ABSTRACT
Background:
In clinical periodontology, treating intraosseous periodontal abnormalities is still difficult. When combined with guided tissue regeneration (GTR), autogenous cortical bone grafting has shown potential for accelerating the regeneration of periodontal tissue.
Materials and Methods:
This randomized controlled clinical study included 30 individuals with intraosseous periodontal abnormalities that were verified by radiography and clinical examination and were between the ages of 25 and 50 years. Autogenous cortical bone grafts taken from the mandibular ramus were used to correct the deformities, together with a bioresorbable GTR membrane. Clinical parameters were measured at baseline and during the 6-month follow-up, including probing pocket depth (PPD), clinical attachment level (CAL), and defect fill. Before and after treatment, the size of the bone defect was measured using cone-beam computed tomography (CBCT).
Results:
In the therapy group, significant progress was seen. After 6 months, the mean CAL gain was 3.6 ± 0.6 mm and the mean PPD decrease was 4.2 ± 0.8 mm. The treated locations had a mean defect fill of 68% ± 10%, according to radiographic examination. During the research period, no serious problems were noted, and patients reported little postoperative pain.
Conclusion:
In the treatment of intraosseous periodontal abnormalities, autogenous cortical bone grafting combined with GTR dramatically enhances clinical and radiographic results.
KEYWORDS: Autogenous bone graft, bone grafting, guided tissue regeneration, intraosseous defects, periodontal regeneration
INTRODUCTION
Because of their intricate architecture and restricted capacity for regeneration, intraosseous periodontal abnormalities provide a substantial difficulty in periodontal treatment.[1] Advanced periodontal disease causes the alveolar bone and its supporting components to be destroyed, which results in these abnormalities.[2] In addition to halting the course of the illness, effective therapy attempts to repair damaged tissues and regain function.[3]
Because of its osteoconductive, osteoinductive, and osteogenic qualities, autogenous bone transplantation is regarded as the gold standard for bone regeneration.[4] Because of their high bone density and biocompatibility, cortical bone grafts—which are taken from intraoral locations like the chin or mandibular ramus—make an excellent source of graft material.[5] The need for supplemental regenerating treatments is highlighted by the possibility that autogenous bone alone may not always lead to full defect resolution.[6]
To enable periodontal ligament and bone cells to repopulate and heal the defect, guided tissue regeneration (GTR) uses barrier membranes to keep epithelial and connective tissue cells out of the defect location.[7] Because the membrane promotes selective cell repopulation and the graft offers a scaffold for new bone production, the combination of autogenous bone grafts with GTR has shown encouraging outcomes.[2]
MATERIALS AND METHODS
Thirty patients with intraosseous periodontal abnormalities, ages 25 to 50 years, were selected from the outpatient department of a teaching hospital for dentistry. Patients with radiographically verified intraosseous defects of >3 mm depth, chronic periodontitis, and probing pocket depth (PPD) ≥6 mm were all eligible. Systemic diseases affecting periodontal health, smoking, pregnancy, breastfeeding, or a history of periodontal surgery within the previous 6 months were among the exclusion criteria.
Two groups were randomly selected from among the patients:
Test Group (n = 15): Received guided tissue regeneration (GTR) in addition to autogenous cortical bone transplantation.
Control Group (n = 15): GTR was the only treatment given.
Using a bone scraper and local anesthetic, autogenous cortical bone was extracted from the mandibular ramus in the test group. After being collected, the bone was prepped for grafting by shaping it. After graft implantation, the defect was covered with a bioresorbable GTR membrane.
To minimize inflammation, all subjects received early phase I treatment, which comprised scaling and root planing. The surgery was carried out under local anesthetic 2 weeks later. To reveal the flaw, full-thickness mucoperiosteal flaps were raised. A GTR membrane was positioned after the defect was debrided in the control group. After debridement, the autogenous bone graft was used to fill the deficiency in the test group, and the GTR membrane was then positioned. 4-0 nonresorbable sutures were used to reposition and stitch the flaps.
Ibuprofen (400 mg, as required for pain) and amoxicillin (500 mg, three times daily for 7 days) were given to the patients. For 4 weeks, it was advised to use mouthwash containing 0.12% chlorhexidine twice a day. Ten days after surgery, the sutures were taken out, and throughout the follow-up period, professional plaque management was done once a month.
Using a calibrated periodontal probe, clinical parameters such as clinical attachment level (CAL) and probing pocket depth (PPD) were measured at baseline and 6 months after surgery. Cone-beam computed tomography (CBCT) was used to quantify bone fill at baseline and 6 months later to radiographically evaluate the deficiency.
Software called SPSS (version 25.0) was used to evaluate the data that were gathered.
RESULTS
Clinical outcomes
All patients completed the 6-month follow-up without significant postoperative complications. The test group (autogenous cortical bone graft + GTR) demonstrated significant improvements in clinical and radiographic parameters compared with the control group (GTR alone).
Probing pocket depth (PPD) reduction
At baseline, the mean PPD was 7.8 ± 0.5 mm in the test group and 7.6 ± 0.4 mm in the control group. After 6 months, the mean PPD reduced to 3.6 ± 0.4 mm in the test group and 4.8 ± 0.5 mm in the control group. The difference between groups was statistically significant (P < 0.05, Table 1).
Table 1.
Clinical Parameters: Probing Pocket Depth (PPD) Reduction and Clinical Attachment Level (CAL) gain
| Parameter | Test Group (n=15) | Control Group (n=15) | P |
|---|---|---|---|
| PPD Reduction (mm) | 4.2±0.4 | 2.8±0.5 | <0.05 |
| CAL Gain (mm) | 3.6±0.5 | 2.0±0.4 | <0.05 |
Source: Study Data
Clinical attachment level (CAL) gain
The mean CAL gain at 6 months was 4.2 ± 0.5 mm in the test group and 3.0 ± 0.4 mm in the control group, with a statistically significant improvement observed in the test group (P < 0.05, Table 1).
Radiographic bone fill
Radiographic analysis using CBCT revealed a mean defect fill of 70% ± 8% in the test group compared with 55% ± 7% in the control group at the 6-month follow-up. This difference was statistically significant (P < 0.05, Table 2).
Table 2.
Radiographic bone fill
| Parameter | Test Group (n=15) | Control Group (n=15) | P |
|---|---|---|---|
| Defect Fill (%) | 70±8 | 55±7 | <0.05 |
Patient comfort and healing
Patients in both groups reported minimal postoperative discomfort. Wound healing was uneventful in all cases, and there were no adverse effects related to graft harvest or membrane placement.
The test group exhibited superior PPD reduction and CAL gain compared with the control group [Table 1]. Similarly, radiographic bone fill was significantly higher in the test group, supporting the efficacy of autogenous cortical bone grafting combined with GTR in promoting periodontal regeneration [Table 2].
DISCUSSION
Because of their osteogenic, osteoinductive, and osteoconductive qualities, autogenous bone transplants are regarded as the gold standard in regenerative operations.[3] A thick, biocompatible graft material that blends in well with host tissues is produced by using cortical bone from the mandibular ramus.[4] In the current research, the test group’s mean CAL gain of 3.6 mm and mean PPD decrease of 4.2 mm were both considerably higher than those of the control group, which received GTR alone. These enhancements might be explained by the GTR membrane’s ability to promote selective cellular repopulation and the bone graft’s ability to function as a scaffold for the growth of new bone.[5]
The cone-beam computed tomography (CBCT) radiographic study provided further support for the clinical results. In line with the findings of previous research looking into related regeneration techniques, the test group’s mean defect fill was 70% as opposed to 55% in the control group.[6,7] Because the graft material not only promotes bone regeneration but also maintains the stability of the defect region throughout the healing process, the improved defect fill in the test group highlights the synergistic impact of combining autogenous bone transplants with GTR.[8,9]
CONCLUSION
In conclusion, a viable therapeutic approach for the treatment of intraosseous periodontal abnormalities is the combination of GTR and autogenous cortical bone grafting. In addition to improving clinical results, this strategy offers a dependable means of obtaining consistent periodontal regeneration.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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