Sture Nyman

Healing of bone defects by guided tissue regeneration.

In this study we describe a principle for the accomplishment of bone regeneration based on the hypothesis that different cellular components in the tissue have varying rates of migration into a wound area during healing. By a mechanical hindrance, using a membrane technique, fibroblasts and other soft connective-tissue cells are prevented from entering the bone defect so that the presumably slower-migrating cells with osteogenic potential are allowed to repopulate the defect. Defects of standard size were created bilaterally through the man-dibular angles of rats. On one side of the jaw the defect was covered with Teflon membranes, whereas the defect on the other side served as control. Histologic analysis after healing demonstrated that on the test (membrane) side, half the number of animals showed complete bone healing after 3 weeks and all animals showed complete healing after 6 weeks. Little or no sign of healing was evident on the control side even after an observation period of 22 weeks.

Healing of Maxillary and Mandibular Bone Defects Using a Membrane Technique: An Experimental Study in Monkeys

Cyst-like cavities in the jaw bone often heal incompletely owing to ingrowth of connective tissue, thus preventing osteogenesis from occurring. In the present study, a new membrane technique has been utilized in an attempt to improve bone healing. By means of an inert, porous membrane, placed in close contact with the bone surface, a secluded space is created which can only be repopulated by cells from the adjacent bone. Thus, osteogenesis is able to occur without interference from other tissue types. Through-and-through bone defects were produced bilaterally (1) in edentulous areas of monkey (n = 5) mandibles, and (2) in conjunction with apicectomy of the lateral maxillary incisors, also in monkeys (n = 7). On one side, the defects were covered buccally as well as lingually/palatally with expanded PTFE membranes, whereas the defects on the other side served as controls (no membrane). In the mandible, complete bone healing was seen at all test sites after a healing period of 3 months. On the control side, 3 experimental sites showed bone discontinuity with a transosseous core of connective tissue, whereas some bone healing had occurred lingually at 2 sites, but with massive soft tissue ingrowth from the buccal side. In the maxillary periapical defects, all the membrane-covered defects had healed with bone closure after 3 months but with a minute portion of connective tissue, probably derived from the periodontal ligament, around the tooth apices. None of the control defects (no membrane) healed spontaneously, but all were filled with connective tissue to varying degrees.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal tissue response to orthodontic movement of teeth with infrabony pockets.

The aim of this study was to evaluate the effect of orthodontic tooth movement on the level of the connective tissue attachment in sites with infrabony pockets. The experiment was carried out in four beagle dogs. The second and fourth premolars were extracted. After healing, angular bony defects were prepared at the mesial aspect of the third premolars. The exposed root surface was scaled and planed, and a notch was prepared at the bottom of the defect. Plaque-collecting cotton floss ligatures were placed around the neck of the teeth and maintained in situ for 3 weeks, followed by an additional 2 months of plaque accumulation before the orthodontic tooth movement was initiated. In each dog, one premolar was moved away from the angular bony defect and one premolar into and through the angular bony defect. The maxillary third premolars served as control teeth and were not subjected to orthodontic tooth movement. After orthodontic treatment (5 to 6 months), the teeth were stabilized for a period of 2 months before biopsy sampling. Clinical, radiographic, and histologic evaluations revealed that it was possible to establish and maintain an infrabony pocket with a subcrestal, plaque-induced inflammatory lesion during the entire course of the study. While the control teeth had maintained their attachment levels, all but one of the orthodontically moved teeth showed additional loss of attachment.(ABSTRACT TRUNCATED AT 250 WORDS)

Guided bone regeneration of cranial defects, using biodegradable barriers: an experimental pilot study in the rabbit

The aim of this study was to test if a biodegradable barrier could be used to achieve proper bone healing of full-thickness trephine skull defects, applying the biological principle of guided tissue regeneration (GTR). Two New Zealand white rabbits were used. In each animal, 2 circular through-and-through bone defects with a diameter of 8 mm were created in the midline of the frontal and parietal bones of the calvarium. One defect was covered with the mucoperiosteal flaps without placement of an intervening membrane barrier (control). One test defect (test 1) was covered by a biodegradable, non-porous polylactic acid membrane on the outer (supra-calvarial) side of the defect, and 2 test defects (tests 2 and 3) were covered by similar membranes on both the outer and the inner aspects of the defects, prior to flap closure. 6 weeks postsurgically, the animals were sacrificed and the defect areas including surrounding tissues were harvested for histological preparation. The control defect was essentially occupied by supra-calvarial soft tissue, located in direct contact with the dural tissue. In the test cavities, there was a continuous bridge of regenerated bone extending from one edge of the defect to the other, although in test 1 not attaining the same thickness as the bone bordering the defect. In the 2 other test defects, the regenerated bone had reached a thickness almost corresponding to that of the surrounding bone. The bone regeneration was achieved without recourse to adjunctive bone graft materials.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation of Periodontal Species After Guided Tissue Regeneration

One advanced localized periodontal lesion in each of 10 patients was treated using the guided tissue regeneration procedure. Six weeks after placement of expanded polytetrafluoroethylene (ePTFE) membranes, microbial samples were taken from each treated site and the membranes were removed. Six weeks later the cases were re-evaluated. They had all healed successfully with varying amounts of gain of clinical attachment. Gram-negative, anaerobic rods were found in all samples and made up 31% of all organisms cultivated. In 1 patient, Porphyromonas gingivalis was found in a proportion of 17.5%. Six of the other 9 patients harbored Prevotella intermedia (mean proportion 21.3%) and 6 Prevotella melaninogenica (6.8%). Fusobacterium and Capnocytophaga were also frequently found. The results demonstrate that ePTFE membranes are frequently colonized by periodontal microorganisms. The importance of bacterial colonization on clinical success is presently not known. Further studies are needed to determine the effect of the presence or absence of putative pathogens during guided tissue regeneration. J Periodontol 1993; 64:1171-1175.

Membrane-guided bone regeneration: Segmental radius defects studied in the rabbit

We tested the principle of guided tissue regeneration (GTR) for healing segmental long-bone defects. 7 mm (3 animals) or 10 mm (5 animals) long segmental defects were created in the diaphyses of both radii in 8 rabbits. The defect on one side was covered with a barrier membrane of expanded polytetrafluoroethylene membrane shaped as a tube, while the contralateral side with no membrane served as the control. Healing was followed with radiographs obtained repeatedly during a 13- (n 3) or 27- (n 5) week period. Thereafter, the animals were killed and ground sections of the defect sites were prepared for histologic examination. Radiographically, the control sites showed some early subperiosteal callus formation and nonunion of the defects after 6 weeks. The bone ends were rounded off and sealed with cortical bone. No major changes were noted after 6 weeks. At the test sites, subperiosteal bone formation at the bone ends was first observed radiographically at 2 weeks. At 9 weeks, a thin cortical bone bridged the defect along the inner surface of the membrane. Histologically, an interrupted line of thin, cortical bone was observed along the inner surface of the barrier membrane. Fatty bone marrow occupied the central and largest volume of the defect. We conclude that it seems possible to use the principle of GTR to accomplish bone union of segmental long-bone defects.

Influence of bone marrow on membrane-guided bone regeneration of segmental long-bone defects in rabbits

Defects 10 mm long were created in long bone in the diaphysis of both radii of 18 rabbits (test and control side). On the test side, ingrowth of bone marrow into the defects was hindered or delayed by: plugging the opening of the cut bone ends with gutta-percha points (n = 7); plugging with Gelfoam (n = 6); or by removing the bone marrow by flushing with saline (n = 5). The defects on both test and control side were covered with an expanded polytetrafluoroethylene membrane, shaped as a tube. Healing was followed with radiographs for four to five months, after which the animals were killed and ground sections of the areas of the defects were prepared for histological examination. On the control side, nine of 18 animals had complete osseous bridging of the defect, and a small transverse non-mineralised zone remained in the centre of the healed defect in the other animals. This zone consisted of loose connective and cartilagenous tissue as well as connective tissue obviously derived from the outside of the membrane. By preventing or delaying the ingrowth of bone marrow we retarded the regeneration of mineralised bone, particularly in the gutta-percha and flushed bone marrow groups. The principle of guided tissue regeneration may be used to achieve regeneration of extensive long-bone defects. Any attempts to delay or prevent bone marrow ingrowth into the defects did retard regeneration of segmental long-bone defects.Defects 10 mm long were created in long bone in the diaphysis of both radii of 18 rabbits (test and control side). On the test side, ingrowth of bone marrow into the defects was hindered or delayed by: plugging the opening of the cut bone ends with gutta-percha points (n = 7); plugging with Gelfoam (n = 6); or by removing the bone marrow by flushing with saline (n = 5). The defects on both test and control side were covered with an expanded polytetrafluoroethylene membrane, shaped as a tube. Healing was followed with radiographs for four to five months, after which the animals were killed and ground sections of the areas of the defects were prepared for histological examination. On the control side, nine of 18 animals had complete osseous bridging of the defect, and a small transverse non-mineralised zone remained in the centre of the healed defect in the other animals. This zone consisted of loose connective and cartilagenous tissue as well as connective tissue obviously derived from the outside of the membrane. By preventing or delaying the ingrowth of bone marrow we retarded the regeneration of mineralised bone, particularly in the gutta-percha and flushed bone marrow groups. The principle of guided tissue regeneration may be used to achieve regeneration of extensive long-bone defects. Any attempts to delay or prevent bone marrow ingrowth into the defects did retard regeneration of segmental long-bone defects.