J Periodontal Implant Sci.  2016 Oct;46(5):303-319. 10.5051/jpis.2016.46.5.303.

The influence of root surface distance to alveolar bone and periodontal ligament on periodontal wound healing

• Montevecchi M
• Parrilli A
• Fini M
• Gatto MR
• Muttini A
• Checchi L

• KMID: 2354929
• DOI: http://doi.org/10.5051/jpis.2016.46.5.303

Abstract

PURPOSE
The purpose of this animal study was to perform a 3-dimensional micro-computed tomography (micro-CT) analysis in order to investigate the influence of root surface distance to the alveolar bone and the periodontal ligament on periodontal wound healing after a guided tissue regeneration (GTR) procedure.
METHODS
Three adult Sus scrofa domesticus specimens were used. The study sample included 6 teeth, corresponding to 2 third mandibular incisors from each animal. After coronectomy, a circumferential bone defect was created in each tooth by means of calibrated piezoelectric inserts. The experimental defects had depths of 3 mm, 5 mm, 7 mm, 9 mm, and 11 mm, with a constant width of 2 mm. One tooth with no defect was used as a control. The defects were covered with a bioresorbable membrane and protected with a flap. After 6 months, the animals were euthanised and tissue blocks were harvested and preserved for micro-CT analysis.
RESULTS
New alveolar bone was consistently present in all experimental defects. Signs of root resorption were observed in all samples, with the extent of resorption directly correlated to the vertical extent of the defect; the medial third of the root was the most commonly affected area. Signs of ankylosis were recorded in the defects that were 3 mm and 7 mm in depth. Density and other indicators of bone quality decreased with increasing defect depth.
CONCLUSIONS
After a GTR procedure, the periodontal ligament and the alveolar bone appeared to compete in periodontal wound healing. Moreover, the observed decrease in bone quality indicators suggests that intrabony defects beyond a critical size cannot be regenerated. This finding may be relevant for the clinical application of periodontal regeneration, since it implies that GTR has a dimensional limit.

Keyword

Bone and bones; Guided tissue regeneration; Three-dimensional imaging; Periodontium; Research design; Root resorption

MeSH Terms

Adult
Animals
Ankylosis
Bone and Bones
Guided Tissue Regeneration
Humans
Imaging, Three-Dimensional
Incisor
Membranes
Periodontal Ligament*
Periodontium
Regeneration
Research Design
Root Resorption
Sus scrofa
Tooth
Wound Healing*
Wounds and Injuries*

Figure

• 

  Figure 1 Scheme of the circumferential defects with constant distance (2 mm) between the root surface and bone margin and with increasing depth (h) depending on sample (h=3, 5, 7, 9, or 11 mm).

• 

  Figure 2 Microstructure bone parameters of alveolar bone along the entire height (h) of the defect (12 mm) but at the different area distance from the root (i.e., A1 at ≤0.4 mm, A2 at 0.4–0.8 mm, A3 at 0.8–1.2 mm, A4 at 1.2–1.6 mm, A5 at 1.6–2.0 mm). (A) Values of bone density (BV/TV) in %; (B) values of trabecular thickness (Tb.Th) in mm; (C) values of trabecular number (Tb.N) in mm-1; (D) values of trabecular separation (Tb.Sp) in mm for all samples including control.

• 

  Figure 3 Microstructure bone parameters of alveolar bone at the coronal thirds and at the different area distance from the root (i.e., A1 at ≤0.4 mm, A2 at 0.4–0.8 mm, A3 at 0.8–1.2mm, A4 at 1.2–1.6 mm, A5 at 1.6–2.0 mm). (A) Values of bone density (BV/TV) in %; (B) values of trabecular thickness (Tb.Th) in mm; (C) values of trabecular number (Tb.N) in mm-1; (D) values of trabecular separation (Tb.Sp) in mm for all samples including control. h, height.

• 

  Figure 4 Color-coded trabecular thickness measured by 3-dimensional (3D) sphere fitting of alveolar bone along the entire height (h) of the defect (12 mm) but at the different area distance from the root (i.e., A1 at ≤0.4 mm, A2 at 0.4–0.8 mm, A3 at 0.8–1.2 mm, A4 at 1.2–1.6 mm, A5 at 1.6–2.0 mm). (A) Control sample; (B) sample with periodontal defect of 3 mm; (C) sample with periodontal defect of 5 mm; (D) sample with periodontal defect of 7 mm; (E) sample with periodontal defect of 9 mm; (F) sample with periodontal defect of 11 mm. The colorcoded bar is encoded between 0 and 250 μm of thickness.

• 

  Figure 5 Bone-root contact (BRC) and root resorption (RR), in mm2 and mm3 respectively, of control and experimental samples. (A, B) Values of BRC and RR along the entire height (h) of the defect (12 mm). (C-H) Values of BRC and RR divided for thirds (coronal, medial, and apical).

• 

  Figure 6 2-dimensional (2D) tomographic sections and 3-dimensional (3D) models of the third mandibular incisors with gradually increasing periodontal defects. (A) Longitudinal section detail (on the left) and 3D model (on the right) of the control sample. (B) Longitudinal section detail (on the left) and 3D model (on the right) of the sample with defect depth of 3 mm showing the contact between root and alveolar bone (arrow). (C) Longitudinal section detail (on the left) and 3D model (on the right) of the sample with defect depth of 5 mm. (D) Longitudinal section detail (on the left) and 3D model (on the right) of the sample with defect depth of 7 mm showing both ankyloses (arrow). (E) Longitudinal section detail (on the left) and 3D model (on the right) of the sample with defect depth of 9 mm. (F) Longitudinal section detail (on the left) and 3D model (on the right) of the sample with defect depth of 11 mm. h, height. *Root resorption.

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