of the interdental space at the intra-bony defect site, either the modified papilla preservation technique (MPPT > 2 mm) or the simplified papilla preservation flap (SPPF when 2 mm or less) was used [14 (link),15 ,16 (link)]. After applying the appropriate infiltrative local anesthesia, a full thickness mucoperiosteal flap was raised, exposing the intra-bony lesion, which was thoroughly debrided from and the affected teeth carefully root planned. Then, randomization and treatment allocation were carried out by opening sealed envelopes containing the assigned treatment modality. Randomization was prepared using a computer-generated randomization list by an independent investigator and was concealed throughout the study from the clinical and radiographic examiners.
Once the experimental and control treatments were allocated, the surgeon filled the intra-bony lesion with either a frozen, radiation sterilized, allogenic, bone granules (FRSABG) in the test sites, or deproteinized bovine bone mineral granules (DBBM (Bio-Oss®, Geistlich Biomaterials, Princeton, NJ, USA) in the control sites. Patients were blind to the treatment mode. In both sites, a porcine-derived bioabsorbable collagen membrane (Bio-Gide®, Geistlich Biomaterials) was trimmed, closely filling the bone replacement graft and adapted to the anatomy of the defect. Flaps were then coronally repositioned without any tension (periosteum was released when necessary) to fully cover the regenerated site and secured with a combination of horizontal mattress sutures (Seralon 5/0 15 mm 3/8, Serag-Wiessner GmbH & Co., Naila, Germany) and a single vertical mattress suture positioned vertically in the inter-dental areas (Seralon 6/0 12 mm 3/8). Periodontal dressing was not used in any case.
Post-surgically, the patients were prescribed the use of anti-inflammatory medication (ibuprofen 600 mg twice a day for 2 days) and systemic antibiotic therapy (amoxicillin clavulanic acid (1 g) twice daily for 7 days). Patients also received postoperative instructions to avoid brushing or chewing for two weeks and to use an antiseptic rinse (0.2% chlorhexidine) for 3 weeks. Sutures were removed at 2 weeks when patients resumed careful brushing with a soft toothbrush. Patients were recalled every 2 weeks during the first 3 months postoperatively, and every 3 months for 1 year afterward.
Once the experimental and control treatments were allocated, the surgeon filled the intra-bony lesion with either a frozen, radiation sterilized, allogenic, bone granules (FRSABG) in the test sites, or deproteinized bovine bone mineral granules (DBBM (Bio-Oss®, Geistlich Biomaterials, Princeton, NJ, USA) in the control sites. Patients were blind to the treatment mode. In both sites, a porcine-derived bioabsorbable collagen membrane (Bio-Gide®, Geistlich Biomaterials) was trimmed, closely filling the bone replacement graft and adapted to the anatomy of the defect. Flaps were then coronally repositioned without any tension (periosteum was released when necessary) to fully cover the regenerated site and secured with a combination of horizontal mattress sutures (Seralon 5/0 15 mm 3/8, Serag-Wiessner GmbH & Co., Naila, Germany) and a single vertical mattress suture positioned vertically in the inter-dental areas (Seralon 6/0 12 mm 3/8). Periodontal dressing was not used in any case.
Post-surgically, the patients were prescribed the use of anti-inflammatory medication (ibuprofen 600 mg twice a day for 2 days) and systemic antibiotic therapy (amoxicillin clavulanic acid (1 g) twice daily for 7 days). Patients also received postoperative instructions to avoid brushing or chewing for two weeks and to use an antiseptic rinse (0.2% chlorhexidine) for 3 weeks. Sutures were removed at 2 weeks when patients resumed careful brushing with a soft toothbrush. Patients were recalled every 2 weeks during the first 3 months postoperatively, and every 3 months for 1 year afterward.
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