Galgut, Peter Neil; (1993) A clinical and laboratory investigation of synthetic materials to enhance healing and aid regenerative procedures in periodontal surgery. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

This study investigated the use of synthetic materials to enhance healing and to encourage regeneration of periodontal tissues after surgical therapy. The study was in two parts, a clinical investigation of the use of hydroxy-apatite implant material, and a laboratory investigation of biodegradable polymer membranes being developed for use as barrier membranes in the technique known as guided tissue regeneration. The aim of this study was to evaluate the efficacy of these materials in surgical wounds, to observe their limitations and to establish their potential to enhance regeneration of tissues. The hydroxy-apatite material was well tolerated by the tissues, but clinically significant benefits could not be established. Radiographically significantly more infill occurred in the sites which received the implant material, with some evidence of the material being modified with time so that the density and structure became more similar to that of the approximating host bone. Histological assessment of specimens from three individuals who were not in the clinical trial demonstrated resorption and osteoid formation over a longer time period. Both the radiographic and histological investigations indicated that there was a wide variation in the tissue responses to this material. The membrane materials were also well tolerated by the tissues, but a highly variable tissue response to them was also noted. Absorption of the biodegradable materials was irregular and unpredictable. The non-degradable Gore-Tex material was associated with prolonged inflammation, poor wound healing and epithelial downgrowth. It was therefore concluded that variable and unpredictable tissue responses occur in relation to these materials. The variations described were attributed to localised tissue responses, and individual site and host variations, rather than to the materials themselves. Other factors like the surface roughness, hydrophobicity or electrostatic surface changes of the materials may also be of importance. Although in general, for the clinical study, results were found to be equal to, or marginally better than control procedures, the enhancement of tissue regeneration using the synthetic implant materials or barrier membranes employed in this study to augment periodontal surgery is not entirely predictable.

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