17 September 2021

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Regeneration of intrabony defects using equine-derived biomaterials: A retrospective study

Author: Giacomo Tarquini

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Periodontitis is an inflammatory disease caused by the formation of a bacterial biofilm that, especially in predisposed subjects, may lead to periodontal ligament destruction and alveolar bone resorption. The aim of this study was to study the effectiveness of the treatment of intrabony defects due to periodontitis using bone granules and equine-derived pericardium membranes.

Materials and methods
Clinical records of 22 patients who underwent regenerative therapy for intrabony defects following periodontitis at the author’s dental centers were retrospectively selected. Patients included in this retrospective study a) had a single 1-, 2- or 3-walls intrabony defect; b) had a probing pocket depth (PPD) ≥5 mm after initial therapy; c) had good oral hygiene (mean plaque index (PI) ≤1); d) were treated using an equine bone graft and equine pericardium membrane; e) were followed up for ≥12 months. According to the individual anatomy, access to the defect was achieved using either the modified papilla preservation technique (MPPT) or the simplified papilla preservation flap (SPPF) procedure. Defects were grafted using an equine bone graft, consisting of a 1:1 mixture of cortical–cancellous granules sized 0.5–1 mm (Osteoxenon, Bioteck, Arcugnano, Italy) after hydrating them using sterile saline. A 25 x 25 x 0.2 mm pericardium membrane (Heart, Bioteck, Arcugnano, Italy) was shaped, hydrated, and positioned to protect the graft. Data extracted from clinical records included the patients’ demographics (age and sex) and their smoking habits (non-smoker or smoked <10 cigarettes/day). Clinical parameters of interest were the Probing Pocket Depth (PPD), the clinical attachment level (CAL), the Plaque Index (PI), and the Sulcus Bleeding Index (SBI) recorded at baseline (before surgery) and at the 12, 24, and 60-months check-up appointments. Complications and adverse effects were also assessed.

Results
Records were analyzed for 22 non-consecutive patients (12 men and 10 women) with a mean age of 59.0±7.0 years (range from 47 to 77 years). All patients completed the healing period following regenerative surgery with no complications or adverse events. The mean follow-up period was 60.1±1.13 months. PI, SBI, PPD, and CAL values were significantly lower at all follow-up visits than at baseline (p <0.05 in all cases). At the final follow-up, the CAL gain was 4.8 mm, corresponding to 58% improvement compared to the pre-operative condition, and the PPD was 2.46±0.50 mm. Starting from the 12-month check-up, the mean CAL remained constant. Additionally, starting from the 24-month check-up, the mean PPD did not show significative differences at the subsequent follow-up, indicating that bone resorption was absent or limited from that time onward.

No correlations were observed at any time point between the measured parameters and the number of walls of the periodontal defect. There were no significant differences between smokers (≤10 cigarettes/day) and non-smokers patients at any time point, except for a difference in the SBI index at the 12-month follow-up visit.

Conclusions
Equine bone granules plus equine pericardium membranes allowed safe and successful regenerative therapy of intrabony defects caused by periodontitis.

Clinical significance
The results presented indicate that bone granules and equine-derived pericardium membranes is a safe and effective instrument for the clinician in the treatment of intrabony defects on a medium-term basis