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Demineralized-Freezed-Dried Bone Allograft and Collagen Membrane in Periodontal Wound Healing Loyola University Chicago Loyola eCommons Master's Theses Theses and Dissertations 1991 Demineralized-Freezed-Dried Bone Allograft and Collagen Membrane in Periodontal Wound Healing Daniele Giordani Loyola University Chicago Follow this and additional works at: https://ecommons.luc.edu/luc_theses Part of the Oral Biology and Oral Pathology Commons Recommended Citation Giordani, Daniele, "Demineralized-Freezed-Dried Bone Allograft and Collagen Membrane in Periodontal Wound Healing" (1991). Master's Theses. 3721. https://ecommons.luc.edu/luc_theses/3721 This Thesis is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Master's Theses by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1991 Daniele Giordani Daniele Giordani D.D.S. DEMINERALIZED-FREEZED-DRIED BONE ALLOGRAFf AND COLLAGEN MEMBRANE IN PERIODONTAL WOUND HEALING Loyola University of Chicago There is still controversy whether bone grafting used alone or in combination with guided tissue regeneration (GTR) plays a role in the regeneration of the periodontal structure (bone, cementum, and periodontal ligament). Therefore, this study was designed to investigate the regenerative potential to reform the lost attachment apparatus and the healing sequence of these two treatment modalities in experimentally created infrabony defects in beagle dogs; the two techniques consisting of, demineralized freezed dried bone allograft (DFDBA) and guided tissue regeneration, by resorbable collagen barrier, were tested separately and combined. Two walls infrabony defects were artificially created on six beagle dogs by removing the disto-buccal bone of the premolar teeth. Orthodontic wires and wooden picks were ligated around the teeth and left in place for 4-6 weeks. The so created defects were randomly assigned to three groups for the experimental treatment and one for control. At the time of the surgical treatment the roots were notched at the base of the periodontal pocket and measurement were taken for reference in the evaluation of the results. The animals were sacrificed at 7, 14, 30, 60, and 90 days post-surgery and block section were taken for histologic analysis. Comparing the final healing results of the collagen group versus the DFDBA implanted groups it is evident that at the same healing stage the collagen membrane always leads to a more intense maturation of the granulation tissue, and both the rate of bone formation and cementum formation shows a more advanced stage of healing with less inflammatory infiltrate. Although, at the end of the experimental period it appears that both bone regeneration and cementum formation are equivalent for both groups where the membrane was implanted. This is less evident for the DFDBA group; however, both the amount of bone formation and new attachment apparatus of this group are significantly greater when compared with the control. The overall results of the present study have demonstrated that both resorbable collagen barrier and DFDBA are effective in diverging or at least retarding the down growth of the gingival epithelium enough to allow the formation of significant new attachment. The results of this study are very encouraging for clinical application, however, before absolute clinical conclusions are drown, experimentation and confrontation of those techniques should be repeated on humans. DEMINERALIZED - FREEZED - DRIED BONE ALLOGRAFT AND COLLAGEN MEMBRANE IN PERIODONTAL WOUND HEALING BY DANIELE GIORDANI D.D.S. A Dissertation Submitted to the Faculty of the Graduate School of Loyola University of Chicago in Partial Fulfillment of the Requirements for the Degree of Master of Science May 1991 ACKNOWLEDGMENT I am indebted to many individuals for their assistance during my studies at Loyola. I would like especially to thank my advisor and mentor Dr. Anthony W. Gargiulo who freely offered his constant guidance, patience, and assistance in developing my clinical and scientific skills. I wish sincerely to thank Dr. Patrick D. Toto for his constant guidance, experience and knowledge which made the completion of this thesis possible. To Dr. Joseph J. Keene, I am grateful for his support and for serving as a member of my advisory board. I would like to express my particular gratitude to a colleague and friend Dr. J. David Cross for the help in the surgical phase of the investigation, and for his assistance and moral support throughout the study. My special thanks to my relatives for their love and support, and especially to my father who has been a constant guidance and support throughout my entire educational carrier. This study would not have been possible without the financial support of the Orban Foundation, to which I forward my profound gratitude. ii VITA The author, Dr. Daniele Giordani, is the second of three sons of Enzo Giordani and Adriana (Dal Carlo) Giordani. He was born in January 12, 1962, in Rome, Italy. His elementary education was carried out in the private school "Villa Flaminia" in Rome. His higher education was completed in July 1980 at the private institution, "De Merode's College", in Rome Italy. In September 1980, Mr. Giordani was accepted in the Dental School at the state University "La Sapienza" in Rome, where he graduated in November 1985 Magnum Cum Laude. In August 1989, Dr. Giordani entered Loyola University of Chicago to pursue his post-graduate specialty training in Periodontics and graduate study in Oral Biology for the degree of the Master in Science. iii TABLE OF CONTENTS Page ACKNOWLEDGMENTS ii VITA. iii LIST OF TABLES . V LIST OF ILLUSTRATIONS................................... VI IN1RODUCTION . 1 CHAPTER I. REVIEW OF THE LITERATURE 4 DFDBA: i. historical review Guided Tissue Regeneration : i. historical review ii. Bio-resorbable Membrane Combined Collagen and DFDBA II. MATERIAL AND METHOD. 20 III. RESULTS . 29 IV. DISCUSSION. 56 V. CONCLUSION. 70 APPENDIX . 72 REFERENCES . 83 iv LIST OF TABLES Page TABLE I Results of clinical studies. 76 TABLE II Defect Preparation and Treatment for Each Dog . 77 TABLE III Results of the non-implanted control defects. 78 TABLE IV Results of DFDBA implanted defects................... 79 TABLE V Results of Collagen Membrane implanted defects. 80 TABLE VI Results of combined Collagen Membrane and DFDBA implanted defects . 81 TABLE VII Induction and maintenance of new bone formation by growth and differentiation factors. 82 V LIST OF ILLUSTRATIONS Page Fig. A : Surgically induced defects. 91 & 98 Fig. B : Example of the defects at the time of the experimental treatment. 91 & 98 Fig. C : Treatment of the two wall bony defect with DFDBA & Coll.Membr..................... 91 & 99 Fig. 1 : Attachment level of the induced periodontal pocket. 91 & 99 Fig. 2 : Control at 1 week (H&E, original magnification, 10 X) ... 91 & 100 Fig. 3 : Control at 2 weeks (Trichrome Masson's, original magnification, 10 X) ..... 91 & 100 Fig. 4 : Control at 1 month (Trichrome Masson's, original magnification, 10 X) ..... 91 & 101 Fig. 5 : DFDBA at 1 week (H&E, original magnification, 25 X) . 92 & 102 Fig. 6 : DFDBA at 2 weeks (H&E, original magnification, 2.5 X) ..................... 92 & 103 Fig. 7: DFDBA at 2 weeks (H&E, original magnification, 25 X) . 92 & 104 Fig. 8: DFDBA at 1 month (H&E, original magnification, 10 X) ............... 92 & 104 vi Fig. 9 : DFDBA at 1 month (H&E, original magnification, 10 X) ............... 93 & 105 Fig. 10: DFDBA at 1 month (H&E, original magnification, 10 X) . 93 & 106 Fig. 11 : DFDBA at 2 months (Trichrome Masson's, original magnification, 2.5 X)..... 93 & 107 Fig. 12: DFDBA at 3 months (H&E, original magnification, 2.5 X). 93 & 108 Fig. 13: DFDBA at 3 months (Trichrome Masson's, original magnification, 10 X) ..... 93 & 109 Fig. 14: DFDBA at 2 weeks (H&E, original magnification, 2.5 X). 93 & 110 Fig. 15 : Collagen Membrane at 2 weeks (H&E, original magnification, 10 X) ............... 94 & 111 Fig. 16: Collagen Membrane at 2 weeks (Trichrome Masson's, original magnification, 2.5 X)..... 94 & 112 Fig. 17 : Collagen Membrane at 1 month (Trichrome Masson's, original magnification, 10 X)..... 94 & 113 Fig. 18: Coll.Membr. at 1 month (H&E, original magnification, 10 X) . 94 & 113 Fig. 19 : Collagen Membrane at 2 months (H&E, original magnification, 2.5 X)............... 94 & 114 vii Fig. 20 : Collagen Membrane at 2 months (Trichrome Masson's, original magnification, 25 X) ..... 95 & 115 Fig. 21: DFDBA & Collagen Membrane at 1 week (Trichrome Masson's, original magnification, 25 X) ..... 95 & 116 Fig. 22: DFDBA & Collagen Membrane at 1 week (Trichrome Masson's, original magnification, 25 X) ..... 95 & 117 Fig. 23: DFDBA & Collagen Membrane at 1 week (H&E, original magnification, 2.5 X) ............... 95 & 118 Fig. 24: DFDBA & Collagen Membrane at 2 weeks (Trichrome Masson's, original magnification, 25 X) ..... 96 & 119 Fig. 25 : DFDBA & Collagen Membrane at 2 weeks (Trichrome Masson's, original magnification, 2.5 X) ..... 96 & 120 Fig. 26: DFDBA & Collagen Membrane at 1 month (Trichrome Masson's, original magnification, 25 X) ..... 96 & 121 Fig. 27: DFDBA & Collagen Membrane at 2 months (Trichrome Masson's, original magnification, 2.5 X) ..... 96 & 122 Fig. 28 : DFDBA & Collagen Membrane at 2 months (H&E, original magnification, 2.5 X) ............... 96 & 123 Fig. 29: DFDBA & Collagen Membrane at 2 months (Trichrome
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