Giovanni Carlo Chiantella

Radboud University Medical Centre (Radboudumc), Nymegen, Gelderland, Netherlands

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Publications (16)38.08 Total impact

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    ABSTRACT: The aim of the present study is to evaluate the clinical and histologic healing of deep intrabony defects treated with guided tissue regeneration (GTR) with a collagen membrane from bovine pericardium and implantation of granular bovine bone biomaterial. Thirty patients with one deep, combined 1- and 2-wall intrabony defect exhibiting a probing depth ≥6 mm and an associated intrabony defect ≥3 mm were treated with GTR with a bioresorbable collagen membrane from bovine pericardium and adjunct implantation of a granular bovine bone biomaterial. The clinical results were evaluated 1 and 3 years after surgery. In addition, five teeth fulfilling the inclusion criteria but scheduled for extraction because of advanced periodontitis or restorative considerations were treated similarly and then extracted along with a portion of their surrounding periodontal tissues for histologic evaluation 6 months after surgery. Healing was uneventful in all patients. Significant clinical improvements were observed at 1 and 3 years postoperatively (P <0.01; probing depth averaged 4.4 ± 1.6 and 4.7 ± 1.4 mm and clinical attachment level gain was 3.9 ± 1.4 and 3.5 ± 1.3 mm, respectively). The histologic evaluation revealed formation of new cellular cementum and new periodontal ligament in four of the five cases. In general, the xenograft particles seemed to be mostly embedded in connective tissue without any evidence of new bone formation. GTR treatment of intrabony defects with the collagen membrane from bovine pericardium and adjunct implantation of the new bovine bone biomaterial may result in significant clinical improvements that can be maintained over a period of 3 years, and regeneration of cementum and periodontal ligament, but without bone formation.
    No preview · Article · Oct 2010 · Journal of Periodontology
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    ABSTRACT: Treatment of intrabony periodontal defects with a combination of an enamel matrix derivative (EMD) and a natural bone mineral (NBM) has been demonstrated to significantly improve clinical parameters such as probing depth (PD) and clinical attachment level (CAL). However, long-term clinical and histologic data on treatment with this approach are limited. The aim of the present study was to present the 5-year clinical and histologic results following treatment of intrabony defects with a combination of EMD + NBM. Eleven healthy patients, all with advanced chronic periodontitis and one deep intrabony defect each, were consecutively treated with a combination of EMD + NBM. PD, recession of the gingival margin (GR), and CAL were measured just before and at 1 and 5 years after treatment. The primary outcome variable was CAL. No adverse healing responses were observed. Mean PD, GR, and CAL were significantly reduced at 1 year and at 5 years versus baseline values. Histologic analysis of a mandibular second molar, extracted 5 years after treatment with EMD + NBM, demonstrated bone formation around the NBM particles. Regenerative surgery with the combination of EMD + NBM may result in bone formation, and the obtained clinical results can be maintained over a period of 5 years.
    No preview · Article · May 2008 · The International journal of periodontics & restorative dentistry
  • Anton Sculean · Frank Schwarz · Giovanni Carlo Chiantella · Nicole Birgit Arweiler · Jürgen Becker
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    ABSTRACT: Treatment of intrabony periodontal defects with an enamel matrix derivative (EMD) has been demonstrated, in the short term, to result in periodontal regeneration and to significantly improve clinical parameters such as probing depth (PD) and clinical attachment level (CAL). The present study evaluated deep intrabony defect sites at 9 years after treatment with EMD. Twenty-one patients with a total of 26 deep intrabony defects with PD > or = 6 mm and intrabony depth > or = 3 mm, as identified by probing and radiographs, were consecutively treated with EMD. PD, recession of the gingival margin (GR), and CAL were evaluated prior to treatment and at 1 and 9 years after treatment. At 1 year, mean PD was significantly reduced. At 9 years, mean PD was statistically significantly increased versus the 1-year results but still significantly improved versus baseline. After I year, mean GR had increased significantly; at 9 years, measurements showed statistically significant improvements compared to the 1-year results and baseline. The mean CAL changed from 10.0 +/- 2.3 mm at baseline to 6.8 +/- 2.3 mm at 1 year and to 7.0 +/- 1.9 mm at 9 years. No treated teeth were lost during the observation period. The clinical improvements obtained following treatment with EMD can be maintained over a period of 9 years.
    No preview · Article · Jun 2007 · The International journal of periodontics & restorative dentistry
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    ABSTRACT: Treatment with a natural bone mineral (NBM) and a guided tissue regeneration (GTR) has been shown to promote periodontal regeneration. However, until now there are only very limited data on the long-term clinical results following this regenerative technique. To present the 5-year results of a prospective, randomized, controlled clinical study evaluating the treatment of deep intra-bony defects either with open flap debridement (OFD) and a combination of an NBM and GTR (test) or OFD alone (control). Nineteen patients diagnosed with advanced chronic periodontitis, and each of whom displayed one intra-bony defect, received randomly the test or the control treatment. Results were evaluated at baseline, at 1 and at 5 years following therapy. No statistically significant differences in any of the investigated parameters were observed at baseline between the two groups. At 1 year after therapy, the test group showed a reduction in mean probing depth (PD) from 9.1+/-1.1 to 3.7+/-0.8 mm (p<0.001) and a change in mean clinical attachment level (CAL) from 10.4+/-1.3 to 6.4+/-1.2 mm (p<0.001). At 5 years, mean PD and CAL measured 4.3+/-0.8 and 6.7+/-1.6 mm, respectively. At 5 years, both PD and CAL were statistically significantly improved compared with baseline (p<0.001) without statistically significant differences between the 1- and 5-year results. In the control group, mean PD was reduced from 8.9+/-1.3 to 4.9+/-1.2 mm (p<0.001) and mean CAL changed from 10.6+/-1.4 to 8.8+/-1.5 mm (p<0.01). At 5 years, mean PD and CAL measured 5.6+/-1.1 and 9.1+/-1.3 mm, respectively, and were still statistically significantly improved compared with baseline (p<0.01). No statistically significant differences were found between the 1- and 5-year results. The test treatment, at both 1 and 5 years, yielded statistically significantly higher CAL gains than the control one (p<0.01). Compared with baseline, at 5 years a CAL gain of > or =3 mm was found in nine defects (90%) of the test group but in none of the defects treated with OFD alone. It was concluded that (i) treatment of intra-bony defects with OFD+NBM+GTR may result in significantly higher CAL gains than treatment with OFD, and (ii) the clinical results obtained after both treatments can be maintained over a period of 5 years.
    Full-text · Article · Feb 2007 · Journal Of Clinical Periodontology
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    ABSTRACT: The purpose of the present study was to compare clinically 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. 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. 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 resulted 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%). Within the limits of the present study, it can be concluded that the combination of BDX Coll+GTR resulted 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.
    No preview · Article · Aug 2005 · Journal Of Clinical Periodontology
  • Anton Sculean · Peter Windisch · Giovanni Carlo Chiantella
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    ABSTRACT: The purpose of the present case report is to clinically and histologically evaluate the healing of one advanced intrabony defect following treatment with an enamel matrix protein derivative (EMD) combined with a bovine-derived xenograft (BDX) and guided tissue regeneration (GTR). One patient with generalized chronic periodontitis and one advanced intrabony defect was treated with EMD + BDX + GTR. Notches were placed in the root at the level of the calculus and alveolar crest to aid histologic identification of new periodontal tissues. Postoperative healing was uneventful. At the 7-month histologic examination, healing in the intrabony component of the defect was characterized by formation of new connective tissue attachment (new cellular cementum with inserting collagen fibers) and new bone in the intrabony component. The BDX particles were surrounded by bone-like tissue. No direct contact between the graft particles and root surface (cementum or dentin) was observed. Healing in the suprabony defect component occurred through epithelial downgrowth that stopped at the level of the coronal notch. The BDX particles were entirely encapsulated in dense connective tissue, without any signs of bone formation. The present case report shows formation of new attachment apparatus consisting of new bone, cementum, and periodontal ligament in the intrabony component of one human defect treated with EMD + BDX + GTR.
    No preview · Article · Sep 2004 · The International journal of periodontics & restorative dentistry
  • Anton Sculean · Giovanni Carlo Chiantella · Asta Miliauskaite · Michel Brecx · Nicole Birgit Arweiler
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    ABSTRACT: Treatment of intrabony periodontal defects with an enamel matrix derivative (EMD) has been shown to predictably enhance periodontal regeneration. The aim of the present study was to evaluate the 4-year results following treatment of intrabony defects with EMD. Thirty-three patients with a total of 46 intrabony defects were treated. Each patient exhibited at least one intrabony defect with a probing depth > or = 6 mm as identified by probing and on radiographs. The following clinical parameters were evaluated prior to and 1 and 4 years after treatment: probing depth, recession of the gingival margin, and clinical attachment level. The primary outcome variable was clinical attachment. Mean probing depth was reduced from 8.1 +/- 1.8 mm to 3.8 - +/-.2 mm at 1 year and to 4.0 +/- 1.2 mm at 4 years. No statistically significant differences were found between the mean probing depth 1 and 4 years postoperative. At 1 year, the mean recession increased from 1.9 +/- 1.5 mm to 3.2 +/- 1.8 mm; at 4 years, it was 2.8 +/- 1.2 mm, a statistically significant improvement compared to the 1-year results, but still significantly increased compared to the baseline. The mean attachment level changed from 10.0 +/- 2.4 mm to 7.0 +/- 2.1 mm at 1 year and 6.8 +/- 1.9 mm at 4 years (no statistically significant difference). The clinical improvements obtained following treatment with EMD can be maintained over a 4-year period.
    No preview · Article · Aug 2003 · The International journal of periodontics & restorative dentistry
  • Anton Sculean · Peter Windisch · Tibor Keglevich · Giovanni Carlo Chiantella · István Gera · Nicolaos Donos
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    ABSTRACT: The purpose of the present case report study was to clinically and histologically evaluate the healing of deep intrabony defects following treatment with either a combination of an enamel matrix protein derivative (EMD) and a bovine-derived xenograft (BDX) or with BDX alone. Three female patients with generalized marginal periodontitis and presenting one advanced intrabony defect each were treated with either a combination of EMD + BDX (two defects) or with BDX alone (one defect). The postoperative healing was uneventful in all three cases. Six months after surgery, a gain of clinical attachment was measured at all treated sites. The histologic examination revealed that all three defects healed with a new connective tissue attachment (ie, new cellular cementum with inserting collagen fibers) and new bone. Most of the BDX particles were surrounded by a bone-like tissue. No direct contact between BDX particles and the root surface (cementum or dentin) was observed. Within their limits, the present data indicate that treatment with either EMD + BDX or with BDX alone may enhance the formation of new connective tissue attachment and new bone in human intrabony defects.
    No preview · Article · Mar 2003 · The International journal of periodontics & restorative dentistry
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    ABSTRACT: : The purpose of the present study was to compare clinically the treatment of deep intrabony defects with a combination of a bovine-derived xenograft (BDX) and a bioresorbable collagen membrane to access flap surgery. : Twenty-eight patients suffering from chronic periodontitis, and each of whom displayed one intrabony defect, were randomly treated with BDX + collagen membrane (test) or with access flap surgery (control). Soft tissue measurements were made at baseline and at 1 year following therapy. : 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 mean probing depth (PD) from 9.2+/-1.3 to 3.9+/-0.7 mm (p<0.001) and a change in mean clinical attachment level (CAL) from 10.2+/-1.5 to 6.2+/-0.5 mm (p<0.0001). In the control group, the mean PD was reduced from 9.0+/-1.2 to 5.2+/-1.8 mm (p<0.001) and the mean CAL changed from 10.5+/-1.5 to 8.4+/-2.1 mm (p<0.01). The test treatment resulted 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 the control group no CAL gain occurred in four sites (29%), whereas at six sites (43%) the CAL gain was 2 mm. A CAL gain of 3 mm or more was measured in four defects (29%). : Within the limits of the present study, it can be concluded that: (i) at 1 year after surgery both therapies resulted in significant PD reductions and CAL gains, and (ii) treatment with BDX+collagen membrane resulted in significantly higher CAL gains than treatment with access flap surgery.
    No preview · Article · Jan 2003 · Journal Of Clinical Periodontology
  • Anton Sculean · Giovanni Carlo Chiantella · Péter Windisch · István Gera · Elmar Reich
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    ABSTRACT: The purpose of the present study was to compare the treatment of deep intrabony defects with a combination of an enamel matrix protein derivative (EMD; Emdogain) and a bovine-derived xenograft (BDX; Bio-Oss) to BDX alone. Twenty-four healthy patients, each of whom displayed one intrabony defect, were randomly treated with a combination of EMD + BDX (test) or with BDX alone (control). Soft tissue measurements were made at baseline and 1 year following the therapy No differences in any of the investigated parameters were observed at baseline between the two groups. No adverse healing response was observed in any of the patients. At 1 year after therapy, the sites treated with EMD + BDX showed a reduction in probing pocket depth (PPD) from 10.0 +/- 1.5 mm to 4.3 +/- 1.4 mm and a change in clinical attachment level (CAL) from 10.9 +/- 2.0 mm to 6.2 +/- 1.9 mm (P <.0001). In the group treated with BDX, the PPD was reduced from 9.7 +/- 2.4 mm to 3.2 +/- 0.7 mm and the CAL changed from 10.1 +/- 2.3 mm to 5.2 +/- 1.2 mm (P <.0001). Hard tissue fill was observed radiographically in all defects. Both treatments resulted in significant improvements of PPD and CAL. However, no statistically significant differences in any of the investigated parameters were observed between the test and control groups. Both therapies led to significant improvements of the investigated clinical parameters.
    No preview · Article · Jun 2002 · The International journal of periodontics & restorative dentistry
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    ABSTRACT: The purpose of the present study was to compare the treatment of deep intrabony defects with a combination of an enamel matrix protein derivative (EMD) and a bioactive glass (BG) to BG alone. Twenty-eight patients with chronic periodontitis, each of whom displayed 1 intrabony defect, were randomly treated with a combination of EMD and BG or with BG alone. Soft tissue measurements were made at baseline and at 1 year following therapy. No differences in any of the investigated parameters were observed at baseline between the 2 groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with EMD and BG showed a reduction in mean probing depth (PD) from 8.07 +/- 1.14 mm to 3.92 +/- 0.73 mm and a change in mean clinical attachment level (CAL) from 9.64 +/- 1.59 mm to 6.42 +/- 1.08 mm (P < 0.0001). In the group treated with BG, the mean PD was reduced from 8.07 +/- 1.32 mm to 3.85 +/- 0.66 mm and the mean CAL changed from 9.78 +/- 1.71 mm to 6.71 +/- 1.89 mm (P < 0.0001). No statistically significant differences in any of the investigated parameters were observed between the test and control group. Within the limits of the present study, it can be concluded that both therapies led to significant improvements of the investigated clinical parameters, and the combination of enamel matrix derivative and bioactive glass does not seem to additionally improve the clinical outcome of the therapy.
    No preview · Article · Apr 2002 · Journal of Periodontology
  • Anton Sculean · Peter Windisch · Giovanni Carlo Chiantella · Nikolaos Donos · Michel Brecx · Elmar Reich
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    ABSTRACT: 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. The aim of the present controlled study was to evaluate clinically the treatment effect of EMD, GTR, combination of EMD and GTR, and flap surgery (control) on intrabony defects. 56 patients each of whom displaying one intrabony defect of a depth of at least 6 mm were randomly 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. 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. 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.
    No preview · Article · May 2001 · Journal Of Clinical Periodontology
  • A Sculean · G C Chiantella · P Windisch · N Donos
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    ABSTRACT: An enamel matrix protein derivative (Emdogain) has been recently shown to promote periodontal regeneration in experimentally created recession-type defects. However, only limited histologic data from human material are available concerning the healing of intrabony periodontal defects following treatment with Emdogain. The aim of the present study was therefore to present the clinical and histologic results following the application of Emdogain in intrabony defects. Two patients with marginal periodontitis and deep intrabony defects adjacent to teeth scheduled for extraction were treated with Emdogain. The postoperative healing phase was uneventful in both cases. At 6 months following treatment, newly formed cementum with inserting collagen fibers was found in both specimens. In one case, the new attachment formation was also accompanied by bone neoformation. The results of this human histologic study indicate that Emdogain possesses the potential to stimulate new connective tissue attachment formation in human intrabony defects.
    No preview · Article · Sep 2000 · The International journal of periodontics & restorative dentistry
  • A Sculean · N Donos · G C Chiantella · P Windisch · E Reich · M Brecx
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    ABSTRACT: The aim of the present study was to evaluate clinically 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.
    No preview · Article · Nov 1999 · The International journal of periodontics & restorative dentistry
  • A Sculean · E Reich · G C Chiantella · M Brecx
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    ABSTRACT: Enamel matrix proteins, including Emdogain, have been proposed as a new modality for regenerative periodontal treatment. However, limited information is available concerning the clinical applicability and therapeutic results with Emdogain. The aim of the present study was therefore to evaluate the clinical outcome following the application of Emdogain in the treatment of intrabony periodontal defects. Twenty-eight patients with marginal periodontitis (thirty-two 2- and 3-walled intrabony defects) were included in this study. The following parameters were evaluated prior to treatment and 8 months after treatment: probing pocket depth, recession of the gingival margin, and clinical attachment level. The postoperative healing phase was uneventful in all cases. There were no complications such as allergic reactions, abscess formation, or infections throughout the entire study period. The mean probing pocket depth was reduced from 8.7 +/- 1.5 mm at baseline to 4.3 +/- 1.6 mm after 8 months (P < 0.001), the mean gingival recession increased from 1.8 +/- 1.2 mm to 3.3 +/- 0.9 mm, and the mean clinical attachment level changed from 10.6 +/- 1.9 mm to 7.6 +/- 1.8 mm (P < 0.001). New hard tissue formation was radiographically observed in 26 of the 32 defects. The present results suggest that the treatment of intrabony periodontal defects with Emdogain may lead to significant improvements of all of the investigated clinical parameters. However, controlled histologic and clinical trials are needed to compare this treatment modality with other conventional and regenerative periodontal surgical methods.
    No preview · Article · May 1999 · The International journal of periodontics & restorative dentistry
  • C. H. F. Hämmerle · Giovanni C. Chiantella · Thorkild Karring · N P Lang
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    ABSTRACT: The aim of the present experiment was to test the effect of a deproteinized bovine bone mineral (Bio-Oss) on guided bone regeneration (GBR) in dehiscence defects around implants. The first 2 molars and all premolars were extracted on both sides of the mandibles of 3 monkeys (Macaca fascicularis). Three months later, 2 titanium plasma-coated cylindrical implants were placed in all quadrants of each monkey. During the surgical procedure, standardized dehiscence defects were produced buccally and lingually, measuring 2.5 mm in width and 3 mm in height. Four different experimental situations were created: 2 sites in each monkey were covered with an ePTFE membrane (M), 2 were filled with the graft material (DBBM), 2 were filled with the graft material and also covered with a membrane (M + DBBM), and 2 control sites were neither grafted nor covered (C). The flaps were sutured to allow for primary healing. Linear measurements of bone height and width were calculated on histological specimens obtained 6 months following surgery. In addition, values for bone density and for surface fraction of graft to new bone contact were measured. Vertical bone growth along the implant surface of 100% (SD 0%) for M + DBBM, 91% (SD 9%) for M, 52% (SD 24%) for DBBM, and 42% (SD 35%) for C was measured. The width of the regenerated bone 1.5 mm above the bottom of the original defect, i.e. at the 50% mark of the vertical extension of the defect, in relation to the width at the bottom of the defect amounted to 97% (SD 2%) for M + DBBM, 85% (SD 9%) for M, 42% (SD 41%) for DBBM, and 23% (SD 31%) for C. Assessment of bone density within the confinement of the regenerated bone resulted in an increase of 30% (SD 11%) for M + DBBM, 45% (SD 20%) for M, 33% (SD 20%) for DBBM, and 22% (SD 23%) for C. The values for graft to new bone contact within this compartment amounted to 80% (SD 15%) for M + DBBM and 89% (SD 14%) for DBBM. In conclusion, Bio-Oss exhibited osteoconductive properties and hence can be recommended for GBR procedures in dehiscence defects with respect to vertical and horizontal growth of bone.
    No preview · Article · Jul 1998 · Clinical Oral Implants Research

Publication Stats

852 Citations
38.08 Total Impact Points

Institutions

  • 2005
    • Radboud University Medical Centre (Radboudumc)
      Nymegen, Gelderland, Netherlands
  • 2003
    • Johannes Gutenberg-Universität Mainz
      • Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)
      Mayence, Rheinland-Pfalz, Germany
  • 2001-2002
    • Universität des Saarlandes
      Saarbrücken, Saarland, Germany
  • 1998
    • Royal Australasian College of Dental Surgeons
      Денмарк, Western Australia, Australia