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Ciardo A, Rampf S, Kim TS. Vital root resection with radicular retrograde partial pulpotomy in furcation-involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects. Int Endod J 2024; 57:617-628. [PMID: 38306111 DOI: 10.1111/iej.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
AIM Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro). SUMMARY Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6-10 mm) preoperatively and 2.62 ± 0.42 mm (3-4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing. KEY LEARNING POINTS In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.
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Affiliation(s)
- Antonio Ciardo
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Sarah Rampf
- Section of Endodontology and Dental Traumatology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Ti-Sun Kim
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, Heidelberg Faculty of Medicine, Heidelberg University, Heidelberg, Germany
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Mukherjee M, Nair V, Phull T, Jain A, Grover V, Ali ABM, Arora S, Das G, Hassan SAB, Sainudeen S, Saluja P. Biometric analysis of furcation area of molar teeth and its relationship with instrumentation. BMC Oral Health 2024; 24:436. [PMID: 38600486 PMCID: PMC11005133 DOI: 10.1186/s12903-024-04164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
The anatomy of furcation favours the bacterial retention and makes periodontal debridement as well as oral hygiene procedures difficult. Teeth that have lost attachment to a level of the furcation are said to have a furcal invasion or furcation involved.Involvement of furcation in a multi-rooted tooth poses a very different type of clinical situation in terms of establishment of diagnosis, determination of prognosis and of course planning the treatment modality.The present study was carried out on 200 selected extracted human first and second permanent molar teeth based on a predefined criteria. Teeth with prosthetic crowns, fused or fractured roots, those not fully developed, grossly carious or heavily restored at the cementoenamel junction (CEJ) were excluded from the study. The morphology of the root trunk was recorded by measuring various dimensions of the root trunk,including furcal angle and root trunk volume was calculated by using a custom made special apparatus. The furcation areas were debrided with different types of curettes in the market in order to see how best the instrument could be maneuvered in the furcation area. The data so obtained was statistically analysed using SPSS version 22. The highest root trunk volume and the longest root trunk length were found to be in the maxillary second molar. 48.60% furcations didn't allow instrument engagementof furcation area with standard area specific curettes. The proposal of inclusion of root trunk length (mm) is suggested in addition to classification of FI to have assess prognosis and appropriate treatment for of the involved tooth.
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Affiliation(s)
| | - Vineet Nair
- Dr. R Ahmed Dental College and Hospital, Kolkata, India
| | - Tanvi Phull
- Department of Oral and Maxillofacial Surgery, Gian Sagar Dental College, Rajpura, Patiala, India
| | - Ashish Jain
- Department of Periodontology and Oral Implantology Dr.H.S.J. Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Vishakha Grover
- Department of Periodontology and Oral Implantology Dr.H.S.J. Institute of Dental Sciences, Panjab University, Chandigarh, India
| | - Ahmed Babiker Mohamed Ali
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia
| | - Suraj Arora
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia
| | - Gotam Das
- Department of Prosthodontics, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia.
| | - Saeed Awod Bin Hassan
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia
| | - Shan Sainudeen
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Saudi Arabia
| | - Priyanka Saluja
- Department of Dentistry, University of Alberta, Edmonton, AB, Canada
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Kim HJ, Kim SY. Cervical enamel projections from a periodontal perspective: A scoping review. Clin Anat 2024; 37:353-365. [PMID: 38348736 DOI: 10.1002/ca.24141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/16/2023] [Accepted: 01/29/2024] [Indexed: 03/16/2024]
Abstract
Cervical enamel projections (CEPs) represent a unique developmental and anatomical anomaly wherein the enamel structure extends apically beyond the cemento-enamel junction of the tooth. In this scoping review, the existing literature on CEPs was evaluated to delineate their characteristics, prevalence, predilection for specific teeth and surfaces, clinical significance, and management approaches. Searches were conducted on MEDLINE (PubMed), Cochrane Library, and Embase databases using the keywords "enamel projection(s)" or "ectopic enamel." In total, 24 studies meeting inclusion criteria were included in the review. The prevalence of CEPs varied widely (8.3%-85.1%), predominantly manifesting as grade I or grade III. Mandibular first and second molars exhibited a higher incidence of CEPs, with a notable predilection for buccal surfaces. The consensus in most studies was that CEPs are associated with localized periodontal diseases. Recommendations inclined toward the removal of ectopic enamel during periodontal surgery to enhance periodontal attachment formation. However, decision-making should involve careful consideration of the benefits and drawbacks based on individual circumstances.
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Affiliation(s)
- Hyun Ju Kim
- Department of Periodontics, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Periodontology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sun-Young Kim
- Department of Conservative Dentistry and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Garg N, Lamba AK, Faraz F, Tandon S, Datta A, Dhingra S. Management of grade II and III furcation defects with intramarrow penetration along with indigenously prepared DFDBA and amniotic membrane: a clinical and radiographic study. Cell Tissue Bank 2024; 25:295-303. [PMID: 36627541 DOI: 10.1007/s10561-022-10068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023]
Abstract
Managing furcation defects constitutes a problem in successful periodontal therapy. Guided tissue regeneration (GTR) is the mainstay for the management of such defects but is expensive. This study makes use of indigenously prepared demineralized freeze-dried bone allograft (DFDBA) and amniotic membrane (AM) as a cost-effective alternative. The purpose of the study was to compare the clinical outcome of grade II and III furcation defects with and without using indigenous DFDBA and AM prepared at Central Tissue Bank, MAIDS. 18 systemically healthy patients with chronic periodontitis displaying either grade II or III furcation defects were treated with open flap debridement (OFD) + intramarrow penetration (IMP) (control group) and OFD + IMP + DFDBA + AM (test group). The clinical and radiographic parameters were recorded at 3 and 6 months postoperatively. All parameters were statistically analyzed. Both treatment modalities resulted in improvement in all clinical variables evaluated. Radiographic dimensions evaluating bone fill showed a statistically significant difference in the test group compared to the control group. Within the limitations of this study, data suggest GTR using indigenously prepared DFDBA and amniotic membrane to be an economical and viable option for treating furcation defects.
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Affiliation(s)
- Neha Garg
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India.
| | - Arundeep Kaur Lamba
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Farrukh Faraz
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shruti Tandon
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Archita Datta
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sachin Dhingra
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Mallapragda S, Gupta R, Gupta S, Sharma H, Srivastava S, Raj A. Evaluation of Regenerative Efficacy of Amnion and Chorion Membrane in Treatment of Mandibular Molar Furcation Defects: A Clinico-radiographic Study. J Contemp Dent Pract 2024; 25:160-167. [PMID: 38514414 DOI: 10.5005/jp-journals-10024-3640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIM Amnion and chorion membranes possess unique inherited biological properties that enhance wound healing and may accelerate periodontal regeneration. The present study aims to evaluate and compare the efficacy of amnion and chorion membranes in the treatment of furcation defects. MATERIALS AND METHODS A total of 20 patients were selected and were randomly allocated to group I and group II with 10 subjects in each group. Amnion and chorion membranes are placental-derived membranes that accelerate regeneration by having natural growth factors with their antimicrobial and inflammation reduction properties. Group I was treated using bone grafting with decalcified freeze-dried bone allograft (DFDBA) and placement of amnion as a membrane for guided tissue regeneration (GTR) whereas group II was treated using bone grafting with DFDBA and placement of chorion as a membrane for GTR. The patients were followed for clinical and radiographic parameters and were evaluated between 3 and 6 months after surgery. RESULT In intragroup comparison, a significant difference was evident in both the groups for all the clinical and radiographic parameters within the groups. (p = 0.01) This means both amnion and chorion membranes showed statistically significant regenerative efficacy. In intergroup comparison, the results show that all the clinical parameters and radiographic parameters show no significant difference between the groups. CONCLUSION The amnion and chorion membranes had similar regenerative efficacy in combination with DFDBA in patients with buccal degree II furcation defects in mandibular molars. CLINICAL SIGNIFICANCE The amnion and chorion membranes have shown significant improvement in clinical and radiographic parameters when used for the treatment of buccal degree II furcation defects in mandibular molars. How to cite this article: Mallapragda S, Gupta R, Gupta S, et al. Evaluation of Regenerative Efficacy of Amnion and Chorion Membrane in Treatment of Mandibular Molar Furcation Defects: A Clinico-radiographic Study. J Contemp Dent Pract 2024;25(2):160-167.
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Affiliation(s)
- Siddharth Mallapragda
- Department of Periodontology, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India, Orcid: https://orcid.org/0000-0001-5233-7092
| | - Radhika Gupta
- Department of Periodontology, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India, Phone: +91 9818150018, e-mail: , Orcid: https://orcid.org/0000-0001-9686-4476
| | - Stuti Gupta
- Department of Periodontology, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India, Orcid: https://orcid.org/0000-0001-8495-8723
| | - Himani Sharma
- Department of Periodontology, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India, Orcid: https://orcid.org/0000-0002-5243-7007
| | - Saransh Srivastava
- Department of Periodontology, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India, Orcid: https://orcid.org/0000-0001-7708-4749
| | - Anusha Raj
- Department of Periodontology, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India, Orcid: https://orcid.org/0000-0002-6026-5030
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Abdelrasoul M, El-Fattah AA, Kotry G, Ramadan O, Essawy M, Kamaldin J, Kandil S. Regeneration of critical-sized grade II furcation using a novel injectable melatonin-loaded scaffold. Oral Dis 2023; 29:3583-3598. [PMID: 35839150 DOI: 10.1111/odi.14314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Periodontal regenerative therapy using bone-substituting materials has gained favorable clinical significance in enhancing osseous regeneration. These materials should be biocompatible, osteogenic, malleable, and biodegradable. This study assessed the periodontal regenerative capacity of a novel biodegradable bioactive hydrogel template of organic-inorganic composite loaded with melatonin. MATERIALS AND METHODS A melatonin-loaded alginate-chitosan/beta-tricalcium phosphate composite hydrogel was successfully prepared and characterized. Thirty-six critical-sized bilateral class II furcation defects were created in six Mongrel dogs, and were randomly divided and allocated to three cohorts; sham, unloaded composite, and melatonin-loaded. Periodontal regenerative capacity was evaluated via histologic and histomorphometric analysis. RESULTS Melatonin-treated group showed accelerated bone formation and advanced maturity, with a significant twofold increase in newly formed inter-radicular bone compared with the unloaded composite. The short-term regenerative efficacy was evident 4 weeks postoperatively as a significant increase in cementum length concurrent with reduction of entrapped epithelium. After 8 weeks, the scaffold produced a quality of newly synthesized bone similar to normal compact bone, with potent periodontal ligament attachment. CONCLUSIONS Melatonin-loaded hydrogel template accelerated formation and enhanced quality of newly formed bone, allowing complete periodontal regeneration. Furthermore, the scaffold prevented overgrowth and entrapment of epithelial cells in furcation defects.
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Affiliation(s)
- Mohamed Abdelrasoul
- Department of Materials Science, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
| | - Ahmed Abd El-Fattah
- Department of Materials Science, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
- Department of Chemistry, College of Science, University of Bahrain, Sakhir, Kingdom of Bahrain
| | - Gehan Kotry
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Omneya Ramadan
- Department of Oral Pathology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Marwa Essawy
- Department of Oral Pathology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
- Center of Excellence for Research in Regenerative Medicine and Applications (CERRMA), Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jahangir Kamaldin
- Integrative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pulau Pinang, Bertam, Malaysia
| | - Sherif Kandil
- Department of Materials Science, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
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Yu Y, Zhong S, Sun W, Lei L. Application of digital technology and platelet-rich fibrin technology in a novel regenerative treatment for posterior lingual furcation defect: a 6-year follow-up case report. Hua Xi Kou Qiang Yi Xue Za Zhi 2023; 41:582-591. [PMID: 37805683 PMCID: PMC10580219 DOI: 10.7518/hxkq.2023.2023112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/13/2023] [Indexed: 10/09/2023]
Abstract
Conventional periodontal regenerative surgery has limited effect on tooth with severe periodontitis-related alveolar bone defects. This article reported a case of regenerative treatment in severe distal-bone defect of mandibular first molar. The treatment involved applying 3D printing, advanced/injectable platelet-rich fibrin, and guided tissue-regeneration technology. After the operation, the periodontal clinical index significantly improved and the alveolar bone was well reconstructed.
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Affiliation(s)
- Yuanyuan Yu
- Dept. of Periodontology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Shuaiqi Zhong
- Dept. of Periodontology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Weilian Sun
- Dept. of Periodontology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Lihong Lei
- Dept. of Periodontology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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Skurska A, Chwiedosik M, Ślebioda Z. Adjunctive use of platelet-rich fibrin in surgical treatment of furcation defects: A systematic review. Adv Med Sci 2023; 68:366-371. [PMID: 37757664 DOI: 10.1016/j.advms.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/20/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Periodontitis is an infectious disease characterized by the inflammatory destruction of the tooth supporting tissues. In multi-rooted teeth, this process leads to periodontal destruction within furcations creating defects demanding in terms of treatment. Regeneration of class II furcation involvement, although possible, is considered an unpredictable procedure, especially in terms of the bone fill. The interest in wound healing improvement by additional use of autologous concentrates of growth factors remains high in many fields of dentistry. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate and biomaterial. PRF forms a solid fibrin matrix, which is slowly remodeled comparable to the natural blood clot. Its utilization is associated with release of growth factors and glycoproteins over a long period of time. PRF activates alkaline phosphates, which show osteoblastic activity and this activation influences the bone formation. The aim of this review of randomized controlled trials (RCTs) was to evaluate the adjunctive use of platelet-rich fibrin in surgical treatment of furcation defects.
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Affiliation(s)
- Anna Skurska
- Department of Integrated Dentistry, Medical University of Bialystok, Poland.
| | | | - Zuzanna Ślebioda
- Department of Oral Surgery, Periodontology and Oral Mucosa Diseases, Poznan University of Medical Sciences, Poznan, Poland
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Jepsen K, Sculean A, Jepsen S. Complications and treatment errors related to regenerative periodontal surgery. Periodontol 2000 2023; 92:120-134. [PMID: 37435999 DOI: 10.1111/prd.12504] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/03/2023] [Indexed: 07/13/2023]
Abstract
Regenerative periodontal surgical procedures are an important component in the treatment of advanced periodontitis. They aim to improve the long-term prognosis of teeth that are periodontally compromised by the presence of intrabony and/or furcation defects, resulting biologically in formation of root cementum, periodontal ligament, and alveolar bone and evidenced clinically by reduction of deep pockets to maintainable probing depths and/or improvements of vertical and horizontal furcation depth. Over the last 25 years, substantial clinical evidence has been accumulated to support the value of regenerative procedures in periodontally compromised dentitions. However, treatment success requires close attention to certain factors on the level of the patient, the tooth/defect, and the operator. Ignoring these factors in case selection, treatment planning, and treatment execution will increase the risk of complications that may jeopardize clinical success and may even be considered as treatment errors. Based on the currently available evidence from clinical practice guidelines, treatment algorithms, and on expert opinion, the present article provides an overview on the main factors, which influence the outcomes of regenerative periodontal surgery and gives recommendations on how to prevent complications and treatment errors.
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Affiliation(s)
- Karin Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Chiou LL, Herron B, Lim G, Hamada Y. The effect of systemic antibiotics on periodontal regeneration: a systematic review and meta-analysis of randomized controlled trials. Quintessence Int 2023; 54:210-219. [PMID: 36472512 DOI: 10.3290/j.qi.b3648957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of the use of systemic antibiotics in regenerative periodontal surgery for treating teeth affected by periodontitis. DATA SOURCES Electronic (MEDLINE, EMBASE, LILACS, Scopus, and Cochrane) and manual literature searches for human randomized controlled trial studies published up to November 2022 were conducted by two reviewers. Meta-analysis was performed to assess probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain in groups receiving systemic antibiotics compared to those not receiving systemic antibiotics. A total of eight studies were included. While treated sites were intrabony defects in six papers, two studies focused on furcation defects. For intrabony defects, the weighted mean difference (WMD) of 0.30 mm (95% CI -0.18 to 0.78) and 0.27 mm (95% CI -0.13 to 0.66) was calculated for PPD reduction and CAL gain, respectively. The differences between antibiotics and non-antibiotics groups for PPD and CAL were not statistically significant. Quantitative analysis could not be performed for furcation defects due to the limited number of studies. However, regardless of the membrane type selection, the existing evidence indicated that antibiotics did not lead to superior clinical outcomes for furcation defects at 9 to 12 months after the regenerative procedures. CONCLUSION Based on this meta-analysis study's findings, the use of adjunct systemic antibiotics in regenerative periodontal surgery did not appear to achieve more favorable clinical outcomes. Thus, the use of adjunct systemic antibiotics as part of the regenerative periodontal therapy might not be justifiable and should be reconsidered. (Quintessence Int 2023;54:210-219; doi: 10.3290/j.qi.b3648957).
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Elboraey MO, Mously EA. Clinical and Radiographic Evaluation of Third-Generation Pericardium Membrane for the Treatment of Grade II Furcation Defect in Stage III Periodontitis Patients. Medicina (B Aires) 2023; 59:medicina59030572. [PMID: 36984573 PMCID: PMC10059014 DOI: 10.3390/medicina59030572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background and Objectives: Guided tissue regeneration, with or without a bone graft, is a modality for the treatment of furcation involvement. Because the direct application of a bone graft into the periodontal defect has drawbacks, such as the risk of microbial contamination and/or graft containment, a new modality of directly loading bone graft particles over the barrier membrane is now used. This study aimed to evaluate clinically and radiographically the effects of a two-layered membrane consisting of a layer of nanohydroxyapatite particles on a pericardium membrane in the treatment of stage III periodontitis, compared with direct application of a nanohydroxyapatite bone graft. Materials and Methods: Forty individuals with grade II furcation involvement were divided into two groups. Group I was treated with a two-layered membrane consisting of a pericardium membrane with nanohydroxy particles loaded onto its surface; group II was treated with direct application of a nano bone graft covered with pericardium membrane. Clinical and cone beam computed tomography (CBCT) radiographic assessments of the two groups were carried out after a 6-month follow-up period. Results: Clinically, the results showed a significant reduction in furcation involvement (F). The CBCT assessment also revealed reductions in depth (D), height (H), width (W), and 3D radiographic volume of furcation involvement in all study groups at baseline and at 6 months postoperative (p < 0.05) with no significant differences between groups. Conclusions: According to the results of the current study, a two-layer membrane formed by direct loading of bone graft particles onto a pericardium membrane can be used as an effective, reliable, and easy-to-use substitute for direct bone graft application into periodontal defects.
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Affiliation(s)
- Mohamed O. Elboraey
- Oral Medicine, Periodontology, Oral Diagnosis and Radiology Department, Faculty of Dentistry, Tanta University, Tanta 31527, Egypt
- Department of Preventive Dental Sciences and Periodontology, College of Dentistry, Taibah University, Madinah 41411, Saudi Arabia
| | - Eihab A. Mously
- Department of Preventive Dental Sciences and Periodontology, College of Dentistry, Taibah University, Madinah 41411, Saudi Arabia
- Correspondence:
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Agrawal AA, Dhadse PV, Kale BV, Bhombe KR, Ganji KK, Kielbassa AM. A blind randomized controlled pilot trial on recombinant human bone morphogenetic protein-2 in combination with a bioresorbable membrane on periodontal regeneration in mandibular molar furcation defects. Quintessence Int 2023; 54:112-124. [PMID: 36445774 DOI: 10.3290/j.qi.b3631815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVES In preparation of a definitive randomized clinical trial (RCT), the current parallel-grouped triple-blind pilot RCT assessed the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) with polylactic acid/polyglycolic acid (PLA/PGA) membrane for improvement of periodontal tissue regeneration in Class II furcation type defects. METHOD AND MATERIALS With the present single-center investigation, 24 patients/24 mandibular molars revealing Class II furcation lesions with involved buccal surfaces were randomly allocated and treated surgically, using either a PLA/PGA membrane alone (control, n = 12) or in combination with rhBMP-2 (n = 12). Assessors, participants, and the statistician were blinded to the treatment groups. Clinical parameters including Plaque Index (PI), Papillary Bleeding Index (PBI), clinical attachment level, vertical probing depth, horizontal probing depth, and gingival recession were assessed at baseline and 6 months postsurgery. RESULTS Baseline values concerning the investigated parameters were comparable between both groups (P > .05). After 6 months, clinical attachment level gain was similar (P = .76), while greater reductions in vertical probing depth (P = .01) and horizontal probing depth (P = .05), along with less gingival recession (P = .03) were observed in the PLA/PGA + rhBMP-2 group (compared to the controls). An increased number of completely closed furcation type defects was observed in the PLA/PGA + rhBMP-2 group (with no adverse effects). CONCLUSIONS When treating Class II furcation lesions, the use of rhBMP-2 (combined with PLA/PGA membranes) seems advantageous. The presented set-up seems feasible with regards to recruitment, randomization, acceptance, retention, and adherence to the study protocol. (Quintessence Int 2023;54:112-124; doi: 10.3290/j.qi.b3631815).
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Limiroli E, Acerboni A, Codari M, Rasperini G. Regenerative Surgery of Mandibular Class II Furcation Defects: A Comparison of Two Techniques in a Randomized Clinical Trial with 3D CBCT Measurements at 24 Months. INT J PERIODONT REST 2023; 43:29-37. [PMID: 36661872 DOI: 10.11607/prd.6364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The aim of the present study was to evaluate, clinically and via CBCT, the long-term efficacy of a bioresorbable polylactic acid membrane combined with deproteinized bovine bone graft (DBBM) and compare it to enamel matrix derivative (EMD) combined with DBBM graft in the treatment of class II furcation defects. Sites were randomly assigned to the test group (Guidor Matrix Barrier + Bio-Oss) or the control group (Emdogain + Bio-Oss). Probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (REC), and keratinized tissue (KT) width were assessed at 12 and 24 months, and radiographic bone gain was investigated at 24 months via CBCT. Both groups showed a significant radiographic bone fill and clinical gain. The combination of Emdogain + Bio-Oss showed better clinical outcomes and less complications, though this difference was not statistically significant.
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Jolivet G, Huck O, Petit C. Evaluation of furcation involvement with diagnostic imaging methods: a systematic review. Dentomaxillofac Radiol 2022; 51:20210529. [PMID: 35787071 PMCID: PMC9717400 DOI: 10.1259/dmfr.20210529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/09/2022] [Accepted: 07/01/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Multirooted teeth respond less favorably to non-surgical periodontal treatment and long-term tooth prognosis is influenced by the degree of furcation involvement (FI). Therapeutic strategy for multirooted teeth is essentially based on accurate diagnosis of the FI. The aim of this systematic review is to evaluate the accuracy of the different furcation assessment methods and to determine if radiographic help is needed to determine early stage of FI. METHODS Electronic databases were searched up to March 2021. Comparative studies describing the reliability of different clinical and/or radiological furcation assessment methods were identified. RESULTS A total of 22 studies comparing at least 2 furcation assessment methods, among which 15 retrospective studies, 5 prospective studies, 1 randomized controlled trial and 1 case series, were included in this review. The reliability of cone beam CT (CBCT), intraoral radiographs (IOs), orthopantomograms (OPGs) and MRI to identify FI was evaluated. Using OFS as a reference for FI detection and diagnosis, agreement ranged from 43.3 to 63% for OPG, 38.7 to 83.1% for IO and 82.4 to 84% for CBCT. The validity of the measurements was mainly influenced by the location of the furcation entrance. For radiological diagnosis, CBCT displayed the closest agreement with OFS while the accuracy of IO and OPG showed modest agreement and were influenced by the examiner's experience. CONCLUSION Altogether, it appears that the use of IO, OPG or CBCT allows detection of FI but could not be considered as gold-standard techniques.
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Bista S, Adhikari K, Baniya BK. Comparative Evaluation of Hydroxyapatite Bone Alloplast with Combination Bone Alloplast (Hydroxyapatitie and ?-Tricalcium Phosphate) in Grade II Mandibular Furcation Involvements. J Nepal Health Res Counc 2022; 20:510-516. [PMID: 36550737 DOI: 10.33314/jnhrc.v20i02.3796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/03/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The management of furcation involvements by regenerative surgery with bone alloplast have been used with varying degrees of success in periodontal therapy. The aim of the study was to clinically and radiographically compare the effectiveness of Hydroxyapatite bone alloplast with combination bone alloplast (Hydroxyapatite and ?-Tricalcium phosphate) for the treatment of Grade II mandibular furcation involvements. METHODS Thirty patients with bilateral Grade II mandibular furcation involvements were distributed in Group A (Hydroxyapatite) and Group B (Hydroxyapatite and ?-Tricalcium phosphate). Clinical parameters such as Plaque Index, Gingival Index, Probing Pocket Depth, Clinical Attachment Level and Horizontal Probing Depth were recorded at baseline and at one, three and six mths postoperatively. Radiographic bone fill measurements were recorded at baseline and six months post-operatively. RESULTS Both the groups showed statistically significant (p <0.01) improvement in clinical and radiographic parameters at each recall visits. Inter-group comparison of clinical parameters showed no significant difference in both the groups whereas radiographic measurements following six months post-surgery showed significantly (p <0.05) greater amount of bone fill in Group B compared to Group A. CONCLUSIONS It can be concluded that at six months post-operative, both the alloplastic materials resulted in significant improvement in clinical parameters and no significant difference was found between both groups. There was a statistically significant radiographic bone fill when a combination of Hydroxyapatite and ?-Tricalcium phosphate was used demontrating its effectiveness in the treatment of Grade II Furcation involvement.
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Affiliation(s)
- Soni Bista
- Department of Periodontology and Oral Implantology, College of Dental Surgery, Gandaki Medical College, Pokhara, Nepal
| | - Khushbu Adhikari
- Department of Periodontology and Oral Implantology, College of Dental Surgery, BPKIHS, Dharan,Nepal
| | - Bikash Kumar Baniya
- Department of Periodontology and Oral Implantology,College of Dental Surgery, Universal College of Medical Science, Bhairahawa, Nepal
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Neumeyer S, Hundeshagen B, Hopmann S, Neumeyer-Wühr S, Bruhnke M, Krüger K, Smeets R, Gosau M, Burg S. Functional and structural aspects in periodontal furcation treatment: a novel approach. Quintessence Int 2022; 53:884-891. [PMID: 36268948 DOI: 10.3290/j.qi.b3418205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The outcome in the treatment of furcation defects is often unsatisfactory. The reasons are morphologic and pathologic peculiarities as well as extensive changes in shape caused by resective treatment of periodontal lesions in multi-rooted teeth. Therefore, augmentative strategies are suggested to improve the prognosis. However, the success rate decreases with increasing severity of the disease. In contrast, if the affected roots are not extracted but are extruded after hemi- or trisection, this leads to a coronal displacement of the disease process and a significantly improved situation for hygiene. At the same time, the resection of inflammatory tissue of the periodontal pockets is accompanied by vertical and horizontal bone apposition. The results are predictable and stable in the long term. The burden for the patient is low. ((Quintessence Int 2022;53: 884-891; Originally published (in German) in Quintessenz Zahnmedizin 2020; 71(9): 1024-1032; doi: 10.3290/j.qi.b3418205).
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Oliveira PR, Sousa TO, Valladares-Neto J, Souza JAC, Silva MA, Roriz VM. Comparison of cone-beam computed tomography, clinical and surgical analysis for detection of maxillary molar furcation. Acta Odontol Latinoam 2021; 34:240-248. [PMID: 35088811 DOI: 10.54589/aol.34/3/240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/01/2021] [Indexed: 06/14/2023]
Abstract
The aim of this study was to compare the performance of conebeam computed tomography (CBCT), clinical and surgical probing in assessing maxillary molar furcation involvement (FI). Furcation defects (n= 120) were assessed through CBCT, clinical and intra-surgical evaluation (ISE). Furcation Involvement, vertical and horizontal bone loss were assessed through clinical probing, CBCT and probing during ISE. Three trained radiologists evaluated CBCT images and intra- and interobserver agreement were calculated by Kappa test and Intraclass Correlation Coefficient (ICC). McNemar and Wilcoxon tests were used to compare clinical probing, ISE and CBCT. Accuracy, sensitivity, specificity, positive and negative predictive values were calculated to detect FI. Clinical findings showed 28 sites with Degree I, 25 sites with Degree II, and 8 sites with Degree III. Good intra- (k=1.00) and interobserver agreement (k=0.773) were observed. Intraobserver and interobserver agreement for horizontal bone loss were moderate, k=0.485 and k=0.549, respectively. Intra-surgical findings showed Degree I at 21 sites, and Degree II and Degree III FI at fifteen sites each. Clinical evaluation showed 75% agreement with ISE and 78% with CBCT. Accuracy for clinical detection of FI was 75%, while for CBCT evaluation ranged from 72.5% to 77.5%, considering the 3 observers. Significant differences were found at distal sites using CBCT (p<0.05). Clinical evaluation and CBCT showed similar results for the presence or absence of FI. Concerning horizontal and vertical bone loss, CBCT was not considered a precise examination method for incipient bone defects.
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Affiliation(s)
- Paula Rd Oliveira
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Estomatologia, Goiânia, Brasil
| | - Thiago O Sousa
- Centro de Diagnóstico Odontológico por Imagem, Goiânia, Brasil
| | - José Valladares-Neto
- Universidade Federal de Goiás, Faculdade de Odontologia Departamento de Reabilitação Oral, Goiânia, Brasil
| | - João Antônio C Souza
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Estomatologia, Goiânia, Brasil
| | - Maria Ag Silva
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Estomatologia, Goiânia, Brasil
| | - Virgílio M Roriz
- Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Estomatologia, Goiânia, Brasil.
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Su WQ, Shi JH, Cheng Y, Lei L, Li HX. Periodontal treatment of furcation involvement at the mandibular first molar with a follow-up of 27 years. Hua Xi Kou Qiang Yi Xue Za Zhi 2021; 39:347-354. [PMID: 34041886 PMCID: PMC8218268 DOI: 10.7518/hxkq.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/19/2021] [Indexed: 11/21/2022]
Abstract
Due to the complicated anatomical structures in the furcation area of multirooted mandibular first molars, dental hygiene is greatly compromised once the furcation is involved in the periodontitis, leading to the unfavorable prognosis of teeth with furcation involvement. A patient came to a dental office with the chief complaint of "mobile mandibular posterior tooth" 27 years ago. The periapical film showed alveolar bone resorption at the root furcation of the right mandibular first molar. Flap surgery and fine supportive therapy were conducted. The patient was diagnosed with "furcation involvement Class Ⅲ" during a revisit three years ago. Satisfactory and healthy periodontal statuses were observed 2, 9, 24, and 33 months after the periodontal flap surgery plus tunneling procedures. A follow-up of 27 years in the present case demonstrated that a favorable prognosis of furcation involvement can be achieved after adequate periodontal treatment.
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Affiliation(s)
- Wen-Qi Su
- Dept. of Periodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Jia-Hong Shi
- Dept. of Periodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Yan Cheng
- Dept. of Periodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Lang Lei
- Dept. of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
| | - Hou-Xuan Li
- Dept. of Periodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
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Swami RK, Kolte AP, Bodhare GH, Kolte RA. Bone replacement grafts with guided tissue regeneration in treatment of grade II furcation defects: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:807-821. [PMID: 33438084 DOI: 10.1007/s00784-021-03776-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022]
Abstract
AIM The present systematic review appended with meta-analysis aimed to evaluate the efficacy of bone replacement graft (BRG) with guided tissue regeneration (GTR) over BRG or open flap debridement (OFD) alone in the treatment of grade II furcation defects. MATERIALS AND METHODS An electronic literature search of PubMed, Cochrane Library and Google Scholar databases accompanied with manual searching was done. Randomized controlled trials (RCTs) up to October 2019, comparing BRG+GTR with BRG or OFD in grade II furcation defects, were identified. Clinical attachment level (CAL) gain, changes in gingival marginal level (GML), vertical defect fill (VDF), horizontal defect fill (HDF) and reduction in defect volume were the outcome parameters. RESULTS Of a total of 12, 9 studies compared BRG+GTR vs BRG while 3 compared BRG+GTR vs OFD. Meta-analysis was carried out for CAL gain, VDF, HDF and GML changes. In the BRG+GTR vs BRG comparison group, out of 9 studies, 6 RCTs showed standardized mean difference (SMD) of 0.513 for VDF, 9 RCTs showed SMD of 0.83 for HDF and 2 RCTs showed SMD of 0.651 for CAL gain, whereas only 2 studies in the same group reported reduction in defect volume. Three studies of the BRG+GTR vs OFD group exhibited significant VDF and CAL gain with SMD of 2.002 and 1.161 respectively. However, no significant change was recorded for GML in both groups. CONCLUSION The present systematic review indicates supplemental benefits of combination therapy of BRG+GTR over monotherapy in resolving grade II furcation defects. CLINICAL RELEVANCE In our quest to achieve maximum regeneration in grade II furcation defects, combination therapies such as BRG+GTR have been accepted as treatment choices over other modalities. Clinical situations warranting near-complete regeneration of the tissues in such defects are better suited for combination therapies.
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Affiliation(s)
- Renuka K Swami
- Department of Periodontics & Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur, 440019, India
| | - Abhay P Kolte
- Department of Periodontics & Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur, 440019, India.
| | - Girish H Bodhare
- Department of Periodontics & Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur, 440019, India
| | - Rajashri A Kolte
- Department of Periodontics & Implantology, VSPM Dental College and Research Centre, Digdoh Hills, Hingna Road, Nagpur, 440019, India
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Bevilacqua L, Fonzar A, Olivier S, De Biasi M, Visintin M, Angerame D, Maglione M. Outcome of Different Surgical Approaches in the Treatment of Class II Furcation Defects in Mandibular Molars: A Randomized Clinical Trial. INT J PERIODONT REST 2020; 40:693-701. [PMID: 32925999 DOI: 10.11607/prd.4850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to investigate which factors play a major role in the healing of Class II mandibular furcation defects treated with different surgical techniques. Twenty-five systemically healthy subjects with periodontitis stage III grade B and Class II buccal mandibular furcation involvement received one of the following open flap debridement approaches: Group 1 (n = 10), no further treatment; Group 2 (n = 10), piezoelectric contouring of the furcation roof; Group 3 (n = 9), piezoelectric contouring of the furcation roof and bone grafting; Group 4 (n = 10), piezoelectric contouring of the furcation roof and bone grafting with coronally positioned flap. Clinical and radiologic variables-bleeding on probing, probing depth (PPD), vertical and horizontal bone level (CAL and PH), gingival recession, root trunk length, radicular separation, and furcation perimeter (FP)-were evaluated at baseline and 180 days and 1 year after surgery. All clinical parameters were statistically analyzed. Surgical techniques caused clinical (CAL, PPD, PH) and radiographic (FP) improvements. Regenerative techniques and the coronally positioned flap yielded a major radiographic reduction of furcation areas. All therapies resulted in significant horizontal and vertical PPD reduction and CAL gain.
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21
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Oliveira HFE, Verri F, Lemos CA, Cruz R, Batista VEDS, Pellizzer E, Santinoni C. Clinical Evidence for Treatment of Class II Periodontal Furcation Defects. Systematic Review and Meta-analysis. J Int Acad Periodontol 2020; 22:117-128. [PMID: 32655037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND This systematic review evaluated the most effective therapeutic approach to treat periodontal furcation defects with a minimum follow-up of 12 months. The primary outcome was clinical attachment level (CAL). Secondary outcomes were probing pocket depth, gingival margin level, gingival index and plaque index. METHODS A comprehensive search of studies published up to December 2019 and listed in PubMed/MEDLINE, Scopus, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) statement. Two reviewers independently searched eligible studies, made a final article selection, and extracted the data of the selected studies to evaluate qualitatively and quantitatively (meta-analysis). RESULTS Overall, 19 studies were selected for the analysis. Six hundred and eighteen patients (mean age, 45.3) were treated. More commonly used treatment was polytetrafluoroethylene barrier (ePTFE), followed by enamel matrix derivative (EMD) and open-flap debridement (OFD). Only one study evaluated maxillary arch and remaining evaluated mandibular arch. All treatments provided CAL gain, but meta-analysis did not show significant difference among more commonly used treatments and controls (P=0.91; P=0.47; P=0.08, respectively). CONCLUSION There is no difference on effectiveness of main therapeutic approaches evaluated for treatment of Class II periodontal furcation defects.
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Affiliation(s)
| | - Fellippo Verri
- Dental School, Univ. Estadual Paulista - UNESP, Araçatuba, Brazil
| | | | - Ronaldo Cruz
- Dental School, Univ. Estadual Paulista - UNESP, Araçatuba, Brazil
| | - Victor Eduardo de Souza Batista
- Dental School, Graduate Program in Dentistry (GPD - Master's Degree) UNOESTE - University of Western Sao Paulo, Presidente Prudente, Brazil
| | | | - Carolina Santinoni
- Dental School, Univ. Estadual Paulista - UNESP, Araçatuba, Brazil. Dental School, Graduate Program in Dentistry (GPD - Master's Degree) UNOESTE - University of Western Sao Paulo, Presidente Prudente, Brazil. E-mail:
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Abstract
Root resection and hemisection is a treatment option for furcated molars, and the prognosis of this technique has been well documented. The aim of the present paper is to systematically review studies examining the survival and/or failure rate of root resection and hemisection and to determine the factors behind the variability in the outcome reported. A Medline (PubMed), Embase, and Google Scholar search was undertaken, looking for articles published up to September 2016. A total of 1,012 publications were screened. Two reviewers analyzed the articles and extracted the data. Case series studies required a minimum of 5 cases, and all levels of evidence were accepted. A total of 22 studies met the inclusion criteria. Survival rate and follow-up times differed widely: survival rate ranged from 40.3% to 100% and follow-up from 6 months to 23 years. Half of the studies had a survival rate > 90% with a follow-up period ranging from 5 to 23 years. Therefore, root resection and hemisection are associated with high survival rates, making it a reliable option for treatment of furcated molars that should be considered before every extraction and implant placement. In a great number of studies, incomplete information was found concerning case selection and endodontic, restorative, and maintenance therapy, which makes one question the obtained results and the occasional reports of low survival rates. These concerns should encourage more detailed, long-term clinical trials, with respect to each phase requirement for the procedure, for a better assessment of survival rate.
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Panda S, Karanxha L, Goker F, Satpathy A, Taschieri S, Francetti L, Das AC, Kumar M, Panda S, Fabbro MD. Autologous Platelet Concentrates in Treatment of Furcation Defects-A Systematic Review and Meta-Analysis. Int J Mol Sci 2019; 20:ijms20061347. [PMID: 30884920 PMCID: PMC6470588 DOI: 10.3390/ijms20061347] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/21/2022] Open
Abstract
Background: The aim of this review was to evaluate the adjunctive effect of autologous platelet concentrates (APCs) for the treatment of furcation defects, in terms of scientific quality of the clinical trials and regeneration parameters assessment. Methods: A systematic search was carried out in the electronic databases MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE, together with hand searching of relevant journals. Two independent reviewers screened the articles yielded in the initial search and retrieved the full-text version of potentially eligible studies. Relevant data and outcomes were extracted from the included studies. Risk of bias assessment was also carried out. The outcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss (HCAL, VCAL), horizontal and vertical furcation depth (HFD, VFD) were considered for meta-analysis. Results: Ten randomized trials were included in this review. Only one study was judged at high risk of bias, while seven had a low risk, testifying to the good level of the evidence of this review. The meta-analysis showed a favorable effect regarding all outcome variables, for APCs used in adjunct to open flap debridement (p < 0.001). Regarding APCs in adjunct to bone grafting, a significant advantage was found only for HCAL (p < 0.001, mean difference 0.74, 95% CI 0.54, 0.94). The sub-group analysis showed that both platelet-rich fibrin and platelet-rich plasma in adjunct with open flap debridement, yielded significantly favorable results. No meta-analysis was performed for APCs in combination with guided tissue regeneration (GTR) as only one study was found. Conclusion: For the treatment of furcation defects APCs may be beneficial as an adjunct to open flap debridement alone and bone grafting, while limited evidence of an effect of APCs when used in combination with GTR was found.
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Affiliation(s)
- Sourav Panda
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan 20122, Italy.
- Institute of Dental Science and SUM Hospital, Siksha O Anusandhan University, Bhubaneswar 751003, India.
| | - Lorena Karanxha
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan 20122, Italy.
| | - Funda Goker
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan 20122, Italy.
| | - Anurag Satpathy
- Institute of Dental Science and SUM Hospital, Siksha O Anusandhan University, Bhubaneswar 751003, India.
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan 20122, Italy.
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, Milan 20161, Italy.
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan 20122, Italy.
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, Milan 20161, Italy.
| | - Abhaya Chandra Das
- Institute of Dental Science and SUM Hospital, Siksha O Anusandhan University, Bhubaneswar 751003, India.
| | - Manoj Kumar
- Institute of Dental Science and SUM Hospital, Siksha O Anusandhan University, Bhubaneswar 751003, India.
| | - Sital Panda
- Department of Public Health, Regional Medical Research Center, Bhubaneswar 751003, India.
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan 20122, Italy.
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, Milan 20161, Italy.
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Pajnigara NG, Kolte AP, Kolte RA, Pajnigara NG. Volumetric Assessment of Regenerative Efficacy of Demineralized Freeze-Dried Bone Allograft With or Without Amnion Membrane in Grade II Furcation Defects: A Cone Beam Computed Tomography Study. INT J PERIODONT REST 2018; 37:255-262. [PMID: 28196167 DOI: 10.11607/prd.2901] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Volumetric changes were evaluated to assess the regenerative efficacy of demineralized freeze-dried bone allograft (DFDBA) with and without amnion membrane (AM) in Grade II furcation defects both clinically and radiographically using cone beam computed tomography (CBCT). Sites were randomly assigned to Group I (DFDBA) and Group II (DFDBA + AM). Clinical parameters such as probing pocket depth, clinical attachment level, gingival recession, and horizontal probing depth were assessed at baseline, 3 months, and 6 months. Radiographic dimensions of the defect height, width, depth, and volume were assessed at baseline and 6 months postoperatively. DFDBA used with AM resulted in significant improvement in clinical and radiographic parameters when compared with DFDBA alone. The mean reductions in radiographic volume of the defect were 11.15 ± 6.39 mL for Group I and 17.02 ± 10.86 mL for Group II. Greater reduction in volume indicated a greater amount of healed regenerated tissue in Group II patients.
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Natto ZS, Green MS. A Leukocyte- and Platelet-Rich Fibrin Showed a Regenerative Potential in Intrabony Defects and Furcation Defects but Not in Periodontal Plastic Surgery. J Evid Based Dent Pract 2017; 17:408-410. [PMID: 29197444 DOI: 10.1016/j.jebdp.2017.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Regenerative potential of leucocyte- and platelet-rich fibrin. Part A: intra-bony defects, furcation defects and periodontal plastic surgery. A systematic review and meta-analysis. Castro AB, Meschi N, Temmerman A, Pinto N, Lambrechts P, Teughels W, Quirynen M. J Clin Periodontol 2017; 44(1):67-82. SOURCE OF FUNDING Self-funded by the authors and their institution TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.
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De Beule F, Alsaadi G, Perić M, Brecx M. Periodontal treatment and maintenance of molars affected with severe periodontitis (DPSI = 4): An up to 27-year retrospective study in a private practice. Quintessence Int 2017; 48:391-405. [PMID: 28396888 DOI: 10.3290/j.qi.a38059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This retrospective study aimed to evaluate the long-term response of molars affected with severe periodontitis to periodontal treatment, to analyze the differences in response between molars with and without furcation involvement (FI) and to reevaluate the usefulness of the existing classification of FI in determining the prognosis. METHOD AND MATERIALS A total of 402 patients from a single private practice were included. The observation period was 27 years (mean 16.5 years). The average frequency of the supportive periodontal therapy (SPT) visits was 1.76 ± 0.57 per year (median 1.95/ year). Inclusion criteria were: at least 10 years of periodontal follow-up, at least one tooth with probing depth ≥ 6 mm, level 4 of the Dutch Periodontal Screening Index (DPSI). RESULTS Of the 2,559 molars present at the initial examination, 125 were extracted immediately. Degrees III or II FI were found in 37.2% molars, while 62.8% exhibited degree I or had no FI. The performed periodontal treatments were: nonsurgical therapy of scaling and root planing (77.6%), eventually repeated scaling and root planing (11.6%), access flap (7.8%), tunnellization (0.2%), and root resection (2.8%). The survival rate was 83.9% (77.5% molars with FI; 87.8% without FI). The presence or absence of FI did not exhibit a significant effect in any of the treatments provided. CONCLUSION Simple treatments can successfully be applied to treat molars affected with severe periodontitis, even with FI, yielding good long-term survival rates. The classification of FI was not of great use in determining the prognosis except in case of degree III FI.
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Qiao J, Duan JY, Chu Y, Sun CZ. [Effect of concentrated growth factors on the treatment of degree II furcation involvements of mandibular molars]. Beijing Da Xue Xue Bao Yi Xue Ban 2017; 49:36-42. [PMID: 28203001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Concentrated growth factors (CGF), a new generation of platelet concentrate products, appears to have more abundant growth factors because of its special centrifugation process. However, there are few studies supporting this. This study was designed to evaluate the effect of CGFs in the treatment of II° furcations of mandibular molars. METHODS In the present study, thirty-one II° furcation involvements in twenty mandiblular molars were included and randomly divided into two groups. The furcation involvements in the experimental group were treated with bone graft therapy combined with CGFs, and the furcation involvements in the control group were treated with bone graft therapy alone. The clinical examination and cone beam computed tomography (CBCT) were performed at baseline and 1 year post-surgery for the two groups. The changes of clinical and CBCT data at baseline and 1 year post-surgery were compared between the experimental group and the control group. RESULTS At baseline, there were no significant differences between the two groups in the probing depth (PD), vertical clinical attachment loss (CAL-V) and horizontal clinical attachment loss (CAL-H): PD (7.36±2.32) mm (the experimental group) vs. (7.53±2.06) mm (the control group); CAL-V (8.69±1.65) mm (the experimental group) vs. (8.81±1.53) mm (the control group); CAL-H (5.24±2.01) mm (the experimental group) vs. (5.35±2.14) mm (the control group). At the end of 1 year post-surgery, the clinical parameters of both groups were significantly improved (P<0.001). For the experimental group, the average vertical attachment gain was (2.78±1.66) mm, and the vertical attachment loss was improved significantly compared with the baseline (P<0.001); the average horizontal attachment gain was (2.10±1.89) mm, and the horizontal attachment loss were improved significantly compared with the baseline (P<0.001). Furthermore, the improvement degree of the experimental group was significantly higher than that of the control group (P<0.001). At baseline, there were no statistical differences in the vertical bone loss (BL-V) or horizontal bone loss (BL-H) between the two groups (P>0.05): BL-V (5.08±2.17) mm (the experimental group) vs. (5.84±2.65) mm (the control group); BL-H (5.85±2.13) mm (the experimental group) vs. (6.01±2.27) mm (the control group). At 1 year post-surgery, both groups showed significant radiographic bone gain at vertical and horizontal directions compared with baseline (P<0.001). For the experimental group, the average vertical radiographic bone gain was (2.20±1.98) mm, the horizontal radiographic bone gain was (2.51±2.18) mm, the vertical and horizontal radiographic bone loss were both significantly reduced compared with the baseline (P<0.001). For the control group, the average vertical radiographic bone gain was (1.89±2.15) mm, the horizontal radiographic bone gain was (1.30±2.47) mm, the vertical and horizontal radiographic bone losses were both significantly reduced compared with the baseline (P<0.001). And the experimental group showed significantly higher bone gain at vertical and horizontal directions compared with the control group (P<0.001). CONCLUSION Within the limitation of the present study, CGFs showed positive role in the treatment of II° furcation involvements of mandibular molars.
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Affiliation(s)
- J Qiao
- First Clinical Division, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100034, China
| | - J Y Duan
- First Clinical Division, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100034, China
| | - Y Chu
- First Clinical Division, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100034, China
| | - C Z Sun
- First Clinical Division, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100034, China
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Müller C, Zaruba M, Gartenmann S, Lampe-Bless K, Schmidlin PR. [Not Available]. Swiss Dent J 2017; 127:867-875. [PMID: 29199419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Constanze Müller
- Klinik für Präventivzahnmedizin, Parodontologie und Kariologie, Zentrum für Zahnmedizin, Universität Zürich, Zürich, Schweiz
| | - Markus Zaruba
- Klinik für Präventivzahnmedizin, Parodontologie und Kariologie, Zentrum für Zahnmedizin, Universität Zürich, Zürich, Schweiz
- Privatpraxis, Deutschland
| | - Stefanie Gartenmann
- Klinik für Präventivzahnmedizin, Parodontologie und Kariologie, Zentrum für Zahnmedizin, Universität Zürich, Zürich, Schweiz
| | - Kathrin Lampe-Bless
- Klinik für Präventivzahnmedizin, Parodontologie und Kariologie, Zentrum für Zahnmedizin, Universität Zürich, Zürich, Schweiz
- Privatpraxis, Schweiz
| | - Patrick R. Schmidlin
- Klinik für Präventivzahnmedizin, Parodontologie und Kariologie, Zentrum für Zahnmedizin, Universität Zürich, Zürich, Schweiz
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Queiroz LA, Santamaria M, Casati M, Silverio K, Nociti-Junior F, Sallum E. Enamel matrix protein derivative plus synthetic bone substitute for the treatment of mandibular Class II furcation defects: a case series. Quintessence Int 2016; 46:199-205. [PMID: 25386635 DOI: 10.3290/j.qi.a32988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this study is to report on the treatment of mandibular Class II furcation defects with enamel matrix protein derivative (EMD) combined with a βTCP/HA (β-tricalcium phosphate/hydroxyapatite) alloplastic material. METHOD AND MATERIALS Thirteen patients were selected. All patients were nonsmokers, systemically healthy, and diagnosed with chronic periodontitis; had not taken medications known to interfere with periodontal tissue health and healing; presented one Class II mandibular furcation defect with horizontal probing equal to or greater than 4 mm at buccal site. The clinical parameters evaluated were probing depth (PD), relative gingival margin position (RGMP), relative vertical clinical attachment level (RVCAL), and relative horizontal clinical attachment level (RHCAL). A paired Student t test was used to detect differences between the baseline and 6-month measurements, with the level of significance of .05. RESULTS After 6 months, the treatment produced a statistically significant reduction in PD and a significant gain in RVCAL and RHCAL, but no observable change in RGMP. RVCAL ranged from 13.77 (± 1.31) at baseline to 12.15 (± 1.29) after 6 months, with a mean change of -1.62 ± 1.00 mm (P < .05). RHCAL ranged from 5.54 (± 0.75) to 2.92 (± 0.92), with a mean change of -2.62 ± 0.63 mm (P < .05). After 6 months, 76.92% of the patients improved their diagnosis to Class I furcation defects while 23.08% remained as Class II. CONCLUSION The present study has shown that positive clinical results may be expected from the combined treatment of Class II furcation defects with EMD and βTCP/HA, especially considering the gain of horizontal attachment level. Despite this result, controlled clinical studies are needed to confirm our outcomes.
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Kini V, Nayak DG, Uppoor AS. A Clinical Evaluation of Biphasic Calcium Phosphate Alloplast with and without a Flowable Bioabsorbable Guided Tissue Regeneration Barrier in the Treatment of Mandibular Molar Class II Furcation Defects. J Contemp Dent Pract 2016; 17:143-148. [PMID: 27207003 DOI: 10.5005/jp-journals-10024-1817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Guided tissue regeneration (GTR) therapy has shown good results in the management of mandibular molar class II furcation defects. Advances in biomaterial sciences have developed alloplastic bone replacement graft materials and bioabsorbable GTR barrier membranes with good biologic response and handling properties. The aim of this study was to compare the attachment gain and the bone fill obtained with an alloplast [biphasic calcium phosphate (BCP) 60% hydroxyapatite (HA) and 40% beta tricalcium phosphate (b-TCP)] with and without a bioabsorbable GTR barrier [flowable poly (DL-lactide) (PLA) dissolved in N-methyl-2-pyrrolidone (NMP)] in the treatment of mandibular molar class II furcation defects. MATERIALS AND METHODS A total of 20 class II furcation defects were treated in 16 patients with chronic periodontitis in a comparative study. Ten defects were treated with Camceram(®) (BCP 60% HA and 40% - TCP) bone replacement graft material (group I) and 10 defects with a combination of Camceram® bone replacement graft material with Atrisorb® Freeflow™, bio-absorbable GTR barrier (flowable PLA dissolved in NMP) (group II). At baseline and at 6 months postsurgery, clinical parameters of vertical probing depth (PD) and horizontal probing depth (P-H), clinical attachment level (CAL), gingival recession (GR), and vertical depth of furcation defect (VDF) and horizontal depth of furcation defect (BP-H) were evaluated. RESULTS Statistical analysis was done with the Statistical Package for Social Sciences (SPSS) program. Intergroup comparisons made at 6 months postsurgery by unpaired Student's t-test showed mean reduction in PD in group I was 3.10 ± 0.73 mm and in group II was 3.20 ± 1.03 mm (p > 0.05). Mean reduction in P-H in group I was 1.60 ± 0.69 mm and in group II was 1.90 ± 0.73 mm (p > 0.05). Gain in CAL in group I was 2.80 ± 1.03 mm and in group II was 2.90 ± 0.94 mm (p > 0.05). Change in GR in group I was -0.30 ± 0.48 mm and in group II was -0.30 ± 0.48 (p > 0.05). Reduction in VDF in group I was 1.30 ± 0.67 mm and in group II was 1.80 ± 0.63 mm (p ≤ 0.01). Reduction in BP-H in group I was 1.30 ± 0.67 mm and in group II was 1.90 ± 0.73 mm (p ≤ 0.05). CONCLUSION It was concluded that the combination technique of BCP alloplast with a flowable bioabsorbable GTR barrier led to better results in regard to defect bone fill as compared with when the BCP alloplast alone was used.
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Affiliation(s)
- Vineet Kini
- Professor, Department of Periodontics, Mahatma Gandhi Mission Dental College and Hospital, Navi Mumbai, Maharashtra, India, Phone: +919769804390, Fax: 022-27433185, e-mail:
| | - Dilip G Nayak
- Department of Periodontics, Manipal College of Dental Sciences, Mangaluru, Karnataka, India
| | - Ashita S Uppoor
- Department of Periodontics, Manipal College of Dental Sciences, Mangaluru, Karnataka, India
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Ivanovic A, Nikou G, Miron RJ, Nikolidakis D, Sculean A. Which biomaterials may promote periodontal regeneration in intrabony periodontal defects? A systematic review of preclinical studies. Quintessence Int 2016; 45:385-95. [PMID: 24634903 DOI: 10.3290/j.qi.a31538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To systematically analyze the regenerative effect of the available biomaterials either alone or in various combinations for the treatment of periodontal intrabony defects as evaluated in preclinical histologic studies. DATA SOURCES A protocol covered all aspects of the systematic review methodology. A literature search was performed in Medline, including hand searching. Combinations of searching terms and several criteria were applied for study identification, selection, and inclusion. The preliminary outcome variable was periodontal regeneration after reconstructive surgery obtained with the various regenerative materials, as demonstrated through histologic/ histomorphometric analysis. New periodontal ligament, new cementum, and new bone formation as a linear measurement in mm or as a percentage of the instrumented root length were recorded. Data were extracted based on the general characteristics, study characteristics, methodologic characteristics, and conclusions. Study selection was limited to preclinical studies involving histologic analysis, evaluating the use of potential regenerative materials (ie, barrier membranes, grafting materials, or growth factors/proteins) for the treatment of periodontal intrabony defects. Any type of biomaterial alone or in various combinations was considered. All studies reporting histologic outcome measures with a healing period of at least 6 weeks were included. A meta-analysis was not possible due to the heterogeneity of the data. CONCLUSION Flap surgery in conjunction with most of the evaluated biomaterials used either alone or in various combinations has been shown to promote periodontal regeneration to a greater extent than control therapy (flap surgery without biomaterials). Among the used biomaterials, autografts revealed the most favorable outcomes, whereas the use of most biologic factors showed inferior results compared to flap surgery.
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Siqueira SJ, Ribeiro FV, Villalpando KT, Cirano FR, Pimentel SP. Maintenance periodontal therapy after systemic antibiotic and regenerative therapy of generalized aggressive periodontitis. A case report with 10-year follow-up. ACTA ACUST UNITED AC 2015; 42:385-6, 389-90, 392-3. [PMID: 26062264 DOI: 10.12968/denu.2015.42.4.385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aggressive periodontitis (AgP) is an inflammatory disease characterized by rapid attachment loss and bone destruction. This case report presents the 10-year results in a subject with generalized AgP treated by a regenerative periodontal therapeutic approach and the adjunctive use of antibiotics, following a systematic maintenance periodontal therapy. The use of enamel matrix derivatives (EMD) and adjunctive antibiotic therapy to treat AgP yielded improvements in clinical parameters and radiographic bony fill. This combined therapeutic approach following a systematic supportive periodontal therapy supports the long-term maintenance of teeth with previous advanced periodontal defects, demonstrating successful stability after 10-years follow-up. Clinical Relevance: The combined treatment protocol using EMD plus adjunctive antibiotic therapy, associated with a systematic supportive periodontal therapy, benefits the long-term maintenance of teeth with previous advanced periodontal defects in subjects presenting AgP, supporting this approach as an alternative in the treatment of AgP.
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Hazzaa HH, El Adawy H, Magdi HM. A Novel Surgical Approach for Treatment of Class II Furcation Defects Using Marginal Periosteal Membrane. J Int Acad Periodontol 2015; 17:20-31. [PMID: 26233970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study was designed to describe and evaluate the use of a vascularized marginal periosteal barrier membrane (MPM) harvested by a semilunar incision, alone or combined with a bone graft, in treatment of class II furcation defects in mandibular molars, compared to open flap debridement (OFD). METHODS Thirty class II furcation defects in mandibular molars were randomly assigned into three equal groups: Group I included OFD, Group II included defects treated with MPM, and Group III consisted of defects treated with MPM after applying demineralized freeze-dried bone allograft (DFDBA). At baseline and 6-month follow-up, vertical probing depth (VPD), clinical attachment level (CAL) measurements, along with a radiographic measurement of bone height (BH), were obtained for each defect. Transmission electron microscopy (TEM) was used for further evaluation of the histological changes associated with gingival samples related to each line of treatment. RESULTS Both Groups II and III reflected significant favorable outcomes in all the assessed parameters compared to OFD. A non-significant difference was found between both groups regarding VPD, while significant improvement in CAL and BH were detected in Group III (p ≤ 0.05). Favorable histological findings were also noticed in the test groups, with more improvement in Group III. CONCLUSION Placement of a vascularized MPM as a barrier membrane, using a semilunar incision, demonstrated a significant improvement in both clinical and histological outcomes of class II furcation defects in lower molars. When it was combined with DFDBA, a meaningful difference was found with regard to early wound healing and gain in CAL and BH.
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Afrashtehfar KI, Moshaverinia A. Five Things to Know About Regenerative Periodontal Therapies in Dental Medicine. J N J Dent Assoc 2015; 86:12-13. [PMID: 26242103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Livada R, Fine N, Shiloah J. Root amputation: a new look into an old procedure. N Y State Dent J 2014; 80:24-28. [PMID: 25219060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A treatment option for managing furcation invasions is root amputation. Long-term survival of resected molars requires a complete harmony of sequential endodontic, periodontic, restorative and maintenance procedures. The main objective of this article is to provide a concise historical perspective of this procedure and to review available literature regarding its efficacy and limitations. It also illustrates a current modification of the procedure using guided bone regeneration (GBR) and socket preservation to eliminate some of the potential disadvantages of the traditional root amputation procedure.
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Kasaj A. Root resective procedures vs implant therapy in the management of furcation-involved molars. Quintessence Int 2014; 45:521-9. [PMID: 24701615 DOI: 10.3290/j.qi.a31806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Therapeutic decision making and successful treatment of furcation- involved molars has been a challenge for many clinicians. Over recent decades, several techniques have been advocated in the treatment of furcated molar teeth, including nonsurgical periodontal therapy, regenerative therapy, and resective surgical procedures. Today, root resection is considered a relevant treatment modality in the management of furcation- involved multirooted molars. However, root resective procedures are very technique-sensitive and require a high level of periodontal, endodontic, and restorative expertise. Given the high documented success rates of implant treatment, the clinician is increasingly confronted with the dilemma of whether to treat a furcated molar by traditional root resective techniques or to extract the tooth and replace it with a dental implant. This article reviews the outcomes of root resective therapy for the management of furcation-involved multirooted teeth and discusses treatment alternatives including implant therapy. Treatment guidelines for root resective therapy, along with advantages and limitations, are presented to help the clinician in the decision-making process.
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Gracio ACMM, Barbieri AA, Da Silva KC, Guedes FP, Capelozza Filho L, Cardoso MA. Autogenous transplantation of a third molar using a two-stage technique. J Clin Orthod 2014; 48:107-112. [PMID: 24763678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | | | | | - Fabio Pinto Guedes
- Department of Orthodontics, University of Sagrado Coração, São Paulo, Brazil.
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Deo V, Gupta S, Ansari S, Kumar P, Yadav R. Evaluation of effectiveness of connective tissue graft as a barrier with bioresorbable collagen membrane in the treatment of mandibular Class II furcation defects in humans: 4-year clinical results. Quintessence Int 2014; 45:15-22. [PMID: 24392491 DOI: 10.3290/j.qi.a30767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Connective tissue grafts (CTGs) have been used as a barrier for closing mandibular Class II furcation defects. The present study compared long-term (48 months) effectiveness of CTG as a barrier with bioresorbable collagen membrane in the treatment of mandibular Class II furcation defects in humans. METHOD AND MATERIALS Twenty chronic periodontitis patients with a single Class II furcation defect on the buccal surface of mandibular teeth were included in the study. Vertical probing pocket depth (V-PPD), vertical relative attachment level (V-RAL), and relative gingival margin level (RGML) were recorded at baseline, 6 months, 12 months, and 48 months post-surgery. RESULTS The mean V-PPD reductions observed in the test group and control group were statistically significant at all time intervals when compared with the baseline. Similarly, the mean V-RAL gain at 6 months, 12 months, and 48 months were statistically significant, compared with the baseline data in both the groups. At 48 months the difference in V-RAL gain between the groups was found to be statistically significant, with greater improvements in test group. Complete closure of furcation and improvement in horizontal classification were better in the test group than in the control group. CONCLUSION It can be concluded that both treatment modalities result in improvement in clinical parameters. However, the results obtained with CTG appeared to be more stable.
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Yuh DY, Cheng GL, Chien WC, Chung CH, Lin FG, Shieh YS, Fang WH, Mau LP, Fu E, Huang RY. Factors Affecting Treatment Decisions and Outcomes of Root-Resected Molars: A Nationwide Study. J Periodontol 2013; 84:1528-35. [PMID: 23327113 DOI: 10.1902/jop.2013.120580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Da-Yo Yuh
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
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Censi R, De Micheli L, Borgonovo AE, Vavassori V, Re D. Treatment of seriously compromised teeth: decision- making criteria and treatment options. Minerva Stomatol 2013; 62:321-333. [PMID: 24126598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of this article was to describe the case of a patient who presented to our attention with severe periodontal disease, complicated by furcation involvement on elements 16 and 17. In addition, the radiographic exam revealed the presence of a deep intrabony defect distal to tooth 15. Surgical therapy is performed after the resolution of the endodontic component of the intra-bony defect on the element 15 and consists on osteoplasty and ostectomy on 16, guided tissue regeneration (GTR) on 15, extraction of 17 and bi-laminar connective tissue graft for the coverage of the recession on tooth 13. The patient is visited monthly and 9 months after surgery, the definitive metal-ceramic crown is delivered and adapted to tooth 16. At 18 months, the patient's periodontal situation is re-evaluated and the pocket depth results healthy (probing depth of tooth 15=2 mm). The surgical practices reported in this work allowed for functional and esthetic rehabilitation of periodontally compromised teeth. The RSR and the GTR represent conservative surgery that allow the preservation of compromised dental elements and if properly performed, guarantee excellent survival rates of the elements in the arch. For these reasons, when it is possible, the RSR and the GTR are a valid alternative to implantology and are to be considered as the first therapeutic option in the treatment plan.
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Affiliation(s)
- R Censi
- Department of Periodontology and Implantology III, Istituto Stomatologico Italiano, Milan, Italy -
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Malterud MI. Continuing education holds the key to minimally invasive biomimetic dental successes. Gen Dent 2013; 61:8-11. [PMID: 23928428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Reis ECC, Borges APB, del Carlo RJ, Oliveira PM, Sepúlveda RV, Fernandes NA, Martins LMA, Carvalho TB. Guided tissue regeneration using rigid absorbable membranes in the dog model of chronic furcation defect. Acta Odontol Scand 2013; 71:372-80. [PMID: 22587413 DOI: 10.3109/00016357.2012.680909] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Absorbable membranes are used to promote the regeneration of periodontal defects by Guided Tissue Regeneration (GTR). However, their collapse into the defect is commonly reported, impairing regeneration. Therefore, absorbable but rigid membranes aiming at preventing such collapse were developed and analyzed in periodontal regeneration. MATERIALS AND METHODS Membranes were analyzed in class II furcation defects in dogs; procedures included periodontal disease induction, prophylaxis and GTR (treated groups) or open flap debridement alone (control group). For GTR, the membranes were made of either 25% hydroxyapatite (HA) in polyhydroxybutyrate matrix (PHB) or 35% HA in PHB. Animals were clinically evaluated for gingival recession, clinical attachment level (CAL) and biopsies were collected at 60 and 120 days. Bone volume, trabeculae number, trabecular thickness and trabecular separation were quantified by micro-computed tomography, followed by histology. RESULTS Membrane exposure was observed in both treated groups (25 and 35% HAP) from the 8(th) day after surgery, continuously progressing until 120 days. Mean CAL for all groups remained above normal values for dogs. Bone volumetric values were not significantly different. Partial formation of bone, cementum and periodontal ligament was observed in treated groups. An inflammatory infiltrate was observed in the dense connective tissue that partially filled the center of the treated defects with active osteoclasts on bone surface. CONCLUSION Although partial regeneration of the defect was observed, it was limited by wound contamination. Consequently, rigid absorbable membranes made of HA and PHB failed to improve the regeneration of class II furcation defects in dogs.
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Sabattini VB, Mascolo A, Patel PB. Solving complex full-arch cases with simple solutions. Dent Today 2013; 32:86-89. [PMID: 23659096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This case report described a new technique for immediately loading an implant-supported fixed screw-retained bridge that has flat abutments to achieve a superior passive fit. The definitive prosthetic bridge was placed within 72 hours from surgery and follow-up data over a 5-year period are presented. Good aesthetic results were achieved, and at the end of the follow-up period neither biological nor biomechanical complications were observed.
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Mangot D. Advancing the standard of care with the LANAP protocol. Dent Today 2013; 32:118-121. [PMID: 23659102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- David Mangot
- University of Medicine and Dentistry of Medicine and Dentistry of New Jersey, New Jersey Dental School, USA.
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Schmitz JP. Layered socket Grafting using an anorganic bovine bone mineral-collagen composite. Tex Dent J 2013; 130:21-29. [PMID: 23488427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Following tooth extraction, socket grafts are commonly used to prevent incomplete healing and to optimize the bony site for implant placement (1). Many particulate, composite, and putty-like bone grafting materials either with or without a membrane have been used as socket grafts. This article introduces the layered socket grafting technique for socket grafting without the use of a membrane or primary closure. This technique uses a particulate anorganic bone mineral to graft the apices of sockets and then a composite material consisting of anorganic bovine bone mineral and collagen for the superior or crestal one-third of a socket or defect. When grafting sockets, the technique is fast and does not require the use of releasing flaps or primary closure and can also be used to manage large periapical defects.
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Johansson KJ, Johansson CS, Ravald N. The prevalence and alterations of furcation involvements 13 to 16 years after periodontal treatment. Swed Dent J 2013; 37:87-95. [PMID: 23957143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of this study was to evaluate the long term outcome of furcation involved molars in a population treated for periodontal disease. Initially, the study sample was 147 referred periodontal patients. Periodontal treatment consisted of oral hygiene instructions, supra- and subgingival scaling and periodontal surgery. After treatment 99 patients participated in a two year study on root caries. The patients got maintenance treatment every third to fourth month during 2 years. At the end of that study the patients were periodontally healthy and were referred back for supportive treatment to the referring dentist. Thirteen to 16 years after periodontal treatment 81 patients were still alive and 64 accepted a re-examination. At the start of the observation period the remaining 64 patients had in total 1537 teeth. During the 13 to 16 year follow up 217 teeth were lost. The number of molars at baseline was 361. The number of furcation involvement with different degrees were; 267 (0), 67 (I), 25 (II) and 2 (III) respectively. Totally 69 molars were lost during follow up. The proportion of molar loss according to the degree of furcation involvements 0 to III at baseline were 15%, 29%, 40% and 100% respectively. It was a significant greater risk of loosing an initially furcation involved molar than a single rooted tooth (p<0.0001). The risk of loosing an initially furcated molar increased with the degree of furcation involvement (degree I; p<0.05, degree II; p<0.01). I N CONCLUSION: During a long term observation period molars with furcation involvements are more frequently lost than not furcation involved molars. However, two thirds are still in function 13 to 16 years after treatment which indicate that molars with furcation involvements might survive long after periodontal treatment.
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Balusubramanya KV, Ramya R, Govindaraj SJ. Clinical and radiological evaluation of human osseous defects (mandibular grade ii furcation involvement) treated with bioresorbable membrane: vicryl mesh. J Contemp Dent Pract 2012; 13:806-811. [PMID: 23404007 DOI: 10.5005/jp-journals-10024-1233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The purpose of the present study was to evaluate clinical and radiological healing effects after treatment of class II furcation defects using bioresorbable periodontal mesh barriers. MATERIALS AND METHODS The patients for the following study were selected from Outpatient, Department of Periodontics, College of Dental Sciences, Davanagere, Karnataka. INCLUSION CRITERIA 1. Patients with age group between 18 and 60 years. 2. Patients who were nonsmokers. 3. Patients who had not undergone any type of periodontal therapy 6 months prior to initial examination. 4. Patients diagnosed as advanced periodontitis having mandibular grade II furcation involvement (Glickman 1953) clinically and radiologically. EXCLUSION CRITERIA 1. Patients who required antibiotic prophylaxis. 2. Patients allergic to tetracycline and/ or chlorhexidine. 3. Pregnant and lactating mother. 4. Patient showing unacceptable oral hygiene during presurgical (phase 1) therapy. RESULTS In this study clinical parameters were compared and attempt was made to compare the results radiographically too, with the limitations, the present study showed that the use of resorbable periodontal mesh barriers for GTR therapy at class II furcations resulted in reduction of furcation involvement. CONCLUSION Therefore it appears that a patient with class II furcations involvement benefits from barrier treatment, because results are superior to conventional treatment without barriers. CLINICAL SIGNIFICANCE The present study was taken up to evaluate the clinical effects of GTR therapy of class II furcations using bioresorbable periodontal mesh barriers.
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Affiliation(s)
- K V Balusubramanya
- Department of Periodontics, KGF College of Dental Sciences and Hospital, No 36, DK Plantation, BEML Nagar Post, Kolar Gold Fields-563115, Karnataka, India.
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Nevins ML, Camelo M, Schupbach P, Kim SW, Kim DM, Nevins M. Human clinical and histologic evaluation of laser-assisted new attachment procedure. INT J PERIODONT REST 2012; 32:497-507. [PMID: 22754897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This investigation was designed to evaluate the healing response to the laser-assisted new attachment procedure (LANAP). Eight patients presenting with 12 teeth predetermined to be surgically extracted were enrolled and consented to treatment with full-mouth LANAP therapy. LANAP surgical therapy consisted of a first pass with a 360-Μm fiber diameter, laser settings with verified output of 4.0 W and energy density of 1,965 mJ/mm2, 100-Μs pulse duration, and 20 Hz applied from the gingival margin to the base of the pocket parallel to the root surface and moved laterally and apically to remove the diseased pocket epithelium. The teeth were aggressively scaled and root planed with piezo ultrasonic instrumentation. A second pass was performed with a 360-Μm fiber diameter, laser settings with verified output of 4.0 W and energy density of 1,965 mJ/mm2, 650-Μs pulse duration, and 20 Hz applied from the apical extent of the bone defect to the gingival margin. After 9 months of healing, en bloc biopsy extractions were provided. Ten teeth were analyzed histologically to assess the periodontal wound healing. Five teeth evidenced a degree of periodontal regeneration with new cementum, periodontal ligament, and alveolar bone. One tooth had new attachment with new cementum and inserting collagen fibers, and four teeth healed via a long junctional epithelium. LANAP therapy should be further investigated with long-term clinical trials to compare the stability of clinical results to conventional therapy. This report provides evidence that LANAP therapy can induce periodontal regeneration.
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Affiliation(s)
- Marc L Nevins
- Division of Periodontology, Dept. of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
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Palioto DB, de O Macedo G, Queiroz AC, Taba M, Souza SLS, Grisi MFM, Novaes AB. Enamel matrix derivative and transforming growth factor-beta1 in Class III furcation defects. A histomorphometric study in dogs. J Int Acad Periodontol 2012; 14:69-75. [PMID: 22908536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of this study was to evaluate histomorphometrically, in dogs, the effect of enamel matrix derivative (EMD), with or without transforming growth factor-beta1 (TGF-beta1), in a periodontal Class III furcation model. Class III furcation defects were created in P3 and P4 of six dogs. The defects were allowed to stabilize for 21 days. Four experimental conditions were established: G1: control (propylene glycol alginate); G2: EMD; G3: TGF-beta1 and G4: EMD + TGF-beta1. After 12 weeks, the dogs were euthanized. Their jaws were removed, fixed, decalcified, dehydrated and embedded in paraffin. Semi-serial sections were obtained, stained and examined with light microscopy. The furcation defects were not completely closed in any specimen, with downgrowth of the junctional epithelium into the furcation area. The morphologic characteristics of the newly formed tissues in the test groups were similar to the control group, with slight differences in average values, but with no statistically significant differences between the groups. This study was not able to provide histological evidence that EMD, TGF-beta1 and EMD + TGF-beta1 present additional advantages in periodontal bone formation in a Class III furcation model in dogs.
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Affiliation(s)
- Daniela B Palioto
- Department of Bucco-Maxillo-Facial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Tucker LM, Melker DJ, Chasolen HM. Combining perio-restorative protocols to maximize function. Gen Dent 2012; 60:280-289. [PMID: 22782039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article describes a team approach for periodontal and restorative treatment intended to produce a predictable, biologically sound outcome that preserves more supporting bone and restores carious and broken down teeth. The goal of periodontal treatment, when performed in conjunction with restorative dentistry, is to provide restorative dentists with a high percentage of tooth structure that allows for a supragingival margin. An equally important goal is to ensure that an adequate thickness of connective tissue exists to create an environment more resistant to trauma and inflammation. The team approach consists of a restorative phase and a surgical phase. The restorative phase involves preparation with complete caries removal, adhesive core buildups, and provisionalization. The surgical phase involves biologic shaping of the roots and judicious osseous resection. Case studies are used to demonstrate the team approach.
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Affiliation(s)
- Lloyd M Tucker
- Pikos Implant Institute, Pam Harbor Institute, Palm Harbor, Florida, USA
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