Histological Evaluation of Granular β-TCP Implantation in Periodontal Intrabony Defects

Objectives: To evaluate clinically and histologically the healing of advanced intrabony defects treated with open flap debridement and implantation of granular β-TCP (chronOS, Synthes, Switzerland). Materials and Methods: Five patients, each of them displaying very advanced combined 1- and 2 - wall intrabony defects around teeth scheduled for extraction or root resection, were included in the study. During surgery, a mark was made on the root surface at the most apical part of the defect to serve as a reference for the histological evaluation. Approximately 6 months after surgery, the teeth or roots were removed together with a portion of their surrounding soft and hard tissues and processed for decalcified histological evaluation. Results: Probing pocket depth was reduced from 10.8 ± 2.3 mm presurgically to 4.6 ± 2.1 mm, while a clinical attachment level gain of 5.0 ± 0.7 mm was observed. Increase in gingival recession was 1.2 ± 3.2 mm. The histological evaluation indicated formation of new cellular cementum with inserting collagen fibers to a varying extent coronal to the most apical extent of root instrumentation (1.9 ± 0.7 mm; range: 1.2 – 3.3 mm). New bone formation was 1.0 ± 0.7 mm (range: 0.0 – 1.9 mm). In one of the specimens, portion of the healing was characterized by ankylosis. In most specimens, the β-TCP particles were embedded in connective tissue, while formation of a mineralized bone-like or cementum-like tissue around the particles was only occasionally observed. Contact between the β-TCP particles and the root surface was never observed. Conclusions: A small portion of the clinical improvements observed after open flap debridement and implantation of granular β-TCP may indeed be characterized by periodontal regeneration, however, β-TCP did not seem to enhance bone and/or periodontal regeneration.

The present study was supported in part by Synthes, Switzerland.