Evaluating Change of Marginal Bone Height with Cone-Beam Computed Tomography Following Surgical Treatment with Guided Tissue Regeneration (Bone Grafting) or Access Flap Alone: A Retrospective Study

Abstract

Background and Objectives: This study aimed to evaluate the change of bone height following treatment of human intrabony defects with guided tissue regeneration (GTR) with bone grafting or access flap alone by cone-beam computed tomography (CBCT) scan. Materials and methods: This study was conducted as a retrospective longitudinal study. In this study, a total of 2281 teeth sites were included: the GTR group had 1210 sites, and the Flap group had 1071 sites. In the GTR group, demineralized freeze-dried bone (DFDBA) particles in combination with resorbable collagen membrane were used. No regenerative material was applied to the Flap group. CBCT images were taken twice at baseline and at least 2.5 months postoperatively. Bone heights were measured using software on CBCT images. Results: The bony change between the GTR and Flap groups was significantly different (p = 0.00001). Both males and females in the GTR group had smaller bone loss than in the Flap group. In age groups, significant differences of bony height between the GTR and Flap groups were observed in the subgroups consisting of those 29-45 and 46-53 years old. The non-smoking subjects in the GTR group had higher bone heights than those in the Flap group. In the absence of systemic disease and medicine, bone formation was higher in the GTR group than in the Flap group. In terms of oral position, the #14-17, #34-37, and #44-47 subgroups of the GTR group showed higher levels of bone heights than those of the Flap group. Conclusions. The results of this study indicated that the GTR procedure offers the additional benefit of higher bone heights than the Flap procedure does.

Keywords: dental materials; guided tissue regeneration; osseous defects; periodontal regeneration; periodontal surgery; periodontitis.

Figure 1

A flow diagram of study participants’ enrollment and follow-up. GTR: guided tissue regeneration; CBCT: cone-beam computed tomography.

Figure 2

(Case 1: A–E and Case 2: F–J): Guided tissue regeneration (GTR); (A–B,F) before treatment, (C,G) full thickness flaps were performed; then, the exposed defects were carefully scaled and root planed, (D,H–I) demineralized freeze-dried bone (DFDBA) and collagen membrane were applied to the defect area, (E,J) suture and resin wire splint were performed. (Case 1: K–O): Open flap surgery (Flap); (K,L) before treatment, (M) full thickness flap and debridement were also performed, (N,O) suture was performed.

Figure 3

(A–D): The distance between the cemento-enamel junction (CEJ) and base of alveolar bone of the mesial and distal sites on the teeth in the preoperative CBCT image, (E): Connecting line of CEJ, (F): Connecting line of basic point between (A) and (D), (A’–D’): The distance of the same site on the second CBCT image after treatment, (A’–D’): The amount of bony change.

Figure 4

(A–F): CBCT images before and after treatment in the GTR group. (G–J): CBCT images before and after treatment in the Flap group (Arrow: bone healing area).