Behandlung von infraalveolären, interproximalen Defekten bei Patienten mit generalisierter fortgeschrittener chronischer Parodontitis. Vergleich zwischen dem „Modified Widman flap“ und einer Lappenoperation mit Applikation von Wachstumsfaktoren

The purpose of this randomized prospective study was to compare clinically and radiographically the effectiveness of two different surgical treatments of infrabony defects. In the experimental group we used a collagen-lyophilizate, which was extracted from the extracellular matrix of bovine bone. This material was obtained from the OSSACUR AG, Oberstenfeld, Germany. It contains growth-factors, especially Bone Morphogenetic Proteins. The lyophilizate is a collagenous matrix, consisting of Type I collagen and other insoluble proteins. In the control group the infrabony defects were treated with a conventional surgical flap technique called “modified Widman flap”. This method was named after their investigators RAMFJORD & NISSLE (1974). 14 Patients in the age between 25 and 60 years were treated at the University of Marburg, Germany. They were all in good health. The main inclusion criterion for the patients to become part of the study was the existence of a generalized chronic periodontitis according to the definition of the workshop in Oak/ Hill USA. Another inclusion parameter was a very good compliance and a high motivation of the patients and an API (Approximal-Plaque-Index) according to LANGE ET AL. (1977) less than 20 %. Patients with a dysfunction at the stomatognath system were not included. Before starting the study treatment all patients had to pass through a causal treatment for 2 or 3 month. Furthermore radiographic examinations were taken in the Baseline period. For radiographic examination the cone beam computed tomography was used. Only teeth with preoperative probing pocket depth of at least 7 mm and 1- to 3- wall infrabony defects where chosen to be treated in the study. Altogether 78 teeth with 112 infrabony defects were chosen for the therapy. Forty teeth with 55 different infrabony defect locations were surgical treated with the Bone Morphogenetic Proteins and 38 teeth with 57 infrabony defect locations were treated with the “Modified Widman flap” technique. The radiographic examination included 31 infrabony defects of 20 teeth. Therefore 9 teeth with 14 different infrabony defect locations of the Bone Morphogenetic Protein treated group and 11 teeth with 17 different infrabony defect locations of the „Modified Widman flap“ treated group were examinated. The randomization was created by tossing a coin for becoming part in one of the 2 groups. The clinical measurements- including plaque index (PI), gingival index (GI), probing pocket depth (PPD), bleeding on probing (BOP), recession (GR), clinical attachment level (CAL) and the involvement of the furcation defect (FD)- were carried out preoperative and postoperative after 6, 9 and 12 month. The radiographic examination was taken in the Baseline period and 12 month after surgical treatment. All infrabony defects- pre- and postoperative- were compared by the measurement of the defect length distances, the defect depth and the defect width. The results were statistically analyzed by determination the mean value and the deviation from the standard and the usage of non- parametric tests. Paired data were compared with the Mann-Whitney U-test. After 12 month the experimental group demonstrated a PPD reduction of 3,40 ± 1,95 mm (p = 0,09 ) and a CAL reductions of 6,36 ± 2,09 mm (p = 0,626 ) and a GR increase of 2,99 ± 1,29 mm (p = 0,001 ). The results of the PPD after 6 and 9 month were statistically significant. The results of the CAL after 6 and 9 month showed no significant differences to the Baseline values while the results of the GR showed after 6 and 9 month a high significance. In the control group the reductions of the PPD showed mean values of 3,26 ± 1,65 mm (p ≤ 0,001) and an increase of the CAL of 6,09 ± 2,19 mm (p = 0,968 ) and of the GR of 6,09 ± 2,19 mm (p = 0,968 ). The results of the PPD in the control group showed after 6 month a statistic significance and after 9 month a high significance. The mean values of the CAL showed no significant differences to the Baseline data. Furthermore the statistic analyze of the GR showed after 6 and 9 month a high significance. The radiographs in the experimental group showed a reduction of the infrabony defect volumes from 30,55 ± 17,90 mm³ to 20,82 ± 13,59 mm³ in the mean value with no significant difference (p = 0,106 ). In the control group a reduction of the infrabony defects from 34,38 ± 13,05 mm³ to 19,16 ± 10,55 mm³ was evaluated. The radiographic values of this group showed a high significance (p ≤ 0,001). There were no significant differences of the clinical and radiographic results between both groups. In conclusion both treatments of the infrabony defects had an equal beneficial. The effect of the treatment depended on a good oral hygiene and the absence of a postoperative periodontal inflammation.