A Clinical Evaluation of Biphasic Calcium Phosphate Alloplast with and without a Flowable Bioabsorbable Guided Tissue Regeneration Barrier in the Treatment of Mandibular Molar Class II Furcation Defects

Abstract

Background: Guided tissue regeneration (GTR) therapy has shown good results in the management of mandibular molar class II furcation defects. Advances in biomaterial sciences have developed alloplastic bone replacement graft materials and bioabsorbable GTR barrier membranes with good biologic response and handling properties. The aim of this study was to compare the attachment gain and the bone fill obtained with an alloplast [biphasic calcium phosphate (BCP) 60% hydroxyapatite (HA) and 40% beta tricalcium phosphate (b-TCP)] with and without a bioabsorbable GTR barrier [flowable poly (DL-lactide) (PLA) dissolved in N-methyl-2-pyrrolidone (NMP)] in the treatment of mandibular molar class II furcation defects.

Materials and methods: A total of 20 class II furcation defects were treated in 16 patients with chronic periodontitis in a comparative study. Ten defects were treated with Camceram(®) (BCP 60% HA and 40% - TCP) bone replacement graft material (group I) and 10 defects with a combination of Camceram® bone replacement graft material with Atrisorb® Freeflow™, bio-absorbable GTR barrier (flowable PLA dissolved in NMP) (group II). At baseline and at 6 months postsurgery, clinical parameters of vertical probing depth (PD) and horizontal probing depth (P-H), clinical attachment level (CAL), gingival recession (GR), and vertical depth of furcation defect (VDF) and horizontal depth of furcation defect (BP-H) were evaluated.

Results: Statistical analysis was done with the Statistical Package for Social Sciences (SPSS) program. Intergroup comparisons made at 6 months postsurgery by unpaired Student's t-test showed mean reduction in PD in group I was 3.10 ± 0.73 mm and in group II was 3.20 ± 1.03 mm (p > 0.05). Mean reduction in P-H in group I was 1.60 ± 0.69 mm and in group II was 1.90 ± 0.73 mm (p > 0.05). Gain in CAL in group I was 2.80 ± 1.03 mm and in group II was 2.90 ± 0.94 mm (p > 0.05). Change in GR in group I was -0.30 ± 0.48 mm and in group II was -0.30 ± 0.48 (p > 0.05). Reduction in VDF in group I was 1.30 ± 0.67 mm and in group II was 1.80 ± 0.63 mm (p ≤ 0.01). Reduction in BP-H in group I was 1.30 ± 0.67 mm and in group II was 1.90 ± 0.73 mm (p ≤ 0.05).

Conclusion: It was concluded that the combination technique of BCP alloplast with a flowable bioabsorbable GTR barrier led to better results in regard to defect bone fill as compared with when the BCP alloplast alone was used.

Keywords: Alloplast; Bioabsorbable GTR; Biphasic calcium phosphate; Bone grafting; Furcation defect; Guided tissue regeneration..