Autogenous bone graft combined with buccal fat pad as barrier in treatment of Class II furcation defect: a case report

Use of Buccal Fat Pad in the Treatment of Peri-Implant Mucosal Defect: A Case Report

The present study describes a clinical case in which the buccal fat pad (BFP) was used to improve the contour of the peri-implant mucosa. To our knowledge, this is the first case report of such an application in the literature. A 58-year-old woman presented with teeth #2 and #3 missing and an indication for extraction of tooth #4. After clinical examination and CBCT analysis, immediate implants were placed in the region of the extracted tooth and that of tooth #2 for prosthetic rehabilitation using a three-unit fixed partial denture. There was an extensive mucosal defect in the region of tooth #3, with vertical and horizontal changes in the contour of the mucosa. As an alternative to the use of a subepithelial connective tissue graft, we opted for displacement of the BFP and its accommodation on the alveolar ridge of tooth #3 to improve the buccal tissue contour. After 5 years of follow-up, satisfactory gain and maintenance of mucosal volume were observed in the treated area, as well as improvement of buccal tissue contour. The use of BFP seems to be a feasible alternative for filling and treating peri-implant mucosal defects.

Periodontal regeneration - furcation defects: a systematic review from the AAP Regeneration Workshop

BACKGROUND

The aim of this review is to present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy to provide clinical guidelines for the therapeutic management of furcation defects and to identify priorities for future research that may advance the understanding of periodontal regenerative medicine.

METHODS

A comprehensive search based on predetermined eligibility criteria was conducted to identify human original studies and systematic reviews on the topic of periodontal regeneration of furcation defects. Two reviewers independently screened the title and abstract of the entries yielded from the initial search. Subsequently, both reviewers read the full-text version of potentially eligible studies, made a final article selection, and extracted the data of the selected studies considering specific clinical scenarios. The clinical scenarios contemplated in this review included the following: 1) facial and interproximal Class I defects in maxillary molars; 2) facial and lingual Class I defects in mandibular molars; 3) facial and interproximal Class II furcation defects in maxillary molars; 4) facial and lingual Class II furcation defects in mandibular molars; 5) Class III furcation defects in maxillary molars; 6) Class III furcation defects in mandibular molars; and 7) Class I, II, or III furcation defects in maxillary premolars. Endpoints of interest included different clinical, radiographic, microbiologic, histologic, and patient-reported outcomes.

RESULTS

The initial search yielded a total of 1,500 entries. The final selection consisted of 150 articles, of which six were systematic reviews, 109 were clinical trials, 27 were case series, and eight were case reports. A summary of the main findings of previously published systematic reviews and the available evidence relative to the indication of regenerative approaches for the treatment of furcation defects compared with conventional surgical therapy are presented. Given the marked methodologic heterogeneity and the wide variety of materials and techniques applied in the selected clinical trials, the conduction of a meta-analysis was not viable.

CONCLUSIONS

On the basis of the reviewed evidence, the following conclusions can be drawn. 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial or interproximal and mandibular facial or lingual Class II furcation defects. 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the evidence is limited to one case report. 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in maxillary molars is limited to clinical case reports. 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy. 5) Future research efforts should be primarily directed toward the conduction of clinical trials to test novel regenerative approaches that place emphasis primarily on patient-reported outcomes and also on histologic demonstration of periodontal regeneration. Investigators should also focus on understanding the influence that local, systemic, and technical factors may have on the outcomes of regenerative therapy in furcation defects.

Regenerative Medicine for Periodontal and Peri-implant Diseases

The balance between bone resorption and bone formation is vital for maintenance and regeneration of alveolar bone and supporting structures around teeth and dental implants. Tissue regeneration in the oral cavity is regulated by multiple cell types, signaling mechanisms, and matrix interactions. A goal for periodontal tissue engineering/regenerative medicine is to restore oral soft and hard tissues through cell, scaffold, and/or signaling approaches to functional and aesthetic oral tissues. Bony defects in the oral cavity can vary significantly, ranging from smaller intrabony lesions resulting from periodontal or peri-implant diseases to large osseous defects that extend through the jaws as a result of trauma, tumor resection, or congenital defects. The disparity in size and location of these alveolar defects is compounded further by patient-specific and environmental factors that contribute to the challenges in periodontal regeneration, peri-implant tissue regeneration, and alveolar ridge reconstruction. Efforts have been made over the last few decades to produce reliable and predictable methods to stimulate bone regeneration in alveolar bone defects. Tissue engineering/regenerative medicine provide new avenues to enhance tissue regeneration by introducing bioactive models or constructing patient-specific substitutes. This review presents an overview of therapies (e.g., protein, gene, and cell based) and biomaterials (e.g., resorbable, nonresorbable, and 3-dimensionally printed) used for alveolar bone engineering around teeth and implants and for implant site development, with emphasis on most recent findings and future directions.

Osteocalcin Immunohistochemical Expression During Repair of Critical-Sized Bone Defects Treated with Subcutaneous Adipose Tissue in Rat and Rabbit Animal Model

The aim of this study was to evaluate the osteocalcin immunoexpression during the bone repair treated with subcutaneous adipose tissue in rats and rabbits. Fourteen rats and 14 rabbits were used in the study. A critical-sized calvarial defect was created in each animal. The animals were divided into 4 experimental groups: RC (rat control), RbC (rabbit control), RAT (rat adipose tissue), RbAT (rabbit adipose tissue). In the groups RC and RbC the defect was filled with a blood clot. In groups RAT and RbAT, the defect was filled with macerated subcutaneous adipose tissue. The euthanasia was performed at 30 days (RC and RAT) and 40 days (RbC and RbAT). Histological analysis and immunohistochemical analysis of osteocalcin protein expression were performed. Data were submitted to descriptive statistical analysis (mode). Osteocalcin immunoexpression was detected in the experimental models. Notwithstanding, RbAT showed higher positivity, especially in the adipocytes, than the group RAT group. In groups RC and RbC, the surgical wound was filled by collagen fibers. In Group RAT, the defect was composed by collagen fibers and adipocytes in the reparative sites. Similarly, in RbAT, the defect also was partially filled by collagen fibers and presence of adipocytes dispersed among the fibers. Additionally, chronic inflammatory process and areas of bone matrix deposition were observed. It may be concluded that in both animal models the adipose tissue demonstrated low osteogenic capacity. However, the rabbit animal model exhibited a more evident osteocalcin immunoexpression and a greater amount of newly formed bone matrix.