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Background:Soft tissue ridge defects often hamper ideally shaped artificial crowns and are basically treated using autogenous soft tissue grafts or alloplastic materials. These approaches present disadvantages such as the necessity of creating additional surgical fields to harvest the graft and the requirement of primary closure, which may reduce ridge height. This investigation evaluated the use of acellular dermal matrix (ADM) in the treatment of soft tissue ridge defects. Methods:Eight patients, non‐smokers with noncontributory medical history, provided 18 sites corresponding to missing teeth in the anterior maxillary arch. The ideal horizontal gain (desired gain) was waxed up in study casts, which served as templates for construction of modified acrylic stents with orthodontic wires. These stents served as references for ideal horizontal gain and also as fixed reference points for further evaluation. The distance from the orthodontic wire to the buccal plate of the defect also represented its baseline horizontal component. Vertical variations were evaluated with another stent and, in this case, no desired gain was considered. After raising partial‐thickness flaps, the ADM material was rehydrated and folded to fill the defect and reproduce the desired gain. Flaps were sutured with no tension, and part of the material was intentionally left exposed to avoid pressure on the incision line and prevent height loss. Patients used local and systemic antimicrobials, and the sutures were removed at 7 days. Results:Evaluations were carried out at 30 days, and 3 and 6 months, and all sites healed uneventfully. Neither infection nor significant pain was reported by the patients, and the material was covered by tissue at about 21 days. Mean horizontal gain of 1.72 ± 0.59 mm (58.5%) at 6 months and mean shrinkage of 1.22 ± 0.46 mm (41.4%) were observed. There was a mean improvement in vertical gain of only 0.61 ± 0.77 mm, although 66.7% of the treated sites showed a 1 to 2 mm gain. Clinically, the total gain in the subjects was very effective and matched the receptor tissues nicely. Conclusions:ADM may be a suitable material for the treatment of soft tissue ridge deformities due to its biocompatibility, color matching, and horizontal gain. Additional controlled, comparative trials are necessary to establish its advantages and potential compared to autogenous soft tissue techniques.J Periodontol 2001;72:265‐273.

Background:The use of graft materials with guided tissue regeneration (GTR) in Class II furcation defects is aimed at improving the outcome of the regenerative technique. In this regard, however, there are a limited number of studies discussing the results obtained when GTR and graft materials are used in the treatment of Class II furcation defects. Furthermore, most studies employ either allogeneic or autogenous materials. The present trial sought to determine whether the use of a bovine‐derived anorganic bone (ABB) in conjunction with GTR influenced the outcome of mandibular Class II furcation treatment. Methods:This study included 14 patients who provided 15 pairs of similar periodontal defects. Each defect was randomly assigned to treatment with either a cellulose membrane in combination with bovine‐derived anorganic bone (GTR+ABB) or membrane alone (GTR). Following basic therapy, baseline measurements were recorded including probing depth (PD), clinical attachment level (CAL), and gingival margin position (GMP). Hard tissue measurements were performed during surgery to determine alveolar crestal height (CEJ‐AC), and vertical (VDD) and horizontal defect depth (HDD). Membranes remained in position for at least 4 weeks. After 6 months, all sites were re‐entered and soft and hard tissue measurements were recorded. Results:Both surgical procedures resulted in statistically significant probing depth reduction and gain in clinical attachment levels, with no significant difference between groups. Gingival recession was more pronounced in the GTR+ABB group (0.87 ± 0.83 mm), but not statistically different from the GTR group (0.46 ± 1.19 mm). Vertical defect resolution was significant in both groups (GTR: 1.60 ± 1.50 mm; GTR+ABB: 1.80 ± 2.11 mm), without differences between groups. Only horizontal furcation resolution (GTR: 2.47 ± 0.99 mm; GTR+ABB: 3.27±1.39 mm) was significantly different between groups (P<0.05). Conclusions:The use of ABB with GTR techniques improved horizontal defect resolution in mandibular Class II furcation defects, but did not yield superior results regarding soft tissue changes when compared to sites treated with GTR alone. Evaluation of a larger sample could indicate differences and advantages between the evaluated approaches and confirm the real necessity of associating filling materials with GTR. J Periodontol 2000;71:904‐911.

Background:Different filling materials have been associated with guided tissue regeneration (GTR) in order to improve its regenerative potential and predictability. Anorganic bovine bone (ABB) has demonstrated biocompatibility and osteoconductive properties; however, there are limited data regarding its performance in the treatment of intrabony defects. This investigation aimed to evaluate the clinical outcome of the association of anorganic bovine bone with cellulose membranes in intrabony defects after 6 months. Methods:Twenty‐six paired intrabony defects were selected from 11 non‐smoking patients with no relevant medical history. The defects were similar regarding the number of bony walls and defect depth, and presented pocket depths ≥ 6 mm. Four weeks after completion of basic therapy, probing depth (PD), clinical attachment level (CAL), and gingival margin position (GP) were recorded (baseline values). The defects were then surgically accessed and debrided, and the intrabony component measured to the nearest millimeter with periodontal probes and customized acrylic stents (distance from the stent to the base of the defect and from the stent to the alveolar crest). Each intrabony defect was randomly assigned to receive the membrane alone (control, C) or the membrane with anorganic bovine bone (test, T). The patients were re‐evaluated after 6 months, and re‐entry procedures were performed. Results:Significant (P<0.01) improvement in all variables was observed: mean pocket reduction of 4.61 ± 1.60 mm (C) and 4.46 ± 1.50 mm (T) and clinical attachment gain of 2.85 ± 1.46 mm (C) and 3.15 ± 1.40 mm (T); the difference between groups was not significant (P>0.05). Nevertheless, gingival recession in the control group (1.84 ± 0.89 mm) was significantly (P<0.05) more pronounced than that observed in the test group (1.30 ± 0.48 mm). Bone measurements indicated a significant resolution of the defects (P<0.01). A mean defect resolution of 2.76 ± 0.72 mm (C) and 2.69 ± 1.03 mm (T) and crestal resorption of 1.07 ± 0.64 mm (C) and 1.30 ± 0.85 mm (T) were detected (P>0.05). Stepwise multiple regression analysis indicated that for both groups, the baseline depth of the defects and the alveolar crest resorption accounted for 82% of the variability of bone fill observed in the control group (F = 23.65, P<0.001) and 89% in the test group (F = 41.32, P<0.001). Conclusions:ABB may be used in conjunction with GTR in the treatment of intrabony defects. Its use, however, did not result in a better outcome than the use of membranes alone. Studies employing more patients would be of interest in order to determine the advantages and indications of the tested approaches on a more predictable basis. J Periodontol 1999;70:1000‐1007.