Treatment of intraosseous periodontal defects with a combined adjunctive therapy of citric acid conditioning, bone grafting, and placement of collagenous membranes

A total of 25 proximal, intraosseous periodontal defects were treated in 21 adult patients. A 3-prong adjunctive, regenerative treatment approach was used. The treatment included (1) citric acid conditioning of the root surfaces, (2) grafting of particles of decalcified, freeze-dried homologous bone, and (3) placement of freeze-dried, homologous dura mater sheets between the replaced surgical flaps and the tooth surfaces. The results, as evaluated by probing attachment and probing bone level measurements, during 1 year of observation, demonstrated limited improvements of the treated defects. The limited results were similar to previous observations in our clinics following treatment of intraosseous defects using different treatment modalities. It appears that new treatment approaches need to be sought to accomplish clinically significant and predictable regeneration in proximal, intraosseous periodontal defects.