Defect-determined regenerative options for treating periodontal intrabony defects in baboons

Comparative evaluation of the effectiveness of concentrated growth factor alone and in combination with diode laser application in the treatment of intrabony periodontal defects: A clinical and radiographic split-mouth study

Background

Applying autologous growth factors and diode laser in periodontal therapy enhances fibroblast-mediated new attachment and osteoblastic differentiation. Hence, this study compared and evaluated the effectiveness of concentrated growth factor (CGF) alone and with diode laser application in managing intrabony periodontal defects.

Methods

Ten patients with stage III periodontitis were included in this study. All the patients underwent an open flap debridement (OFD) procedure followed by CGF membrane placement in the intrabony defect in site A, whereas, in site B, after OFD, all the patients underwent diode laser irradiation before CGF membrane placement. Plaque and gingival bleeding index (PI & GBI), PPD, and clinical attachment level (CAL) were evaluated at baseline and 3 and 6 months later. Bone fill (BF), BF%, bone crest changes (BCC), and BCC% were assessed radiographically at six months postoperatively.

Results

Significant reductions in PI and GBI scores, probing pocket depth (PPD), and CAL gain were observed at both sites 3 and 6 months from baseline. A significant reduction in PPD and CAL gain was noted between sites, which were higher in site B than in site A with a mean difference of 0.70±0.05 mm and 1.30±0.18 mm, 0.90±1.89 mm at 3 and 6 months, respectively. Radiographic measurement showed better BF, BF%, BCC, and BCC% at both sites at six months, which were higher at site B than at site A but statistically insignificant.

Conclusion

The combination of CGF and diode laser application has demonstrated successful and promising results in terms of regeneration, improving the clinical and radiographic parameters.

INTRABONY DEFECT TREATMENT WITH PLATELET-RICH FIBRIN, GUIDED TISSUE REGENERATION AND OPEN-FLAP DEBRIDEMENT: A RANDOMIZED CONTROLLED TRIAL

OBJECTIVE

To comparatively assess the outcomes of the treatment of periodontal intrabony defects with platelet-rich fibrin (PRF) combined with open-flap debridement (OFD), guided tissue regeneration (GTR) or OFD alone based on clinical, radiographic, and wound healing parameters for 12 months of follow-up.

MATERIALS AND METHODS

Ninety intrabony defects were randomly divided into 3 different groups and treated as group 1 (PRF + OFD), group 2 (GTR), or group 3 (OFD alone). Clinical parameters, including the plaque index, gingival index, bleeding on probing, probing depth (PD), clinical attachment loss (CAL), and tooth mobility were assessed at 3, 6, and 12 months. Additionally, the wound healing index was assessed at 7 and 14 days postsurgery. Radiographic parameters, including bony defect fill and alveolar crestal resorption, were measured at 6 and 12 months postsurgery and calculated using image analysis software.

RESULTS

Intragroup comparisons showed consistently significant improvements in all the clinical and radiographic parameters in the 3 groups at 12 months postsurgery. Compared to baseline, in group 1, the PD decreased to 2.37 ± 0.56; 3.30 ± 0.84; 4.80 ± 0.71 mm, and CAL decreased to 2.23 ± 0.90; 3.33 ± 0.71; 5.00 ± 0.46 mm; in group 2, the PD decreased to 2.30 ± 0.60; 3.23 ± 0.86; 4.63 ± 0.67 mm, and CAL decreased to 2.00 ± 0.98; 3.20 ± 0.71; 4.53 ± 0.57 mm); and in group 3, the PD decreased to 1.87 ± 0.68; 2.57 ± 1.36; 3.37 ± 1.00 mm, and CAL decreased to 1.60 ± 0.93; 2.23 ± 1.22; 3.37 ± 1.22 mm at 3, 6, and 12 months postsurgery, respectively. The bone fill percentages in group 1 (26.45 ± 16.47 and 45.25 ± 5.20%), group 2 (22.20 ± 15.76 and 42.15 ± 6.39%) and group 3 (10.21 ± 6.47 and 23.13 ± 6.98%) were observed at 6 and 12 months postsurgery. The alveolar crestal resorption levels were -1.07 ± 0.52 and -1.70 ± 0.60 mm in group 1, -1.03 ± 0.72 and -1.47 ± 0.73 mm in group 2 and 0.37 ± 0.62 and 0.43 ± 0.73 mm in group 3, respectively. The percentages of sites with a WHI score of 1 were 93% and 100% in group 1, 81%, and 94% in group 2 and 45% and 71% in group 3 at 7 and 14 days postsurgery, respectively.

CONCLUSIONS

Compared to GTR, PRF yielded comparable treatment outcomes and periodontal tissue healing in terms of improvements in clinical and radiographic parameters. Compared to OFD alone, PRF also significantly improved these parameters in the treatment of intrabony defects.

Effectiveness of porcine-derived xenograft with enamel matrix derivative for periodontal regenerative treatment of intrabony defects associated with a fixed dental prosthesis: a 2-year follow-up retrospective study

Purpose

Due to the difficulty of the hygienic care and sanitary management of abutment teeth and subpontic areas associated with fixed dental prostheses (FDPs), intrabony defects occur and accelerate due to the accumulation of plaque and calculus. This study aimed to evaluate the efficacy of regenerative periodontal surgery for intrabony defects associated with FDPs.

Methods

The study inclusion criteria were met by 60 patients who underwent regenerative treatment between 2016 and 2018, involving a total of 82 intrabony defects associated with FDPs. Periodontal osseous lesions were classified as 1-, 2-, and 3-wall intrabony defects and were treated with an enamel matrix derivative in combination with bone graft material. The changes in clinical (pocket probing depth [PPD] and clinical attachment level [CAL]) and radiographic (defect depth and width) outcomes were measured at baseline and at 6, 12, and 24 months.

Results

Six months after regenerative treatment, a significant reduction was observed in the PPD of 1-wall (P<0.001), 2-wall (P<0.001), and 3-wall (P<0.001) defects, as well as a significant reduction in the CAL of 2-wall (P<0.001) and 3-wall (P<0.001) intrabony defects. However, there was a significant increase in the CAL of 1-wall intrabony defects (P=0.003). Radiographically, a significant reduction in the depth of the 3-wall (P<0.001) defects and a significant reduction in the width of 2-wall (P=0.008) and 3-wall (P<0.001) defects were observed. The depth decreased in 1-wall defects; however, this change was not statistically significant (P=0.066).

Conclusions

Within the limitations of the current study, regenerative treatment of 2- and 3-wall intrabony defects associated with FDPs improved clinical and radiological outcomes. Additional prospective studies are necessary to confirm our findings and to assess long-term outcomes.

Comparison of GTR, T-PRF and open-flap debridement in the treatment of intrabony defects with endo-perio lesions: a randomized controlled trial

BACKGROUND

Titanium- prepared platelet rich fibrin (T-PRF) is an autologous hemo-component with a high concentration of platelets that also incorporates leukocytes, and growth factors into the dense fibrin matrix and can be used as a healing biomaterial. This study assesses the adjunctive use of T-PRF in intrabony defects (IBDs) with open flap debridement (OFD) in comparison with guided tissue regeneration (GTR) as a gold standard and OFD alone as a control.

MATERIAL AND METHODS

A total of 45 patients (15 per group) were randomized as either T-PRF (test group), GTR (test group), or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and IBD were recorded. The radiographic depth of IBD was also measured. Primary outcomes assessed were changes in PD, CAL, and radiographic IBD that were assessed at the beginning and nine months later.  Results: The PRF and GTR group showed significant improvement in clinical parameters compared with the OFD alone (control group) at nine months. While there were no significant differences in PD and CAL between test groups (T-PRF and GTR groups), the significant difference was found in radiographic IBD depth.

CONCLUSION

T-PRF may give similar successful results as GTR in the treatment of IBDs with endo-perio lesions.

Comparison of Attachment and Proliferation of Human Gingival Fibroblasts on Different Collagen Membranes

Background and Aim

Human gingival fibroblasts cultured on collagen membrane as an alternative treatment method used in tissue regeneration can lead to improved results in root coverage. The aim of this study was to evaluate the human gingival fibroblast proliferation and adhesion cultured on three types of collagen membranes.

Materials and Methods

In this in vitro study, first-line human gingival fibroblast cells (HGF1-RT1) prepared and cultured on three membranes, including porcine pericardium (PP) (Jason, Botiss dental), human pericardium (HP) (Regen, Faravardeh Baft Iranian), and glutaraldehyde cross-linked (GC) (BioMend Extend, Zimmer Dental). Cell survival was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) after 24, 48, and 72 h and 7 days. Furthermore, morphology and adhesion of cells on the membrane were evaluated after 1 and 7 days by electron microscopy (scanning electron microscopy [SEM]). Statistical analysis was performed using two-way ANOVA with a significance level of 0.05.

Results

Based on the results of MTT, cell survival on HP and PP membranes after 7 days significantly increased (P < 0.001), but for the GC membrane, it was reduced after 7 days (P = 0.031). Cell survival on HP and PP membranes did not differ (P = 1) and was more than GC (P < 0.001). SEM images showed that the adhesion of cells was better on HP and PP membranes than GC.

Conclusion

The results of this study showed that natural collagen membranes (HP and PP) similarly support proliferation and adhesion of gingival fibroblasts. Survival and adhesion of gingival fibroblasts on cross-linked collagen membrane was less than two other membranes.

Platelet-Rich Fibrin in Regeneration of Intrabony Defects: A Randomized Controlled Trial

BACKGROUND

Platelet-rich fibrin (PRF) is an autologous non-transfusional hemo-component with a high concentration of platelets. It incorporates leukocytes, platelets, and growth factors within the dense fibrin matrix and can be used as healing biomaterial. This study assesses the adjunctive use of PRF in regenerative management of intrabony defects in comparison with open flap debridement (OFD).

METHODS

Twenty-six bilateral defects (13 per group) in 13 patients were randomized as either PRF (test group) or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and bone PD were recorded. Reduction in defect depth and percentage of bone fill was assessed radiographically. Primary outcomes assessed were changes in PD, CAL, and percentage of bone fill, and they were assessed at 6, 9, and 12 months. Secondary outcome was assessment of wound healing using a wound healing index (WHI).

RESULTS

The PRF group showed significant improvement in clinical parameters compared with the control group at 6, 9, and 12 months. The PRF group showed a bone fill of 45.18% ± 7.57%, which was statistically significant compared with 21.6% ± 9.3% seen in the control group at the end of the study period. The PRF group also showed significant soft tissue healing and reduction in PD. WHI also showed significant advantages for the PRF group.

CONCLUSION

The adjunctive use of PRF to conventional OFD may be potentially used in the treatment of intrabony defects.

Comparative Evaluation of the Efficacy of Platelet-rich Fibrin and Calcium Phosphosilicate Putty alone and in Combination in the Treatment of Intrabony Defects: A Randomized Clinical and Radiographic Study

Background:

Combination of platelet-rich fibrin (PRF) and bone substitutes for the treatment of intrabony pockets is based on sound biologic rationale. The present study aimed to explore the clinical and radiographic effectiveness of autologous PRF and calcium phosphosilicate (CPS) putty alone and in combination in treatment of intrabony defects.

Materials and Methods:

A total of 45 intrabony defects were selected and randomly divided into three groups. In Group I, mucoperiosteal flap elevation followed by placement of PRF was done. In Group II, mucoperiosteal flap elevation followed by placement of CPS putty was done. In Group III, mucoperiosteal flap elevation followed by placement of PRF and CPS putty was done. Clinical parameters such as gingival index (GI), pocket depth (PD), clinical attachment level (CAL), gingival marginal position and radiographic parameters such as bone fill, changes in crestal bone level, and defect depth resolution were recorded at baseline and after 6 months postoperatively.

Results:

Statistically significant changes in GI, PD reduction, CAL gain, defect fill, and defect depth resolution from baseline to 6 months were seen in all the three groups (P < 0.05). On intergroup comparison, no statistically significant changes were seen in all clinical parameters. However, the difference in defect fill and defect depth resolution between the Groups I and III and Group II and III was significant.

Conclusion:

Within limitations of study, combination of PRF and CPS putty showed a significant improvement in PD reduction, CAL gain, and bone fill.

A radiological evaluation of alveolar bone regeneration between the left and right mandibles and maxillae of the Chacma baboon

There is a lack of information in comparing the healing rate between the left and right sides of the maxilla and mandible. Osteogenesis of alveolar bone was evaluated with digital radiology by comparing differences in bone density (BD) at different time points within the left and right maxilla and mandible. Alveolar bone defects were created in five healthy Chacma baboons. Standardised x-ray images were acquired over time and the densities of the selected trauma areas were measured pre-operatively, post-operatively and at 3 and 6 weeks post-operatively. Differences in densities were statistically tested. There was no significant difference when the grey scale averages of the combined first and fourth quadrants (right side) and combined second and third quadrants (left side) were compared pre-operatively (t = 0.70), immediately post-operatively (t = 0.34), 3 weeks post-operatively (t = 0.40) and 6 weeks post-operatively (t = 0.66). There was also no significant difference between the values for the first and second quadrants (maxilla) pre-operatively (t = 0.37), immediately post-operatively (t = 0.30), 3 weeks post-operatively (t = 0.30) and 6 weeks post-operatively (t = 0.38); the third and fourth quadrants (mandible) were also not significantly different pre-operatively (t = 0.29), immediately post-operatively (t = 0.69), 3 weeks post-operatively (t = 0.07) and 6 weeks postoperatively (t = 0.06). However, the results showed an increased predisposition of the right side to regenerate faster than the left side and indicated sufficient information to investigate the effect of laterality and preferred side of mastication on the rate of healing and alveolar BD in the maxilla and mandible.

Synergistic Approach Using Platelet-Rich Fibrin and 1% Alendronate for Intrabony Defect Treatment in Chronic Periodontitis: A Randomized Clinical Trial

BACKGROUND

Platelet-rich fibrin (PRF) is a reservoir of concentrated platelets that provides a pool of biologic growth-promoting factors and cytokines, which help in mediating regeneration of lost bone and soft tissue maturation. Alendronate (ALN), a member of the amino-bisphosphonate group, is known to enhance periodontal tissue regeneration by inhibiting osteoclast-mediated bone resorption and promoting osteoblast-mediated osteogenesis. The current intervention aims to assess combined effectiveness of PRF and 1% ALN with access therapy in intrabony defect (IBD) treatment in patients with chronic periodontitis (CP).

METHODS

Single IBDs in 90 patients were categorized into three groups: 1) group 1 had access therapy alone; 2) group 2 had access therapy with PRF; and 3) group 3 had access therapy with PRF + 1% ALN. Site-specific plaque index, modified sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), and gingival marginal level, included as parameters for clinical assessment, were evaluated before surgery at baseline and 9 months postoperatively. Percentage IBD depth reduction, assessed using radiographs, was evaluated at baseline and postoperatively.

RESULTS

Compared with groups 1 and 2, group 3 exhibited significantly greater reduction in PD and gain in CAL postoperatively. Significantly greater IBD depth reduction was shown in group 3 (54.05% ± 2.88%) compared with group 2 (46% ± 1.89%) and group 1 (7.33% ± 4.86%) postoperatively.

CONCLUSION

Combined approach therapy of PRF + 1% ALN for IBD treatment in patients with CP showed better clinical parameter outcomes with greater IBD depth reduction compared with PRF and access therapy alone.

Platelet-Rich Fibrin Combined With 1.2% Atorvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

BACKGROUND

Platelet-rich fibrin (PRF), a second-generation platelet concentrate, and atorvastatin (ATV), a potent member of the statin group, are known to promote tissue regeneration. The current study is designed to evaluate combined efficacy of PRF and 1.2% ATV gel with open flap debridement (OFD) in treatment of intrabony defects (IBDs) in individuals with chronic periodontitis (CP).

METHODS

Ninety-six individuals with single defects were categorized into three groups: 1) OFD with PRF; 2) OFD with PRF + 1.2% ATV; and 3) OFD alone. Clinical parameters: 1) site-specific plaque index; 2) modified sulcus bleeding index; 3) probing depth (PD); 4) relative clinical attachment level (rCAL); and 5) gingival marginal level were recorded at baseline before surgery and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated at baseline and 9 months.

RESULTS

PRF + 1.2% ATV and PRF alone showed significantly greater PD reduction and rCAL gain compared with OFD alone at 9 months. Furthermore, PRF + 1.2% ATV showed a similar percentage radiographic defect depth reduction (50.96% ± 4.88%) compared with PRF alone (47.91% ± 4.79%), and a greater reduction compared with OFD alone (5.54% ± 1.71%) at 9 months.

CONCLUSIONS

PRF + 1.2% ATV showed similar improvements in clinical parameters with a greater percentage radiographic defect depth reduction compared with PRF alone in treatment of IBDs in individuals with CP. Thus, 1.2% ATV failed to augment the regenerative potential of PRF alone in periodontal IBDs.

Evaluation of platelet-rich plasma alone or in combination with demineralized freeze dried bone allograft in treatment of periodontal infrabony defects: A comparative clinical trial

Aims:

The use of platelet-rich plasma (PRP) alone in periodontal defects has been controversial and inconclusive. Hence, the present study was designed with the aim to assess the clinical and radiographic effectiveness of PRP alone in infrabony defects.

Materials and Methods:

Thirty infrabony defects were treated with either autologous PRP with open flap debridement (OFD) or autologous PRP + demineralized freeze dried bone graft (DFDBA) with OFD or OFD alone. Clinical parameters recorded were gingival index, plaque index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). Radiographic parameters included defect depth reduction, defect resolution, and crestal bone level. All the parameters were recorded at baseline and 12 months postoperatively.

Results:

Mean PD reduction and CAL gain were greater in PRP + DFDBA (4.88 ± 1.12 mm and 4.26 ± 1.85 mm) and PRP (4.86 ± 2.12 mm and 4.10 ± 1.47 mm) groups than the control group (2.69 ± 1.37 mm and 1.27 ± 0.89 mm).

Conclusions:

Within the limits of the study, all the three groups showed significant improvement in clinical parameters from baseline to postoperative 12 months. The amount of defect depth reduction and defect resolution treated with PRP alone group were significantly < PRP + DFDBA. The results pertaining to these parameters were significantly better than the control group.

Platelet-rich fibrin with 1% metformin for the treatment of intrabony defects in chronic periodontitis: a randomized controlled clinical trial

BACKGROUND

Platelet-rich fibrin (PRF) is a second-generation platelet concentrate that releases various growth factors that promote tissue regeneration. Metformin (MF), a member of the biguanide group, has been shown to facilitate osteoblast differentiation and thus may exhibit a favorable effect on alveolar bone. The current study is designed to evaluate the efficacy of open-flap debridement (OFD) combined with PRF, 1% MF gel, and PRF + 1% MF gel in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP).

METHODS

One hundred twenty patients with single defects were categorized into four treatment groups: OFD alone, OFD with PRF, OFD with 1% MF, and OFD with PRF plus 1% MF. Clinical parameters such as site-specific plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), relative attachment level (RAL), and gingival marginal level (GML) were recorded at baseline (before surgery) and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated using computer-aided software at baseline and 9 months.

RESULTS

PRF, 1% MF, and PRF + 1% MF groups showed significantly more PD reduction and RAL gain than the OFD-only group. Mean PD reduction and mean RAL gain were found to be greater in the PRF + 1% MF group compared to just PRF or MF at 9 months. Furthermore, PRF + 1% MF group sites showed a significantly greater percentage of radiographic defect depth reduction (52.65% ± 0.031%) compared to MF (48.69% ± 0.026%), PRF (48% ± 0.029%), and OFD alone (9.14% ± 0.04%) at 9 months.

CONCLUSION

The PRF + 1% MF group showed greater improvements in clinical parameters, with greater percentage radiographic defect depth reduction compared to MF, PRF, or OFD alone in treatment of IBDs in patients with CP.

Evaluation of intrabony defects treated with platelet-rich fibrin or autogenous bone graft: A comparative analysis

OBJECTIVE

The primary objective of this study was to compare clinically and radiographically the efficacy of autologous platelet rich fibrin (PRF) and autogenous bone graft (ABG) obtained using bone scrapper in the treatment of intrabony periodontal defects.

MATERIALS AND METHODS

Thirty-eight intrabony defects (IBDs) were treated with either open flap debridement (OFD) with PRF or OFD with ABG. Clinical parameters were recorded at baseline and 6 months postoperatively. The defect-fill and defect resolution at baseline and 6 months were calculated radiographically (intraoral periapical radiographs [IOPA] and orthopantomogram [OPG]).

RESULTS

Significant probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, defect fill and defect resolution at both PRF and ABG treated sites with OFD was observed. However, inter-group comparison was non-significant (P > 0.05). The bivariate correlation results revealed that any of the two radiographic techniques (IOPA and OPG) can be used for analysis of the regenerative therapy in IBDs.

CONCLUSION

The use of either PRF or ABG were effective in the treatment of three wall IBDs with an uneventful healing of the sites.

Comparison of treatment effects of guided tissue regeneration on infrabony lesions between animal and human studies: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

For ethical reasons it is becoming increasingly more difficult to obtain, from clinical studies, histological data on infrabony defects treated with guided tissue regeneration (GTR) techniques. The aim of this systematic review was to find the value of extrapolating animal data on treatment of periodontal infrabony lesions, using GTR only or GTR + bone grafts, to human clinical results.

MATERIAL AND METHODS

Searches of the PubMed and Cochrane databases were combined with hand searching of articles published from 1 January 1969 to 1 August 2012. The search included any type of barrier membrane, with or without grafted materials, used to treat periodontal infrabony lesions. All studies with histological or re-entry methodology outcome parameters that evaluated bone-filling and/or new-cementum-formation ratios from a defect depth were collected. When comparing animal and human outcomes, a meta-analysis was used to evaluate the bone-filling ratio, but only a descriptive analysis of the histological studies was performed.

RESULTS

In total, 22 studies were selected for the meta-analysis. In the GTR + bone graft groups the weighted-average bone-filling ratios were 52% (95% CI: 18-85%) in animals and 57% (95% CI: 30-83%) in humans, which were not statistically significantly different (p = 0.825). Similar results were found in the GTR-only groups, in which the weighted-average bone-filling ratios were 54% (95% CI: 37-72%) in animals and 59% (95% CI: 42-77%) in humans (p = 0.703). New-cementum formation of GTR only and GTR + bone grafts showed comparable ratio outcomes, and both were superior to the control group in animals only (p = 0.042).

CONCLUSION

Although quality assessments differed between animal and human studies, our analysis indicated that animal models and human results showed similar bone-filling ratios in infrabony defects treated with GTR only or with GTR + bone grafting.

A comparative evaluation of the effectiveness of guided tissue regeneration by using a collagen membrane with or without decalcified freeze-dried bone allograft in the treatment of infrabony defects: A clinical and radiographic study

BACKGROUND

The present, randomized, controlled clinical and radiographic study was undertaken to compare the effectiveness of guided tissue regeneration (GTR) by using a collagen membrane barrier with or without decalcified freeze-dried bone allograft (DFDBA) in the treatment of periodontal infrabony defects characterized by unfavorable architecture.

MATERIALS AND METHODS

Sixteen systemically healthy patients with 20 periodontal infrabony defects were selected for the study. Each patient had at least ≥ 5 mm clinical probing pocket depth (PPD) at the selected site and depth of intrabony component ≥ 3 mm as assessed by clinical and radiographic measurements. Baseline measurements included plaque index, papillary bleeding index, PPD, gingival recession, clinical attachment level and radiographic defect depth (DD). At the time of surgery, the defects were randomly assigned to either the test group (collagen membrane plus DFDBA) or the control group (collagen membrane only).

RESULTS

At the 6-month examination, PPPD reduction was significantly greater in the GTR + DFDBA group (4.06 ± 0.38 mm) compared with the GTR group (3.2 ± 0.74 mm). The mean gains of clinical attachment were 3.54 ± 0.36 mm in the test group and 2.50 ± 0.74 mm in the control group. Radiographic DD reduction was similarly greater in the GTR + DFDBA group (2.40 ± 0.51 mm) compared with the GTR group (1.60 ± 0.51 mm).

CONCLUSIONS

The results of the present study indicate that the use of a GTR membrane with bone graft has significantly improved all clinical parameters tested as compared with the use of bioresorbable membrane alone in the treatment of infrabony defects characterized by unfavorable architecture.

Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of 3-wall intrabony defects in chronic periodontitis: a randomized controlled clinical trial

BACKGROUND

The topical use of platelet concentrates is recent, and its efficiency remains controversial. The present study aims to explore the clinical and radiographic effectiveness of autologous platelet-rich fibrin (PRF) and platelet-rich plasma (PRP) in the treatment of intrabony defects in patients with chronic periodontitis.

METHODS

Ninety intrabony defects were treated with either autologous PRF with open-flap debridement or autologous PRP with open-flap debridement or open-flap debridement alone. Clinical and radiologic parameters, such as probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage defect fill, were recorded at baseline and 9 months postoperatively.

RESULTS

Mean PD reduction and CAL gain were greater in PRF (3.77 ± 1.19 and 3.17 ± 1.29 mm) and PRP (3.77 ± 1.07 and 2.93 ± 1.08 mm) groups than the control group (2.97 ± 0.93 and 2.83 ± 0.91 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (55.41% ± 11.39%) and PRP (56.85% ± 14.01%) groups compared with the control (1.56% ± 15.12%) group.

CONCLUSIONS

Within the limit of the present study, there was similar PD reduction, CAL gain, and bone fill at sites treated with PRF or PRP with conventional open-flap debridement. Because PRF is less time consuming and less technique sensitive, it may seem a better treatment option than PRP. However, long-term, multicenter randomized, controlled clinical trials will be required to know their clinical and radiographic effects on bone regeneration.

Treatment of intrabony defects with beta-tricalciumphosphate alone and in combination with platelet-rich plasma

BACKGROUND

The therapeutic efficacy of platelet-rich plasma (PRP) still remains controversial. This study aimed to compare the efficacy of a beta-tricalcium phosphate (β-TCP) and PRP/β-TCP combination both clinically and radiographically.

METHODS

Fourteen chronic periodontitis patients with at least two similar three-walled defects were included in the study. Each patient was randomly treated with both β-TCP (n = 14) and PRP/β-TCP (n = 14) in the same session. Baseline and 6-month evaluations of plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), bleeding on probing, and radiographic intrabony defect depth (RIDD) were assessed statistically.

RESULTS

At 6 months, statistically significant reductions of GI, PPD, BOP, and RIDD were observed in both groups. The median values of CAL decreased from 7.0 to 6.0 mm in the β-TCP group (p = 0.002), and 7.5 to 5.0 mm in the PRP/β-TCP group (p < 0.001). No statistically significant difference was detected between the two groups for all clinical indices.

CONCLUSION

After a 6-month healing period, both β-TCP and PRP/β-TCP were found effective in the treatment of three-walled intrabony defects and no additional statistically significant benefits were found with PRP.

Biomimetic surface modification using synthetic oligopeptides for enhanced guided bone regeneration in beagles

BACKGROUND

In previous studies, oligopeptide corresponding to the cell-binding domains of bone morphogenetic proteins that bind to bone morphogenetic protein receptor enhanced the bone regenerative capacity of bovine bone minerals (BBM). The aim of this study is to evaluate the ability of BBM coated with oligopeptide to promote periodontal regeneration in a 1-wall intrabony defect model in dogs.

METHODS

The second and third mandibular premolars and first molars of six adult beagles were extracted bilaterally, and the extraction sites were allowed to heal for 10 weeks. The 1-wall intrabony defects were prepared bilaterally on the mesial and distal side of the fourth mandibular premolars. Twenty-four intrabony defects were assigned to four treatment groups: 1) open flap debridement; 2) guided tissue regeneration (GTR); 3) GTR with a collagen membrane and BBM; and 4) GTR with a collagen membrane and BBM coated with the oligopeptide (Pep-BBM). The animals were sacrificed 10 weeks after surgery. For the histometric analysis, defect height, junctional epithelium migration, new cementum, new bone height, and new bone area were measured. New bone volume was measured using microcomputed tomography.

RESULTS

Wound healing was generally uneventful. For junctional epithelium migration, the BBM and Pep-BBM groups exhibited mean (± SE) values of 0.53 ± 0.41 and 0.48 ± 0.30 mm, and for new cementum height, 1.71 ± 0.46 and 2.50 ± 2.00 mm, respectively. For junctional epithelium migration and cementum regeneration, there were no significant differences between the two groups. The mean (± SE) values of new bone height and new bone volume in the Pep-BBM group (3.88 ± 0.31 mm and 32.35% ± 9.60%) were significantly greater than the mean values for the BBM group (2.60 ± 0.41 mm and 20.56% ± 1.89%). For bone regeneration, the Pep-BBM group showed superior results compared to the BBM group with statistically significant differences.

CONCLUSIONS

Through various parameters to evaluate periodontal regeneration, this oligopeptide coating influenced only the ability of BBM to promote bone regeneration in 1-wall intrabony defects in beagles. Junctional epithelium migration and cementum regeneration were not affected by this oligopeptide coating, and further investigations with special focus on regeneration of the periodontal ligament are necessary.

Evaluation of an anorganic bovine-derived mineral with P-15 hydrogel bone graft: preliminary study in a rabbit cranial bone model

OBJECTIVES

The present investigation aimed to assess the bone-regenerative potential of two formulations of anorganic bovine-derived mineral bound to a P-15 (ABM/P-15) bone graft - the particulate and the hydrogel forms - in a delayed healing rabbit cranial defect model.

MATERIAL AND METHODS

Ten adult male New Zealand White rabbits were used to create two 8 mm transcortical cranial defects per rabbit and each one received randomly the test material (ABM/P-15 carboxymethyl cellulose (CMC)-hydrogel graft), the standard control material (ABM/P-15 particulate graft) or remained empty as a negative control. The defects were allowed to heal for 2 and 4 weeks. Qualitative and quantitative histological outcomes were assessed on undecalcified sections.

RESULTS

In the defects grafted with the test material, at both time points, there was a marked random migration of the bone substitute particles. As a consequence, the space maintenance provision was lost and new bone formation was reduced compared with the control particulate graft material. The histomorphometric analysis showed that the control material attained better results, with an average of 13.8 ± 1.9% and 18.2 ± 4.4% of new bone at 2 and 4 weeks, compared with 8.5 ± 2.4% and 13 ± 2.9% for the test material. These differences were significant at 2 weeks (P ≤ 0.05), but not at 4 weeks (P>0.05). Additionally, there was a significant difference in the total area of mineralized tissue (new bone plus particles), favoring the standard control over the test material: 43.2 ± 14.4% vs. 14.2 ± 5.3% at 2 weeks and 56.9 ± 4.2% vs. 24.2 ± 9.6% at 4 weeks, respectively.

CONCLUSIONS

The test ABM/P-15 CMC-hydrogel graft material behaved in this animal model by migration of the graft particles, what determined an unpredictable osseoconduction and, consequently, a decreased quality and quantity of bone regeneration as compared with the osseopromotive behavior exhibited by the standard particulate form of the ABM/P-15 control graft. It is therefore suggested to restrain the application of the hydrogel graft form in non-contained anatomical bone defects.

Treatment of 3-wall intrabony defects in patients with chronic periodontitis with autologous platelet-rich fibrin: a randomized controlled clinical trial

BACKGROUND

Platelet-rich fibrin (PRF) is considered a second-generation platelet concentrate that is widely used in osseous regeneration. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF in the treatment of intrabony defects in patients with chronic periodontitis.

METHODS

Fifty-six intrabony defects were treated with either autologous PRF with open-flap debridement or open-flap debridement alone. Clinical parameters such as the probing depth (PD) and periodontal attachment level (PAL) were recorded at baseline and 9 months postoperatively. The defect fill at baseline and 9 months was calculated on standardized radiographs by using image-analysis software.

RESULTS

The mean PD reduction was greater in the test group (4.55 ± 1.87 mm) than in the control group (3.21 ± 1.64 mm), whereas the mean PAL gain was also greater in the test group (3.31 ± 1.76) compared to the control group (2.77 ± 1.44 mm). Furthermore, a significantly greater percentage of mean bone fill was found in the test group (48.26% ± 5.72%) compared to the control group (1.80% ± 1.56%).

CONCLUSIONS

Within the limits of the present study, there was greater PD reduction, PAL gain, and bone fill at sites treated with PRF with conventional open-flap debridement compared to conventional open-flap debridement alone. However, a long-term, multicentered randomized controlled clinical trial is required to know the clinical and radiographic effects of PRF on bone regeneration.

Biological effects of a porcine-derived collagen membrane on intrabony defects

Purpose

To prolong the degradation time of collagen membranes, various cross-linking techniques have been developed. For cross-linking, chemicals such as formaldehyde and glutaraldehyde are added to collagen membranes, but these chemicals could adversely affect surrounding tissues. The aim of this study is to evaluate the ability of porous non-chemical cross-linking porcine-derived collagen nanofibrous membrane to enhance bone and associated tissue regeneration in one-wall intrabony defects in beagle dogs.

Methods

The second and third mandibular premolars and the first molars of 2 adult beagles were extracted bilaterally and the extraction sites were allowed to heal for 10 weeks. One-wall intrabony defects were prepared bilaterally on the mesial and distal side of the fourth mandibular premolars. Among eight defects, four defects were not covered with membrane as controls and the other four defects were covered with membrane as the experimental group. The animals were sacrificed 10 weeks after surgery.

Results

Wound healing was generally uneventful. For all parameters evaluating bone regeneration, the experimental group showed significantly superior results compared to the control. In new bone height (NBh), the experimental group exhibited a greater mean value than the control (3.04 ± 0.23 mm/1.57 ± 0.59, P = 0.003). Also, in new bone area (NBa) and new bone volume (NBv), the experimental group showed superior results compared to the control (NBa, 34.48 ± 10.21% vs. 5.09 ± 5.76%, P = 0.014; and NBv, 28.04 ± 12.96 vs. 1.55 ± 0.57, P = 0.041). On the other hand, for parameters evaluating periodontal tissue regeneration, including junctional epithelium migration and new cementum height, there were no statistically significant differences between two groups.

Conclusions

Within the limitations of this study, this collagen membrane enhanced bone regeneration at one-wall intrabony defects. On the other hand, no influence of this membrane on periodontal tissue regeneration could be ascertained in this study.

Favorable Periodontal Healing of 1-Wall Infrabony Defects After Application of Calcium Phosphate Cement Wall Alone or in Combination With Enamel Matrix Derivative: A Pilot Study With Canine Mandibles

BACKGROUND

Although various periodontal regenerative therapies are used, their effects on non-contained infrabony defects are unpredictable. Our previous studies showed that injectable, moldable, fast-setting calcium phosphate cement (CPC) promoted histocompatible periodontal healing in 3-wall intrabony defects. The present study evaluated healing patterns after surgical application of CPC walls with and without an enamel matrix derivative (EMD) in 1-wall infrabony defects in dogs.

METHODS

One-wall infrabony defects (5 x 5 x 4 mm) were created surgically on the mesial and distal sides of bilateral mandibular fourth premolars in four beagle dogs. After elevating a full-thickness flap, exposed root surfaces were planed thoroughly. The 16 defects were assigned randomly to one of the following experimental conditions: CPC, CPC+EMD, EMD, and open flap debridement (OFD). Ten weeks post-surgery, the animals were sacrificed, and histologic specimens were prepared for histomorphometric evaluation.

RESULTS

Defect sites treated with EMD only exhibited varying degrees of new cementum and new bone formation, whereas the OFD group presented only limited new cementum and bone formation. Defect sites where a CPC wall was implanted (CPC and CPC+EMD groups) revealed significantly greater regeneration of new bone and new cementum than in the EMD and OFD groups. No significant differences were observed between the CPC and CPC+EMD groups.

CONCLUSIONS

CPC walls with and without EMD promoted regeneration of alveolar bone and cementum in 1-wall infrabony defects. Space and stable wound healing are believed to be crucial for periodontal regeneration in non-contained infrabony defects.

Bone repair in rat mandible by rhBMP-2 associated with two carriers

This study evaluated the quantity and quality of newly formed bone, stimulated by rhBMP-2 in combination with monoolein or chitosan gel as carriers, in critical bone defects created in 36 Wistar rat mandibles. Two weeks after surgery, the animals were anesthetized with 37.5% urethane submitted to perfusion and the hemi-mandibles removed for histological and histomorphometrical analysis. The results showed that there was a statistical difference between groups of animals receiving or not rhBMP-2 (p<0.05). Newly formed bone was more intense in the occlusal region, followed by the basal and middle regions, respectively. Both carriers, monoolein and chitosan gels were adequate for defect filling and control of protein release.

Treatment of Wide, Shallow, and Predominantly 1-Wall Intrabony Defects With a Bioabsorbable Membrane: A Randomized Controlled Clinical Trial

BACKGROUND

The regenerative therapy of non-contained intrabony defects achieves better results when bioabsorbable membranes are combined with a filling material. The purpose of the present study was to analyze clinical and radiographic effectiveness of a space-making bioabsorbable membrane in the treatment of wide and shallow intrabony defects characterized by a relevant 1-wall component.

METHODS

Eighteen pairs of angular bone defects were selected in 18 healthy, non-smoking patients (age range 30 to 66 years). Prior to the surgical phase, patients were enrolled in a strict periodontal program including oral hygiene instructions and scaling and root planing (presurgical full-mouth plaque score <10%). Using a split-mouth design, 18 sites were randomly assigned to receive guided tissue regeneration (GTR) using a bioabsorbable membrane (test group) and 18 to receive open flap debridement alone (control group). Clinical treatment outcome was evaluated 12 months postoperatively for changes in probing depth (PD), clinical attachment level (CAL), and position of gingival margin (REC) and radiographically for bone changes.

RESULTS

Open flap debridement and GTR yielded statistically significant (P<0.0001) PD reduction (2.39+/- 0.92 mm and 3.44+/- 0.78 mm), CAL gain (1.50+/- 0.99 mm and 2.89 +/- 0.90 mm), increased REC (-0.89 +/- 0.58 mm and -0.56 +/- 0.92 mm) and bone fill (1.05+/- 0.94 mm and 2.13+/- 1.21 mm) when 12-month data were compared to baseline. The differences between test and control groups were statistically significant for all parameters (P<0.007) except for REC (P=0.25).

CONCLUSION

The use of this bioabsorbable membrane would seem to be effective in the treatment of intrabony defects with unfavorable architecture without the use of filling materials.