HEALING IN PERIODONTAL DEFECTS TREATED BY DECALCIFIED FREEZE-DRIED BONE ALLOGRAFTS IN COMBINATION WITH EPTFE MEMBRANES - ASSESSMENT BY COMPUTERIZED DENSITOMETRIC ANALYSIS

This study quantitatively assessed radiographic changes in alveolar bone density by computer-assisted densitometric image analysis (CADIA) in periodontal defects that were treated with decalcified freeze dried bone allograft (DFDBA) alone or in combination with interproximal expanded polytetrafluoroethylene membranes (ePTFE). The radiographic changes where then analyzed for correlation with the clinically assessed changes. The radiographic changes were evaluated on standardized radiographs of treated sites treated prior to, 1 week after surgery, and 6 months post-operatively. 15 patients with one pair of bilateral interproximal periodontal defects of similar morphology and greater-than-or-equal-to 6 mm in pocket depth participated. Analysis of the changes 6 months after treatment showed that the increases in density in the defect areas that received the graft were significantly greater than the adjacent areas (p < 0.001). These adjacent areas, in contrast, demonstrated significantly larger loss in radiographic density than the defect area (p < 0.001). The placement of DFDBA into the defects produced in itself significant increases in radiographic density, as illustrated by the results of one week which remained at six months. Utilization of ePTFE addition to DFDBA did not lead to additional radiographic gains in the defect area. While at one week the analysis suggested increased resorption by the combined treatment over grafting alone, such differences did not persist at 6 months post-surgery. Analysis comparing CADIA derived values for change with those of the clinical assessment revealed some associations. When categorizing outcomes of density measurements as equal to 0 or numerically greater than 0, changes in density showed a non-random correlation with clinical changes expressed by the distance from CEJ to the bottom of the defect (p < 0.001) among sites treated by DFDBA. The corresponding correlation was not significant upon adjunctive treatment by ePTFE. Further analysis, however, demonstrated that the magnitudes of change by the different assessment methods were not significantly correlated. This may be an effect of the region-of-interest selection in this study. Further studies are needed to clarify the correlations between radiographic and clinical methods for assessing treatment effects.