A retrospective radiographic outcome assessment study of intra-bony defects treated by osseous surgery or by bone graft procedures

Background: Intra-bony defects remain a significant therapeutic problem in periodontal therapy. Various non-surgical and surgical treatment modalities are being used. The long-term stability following treatment of intra-bony defects is poorly documented. Objectives: To assess changes in intra-bony defects after either osseous surgery or open flap debridement in combination with grafting procedures with demineralized freeze-dried bone allografts (DFDBA). Method: Pre- and post-surgical computer digitized images of intra-oral radiographs from 60 patients who had received periodontal surgery to manage intrabony defects were analyzed by linear measurements. Results: 36 patients were treated with osseous surgery and 24 had received flap procedures and grafting with DFDBA. Post-surgical radiographs were obtained on average after 4.8 years (SD+/-2.8) and after 9.6 years (SD+/-3.6). A minor mean bone fill of 0.0 mm (SD+/-0.8) for osseous surgery sites and 0.5 mm (SD+/-0.9) for DFDBA sites, was noticed, but this gain was within the margin of measurement errors. Osseous surgery and modified Widman flap procedures with DFDBA resulted in crestal resorption, on average 1.7 mm (SD+/-1.1) and 1.5 mm (SD+/-1.5) and remaining mean defect depth of 2.0 mm (SD+/-1.4) and 2.5 mm (SD+/-1.6), respectively. Conclusions: Bone changes following bone graft procedures with DFDBA did not differ from those following osseous surgery, and neither procedure resulted in defect resolution with bone fill. It was also concluded that over the study period, stable treatment results were obtained as a result of both osseous surgery and modified Widman flap procedures with adjunct DFDBA.