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Thirteen patients received Durapatite, a hydroxylapatite ceramic (Periograf®), as a bone implant material in various types of intrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the cemento‐enamel junction (CEJ) at specific locations using a standardized periodontal probe. Similarly debrided, nonimplanted defects served as controls. Defect selection as either experimental or control site was based on an alternating defects design after local therapy was completed. Periodontal dressing and systemic tetracycline were used for 10 days. Postsurgical visits for documentation and plaque control were at 10, 20 and 30 days, and 3, 6, 9 and 12 months. Measurements relating to defect changes were made at the 12‐month surgical reentry. For evaluation purposes original defect depths were divided into three groups. In Group I (<3 mm) defect fill was 1.0 mm (47%) for the implanted defects and 0.3 mm (33%) for the control sites (significantly different at P< 0.05). In Group II (3– 6 mm) defect fill of 1.7 mm (44%) for implanted sites was significantly better (P< 0.05) than the 0.8 mm (29%) found in control sites. In the deepest group (Group III, >6 mm) Durapatite placement yielded 2.1 mm (32%) of defect fill while debridement alone resulted in 1.8 mm (26%) of fill (P> 0.05). Hard tissue responses demonstrated a substantial advantage for use of Durapatite over controls, while soft tissue changes were similar for both. The findings of this study indicate that Durapatite use resulted in greater fill of periodontal osseous defects than debridement alone at 1 year postsurgically. However, one must be cautious in comparing clinical studies of this type, and put small numerical differences even if statistically significant into proper biologic perspective. Furthermore, whereas the findings suggest that the use of Durapatite will generally be the better treatment in a given patient, it is not universally more beneficial. Occasionally, the debridement‐only defects outperformed or had similar results as the grafted areas.

Eight patientsreceived a new polycrystalline ceramic form of pure hydroxylapatite (Durapatite) as a bone implant material in various types of infrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the CEJ using a standardized periodontal probe. Similarly debrided defects that were not implanted served as controls. Defect selection as either experimental or control site was based on either split‐mouth or alternating defects design. Periodontal dressing and systemic tetracycline were used for 10 days. Recalls for documentation and plaque control were at 10, 20, and 30 days, and 3 and 6 months. Measurements relating to defect changes were made at the 6‐month surgical re‐entry. For evaluation purposes original defect depths were divided into three groups. In Group I (<3 mm) defect fill was 1.2 mm (60%) for the implanted defects and 0.6 mm (40.5%) for the control sites (significantly different at P< 0.05). In Group II (3–6 mm) defect fill of 1.7 mm (48.5%) for implanted sites was significantly better than the 0.1 mm (11.1%) for the control sites. In the deepest group (Group III ≥ 6 mm) Durapatite placement yielded 2.6 mm (39.9%) of defect fill while debridement alone resulted in 1.3 mm (14.8%) of fill. Hard tissue changes demonstrated a substantial advantage for use of Durapatite over controls, while soft tissue changes were similar for both. The clinical impression at re‐entry and the numerical data indicate that pure hydroxylapatite ceramic has a definite potential as an alloplastic implant in the treatment of periodontal osseous defects.

Six patients who participatedin a clinical study comparing the response of periodontal osseous defects to either grafting with Periograf (durapatite) hydroxylapatite (HA) ceramic or debridement alone (DEBR) were followed under an active maintenance program for 5 years. Mean values for gingival recession and attachment levels remained essentially stable following either treatment over the 5 year period. However, mean probeable pocket depths shifted from being significantly (P< 0.05) shallower for DEBR sites at 6 months and 1 year to being significantly shallower for HA sites at 5 years. The probing pocket depth change for grafted sites was steady and the change from presurgical values was significantly greater than the change for DEBR areas, which became about 1.5 mm deeper over the 5 year postsurgical period. Intrapatient comparisons showed that recession, attachment gain, and pocket depth decrease were most frequently greater for the Periograf‐treated sites. Assessment of the pattern of clinical changes during the 5 year postsurgical period demonstrated that the attachment level of grafted sites improved or stayed the same 86% of the time compared to only 62% stability or improvement in the DEBR only sites. In fact, 38% of the DEBR sites were worse at 5 years than at the time of surgery, a 3 times greater failure rate than that found in the HA‐grafted sites. Pocket depth measurements showed that 98% of the Periograf‐treated sites were better or the same as presurgically (2% worse), while only 80% of DEBR sites showed positive results and 20% had deeper pockets than at the time of surgery. These findings suggest that Periograf–treated sites were stable for 5 years following surgery and resulted in a high frequency of clinical improvement, while areas treated by open flap debridement alone were not stable and regressed at a rate 3 to 5 times that of the grafted sites. It is probable that other grafting materials would demonstrate similar comparative results to debridement alone. (J Periodontol1989;60:544–551)

Ten patients with bilateral, posterior osseous defects associated with localized juvenile Periodontitis (LJP) completed the study. Following the initial therapy, osseous defects were surgically debrided and grafted with a 4:1 volume ratio combination of either Synthograft/ tetracycline (b‐TCP/TTC), Periograf/tetracycline (HA/TTC) or freeze‐dried bone allograft/ tetracycline (FDBA/TTC). Graft materials were selected randomly for each half mouth following defect debridement, with a different material used on the opposite side for that patient. Immediately following each surgery, patients were placed on doxycycline 100 mg/ day for 10 days. Direct re‐entry evaluation of 51 osseous defects demonstrated no significant differences among the graft materials regarding hard tissue or soft tissue changes, except for greater percent defect fill for HA/TTC compared to b‐TCP/TTC. Significant decreases in defect depth and pocket depth were achieved with each graft material. No adverse reactions to the use of any of the graft materials in combination with local and systemic tetracycline were found. The results indicate all three graft materials used in conjunction with TTC are acceptable and beneficial for the treatment and repair of osseous defects associated with localized juvenile Periodontitis. {J Periodontol1989;60:491–497)

Seven patients who participatedin a clinical study comparing the response of periodontal osseous defects to either grafting with Durapatite ceramic or debridement alone were followed under an active maintenance program for 3 years. Comparison of mean values showed that gingival recession, attachment levels and probeable pocket depths remained essentially stable for Durapatite sites over the 3 years. Attachment levels for debridement sites also remained constant, but these areas showed significant coronal migration of the free gingival margin and increases in probeable pocket depths. These latter changes became apparent and significant only after 3 years. Intrapatient comparisons showed that recession and attachment gain were most frequently greater and pocket depths most frequently less for Durapatite sites. These findings suggest that the Durapatite‐treated sites were stable for 3 years following surgery, while areas treated with debridement alone regressed.