J Periodontal Implant Sci.  2019 Apr;49(2):90-104. 10.5051/jpis.2019.49.2.90.

Periodontal regenerative therapy in endo-periodontal lesions: a retrospective study over 5 years

• Oh S
• Chung SH
• Han JY

• KMID: 2444221
• DOI: http://doi.org/10.5051/jpis.2019.49.2.90

Abstract

PURPOSE
The aim of this study was to evaluate clinical and radiographic changes and the survival rate after periodontal surgery using deproteinized bovine bone mineral (DBBM) with 10% collagen or DBBM with a collagen membrane in endo-periodontal lesions.
METHODS
A total of 52 cases (41 patients) with at least 5 years of follow-up were included in this study. After scaling and root planing with or without endodontic treatment, periodontal regenerative procedures with DBBM with 10% collagen alone or DBBM with a collagen membrane were performed, yielding the DBBM + 10% collagen and DBBM + collagen membrane groups, respectively. Changes in clinical parameters including the plaque index, bleeding on probing, probing pocket depth, gingival recession, relative clinical attachment level, mobility, and radiographic bone gains were evaluated immediately before periodontal surgical procedures and at a 12-month follow-up.
RESULTS
At the 12-month follow-up after regenerative procedures, improvements in clinical parameters and radiographic bone gains were observed in both treatment groups. The DBBM + 10% collagen group showed greater probing pocket depth reduction (4.52±1.06 mm) than the DBBM + collagen membrane group (4.04±0.82 mm). However, there were no significant differences between the groups. Additionally, the radiographic bone gain in the DBBM + 10% collagen group (5.15±1.54 mm) was comparable to that of the DBBM + collagen membrane group (5.35±1.84 mm). The 5-year survival rate of the teeth with endo-periodontal lesions after periodontal regenerative procedures was 92.31%.
CONCLUSIONS
This study showed that regenerative procedures using DBBM with 10% collagen alone improved the clinical attachment level and radiographic bone level in endo-periodontal lesions. Successful maintenance of the results after regenerative procedures in endo-periodontal lesions can be obtained by repeated oral hygiene education within strict supportive periodontal treatment.

Keyword

Guided tissue regeneration; Oral hygiene; Periapical periodontitis; Periodontitis; Regenerative endodontics

MeSH Terms

Collagen
Education
Follow-Up Studies
Gingival Recession
Guided Tissue Regeneration
Hemorrhage
Membranes
Miners
Oral Hygiene
Periapical Periodontitis
Periodontitis
Retrospective Studies*
Root Planing
Survival Rate
Tooth
Collagen

Figure

• 

  Figure 1 Flow chart of the participants in this study. PI: plaque index, BOP: bleeding on probing, PPD: probing pocket depth, RAL: relative clinical attachment level, DBBM: deproteinized bovine bone mineral.

• 

  Figure 2 Pre- and post-operative radiographs and clinical photographs of endo-periodontal lesion. (A) A periapical radiograph before the periodontal regenerative procedure. (B) After reflecting the flap, the bony defect adjacent to the apex was shown. (C) The bone defect was grafted with DBBM and (D) covered with a collagen membrane. (E) Three-dimensional CBCT image before surgery. (F) Three-dimensional CBCT image at the 12-month follow-up showed the bone defect filled with hard tissue. (G) Sagittal CBCT image before surgery showed bone destruction extending to the apex. (H) Sagittal CBCT view at 12 months after surgery. The bone defect was filled with hard tissue. (I) Coronal CBCT image before surgery showed the buccal bone defect extending to the apex. (J) At the 12-month follow-up, the bone defect was filled with hard tissue. (K) Axial CBCT image showing the resorption of the buccal cortical plate. (L) The buccal bone defect was filled with hard tissue at the 12-month follow-up after the periodontal regenerative procedure. CEJ: cemento-enamel junction, BD: bottom of the defect, RA: root apex, DBBM: deproteinized bovine bone mineral, CBCT: cone-beam computed tomography.

• 

  Figure 3 Radiographic and histologic evaluation of endo-periodontal lesion. (A) A periapical radiograph before surgery showed a bone defect around the apex of the left maxillary central incisor. (B) An endo-periodontal lesion was filled with hard tissue. (C) At 11 years after surgery, the root was fused with the adjacent hard tissue, similar to ankylosis. (D) Reconstructed micro-computed tomography image of the extracted tooth. (E) A histologic evaluation showed that the bone-like mass was directly adhered to the root surface (H&E stain, original magnification, ×1.2, scale bar=2,000 μm). (F) The root was directly in contact with the adjacent bone surrounding the DBBM particles (Masson-Goldner trichrome stain, original magnification, ×1.2, scale bar=2,000 μm) (G) The DBBM particles were surrounded with mature bone (H&E stain, original magnification, ×10, scale bar=500 μm). (H) Higher magnification of (G). The cementum was directly in contact with the adjacent mature bone (H&E stain, original magnification, ×40, scale bar=50 μm). D: dentin, C: cementum, MB: mature bone, P: DBBM particles, H&E: haemotoxylin and eosin.

• 

  Figure 4 Comparison of clinical parameters and radiographic bone gain according to (A) the use of a membrane, (B) endodontic treatment, and (C) new prosthesis delivery. ΔPPD: difference in the probing pocket depth between baseline and the 12-month follow-up, ΔPPDD: difference in the deepest probing pocket depth between baseline and the 12-month follow-up, ΔRAL: difference in the relative attachment level between baseline and the 12-month follow-up, ΔRALD: difference in the relative attachment level at the deepest point between baseline and the 12-month follow-up, ΔCEJ-BD: difference in the radiographic distance from the cemento-enamel junction (or a restorative margin) to the most apical extension of bone destruction between baseline and the 12-month follow-up. a)Statistically significant difference (P<0.01); b)Statistically significant difference (P<0.05).

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