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Mehrani Y, Kazemi Mehrjerdi H, Tavakoli A, Shafieian R, Salari A. Effects of Probiotic Lactobacilli plantarum in Treatment of Experimentally Induced Periodontal Disease in Rabbits. J Vet Dent 2024; 41:210-216. [PMID: 36927186 DOI: 10.1177/08987564231163193] [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: 03/18/2023]
Abstract
The aim of this study was to evaluate the therapeutic effects of probiotic Lactobacillus plantarum in experimentally induced periodontal disease in rabbits. The incisor teeth of 24 rabbits were scaled under general anesthesia. Two weeks later, silk ligatures were placed at the gingival margin of the incisor teeth to induce periodontal disease. After confirming the presence of periodontal disease by periodontal probing four weeks later, incisor mucogingival flaps were created and gingival pocket lavage and debridement was performed. The rabbits were randomly divided into four groups. Group 1: Control; Group 2: Microencapsulated form of the probiotic; Group 3: Planktonic form of the probiotic; and Group 4: Biofilm form of the probiotic. The rabbits were euthanized eight weeks later, and gingival connective tissue and epithelium were resected for histopathological and histomorphometric evaluation. The results showed that the rate of epithelial regeneration was lower and bone regeneration was significantly higher in the treatment groups compared to the Control group. The highest level of bone regeneration was in Group 2 (Microencapsulated probiotic). There was no significant difference in bone regeneration observed between the biofilm and planktonic probiotic groups. This study showed that applying the probiotic Lactobacillus plantarum in microencapsulated form improved bone regeneration in experimentally induced periodontal disease in rabbits.
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Affiliation(s)
- Yeganeh Mehrani
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Hossien Kazemi Mehrjerdi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Azin Tavakoli
- Department of Clinical Sciences, Islamic Azad University Garmsar Branch, Garmsar, Iran
| | - Reyhaneh Shafieian
- Department of Anatomy and Cell Biology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Salari
- Department of Food Hygiene and Aquaculture, Ferdowsi University of Mashhad, Mashhad, Iran
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Chen FM. [Periodontal tissue regeneration: current therapeutic strategies and future directions in further research]. Zhonghua Kou Qiang Yi Xue Za Zhi 2024; 59:312-317. [PMID: 38548587 DOI: 10.3760/cma.j.cn112144-20240130-00050] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Chronic and progressive destruction/damage of the periodontal tissues resulted from periodontitis is the leading cause of tooth loss in adults. Traditional periodontal therapies such as scaling and root planning or flap surgery have demonstrated effective in controlling local inflammation and in suppressing/arresting the disease progression of periodontitis. However, those infection control measures cannot help to regenerate lost periodontal tissues to a statistically or clinically significant degree. Although some successes regarding the reduction of the intrabony defect and maintenance of the periodontal homeostasis have been achieved in periodontal regenerative procedures, comprising but not limited to guided tissue regeneration (GTR) or bone grafting technique, the restorative effectiveness of the architecture and function of the lost or injured tissues is far from our clinical expectation. The use of the concept, technique, and method of tissue engineering for periodontal regeneration is a hotspot and animal studies have shown interesting outcomes in terms of functional regeneration of lost/damaged support tissues in the periodontium, including alveolar bone, periodontal ligament, and cementum. However, numerous issues need to be addressed before those regenerative approaches can be responsibly transformed to novel clinical therapies. Recently, paradigm that induces homing of host stem cells to site of the periodontium and encourage the body's innate capability to repair is a new research field termed endogenous regeneration. Given that endogenous regenerative technique avoids ex-vivo cell culture and transplantation, it should be relatively easier to be used in the treatment of clinical patients. Due to the limited oral microenvironment and harsh periodontal local condition for tissue regeneration, as well as poor understanding of periodontal regenerative biology, there is still a long way ahead to explore new effective, practical, and economical therapies to save and protect natural tooth and for combating highly prevalent periodontal disease.
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Affiliation(s)
- F M Chen
- Department of Periodontology, School of Stomatology, The Fourth Military Medical University, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi International Joint Research Center for Oral Diseases, Xi'an 710032, China
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Takallu S, Mirzaei E, Zakeri Bazmandeh A, Ghaderi Jafarbeigloo HR, Khorshidi H. Addressing Antimicrobial Properties in Guided Tissue/Bone Regeneration Membrane: Enhancing Effectiveness in Periodontitis Treatment. ACS Infect Dis 2024; 10:779-807. [PMID: 38300991 DOI: 10.1021/acsinfecdis.3c00568] [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: 02/03/2024]
Abstract
Guided tissue regeneration (GTR) and guided bone regeneration (GBR) are the two surgical techniques generally used for periodontitis disease treatment. These techniques are based on a barrier membrane to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics, or prosthetic restoration. Numerous studies have highlighted biocompatibility, space-creation, cell-blocking, bioactivity, and proper handling as essential characteristics of a membrane's performance. Given that bacterial infection is the primary cause of periodontitis, we strongly believe that addressing the antimicrobial properties of these membranes is of utmost importance. Indeed, the absence of effective inhibition of periodontal pathogens has been recognized as a primary factor contributing to the failure of GTR/GBR membranes. Therefore, we suggest considering antimicrobial properties as one of the key factors in the design of GTR/GBR membranes. Antibiotics are potent medications frequently administered systemically to combat microbes and mitigate bacterial infections. Nevertheless, the excessive use of antibiotics has resulted in a surge in bacterial resistance. To overcome this challenge, alternative antibacterial substances have been developed. In this review, we explore the utilization of alternative substances with antimicrobial properties for topical application in membranes. The use of antibacterial nanoparticles, phytochemical compounds, and antimicrobial peptides in this context was investigated. By carefully selecting and integrating antimicrobial agents into GTR/GBR membranes, we can significantly enhance their effectiveness in combating periodontitis. These antibacterial substances not only act as barriers against pathogenic bacteria but also promote the process of periodontal healing.
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Affiliation(s)
- Sara Takallu
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz 7133654361, Iran
| | - Esmaeil Mirzaei
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz 7133654361, Iran
| | - Abbas Zakeri Bazmandeh
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz 7133654361, Iran
| | - Hamid Reza Ghaderi Jafarbeigloo
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, University of Medical Sciences, Fasa 7461686688, Iran
- Student Research Center committee, Fasa University of Medical Sciences, Fasa 7461686688, Iran
| | - Hooman Khorshidi
- Department of Periodontology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz 7195615878, Iran
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Pasqualini E, Castro F, Curado D, Martelete A, Heboyan A, Saleh MH, Fernandes JCH, Fernandes GVO. Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies. Evid Based Dent 2024; 25:54. [PMID: 38182662 DOI: 10.1038/s41432-023-00964-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/17/2023] [Accepted: 11/28/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT). METHODS The focus question was "For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques' outcomes (C) to improve PD, CAL, GR, and periodontal stability (O)?" An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified. RESULTS After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%). CONCLUSION MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity.
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Affiliation(s)
- Elisa Pasqualini
- Masters' student, FCS, Universidade Fernando Pessoa, 4249-004, Porto, Portugal
| | - Filipe Castro
- FP-I3ID, FCS, Universidade Fernando Pessoa, 4249-004, Porto, Portugal
| | - Denise Curado
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | | | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Str. Koryun 2, Yerevan, 0025, Armenia
| | - Muhammad H Saleh
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | | | - Gustavo Vicentis Oliveira Fernandes
- Periodontics and Oral Medicine Department, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
- A.T. Still University - Missouri School of Dentistry & Oral Health, St. Louis, MO, USA.
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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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Ghouraba RF, Abotaha NF, Sagha SMA. Comparative evaluation of treatment of angular bone defect related to over-erupted tooth using guided tissue regeneration (GTR) followed by orthodontic intrusion (OI) versus OI followed by GTR: a controlled clinical trial. BMC Oral Health 2024; 24:273. [PMID: 38402144 PMCID: PMC10894484 DOI: 10.1186/s12903-024-04036-9] [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: 04/11/2023] [Accepted: 02/15/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Prematurity resulted from pathological migration of periodontally involved teeth with the loss of vertical stopping points between teeth, which can lead to teeth over eruption with dimensional changes favoring occlusal discrepancies. Therefore, evaluating and comparing the effect of guided tissue regeneration followed by orthodontic intrusion as opposed to orthodontic intrusion tracked by guided tissue regeneration in the treatment of an over-erupted tooth with angular bone loss. METHODS Twenty teeth in ten cases were selected with at least two teeth with vertical over-eruption and angular bone loss with the presence of their opposing. In group one, ten teeth over-erupted were treated by guided tissue regeneration followed by orthodontic intrusion, whereas, in group two, ten teeth over-erupted were treated by orthodontic intrusion followed by guided tissue regeneration. They were evaluated clinically for pocket depth, bleeding on probing, and tooth mobility. Radiographical evaluation assessed by cone beam computed tomography. RESULTS Clinically, there existed a statistically significant difference (P value ≤ 0.05) in favor of group one at six months post and in favor of group two at one year from re-evaluation regarding pocket depth and tooth mobility. Radiographically, in group one, there was a statistically significant improvement (P value ≤ 0.05) at six months post-guided tissue regeneration or orthodontic intrusion regarding defect depth and dimensional changes of the defect area, with a statistically significant difference (P value ≤ 0.05) in favor of group two at one year from re-evaluation phase regarding defect depth and defect area dimensional changes. CONCLUSION There was a short-term improvement in group one, which deteriorated over a long period compared with group two, so it is preferable to start orthodontic intrusion before guided tissue regeneration.
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Affiliation(s)
- Rehab F Ghouraba
- Oral medicine, Periodontology, Oral Diagnosis and Radiology Department, Faculty of Dentistry, Tanta University, Tanta, Egypt.
| | - Neveen Fakhry Abotaha
- Orthodontic Department, Faculty of Dentistry, Tanta University, El-Giesh St, Tanta, Gharbia, Egypt
| | - Sara Mohamed Ahmed Sagha
- Oral medicine, Periodontology, Oral Diagnosis and Radiology Department, Faculty of Dentistry, Tanta University, Tanta, Egypt
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Shi JH, Li JW, Jiang LS, Lei L, Li HX. [A novel periodontal endoscopy-aided non-incisional periodontal regeneration technique:a case series study]. Shanghai Kou Qiang Yi Xue 2024; 33:80-84. [PMID: 38583030] [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: 04/08/2024]
Abstract
PURPOSE To investigate the effect of endoscopy-aided non-incisional periodontal regeneration technique (NIT) in the treatment of alveolar bone angular resorption. METHODS Thirteen patients with severe periodontitis(13 diseased teeth) were selected. All patients had alveolar bone angular resorption on adjacent surface. The patients received NIT treatment 6 weeks after periodontal primary therapy. The visualization of subgingival environment was acquired by the periodontal endoscopy. Following the removal of the subgingival plaque, calculus and intra-bony granulation tissue, bone grafting materials were placed into the intra-bony defects with the assistance of a delicate gingival protector. No flap was elevated and no sutures were applied. Probing depth (PD), gingival recession (GR), clinical attachment level (CAL), as well as radiographic parameters were evaluated at baseline and 2 years after treatment. SPSS 22.0 software package was used for data analysis. RESULTS At 2-years follow-up, an average CAL gain of (3.65±2.10) mm (P<0.001), PD reduction of (4.42±1.66) mm (P<0.001), and minimal increase in GR of (0.38±0.87) mm (P=0.25) were observed. Alveolar bone was significantly improved at 2-years follow-up on radiographs (P<0.001). CONCLUSIONS For angular resorption site of alveolar bone, NIT treatment can obtain good periodontal regeneration results without flap inversion.
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Affiliation(s)
- Jia-Hong Shi
- Department of Periodontology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Research Institute of Stomatology, Nanjing University. Nanjing 210008, Jiangsu Province, China. E-mail:
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Carbone AC, Joly JC, Botelho J, Machado V, Avila-Ortiz G, Cairo F, Chambrone L. Long-term stability of gingival margin and periodontal soft-tissue phenotype achieved after mucogingival therapy: A systematic review. J Clin Periodontol 2024; 51:177-195. [PMID: 37963451 DOI: 10.1111/jcpe.13900] [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: 08/24/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND The aim of this systematic review was two-fold: (i) to evaluate the long-term (≥5 years) stability of the gingival margin position, keratinized tissue width (KTW) and gingival thickness (GT) in sites that underwent root coverage (RC) or gingival augmentation (GA); and (ii) to assess the influence of different local variables on the long-term stability of dental and gingival tissues. MATERIALS AND METHODS Randomized controlled trials (RCTs) and non-RCTs reporting short-term (i.e., 6-12 months after baseline surgical intervention) and long-term (≥5 years) follow-up data after surgical treatment of adult patients presenting single or multiple mucogingival deformities, defined as sites presenting gingival recession defects (GRDs) and/or (KTW) deficiency (i.e., <2 mm), were considered eligible for inclusion. MEDLINE-PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases were searched for articles published up to 15 May 2023. Mixed-effects multiple linear regression was used to assess the association between KTW, type of surgical procedure and time (i.e., independent variables) on the stability of the gingival margin in sites that received RC or GA therapy. RESULTS Of the 2569 potentially eligible records, 41 (reporting 40 studies) met the eligibility criteria. Graphical estimates including data from all RC procedures found an upward trend in recession depth (RD) increase over time. Conversely, it was observed that in 63.63% of RC studies and in 59.32% of RC treatment arms KTW increased over time, particularly in sites treated with subepithelial connective tissue grafts (SCTGs). Conversely, sites that underwent GA procedures generally exhibited an overall reduction of KTW over time. However, sites treated with free gingival grafts (FGGs) showed a decrease in RD after 10 years of follow-up. Three main findings derived from the pooled estimates were identified: (i) Gingival margin stability was associated with the amount of KTW present during short-term assessment (i.e. the greater the KTW at 6-12 months after treatment, the more stable the gingival margin). (ii) The use of autogenous soft-tissue grafts was associated with lower RD increase over time. (iii) Treatment approaches that contribute to the three-dimensional enhancement of the gingival phenotype, as clearly demonstrated by FGG, were associated with gingival margin stability. CONCLUSIONS The extent of apical migration of the gingival margin appears to be directly related to the amount of KTW and GT upon tissue maturation. Interventions involving the use of autogenous grafts, either SCTG or FGG, are associated with greater short-term KTW gain and lower RD increase over time.
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Affiliation(s)
- Ana Claudia Carbone
- Implantology and Periodontology, São Leopoldo Mandic Research Institute, Campinas, Brazil
| | - Julio Cesar Joly
- Implantology and Periodontology, São Leopoldo Mandic Research Institute, Campinas, Brazil
| | - João Botelho
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-School of Health & Science, Almada, Portugal
| | - Vanessa Machado
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz-School of Health & Science, Almada, Portugal
| | - Gustavo Avila-Ortiz
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Private Practice, Atelier Dental Madrid, Madrid, Spain
| | - Francesco Cairo
- Department of Clinical and Experimental Medicine, Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Leandro Chambrone
- Evidence-Based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
- Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia
- Department of Periodontics, School of Dental Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Imber JC, Imber LC, Roccuzzo A, Stähli A, Muñoz F, Weusmann J, Bosshardt DD, Sculean A. Preclinical evaluation of a new synthetic carbonate apatite bone substitute on periodontal regeneration in intrabony defects. J Periodontal Res 2024; 59:42-52. [PMID: 37997207 DOI: 10.1111/jre.13203] [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: 11/12/2022] [Revised: 08/28/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To evaluate the potential of a novel synthetic carbonate apatite bone substitute (CO3 Ap-BS) on periodontal regeneration. BACKGROUND The use of various synthetic bone substitutes as a monotherapy for periodontal regeneration mainly results in a reparative healing pattern. Since xenografts or allografts are not always accepted by patients for various reasons, a synthetic alternative would be desirable. METHODS Acute-type 3-wall intrabony defects were surgically created in 4 female beagle dogs. Defects were randomly allocated and filled with CO3 Ap-BS (test) and deproteinized bovine bone mineral (DBBM) or left empty (control). After 8 weeks, the retrieved specimens were scanned by micro-CT, and the percentages of new bone, bone substitute, and soft tissues were evaluated. Thereafter, the tissues were histologically and histometrically analyzed. RESULTS Healing was uneventful in all animals, and defects were present without any signs of adverse events. Formation of periodontal ligament and cementum occurred to varying extent in all groups without statistically significant differences between the groups. Residues of both bone substitutes were still present and showed integration into new bone. Histometry and micro-CT revealed that the total mineralized area or volume was higher with the use of CO3 Ap-BS compared to control (66.06 ± 9.34%, 36.11 ± 6.40%; p = .014, or 69.74 ± 2.95%, 42.68 ± 8.68%; p = .014). The percentage of bone substitute surface covered by new bone was higher for CO3 Ap-BS (47.22 ± 3.96%) than for DBBM (16.69 ± 5.66, p = .114). CONCLUSIONS CO3 Ap-BS and DBBM demonstrated similar effects on periodontal regeneration. However, away from the root surface, more new bone, total mineralized area/volume, and higher osteoconductivity were observed for the CO3 Ap-BS group compared to the DBBM group. These findings point to the potential of CO3 Ap-BS for periodontal and bone regeneration.
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Affiliation(s)
- Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Larissa Carmela Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Fernando Muñoz
- Department of Veterinary Clinical Sciences, University of Santiago de Compostela, Ibonelab SL, Lugo, Spain
| | - Jens Weusmann
- Department of Periodontology and Operative Dentistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Dieter Daniel Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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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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Abd El-Azeem SH, Khalil AA, Ibrahim MAM, Gamal AY. The use of integrin binding domain loaded hydrogel (RGD) with minimally invasive surgical technique in treatment of periodontal intrabony defect: a randomized clinical and biochemical study. J Appl Oral Sci 2023; 31:e20230263. [PMID: 38126565 PMCID: PMC10786453 DOI: 10.1590/1678-7757-2023-0263] [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: 08/18/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Periodontal regeneration faces multiple challenges, the most important being cellular insufficiency. In an attempt to improve defect cellularity, we aimed to demonstrate enhancing cellular attraction using arginine-glycine-aspartic acid (RGD) adhesion molecule legend blended hydrogel within the intrabony defects. METHODOLOGY Forty-five intrabony defects were selected from patients with stage III or IV - grade A or B periodontitis and divided randomly into three equal groups of 15 each: group1 (G1): received minimally invasive surgical technique (MIST) alone, group2 (G2): received MIST and placebo hydrogel injection, and group3 (G3): were treated with MIST and RGD hydrogel injection. Primary outcomes 6 months following therapy were; defect base fill (DBF) and defect width measurement (DW); secondary outcomes were clinical attachment level (CAL), pocket depth (PD), plaque index (PI), gingival index (GI), and biochemical analysis of bone morphogenetic protein (BMP-2) evaluated at 1,7,14 and 21 days following therapy. RESULTS Significant improvements in DBF, CAL, and PD were observed in the three studied groups 6 months following therapy compared to baseline (p<0.05). A significant improvement in DBF was reported in G3 compared to G1 and 2 (p=0.005). Additionally, a significantly higher CAL gain was reported in G3 compared to that of G1 (p=0.02). Group 3 was associated with a significantly higher level of BMP-2 compared to G1 and G2 in all reported periods. CONCLUSION RGD peptide carried on a hydrogel delivery agent and contained with a minimally invasive flap could be a reliable option in improving the outcomes of periodontal therapy.
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Affiliation(s)
- Shaimaa Hamdy Abd El-Azeem
- Nahda University, Faculty of Dentistry Oral Medicine, Oral Diagnosis and Periodontology Department, Beni Swef, Egypt
| | - Ahmed Abdallah Khalil
- Minia University, Faculty of Dentistry Oral Medicine, Oral Diagnosis and Periodontology Department, Minia, Egypt
| | | | - Ahmed Y Gamal
- Ain Shams Universit, Faculty of Dentistry Oral Medicine, Oral Diagnosis and Periodontology Department, Cairo, Egypt
- Misr University for Science and Technology, Faculty of Dentistry, Cairo, Egypt
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Shi J, Wang J, Yang Z, Li J, Lei L, Li H. A novel periodontal endoscopy-aided non-incisional periodontal regeneration technique in the treatment of intrabony defects: a retrospective cohort study. BMC Oral Health 2023; 23:962. [PMID: 38044459 PMCID: PMC10693706 DOI: 10.1186/s12903-023-03674-9] [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: 09/25/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Gingival recession and post-operation discomfort are still a problem for patients receiving the periodontal regeneration surgery for intra-bony defects. To further reduce the trauma and the post-operation gingival recession, a novel periodontal endoscopy-aided non-incisional regeneration technique (NIT) was proposed in the treatment of intra-bony defects. METHODS Retrospective analysis of 21 subjects treated with NIT and 21 subjects with periodontal endoscopy-aided scaling and root planing (PSRP) at baseline and 1-year evaluation was conducted. After removing the subgingival calculus and granulation tissue, bone grafting materials were placed into intrabony defects with the assistance of a gingival retractor in the NIT group. Probing depth (PD), gingival recession (GR), clinical attachment level (CAL), as well as the distance between bone crest (BC) level and base of the defect (BD) (intrabony defect depth, IBD) were evaluated at baseline and 1 year after treatment. RESULTS At 1-year follow-up, the value of CAL, PD and IBD were statistically significant different compared with baseline in both two groups (p<0.001). CAL gain (p = 0.012) and PD reduction (p = 0.004) was greater in the NIT than PSRP. However, no difference in the IBD reduction was found between the NIT group and PSRP. Better CAL gain and PD reduction was achieved in the 1-year term in the NIT when compared with PSRP. CONCLUSION NIT have resulted in significant gains in both clinical and radiographic parameters. NIT might be utilized as an alternative of the surgical treatment for periodontal intrabony defects. TRIAL REGISTRATION This clinical trial registration was registered retrospectively (August 3, 2023) and the number is ChiCTR2300074317.
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Affiliation(s)
- Jiahong Shi
- Department of Periodontics, Nanjing Stomatological Hospital, Affiliated Hospital of medical School, Nanjing University, Nanjing, China
| | - Jinmeng Wang
- Department of Periodontics, Nanjing Stomatological Hospital, Affiliated Hospital of medical School, Nanjing University, Nanjing, China
| | - Zhiyu Yang
- Department of Periodontics, Nanjing Stomatological Hospital, Affiliated Hospital of medical School, Nanjing University, Nanjing, China
| | - Jingwen Li
- Department of Periodontics, Nanjing Stomatological Hospital, Affiliated Hospital of medical School, Nanjing University, Nanjing, China
| | - Lang Lei
- Department of Orthodontics, Nanjing Stomatological Hospital, Affiliated Hospital of medical School, Nanjing University, Nanjing, China.
| | - Houxuan Li
- Department of Periodontics, Nanjing Stomatological Hospital, Affiliated Hospital of medical School, Nanjing University, Nanjing, China.
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Marques D, Teixeira LN, Elias CN, Lemos AB, Martinez EF. Surface topography of resorbable porcine collagen membranes, and their effect on early osteogenesis: An in vitro study. J Stomatol Oral Maxillofac Surg 2023; 124:101607. [PMID: 37582461 DOI: 10.1016/j.jormas.2023.101607] [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] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Guided tissue regeneration (GTR) is based on the use of different membranes that function as sealants and barriers in specific clinical situations. Among the several tissue production methods and origins, resorbable porcine-derived membranes are the most commonly used. Because these membranes are so diverse, and have several different clinical applications, doubts linger as to their effect in stimulating osteogenesis. The objective of this study was to make an in vitro evaluation of the viability and differentiation of osteoblastic cells cultured on the surface of the following collagen membranes: Jason® (Botiss Biomaterials), Collprotect® (Botiss Biomaterials), and Bio-Gide® (Geistlich). MATERIAL AND METHODS Fragments of the 3 resorbable collagen membranes (5 × 5 mm) were used, and pre-osteoblastic SAOS-2 cells (ATCC, USA) were plated on their porous surfaces. Evaluation of the membranes was performed at 3, 5 and 7 days, considering the following parameters: (1) topographic analysis of the different surfaces by scanning electron microscope; (2) cellular viability by MTT, (3) quantification of type I collagen and osteopontin by Elisa. The quantitative analyses were carried out using a significance level of 5%. RESULTS Collprotect® and Jason® membranes presented a rough surface with an irregular aspect on both sides, while double-layered Bio-Gide® had one layer with a smooth surface and the other with a rough surface along each respective length. The viability assays revealed that the cells cultured the cells grown on Collprotect® showed higher viability than those grown in Bio-Gide® or Jason®, especially after 5 and 7 days. After 3 and 5 days, evaluation of type I collagen showed that the cells plated on the Jason® and Collprotect® surfaces had greater collagen secretion than those plated on BioGide®. After 7 days, an increase in osteopontin levels was observed when the cells were plated on all the experimental membranes, compared with the control group. CONCLUSION All the tested membranes were suitable for use in GTR clinical procedures. Their indication in specific regenerative cases depends on the mechanical and biological properties of their originating tissues, thus enabling better results and assertive choices by dental professionals.
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Affiliation(s)
- Dalton Marques
- Division of Oral Implantology, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil
| | | | - Carlos Nelson Elias
- Instituto Militar de Engenharia, Departamento de Ciência dos Materiais, Rio de Janeiro, RJ, Brasil
| | - Alexandre Barboza Lemos
- Division of Oral Implantology, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil; Instituto Militar de Engenharia, Departamento de Ciência dos Materiais, Rio de Janeiro, RJ, Brasil
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Bokobza A, Nicot R, Raoul G, Afota F, Choukroun J, Savoldelli C. Management of postoperative outcomes of polytetrafluoroethylene membranes in alveolar ridge reconstruction: a systematic review. J Stomatol Oral Maxillofac Surg 2023; 124:101641. [PMID: 37739223 DOI: 10.1016/j.jormas.2023.101641] [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: 09/03/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
Guided bone regeneration (GBR) is a validated technique with satisfactory outcomes during 30 years of follow-up. The use of polytetrafluoroethylene (PTFE) membrane for vertical augmentation has been studied extensively. However, studies have reported exposure rates of up to 31%, there is no consensus on the management of postoperative exposure. The objective of this study was to propose a management approach for postoperative exposure of polytetrafluoroethylene (PTFE) membranes in alveolar ridge reconstruction. MATERIAL AND METHOD An electronic search in PubMed Central's and additional electronic databases was performed. The search strategy was limited to human studies, full-text English or French articles published from 1990 until april 2023. The extracted data included defect location, membrane type, biomaterials, time to postoperative exposure, and Fontana classification stage. Protocol bias assessment was performed using an adaptation of the QUADAS-2 tool. This review has been registered on PROSPERO (ID: CRD42023445497). RESULTS A total of 43 articles were found to be eligible, and 11 of these met the predefined inclusion and exclusion criteria. Based on the results of this systematic review, an algorithm for the management of PTFE membrane exposure is proposed. CONCLUSION Postoperative membrane exposure is not a determining factor for the success of bone grafting. In cases with postoperative complications, the majority of cases still achieved adequate implant-prosthetic rehabilitation. Lastly, this series of 11 articles was insufficient to draw conclusions regarding good practice recommendations. A larger series is required to validate the specific management approaches.
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Affiliation(s)
- Allan Bokobza
- Univ. Lille, CHU Lille, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France.
| | - Romain Nicot
- Univ. Lille, CHU Lille, Inserm, Department of Oral and Maxillofacial Surgery, U1008 - Advanced Drug Delivery Systems, F-59000 Lille, France
| | - Gwénaël Raoul
- Univ. Lille, CHU Lille, Inserm, Department of Oral and Maxillofacial Surgery, U1008 - Advanced Drug Delivery Systems, F-59000 Lille, France
| | - Franck Afota
- Head and Neck Institute, University Hospital of Nice, 31 avenue de Valombrose, 06100 Nice, France
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Khehra A, Chen CY, Kim DM. The long-term success of periodontal regeneration: a 10-year follow-up case report. Quintessence Int 2023; 54:802-807. [PMID: 37497787 DOI: 10.3290/j.qi.b4240197] [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: 07/28/2023]
Abstract
OBJECTIVE The predictability and long-term success of periodontal regeneration begins with oral hygiene education, disease management, and an individually tailored periodontal maintenance protocol. The treatment outcomes could be enhanced when biologics and bone grafts are combined. The aim of this report was to describe the outcome of two complex infrabony defects in the same patient treated with recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and freeze-dried bone allograft (FDBA) over 10 years. CASE PRESENTATION Two complex infrabony defects were treated following guided tissue regeneration principles and procedures. Full-thickness flaps were raised to allow visualization of the defects. The areas were debrided, and exposed root surfaces were planed. FDBA and rhPDGF-BB were combined to fill both defects. A collagen membrane was used over the bone graft in one case. The flaps were reapproximated to achieve primary closure. The patient was seen for regular periodontal maintenance visits and clinical and radiographic follow-ups over 10 years. Throughout the examination periods, the probing depths improved without bleeding on probing, and there was radiographic evidence of bone regeneration. CONCLUSION The growth factor-infused bone graft was successfully utilized for periodontal regeneration in complex bony defects.
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Hangyasi DB, Körtvélyessy G, Blašković M, Rider P, Rogge S, Siber S, Kačarević ŽP, Čandrlić M. Regeneration of Intrabony Defects Using a Novel Magnesium Membrane. Medicina (Kaunas) 2023; 59:2018. [PMID: 38004067 PMCID: PMC10672749 DOI: 10.3390/medicina59112018] [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: 10/10/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Due to their specific morphology, the regeneration of intrabony defects (IBDs) represents one of the greatest challenges for clinicians. Based on the specific properties of a magnesium membrane, a new approach for the surgical treatment of IBD was developed. The surgical procedure was described using a series of three cases. Materials and Methods: The patients were healthy individuals suffering from a severe form of periodontitis associated with IBD. Based on radiographic examination, the patients had interproximal bone loss of at least 4 mm. Due to its good mechanical properties, it was easy to cut and shape the magnesium membrane into three different shapes to treat the specific morphology of each IBD. In accordance with the principles of guided bone regeneration, a bovine xenograft was used to fill the IBD in all cases. Results: After a healing period of 4 to 6 months, successful bone regeneration was confirmed using radiological analysis. The periodontal probing depth (PPD) after healing showed a reduction of 1.66 ± 0.29 mm. Conclusions: Overall, the use of the different shapes of the magnesium membrane in the treatment of IBD resulted in a satisfactory functional and esthetic outcome.
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Affiliation(s)
- David Botond Hangyasi
- Department of Periodontology, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66, H-6720 Szeged, Hungary;
| | - Győző Körtvélyessy
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, Tisza Lajos krt. 64-66, H-6720 Szeged, Hungary;
| | - Marko Blašković
- Department of Oral Surgery, Faculty of Dental Medicine Rijeka, University of Rijeka, Krešimirova 40/42, 51 000 Rijeka, Croatia;
| | - Patrick Rider
- Botiss Biomaterials GmbH, 15806 Zossen, Germany; (P.R.); (S.R.)
| | - Svenja Rogge
- Botiss Biomaterials GmbH, 15806 Zossen, Germany; (P.R.); (S.R.)
| | - Stjepan Siber
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, Crkvena 21, 31 000 Osijek, Croatia;
| | - Željka Perić Kačarević
- Botiss Biomaterials GmbH, 15806 Zossen, Germany; (P.R.); (S.R.)
- Department of Anatomy, Histology, Embryology, Pathologic Anatomy and Pathologic Histology, J.J. Strossmayer University of Osijek, Crkvena 21, 31 000 Osijek, Croatia
| | - Marija Čandrlić
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, Crkvena 21, 31 000 Osijek, Croatia;
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Pohl S, Buljan M. VISTA Approach in Conjunction with Enamel Matrix Derivative, Corticocancellous Bone, and Connective Tissue Graft for Periodontal Defect Surgery: A Case Series. INT J PERIODONT REST 2023; 43:715-723. [PMID: 37347613 DOI: 10.11607/prd.6094] [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: 06/24/2023]
Abstract
The biggest challenge during periodontal regeneration in the anterior region is the prevention of soft tissue recession. Minimally invasive surgeries, particularly papilla preservation techniques and soft tissue augmentation, may significantly reduce such postoperative soft tissue recession. This article presents the vestibular incision subperiosteal tunnel access (VISTA) approach for periodontal regeneration in the anterior region. A subperiosteal tunnel prepared from a single vertical vestibular incision adjacent to the defect is used for debridement, application of enamel matrix derivative, defect grafting with corticocancellous tuberosity bone, and insertion of the connective tissue graft. Evaluation of six cases with up to 6 years of follow-up showed improvements in all clinical parameters. The probing pocket depth improved from 8.2 ± 0.75 mm initially to 2.7 ± 0.52 mm at follow-up, clinical attachment level improved from 8.5 ± 0.83 mm initially to 2.7 ± 0.52 mm at follow-up, and midfacial gingival recession of 1 mm at two sites was corrected. The papillae were stable at all sites, with an average distance of 4.8 mm from the incisal edge to the papilla tip. This technique seems to be a promising approach for achieving both esthetic and functional goals of periodontal regenerative surgery. However, experience in performing microsurgeries and harvesting tuberosity tissues may be a limitation.
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Dogan Kaplan A, Cinar IC, Gultekin BA, Avci Kupeli Z, Ozfirat EC, Yalcin S. The Effect of Different Types of Collagen Membranes on Peri-Implant Dehiscence Defects. J Craniofac Surg 2023; 34:2479-2484. [PMID: 37431934 DOI: 10.1097/scs.0000000000009536] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/20/2023] [Indexed: 07/12/2023] Open
Abstract
AIM This experimental study aimed to compare the bone-implant contact (BIC) following guided bone regeneration with 3 bioabsorbable collagen membranes on peri-implant dehiscence defects. METHODS Forty-eight standard dehiscence defects were created in the sheep iliac bone crest, and dental implants were placed into the defects. With the guided bone regeneration technique, the autogenous graft was placed into the defect and covered with different types of membranes: Geistlich Bio-Gide, Ossix Plus, and Symbios Prehydrated were covered. One group was left without a membrane as the control group (C) by applying only an autogenous graft. After recovery periods of 3 and 6 weeks, the experimental animals were sacrificed. Histologic sections were prepared by a nondecalcified method, and BIC was examined. RESULTS There was no statistically important difference between groups in the third week ( P >0.05). A statistically significant difference between groups was found in the sixth week ( P <0.01). Bone-implant contact values of the C group were significantly lower than those of the Geistlich Bio-Gide and Ossix Plus groups ( P <0.05). There was no statistically significant difference between control and Symbios Prehydrated groups ( P >0.05). In all sections, osseointegration was observed, with no signs of inflammation, necrosis, or foreign body reaction. CONCLUSION In our study, it has been concluded that the resorbable collagen membranes used in treating peri-implant dehiscence defects might affect the BIC, and the success varies according to the type of membrane used.
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Affiliation(s)
- Aylin Dogan Kaplan
- Department of Oral Implantology, Istanbul University Faculty of Dentistry, Istanbul
| | - Ihsan Caglar Cinar
- Department of Oral Implantology, Istanbul University Faculty of Dentistry, Istanbul
| | | | - Zehra Avci Kupeli
- Department of Pathology, Faculty of Veterinary Medicine, Bursa Uludag University
| | - Eren Can Ozfirat
- Department of Surgery, Faculty of Veterinary Medicine, Bursa Uludag University, Bursa, Turkey
| | - Serdar Yalcin
- Department of Oral Implantology, Istanbul University Faculty of Dentistry, Istanbul
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Alotaibi FF, Rocchietta I, Buti J, D'Aiuto F. Comparative evidence of different surgical techniques for the management of vertical alveolar ridge defects in terms of complications and efficacy: A systematic review and network meta-analysis. J Clin Periodontol 2023; 50:1487-1519. [PMID: 37495541 DOI: 10.1111/jcpe.13850] [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: 12/07/2022] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
AIM To systematically appraise the available evidence on vertical ridge augmentation (VRA) techniques and estimate a treatment-based ranking on the incidence of complications as well as their clinical effectiveness. MATERIALS AND METHODS Searches were conducted in six databases to identify randomized clinical trials comparing VRA techniques up to November 2022. The incidence of complications (primary) and of early, major, surgical and intra-operative complications, vertical bone gain (VBG), marginal bone loss, need for additional grafting, implant success/survival, and patient-reported outcome measures (secondary) were chosen as outcomes. Direct and indirect effects and treatment ranking were estimated using Bayesian pair-wise and network meta-analysis (NMA) models. RESULTS Thirty-two trials (761 participants and 943 defects) were included. Five NMA models involving nine treatment groups were created: onlay, inlay, dense-polytetrafluoroethylene, expanded-polytetrafluoroethylene, titanium, resorbable membranes, distraction osteogenesis, tissue expansion and short implants. Compared with short implants, statistically significant higher odds ratios of healing complications were confirmed for all groups except those with resorbable membranes (odds ratio 5.4, 95% credible interval 0.92-29.14). The latter group, however, ranked last in clinical VBG. CONCLUSIONS VRA techniques achieving greater VBG are also associated with higher incidence of healing complications. Guided bone regeneration techniques using non-resorbable membranes yield the most favourable results in relation to VBG and complications.
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Affiliation(s)
- Faisal F Alotaibi
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
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Singh N, Kashyap M. Is Autologous Sticky Bone Better Than a Simple Mixture of Autologous PRF and Bioactive Glass in the Regeneration of Human Periodontal Intrabony Defects? An Extensive Clinical and CBCT Study. INT J PERIODONT REST 2023; 43:s264-s282. [PMID: 37879062 DOI: 10.11607/prd.6152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Periodontal intrabony defects (IBDs) are commonly encountered in dental practice and are usually treated by open flap debridement (OFD) with or without bone grafts and/or guided tissue regeneration (GTR), platelet-rich fibrin (PRF), or other additives. A difficulty with these approaches is maintaining the space for bone growth at the determined location. In this report, autologous sticky bone (ASB) was used and compared to a simple mixture of PRF and bone graft (PRF-BG) using the identical graft material-bioactive glass morsels-to assess its regenerative potential in IBDs, as sticky bone is known to maintain the space, according to previous research. A total of 21 IBDs were treated by OFD, PRF-BG mixture, or ASB. Regenerative assessment was clinically and radiographically performed by CBCT at 1 year. All the treatment modalities (OFD, PRF-BG, and ASB) showed statistically significant improvements clinically and radiographically at 1 year in terms of probing pocket depth reduction (PPDR), clinical attachment level gain (CALG), CBCT defect fill (CBCT-DF), and CBCT defect resolution (CBCT-DR); P < .05. The ASB group depicted the most favorable results (P < .05) in terms of the parameters at 1 year followed by the PRF-BG group and then the OFD group. Treatment of periodontal IBDs with ASB resulted in significant improvements in clinical and CBCT parameters compared to baseline at 1 year, and intrasurgical graft handling was much better in the ASB group.
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Attia R, El-Nahass H, Anis M, Hosny M. Clinical Evaluation of the Coronally Advanced Lingual Flap Technique for Maintaining Primary Wound Closure Over Titanium Mesh After Guided Bone Regeneration: A Randomized Control Trial. INT J PERIODONT REST 2023; 43:s36-s52. [PMID: 37294592 DOI: 10.11607/prd.6179] [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: 06/10/2023]
Abstract
PURPOSE To evaluate the clinical efficacy of the coronally advanced lingual flap (CALF) technique in terms of the extent of lingual and buccal flap advancement, the maintenance of primary wound closure, and safety in comparison to buccal flap advancement alone during horizontal ridge augmentation in the posterior mandible. MATERIALS AND METHODS A total of 14 patients were randomly allocated to two different groups: buccal flap advancement without the CALF technique (control), referred to as the NO-CALF group, and buccal flap advancement with the CALF technique (test), referred to as the CALF group. Wound healing was monitored weekly for the first 4 weeks, then at 2, 4, 6, and 9 months postoperatively for any soft tissue dehiscence (titanium mesh [TM] exposure) along the incision line. The extent of lingual and buccal flap advancement was measured, and any intraoperative and postoperative CALF-related complications were reported. RESULTS The difference between groups was statistically significant (P < .0001) in terms of (1) TM exposure: 83.3% of cases in the NO-CALF group showed early Class П exposures, whereas the CALF group showed no exposure; (2) mean lingual flap advancement: 3.9 ± 1.1 mm and 14.4 ± 3.8 mm for the NO-CALF and CALF groups, respectively; and (3) mean buccal flap advancement: 15.8 ± 2.1 mm and 10.5 ± 1.4 mm for the NO-CALF and CALF groups, respectively. There were no reported complications related to the CALF technique. CONCLUSION Tension-free primary wound closure was facilitated and maintained during the healing period by applying the CALF technique, which is a reliable technique to safely advance the lingual flap coronally.
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Pesce P, Zubery Y, Goldlust A, Bayer T, Abundo R, Canullo L. Ossification and Bone Regeneration in a Canine GBR Model, Part 2: Glycated Cross-Linked Collagenated Alloplastic Hydroxyapatite Scaffold vs Non-Cross-Linked Collagenated Xenographic Bone Hydroxyapatite. Int J Oral Maxillofac Implants 2023; 38:923-932. [PMID: 37847834 DOI: 10.11607/jomi.9822] [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] [Indexed: 10/19/2023] Open
Abstract
PURPOSE To compare bone substitutes composed of glycated collagen with synthetic micro-sized (1 to 10 μm) hydroxyapatite (OB) vs non-cross-linked collagen matrix with large-particle (250 to 1,000 μm) bovine-derived hydroxyapatite (BOC). MATERIALS AND METHODS The P1 to P4 premolars were bilaterally extracted from the mandibles of 19 Beagle dogs. After 21 days, osteotomies were created in each dog that received OB or BOC and were covered with a collagen membrane or were left untreated. The animals were randomly divided into three groups based on sacrifice time (4, 12, or 24 weeks). The right and left hemimandibles were trimmed to facilitate imaging and histology, and all tissues were placed in 10% neutral-buffered formalin. Microcomputed tomography (MicroCT 40 Scanner, Scanco) was used to analyze bone sections. Bone volume, residual material volume, and bone mineral density were determined for each treatment site (OB and BOC) based on a volume of interest that encompassed the original defect. Additionally, blinded histopathologic assessment (based on the ISO 10993-6 scoring system) and histomorphometry were performed on sections ground to < 100 μm thick and stained with Stevenel's blue. RESULTS No clinical side effects were noted. No statistical differences were observed for OB vs BOC regarding the mineral volume percentage. Compared to OB, BOC had significantly higher mean mineralization densities at 12 weeks (P < .01), but this difference did not extend to 24 weeks. For residual grafting material, bone maturation, alveolar ridge restoration, and inflammatory response, OB showed a residual amount of bone graft and no statistical differences compared to BOC. CONCLUSION Both OB and BOC represent valid treatment options for critically sized bone defects. Both bone fillers outperformed the sham-operated, ungrafted (empty) control, demonstrating statistically improved bone growth and ridge restoration.
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Lin J, He Y, He Y, Feng Y, Wang X, Yuan L, Wang Y, Chen J, Luo F, Li Z, Li J, Tan H. Janus functional electrospun polyurethane fibrous membranes for periodontal tissue regeneration. J Mater Chem B 2023; 11:9223-9236. [PMID: 37700625 DOI: 10.1039/d3tb01407j] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
The guided tissue regeneration (GTR) technique with GTR membranes is an efficient method for repairing periodontal defects. Conventional periodontal membranes act as physical barriers that resist the growth of fibroblasts, epithelial cells, and connective tissue. However, they cannot facilitate the regeneration of periodontal tissue. To address this issue, the exploitation of novel GTR membranes with bioactive functions based on therapeutic requirements is critical. Herein, we exploited a biodegradable bilayer polyurethane fibrous membrane by uniaxial electrostatic spinning to construct two sides with Janus properties by integrating the bioactive molecule dopamine (DA) and antimicrobial Gemini quaternary ammonium salt (QAS). The DA-containing side, located inside the injury, can effectively promote cell adhesion and mesenchymal stem cell growth as well as support mineralization and antioxidant properties, which are beneficial for bone regeneration. The QAS-containing side, located on the outer surface of the injury, endows antibacterial properties and limits fibroblast adhesion and growth on its surface owing to its strong hydrophilicity. An in vivo study demonstrates that the Janus polyurethane fibrous membrane can significantly promote the regeneration of periodontal defects in rats. Owing to its superior mechanical properties and biocompatibility, this polyurethane fibrous membrane has potential applications in the field of periodontal regeneration.
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Affiliation(s)
- Jingjing Lin
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
| | - Yushui He
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
| | - Yuanyuan He
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
| | - Yuan Feng
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
| | - Xiao Wang
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
| | - Lei Yuan
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
| | - Yanchao Wang
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, 610000, China
| | - Jie Chen
- Department of Pediatric Dentistry, West China School of Stomatology, Sichuan University, Chengdu 610065, China
| | - Feng Luo
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
| | - Zhen Li
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
| | - Jiehua Li
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
| | - Hong Tan
- College of Polymer Science and Engineering, State Kedy Laboratory of Polymer Materials Engineering, Med-X Center of Materials, Sichuan University, Chengdu 610065, China.
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Yu SH, Saleh MHA, Wang HL. Simultaneous or staged lateral ridge augmentation: A clinical guideline on the decision-making process. Periodontol 2000 2023; 93:107-128. [PMID: 37529966 DOI: 10.1111/prd.12512] [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: 01/29/2023] [Revised: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
Lateral ridge augmentation is a standard surgical procedure that can be performed prior to (staged) or simultaneously with implant placement. The decision between a simultaneous or staged approach involves considering multiple variables. This paper proposed a decision-making process that serves as a guideline for choosing the best treatment choice based on the available evidence and the author's clinical experience.
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Affiliation(s)
- Shan-Huey Yu
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Private Practice, Vienna, Virginia, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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25
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Quirynen M, Siawasch S, Temmerman A, Cortellini S, Dhondt R, Teughels W, Castro AB. Do autologous platelet concentrates (APCs) have a role in intra-oral bone regeneration? A critical review of clinical guidelines on decision-making process. Periodontol 2000 2023; 93:254-269. [PMID: 37845802 DOI: 10.1111/prd.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/22/2022] [Revised: 07/05/2023] [Accepted: 08/15/2023] [Indexed: 10/18/2023]
Abstract
In the past decades, personalized regenerative medicine has gained increased attention. Autologous platelet concentrates (APCs) such as PRP, PRGF, and L-PRF, all serving as a source of a large variety of cells and growth factors that participate in hard and soft tissue healing and regeneration, could play a significant role in regenerative periodontal procedures. This narrative review evaluated the relative impact of APCs in alveolar ridge preservation, sinus floor augmentation, and the regeneration of bony craters around teeth, both as a single substitute or in combination with a xenograft. L-PRF has a significant beneficial effect on alveolar ridge preservation ( bone quality). The data for PRGF are less convincing, and PRP is controversial. L-PRF can successfully be used as a single substitute during transcrestal (≥3.5 mm bone gain) as well as 1-stage lateral window sinus floor elevation (>5 mm bone gain). For PRGF and especially PRP the data are very scarce. In the treatment of bony craters around teeth, during open flap debridement, L-PRF as a single substitute showed significant adjunctive benefits (e.g., >PPD reduction, >CAL gain, >crater depth reduction). The data for PRP and PRGF were non-conclusive. Adding PRP or L-PRF to a xenograft during OFD resulted in additional improvements (>PPD reduction, >CAL gain, >bone fill), for PRGF no data were found. Autologous platelet concentrates demonstrated to enhance bone and soft tissue healing in periodontal regenerative procedures. The data for L-PRF were most convincing. L-PRF also has the advantage of a greater simplicity of production, and its 100% autologous character.
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Affiliation(s)
- Marc Quirynen
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Sam Siawasch
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Andy Temmerman
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Simone Cortellini
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Rutger Dhondt
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Wim Teughels
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Anna B Castro
- Department of Oral Health Sciences, Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
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26
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Quan BD, Sadeghi R, Ikeda Y, Ganss B, Hamilton DW, McCulloch CA, Sone ED. Screening of functionalized collagen membranes with a porcine periodontal regeneration model. Oral Dis 2023; 29:2845-2853. [PMID: 36458549 DOI: 10.1111/odi.14445] [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: 07/04/2022] [Revised: 10/18/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES Current methods for periodontal regeneration do not promote collagen fiber insertions into new bone and cementum. We used a pig wound model to screen different functionalized collagen membranes in promoting periodontal reattachment to root surfaces. METHODS Treatment groups included (1) control with no membranes, (2) collagen-coated membranes, (3) membranes with insulin-like growth factor-1 (IGF-1), (4) membranes with amelotin, or (5) membranes attached with calcium phosphate cement (CPC), or with CPC combined with IGF-1. Flap procedures were performed on mandibular and maxillary premolars of each pig. RESULTS Histomorphometric, micro-CT, and clinical measurements obtained at 4 and 12 weeks after surgery showed cementum formation on denuded roots and reformation of alveolar bone, indicating that the pig model can model healing responses in periodontal regeneration. Calcium phosphate cement simplified procedures by eliminating the need for sutures and improved regeneration of alveolar bone (p < 0.05) compared with other treatments. There was a reduction (p < 0.05) of PD only for the IGF group. Large observed variances between treatment groups indicated that a priori power analyses should be conducted to optimize statistical analysis. CONCLUSIONS Pigs can model discrete elements of periodontal healing using collagen-based, functionalized membranes. Screening indicates that membrane anchorage with calcium phosphate cements improve regeneration of alveolar bone.
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Affiliation(s)
- Bryan D Quan
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Rokhsareh Sadeghi
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Yuichi Ikeda
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Department of Periodontology, Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Bernhard Ganss
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Douglas W Hamilton
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | - Eli D Sone
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Department of Materials Science and Engineering, University of Toronto, Toronto, Ontario, Canada
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Calciolari E, Corbella S, Gkranias N, Viganó M, Sculean A, Donos N. Efficacy of biomaterials for lateral bone augmentation performed with guided bone regeneration. A network meta-analysis. Periodontol 2000 2023; 93:77-106. [PMID: 37752820 DOI: 10.1111/prd.12531] [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: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
Bone regeneration is often required concomitant with implant placement to treat a bone fenestration, a dehiscence, and for contouring. This systematic review assessed the impact of different biomaterials employed for guided bone regeneration (GBR) simultaneous to implant placement on the stability of radiographic peri-implant bone levels at ≥12 months of follow-up (focused question 1), as well as on bone defect dimension (width/height) changes at re-assessment after ≥4 months (focused question 2). Only randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared different biomaterials for GBR were considered. A Bayesian network meta-analysis (NMA) was performed using a random-effects model. A ranking probability between treatments was obtained, as well as an estimation of the surface under the cumulative ranking value (SUCRA). Overall, whenever the biological principle of GBR was followed, regeneration occurred in a predictable way, irrespective of the type of biomaterial used. A lower efficacy of GBR treatments was suggested for initially large defects, despite the trend did not reach statistical significance. Regardless of the biomaterial employed, a certain resorption of the augmented bone was observed overtime. While GBR was shown to be a safe and predictable treatment, several complications (including exposure, infection, and soft tissue dehiscence) were reported, which tend to be higher when using cross-linked collagen membranes.
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Affiliation(s)
- Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
- Dental School, Department of Medicine and Dentistry, Università di Parma, Parma, Italy
| | - Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS, Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Nikolaos Gkranias
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Marco Viganó
- Medacta International SA, Castel San Pietro, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Nikolaos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Mizraji G, Davidzohn A, Gursoy M, Gursoy U, Shapira L, Wilensky A. Membrane barriers for guided bone regeneration: An overview of available biomaterials. Periodontol 2000 2023; 93:56-76. [PMID: 37855164 DOI: 10.1111/prd.12502] [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: 03/13/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 10/20/2023]
Abstract
Dental implants revolutionized the treatment options for restoring form, function, and esthetics when one or more teeth are missing. At sites of insufficient bone, guided bone regeneration (GBR) is performed either prior to or in conjunction with implant placement to achieve a three-dimensional prosthetic-driven implant position. To date, GBR is well documented, widely used, and constitutes a predictable and successful approach for lateral and vertical bone augmentation of atrophic ridges. Evidence suggests that the use of barrier membranes maintains the major biological principles of GBR. Since the material used to construct barrier membranes ultimately dictates its characteristics and its ability to maintain the biological principles of GBR, several materials have been used over time. This review, summarizes the evolution of barrier membranes, focusing on the characteristics, advantages, and disadvantages of available occlusive barrier membranes and presents results of updated meta-analyses focusing on the effects of these membranes on the overall outcome.
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Affiliation(s)
- Gabriel Mizraji
- Department of Periodontology, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Mervi Gursoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
- Oral Health Care, Welfare Division, City of Turku, Turku, Finland
| | - Ulvi Gursoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Lior Shapira
- Department of Periodontology, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asaf Wilensky
- Department of Periodontology, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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29
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Ramanauskaite A, Becker K, Cafferata EA, Schwarz F. Clinical efficacy of guided bone regeneration in peri-implantitis defects. A network meta-analysis. Periodontol 2000 2023; 93:236-253. [PMID: 37490412 DOI: 10.1111/prd.12510] [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: 03/08/2023] [Revised: 05/17/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023]
Abstract
Guided bone regeneration (GBR) at peri-implantitis-related bone defects involves the placement of bone-filler particles in the intrabony defects and the application of a barrier membrane. The efficacy of different GBR-supported reconstructive measures as well as their potential superiority compared to non-GBR-supported treatment strategies for bone defects at peri-implantitis sites, however, remains unclear. Therefore, this analysis was designed to evaluate the long-term (≥12 months) clinical efficacy of GBR-supported reconstructive surgical therapy for peri-implantitis-related bone defects. In terms of resolving inflammation, the implementation of GBR protocols applying xenogenic bone substitutes yielded a higher reduction of bleeding on probing and probing depth value compared to the GBR protocol applying autogenous bone. Furthermore, for the changes in bleeding on probing and probing depths, GBR approaches using xenogenic bone showed superiority over the non-GBR treatments. Xenogenic bone with or without a barrier membrane was associated with improved radiographic bone levels and less soft tissue recession compared to the use of a GBR protocol implementing autogenous bone. Nonetheless, when interpreting this findings, the limited number of available studies with low to serious risk of bias and the short follow-up periods limited to 12 months should be considered.
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Affiliation(s)
- Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Emilio A Cafferata
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
- Department of Periodontology, School of Dentistry, Universidad Científica del Sur, Lima, Peru
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
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Park JY, Chung HM, Strauss FJ, Lee JS. Dimensional changes after horizontal and vertical guided bone regeneration without membrane fixation using the retentive flap technique: A 1-year retrospective study. Clin Implant Dent Relat Res 2023; 25:871-880. [PMID: 37309236 DOI: 10.1111/cid.13237] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
AIM To evaluate the dimensional changes after horizontal and vertical guided bone regeneration (GBR) without membrane fixation using the retentive flap technique. METHODS This study retrospectively examined two cohorts that received vertical or horizontal ridge augmentations (VA or HA groups). GBR was performed using particulate bone substitutes and resorbable collagen membranes. The augmented sites were stabilized using the retentive flap technique without any additional membrane fixation. The augmented tissue dimensions were assessed using cone-beam computed tomography at preoperative, immediately postoperative (IP), 4 months (4M), and 1 year (1Y). RESULTS Postoperative vertical bone gain in 11 participants of VA group amounted to 5.96 ± 1.88 mm at IP, which decreased to 5.53 ± 1.62 at 4M and to 5.26 ± 1.52 mm at 1Y (intragroup p < 0.05). The horizontal bone gain at IP in 12 participants amounted to 3.98 ± 2.06 mm, which decreased to 3.02 ± 2.06 at 4M and to 2.48 ± 2.09 mm at 1Y (intragroup p < 0.05). The mean implant dehiscence defect height after 1Y was 0.19 ± 0.50 mm in the VA group, and 0.57 ± 0.93 mm in the HA group. CONCLUSION GBR without membrane fixation using the retentive flap technique seems to preserve the radiographic bone dimensions of vertically augmented sites. This technique may be less effective at preserving the width of the augmented tissue.
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Affiliation(s)
- Jin-Young Park
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
- Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul, Republic of Korea
| | - Hye-Min Chung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Franz-Josef Strauss
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
- Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
- Innovation Research and Support Center for Dental Science, Yonsei University Dental Hospital, Seoul, Republic of Korea
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Chackartchi T, Imber JC, Stähli A, Bosshardt D, Sacks H, Nagy K, Sculean A. Healing of intrabony defects using a novel human recombinant amelogenin: a preclinical study. Quintessence Int 2023; 54:622-628. [PMID: 37010441 DOI: 10.3290/j.qi.b4007601] [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: 04/04/2023]
Abstract
OBJECTIVE To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing/regeneration in intrabony defects. METHOD AND MATERIALS Intrabony defects were surgically created in the mandible of three minipigs. Twelve defects were randomly treated with either rAmelX and carrier (test group) or with the carrier only (control group). At 3 months following reconstructive surgery, the animals were euthanized, and the tissues histologically processed. Thereafter, descriptive histology, histometry, and statistical analyses were performed. RESULTS Postoperative clinical healing was uneventful. At the defect level, no adverse reactions (eg, suppuration, abscess formation, unusual inflammatory reaction) were observed with a good biocompatibility of the tested products. The test group yielded higher values for new cementum formation (4.81 ± 1.17 mm) compared to the control group (4.39 ± 1.71 mm) without reaching statistical significance (P = .937). Moreover, regrowth of new bone was greater in the test compared to the control group (3.51 mm and 2.97 mm, respectively, P = .309). CONCLUSIONS The present results provided for the first-time histologic evidence for periodontal regeneration following the use of rAmelX in intrabony defects, thus pointing to the potential of this novel recombinant amelogenin as a possible alternative to regenerative materials from animal origins.
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Simonelli A, Farina R, Minenna L, Tomasi C, Trombelli L. Prognostic value of a composite outcome measure for periodontal stability following periodontal regenerative treatment: A retrospective analysis at 4 years. J Periodontol 2023; 94:1090-1099. [PMID: 37070225 DOI: 10.1002/jper.22-0645] [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: 11/02/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Recently, a composite outcome measure (COM) was proposed to describe the short-term results of periodontal regenerative treatment. The present retrospective study aimed at evaluating the prognostic value of COM on clinical attachment level (CAL) change over a 4-year period of supportive periodontal care (SPC). METHODS Seventy-four intraosseous defects in 59 patients were evaluated at 6 months and 4 years following regenerative treatment. Based on 6-month CAL change and probing depth (PD), defects were classified as: COM1 (CAL gain ≥3 mm, PD ≤4 mm); COM2 (CAL gain <3 mm, PD ≤4 mm); COM3 (CAL gain ≥3 mm, PD >4 mm); or COM4 (CAL gain <3 mm, PD >4 mm). COM groups were compared for "stability" (i.e., CAL gain, no change in CAL or CAL loss <1 mm) at 4 years. Also, groups were compared for mean change in PD and CAL, need for surgical retreatment, and tooth survival. RESULTS At 4 years, the proportion of stable defects in COM1, COM2, COM3, and COM4 group was 69.2%, 75%, 50%, and 28.6%, respectively, with a substantially higher probability for a defect to show stability for COM1, COM2, and COM3 compared with COM4 (odds ratio 4.6, 9.1, and 2.4, respectively). Although higher prevalence of surgical reinterventions and lower tooth survival were observed in COM4, no significant differences were detected among COM groups. CONCLUSIONS COM may be of value in predicting CAL change at sites undergoing SPC following periodontal regenerative surgery. Studies on larger cohorts, however, are needed to substantiate the present findings.
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Affiliation(s)
- Anna Simonelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, AUSL of Ferrara, Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, AUSL of Ferrara, Ferrara, Italy
| | - Luigi Minenna
- Operative Unit of Dentistry, AUSL of Ferrara, Ferrara, Italy
| | - Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, AUSL of Ferrara, Ferrara, Italy
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33
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Romito GA, Soares HH, do Amaral GCLS, Fonseca MA, Sapata VM, Conde MC, Hammerle CHF, Schwarz F, Villar CC. Radiographic outcomes of ridge reconstruction with autogenous bone block versus collagenated xenogeneic bone block: A randomized clinical trial. Clin Oral Implants Res 2023; 34:863-871. [PMID: 37309738 DOI: 10.1111/clr.14114] [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: 02/14/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
AIM To compare, at different levels from the alveolar crest, the radiographic outcomes of equine-derived collagenated xenogeneic bone blocks (CXBB) and autogenous bone blocks (ABB) used for lateral alveolar ridge augmentation. MATERIALS AND METHODS Sixty-four patients with tooth gaps in atrophic alveolar ridges with ≤4 mm were randomly assigned to lateral augmentation using CXBB or ABB. The lateral bone thickness (LBT) was measured 2, 4, 6, 8, and 10 mm below the alveolar crest using CBCT scans obtained before augmentation surgery and at 30 weeks, prior to implant placement. Statistical analysis was performed using Shapiro-Wilk, Fisher's exact, Mann-Whitney, and Wilcoxon signed-rank tests. RESULTS Both CXBB and ABB resulted in significant total and buccal LBT gains at 2, 4, 6, 8, and 10 mm. LBT gains were similar between CXBB- and ABB-augmented sites, except for greater buccal LBT gains at 8 mm at CXBB-augmented sites. While ABB-augmented sites gained vertical bone height, CXBB-treated sites suffered vertical bone loss (CXBB: -0.16 mm; ABB: 0.38 mm, p < .0009). CONCLUSIONS CXBB and ABB were both associated with significant and similar LBT gains at 30 weeks.
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Affiliation(s)
| | - Herbert Horiuti Soares
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | - Vitor Marques Sapata
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marina Clemente Conde
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University, Carolinum, Frankfurt, Germany
| | - Cristina Cunha Villar
- Discipline of Periodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Koronna I, Schacher B, Dahmer I, Nickles K, Sonnenschein SK, Kim TS, Eickholz P, Petsos H. Long-term stability of infrabony defects treated with enamel matrix derivative alone: A retrospective two-centre cohort study. J Clin Periodontol 2023; 50:996-1009. [PMID: 37051653 DOI: 10.1111/jcpe.13814] [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: 01/16/2023] [Revised: 03/05/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023]
Abstract
AIM To assess the long-term stability of attachment gain in infrabony defects (IBDs) 10 years after regenerative treatment with an enamel matrix derivative (EMD) alone. MATERIALS AND METHODS Two centres (Frankfurt [F] and Heidelberg [HD]) invited patients for re-examination 120 ± 12 months after regenerative therapy. Re-examination included clinical examination (periodontal probing depths (PPD), vertical clinical attachment level (CAL), plaque index (PlI), gingival index (GI), plaque control record, gingival bleeding index and periodontal risk assessment) and review of patient charts (number of supportive periodontal care [SPC] visits). RESULTS Both centres included 52 patients (29 female; median baseline age: 52.0 years; lower/upper quartile: 45.0/58.8 years; eight smokers), each contributing one IBD. Nine teeth were lost. For the remaining 43 teeth, regenerative therapy showed significant CAL gain after 1 year (3.0; 2.0/4.4 mm; p < .001) and 10 years (3.0; 1.5/4.1 mm; p < .001) during which CAL remained stable (-0.5; -1.0/1.0 mm; p = 1.000) after an average SPC of 9 years. Mixed-model regression analyses revealed a positive association of CAL gain from 1 to 10 years with CAL 12 months post operation (logistic: p = .01) as well as a higher probability for CAL loss with an increasing vertical extent of a three-walled defect component (linear: p = .008). Cox proportional hazard analysis showed a positive association between PlI after 12 months and tooth loss (p = .046). CONCLUSION Regenerative therapy of IBDs showed stable results over 9 years. CAL gain is associated with CAL after 12 months and decreasing initial defect depth in a three-walled defect morphology. Tooth loss is associated with PlI 12 months post operation. CLINICAL TRIAL NUMBER DRKS00021148 (URL: https://drks.de).
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Affiliation(s)
- Ilona Koronna
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
- Private Practice, Hanau, Germany
| | - Beate Schacher
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
| | - Iulia Dahmer
- Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt, Germany
- Center of Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
| | - Katrin Nickles
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
- Private Practice, Mannheim, Germany
| | - Sarah K Sonnenschein
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Frankfurt, Germany
| | - Ti-Sun Kim
- Section of Periodontology, Department of Conservative Dentistry, Clinic for Oral, Dental and Maxillofacial Diseases, University Hospital Heidelberg, Frankfurt, Germany
| | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
| | - Hari Petsos
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Frankfurt, Germany
- Private Practice, Butzbach, Germany
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Fien M, Puterman I, Mesquida J, Bauza G, Ginebreda I. The Ribroast Technique™: An Alternative Method to Stabilize a Resorbable Collagen Membrane for Guided Bone Regeneration. Compend Contin Educ Dent 2023; 44:408-414. [PMID: 37450679] [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: 07/18/2023]
Abstract
Stabilization of the graft-membrane complex during guided bone regeneration is a critically important aspect of implant dentistry. Several articles in the dental literature have introduced the utilization of periosteal biting stabilization sutures, rather than fixation screws and pins, to stabilize a bioabsorbable collagen membrane. This article reviews the concept of stabilization using sutures in periodontal regeneration and describes an alternative method, the Ribroast technique™, to stabilize a bioabsorbable membrane, whereby single periosteal biting horizontal mattress sutures are placed along the length of the defect to achieve sufficient stabilization. Two cases are presented that highlight the utility of this technique. Guidelines and limitations for the use of periosteal biting sutures are also discussed along with considerations and protocols that may be useful for improving treatment outcomes.
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Affiliation(s)
- Matthew Fien
- Co-Medical Director, International Dentistry Research Group; Private Practice, Fort Lauderdale, Florida
| | - Israel Puterman
- Co-Medical Director, International Dentistry Research Group; Private Practice Chevy Chase, Maryland
| | - Juan Mesquida
- Co-Medical Director, International Dentistry Research Group; Private Practice, Palma de Mallorca, Spain
| | - Guillermo Bauza
- Co-founder, Research Director, International Dentistry Research Group; Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales;Private Practice, Palma de Mallorca, Spain
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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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Gil ACK, Prado MM, Rocha LRD, Benfatti C, Schuldt Filho G, Almeida JD. In vitro evaluation of membranes for regenerative procedures against oral bacteria. Braz Dent J 2023; 34:57-65. [PMID: 37466526 PMCID: PMC10355258 DOI: 10.1590/0103-6440202305060] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 03/20/2023] [Indexed: 07/20/2023] Open
Abstract
The current literature on guided bone regeneration (GBR) and guided tissue regeneration (GTR) membrane contamination reports that the physicochemical characteristics of these biomaterials might influence affinity to bacteria, which appears to be a major drawback for the clinical outcome of the regenerative procedures. Thus, this study aimed to evaluate, in vitro, a multispecies biofilm adherence and passage of bacteria through different types of commercially available membranes for GTR/GBR. Four types of membranes were tested (n=12): LC) Lumina Coat®; JS) Jason®; BG) Biogide®; and LP) Lumina PTFE®. Aluminum foil (AL) simulated an impermeable barrier and was used as the control. The membranes were adapted to specific apparatus and challenged with a mixed bacterial culture composed of A. actinomycetemcomitans b, S. mutans, S. mitis, and A. israelii. After 2 h or 7 days, bacterial adhesion and passage of bacteria were evaluated through CFU counting, which was analyzed by two-way ANOVA e post hoc Tukey, at a 5% significance level. Representative areas of two membranes of each group were analyzed through scanning electron microscopy (SEM) to assess the morphology and organization of the biofilm over the membrane fibers. LC and LP presented similar values of adhered bacterial cells (p > 0.05), significantly inferior when compared to the other groups, in both time points (p < 0.05). All the tested groups were permeable to bacterial cells, with no significant difference between the trial period of 2 h and 7 days (p > 0.05). SEM analyses demonstrated that adhered bacteria number increased throughout the time points (2 h < 7 days). Commercially available biological membranes demonstrated intense bacterial adherence and passage of bacteria, which increased throughout the trial period.
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Affiliation(s)
- Ana Clara Kuerten Gil
- Department of Implant Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Maick Meneguzzo Prado
- Department of Chemical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Laura Rhoden da Rocha
- Department of Endodontics, University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - César Benfatti
- Department of Implant Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Guenther Schuldt Filho
- Department of Implant Dentistry, University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
| | - Josiane de Almeida
- Department of Endodontics, University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina, Brazil
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Ye L, Mashrah MA, Ge L, Fang Y, Guo X, Ge Q, Wang L. Network meta-analysis of platelet-rich fibrin in periodontal intrabony defects. J Oral Pathol Med 2023; 52:206-215. [PMID: 36793244 DOI: 10.1111/jop.13409] [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: 11/01/2022] [Revised: 01/08/2023] [Accepted: 01/23/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To evaluate the effect of platelet-rich fibrin alone or in combination with different biomaterials for the treatment of periodontal intra-bony defect. METHODS Up to April 2022, Cochrane library, Medline, EMBASE, and Web of Science databases were searched for randomized clinical trials. The outcomes of interest were probing pocket depth reduction, clinical attachment level gain, bone gain, and bone defect depth reduction. Bayesian network meta-analysis with 95% credible intervals was calculated. RESULTS Thirty-eight studies with 1157 participants were included. Platelet-rich fibrin alone or platelet-rich fibrin +biomaterials showed a statistically significant difference when compared with open flap debridement (p < 0.05, low to high certainty evidence). Neither biomaterials alone nor platelet-rich fibrin +biomaterials showed a statistically significant difference when compared to platelet-rich fibrin alone (p > 0.05, very low to high certainty evidence). Platelet-rich fibrin +biomaterials showed insignificant differences as compared to biomaterials alone (p > 0.05, very low to high certainty evidence). Allograft +collagen membrane ranked the best in probing pocket depth reduction while platelet-rich fibrin +hydroxyapatite ranked the best in bone gain. CONCLUSION It seems that (1) platelet-rich fibrin with/without biomaterials were more effective than open flap debridement. (2) Platelet-rich fibrin alone provides a comparable effect to biomaterials alone and platelet-rich fibrin +biomaterials. (3) Platelet-rich fibrin +biomaterials provide a comparable effect to biomaterials alone. Although allograft +collagen membrane and platelet-rich fibrin +hydroxyapatite ranked the best in terms of probing pocket depth reduction and bone gain respectively, the difference between different regenerative therapies remains insignificant, and therefore, further studies are still needed to confirm these results.
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Affiliation(s)
- Lianmei Ye
- Department of Oral Implant, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
- Department of Stomatology, Dongguan TungWah Hospital, Dongguan, Guangdong, China
| | - Mubarak Ahmed Mashrah
- Department of Oral Implant, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - Linhu Ge
- Department of Oral Implant, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - Ying Fang
- Department of Oral Implant, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - Xueqi Guo
- Department of Oral Implant, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - Qing Ge
- Department of Oral Implant, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
| | - Liping Wang
- Department of Oral Implant, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong, China
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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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40
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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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Mourlaas J, Cortasse B, Vigouroux F, Dagba A. The Tunnel Wall Approach and Enamel Matrix Derivative to Cover Exposed Roots and Improve Clinical Attachment Levels in Cairo Class III Defects Associated with an Intrabony Lesion in the Anterior Area: Three Cases. INT J PERIODONT REST 2023; 43:95-102. [PMID: 36661883 DOI: 10.11607/prd.6352] [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
These case reports present a surgical technique to improve the clinical attachment level and cover the exposed root surface in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area. The tunnel wall approach combined previously described concepts and placed a CTG into a modified tunnel-type flap through a vertical releasing incision. The CTG acted both as a buccal soft tissue wall to stabilize the blood clot and as a space maintainer to coronally move the tissue. The decontaminated root surfaces were treated with enamel matrix derivative, and a bone filler material was placed from the bottom of the intrabony defect up to the cementoenamel junction to support the proximal soft tissue architecture. Healing of the four presented sites was uneventful. Clinical measurements up to 12 months showed significant probing depth reduction, clinical attachment gain, and coverage of the buccal recession in each case. Papilla improvement was reported in three cases. Radiographic examinations confirmed intrabony defect healing and the presence of embedded bone filler material in the soft tissue above the bone crest. The tunnel wall approach seems to be a valuable option to safely enhance the clinical attachment level and cover the exposed root in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area.
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Takedachi M, Kawasaki K, Sawada K, Sakura K, Murata M, Shimomura J, Kawakami K, Morimoto C, Miki K, Takeshita N, Iwayama T, Okura H, Matsuyama A, Saito M, Kitamura M, Murakami S. Periodontal Tissue Regeneration by Transplantation of Autologous Adipose Tissue-Derived Multi-Lineage Progenitor Cells With Carbonate Apatite. Cell Transplant 2023; 32:9636897231198296. [PMID: 37710973 PMCID: PMC10503283 DOI: 10.1177/09636897231198296] [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: 03/27/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
We have developed an autologous transplantation method using adipose tissue-derived multi-lineage progenitor cells (ADMPCs) as a method of periodontal tissue regeneration that can be adapted to severe periodontal disease. Our previous clinical study confirmed the safety of autologous transplantation of ADMPCs and demonstrated its usefulness in the treatment of severe periodontal disease. However, in the same clinical study, we found that the fibrin gel used as the scaffold material might have caused gingival recession and impaired tissue regeneration in some patients. Carbonate apatite has a high space-making capacity and has been approved in Japan for periodontal tissue regeneration. In this study, we selected carbonate apatite as a candidate scaffold material for ADMPCs and conducted an in vitro examination of its effect on the cellular function of ADMPCs. We further performed autologous ADMPC transplantation with carbonate apatite as the scaffold material in a model of one-wall bone defects in beagles and then analyzed the effect on periodontal tissue regeneration. The findings showed that carbonate apatite did not affect the cell morphology of ADMPCs and that it promoted proliferation. Moreover, no effect on secretor factor transcription was found. The results of the in vivo analysis confirmed the space-making capacity of carbonate apatite, and the acquisition of significant new attachment was observed in the group involving ADMPC transplantation with carbonate apatite compared with the group involving carbonate apatite application alone. Our results demonstrate the usefulness of carbonate apatite as a scaffold material for ADMPC transplantation.
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Affiliation(s)
- Masahide Takedachi
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Kohsuke Kawasaki
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Keigo Sawada
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Kazuma Sakura
- Department of Medical Innovation, Osaka University Hospital, Suita, Japan
| | - Mari Murata
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Junpei Shimomura
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Kazuma Kawakami
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Chiaki Morimoto
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Koji Miki
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Noboru Takeshita
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Tomoaki Iwayama
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Hanayuki Okura
- Center for Reverse Translational Research, Osaka Habikino Medical Center, Osaka Prefectural Hospital Organization, Habikino, Japan
- Adipo Medical Technology, Osaka, Japan
- Institute of Innovative Medical Technology, Osaka. Japan
| | - Akifumi Matsuyama
- Center for Reverse Translational Research, Osaka Habikino Medical Center, Osaka Prefectural Hospital Organization, Habikino, Japan
| | - Masahiro Saito
- Department of Restorative Dentistry, Division of Operative Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Masahiro Kitamura
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shinya Murakami
- Department of Periodontology and Regenerative Dentistry, Osaka University Graduate School of Dentistry, Suita, Japan
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Ren Y, Fan L, Alkildani S, Liu L, Emmert S, Najman S, Rimashevskiy D, Schnettler R, Jung O, Xiong X, Barbeck M. Barrier Membranes for Guided Bone Regeneration (GBR): A Focus on Recent Advances in Collagen Membranes. Int J Mol Sci 2022; 23:ijms232314987. [PMID: 36499315 PMCID: PMC9735671 DOI: 10.3390/ijms232314987] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/25/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022] Open
Abstract
Guided bone regeneration (GBR) has become a clinically standard modality for the treatment of localized jawbone defects. Barrier membranes play an important role in this process by preventing soft tissue invasion outgoing from the mucosa and creating an underlying space to support bone growth. Different membrane types provide different biological mechanisms due to their different origins, preparation methods and structures. Among them, collagen membranes have attracted great interest due to their excellent biological properties and desired bone regeneration results to non-absorbable membranes even without a second surgery for removal. This work provides a comparative summary of common barrier membranes used in GBR, focusing on recent advances in collagen membranes and their biological mechanisms. In conclusion, the review article highlights the biological and regenerative properties of currently available barrier membranes with a particular focus on bioresorbable collagen-based materials. In addition, the advantages and disadvantages of these biomaterials are highlighted, and possible improvements for future material developments are summarized.
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Affiliation(s)
- Yanru Ren
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany
- BerlinAnalytix GmbH, 12109 Berlin, Germany
| | - Lu Fan
- NMI Natural and Medical Sciences Institute, University of Tübingen, 72770 Reutlingen, Germany
| | | | - Luo Liu
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100013, China
| | - Steffen Emmert
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Stevo Najman
- Scientific Research Center for Biomedicine, Department for Cell and Tissue Engineering, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
- Department of Biology and Human Genetics, Faculty of Medicine, University of Niš, 18000 Niš, Serbia
| | - Denis Rimashevskiy
- Department of Traumatology and Orthopedics, Peoples’ Friendship University of Russia, 117198 Moscow, Russia
| | - Reinhard Schnettler
- University Medical Centre, Justus Liebig University of Giessen, 35390 Giessen, Germany
| | - Ole Jung
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany
| | - Xin Xiong
- NMI Natural and Medical Sciences Institute, University of Tübingen, 72770 Reutlingen, Germany
| | - Mike Barbeck
- Clinic and Policlinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany
- BerlinAnalytix GmbH, 12109 Berlin, Germany
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100013, China
- Correspondence: ; Tel.: +49-(0)-176-81022467
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Mehta V, Kaçani G, Moaleem MMA, Almohammadi AA, Alwafi MM, Mulla AK, Alharbi SO, Aljayyar AW, Qeli E, Toti Ç, Meto A, Fiorillo L. Hyaluronic Acid: A New Approach for the Treatment of Gingival Recession-A Systematic Review. Int J Environ Res Public Health 2022; 19:14330. [PMID: 36361208 PMCID: PMC9658310 DOI: 10.3390/ijerph192114330] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
This systematic review aimed to investigate the effectiveness of hyaluronic acid (HA) on the clinical treatment outcomes of patients with gingival recession. A systematic search was performed in PubMed, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Google Scholar for studies up to 15 August 2022. Two reviewers separately selected the papers for eligibility after conducting a thorough search. The study includes randomized controlled clinical trials in which participants were given HA in addition to periodontal treatment surgical procedures. The changes following the treatment protocol were evaluated for complete and mean root coverage as a primary outcome and gingival recession gain as the secondary outcome. Three articles met the eligibility criteria out of 557 titles. In periodontal surgery, HA exhibited better results in complete root coverage and mean root coverage when compared to the control group. Gingival recession reduction, clinical attachment level, and keratinized tissue gain were significantly increased compared to the control groups. However, the comparison presented in the following study might show heterogeneity among the studies and risk of bias in general. Given the scope of this analysis, results suggest that adjunctive treatment with HA gel for root coverage could be clinically beneficial.
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Affiliation(s)
- Vini Mehta
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 411018, India
| | - Gerta Kaçani
- Department of Prosthetic, Faculty of Dental Medicine, University of Medicine, 1005 Tirana, Albania
| | - Mohammed M. Al Moaleem
- Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Faculty of Dentistry, University of Ibn Al-Nafis for Medical Sciences, Sana’a 4337, Yemen
| | | | - Malak Mohammed Alwafi
- College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Medina 41311, Saudi Arabia
| | | | - Shahad Owaidh Alharbi
- College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Medina 41311, Saudi Arabia
| | | | - Etleva Qeli
- Department of Conservative, Faculty of Dental Medicine, University of Medicine, 1005 Tirana, Albania
| | - Çeljana Toti
- Department of Prosthetic, Faculty of Dental Medicine, University of Medicine, 1005 Tirana, Albania
| | - Agron Meto
- Department of Dentistry, University of Aldent, 1007 Tirana, Albania
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy
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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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De Ry SP, Pagnamenta M, Ramseier CA, Roccuzzo A, Salvi GE, Sculean A. Five-year results following regenerative periodontal surgery with an enamel matrix derivative in patients with different smoking status. Quintessence Int 2022; 53:832-838. [PMID: 36169272 DOI: 10.3290/j.qi.b3418233] [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
OBJECTIVE To evaluate the five-year results following regenerative periodontal surgery of intrabony defects using an enamel matrix derivative (EMD) in patients with different smoking status. METHOD AND MATERIALS The dental records of patients treated with regenerative periodontal surgery with EMD between 2001 and 2011 were screened. The clinical parameters at baseline (T0) and 6 months (T1) and 5 years (T2) after surgery were collected and analyzed in relation to patient's smoking status (smokers, former smokers, and nonsmokers). RESULTS A total of 71 sites were initially assessed in 38 patients. In total, 56 sites could be evaluated at T1, and 34 after 5 years (T2). At 6 months after surgery, a statistically significant mean probing pocket depth (PPD) reduction of 2.91 ± 1.60 mm and a mean clinical attachment level (CAL) gain of 1.89 ± 1.90 mm were measured. Nonsmokers revealed a greater, statistically not significant CAL gain compared to smokers (2.38 ± 2.12 mm vs 1.50 ± 1.71 mm). Although at 5 years the site-specific PPD values remained stable in nonsmokers, smokers showed an increase of 1.60 ± 2.41 mm. CONCLUSIONS The present study provides evidence that regenerative periodontal surgery with EMD may lead to clinically relevant improvements even in smoking patients. However, the positive effect of EMD seems to be limited in time and can only partially compensate for the negative influence of smoking.
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Neiva BT, Neiva GF, Neiva R. Lasso Guided Bone Regeneration Technique for the Management of Implant Fenestration Defects. Compend Contin Educ Dent 2022; 43:426-432. [PMID: 35790479] [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: 06/15/2023]
Abstract
Implant placement in the anterior maxilla provides many unique challenges to the clinician, including esthetics and potential alveolar bone anatomic variations. The depth of the implant osteotomy is a key consideration to avoid a fenestration defect, which could necessitate subsequent treatment. Treatment options for such defects include bone augmentation with or without implantoplasty. Bone augmentation for the correction of dehiscence or fenestration defects on restored dental implants can be difficult due to the grafted site being close to the margin of the flap, thereby favoring premature bone graft and/or barrier membrane exposure. This article describes the management of an implant fenestration defect using lasso guided bone regeneration, a contemporary technique for bone augmentation and alveolar reconstruction designed to maximize predictability and tissue quality by combining fast-absorbing bone replacement materials with long-lasting barrier membranes and stabilization with internal periosteal sutures.
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Affiliation(s)
- Bruna T Neiva
- Academic Director, Neiva Institute, Curitiba, Paraná, Brazil
| | - Gisele F Neiva
- Clinical Associate Professor and Graduate Program Director, Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Rodrigo Neiva
- Chairman and Clinical Professor, Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania
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Imamura K, Suzuki E, Takeuchi T, Saito A. Clinical Outcomes of Periodontal Regenerative Therapy Using rhFGF-2 with a Modified Minimally Invasive Surgical Technique for Intrabony Defects: Case Series with a 12-Month Follow-up. INT J PERIODONT REST 2022; 42:507-513. [PMID: 35830316 DOI: 10.11607/prd.5572] [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: 11/12/2022]
Abstract
The Modified Minimally Invasive Surgical Technique (M-MIST) was designed to improve wound stability and reduce patient morbidity. This case series aimed to evaluate clinical outcomes of periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF)-2 with M-MIST for the treatment of intrabony defects. Following initial periodontal therapy, nine intrabony defects in seven patients received rhFGF-2 therapy. Using M-MIST, a buccal incision was made to gain access to the defect without interdental and lingual incisions. After debridement, rhFGF-2 was applied to the defect. Periodontal parameters were evaluated at baseline and at 3, 6, and 12 months postoperatively. Composite Outcome Measure (COM) and patient-reported outcome measure (PROM, recorded using an oral health-related quality of life [QoL] instrument) were also used for evaluation. At 12 months postoperative, mean probing depth reduction was 4.2 ± 0.8 mm and clinical attachment gain was 4.7 ± 0.7 mm. The mean value for gingival recession was -0.3 ± 0.5 mm. According to COM, the outcomes of the treated sites were successful. An improvement in oral health-related QoL was noted at 12 months compared to after the initial periodontal therapy. This case series shows that rhFGF-2 therapy with M-MIST yields favorable clinical outcomes in the treatment of intrabony defects.
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Merli M, Merli M, Pagliaro U, Fratini A, Lo Russo L, Nieri M. The Multilayer GBR Technique: An Alternative Approach for One-Stage Transmucosal Implant Placement in the Presence of Horizontal Defects. A Case Series. INT J PERIODONT REST 2022; 42:e113-e120. [PMID: 35830318 DOI: 10.11607/prd.6084] [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: 11/12/2022]
Abstract
This study presents a one-stage technique for horizontal guided bone regeneration and transmucosal implant placement in the presence of hard and soft tissue defects. The proposed technique uses autologous bone particles, deproteinized bovine bone matrix, collagen membranes, and concentrated growth factor membranes to create a multilayer barrier and enhance tissue regeneration. Four patients were treated with a total of seven implants. Digital analyses of intraoral scan data taken at baseline and at 6 months postsurgery showed a mean increase in tissue volume of 157.4 mm3. The patient satisfaction was high, and no complications were observed.
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Estrin NE, Moraschini V, Zhang Y, Miron RJ. Use of Enamel Matrix Derivative in Minimally Invasive/Flapless Approaches: A Systematic Review with Meta-Analysis. Oral Health Prev Dent 2022; 20:233-242. [PMID: 35695693 DOI: 10.3290/j.ohpd.b3125655] [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: 06/15/2023]
Abstract
PURPOSE The aim of the present systematic review with meta-analysis was to investigate the clinical effectiveness of EMD (enamel matrix derivative) using a minimally invasive surgical technique (MIST) or flapless approach for the treatment of severe periodontal probing depths. MATERIALS AND METHODS A systematic review of the literature including searches in PubMed/Medline, Cochrane Library, Google Scholar, and Grey Literature databases as well as manual searches was performed on September 1st, 2021. Studies utilising EMD in a non-surgical or minimally invasive approach were included. The eligibility criteria comprised randomised controlled trials (RCTs) comparing minimally-invasive/flapless approaches with/without EMD for the treatment of probing depths >5 mm. RESULTS From 1525 initial articles, 7 RCTs were included and 12 case series discussed. Three studies investigated a MIST approach, whereas 3 studies utilised a flapless approach. One study compared EMD with either a MIST or a flapless approach. The RCTs included ranged from 19-49 patients with at least 6 months of follow-up. While 5 of the studies included smokers, patients smoking >20 cigarettes/day were excluded from the study. The meta-analysis revealed that EMD with MIST improved recession coverage (REC) and bone fill (BF) when compared to MIST without EMD. However, no difference in CAL or PD was observed between MIST + EMD vs MIST without EMD. No statistically significant advantage was found for employing the EMD via the flapless approach. CONCLUSIONS Implementing EMD in MIST procedures displayed statistically significant improvement in REC and BF when compared to MIST alone. These findings suggest that MIST in combination with EMD led to improved clinical outcomes while EMD employed in nonsurgical flapless therapy yielded no clinical benefits when compared to nonsurgical therapy alone without EMD. More research is needed to substantiate these findings.
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