Histological evaluation of bone grafts combined with GTR for the treatment of bone dehiscences

Aim of the study

To demonstrate periodontal regeneration histologically after bone grafts associated with guided tissue regeneration.

Materials and methods

The four maxillary premolars of a 47 year-old patient needed to be extracted. They presented with deep palatal lesions of 7 to 10 mm. During the surgery, a notch was cut to mark the apical limit of calculus. A bone graft with DFDBA, with or without porous hydroxyapatite was placed and covered with a resorbable membrane in 4 lesions at the same surgical visit. The teeth were removed 7 months later, together with the adjacent soft tissues for histological analysis.

Results

Despite an improvement in the clinical signs, none of the sites proved that regeneration had occurred. A long junctional epithelium was found in all cases except in the region of the notch in 2 cases where new cementum with inserted collagen fibres could be observed with the DFDBA specimen, with or without hydroxyapatite.

Conclusion

Dehiscence-type defects have an unfavourable prognosis and the teeth were mobile. Also, the notch underestimated the depths of the pockets and the various measurements did not allow conclusions to be drawn. The study could not be conducted blind.

Commentaries

This study did not provide information on whether graft or the filling material is implicated. In addition, it is a question of 4 teeth in one patient only, where the quality of healing was not compared with a control.