|Year : 2014 | Volume
| Issue : 2 | Page : 69-72
Usage of Surgicel ® an absorbable hemostat as a graft for management of periodontal defects: An in vivo study
Lalitha B Shiggaon1, Munivenkatappa Lakshmaiah Venkatesh Prabhuji2, Deepak Viswanath3, Veerendra V Kerudi4
1 Department of Periodontics, A.C.P.M. Dental College, Dhule, Maharashtra, India
2 Department of Periodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
3 Department of Pedodontics and Preventive Dentistry, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
4 Department of Orthodontics, A.C.P.M. Dental College, Dhule, Maharashtra, India
|Date of Web Publication||7-May-2014|
Munivenkatappa Lakshmaiah Venkatesh Prabhuji
Department of Periodontics, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background: The potential for regeneration is demonstrated using variety of biodegradable and nonbiodegradable membranes. The aim of the present study was to evaluate the clinical results of guided tissue regeneration using Surgicel ® as graft material and as barrier membrane. Materials and Methods: The present study was a split mouth design, where 10 systemically healthy patients aged (20-45 years) with 20 similar, two walled or three walled intraosseous defects were selected and randomly divided into control and test sites. In control site only open flap debridement was carried out and test site received oxidized regenerated cellulose (Surgicel ® ) as barrier membrane and as graft. Clinical recordings assessed at baseline and 6 months postoperatively. Results: The results indicated that, reduction of probing pocket depth and gain in clinical attachment level were significant within control site and test site, when compared between control and test no statistically significant difference was found. For gingival recession, no statistically significant difference was observed in between the study group. Conclusion: Results show that Surgicel ® had less regenerative potential as a barrier membrane and as graft in the technique of guided tissue regeneration.
Keywords: Barrier membrane, bone, grafts, periodontal regeneration, Surgicel ®
|How to cite this article:|
Shiggaon LB, Prabhuji MV, Viswanath D, Kerudi VV. Usage of Surgicel ® an absorbable hemostat as a graft for management of periodontal defects: An in vivo study. SRM J Res Dent Sci 2014;5:69-72
|How to cite this URL:|
Shiggaon LB, Prabhuji MV, Viswanath D, Kerudi VV. Usage of Surgicel ® an absorbable hemostat as a graft for management of periodontal defects: An in vivo study. SRM J Res Dent Sci [serial online] 2014 [cited 2022 Dec 4];5:69-72. Available from: https://www.srmjrds.in/text.asp?2014/5/2/69/132073
| Introduction|| |
Periodontal regeneration implies formation of new cementum, new periodontal ligament, and new alveolar bone with inserting collagen fibers and bone, is the ideal result for correction of bony defects.  Resorbable membranes do not have space maintaining ability and collapse of membrane may be prevented by graft placement into the defect. 
Surgicel ® (Johnson and Johnson, Slough, UK) is a commercially available resorbable hemostatic dressing containing oxidized regenerated cellulose at a low pH (2.8) in the form of knitted fibrous mesh [Figure 1]. The advantages of Surgicel ® are, fast, effective hemostasis, absorption, quick availability - no need to reconstitute, mix, or soak, plant based product - eliminates the possibility of animal or human - borne contaminants, antibacterial activity of the material has been demonstrated without deleterious effects to the healing process, excellent handling characteristics-can be molded to fit any anatomical sites.  It is used in a variety of clinical situations, notably to assist blood clot formation as an adjunct to wound healing. The material is resorbed, with in-growth of normal tissue.  Most of the studies on Surgicel ® case reports, and very few clinical trials has been conducted.
Therefore, the present study was conducted to evaluate clinically Surgicel ® for the treatment of intrabony defects using the guided tissue regeneration technique.
| Materials and methods|| |
The study population consisted of 10 patients of which 7 were male and 3 were female who exhibited 2 or 3 walled intraosseous defects as determined by radiographic and clinical evaluation. Exclusion criteria were history of any systemic disease, allergies and smoking. Plaque and gingival indices were recorded at pre- and post-phase I therapy. They all exhibited high oral hygiene standards and consent was obtained. All the measurements were standardized using customized acrylic stents. The recordings were made using a periodontal probe (CP UNC-15 Probe Hu - Friedy) [Figure 2].
The clinical parameters gingival recession, probing pocket depth (PPD), and clinical attachment level (CAL) were recorded and calculated using stent as fixed reference point (FRP). The following calculations were made from the clinical measurements recorded:
- Pocket depth: (FRP to base of the pocket [BOP]) - (FRP to gingival margin [GM]).
- CAL: (FRP to BOP) - (FRP to cemento-enamel junction [CEJ]).
- Gingival recession: (FRP to CEJ) - (FRP to GM).
Following local anesthesia, conventional flap was raised to gain complete access to the defect on both test and control site. Defects were carefully debrided, the root surface were scaled and planed with hand and ultrasonic instruments [Figure 3]. At the test site Surgicel ® was packed into the defect as a graft and as a membrane, it was contoured to the anatomy of the apical and the interdental regions [Figure 4]. The flaps were positioned at the presurgical level to achieve primary closure of the interdental area and were held in place by means of interrupted sutures [Figure 5]. The surgical sites were protected with noneugenol pack (Coe-Pak™ ) and postoperatively antibiotics ]amoxicillin 500 mg] every 8 h × 7 days) and analgesics for 3 days were prescribed , and 0.2% chlorhexidine gluconate rinse was given to be used twice daily for 2 weeks. Further instructions were given to all the patients to report back after 24 h of surgery and then again after 7 days. Postoperative clinical parameters were recorded at 6 months [Figure 6].
| Results|| |
Data were evenly distributed and were subjected to paired Student's t-test to determine whether there was a statistical difference within and in between study group in the parameters measured. The results show the mean PPD in control site and test site preoperatively was 6.2 mm and 7.5 mm, respectively; which was reduced to 2.7 mm and 3.1 mm (respectively) on a postoperative evaluation after 6 months and this was statistically significant (P = 0.00).
The mean CAL in control site and test site preoperatively was 7.0 mm and 8.2 mm; further restored to 4.6 mm and 5.5 mm postoperatively at 6 months evaluation (P = 0.01), and (P = 0.00) which was statistically significant.
The mean gingival recession in control site and test site preoperatively 1.0 mm and 1.2 mm increased to 2.1 mm and 2.6 mm postoperatively at 6 months, but this difference was not statically significant (P = 0.06) and (P = 0.05) [Table 1]. The mean PPD reduction and gain in CAL level between the control site and test site were 3.5 mm and 4.4 mm; 2.4 mm, and 2.7 mm on a postoperative evaluation at 6 months, which was statistically not significant (P = 0.14) and (P = 0.60) [Table 2]. Further, the mean gingival recession between the control site and test site postoperatively at 1 week revealed a statistically insignificant difference (P = 0.50) [Table 3].
|Table 1: Mean comparison of preoperative versus postoperative PPD, CAL and gingival recession within group |
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|Table 2: Mean comparison of PPD reduction, gain in the clinical and gingival recession attachment level between the study groups at 6 months postoperatively |
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|Table 3: Mean comparison of gingival recession between the study groups at 1 week |
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The mean gingival recession between the control site and test site preoperatively 1.0 mm, 1.1 mm and 1.2 mm,1.4 mm; and further on postoperative evaluation at 6 months revealed an insignificant score (P = 0.70 and P = 0.40) [Table 2].
| Discussion|| |
New attachment with periodontal regeneration is the ideal outcome of therapy because it results in obliteration of pocket and reconstruction of the periodontium.  Literature review shows good soft-tissue healing and oso-inductive properties of Surgicel ® ; ,,,,,,, some authors claim that Surgicel ® does not induce bone formation  and may even be detrimental , noted that Surgicel ® left in situ exhibited a slower rate of bone repair than controls; the possible explanation could be that the acid pH of Surgicel ® may delay the "alkaline tide" essential to the function of alkaline phosphatase.  The soft-tissue healing was good and no abnormal signs of inflammation, necrosis of the soft-tissue flap was observed with Surgicel ® sites.
The sites were restored and the normal healthy gingival sulcus was evaluated postoperatively at 6 months, which represents resolution of pocket by healing in control site and regeneration in the test site. Owing to the limitations of the present study, a histological examination was not done.
In the pre- and post-operative visits when the mean comparison of PPD, CAL and gingival recession were checked, it was statistically significant.
Between the study group at pre- and post-operative visits the mean comparison of reduction in PPD, gain in CAL and gingival recession were statistically not significant which indicated that Surgicel ® had less regenerative potential in relation to treatment of periodontal osseous defects.
On radiographic examination, the defects were filled with a bone - like material over a protracted period and we can conclude that the regeneration of tissues, with bone deposition in infrabony defects, may require a longer period which might be as long as 12 months after surgery.
The reasons for lesser regeneration may be due to:
- Periodontal osseous defects are chronically induced by micro-organisms.
- The barrier material, due to its structural and textural characteristics, creates an ecological niche suitable for the growth of and colonization by putative periodontopathogens. On the contrary, Surgicel ® showed good regenerative potential when used in sinus lift procedures and experimentally created bone defects. ,
| Conclusion|| |
Surgicel ® showed less regenerative potential and should be confirmed on a larger sample group. Regenerative capacity of this material can be enhanced using growth factors, antibiotics and adhesion factors which is a dlimitation of the present study.
| References|| |
|1.||Wang HL, Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, et al. Periodontal regeneration. J Periodontol 2005;76:1601-22. |
|2.||Galgut PN. The role of surgery in periodontal treatment. In: Galgut PN, Periodontics: Current Concepts and Treatment Strategies. United Kingdom: Martin Dunitz Ltd.; 2001. p. 126-9. |
|3.||SURGICEL ® Absorbable hemostat literature compendium overview. Available from: http://www.ethicon360.com/products/surgicel-family-absorbable-hemostats.htm. [Last accessed on 2014 mar 25]. |
|4.||Meadows CL, Gher ME, Quintero G, Lafferty TA. A comparison of polylactic acid granules and decalcified freeze-dried bone allograft in human periodontal osseous defects. J Periodontol 1993;64:103-9. |
|5.||Carranza FA, Takei HH. Reconstructive periodontal surgery. In: Newman MG, Takei HH, Klokkevold PR, editors. Carranza's Clinical Periodontology. 10 th ed. St. Louis, Missouri: Saunders; 2006. p. 373-90. |
|6.||Skoll PJ. Surgicel in cleft palate repair. Plast Reconstruct Surg 2001;108:1083-4. |
|7.||Galgut PN. Oxidized cellulose mesh. I. Biodegradable membrane in periodontal surgery. Biomaterials 1990;11:561-4. |
|8.||Galgut PN. Oxidized cellulose mesh. II. Using hydroxy-apatite bone grafting material in the treatment of infrabony defects. Biomaterials 1990;11:565-7. |
|9.||Galgut PN. Radiographic evidence of bone regeneration using oxidized cellulose mesh as a bioabsorbable membrane: Some case studies. Periodontal Clin Investig 1996;18:22-5. |
|10.||Gray CF, Redpath TW, Bainton R, Smith FW. Magnetic resonance imaging assessment of a sinus lift operation using reoxidised cellulose (Surgicel) as graft material. Clin Oral Implants Res 2001;12:526-30. |
|11.||Askar I, Gultan SM, Erden E, Yormuk E. Effects of polyglycolic acid bioabsorbable membrane and oxidised cellulose on the osteogenesis in bone defects: An experimental study. Acta Chir Plast 2003;45:131-8. |
|12.||Galgut PN. Oxidized cellulose mesh used as a biodegradable barrier membrane in the technique of guided tissue regeneration. A case report. J Periodontol 1990;61:766-8. |
|13.||Chaturvedi R, Gill AS, Sikri P. Evaluation of the regenerative potential of 25% doxycycline-loaded biodegradable membrane vs biodegradable membrane alone in the treatment of human periodontal infrabony defects: A clinical and radiological study. Indian J Dent Res 2008;19:116-23. |
|14.||Matthew IR, Browne RM, Frame JW, Millar BG. Subperiosteal behaviour of alginate and cellulose wound dressing materials. Biomaterials 1995;16:275-8. |
|15.||Nappi JF, Lehman JA Jr. The effects of Surgicel on bone formation. Cleft Palate J 1980;17:291-6. |
|16.||Ibarrola JL, Bjorenson JE, Austin BP, Gerstein H. Osseous reactions to three hemostatic agents. J Endod 1985;11:75-83. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3]