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Abdo VL, Suarez LJ, de Paula LG, Costa RC, Shibli J, Feres M, Barāo VAR, Bertolini M, Souza JGS. Underestimated microbial infection of resorbable membranes on guided regeneration. Colloids Surf B Biointerfaces 2023; 226:113318. [PMID: 37075523 DOI: 10.1016/j.colsurfb.2023.113318] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
Barrier membranes are critical in creating tissuecompartmentalization for guided tissue (GTR) and bone regeneration (GBR) therapies. More recently, resorbable membranes have been widely used for tissue and bone regeneration due to their improved properties and the dispensable re-entry surgery for membrane removal. However, in cases with membrane exposure, this may lead to microbial contamination that will compromise the integrity of the membrane, surrounding tissue, and bone regeneration, resulting in treatment failure. Although the microbial infection can negatively influence the clinical outcomes of regenerative therapy, such as GBR and GTR, there is a lack of clinical investigations in this field, especially concerning the microbial colonization of different types of membranes. Importantly, a deeper understanding of the mechanisms of biofilm growth and composition and pathogenesis on exposed membranes is still missing, explaining the mechanisms by which bone regeneration is reduced during membrane exposure. This scoping review comprehensively screened and discussed the current in vivo evidence and possible new perspectives on the microbial contamination of resorbable membranes. Results from eligible in vivo studies suggested that different bacterial species colonized exposed membranes according to their composition (collagen, expanded polytetrafluoroethylene (non-resorbable), and polylactic acid), but in all cases, it negatively affected the attachment level and amount of bone gain. However, limited models and techniques have evaluated the newly developed materials, and evidence is scarce. Finally, new approaches to enhance the antimicrobial effect should consider changing the membrane surface or incorporating long-term released antimicrobials in an effort to achieve better clinical success.
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Affiliation(s)
- Victoria L Abdo
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil
| | - Lina J Suarez
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil; Departamento de Ciencias Básicas y Medicina Oral, Universidad Nacional de Colombia, Cra 45 # 26-85, Bogotá 11001, Colombia
| | - Lucca Gomes de Paula
- Dental Science School (Faculdade de Ciências Odontológicas - FCO), Av. Waldomiro Marcondes Oliveira, 20 - Ibituruna, Montes Claros, Minas Gerais 39401-303, Brazil
| | - Raphael C Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo 13414-903, Brazil
| | - Jamil Shibli
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil; Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Valentim A R Barāo
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo 13414-903, Brazil
| | - Martinna Bertolini
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, 3501 Terrace St, Pittsburgh, PA 15213, USA
| | - Joāo Gabriel Silva Souza
- Department of Periodontology, Dental Research Division, Guarulhos University, Praça Tereza Cristina, 88 - Centro, Guarulhos, São Paulo 07023-070, Brazil; Dental Science School (Faculdade de Ciências Odontológicas - FCO), Av. Waldomiro Marcondes Oliveira, 20 - Ibituruna, Montes Claros, Minas Gerais 39401-303, Brazil.
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The efficiency of the regeneration of periodontal intrabony defects in East Asians: A systematic review and pooled analysis. J Dent Sci 2023; 18:1-8. [PMID: 36643225 PMCID: PMC9831819 DOI: 10.1016/j.jds.2022.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
This article aimed to assess the efficacy of periodontal regenerative therapy (PRT) for treating periodontal intrabony defects in East Asians. The systematic review was performed according to the PRISMA guidelines. Literature searches on the PubMed and national medical journal databases, and representative clinical journals of the East Asians were performed on July 31, 2018. Randomized controlled trials, prospective case-control studies, retrospective analyses, and case series receiving regenerative procedures, including barrier membrane (BM) and enamel matrix derivative (EMD) applications with or without bone replacement graft (BRG), with follow-up periods of 6 and 12 months were evaluated. The outcome variables were probing depth (PD) reduction and clinical attachment level (CAL) gain. Twenty studies were included, of which eight were assessed for bias risk. Compared to open flap debridement, PD reduction and CAL gain were superior in all PRTs at both follow-up time points. BM or EMD alone showed equivalent outcomes at 6 months, and CAL gain appeared greater with BM alone at 12 months. BM with BRG showed inferior CAL gain relative to BM alone, but EMD with BRG showed superior CAL gain relative to EMD alone at 12 months. In conclusion, PRT showed improved regenerative outcomes compared with OFD in East Asians, while BM application appeared less efficient than in non-East Asians. BRG supplementation provided additional clinical benefits in EMD application.
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Lee JB, Kweon HHI, Cho HJ, Kim CS, Kim YT. Characteristics of Local Delivery Agents for Treating Peri-Implantitis on Dental Implant Surfaces: A Preclinical Study. J ORAL IMPLANTOL 2018; 45:116-126. [PMID: 30452331 DOI: 10.1563/aaid-joi-d-17-00261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Local delivery agents (LDAs) are widely used in peri-implantitis treatments. The aim of this study was to identify LDAs remaining on the dental implant surfaces and to analyze the components of these residues after applying various cleaning methods. Implants were prepared with a sand-blasted, large-grit, acid-etched surface. Four kinds of LDAs were applied on the implant surfaces: chlorhexidine gel (group 2), tetracycline solution (group 3), and 2 kinds of minocycline hydrochloride agents (groups 4 and 5). Group 1 received normal saline as a control. Two cleaning methods were applied for different durations as follows: (1) running distilled water for 10 seconds (subgroup A), 5 minutes (subgroup B), and 15 minutes (subgroup C); and (2) water spray of a dental-unit chair for 10 seconds (subgroup D) and 5 minutes (subgroup E). Scanning electron microscopy and energy-dispersive x-ray spectroscopy were used to analyze the surface morphology and residue components for all implants. The amount of LDA removed from the implant surfaces in groups 1, 2, 3, and 5 increased with the cleaning duration and pressure. However, Minocline remained coated on the implant surfaces in group 4 under all cleaning conditions. Minocline could not be cleaned off well by water due to its hydrophobicity. Therefore, directly using this agent on implant surfaces with peri-implantitis should be carefully considered. The presence of LDA residues without drug efficacies on implant surfaces might interfere with reosseointegration and act as a reservoir of microorganisms.
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Affiliation(s)
- Jong-Bin Lee
- 1 Department of Periodontology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.,2 Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Helen Hye-In Kweon
- 3 Department of Periodontology, Ilsan Hospital, National Health Insurance Service, Goyang, Gyeonggi-do, Republic of Korea
| | - Hyun-Jae Cho
- 4 Department of Preventive Dentistry and Public Oral Health, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Chang-Sung Kim
- 2 Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Young-Taek Kim
- 3 Department of Periodontology, Ilsan Hospital, National Health Insurance Service, Goyang, Gyeonggi-do, Republic of Korea
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Martin V, Bettencourt A. Bone regeneration: Biomaterials as local delivery systems with improved osteoinductive properties. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 82:363-371. [PMID: 29025670 DOI: 10.1016/j.msec.2017.04.038] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 12/15/2022]
Abstract
Bone is a mineralized conjunctive tissue, with a unique trauma healing capability. However, the replacement or regeneration of lost bone is not always successful and becomes more difficult the wider the bone defect. A significant growth in the demand for orthopedic and maxillofacial surgical procedures as a result of population aging and increase in chronic diseases as diabetes is a fact and successful approaches for bone regeneration are still needed. Until today, autogenous bone graft continues to be the best solution even with important limitations, as quantity and the requirement of a donator area. Alternatively, local delivery systems combining an osteoconductive biomaterial with osteoinductive compounds as hormones, growth factors or drugs is a popular approach aiming to replace the need for autogenous bone grafts. Nevertheless, in spite of the intense research in the area, presently there is no system that can mimic all the biological functions of the autogenous bone grafts. In this context, the present work provides an overview of the most recent advances in the field of synthetic bone grafts. The opportunities and limitations are detailed along with the remaining gaps in the research that are still preventing the successful translation of more products into the market able to be a valuable option in comparison to the autogenous bone grafts.
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Affiliation(s)
- Victor Martin
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal
| | - Ana Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal.
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Kütan E, Duygu-Çapar G, Özçakir-Tomruk C, Dilek OC, Özen F, Erdoğan Ö, Özdemir I, Korachi M, Gürel A. Efficacy of doxycycline release collagen membrane on surgically created and contaminated defects in rat tibiae: A histopathological and microbiological study. Arch Oral Biol 2015; 63:15-21. [PMID: 26658367 DOI: 10.1016/j.archoralbio.2015.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 06/29/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The effects of systemic antibiotics on controlling infective pathogens after guided bone regeneration(GBR) procedures especially in membrane exposures are limited. However, local administrations of antibiotics are rare in GBR techniques. AIM The aim of this study was to investigate the osteogenesis potential and the antibacterial effect of a doxycycline releasing collagen membrane in surgically created and contaminated defects in rat tibiae. MATERIAL AND METHODS Defects were created in 20 rats that were randomly divided in to two groups: control group (defect contaminated by Porphyromonas gingivalis, filled with bone graft and covered by collagen membrane); test group (defect contaminated by P. gingivalis filled with bone graft and covered by collagen membrane containing 1mg/cm(2) doxycycline. Animals were sacrificed post surgically on the 14th day for microbiologic evaluation and on the 28th day for histopathological evaluation. RESULTS The degree of osteogenesis in the test group was seen to be significantly higher than control group (p: 0.011; p<0.05). Furthermore in test group, no bacterial growth was observed. The bacteria counts were determined between 1×104 and 268×104CFU/g with a median of 1.32×104 for control group. CONCLUSIONS Within the limitations of this study, the results of the present study suggests that the use of a doxycycline releasing membrane has a positive effect on contaminated GBR procedures for limiting P. gingivalis infections leading to bone formation following GBR procedures in a rat model.
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Affiliation(s)
- Esma Kütan
- Department of Oral Implantology, Faculty of Dentistry, Yeditepe University,Göztepe, Istanbul, Turkey.
| | - Gonca Duygu-Çapar
- Department of Oral and Maxillofacial Surgery, Trakya University, Edirne, Turkey
| | - Ceyda Özçakir-Tomruk
- Department of Oral and Maxillofacial Surgery, Yeditepe University, Göztepe, Istanbul, Turkey
| | - Ozkan Cem Dilek
- Department of Oral Implantology, Faculty of Dentistry, Yeditepe University, Göztepe, Istanbul, Turkey
| | - Fatma Özen
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, Kayışdaği, Istanbul, Turkey
| | - Özge Erdoğan
- Department of Pathology, Faculty of Veterinary, Istanbul University, Avcilar, Istanbul, Turkey
| | - Ipek Özdemir
- Department of Biological Sciences and Bioengineering, Faculty of Engineering and Natural Sciences, Sabanci University, Tuzla, Istanbul, Turkey
| | - May Korachi
- Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, Kayışdaği, Istanbul, Turkey
| | - Aydin Gürel
- Department of Pathology, Faculty of Veterinary,Istanbul University, Avcilar, Istanbul, Turkey
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Cheng CF, Wu KM, Chen YT, Hung SL. Bacterial adhesion to antibiotic-loaded guided tissue regeneration membranes - a scanning electron microscopy study. J Formos Med Assoc 2013; 114:35-45. [PMID: 23969040 DOI: 10.1016/j.jfma.2013.07.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 07/04/2013] [Accepted: 07/16/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/PURPOSE Bacterial contamination of sites undergoing guided tissue regeneration (GTR) therapy may reduce the efficiency of periodontal regeneration. This study compared bacterial adhesion onto various GTR membranes incorporated with antibiotics. METHODS Three barrier membranes, including expanded polytetrafluoroethylene (ePTFE) membrane, collagen membrane, and glycolide fiber membrane, were loaded with tetracycline or amoxicillin. The adhesion of Streptococcus mutans and Aggregatibacter actinomycetemcomitans onto the GTR membranes with or without antibiotics was analyzed using the scanning electron microscopy (SEM) analysis. RESULTS The SEM analysis showed no apparent alteration in the physical structure of the membranes loaded with antibiotics. Both S. mutans and A. actinomycetemcomitans attached best on the collagen membranes, followed by the ePTFE membranes, and then the glycolide fiber membranes without antibiotics. Moreover, higher numbers of bacteria were observed on the fibril areas than on the laminar areas of the ePTFE membranes. The amounts of attached bacteria on the GTR membranes increased after longer incubation. Incorporation of tetracycline or amoxicillin greatly reduced the adhesion of S. mutans and A. actinomycetemcomitans onto all of the GTR membranes examined. CONCLUSION Incorporation of tetracycline or amoxicillin greatly reduced adhesion of S. mutans or A. actinomycetemcomitans on the ePTFE, glycolide fiber, or collagen membranes. This finding indicates that it is valuable and effective to use the antibiotic-loaded GTR membranes for periodontal regeneration therapy.
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Affiliation(s)
- Chi-Fang Cheng
- Department of Community Dentistry, Zhong-Xiao Branch, Taipei City Hospital, Taipei, Taiwan; Department of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Ming Wu
- School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Taipei Municipal Hospital, Taipei, Taiwan; Keelung City Municipal Hospital, Keelung City, Taiwan
| | - Yen-Ting Chen
- Department of Dentistry, National Yang-Ming University, Taipei, Taiwan; Institute of Oral Biology, National Yang-Ming University, Taipei, Taiwan
| | - Shan-Ling Hung
- Institute of Oral Biology, National Yang-Ming University, Taipei, Taiwan; Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.
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Gamal AY, Kumper RM. A Novel Approach to the Use of Doxycycline-Loaded Biodegradable Membrane and EDTA Root Surface Etching in Chronic Periodontitis: A Randomized Clinical Trial. J Periodontol 2012; 83:1086-94. [DOI: 10.1902/jop.2011.110476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Machtei EE, Hirsh I, Falah M, Shoshani E, Avramoff A, Penhasi A. Multiple applications of flurbiprofen and chlorhexidine chips in patients with chronic periodontitis: a randomized, double blind, parallel, 2-arms clinical trial. J Clin Periodontol 2011; 38:1037-43. [PMID: 22092475 PMCID: PMC3586660 DOI: 10.1111/j.1600-051x.2011.01779.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2011] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present randomized, double blind, parallel, 2-arm clinical study was to examine the safety and efficacy of frequent applications of chlorhexidine chip (CHX) and flurbiprofen chip (FBP) in patients with chronic periodontitis. METHODS Sixty patients were randomized into CHX and FBP groups. Following OHI and scaling and root planing (SRP), baseline pocket depth (PD) measurements, gingival recession and bleeding on probing (BOP) were performed and repeated at week 4 and 8. The assigned chip was placed at weeks 0, 1, 2, 3, 5, 7. RESULTS Mean PD reduction in the CHX group was 2.08 mm (7.17 to 5.09, p < 0.0001). Mean PD reduction in the FBP group was 2.27 mm (6.72 to 4.45, p < 0.0001). Ninety-seven percentage and 95% of these sites exhibited PD reduction ≥1 mm, while 38% and 34% of the sites exhibited PD ≥3 mm (FBP and CHX, respectively). Clinical attachment level gain (1.66 and 1.95 mm, respectively) was statistically significant (p < 0.0001). Baseline BOP dropped from 98% and 100% to 24% and 30% for the CHX and FBP groups, respectively (p < 0.0001). CONCLUSION Frequent applications of CHX and FBP chips resulted in a significant improvement in the periodontal condition in these sites. Furthermore studies will be required to compare this new treatment regimen to SRP or SRP with single chip application.
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Affiliation(s)
- Eli E Machtei
- Department of Periodontology, School of Graduate Dentistry, Rambam Health Care Campus and the Faculty of Medicine - Technion (I.I.T.), Haifa, Israel.
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Thomas MV, Puleo DA. Infection, inflammation, and bone regeneration: a paradoxical relationship. J Dent Res 2011; 90:1052-61. [PMID: 21248364 PMCID: PMC3169879 DOI: 10.1177/0022034510393967] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/17/2010] [Accepted: 11/18/2010] [Indexed: 02/06/2023] Open
Abstract
Various strategies have been developed to promote bone regeneration in the craniofacial region. Most of these interventions utilize implantable materials or devices. Infections resulting from colonization of these implants may result in local tissue destruction in a manner analogous to periodontitis. This destruction is mediated via the expression of various inflammatory mediators and tissue-destructive enzymes. Given the well-documented association among microbial biofilms, inflammatory mediators, and tissue destruction, it seems reasonable to assume that inflammation may interfere with bone healing and regeneration. Paradoxically, recent evidence also suggests that the presence of certain pro-inflammatory mediators is actually required for bone healing. Bone injury (e.g., subsequent to a fracture or surgical intervention) is followed by a choreographed cascade of events, some of which are dependent upon the presence of pro-inflammatory mediators. If inflammation resolves promptly, then proper bone healing may occur. However, if inflammation persists (which might occur in the presence of an infected implant or graft material), then the continued inflammatory response may result in suboptimal bone formation. Thus, the effect of a given mediator is dependent upon the temporal context in which it is expressed. Better understanding of this temporal sequence may be used to optimize regenerative outcomes.
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Affiliation(s)
- M V Thomas
- Department of Oral Health Practice, University of Kentucky College of Dentistry, 800 Rose Street, Room D-124, Lexington, KY 40536-0297, USA.
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Gamal AY, Kumper RM, Sadek HS, El Destawy MT. Chlorhexidine Controlled-Release Profile After EDTA Root Surface Etching: An In Vivo Study. J Periodontol 2011; 82:751-7. [DOI: 10.1902/jop.2010.100523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kasaj A, Willershausen B, Junker R, Callaway A, Krahn U, Kraft B, Pietsch M. Influence of different biomaterials on the viability of Aggregatibacter actinomycetemcomitans. Arch Oral Biol 2011; 56:917-23. [PMID: 21420071 DOI: 10.1016/j.archoralbio.2011.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 01/26/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of the present in vitro study was to evaluate the effects of different biomaterials used for regenerative periodontal surgery on the growth of the periodontopathogen Aggregatibacter actinomycetemcomitans. METHODS Three commercially available biomaterials of synthetic origin (hydroxyapatite/beta-tricalcium phosphate, nanostructured hydroxyapatite paste, oily calcium hydroxide suspension), a bovine-derived xenograft as well as an enamel matrix derivative (EMD) were added in different concentrations to calibrated suspensions of A. actinomycetemcomitans ATCC 43718/33384 (serotype b/c). Equal aliquots (0.1 ml) for the viability assay were taken after 5 min, 1h, 3h, 8h and 24h, plated on blood agar and incubated in an anaerobic environment for 48 h at 37°C. Viable cell counts were expressed as colony forming units (cfu)/0.1 ml. RESULTS The results demonstrated that none of the investigated biomaterials could inhibit the growth of A. actinomycetemcomitans serotype b. A marked growth reduction of A. actinomycetemcomitans serotype c was observed in the presence of oily calcium hydroxide suspension and nanostructured hydroxyapatite. In contrast, no significant growth inhibition could be observed in the presence of hydroxyapatite/beta-tricalcium phosphate, enamel matrix derivative and bovine-derived xenograft. CONCLUSIONS The results of the present study suggest that none of the investigated biomaterials possesses antimicrobial properties against A. actinomycetemcomitans serotype b. Therefore, the use of these biomaterials for regenerative procedures should be weighted critically in the presence of A. actinomycetemcomitans serotype b.
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Affiliation(s)
- Adrian Kasaj
- Department of Operative Dentistry and Periodontology, University Medical Center, Johannes Gutenberg-University, Augustusplatz 2, 55131 Mainz, Germany.
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Cheng CF, Lee YY, Chi LY, Chen YT, Hung SL, Ling LJ. Bacterial penetration through antibiotic-loaded guided tissue regeneration membranes. J Periodontol 2009; 80:1471-8. [PMID: 19722798 DOI: 10.1902/jop.2009.090044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study compared bacterial penetration through guided tissue regeneration (GTR) membranes impregnated with antibiotics. METHODS Three barrier membranes, expanded polytetrafluoroethylene (ePTFE) membrane, collagen membrane, and glycolide fiber composite membrane, were loaded with amoxicillin or tetracycline. The penetration of Streptococcus mutans and Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) through the GTR membranes was achieved using a device consisting of an inner tube and an outer bottle filled with culture media. RESULTS The penetration of S. mutans or A. actinomycetemcomitans into the inner tubes significantly decreased with all of the antibiotic-loaded membranes compared to membranes without antibiotics. However, differences were found in the behavior of the three membranes. The antibiotic-loaded ePTFE membranes showed the best barrier effect. Moreover, the inhibitory effect of tetracycline on S. mutans was greater than that of amoxicillin for all GTR membranes. Furthermore, the inhibitory effect of tetracycline on A. actinomycetemcomitans was lower than that of amoxicillin with the glycolide fiber membrane. CONCLUSIONS The results showed that penetration of S. mutans and A. actinomycetemcomitans through amoxicillin- or tetracycline-loaded ePTFE membrane, glycolide fiber membrane, and collagen membrane was delayed and/or reduced. Thus, incorporation of an antibiotic into the membrane may be of value when controlling membrane-associated infection during GTR therapy.
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Affiliation(s)
- Chi-Fang Cheng
- Department of Community Dentistry, Zhong-Xiao Branch, Taipei City Hospital, Taipei, Taiwan
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Parrish LC, Miyamoto T, Fong N, Mattson JS, Cerutis DR. Non-bioabsorbable vs. bioabsorbable membrane: assessment of their clinical efficacy in guided tissue regeneration technique. A systematic review. J Oral Sci 2009; 51:383-400. [DOI: 10.2334/josnusd.51.383] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Lyons LC, Weltman RL, Moretti AJ, Trejo PM. Regeneration of Degree II Furcation Defects With a 4% Doxycycline Hyclate Bioabsorbable Barrier. J Periodontol 2008; 79:72-9. [DOI: 10.1902/jop.2008.070161] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Leprêtre S, Boschin F, Tabary N, Bria M, Martel B, Blanchemain N, Hildebrand HF, Morcellet M, Delcourt-Debruyne E. Guided tissue regeneration membranes with controlled delivery properties of chlorhexidine by their functionalization with cyclodextrins. J INCL PHENOM MACRO 2007. [DOI: 10.1007/s10847-006-9176-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Xu Y, Wei W. A comparative study of systemic subantimicrobial and topical treatment of minocycline in experimental periodontitis of rats. Arch Oral Biol 2006; 51:794-803. [PMID: 16712777 DOI: 10.1016/j.archoralbio.2006.03.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 03/12/2006] [Accepted: 03/27/2006] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effectiveness of minocycline on treating experimentally induced periodontitis in rats when administered either as a systemic subantimicrobial dose or as a topical ointment. DESIGN Thirty-two adult male Sprague-Dawley rats in four experimental groups-(1) model group; (2) systemic subantimicrobial dose of minocycline (5mg/kg/day) treatment group; (3) topical subgingival dose of minocycline (2mg/animal/week) treatment group; (4) control group. Experimentally induced periodontitis-silk ligatures were placed around the crevices of the second molar teeth and the animals fed a 10% sucrose drink. Assessment was carried out at days 28 and 56 using a number of different visual, histological and ultrastructure approaches. (1) Visual assessment-tooth mobility, gingival index and alveolar bone loss. (2) Histological examination-monocyte infiltration and resorption lacunae with osteoclasts. (3) Transmission electron microscopy (TEM)-morphological transformation of fibroblasts and osteoclasts. The collected data were analysed for statistical significance using the analysis of variance statistical test. RESULTS Minocycline significantly reduced tooth mobility, gingival index and alveolar bone loss when administered either systemically or as a topical ointment compared to the model group (P<0.01). However, the alveolar bone loss was significantly less (P<0.01 in the systemic treatment group compared to the local treatment group. Monocyte infiltration and resorption lacunae with osteoclasts were significantly less in the both treatment groups compared to the model group (P<0.01). The osteoclasts failed to form a ruffled border in the systemic treatment group. CONCLUSION Topical treatment significantly reduces gingivitis while systemic treatment is beneficial in terms of inhibiting alveolar bone loss.
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Affiliation(s)
- Yan Xu
- Key Laboratory of Antiinflammatory-Immunopharmacology in Anhui Province, Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, PR China
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Heitz-Mayfield L, Tonetti MS, Cortellini P, Lang NP. Microbial colonization patterns predict the outcomes of surgical treatment of intrabony defects. J Clin Periodontol 2006; 33:62-8. [PMID: 16367858 DOI: 10.1111/j.1600-051x.2005.00872.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To explore the impact of bacterial load and microbial colonization patterns on the clinical outcomes of periodontal surgery at deep intrabony defects. MATERIALS AND METHODS One hundred and twenty-two patients with advanced chronic periodontitis and at least one intrabony defect of >3 mm were recruited in 10 centres. Before recruitment, the infection control phase of periodontal therapy was completed. After surgical access and debridement, the regenerative material was applied in the test subjects, and omitted in the controls. At baseline and 1 year following the interventions, clinical attachment levels (CAL), pocket probing depths (PPD), recession (REC), full-mouth plaque scores and full-mouth bleeding scores were assessed. Microbial colonization of the defect-associated pocket was assessed using a DNA-DNA checkerboard analysis. RESULTS Total bacterial load and counts of red complex bacteria were negatively associated with CAL gains 1 year following treatment. The probability of achieving above median CAL gains (>3 mm) was significantly decreased by higher total bacterial counts, higher red complex and T. forsythensis counts immediately before surgery. CONCLUSIONS Presence of high bacterial load and specific periodontal pathogen complexes in deep periodontal pockets associated with intrabony defects had a significant negative impact on the 1 year outcome of surgical/regenerative treatment.
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Affiliation(s)
- Lisa Heitz-Mayfield
- Department of Periodontology and Fixed Prosthodontics, University of Berne, Berne, Switzerland
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Boschin F, Blanchemain N, Bria M, Delcourt-Debruyne E, Morcellet M, Hildebrand HF, Martel B. Improved drug delivery properties of PVDF membranes functionalized with β-cyclodextrin—Application to guided tissue regeneration in periodontology. J Biomed Mater Res A 2006; 79:78-85. [PMID: 16758457 DOI: 10.1002/jbm.a.30769] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to develop a membrane for guided tissue regeneration applicable in periodontology that could release antimicrobial agent during the healing period. Our strategy consisted to graft beta-cyclodextrin (beta-CD), a molecule that is known to form inclusion complexes with a large variety of drugs, onto PVDF membranes. Grafting occurred by using citric acid that provoked a crosslinking reaction of beta-CD, and the resulting polymer was imprisoned into the porous structure of the PVDF membrane. The reaction produced a weight increase of the membrane, the range of which depended on the temperature and on the time of curing applied in the process. The biological behavior of the membranes evaluated by proliferation and vitality tests showed good proliferation and improved activity of L132 epithelial cells on the raw and on the grafted membranes. Doxycyclin (DOX) and chlorhexidine (CHX) were used as antimicrobial agents. Their inclusion into the beta-CD cavity in aqueous solutions was confirmed by NMR spectroscopy. After the impregnation of the membranes with DOX and CHX, their release was studied in vitro in batch type experiments and measured by UV spectrophotometry. Low amounts of DOX and CHX were delivered from the raw membranes within the first few hours of tests. Grafted membranes, however, delivered DOX and CHX in larger quantities within 24 h and 10 days respectively.
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Affiliation(s)
- F Boschin
- Laboratoire de Chimie Organique et Macromoléculaire, CNRS-UMR 8009, USTL, 59655 Villeneuve d'Ascq, France
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Reddy MS, Geurs NC, Gunsolley JC. Periodontal host modulation with antiproteinase, anti-inflammatory, and bone-sparing agents. A systematic review. ACTA ACUST UNITED AC 2004; 8:12-37. [PMID: 14971246 DOI: 10.1902/annals.2003.8.1.12] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The use of modulating agents, including inhibition of matrix metalloproteinases (MMPs) with antiproteinases, blocking production of proinflammatory cytokines and prostaglandins with anti-inflammatory drugs, and inhibiting activation of osteoclasts with bone-sparing agents, has been postulated to be of therapeutic value as an adjunctive therapy to the management of chronic periodontitis. RATIONALE The objective of this systematic review of the literature was to assess the adjunctive efficacy of antiproteinase, anti-inflammatory, and bone-sparing host-modulating agents in the treatment of gingivitis, aggressive periodontitis, and chronic periodontitis. FOCUSED QUESTIONS: 1. In patients with periodontal diseases, what is the effect of host-modulation agents, alone or combined with conventional therapy, compared to conventional therapy alone as assessed by clinical, radiographic, adverse, and patient-centered outcomes? 2. In patients with dental implants, what is the effect of host-modulation agents on implant success assessed by clinical, radiographic, adverse, and patient-centered outcomes? SEARCH PROTOCOL MEDLINE, Embase, and the Cochrane Library databases were searched without language restrictions through April 1, 2002 for studies that used tetracycline (TET)-related matrix metalloproteinase (MMP) inhibitors, or non-steroidal anti-inflammatory drugs (NSAIDs) and bisphosphonate anti-osteolytic agents. The investigation also included hand searching of journals and contacting authors and industry experts. SELECTION CRITERIA INCLUSION CRITERIA Only human studies (randomized controlled clinical trials, cohort studies, case-control studies, cross-sectional studies, and case series) were selected. Studies were on subjects with gingivitis, aggressive or chronic periodontitis, or dental implants. Interventions included TET-related MMP inhibitors, NSAIDs, or bisphosphonate anti-osteolytic agents. EXCLUSION CRITERIA Studies that used MMP tissue inhibitors as diagnostic or prognostic indicators of periodontal disease or that evaluated short-term systemic antibodies or locally delivered levels of drugs with antiproteinase activity were excluded. DATA COLLECTION AND ANALYSIS The primary outcomes for assessment were changes in bone or clinical attachment levels (CAL); secondary outcomes included clinical measures of plaque, gingival inflammation, probing depth (PD), and mobility. Summary data appropriate for meta-analysis were pooled using a weighted average and analyzed using a standardized difference; the results were checked with both fixed-effects and random-effects models. MAIN RESULTS 1. A meta-analysis done on the studies reporting changes in CAL and PD following administration of sub-antimicrobial doses of doxycycline (SDD) in conjunction with scaling and root planing (SRP) in patients with periodontitis showed a statistically significant beneficial adjunctive effect. 2. There were insufficient data to provide meta-analyses on periodontal patients treated with other host-modulating agents; descriptive tables are included. 3. NSAIDS show promise in their ability to slow periodontal disease. 4. Preliminary data on bisphosphonate agents indicate there is a potential role for these agents in periodontitis management. 5. There are a very limited number of studies on host-modulating agents and dental implants and no analyses were possible. 6. Because the treatment methodologies and clinical variables differed considerably among the studies, it is difficult to summarize the information and identify a reliable total patient population. REVIEWERS' CONCLUSIONS 1. Large multi-center trials are needed to evaluate the role of host-modulating agents in the treatment of periodontitis. 2. NSAIDS and bisphosphonate drugs may have a potential adjunctive role in periodontal therapy. 3. The adjunctive use of SDD with SRP is statistically more effective than SRP alone in reducing PD and in achieving CAL gain.
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Affiliation(s)
- Michael S Reddy
- University of Alabama, Birmingham School of Dentistry, Department of Periodontology, Birmingham, Alabama, USA
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Abstract
Both systemic and topical antibiotics are increasingly used in the management of periodontal infections. Whilst these drugs are used mostly on an empirical basis, some contend that rational use of antibiotics should be the norm due to their wide abuse and consequential global emergence of antibiotic resistance organisms. Here we review the rationale and principles of antimicrobial therapy, treatment goals, drug delivery routes and various antibiotics that are used in the management of periodontal diseases. The pros and cons of systemic and local antibiotic therapy are described together with practical guidelines for their delivery. The available data indicate, in general, that mechanical periodontal treatment alone is adequate to ameliorate or resolve the clinical condition in most cases, but adjunctive antimicrobial agents, delivered either locally or systemically, can enhance the effect of therapy in specific situations. This is particularly true for aggressive (early onset) periodontitis, in patients with generalised systemic disease that may affect host resistance and in case of poor response to conventional mechanical therapy. Locally delivered antibiotics together with mechanical debridement are indicated for non-responding sites of focal infection or in localised recurrent disease. After resolution of the periodontal infection, the patient should be placed on an individually tailored maintenance care programme. Optimal plaque control by the patient is of paramount importance for a favourable clinical and microbiological response to any form of periodontal therapy.
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Reddy MS, Jeffcoat MK, Geurs NC, Palcanis KG, Weatherford TW, Traxler BM, Finkelman RD. Efficacy of controlled-release subgingival chlorhexidine to enhance periodontal regeneration. J Periodontol 2003; 74:411-9. [PMID: 12747444 DOI: 10.1902/jop.2003.74.4.411] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Periodontal regeneration success may be limited by placing bone grafts and membranes in infected sites. The objective of this study was to test the hypothesis that adjunctive subgingival administration of chlorhexidine gelatin bioresorbable chips enhances bone gain when used in conjunction with guided tissue regeneration. METHODS This was a single center, blinded, 2-arm parallel design study of 44 subjects with one or more sites with probing depth and clinical attachment loss > or = 5 mm following initial therapy and radiographic evidence of bone loss. The patients were randomly assigned to receive either chlorhexidine (CHX) chip or sham chip placement one week prior to regenerative therapy that included graft placement and site coverage with guided tissue membranes. Patients also received CHX or sham chip placement, per their randomization, adjunctively to scaling and root planing or maintenance procedures. Periodontal examinations were completed at baseline (8 weeks prior to surgery); 1 week prior to surgery; and at 3, 6, and 9 months postsurgery. The major outcomes for the study were changes in bone height and bone mass as measured from standardized radiographs used for quantitative digital subtraction radiography over the 11-month study period. RESULTS Subjects receiving sham chip placement gained a mean bone height of 1.49 +/- 0.22 mm, while patients receiving the CHX chips gained significantly more bone height (3.54 +/- 0.45 mm; P<0.001). Similarly, subjects receiving CHX chips as an adjunct gained significantly more bone mass (5.57 +/- 0.69 mg; P<0.001) than the standard therapy (2.59 +/- 0.34 mg). CONCLUSIONS These pilot results indicate that locally delivered, controlled-release antimicrobial treatment may improve the amount of bone gain during guided tissue regeneration procedures. These data support the evidence that infection control is an important variable in successful regeneration.
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Affiliation(s)
- Michael S Reddy
- University of Alabama School of Dentistry, Department of Periodontology, Birmingham, AL 35294-0007, USA.
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