Use of an amniotic membrane as a novel barrier in a tooth with a questionable prognosis

Human amniotic membrane as therapeutic agent in pulpotomy of permanent molars

A 22-year-old woman reported with a cariously exposed mandibular molar. Pulpotomy was planned rather than routine root canal treatment, which was otherwise indicated. Amniotic membrane (AM) that has been extensively researched in different fields of medicine was used as the pulpotomy agent. After gaining coronal access to the root orifices, bleeding was arrested and activated AM was placed over the root stumps. Glass ionomer cement(GIC) was placed over the membrane and temporary restoration was done. One week later, permanent restoration with composite resin was done. The patient's symptoms resolved, and the tooth started responding normally to vitality tests at subsequent follow-ups. The present case report is an attempt to use human AM as a natural pulpotomy agent for treating irreversible pulpitis in permanent teeth. Understanding of innumerable beneficial properties of the AM and its application in preserving vitality of permanent teeth is the main learning objective.

Surgical Application of Human Amniotic Membrane and Amnion-Chorion Membrane in the Oral Cavity and Efficacy Evaluation: Corollary With Ophthalmological and Wound Healing Experiences

Due to its intrinsic properties, there has been growing interest in human amniotic membrane (hAM) in recent years particularly for the treatment of ocular surface disorders and for wound healing. Herein, we investigate the potential use of hAM and amnion-chorion membrane (ACM) in oral surgery. Based on our analysis of the literature, it appears that their applications are very poorly defined. There are two options: implantation or use as a cover material graft. The oral cavity is submitted to various mechanical and biological stimulations that impair membrane stability and maintenance. Thus, some devices have been combined with the graft to secure its positioning and protect it in this location. This current opinion paper addresses in detail suitable procedures for hAM and ACM utilization in soft and hard tissue reconstruction in the oral cavity. We address their implantation and/or use as a covering, storage format, application side, size and number, multilayer use or folding, suture or use of additional protective covers, re-application and resorption/fate. We gathered evidence on pre- and post-surgical care and evaluation tools. Finally, we integrated ophthalmological and wound healing practices into the collected information. This review aims to help practitioners and researchers better understand the application of hAM and ACM in the oral cavity, a place less easily accessible than ocular or cutaneous surfaces. Additionally, it could be a useful reference in the generation of new ideas for the development of innovative protective covering, suturing or handling devices in this specific indication. Finally, this overview could be considered as a position paper to guide investigators to fulfill all the identified criteria in the future.

Periodontal approach in the management of alveolar cleft

The alveolar cleft is a bone-related developmental defect in the alveolar process of the maxillae, which is termed as cleft alveolus. The deformity occurs in 75% of the cleft palate and lip patients. Reconstructive surgery can provide both functional and esthetic benefits to such individuals. Conflicting opinions exist on the management of alveolar cleft, and these affect the treatment planning. We present the case of a 19-year-old female patient with a complaint of mobile teeth in the left frontal region of the upper jaw. On clinical examination, unilateral cleft alveolus was observed between the left lateral incisor and the canine region. A multidisciplinary approach was adopted, orthodontic treatment was started, and periodontal regenerative surgery was planned. This report also discusses the substitution of autogenous bone grafts with other materials such as allogenic grafts (demineralized freeze-dried bone allograft), platelet-rich plasma, platelet-rich fibrin membranes, and amnion membranes, which could serve as a new line of treatment for the condition.

Treatment of an Endo-Perio Lesion with Ozone Gas in a Patient with Aggressive Periodontitis: A Clinical Case Report and Literature Review

The pulp and periodontium have obvious relationships that have been described in many studies. Pulp infections may affect periodontal tissues and vice versa. Teeth with endo-perio lesions have a worse prognosis than isolated endodontic or periodontal lesions. Elimination of endodontic and periodontal infections is essential for successful treatment, so co-operation between endodontists and periodontists is necessary. In this clinical case, a 44-year-old male presented with primary periodontal disease with secondary endodontic involvement in his lower right canine because of aggressive periodontitis. There was 10 mm of clinical attachment loss and 8 mm periodontal pocket mesial from the tooth and bone radiolucency periapical and lateral from the root. Periodontal therapy was followed by endodontic treatment. Periodontal therapy included root scaling and planing, treatment of the periodontal pocket with ozone gas, systemic antibiotics, oral hygiene instructions, and chlorhexidine rinsing. Endodontic therapy included root canal instrumentation with rotary endodontic files, irrigation, root canal treatment with ozone gas, and obturation with lateral compaction. Radiographs at a 6-month follow-up appointment showed complete healing of the periapical lesion and alveolar bone lateral to the root. Using an interdisciplinary approach to treat endo-perio lesions provides favorable clinical outcomes. Ozone therapy is beneficial for the successful treatment of endo-perio lesions with narrow periodontal pockets in patients with aggressive periodontitis and poor prognosis.

Update review on five top clinical applications of human amniotic membrane in regenerative medicine

Due to the increasing number of studies performed in the field of regenerative medicine during the last two decades, more analytic studies are still needed to clarify the future prospect of this area of science. The main aim of this research was to review the clinical applications of human Amniotic membrane in the field of regenerative medicine critically. Furthermore, in the light of increasing numbers of available products derived from amniotic membrane, we aimed look in depth to see whether regenerative medicine research strategies have a place in the clinical setting. More specifically, in the present study, we attempted to provide insight on developing the new indication for more research and in the next step, for market leaders companies to expand cost-effectiveness of new derived AM products. 20 companies or distributers have offered some commercial products in this field. Survey on more than 90 clinical trials in last five years showed dermatology (and more specific wound healing), orthopedic, and ophthalmology are heavily biased toward multibillion dollar industry. Moreover, urology and dentistry with fewer numbers of clinical data in comparison with the above-mentioned areas, currently are in the path of translation (especially dentistry). In addition, otolaryngology and oncology with the lowest number showed more potential of research thorough understanding the properties that will help guiding the use of AM-derived products in these two areas in future. More than 50% of clinical studies were done or are developing in USA, which have the biggest share in market products. Subsequently, China, Egypt, India, Iran, and Germany with the ongoing clinical trials in different phases may have more approved products in near future.

Histological Comparison of New Bone Formation Using Amnion Membrane Graft Versus Resorbable Collagen Membrane: An Animal Study

The purpose of this article was to evaluate the bone induction effects of an amnion membrane-protected graft compared with a collagen membrane-protected graft in the repair of tibial bony defects in dogs. This study was performed using the tibial bone of dogs. After the removal of periosteum, similar holes were made with a 16-mm trephine drill (38 holes in total). For the study group, 10 holes were covered by absorbable collagen and 16 holes by amniotic membrane. In the control group, 12 holes were made and covered by the overlying soft tissue. Tibial bones were exposed after 6 and 12 weeks, and the samples were harvested and histologically processed. New bone formation was evaluated by histomorphometric study. Four Iranian mixed dogs older than 1.5 years were included in this study. The new bone formation was less in the control group when compared with the collagen group ( P = .863). The collagen group showed less bone formation than the amnion group ( P = .194), but this difference was not significant. However, bone formation in the amnion group was significantly more than in the control group ( P = .050). Using the amniotic membrane appears to accelerate bone formation in guided bone regeneration. However, further studies should investigate its clinical impact on bone healing.