Calcium sulfate: A four-year observation of its use as a resorbable barrier in guided tissue regeneration of periodontal defects
The author describes the disadvantages of using both nonresorbable and resorbable membranes for the regeneration of periodontal structures and compares them to medical grade calcium sulfate as a resorbable barrier. The advantages of calcium sulfate include (1) lack of infection if the material is exposed, even in the areas of vertical releasing incisions; (2) adapts well to root surfaces, including concavities; (3) short chair time; (4) easier treatment of multiple defects in the same quadrant; (5) permits growth of soft tissue; (6) no need for a second surgery; (7) excellent tissue response as the material allows fluid exchange to the overlying flap; (8) possible increase of the rate of bone remineralization; (9) may be dense enough to exclude epithelium and connective tissue; and (10) lower cost.
The surgical procedure starts out with the same protocol as GTR membranes, including meticulous root planing and soft tissue debridement, root conditioning with citric acid or tetracycline, occlusal adjust-ment in teeth with fremitus, and penetration with a small round bur if the walls of the defect have dense bone. The graft consists of a volume of calcium sulfate equal to 25% of the weight of demineralized freeze-dried bone (DFDBA) combined with either sterile saline or anesthetic solution, which is mixed immedi-ately before graft placement. A dry surgical field is critical at this point. A paste of calcium sulfate, applied over the graft, is 1.5 to 2 mm thick and extends at least 2 to 3 mm beyond the borders.
The authors show four successful clinical cases of bone fill. [C.S.]
Anson, D., Compendium, 17:895,1996