April 2014

Background: In guided tissue regenerative surgery, membrane perforations may serve as a mechanism for the passage of cells and biologic mediators from the periosteum and overlying gingival connective tissue into the periodontal defects. To test this assumption, this study was designed to evaluate levels of bone morphogenetic protein-2 (BMP-2) in gingival crevicular fluid (GCF) during the early stages of healing for sites treated with modified perforated membranes (MPMs) as compared with occlusive membranes (OMs). Methods: Fifteen non-smoking patients with severe chronic periodontitis participated in this prospective, randomized and single-blinded clinical trial. Each patient contributed two interproximal contralateral defects that were randomly assigned to either an experimental modified perforated membrane group (15 sites) or a control occlusive membrane group (15 sites). Plaque index, gingival index, probing depth (PD), clinical attachment level (CAL) and the relative intrabony depth of the defect (rIBD) were measured at baseline and reassessed at three, six and nine months after therapy. Gingival crevicular fluid samples were collected on day 1 and 3, 7, 14, 21, and 30 days after therapy. Results: The MPM-treated group showed a statistically significant improvement in PD reduction and clinical attachment gain compared to the OM control group. Similarly, rIBD was significantly reduced in MPM-treated sites as compared with those of the OM group. BMP-2 concentrations peaked in the MPM samples obtained during the early postoperative period (days 1, 3 and 7) with a statistically significant difference compared with OM-treated groups. BMP-2 levels decreased sharply in the samples obtained at days 14, 21 and 30 with non-significant higher levels in MPM samples as compared with those of OM sites. Conclusion: Within the limits of the present study, one can conclude that MPM coverage of periodontal defects is associated with a significant initial increase in GCF levels of BMP-2, a factor that could improve the clinical outcomes of guided tissue regenerative surgery.