Treatment of intrabony defects using guided tissue regeneration and autogenous spongiosa alone or combined with hydroxyapatite β-tricalcium phosphate bone substitute or bovine-derived xenograft

Background: The aim of this case-control study was to investigate the clinical regeneration of deep intrabony defects using guided tissue regeneration (GTR) with autogenous spongiosa (ASB) alone or using GTR with a mixture of ASB with a bovine-derived xenograft (BDX) or asynthetic composite bone substitute (hydroxyapatite/beta-tricalcium phosphate [HA/beta-TCP]). Methods: Sixty-four patients with a total of 93 intrabony defects of 2- or 3-wall morphology and an intrabony component (IC) >= 4 mm participated in this study. Defects were treated with a bioabsorbable membrane and ASB alone or ASB mixed with HA/beta-TCP or BDX. Clinical parameters measured at baseline and 12 months after surgery included IC, bleeding on probing (BOP), and plaque accumulation (PLI). Vertical bone gain (VBG) and percentage relative bone gain (RBG) were used as indicators of treatment efficacy. A stringent plaque control regimen was enforced in all patients during the 12-month observation period. Results: At baseline, no statistically significant differences in any of the clinical parameters were observed between the groups. At 12 months, HA/beta-TCP and BDX treatments produced similar improvements in intrabony tissue regeneration as shown by VBG (P = 0.616) and RBG (P = 0.826) with significantly better outcomes than ASB alone (P < 0.0001). Changes in BOP and PLI did not differ significantly between the groups. Conclusion: The combined use of ASB with BDX or HA/beta-TCP led to significantly greater gain of clinical attachment and hard tissue formation compared to the use of ASB alone.