ALVXOLAR BONE REGENERATION AFTER DEMINERALIZED FREEZE DRIED BONE ALLOGRAFT ( DFDBA ) BONE GRAFTING Sri

Periodontal treatment by conventional way will result in healing repair, which easily cause recurrence. Vodification ofteatment should b€ done to get an effective resull, that is the regeneration of alveolar bone and io reduce inflammation. Tbe objeclive ofthis study is to det€rmin€ the alveolar bone regeneration after irsing DFDBA (Demineraliz€d Freeze Dried Allograft). Quasi experimental designs with pre and post test method was used in this study, From l3 patients, 26 defects got conventional or regenerative treatmedt. The indicator of alveolar bode regeneration i bone height in mdiographic appearence and lev€l ofosteocalsin in gingival crevicular fluid (GCF) were checked before and after the treatment, then the chaoges that occure w€re analyz4d. The .esult ofthe research showed that alveolar bone reg€neration only occurred to lhe group of r€gen€rative treatment by using DFDBA. The conclusion is the €ffective p€riodontal tissue regeneration occurred at r€generative tr€atneot by using DFDBA, and the osteo€alsin in GCF can b€ used as indicator of bone gro\ih. lndonesian Jotnal of Dentistry 2006; Edisi Khuslts KPPIKCXIy:37-11


Introductiod
P€riodontal disease is generally initiated by gingival inflammation followed by other supporting tissue breakdown, including alveolar bone.'With d€bridement only or conveotiornl treatment, the destruction can not be aestored, Substraction radiogaphy study showed that bone density after root planing was 57o only.' Yukna' showed that SRP (Scaling Root Planing) treatment in p€riodontrtrs could only produce pocket coverin& but histological and radiological findings revealed minimal alveolar bone regeneration.These problems might cause the prevalence of pe odo[tal disease was still high.Therefore, the efTort to modi& the treatment was required, for example regenemtive treatment.
Regeneration ini p€riodontal dis€ase, willresult bears of new bone at place of lesion occurred,' hav€ so long that evaluation of successful regenemtive treatment is bas€ on clinical, radiology and histology evaluation, This assessment have some weakness.thus we try to evaluate the regenerations by bone $aft with Demineralized Freeze Dried Allograft (DFDBA) using osteoclastin in cingival Crevicular Fluid (GCD as an indicator.The emcation of this study is to measure exactly the gain of treatment, and further be the basic of treatment planning.

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This ,udy $as a clinical erpenmenl, that rs a quasr-€\perimenral with non mndomized pre and posr resl conlrol group design Srong theorencal Dare or immunoparhotogl supponid varralte Jlnarnic and complex process.These are many laclors involved jn human body change.That's why rhe selection of measurement tools is required jpecifically.To avoid sysl€mic efTect of change, CCF \ras used as l'luid closed to observed site.
This study is involve 13 patieni with 26 bone d.ibcl.Patient is chosen according inclusion and c\clusion criteria, and than classified with flap rDeration group a d flap opemlion plus DFDBA lToup.Three rnonth laler the patient rcevaluarion.Aveolar bone regenemlive indicators were detemrined by radiographic fmding, bone h€ighr aldition base on radio-opaque on bone.defect, and the increase of osteoblast biological activity by observing one of its secretion, osteocalcin.The increase of CCF osteocalcin level is the marker of the increase of osteoblast numbet that means the increas€ of bone foming activity.

Result
Examination before and after treatment in realment group revealed the significant difference in bone heighr and osteocalcin.Conrrol gmup also showed a signjficant dillerence in bone heigh!bui there is no significant difference in osteocalcin wm paired t-test (P 5 0,05), as shown in Table L Th€ examinatiou between treatmenl aDd control gronp before tr€atment for bone height and osleocalcin didn't show siSnjficant diflerence.Significant diflerence in bone height and osteocalcin was found wirh independent t-test (P : 0,05), as shown in Table 2.
Bone h€ight before treatment in two g.oups differed, in treatment group, bone height mean was 4 mm, in control group, 3 mm.After h€atment, in treatment group, bone height mean decreased lo 2 mm, thal m€ans tha bone position increased.Whereas, in confol group, bone height man didn't cbange as seen at Diagrain l, Osteocalcin level was shown in Diagram 2. Before treatrnent, lhe level was the same 0,5 mg/ml.Aller treatment, osteocalcin level was increased in treatment group 2 mg/ml, in control group, ihe increas€ is lower, 1,3 mg/ml.

Dilcussion
Regeneraiive eflort by DFDBA agent addiljon in this study lvas o€cuned by modirying healing process througb osteoinduction.with the availability ol growth factor.Osaeoiniiuction runs mechanicall.vas bone growth site and prevented epithel;al growh in injurious direction.on€ of the Fo\rth factors cotuained in DFDBA matrix bone is BMP working as regulator of development and repair of €ells, including osl-_oblast, chordroblast, nerve cell, and epithelium.Demineralized Fr€€ze Died Bone Allograft is also mult;tunctional nor?hogen which regulating developmenl and apoptosis" and it is proved to initiat€ cementum and pedodontal ligament regeneration.ln this sludy, there was bone mass incr*rse after treatment bolh in treatment group and control exoup.But the inc.ease is ligber in treasnent group or in the group with regenerative treatnent by DFDBA.This result was ohained from the differenc€ between two groups.Bone filling based on the radiography showed mean i rnm and thrs 'csulr i5 equal Io Crunnsky.Bul. this tdlue is higher fian of Hudoyono'", around 1,32 mm.This differeni result was caused by inaccuracy of radiography or the difference in rnetbod and measuremenl tools useo.
Bone regeneration r€sulted fiom allograft was vari€d.This was caused by bone inductive protein was nor enougi to produce bone.inactive bone inductive component-and the difference of sterilization proc€ss in hosl.The agent used in this study had been slerilized by radiation.while radiation can d€crease the capability of bone induction until 40%, that's why allogialt wilh other st€rilization will give significant result.
Regenerative ireatment using other agent.for example m€mbrane.show€d bone fillhg effect.Study ofLindh€" showedthat bone fiUing is 1.7 nm and Mattson'' show€d 2.15 mm, and this study showed that bone filling is 3 rnm.The results of these ihree studies described the sup€tionty of DFDBA.This is caused by DFDBA tunction as osteoinduction and osteoconduclion.while membrane jusl limits epith€lial development and allows cells to differenriate and proliferate withoul modirying its plecrmor cells.This differ€nce could be happened because of the difTerence in the examination ethod.
DFDBA agent used in this sludy was included in small particles group (!00 100 meevt).Thts 's possible to give the success of alveolar tone regeneration, for small particles will increase th.surlace drea and osreogenn induc on.\rirh lighr microscope and fluore\cenc<.\hapof re!raled that small particles would increased bone marrow necroses and released osGogenic agent and srimulaled hosr cell around gran ared becoming osteoblast.Smaller particles (< I00 inees/p) will be resorbed witltout bone fbrmatiox.
The €xarnination of osteocalcin level in GCf was cani€d out to cl€ar the occurence of alveolar bone regeneration in this study.Osleocalcin level examination is beli€led as ihe mark€r of bone gro$rh activity'q'1'3.Osteocal€h value in CCF obtained by researcher is very varied.Kunjmatsu'' r€port€d high value, 200 500 tines {hat in serum.In this srudy.lhe examinaiion oflevel in serum was not carried oui, so that we could not €ompare to Kuninatsu''.and .hevalue was different.Thrs rs caused by the diference in neasurement iools sensiiiviry.so that the values were different entirely.

Conclusion and Suggestiotr I Alveolar bone regeneration was occurred bolh
In regenerdltrc dnd contc t;onal rredlment .lAlveolar bonc regenerarion was bencr ro regenerative treatmenr than convenronar i. Osteocalcin examination in cct coutd be used as bone growth marker in reg€nerariv€ treatment WIth DFDBA.