The dynamics of microbial colonization of barrier membranes for guided tissue regeneration

The microbial colonization of expanded polytetrafluoroethylene membrane by putative periodontopathogens at 3 minutes of intraoral manipulation was determined in 42 patients with 42 mandibular posterior two- to three-wall defects. Twenty patients exhibited no periodontal pockets of > or = 5 mm, other than the study site, and low levels of pathogens (group A). Twenty-two patients revealed multiple periodontal pockets of 5 mm or more and numerous pathogens (group B). Within the preceding 3 months of regenerative surgery, group A patients had received apically positioned flap surgery with osseous recontouring (except for the study site), and group B patients had been enrolled in a non-surgical maintenance program. The subgingival microbiota was examined prior to regenerative therapy, and the membrane microbiota was examined at 3 minutes and at the time of removal at 6 weeks by culture, DNA probes, and phase-contrast microscopy. The mean initial defect depth was 7.4 mm for group A and 7.2 mm for group B. At 6 months, the difference in mean clinical attachment gain was statistically significant (P < 0.001; group A: 3.4 mm; group B: 1.4 mm). At 3 minutes, putative pathogens were detected in seven (16.7%) membranes in group B (group Binfected), and the associated sites gained only 0.6 mm in clinical attachment at 6 months. Clinical attachment gain was modeled as a linear function of the explanatory variables (r2 = 86%). The presence of Porphyromonas gingivalis detected by DNA probe at 3 minutes was associated with 1.5 mm less expected gain (P = 0.0002). Total microbial counts and the percentage of Peptostreptococcus micros and Capnocytophaga species at baseline, and of motile rods on the membrane surface facing the gingiva at 6 weeks, were statistically significant negative predictors of clinical attachment. For each week the membrane remained covered, an additional 0.5 mm gain could be expected (P = 0.002); and for every 10 sites that exhibited bleeding on probing, the clinical attachment gain was 0.6 mm less at the site of regeneration (P < 0.0001). The present results showed that putative pathogens may colonize membranes within 3 minutes of intraoral manipulation. The patient group treated with periodontal osseous surgery revealed the lowest levels of periodontal pathogens in the membranes and exhibited the most gain in clinical attachment.