Periodontal regeneration with 0.3% basic fibroblast growth factor (FGF-2) for a patient with aggressive periodontitis: a case report

Recombinant human fibroblast growth factor and autogenous bone for periodontal regeneration: Alone or in combination? A randomized clinical trial

AIM

To compare the outcomes of therapy using recombinant human fibroblast growth factor (rhFGF)-2 combined with autologous bone grafting (ABG) therapy with those of rhFGF-2 alone and ABG alone in the treatment of periodontal intraosseous defects.

METHODS

Periodontal intraosseous defects were randomized to receive rhFGF-2 therapy + ABG, rhFGF-2 therapy alone, or ABG alone. Periodontal examination and periapical radiography were performed preoperatively and at 3, 6, and 12 months postoperatively.

RESULTS

At the 12 months follow-up, all three groups showed significant improvement in the clinical attachment level (CAL): 5.6 ± 1.6, 5.8 ± 1.7, and 5.2 ± 1.6 mm in the rhFGF-2 + ABG, rhFGF-2 alone, and ABG alone groups, respectively, with no significant inter-group differences (p < .05). rhFGF-2 therapy (alone or in combination) resulted in greater bone defect filling (BDF) (2.3 ± 1.2 mm and 2.6 ± 1.9 mm, respectively) than ABG therapy alone (1.2 ± 1.2 mm). Gingival recession was lesser in the ABG alone (1.2 ± 1.1 mm) and rhFGF-2 + ABG groups (1.4 ± 0.8 mm) than in the rhFGF-2 alone group (2.2 ± 1.2 mm).

CONCLUSION

The results of this study showed that at 12 months postoperatively, all treatments resulted in statistically significant clinical improvements compared to the baseline. From these results, it can be concluded that rhFGF-2 promotes hard tissue regeneration in intraosseous defects.

Exploring Epigenetic Mechanisms in Aggressive Periodontitis; Unraveling the Molecular Dynamics of Disease Progression: A Narrative Review

Aggressive periodontitis is an inflammation of the periodontal tissue that usually affects adolescents and young adults aged <30 years, caused by attachment loss and fast bone degradation. The correlation between the epigenetic status and the initiation and progression of numerous acquired diseases was documented. Consequently, targeting epigenetic factors within periodontal tissues stands as an appealing prospect for both the diagnosis and treatment of periodontitis. In addition to the role of pathogenic bacteria and their products, alterations in gene expression due to extrinsic and intrinsic factors can cause disturbances in the host's immune response. Epigenetic changes, whether DNA methylation or microRNA (miRNA) dysregulation, can cause changes in gene expression in aggressive periodontitis and lead to more severe and rapid loss of the periodontal tissues. This study aimed to elucidate the relationships between oral hygiene, pathogenic bacteria, and genetics in periodontitis development to promote targeted prevention and treatment for enhanced oral health in individuals at risk of aggressive periodontitis. The method employed in this study entailed a comprehensive review and analysis of scholarly literature on the relationship between epigenetic mechanisms and the development of aggressive periodontitis. In conclusion, epigenetic regulation plays an important role in the pathogenesis of periodontitis through DNA methylation mechanisms that begin with Toll-like receptors (TLRs), cytokine signaling pathways, promoter genes, and progress to pro-inflammatory cells. When periodontal tissue inflammation occurs, miRNA inhibits protein translation from messenger ribonucleic acid (mRNA), which contributes to its aggressiveness.

Effects of combined application of fibroblast growth factor (FGF)-2 and carbonate apatite for tissue regeneration in a beagle dog model of one-wall periodontal defect

Introduction

There has been an increasing desire for the development of predictive periodontal regenerative therapy for severe periodontitis. In this study, we investigated the effect of the combined use of fibroblast growth factor-2 (FGF-2), a drug for periodontal regeneration approved in Japan, and carbonated apatite (CO₃Ap), bioresorbable and osteoconductive scaffold, on periodontal regeneration in beagle dog model of one-wall periodontal defect (severe intraosseous defect) for 24 weeks in comparison with CO₃Ap or vehicle alone.

Methods

One-wall periodontal defects were created (mesiodistal width × depth: 4 × 4 mm) on the mesial portion of the mandibular first molar (M1) of beagle dogs on both side. Mixture of FGF-2 and CO₃Ap, vehicle and CO₃Ap, or vehicle alone were administered to the defects and designated as groups FGF-2+CO₃Ap, CO₃Ap, and control, respectively. To assess the periodontal regeneration, radiographic analysis over time for 24 weeks, and micro computed tomography (μCT) and histological evaluation at 6 and 24 weeks were performed.

Results

For the regenerated tissue in the defect site, the mineral content of the FGF-2+CO₃Ap group was higher than that of the CO₃Ap group in the radiographic analysis at 6-24 weeks. In the context of new bone formation and replacement, the FGF-2+CO₃Ap group exhibited significantly greater new bone volume and smaller CO₃Ap volume than the CO₃Ap group in the μCT analysis at 6 and 24 weeks. Furthermore, the density of the new bone in the FGF-2+CO₃Ap group at 24 weeks was similar to those in the control and CO₃Ap groups. Histological evaluation revealed that the length of the new periodontal ligament and cementum in the FGF-2+CO₃Ap group was greater than that in the CO₃Ap group at 6 weeks. We also examined the effect of the combined use of the FGF-2 and CO₃Ap on the existing bone adjacent to the defect and demonstrated that the existing bone height and volume in the FGF-2+CO₃Ap group remained significantly greater than those in the CO₃Ap group.

Conclusion

This study demonstrated that the combination of FGF-2 and CO₃Ap was effective not only in enhancing new bone formation and replacing scaffold but also in maintaining the existing bone adjacent to the defect site in a beagle dog model of one-wall periodontal defect. Additionally, new periodontal tissues induced by FGF-2 and CO₃Ap may follow a maturation process similar to that formed by spontaneous healing. This suggests that the combined use of FGF-2 and CO₃Ap would promote periodontal regeneration in severe bony defects of periodontitis patient.

The expression of BMP4 and FGF2 in Wistar rats (Rattus norvegicus) post application of gourami fish (Osphronemus goramy) collagen

Background: Periodontitis is a chronic inflammatory disease of the periodontal tissue that is characterized by alveolar bone resorption. This occurs due to an imbalance of osteoblast and osteoclast during the bone formation and resorption processes. In order to obtain complete regeneration of periodontal tissue, bone grafting is frequently used in periodontal surgical therapy. Although each material has disadvantages, safe graft materials derived from animal sources can be employed as an alternative to bone graft materials. Osteoblast, osteoclast, calcified bone matrix, type I collagen, osteonectin, and hydroxyapatite can all be found in gourami scales, a form of food waste. BMP4 has osteoinduction functions, which are important in bone metabolism. Through angiogenic activity, FGF2 also contributes to periodontal regeneration. Purpose: The aim of the study was to assess the expression of BMP4 and FGF2 after the treatment group had been given gourami fish scale extract. Methods: Thirty-two experimental three-month-old male Wistar rats (150-200g) were randomly divided into four groups: a seven-day control group, a seven-day treatment group, a 14-day control group, and a 14-day treatment group. One mandibular incisor was extracted from each Wistar rat. The post-extraction socket was filled with blood for the control group and collagen extract for the treatment. Results: The one-way ANOVA test showed a significance level of 0.000 (p = <0.05). Conclusion: The expression of BMP4 and FGF2 increased after the application of collagen extract from gourami scales.

Visual and histological evaluation of the effects of trafermin in a dog oronasal fistula model

The standard procedure to treat oronasal fistula in dogs requires tooth extraction to close the fistula; hence, the subject would lose its tooth. In this study, trafermin was applied to four dog models with oronasal fistula to investigate the periodontal tissue regenerative effects of trafermin in the treatment without tooth extraction. A fistula was created along the palatal side of each upper canine tooth. One of the fistulae was filled with trafermin, whereas that on the contralateral side was left unfilled as a control. The results showed a significant decrease in the non-calcified periodontal tissue volume on the trafermin side after the fourth week. In addition, oronasal fistula closure was visually and histologically confirmed at the eighth week on the trafermin side of all four models.

The Role of Type 2 Fibroblast Growth Factor in Periodontal Therapy

The prevalence of periodontitis is around 20-50% in the global population. If it is not treated, it can cause tooth loss. Periodontal treatment aims at preserving the patient's teeth from various damages, including infection control and restoring lost periodontal tissue. The periodontium has great biological regenerative potential, and several biomaterials can be used to improve the outcome of periodontal treatment. To achieve the goal of periodontal tissue regeneration, numerous studies have used fibroblast growth factor 2 (FGF2) to stimulate the regeneration of both the soft tissue and bone. FGF2 induced a significant increment in the percentage of bone fill, bone mineral levels of the defect sites, length of the regenerated periodontal ligament, angiogenesis, connective tissue formation on the root surface, formation of dense fibers bound to the alveolar bone and newly synthesized cementum in teeth. This review will open further avenues to better understand the FGF2 therapy for periodontal regeneration.