Periodontal regeneration: is it still a goal in clinical periodontology?

Shedding Light on the Therapeutic Efficiency of Oxygen-Releasing Gel and Photodynamic Therapy as Adjuvants in the Treatment of Experimental Periodontitis

Objectives: We aimed to compare the effectiveness of oxygen-releasing gel (Blue®M [BM]) alone or associated with photodynamic therapy (PDT), after scaling and root planing (SRP), as adjuvants during the treatment of ligature-induced experimental periodontitis (EP). Materials and Methods: For this aim, Wistar rats underwent EP by placing a cotton ligature around the lower first molar. Ligatures were maintained for 7 days and were subsequently removed. Then, rats were arbitrarily allocated into five groups: EP group-untreated animals; SRP group-SRP followed by the application of saline; BM group-SRP followed by the application of BM gel (0.4 mL); PDT group-SRP followed by photosensitizer and low power laser irradiation (660 nm, 40mW, 60 s); and BM+PDT-SRP followed by BM and later PDT. Results: Treatment with BM, PDT, and BM+PDT groups at both 7 and 30 days resulted in decreased alveolar bone destruction compared with the EP and SRP groups. At 30 days, the PDT and BM+PDT groups enhanced the resolution of inflammation by decreasing the inflammatory infiltrate and increasing alveolar bone neoformation, as evidenced by increased immunostaining of osteocalcin, transforming growth factor beta 1, bone morphogenetic protein-2, and -4. The BM group showed positive effects regarding the inhibition of bone resorption and inflammation but was less effective when compared with the PDT group. Conclusion: In conclusion, our findings demonstrate that PDT significantly reduces alveolar bone loss and enhances connective tissue repair. Treatment with BM gel alone also decreases bone loss and ameliorates the repair of periodontal tissues. However, combining BM with PDT appears to diminish the effects of PDT.

1,25(OH)2D3 increase osteogenic potential of human periodontal ligament cells with low osteoblast potential

OBJECTIVE

Periodontal dental ligament mesenchymal stem cells (PDLMSCs) play a major role in periodontal tissue regeneration by the neoformation of root cementum and alveolar bone. These cells are highly heterogeneous, and many present low potential to renovate the hard tissue damaged by periodontal disease. A previous study found that the low osteoblast/cementoblast (O/C) differentiation potential of PDLMSCs is related to high asporin (ASPN) expression, which was identified as a negative regulator of PDL cells differentiation and mineralization, suppressing BMP-2-induced O/C differentiation. This study aimed to investigate whether 1,25(OH)2D3 treatment could stimulate the O/C differentiation of periodontal ligament mesenchymal progenitor cells characterized as low osteoblast potential (LOP), by asporin and bone morphogenetic protein-2 alteration.

METHODOLOGY

Three LOP cell populations were cultured in standard medium (CONTROL), osteogenic medium (OM), and osteogenic medium associated with 1 nM of 1,25(OH)2D3 (OM + VD). The following assays were performed: 1) MTT to evaluate metabolic activity; 2) gene expression for asporin (ASPN), bone morphogenetic protein-2 (BMP-2), runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP), osteocalcin (OCN), and vitamin D receptor (VDR) using qRT-PCR; 3) BMP-2 extracellular expression; and 4) quantification of mineralized nodule deposition by Alizarin Red Staining. Data were subjected to two-way ANOVA and Tukey's test (P<0.05).

RESULTS

The results showed that the 1,25(OH)2D3 treatment did not affect the cell viability, as demonstrated by metabolic activity increase over the 10 days in culture. After 14 days of 1,25(OH)2D3 treatment, the mRNA levels for ASPN and VDR decreased (P<0.05), while BMP-2 transcripts and extracellular expression increased (P<0.05). In parallel, RUNX2, ALP, and OCN gene expression was upregulated by 1,25(OH)2D3 treatment, resulting in an increase of mineral nodule deposition in vitro (P<0.05).

CONCLUSIONS

These data show that 1,25(OH)2D3 improves osteoblast/cementoblast differentiation of low osteoblast potential accompanied by alterations in ASPN and BMP-2 expression.

Plasma Rich in Growth Factors Compared to Xenogenic Bone Graft in Treatment of Periodontal Intra-Osseous Defects-A Prospective, Comparative Clinical Study

BACKGROUND

Periodontal intra-bony defects are challenging conditions in dental practice, often requiring regenerative approaches for successful treatment. This clinical study aimed to compare the effectiveness of plasma rich in growth factors (PRGF) versus xenogenic bone graft (BXG) in addressing intra-bony defects.

METHODS

Forty patients aged between 30 and 50 years presenting with generalized periodontitis were included. The study assessed various parameters, including relative attachment level (RAL); probing pocket depth (PPD); gingival marginal level (GML); intra-bony defect depth (IBDD) at baseline, 3, and 6 months; and level of pain, post-operative bleeding, and swelling, as patient-reported outcomes during the first seven days post operation.

RESULTS

The results revealed that both PRGF and BXG treatments led to significant reductions in IBDD over the 6-month study period. PRGF demonstrated significant advantages in GML enhancement and post-operative pain management during the initial post-treatment days. However, BXG showed a significantly greater reduction in IBDD compared to PRGF. Post-operative bleeding and swelling levels were comparable between the two treatments.

CONCLUSIONS

These findings underscore the efficacy of both PRGF and BXG in periodontal regeneration, with treatment decisions guided by patient-specific factors and clinical goals.

Beyond Bone Grafts: Exploring the Efficacy of Alternative Regenerative Therapies

Context A vast body of published literature examines and evaluates the properties of bone restorative materials in combination with other biomaterials or as stand-alone applications. If we exclude the studies investigating the effectiveness of regenerative therapy with enamel matrix derivative (EMD), in all other cases, bone regenerative materials are placed on a "pedestal." Therefore, the study we have initiated covers methods whose protocol does not use bone-repair materials. The clinical and radiographic results obtained are compared to determine which of these methods is the most reliable. The most important goal we set out was to determine if periodontal regenerative therapy would be effective without the use of bone graft restorative materials.  Aim This study aimed to investigate, analyze, and compare the outcomes of four groups of patients with vertical bone defects (infrabony defects (IBDs)) who were treated using regenerative methods without the involvement of bone repair materials.  Materials and methods Forty-eight cases that fulfilled all participation criteria for the study were selected. The O'Leary plaque index (PI) and Ainamo and Bay gingival index (GI) were assessed at the reassessment visit after the Hygiene Phase, the current periodontal status was recorded, and at least one IBD was identified. Cone beam computed tomography (CBCT) was ordered, and the size of each defect was measured by three parameters. In this study, all IBDs were randomly allocated to four groups. The first category encompasses IBDs, wherein regenerative therapy utilizing autogenous, platelet-rich plasma (PRP) is implemented. The second group comprises IBDs, which undergo regenerative therapy utilizing EMD. The third category encompasses IBDs in which guided tissue regeneration (GTR) is conducted using solely a barrier membrane. The fourth group encompasses IBDs, wherein GTR utilizing a barrier membrane and PRP took place. Six months after regenerative therapy, regardless of which of the four methods was used, all patients were reassessed clinically by CBCT. Statistical methods were used to evaluate, analyze, and compare the results in the four groups. Results A statistically significant decrease in the "probing pocket depth" indication, a statistically significant clinical attachment level gain, and a statistically significant decrease in the CBCT indicators "A" and "B" were observed in all four groups of patients under study. When it comes to the CBCT indicator "C," the results for each of the four groups of patients under study fall somewhere between statistical significance and non-significant. Conclusions Regardless of the regenerative therapy technique used, all patients under examination showed improvements in imaging and clinical markers. The four patient groups' results did not differ in any way that was statistically significant.

Comparison of immediate vs. delayed guided tissue regeneration in Infrabony defect of second molars after adjacent third molar extraction: a retrospective study

BACKGROUND

The distal aspect of the second molar (d-M2) often exhibits infrabony defects due to the adjacent third molar. Although the defects can be treated by guided tissue regeneration (GTR) after removing the third molar, the optimal timing remains uncertain following third molar removal in clinical decision-making. This study aimed to compare delayed and immediate GTR treatments to assist in clinical decision-making.

METHODS

D-M2 infrabony defects with a minimum 1-year follow-up were collected and divided into three groups: Immediate GTR group, which underwent third molar extraction and received GTR simultaneously; Delayed GTR group, which underwent delayed GTR at least 3 months after third molar extraction; and Control group, which underwent only scaling and root planing during third molar extraction. The clinical and radiographic parameters related to the infrabony defect before GTR and post-surgery were evaluated using the Kruskal-Wallis test or one-way ANOVA, followed by post-hoc Dunn's test or the Bonferroni test for pairwise comparisons.

RESULTS

A total of 109 d-M2 infrabony defects were assessed. No significant differences were found between the two GTR groups, although both of them showed significant reductions in infrabony defect depth: the immediate GTR group (2.77 ± 1.97 mm vs. 0.68 ± 1.03 mm, p < 0.001) and the delayed GTR group (2.98 ± 1.08 mm vs. 0.68 ± 1.03 mm, p < 0.001) compared to the control group.

CONCLUSION

GTR can effectively improve d-M2 infrabony defects when the third molar is removed, whether simultaneously or delayed. Patients may experience less discomfort with immediate GTR treatment as it requires only one surgery.

From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials

Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.

One-Stage Approach to Rehabilitate a Hopeless Tooth in the Maxilla by Means of Immediate Dentoalveolar Restoration: Surgical and Prosthetic Considerations

Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient's expectations.

The use of integrin binding domain loaded hydrogel (RGD) with minimally invasive surgical technique in treatment of periodontal intrabony defect: a randomized clinical and biochemical study

BACKGROUND

Periodontal regeneration faces multiple challenges, the most important being cellular insufficiency. In an attempt to improve defect cellularity, we aimed to demonstrate enhancing cellular attraction using arginine-glycine-aspartic acid (RGD) adhesion molecule legend blended hydrogel within the intrabony defects.

METHODOLOGY

Forty-five intrabony defects were selected from patients with stage III or IV - grade A or B periodontitis and divided randomly into three equal groups of 15 each: group1 (G1): received minimally invasive surgical technique (MIST) alone, group2 (G2): received MIST and placebo hydrogel injection, and group3 (G3): were treated with MIST and RGD hydrogel injection. Primary outcomes 6 months following therapy were; defect base fill (DBF) and defect width measurement (DW); secondary outcomes were clinical attachment level (CAL), pocket depth (PD), plaque index (PI), gingival index (GI), and biochemical analysis of bone morphogenetic protein (BMP-2) evaluated at 1,7,14 and 21 days following therapy.

RESULTS

Significant improvements in DBF, CAL, and PD were observed in the three studied groups 6 months following therapy compared to baseline (p<0.05). A significant improvement in DBF was reported in G3 compared to G1 and 2 (p=0.005). Additionally, a significantly higher CAL gain was reported in G3 compared to that of G1 (p=0.02). Group 3 was associated with a significantly higher level of BMP-2 compared to G1 and G2 in all reported periods.

CONCLUSION

RGD peptide carried on a hydrogel delivery agent and contained with a minimally invasive flap could be a reliable option in improving the outcomes of periodontal therapy.

Multidisciplinary approach involving strategic implant placement before orthodontic (SIMBO) treatment for generalized stage IV grade C periodontitis: A case report with 10-year follow-up

OBJECTIVE

The aim of this case report was to demonstrate the long-term effects of a multidisciplinary approach involving periodontal reconstructive surgery and strategic implant placement before orthodontic (SIMBO) treatment in a patient with severe periodontitis (e.g., stage IV/grade C).

CLINICAL CONSIDERATIONS

The patient presented with severe periodontitis and pathologic tooth migration (PTM) without stable occlusion or occlusal support. After performing cause-related therapy, periodontal regenerative surgery, pre-orthodontic posterior implant placement, and orthodontic treatment involving anterior implant placement with papilla reconstruction, the patient achieved full-mouth rehabilitation and improvement of dental and smile esthetics. The clinical and radiographic results obtained were maintained over a 10-year period.

CONCLUSION

Within the limits of this as a single case, multidisciplinary treatment involving the SIMBO approach appeared to allow long-term improvement of periodontal condition, stability of the dental arches and occlusion, and esthetics in a patient with severe periodontitis, PTM and posterior bite collapse. Future studies with more subjects are needed to evaluate and validate this approach.

CLINICAL SIGNIFICANCE

When addressing periodontal disease, SIMBO approach-based multidisciplinary treatment appears safe and effective as a clinical protocol for establishing esthetic and functional rehabilitation in generalized stage IV/grade C periodontitis.

3D Printed and Bioprinted Membranes and Scaffolds for the Periodontal Tissue Regeneration: A Narrative Review

Numerous technologies and materials were developed with the aim of repairing and reconstructing the tissue loss in patients with periodontitis. Periodontal guided bone regeneration (GBR) and guided tissue regeneration (GTR) involves the use of a membrane which prevents epithelial cell migration, and helps to maintain the space, creating a protected area in which tissue regeneration is favored. Over the time, manufacturing procedures of such barrier membranes followed important improvements. Three-dimensional (3D) printing technology has led to major innovations in periodontal regeneration methods, using technologies such as inkjet printing, light-assisted 3D printing or micro-extrusion. Besides the 3D printing of monophasic and multi-phasic scaffolds, bioprinting and tissue engineering have emerged as innovative technologies which can change the way we see GTR and GBR.

Advances in Clinical and Molecular Research of Biomaterials in Dentistry: The New Era for Dental Applications

Biomaterials in dentistry play a fundamental role in the quality of regeneration mechanisms and in healing following different rehabilitation techniques [...].