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Patra L, Raj SC, Katti N, Mohanty D, Pradhan SS, Tabassum S, Mishra AK, Patnaik K, Mahapatra A. Comparative evaluation of effect of injectable platelet-rich fibrin with collagen membrane compared with collagen membrane alone for gingival recession coverage. World J Exp Med 2022; 12:68-91. [PMID: 36157336 PMCID: PMC9350719 DOI: 10.5493/wjem.v12.i4.68] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/26/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Collagen membrane and platelet-rich fibrin (PRF) have emerged as vital biomaterials in the field of periodontal regeneration. Minimally invasive techniques are being preferred by most periodontists, as it is patient compliant with fewer post-surgical complications as compared to conventional surgical techniques. Thus, in this study we have evaluated the effect of injectable PRF (i-PRF) with collagen membrane compared with collagen membrane alone using vestibular incision subperiosteal tunnel access (VISTA) technique for gingival recession coverage.
AIM To compare the efficacy of VISTA using collagen membrane with collagen membrane soaked in injectable PRF for gingival recession coverage.
METHODS A split mouth randomized controlled clinical trial was designed;13 subjects having at least 2 teeth indicated for recession coverage were enrolled in this study. The sites were randomly assigned to control group (VISTA using collagen membrane alone) and the test group (VISTA using collagen membrane with i-PRF). The clinical parameters assessed were pocket depth, recession depth (RD), recession width (RW), relative attachment level, keratinised tissue width (KTW), keratinised tissue thickness (KTT), and percentage root coverage.
RESULTS RD showed a statistically significant difference between the test group at 3 mo (0.5 ± 0.513) and 6 mo (0.9 ± 0.641) and the control group at 3 mo (0.95 ± 0.51) and 6 mo (1.5 ± 0.571), with P values of 0.008 and 0.04, respectively. RW also showed a statistically significant difference between the test group at 3 mo (1 ± 1.026) and 6 mo (1.65 ± 1.04) and the control group at 3 mo (1.85 ± 0.875) and 6 mo (2.25 ± 0.759), with P values of 0.008 and 0.001, respectively. Results for KTW showed statistically significant results between the test group at 1 mo (2.85 ± 0.489), 3 mo (3.5 ± 0.513), and 6 mo (3.4 ± 0.598) and the control group at 1 mo (2.45 ± 0.605), 3 mo (2.9 ± 0.447), and 6 mo (2.75 ± 0.444), with P values of 0.04, 0.004, and 0.003, respectively. Results for KTT also showed statistically significant results between test group at 1 mo (2.69 ± 0.233), 3 mo (2.53 ± 0.212), and 6 mo (2.46 ± 0.252) and the control group at 1 mo (2.12 ± 0.193), 3 mo (2.02 ± 0.18), and 6 mo (1.91 ± 0.166), with P values of 0.001, 0.001, and 0.001, respectively. The test group showed 91.6%, 81.6%, and 67% root coverage at 1 mo, 3 mo, and 6 mo, while the control group showed 82.3%, 66.4%, and 53.95% of root coverage at 1 mo, 3 mo, and 6 mo, respectively.
CONCLUSION The use of minimally invasive VISTA technique along with collagen membrane and injectable form of platelet-rich fibrin can be successfully used as a treatment method for multiple or isolated gingival recessions of Miller’s class-I and class-II defects.
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Affiliation(s)
- Laxmikanta Patra
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Subash Chandra Raj
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Neelima Katti
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Devapratim Mohanty
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Shib Shankar Pradhan
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Shaheda Tabassum
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Asit Kumar Mishra
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Kaushik Patnaik
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
| | - Annuroopa Mahapatra
- Department of Periodontics, SCB Dental College and Hospital, Odisha 753007, India
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Georgiou GO, Tarallo F, Marchetti E, Bizzarro S. Overview of the Effect of Different Regenerative Materials in Class II Furcation Defects in Periodontal Patients. MATERIALS (BASEL, SWITZERLAND) 2022; 15:3194. [PMID: 35591533 PMCID: PMC9103580 DOI: 10.3390/ma15093194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
The aim of this review was to give an overview of the outcomes of the use of different regenerative materials to treat molars with class II furcation defects in patients with periodontitis in comparison with open flap debridement (OFD). A search of five databases (PubMed-Medline, Embase, Cochrane, Scopus and Web of Science) was conducted up to and including January 2022. According to the PICOS guidelines, only randomized control trials (S) considering periodontal patients with at least one molar with a class II furcation involvement (P) treated with regenerative materials (I) in comparison to OFD as control treatment (C) and a minimum follow-up period of 6 months were included. Vertical clinical attachment level (VCAL) was considered as the primary outcome (O), while horizontal clinical attachment level (HCAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were considered as secondary outcomes. The search through the databases initially identified 1315 articles. Only 25 of them met the eligibility criteria and were included. The studies were grouped in four macro-categories according to the material used: absorbable and non-absorbable membranes, blood derivatives and a combination of different materials. The greater part of the included studies reported a statistically significant difference in using regenerative materials when compared to OFD. The blood derivatives groups reported a range of mean changes in VCAL of 0.86-4.6 mm, absorbable membrane groups reported -0.6-3.75 mm, non-absorbable membranes groups reported -2.47-4.1 mm, multiple materials groups reported -1.5-4.87 mm and enamel matrix derivatives reported a mean change in VCAL of 1.45 mm. OFD showed a range of mean VCAL changes of -1.86-2.81 mm. Although no statistical analysis was performed, the use of regenerative materials may be considered moderately beneficial in the treatment of molars with grade II furcation involvement. However, the substantial heterogeneity in the protocols' design does not allow us to draw definitive conclusions. In addition, low levels of evidence for morbidity and patient-centered outcomes were reported.
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Affiliation(s)
- Gerasimos Odysseas Georgiou
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, 1081 LA Amsterdam, The Netherlands; (G.O.G.); (S.B.)
| | - Francesco Tarallo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Coppito, 67100 L’Aquila, Italy;
| | - Enrico Marchetti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Coppito, 67100 L’Aquila, Italy;
| | - Sergio Bizzarro
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, 1081 LA Amsterdam, The Netherlands; (G.O.G.); (S.B.)
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Hoshi M, Sawada T, Hatakeyama W, Taira M, Hachinohe Y, Takafuji K, Kihara H, Takemoto S, Kondo H. Characterization of Five Collagenous Biomaterials by SEM Observations, TG-DTA, Collagenase Dissolution Tests and Subcutaneous Implantation Tests. MATERIALS 2022; 15:ma15031155. [PMID: 35161098 PMCID: PMC8839282 DOI: 10.3390/ma15031155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 11/25/2022]
Abstract
Collagenous biomaterials that are clinically applied in dentistry have dermis-type and membrane-type, both of which are materials for promoting bone and soft tissue formation. The properties of materials supplied with different types could affect their biodegradation periods. The purpose of this study was to characterize five of these products by four different methods: scanning electron microscopy (SEM) observation, thermogravimetry-differential thermal analysis (TG-DTA), 0.01 wt% collagenase dissolution test, and subcutaneous implantation test in vivo. SEM micrographs revealed that both dermis and membranous materials were fibrous and porous. The membranous materials had higher specific derivative thermal gravimetry (DTG) peak temperatures in TG-DTA at around 320 °C, longer collagenase dissolution time ranging from about 300 to 500 min, and more longevity in mice exceeding 9 weeks than the dermis materials. There existed a correlation between the peak temperature in TG-DTA and the collagenase dissolution time. It was considered that higher cross-link degree among collagen fibrils of the membrane-type collagenous materials might account for these phenomena. The experimental protocol and numerical results obtained could be helpful for selection and future development of fibrous collagenous biomaterials in clinical use.
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Affiliation(s)
- Miki Hoshi
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Iwate, Japan; (M.H.); (W.H.); (Y.H.); (K.T.); (H.K.); (H.K.)
| | - Tomofumi Sawada
- Department of Biomedical Engineering, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho 028-3694, Iwate, Japan; (T.S.); (S.T.)
| | - Wataru Hatakeyama
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Iwate, Japan; (M.H.); (W.H.); (Y.H.); (K.T.); (H.K.); (H.K.)
| | - Masayuki Taira
- Department of Biomedical Engineering, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho 028-3694, Iwate, Japan; (T.S.); (S.T.)
- Correspondence: ; Tel.: +81-19-651-5110
| | - Yuki Hachinohe
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Iwate, Japan; (M.H.); (W.H.); (Y.H.); (K.T.); (H.K.); (H.K.)
| | - Kyoko Takafuji
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Iwate, Japan; (M.H.); (W.H.); (Y.H.); (K.T.); (H.K.); (H.K.)
| | - Hidemichi Kihara
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Iwate, Japan; (M.H.); (W.H.); (Y.H.); (K.T.); (H.K.); (H.K.)
| | - Shinji Takemoto
- Department of Biomedical Engineering, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho 028-3694, Iwate, Japan; (T.S.); (S.T.)
| | - Hisatomo Kondo
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka 020-8505, Iwate, Japan; (M.H.); (W.H.); (Y.H.); (K.T.); (H.K.); (H.K.)
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Majzoub J, Salami A, Barootchi S, Tavelli L, Wang HL, Chan HL. Multivariate outcome evaluation of furcation-involved molars treated with non-surgical mechanical therapy alone or combined with open flap debridement: A retrospective study. J Periodontol 2021; 93:673-686. [PMID: 34449893 DOI: 10.1002/jper.21-0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND This retrospective study assessed the effect of non-surgical and surgical mechanical therapy for furcation-involved molars. METHODS Furcation defects treated and followed for at least 1 year were selected. Data relative to the clinical outcomes were recorded. The immediate (3- to 6-month) clinical outcomes and the long-term survival of the treated molars were assessed. The potential variables influencing the treatment outcomes through multi-level regression analysis, and Cox Proportional-Hazards Models were also analyzed. RESULTS One hundred and eighty-four molars were included with an average follow-up of 7.52 years. At the 3- to 6-month re-evaluation 1.39 ± 0.99 mm pocket depth reduction, 0.88 ± 1.29 mm clinical attachment gain, and a 0.51 ± 1.13 mm increase in recession was observed. The 5- and 10-year survival rates were 88.3% and 61.3%, respectively. The horizontal and vertical extent of furcation involvement, baseline probing depth, mucoperiosteal flap elevation, and the frequency of supportive periodontal therapy influenced the clinical outcomes and tooth survival. CONCLUSION Non-surgical and surgical mechanical root debridement is a viable treatment for the management of furcation involved molars with shallow horizontal and vertical components.
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Affiliation(s)
- Jad Majzoub
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Ali Salami
- Department of Mathematics, Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI.,Department of Oral Medicine, Infection and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Hsun-Liang Chan
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
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Guided Tissue Regeneration Treatment Yields Better Results in Class II Furcations in the Mandible Than in the Maxilla: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147447. [PMID: 34299898 PMCID: PMC8303943 DOI: 10.3390/ijerph18147447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/05/2023]
Abstract
Absorbable porcine collagen membrane with a bovine bone graft can be considered for regenerative treatment in periodontal class II furcation defects. We evaluated the clinical efficacy of guided tissue regeneration (GTR) treatment with bovine bone xenograft and a porcine collagen membrane in molars with class II furcations. Probing depth (PD), clinical attachment level (CAL), and bone level (BL) were recorded at baseline and at 3, 6, and 9 months postoperatively. Thirty class II furcation defects from the lower and upper molars were assessed. Significant improvements in PD and CAL were observed from baseline to 9 months in all groups (p < 0.01). BL improved in all groups except group A in the upper molars in radiographic assessment (p < 0.05). The lower and upper molars showed PD reduction of 50.5% ± 7.44% and 46.2% ± 11.2%, respectively, at 9 months (p = 0.044). In furcations of 1–3 mm, the lower and upper molars showed PD reductions of 51.2% ± 4.49% and 36.5% ± 16.14%, respectively (p = 0.035). The lower and upper molars showed a CAL gain of 51.1% ± 4.64% and 33.6% ± 18.8%, respectively (p = 0.037). Thus, GTR with bovine bone graft and porcine collagen membrane yielded good results in class II furcations, with better results in the lower than in the upper molars.
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Ahmad F, Lata J. Collagen matrix membrane as a biological dressing in defects of the oral mucosa. Natl J Maxillofac Surg 2021; 12:199-205. [PMID: 34483577 PMCID: PMC8386252 DOI: 10.4103/njms.njms_128_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/02/2020] [Accepted: 10/31/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The objectives of this study were to evaluate the usefulness of the extracellular collagen matrix membrane as a biological wound dressing material for defects of the oral mucosa. MATERIALS AND METHODS One hundred two patients were included in the study. A bovine-based extracellular matrix collagen membrane was used. The study was confined to those defects of oral mucosa which were large enough to close primarily. RESULTS The results were evaluated under various parameters such as hemostasis, pain relief, granulation, epithelialization, and contracture of the wound. Secondary infection and allergenicity to the membrane were also considered, and finally, the usefulness of the collagen membrane was tested by the use of the Chi-square test and P < 0.001 was found. CONCLUSION We concluded that the extracellular collagen membrane could be used as a biological dressing in oral defects. Although it does not replace, it is proved as a good substitute of autologous graft.
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Affiliation(s)
- Fahad Ahmad
- Department of Oral and Maxillofacial Surgery, Al-Jahra Specialty Dental Center, Al-Jahra, Kuwait,Address for correspondence: Dr. Fahad Ahmad, Department of Oral and Maxillofacial Surgery, Al-Jahra Specialty Dental Center, Al-Jahra, Kuwait. E-mail:
| | - Jeevan Lata
- Department of Oral and Maxillofacial Surgery, Punjab Government Dental College and Hospital, Amritsar, Punjab, India
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Hyaluronan alkyl derivatives-based electrospun membranes for potential guided bone regeneration: Fabrication, characterization and in vitro osteoinductive properties. Colloids Surf B Biointerfaces 2020; 197:111438. [PMID: 33166935 DOI: 10.1016/j.colsurfb.2020.111438] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 10/19/2020] [Indexed: 01/16/2023]
Abstract
The aim of the work was to determine the effects of the chemical functionalization of hyaluronic acid (HA) with pendant aliphatic tails at different lengths and free amino groups in terms of chemical reactivity, degradation rate, drug-eluting features, and surface properties when processed as electrospun membranes (EM) evaluating the osteoinductive potential for a possible application as guided bone regeneration (GBR). To this end, a series of HA derivatives with different aliphatic tails (DD-Cx mol% ≈ 12.0 mol%) and decreasing derivatization of free amino groups (DDEDA mol% from 70.0 to 30.0 mol%) were first synthesized, namely Hn. Then dexamethasone-loaded Hn EM, i.e. HnX were prepared from aqueous polymeric solutions with polyvinyl alcohol (PVA), as a non-ionogenic linear flexible polymeric carrier, and the multifunctional 2-hydroxypropyl- cyclodextrin (HPCD) which acted as a rheological modifier, a stabilizer of Taylor's cone, and a solubilizing agent. A comprehensive characterization of the membranes was carried out through ATR-IR, XRD, and WCA measurements. According to the in vitro hydrolytic and enzymatic degradation and drug release in different aqueous media for two months, the insertion of alkyl pendant grafts and the crosslinking process provided tuneable additional resistance to the whole membrane suitably for the final application of the membranes. Cell culture showed the cytocompatibility and cell proliferation until 7 days. Osteogenic differentiation and mineralization of pre-osteoblastic MC3T3 cells occurred for most of membranes after 35 days as valued by measuring ALP activity (50 nmol 4-np/h/nf DNA) and the deposition of calcium (120-140 μg ml-1).
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Farnezi Bassi AP, Bizelli VF, Brasil LFDM, Pereira JC, Al-Sharani HM, Momesso GAC, Faverani LP, Lucas FDA. Is the Bacterial Cellulose Membrane Feasible for Osteopromotive Property? MEMBRANES 2020; 10:membranes10090230. [PMID: 32932731 PMCID: PMC7558580 DOI: 10.3390/membranes10090230] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023]
Abstract
Guided bone regeneration was studied to establish protocols and develop new biomaterials that revealed satisfactory results. The present study aimed to comparatively evaluate the efficiency of the bacterial cellulose membrane (Nanoskin®) and collagen membrane Bio-Gide® in the bone repair of 8-mm critical size defects in rat calvaria. Seventy-two adult male rats were divided into three experimental groups (n = 24): the CG—membrane-free control group (only blood clot, negative control), BG—porcine collagen membrane group (Bio-Guide®, positive control), and BC—bacterial cellulose membrane group (experimental group). The comparison periods were 7, 15, 30, and 60 days postoperatively. Histological, histometric, and immunohistochemical analyses were performed. The quantitative data were subjected to 2-way ANOVA and Tukey’s post-test, and p < 0.05 was considered significant. At 30 and 60 days postoperatively, the BG group showed more healing of the surgical wound than the other groups, with a high amount of newly formed bone (p < 0.001), while the BC group showed mature connective tissue filling the defect. The inflammatory cell count at postoperative days 7 and 15 was higher in the BC group than in the BG group (Tukey’s test, p = 0.006). At postoperative days 30 and 60, the area of new bone formed was greater in the BG group than in the other groups (p < 0.001). Immunohistochemical analysis showed moderate and intense immunolabeling of osteocalcin and osteopontin at postoperative day 60 in the BG and BC groups. Thus, despite the promising application of the BC membrane in soft-tissue repair, it did not induce bone repair in rat calvaria.
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Affiliation(s)
- Ana Paula Farnezi Bassi
- Department of Diagnosis and Surgery, São Paulo State University, UNESP, School of Dentistry, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (L.F.d.M.B.); (J.C.P.); (G.A.C.M.); (L.P.F.)
- Correspondence: ; Tel.: +55-18-36363242
| | - Vinícius Ferreira Bizelli
- Department of Diagnosis and Surgery, São Paulo State University, UNESP, School of Dentistry, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (L.F.d.M.B.); (J.C.P.); (G.A.C.M.); (L.P.F.)
| | - Leticia Freitas de Mendes Brasil
- Department of Diagnosis and Surgery, São Paulo State University, UNESP, School of Dentistry, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (L.F.d.M.B.); (J.C.P.); (G.A.C.M.); (L.P.F.)
| | - Járede Carvalho Pereira
- Department of Diagnosis and Surgery, São Paulo State University, UNESP, School of Dentistry, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (L.F.d.M.B.); (J.C.P.); (G.A.C.M.); (L.P.F.)
| | - Hesham Mohammed Al-Sharani
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Ibb University, Ibb 16015-050, Yemen;
| | - Gustavo Antonio Correa Momesso
- Department of Diagnosis and Surgery, São Paulo State University, UNESP, School of Dentistry, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (L.F.d.M.B.); (J.C.P.); (G.A.C.M.); (L.P.F.)
| | - Leonardo P. Faverani
- Department of Diagnosis and Surgery, São Paulo State University, UNESP, School of Dentistry, Araçatuba, São Paulo 16015-050, Brazil; (V.F.B.); (L.F.d.M.B.); (J.C.P.); (G.A.C.M.); (L.P.F.)
| | - Flavia de Almeida Lucas
- Department of Animal Clinic, Surgery and Reproduction, São Paulo State University, UNESP, School of Veterinary Medicine, Araçatuba, São Paulo 16050-698, Brazil;
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Jepsen S, Gennai S, Hirschfeld J, Kalemaj Z, Buti J, Graziani F. Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials. J Clin Periodontol 2020; 47 Suppl 22:352-374. [PMID: 31860125 DOI: 10.1111/jcpe.13238] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 01/10/2023]
Abstract
AIMS To investigate the clinical performance of regenerative periodontal surgery in the treatment of furcation defects versus open flap debridement (OFD) and to compare different regenerative modalities. MATERIAL AND METHODS A systematic search was conducted to identify RCTs evaluating regenerative surgical treatment of furcations with a minimum of 12-month follow-up. Three authors independently reviewed, selected and extracted data from the search conducted and assessed risk of bias. Primary outcomes were tooth loss, furcation improvement (closure/conversion) (FImp), gain of horizontal bone level (HBL) and attachment level (HCAL). Secondary outcomes were gain in vertical attachment level (VCAL), probing pocket depth (PPD) reduction, PROMs and adverse events. Data were summarized into Bayesian standard and network meta-analysis in order to estimate direct and indirect treatment effects and to establish a ranking of treatments. RESULTS The search identified 19 articles, reporting on 20 RCTs (19 on class II, 1 on class III furcations) with a total of 575 patients/787 defects. Tooth loss was not reported. Furcation closure ranged between 0% and 60% (10 trials), and class I conversion from 29% to 100% (six trials). Regenerative techniques were superior to OFD for FImp (OR = 20.9; 90% CrI = 5.81, 69.41), HCAL gain (1.6 mm), VCAL gain (1.3 mm) and PPD reduction (1.3 mm). Bone replacement grafts (BRG) resulted in the highest probability (Pr = 61%) of being the best treatment for HBL gain. Non-resorbable membranes + BRG ranked as the best treatment for VCAL gain (Pr = 75%) and PPD reduction (Pr = 56%). CONCLUSIONS Regenerative surgery of class II furcations is superior to OFD. FImp (furcation closure or class I conversion) can be expected for the majority of defects. Treatment modalities involving BRG are associated with higher performance.
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Affiliation(s)
- Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University Hospital Bonn, Bonn, Germany
| | - Stefano Gennai
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | | | | | - Jacopo Buti
- Unit of Periodontology, UCL Eastman Dental Institute, London, UK
| | - Filippo Graziani
- Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
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Majzoub J, Barootchi S, Tavelli L, Wang C, Travan S, Wang H. Treatment effect of guided tissue regeneration on the horizontal and vertical components of furcation defects: A retrospective study. J Periodontol 2020; 91:1148-1158. [DOI: 10.1002/jper.19-0529] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Jad Majzoub
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Chin‐Wei Wang
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Sunčica Travan
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Hom‐Lay Wang
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
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Ausenda F, Rasperini G, Acunzo R, Gorbunkova A, Pagni G. New Perspectives in the Use of Biomaterials for Periodontal Regeneration. MATERIALS 2019; 12:ma12132197. [PMID: 31288437 PMCID: PMC6651816 DOI: 10.3390/ma12132197] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 02/05/2023]
Abstract
Periodontitis is a disease with a high prevalence among adults. If not treated, it can lead to loss of teeth. Periodontal therapy aims at maintaining patient’s teeth through infection control and correction of non-maintainable anatomies including—when possible—regeneration of lost periodontal tissues. The biological regenerative potential of the periodontium is high, and several biomaterials can be utilized to improve the outcome of periodontal therapy. Use of different natural and synthetic materials in the periodontal field has been studied for many years. The main materials used today in periodontology analyzed in this review are: Resorbable and non-resorbable barrier membranes; autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes; biological agents, such as amelogenins; platelet-derived growth factor; bone morphogenic proteins; rh fibroblast growth factor 2; teriparatide hormone; platelet concentrates; and 3D scaffolds. With the development of new surgical techniques some concepts on periodontal regeneration that were strictly applied in the past seem to be not so critical today. This can have an impact on the materials that are needed when attempting to regenerate lost periodontal structures. This review aims at presenting a rationale behind the use of biomaterials in modern periodontal regeneration
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Affiliation(s)
- Federico Ausenda
- Unit of Periodontology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS C'a Granda, 20142 Milan, Italy
| | - Giulio Rasperini
- Unit of Periodontology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS C'a Granda, 20142 Milan, Italy
| | - Raffaele Acunzo
- Unit of Periodontology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS C'a Granda, 20142 Milan, Italy
| | - Angelina Gorbunkova
- Unit of Periodontology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS C'a Granda, 20142 Milan, Italy
| | - Giorgio Pagni
- Unit of Periodontology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS C'a Granda, 20142 Milan, Italy.
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Mehrotra S, Chowdhary Z, Rastogi T. Evaluation and comparison of hydroxyapatite crystals with collagen fibrils bone graft alone and in combination with guided tissue regeneration membrane. J Indian Soc Periodontol 2019; 23:234-241. [PMID: 31143004 PMCID: PMC6519101 DOI: 10.4103/jisp.jisp_386_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/02/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The combination of collagen in bone grafts is being used because of its properties that accentuate the degree of regeneration. Furcation involvement poses challenge to the prognosis of a tooth, the use of bone grafts and a combination of grafts and membranes have proved to be beneficial in the treatment of furcation defects. Thus, the aim of the present study was to clinically evaluate and compare the effectiveness of collagen fiber bone graft with and without a membrane in the treatment of mandibular Grade II furcation defects. MATERIALS AND METHODS A clinical split-mouth randomized control trial, which included ten patients having bilateral mandibular Grade II furcation defects, was randomly assigned to Group I, treated with bone graft of hydroxyapatite with collagen fibers, and Group II, treated with bone graft of hydroxyapatite with collagen fibers and guided tissue regeneration membrane of polyglycolide and polylactide copolymer, respectively. The clinical measurements were recorded at baseline and 6 months after surgery; and plaque and gingival index were recorded at baseline and at 3 and 6 months after surgery. The data obtained was statistically evaluated. RESULTS The overall results showed that the treatment procedures demonstrated statistically significant reduction in probing pocket depth, vertical defect fill, and horizontal depth of furcation, with a gain in clinical attachment level. On comparison of both the groups, Group II showed superior results with a statistically significant difference in all parameters except in gingival recession. CONCLUSION The findings of the study demonstrated superior clinical results obtained with hydroxyapatite with collagen fibers, used in combination with polyglycolide and polylactide copolymer as compared to used alone in the treatment of Grade II furcation defects.
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Affiliation(s)
- Shalabh Mehrotra
- Department of Periodontology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
| | - Zoya Chowdhary
- Department of Periodontology, Indira Gandhi Government Dental College, Jammu, Jammu and Kashmir, India
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Caballé-Serrano J, Abdeslam-Mohamed Y, Munar-Frau A, Fujioka-Kobayashi M, Hernández-Alfaro F, Miron R. Adsorption and release kinetics of growth factors on barrier membranes for guided tissue/bone regeneration: A systematic review. Arch Oral Biol 2019; 100:57-68. [PMID: 30798032 DOI: 10.1016/j.archoralbio.2019.02.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/21/2019] [Accepted: 02/15/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Guided bone / tissue regeneration (GBR/GTR) procedures are necessary to improve conditions for implant placement. These techniques in turn can be enhanced by using growth factors (GFs) such as bone morphogenetic protein (BMP-2) and platelet-derived growth factor (PDGF) to accelerate regeneration. The aim of the present systematic review was to evaluate the GF loading and release kinetics of barrier membranes. STUDY DESIGN A total of 138 articles were screened in PubMed databases, and 31 meeting the inclusion criteria were included in the present systematic review. RESULTS All the articles evaluated bio-resorbable membranes, especially collagen or polymer-based membranes. In most studies, the retention and release kinetics of osteogenic GFs such as BMP-2 and PDGF were widely investigated. Growth factors were incorporated to the membranes by soaking and incubating the membranes in GF solution, followed by lyophilization, or mixing in the polymers before evaporation. Adsorption onto the membranes depended upon the membrane materials and additional reagents such as heparin, cross-linkers and GF concentration. Interestingly, most studies showed two phases of GF release from the membranes: a first phase comprising a burst release (about 1 day), followed by a second phase characterized by slower release. Furthermore, all the studies demonstrated the controlled release of sufficient concentrations of GFs from the membranes for bioactivities. CONCLUSIONS The adsorption and release kinetics varied among the different materials, forms and GFs. The combination of membrane materials, GFs and manufacturing methods should be considered for optimizing GBR/GTR procedures.
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Affiliation(s)
- Jordi Caballé-Serrano
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Universitat Internacional de Catalunya, Barcelona, Spain; Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Switzerland; Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Switzerland.
| | - Yusra Abdeslam-Mohamed
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Antonio Munar-Frau
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.
| | | | - Federico Hernández-Alfaro
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Richard Miron
- Department of Craniomaxillofacial Surgery, University of Bern, Bern, Switzerland.
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Mehta DB, Deshpande NC, Dandekar SA. Comparative evaluation of platelet-rich fibrin membrane and collagen membrane along with demineralized freeze-dried bone allograft in Grade II furcation defects: A randomized controlled study. J Indian Soc Periodontol 2018; 22:322-327. [PMID: 30131624 PMCID: PMC6077968 DOI: 10.4103/jisp.jisp_310_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The management of the furcation areas in multirooted teeth is often challenging due to difficulty in access. Platelet-rich fibrin (PRF), a second-generation platelet concentrate, has shown to accelerate the healing of soft and hard tissues. This study was designed to evaluate the efficacy of autologous PRF as a membrane in treatment of Grade II furcation defects in molars as compared to collagen membrane along with demineralized freeze-dried bone allograft in both the groups. Materials and Methods: A split-mouth study was planned with 18 patients having 2 sites of Grade II furcation defects each. Random allocation of the defect site was done for the test and control group. Plaque index, probing depth (PD), relative vertical clinical attachment level (RVCAL), gingival marginal level, and radiographic bone levels were recorded at baseline, 3 months, and 6 months postoperatively. Results: Both the groups showed statistically significant outcomes in intragroup comparison from baseline to 3 and 6 months. However, there was no statistical difference between PRF membrane and collagen membrane groups on intergroup comparison. Conclusion: There was a significant reduction of PD, improvement in RVCAL, and defect fill with autogenous PRF as membrane. This indicates its role as a regenerative material in treating furcation defects, which can be used as alternative to other expensive membranes.
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Affiliation(s)
- Dhruv Bipinchandra Mehta
- Department of Periodontology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Neeraj Chandrahas Deshpande
- Department of Periodontology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Shivani Ashwinikumar Dandekar
- Department of Periodontology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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Khanna R, Khanna R, Pardhe ND, Srivastava N, Bajpai M, Gupta S. Pure Titanium Membrane (Ultra - Ti ®) in the Treatment of Periodontal Osseous Defects: A Split-Mouth Comparative Study. J Clin Diagn Res 2016; 10:ZC47-ZC51. [PMID: 27790579 DOI: 10.7860/jcdr/2016/18333.8487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 06/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although many different types of Guided Tissue Regeneration (GTR) membranes (resorbable/non-resorbable, including titanium mesh) have been used in the field of Periodontics till now, but this is the first and only clinical study testing the effectiveness of an ultra thin pure Titanium Membrane (Ultra Ti) as a GTR membrane in infra-bony periodontal defects. AIM To compare the efficacy of GTR in intra-bony defects with newly introduced non-resorbable barrier membrane, made of titanium called "Ultra-Ti ® GTR Membrane" versus open flap debridement. MATERIALS AND METHODS A prospective, randomized, controlled, clinical split mouth study was designed wherein each patient received both the control and test treatment. Two similar defects were selected in each of the 12 patients and were randomly assigned to one of the two treatments. Both the surgeries consisted of identical procedures except for the omission of the barrier membrane in the control sites. Full mouth Plaque Index (PI), Gingival Index (GI), Pocket Probing Depth (PPD) and Relative Attachment Level (RAL) were recorded before surgery and after 6 months and 9 months along with hard tissue measurements at the time of surgery and then at re-entry after 9 months. Radiographs were also taken before surgery and 9 months post operatively. Student's paired t-test and unpaired t-test (SPSS software version 9) were used to analyze the results. RESULTS Nine months after treatment, the test defects gained 4.375 ± 1.189mm of RAL, while the control defects yielded a significantly lower RAL gain of 3.417 ± 0.996mm. Pocket reduction was also significantly higher in the test group (4.917 ± 0.996mm) when compared with the controls (3.83 ± 0.718mm). There was a significant bone fill (54.69% of defect fill) obtained in the test site, unlike the control site (8.91%). CONCLUSION The present study demonstrated that GTR with "Ultra-Ti® GTR Membrane" resulted in a significant added benefit in comparison with open flap debridement.
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Affiliation(s)
- Rashmi Khanna
- Associate Professor, Department of Periodontics, NIMS Dental College and Hospital , Jaipur, Rajasthan, India
| | - Rajeev Khanna
- Associate Professor, Department of Pharmacy, Swasthya Kalyan Homeopathy Medical College and Research Centre , Jaipur, Rajasthan, India
| | - Nilesh Dinesh Pardhe
- Professor and Head, Department of Oral and Maxillofacial Pathology, NIMS Dental College and Hospital , Jaipur, Rajasthan, India
| | - Nancy Srivastava
- Senior Lecturer, Department of Periodontics, NIMS Dental College and Hospital , Jaipur, Rajasthan, India
| | - Manas Bajpai
- Senior Lecturer, Department of Oral and Maxillofacial Pathology, NIMS Dental College and Hospital , Jaipur, Rajasthan, India
| | - Shailendra Gupta
- Professor and Head, Department of Conservative Dentistry and Endodontics, Guru Gobind Singh College of Dental Sciences and Research Centre , Burhanpur, Madhya Pradesh, India
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Avila-Ortiz G, De Buitrago JG, Reddy MS. Periodontal regeneration - furcation defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2016; 86:S108-30. [PMID: 25644295 DOI: 10.1902/jop.2015.130677] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this review is to present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy to provide clinical guidelines for the therapeutic management of furcation defects and to identify priorities for future research that may advance the understanding of periodontal regenerative medicine. METHODS A comprehensive search based on predetermined eligibility criteria was conducted to identify human original studies and systematic reviews on the topic of periodontal regeneration of furcation defects. Two reviewers independently screened the title and abstract of the entries yielded from the initial search. Subsequently, both reviewers read the full-text version of potentially eligible studies, made a final article selection, and extracted the data of the selected studies considering specific clinical scenarios. The clinical scenarios contemplated in this review included the following: 1) facial and interproximal Class I defects in maxillary molars; 2) facial and lingual Class I defects in mandibular molars; 3) facial and interproximal Class II furcation defects in maxillary molars; 4) facial and lingual Class II furcation defects in mandibular molars; 5) Class III furcation defects in maxillary molars; 6) Class III furcation defects in mandibular molars; and 7) Class I, II, or III furcation defects in maxillary premolars. Endpoints of interest included different clinical, radiographic, microbiologic, histologic, and patient-reported outcomes. RESULTS The initial search yielded a total of 1,500 entries. The final selection consisted of 150 articles, of which six were systematic reviews, 109 were clinical trials, 27 were case series, and eight were case reports. A summary of the main findings of previously published systematic reviews and the available evidence relative to the indication of regenerative approaches for the treatment of furcation defects compared with conventional surgical therapy are presented. Given the marked methodologic heterogeneity and the wide variety of materials and techniques applied in the selected clinical trials, the conduction of a meta-analysis was not viable. CONCLUSIONS On the basis of the reviewed evidence, the following conclusions can be drawn. 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial or interproximal and mandibular facial or lingual Class II furcation defects. 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the evidence is limited to one case report. 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in maxillary molars is limited to clinical case reports. 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy. 5) Future research efforts should be primarily directed toward the conduction of clinical trials to test novel regenerative approaches that place emphasis primarily on patient-reported outcomes and also on histologic demonstration of periodontal regeneration. Investigators should also focus on understanding the influence that local, systemic, and technical factors may have on the outcomes of regenerative therapy in furcation defects.
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17
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Sanz M, Jepsen K, Eickholz P, Jepsen S. Clinical concepts for regenerative therapy in furcations. Periodontol 2000 2015; 68:308-32. [DOI: 10.1111/prd.12081] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
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Cortellini P, Tonetti MS. Clinical concepts for regenerative therapy in intrabony defects. Periodontol 2000 2015; 68:282-307. [DOI: 10.1111/prd.12048] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 12/14/2022]
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Graziani F, Gennai S, Karapetsa D, Rosini S, Filice N, Gabriele M, Tonetti M. Clinical performance of access flap in the treatment of class II furcation defects. A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol 2015; 42:169-81. [DOI: 10.1111/jcpe.12327] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Filippo Graziani
- Department of surgery; Unit of Dentistry and Oral Surgery; University of Pisa; Pisa Italy
| | - Stefano Gennai
- Department of surgery; Unit of Dentistry and Oral Surgery; University of Pisa; Pisa Italy
| | - Dimitra Karapetsa
- Department of surgery; Unit of Dentistry and Oral Surgery; University of Pisa; Pisa Italy
| | - Stefano Rosini
- Department of surgery; Unit of Dentistry and Oral Surgery; University of Pisa; Pisa Italy
| | - Natalia Filice
- Department of surgery; Unit of Dentistry and Oral Surgery; University of Pisa; Pisa Italy
| | - Mario Gabriele
- Department of surgery; Unit of Dentistry and Oral Surgery; University of Pisa; Pisa Italy
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20
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Soni N, Sikri P, Kapoor D, Soni BW, Jain R. Evaluation of the efficacy of 100% Type-I collagen membrane of bovine origin in the treatment of human gingival recession: A clinical study. Indian J Dent 2014; 5:132-8. [PMID: 25565742 PMCID: PMC4213877 DOI: 10.4103/0975-962x.140822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Various treatment modalities have been devised for gingival recession, which is one of the most common signs of periodontal disease. The present study evaluates the efficacy of bioresorbable 100% type I collagen membrane of bovine origin in the treatment of human gingival recession. MATERIALS AND METHODS Twenty cases of Miller's class I or class II localized gingival recession defects on the facial surface were treated with 100% type I collagen membrane of bovine origin in conjunction with coronally positioned flap. Pre-operative and post-operative assessments were performed with respect to probing pocket depth, clinical attachment level and clinical recession at 12, 24 and 36 weeks. The data thus collected were analyzed statistically. RESULTS Statistically significant improvement based on Student's t test was found in all the three clinical parameters. CONCLUSION Bioresorbable 100% type I collagen membrane of bovine origin has given inspiring results in the treatment of human gingival recession defects, thereby justifying the use of this material wherever indicated.
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Affiliation(s)
- Nitin Soni
- Department of Periodontology, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
| | - Poonam Sikri
- Desh Bhagat Dental College, Muktsar, Punjab, India
| | - Daljit Kapoor
- Department of Periodontology, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
| | | | - Rachna Jain
- Department of Periodontology, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
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Yamano S, Haku K, Yamanaka T, Dai J, Takayama T, Shohara R, Tachi K, Ishioka M, Hanatani S, Karunagaran S, Wada K, Moursi AM. The effect of a bioactive collagen membrane releasing PDGF or GDF-5 on bone regeneration. Biomaterials 2013; 35:2446-53. [PMID: 24388383 DOI: 10.1016/j.biomaterials.2013.12.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 12/08/2013] [Indexed: 12/21/2022]
Abstract
Regenerative procedures using barrier membrane technology are presently well established in periodontal/endodontic surgery. The objective of this study was to compare the subsequent effects of the released platelet-derived growth factor (PDGF) and growth/differentiation factor 5 (GDF-5) from collagen membranes (CMs) on bone regeneration in vitro and in vivo. In vitro studies were conducted using MC3T3-E1 mouse preosteoblasts cultured with or without factors. Cell viability, cell proliferation, alkaline phosphatase (ALP) activity and bone marker gene expression were then measured. In vivo studies were conducted by placing CMs with low or high dose PDGF or GDF-5 in rat mandibular defects. At 4 weeks after surgery new bone formation was measured using μCT and histological analysis. The results of in vitro studies showed that CM/GDF-5 significantly increased ALP and cell proliferation activities without cytotoxicity in MC3T3-E1 cells when compared to CM/PDGF or CM alone. Gene expression analysis revealed that Runx2 and Osteocalcin were significantly increased in CM/GDF-5 compared to CM/PDGF or control. Quantitative and qualitative μCT and histological analysis for new bone formation revealed that although CM/PDGF significantly enhanced bone regeneration compared to CM alone or control, CM/GDF-5 significantly accelerated bone regeneration to an even greater extent than CM/PDGF. The results also showed that GDF-5 induced new bone formation in a dose-dependent manner. These results suggest that this strategy, using a CM carrying GDF-5, might lead to an improvement in the current clinical treatment of bone defects for periodontal and implant therapy.
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Affiliation(s)
- Seiichi Yamano
- Department of Prosthodontics, New York University College of Dentistry, New York, NY 10010, USA.
| | - Ken Haku
- Department of Prosthodontics, New York University College of Dentistry, New York, NY 10010, USA
| | - Takuto Yamanaka
- Department of Prosthodontics, New York University College of Dentistry, New York, NY 10010, USA
| | - Jisen Dai
- Department of Prosthodontics, New York University College of Dentistry, New York, NY 10010, USA
| | - Tadahiro Takayama
- Department of Prosthodontics, New York University College of Dentistry, New York, NY 10010, USA
| | - Ryutaro Shohara
- Department of Prosthodontics, New York University College of Dentistry, New York, NY 10010, USA
| | - Keita Tachi
- Department of Prosthodontics, New York University College of Dentistry, New York, NY 10010, USA
| | - Mika Ishioka
- Department of Prosthodontics, New York University College of Dentistry, New York, NY 10010, USA
| | - Shigeru Hanatani
- Department of Prosthodontics, New York University College of Dentistry, New York, NY 10010, USA
| | - Sanjay Karunagaran
- Department of Prosthodontics, The University of Tennessee College of Dentistry, Memphis, TN 38103, USA
| | - Keisuke Wada
- Department of Periodontics, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA
| | - Amr M Moursi
- Department of Pediatric Dentistry, New York University College of Dentistry, New York, NY 10010, USA
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Malathi KG, Dev JN, Kumar KS, Srikanth C, Ravi Chandra PV, Paul A. A clinical evaluation of a bioresorbable membrane and porous hydroxyapatite in the treatment of human molar class II furcations. J Indian Soc Periodontol 2013; 17:617-23. [PMID: 24174756 PMCID: PMC3808017 DOI: 10.4103/0972-124x.119276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 08/13/2013] [Indexed: 11/11/2022] Open
Abstract
Background: The ultimate goal of periodontal therapy is predictable regeneration of a functional attachment apparatus destroyed as a result of periodontitis. Reconstructive procedures have been used with varying success during the past decades to accomplish this goal. Aim: To evaluate whether the use of porous hydroxyapatite alone or a bioresorbable membrane alone would enhance the clinical results in the treatment of class II furcation defects in human lower molars. Materials and Methods: Fifteen patients with chronic periodontitis, aged between 39 and 49 years, with a pair of similar bilateral class II furcation defects (classification of Hamp et al.) in mandibular first molars were selected. A split-mouth design was incorporated and the selected 30 furcation defects were assigned to one of the two treatment groups, i.e., Group I treated with a bioresorbable membrane from bovine-derived collagen guided tissue regeneration membrane and Group II treated using porous hydroxyapatite bone graft material on the contralateral sides. Evaluation of clinical parameters, probing depths and attachment levels, and radiographs was done preoperatively and 6 months postoperatively. Results: Both the groups showed statistically significant mean reduction in probing depths and gain in clinical attachment levels and linear bone fill. Comparison between Group I and Group II showed insignificant difference. Conclusion: Within the limits of this study, both the treatment modalities are beneficial for the treatment of human mandibular class II furcation defects.
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Affiliation(s)
- K Gita Malathi
- Department of Periodontics, SVS Institute of Dental Sciences, Appannapally, Mahabubnagar, India
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Chen TH, Tu YK, Yen CC, Lu HK. A systematic review and meta-analysis of guided tissue regeneration/osseous grafting for the treatment of Class II furcation defects. J Dent Sci 2013. [DOI: 10.1016/j.jds.2013.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Prathap S, Hegde S, Kashyap R, Prathap MS, Arunkumar MS. Clinical evaluation of porous hydroxyapatite bone graft (Periobone G) with and without collagen membrane (Periocol) in the treatment of bilateral grade II furcation defects in mandibular first permanent molars. J Indian Soc Periodontol 2013; 17:228-34. [PMID: 23869132 PMCID: PMC3713757 DOI: 10.4103/0972-124x.113083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 01/24/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Furcation invasions represent one of the most demanding therapeutic challenges in periodontics. This investigation assessed and compared the clinical efficacy of hydroxyapatite bone graft material when used alone and with collagen membrane in the treatment of grade II furcation defects. MATERIALS AND METHODS Ten patients with comparable bilateral furcation defects in relation to mandibular first molars were selected and treated in a split-mouth design. After the hygiene phase of therapy was completed, the groups were selected randomly either for treatment with hydroxyapatite bone graft (Periobone G) alone or with a combination of bone graft and guided tissue regeneration (GTR) membrane (Periocol). Clinical parameters like plaque index, gingival index, vertical probing depth, horizontal probing depth, clinical attachment level, position of marginal gingiva, and the amount of bone fill were used at baseline and at 3 and 6 months postoperatively. RESULTS At 6 months, both surgical procedures resulted in statistically significant reduction in vertical and horizontal probing depths and gain in the clinical attachment level. CONCLUSION The use of combination technique yielded superior results compared to sites treated with bone graft alone. However, the difference was not statistically significant.
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Affiliation(s)
- Sruthy Prathap
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
| | - Shashikanth Hegde
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
| | - Rajesh Kashyap
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
| | - M. S. Prathap
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
| | - M. S. Arunkumar
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
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Gamal AY, Iacono VJ. Enhancing guided tissue regeneration of periodontal defects by using a novel perforated barrier membrane. J Periodontol 2012; 84:905-13. [PMID: 23003916 DOI: 10.1902/jop.2012.120301] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The present study was designed to determine whether exclusion of the gingival connective tissue (CT) and periosteum with contained stem cells has a positive or negative effect on periodontal regeneration by comparing the use of a novel modified perforated collagen membrane with a traditional cell occlusive barrier membrane. METHODS Twenty non-smoking patients with severe chronic periodontitis were included in the study. Single deep intrabony defects from each of the patients were randomly divided into two groups, as follows: occlusive bovine collagen membranes (OM control group, 10 sites) and modified perforated bovine collagen membranes (MPM test group, 10 sites). Plaque index, gingival index, probing depth (PD), clinical attachment level (CAL), defect base level (DBL), and crestal bone level (CBL) were measured at baseline and were reassessed at 6 and 9 months after therapy to evaluate the quantitative changes in the defect. RESULTS At 6- and 9-month observation periods, the MPM-treated sites showed a statistically significant improvement in PD reduction and CAL gain compared with the OM control group. DBL was significantly reduced with no significant difference between the two groups at 6- and 9-month observation periods. CBL was significantly higher in the MPM group when compared with that of the OM group at both observation periods. The postoperative differences between the two groups were 2 and 1.7 mm at 6 and 9 months, respectively, in favor of the MPM-treated sites. CONCLUSIONS The present study demonstrated enhanced clinical outcomes when using novel MPMs compared to OMs in guided tissue regeneration procedures. These results may be affected by the penetration of gingival CT contained stem cells and periosteal cells and their differentiation into components of the attachment apparatus.
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Affiliation(s)
- Ahmed Y Gamal
- Faculty of Dental Medicine, Department of Periodontology, Al Azhar University, Cairo, Egypt
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Miron RJ, Saulacic N, Buser D, Iizuka T, Sculean A. Osteoblast proliferation and differentiation on a barrier membrane in combination with BMP2 and TGFβ1. Clin Oral Investig 2012; 17:981-8. [DOI: 10.1007/s00784-012-0764-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 05/25/2012] [Indexed: 02/06/2023]
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Oh SH, Kim JH, Kim JM, Lee JH. Asymmetrically porous PLGA/Pluronic F127 membrane for effective guided bone regeneration. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012; 17:1375-87. [PMID: 17260509 DOI: 10.1163/156856206778937253] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Porous guided bone regeneration (GBR) membranes with selective permeability, hydrophilicity and adhesiveness to bone were prepared with PLGA and Pluronic F127 using an immersion precipitation method. The porous PLGA/Pluronic F127 membranes were fabricated by immersing the PLGA/Pluronic F127 mixture solution (in tetraglycol) in a mold into water. The PLGA/Pluronic F127 mixture was precipitated in water by the diffusion of water into PLGA/Pluronic F127 mixture solution. It was observed that the membrane has an asymmetric column-shape porous structure. The top surface of the membrane (water contact side) had nano-size pores (approx. 50 nm) which can effectively prevent from fibrous connective tissue invasion but permeate nutrients, while the bottom surface (mold contact size) had micro-size pores (approx. 40 microm) which can improve adhesiveness with bone. From the investigations of mechanical property, water absorbability, model nutrient permeability and preliminary in vivo bone regeneration, the hydrophilized porous PLGA/F127 (5 wt%) membrane seems to be a good candidate as a GBR membrane for the effective permeation of nutrients and osteoconductivity, as well as good mechanical strength to maintain a secluded space for bone regeneration.
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Affiliation(s)
- Se Heang Oh
- Department of Advanced Materials, Hannam University, 133 Ojeong Dong, Daedeog Gu, Daejeon 306-791, South Korea
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Patel S, Kubavat A, Ruparelia B, Agarwal A, Panda A. Comparative evaluation of guided tissue regeneration with use of collagen-based barrier freeze-dried dura mater allograft for mandibular class 2 furcation defects (a comparative controlled clinical study). J Contemp Dent Pract 2012; 13:11-5. [PMID: 22430687 DOI: 10.5005/jp-journals-10024-1088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The aim of periodontal surgery is complete regeneration. The present study was designed to evaluate and compare clinically soft tissue changes in form of probing pocket depth, gingival shrinkage, attachment level and hard tissue changes in form of horizontal and vertical bone level using resorbable membranes. MATERIALS AND METHODS Twelve subjects with bilateral class 2 furcation defects were selected. After initial phase one treatment, open debridement was performed in control site while freezedried dura mater allograft was used in experimental site. Soft and hard tissue parameters were registered intrasurgically. Nine months reentry ensured better understanding and evaluation of the final outcome of the study. RESULTS Guided tissue regeneration is a predictable treatment modality for class 2 furcation defect. There was statistically significant reduction in pocket depth as compared to control (p < 0.01). There is statistically significant increase in periodontal attachment level within control and experimental sites showed better results (p < 0.01). For hard tissue parameter, significant defect fill resulted in experimental group, while in control group, less significant defect fill was found in horizontal direction and nonsignificant defect fill was found in vertical direction. CONCLUSION The results showed statistically significant improvement in soft and hard tissue parameters and less gingival shrinkage in experimental sites compared to control site. CLINICAL SIGNIFICANCE The use of FDDMA in furcation defects helps us to achieve predictable results. This cross-linked collagen membrane has better handling properties and ease of procurement as well as economic viability making it a logical material to be used in regenerative surgeries.
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Affiliation(s)
- Sandeep Patel
- Department of Periodontology, Narsinbhai Patel Dental College, Visnagar, Gujarat, India.
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Kinaia BM, Steiger J, Neely AL, Shah M, Bhola M. Treatment of Class II Molar Furcation Involvement: Meta-Analyses of Reentry Results. J Periodontol 2011; 82:413-28. [DOI: 10.1902/jop.2010.100306] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
The concept that only fibroblasts from the periodontal ligament or undifferentiated mesenchymal cells have the potential to re-create the original periodontal attachment has been long recognized. Based on this concept, guided tissue regeneration has been applied with variable success to regenerate periodontal defects. Quantitative analysis of clinical outcomes after guided tissue regeneration suggests that this therapy is a successful and predictable procedure to treat narrow intrabony defects and class II mandibular furcations, but offers limited benefits in the treatment of other types of periodontal defects.
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Affiliation(s)
- Cristina C Villar
- Department of Periodontics, The University of Texas, Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 7894, San Antonio, TX 78229-3900, USA.
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Taheri M, Molla R, Radvar M, Sohrabi K, Najafi MH. An evaluation of bovine derived xenograft with and without a bioabsorbable collagen membrane in the treatment of mandibular Class II furcation defects. Aust Dent J 2009; 54:220-7. [DOI: 10.1111/j.1834-7819.2009.01122.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bashutski JD, Wang HL. Periodontal and endodontic regeneration. J Endod 2009; 35:321-8. [PMID: 19249588 DOI: 10.1016/j.joen.2008.11.023] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/25/2008] [Accepted: 11/28/2008] [Indexed: 02/05/2023]
Abstract
Guided tissue regeneration (GTR) is effective in halting tissue and bone destruction and promoting new tissue and bone formation. Although the goal of complete and predictable regeneration still remains elusive, many techniques and materials have been developed that show good clinical and histologic outcomes. The most commonly used materials in GTR include bone replacement grafts from numerous sources, nonresorbable and bioabsorbable membranes, and recently growth hormones/cytokines and other host modulating factors. This article reviews the biologic rationale behind current techniques used for tissue/bone regeneration, reviews the most common materials and techniques, and attempts to explain the factors that influence the outcomes of these therapies.
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Affiliation(s)
- Jill D Bashutski
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA
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Xianmiao C, Yubao L, Yi Z, Li Z, Jidong L, Huanan W. Properties and in vitro biological evaluation of nano-hydroxyapatite/chitosan membranes for bone guided regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2009. [DOI: 10.1016/j.msec.2008.05.008] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shin JA, Choi JY, Kim ST, Kim CS, Lee YK, Cho KS, Chai JK, Kim CK, Choi SH. The Effects of Hydroxyapatite-Chitosan Membrane on Bone Regeneration in Rat Calvarial Defects. ACTA ACUST UNITED AC 2009. [DOI: 10.5051/jkape.2009.39.s.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jung-A Shin
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University, College of Dentistry, Korea
| | - Jung-Yoo Choi
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University, College of Dentistry, Korea
| | - Sung-Tae Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University, College of Dentistry, Korea
| | - Chang-Sung Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University, College of Dentistry, Korea
| | - Yong-Keun Lee
- Department and Research Institute of Dental Biomaterials and Bioengineering, Yonsei University, College of Dentistry, Korea
| | - Kyoo-Sung Cho
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University, College of Dentistry, Korea
| | - Jung-Kiu Chai
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University, College of Dentistry, Korea
| | - Chong-Kwan Kim
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University, College of Dentistry, Korea
| | - Seong-Ho Choi
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University, College of Dentistry, Korea
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Mahajan A, Dixit J, Verma UP. A patient-centered clinical evaluation of acellular dermal matrix graft in the treatment of gingival recession defects. J Periodontol 2008; 78:2348-55. [PMID: 18052708 DOI: 10.1902/jop.2007.070074] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The present randomized controlled trial was conducted to evaluate acellular dermal matrix (ADM) graft in terms of patient satisfaction and its effectiveness and efficiency in the treatment of gingival recession. METHODS Fourteen patients (seven males and seven females) with Miller Class I and II recessions > or =3 mm participated in this 6-month clinical study. They were assigned randomly to the ADM group (ADM graft and coronally positioned flap [CPF]) or the CPF group (CPF alone). Results were evaluated based on parameters measuring patient satisfaction and clinical outcomes associated with the two treatment procedures. Significance was set at P <0.05. RESULTS The mean recession was 4.0 +/- 1.0 mm and 3.7 +/- 0.7 mm for the ADM and CPF groups, respectively. For the ADM group, the defect coverage was 3.85 +/- 0.89 mm or 97.14% compared to the CPF group, in which the defect coverage was 2.85 +/- 0.89 mm or 77.42%. The difference between the two groups was statistically significant (P <0.05). There were no statistically significant differences between the two groups in the remaining clinical parameters and overall patient satisfaction except in criteria related to patient comfort and cost effectiveness, in which CPF alone produced significantly better results (P <0.03). CONCLUSIONS ADM graft is significantly superior with regard to effectiveness and efficiency in the treatment of gingival recession than CPF alone. CPF emerges as a better option than ADM graft in terms of cost effectiveness and patient comfort.
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Affiliation(s)
- Ajay Mahajan
- Department of Periodontics, King George's University of Dental Sciences, Lucknow, India.
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Barber HD, Lignelli J, Smith BM, Bartee BK. Using a dense PTFE membrane without primary closure to achieve bone and tissue regeneration. J Oral Maxillofac Surg 2007; 65:748-52. [PMID: 17368373 DOI: 10.1016/j.joms.2006.10.042] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Revised: 06/15/2006] [Accepted: 10/18/2006] [Indexed: 11/26/2022]
Abstract
The most common types of barrier membranes used for bone or tissue regeneration are made of expanded-polytetrafluoroethylene (e-PTFE) or resorbable materials, such as collagen. Both the e-PTFE and resorbable membranes require primary soft tissue coverage. This article explores the use of a dense-polytetrafluoroethylene (d-PTFE) membrane, which does not require primary soft tissue coverage. The advantages of d-PTFE in contrast to the other more commonly used types of barrier membranes and the clinical significance of these advantages for implant surgical and restorative treatment are discussed.
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Affiliation(s)
- H Dexter Barber
- Department of Oral and Maxillofacial Surgery, Temple University Hospitals, Philadelphia, PA, USA.
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Abstract
BACKGROUND The advent of osseointegration and advances in biomaterials and techniques have contributed to increased application of dental implants in the restoration of partial and completely edentulous patients. Often, in these patients, soft and hard tissue defects result from a variety of causes, such as infection, trauma, and tooth loss. These create an anatomically less favorable foundation for ideal implant placement. For prosthetic-driven dental implant therapy, reconstruction of the alveolar bone through a variety of regenerative surgical procedures has become predictable; it may be necessary prior to implant placement or simultaneously at the time of implant surgery to provide a restoration with a good long-term prognosis. Regenerative procedures are used for socket preservation, sinus augmentation, and horizontal and vertical ridge augmentation. METHODS A broad overview of the published findings in the English literature related to various bone augmentation techniques is outlined. A comprehensive computer-based search was performed using various databases that include Medline and PubMed. A total of 267 papers were considered, with non-peer-reviewed articles eliminated as much as possible. RESULTS The techniques for reconstruction of bony defects that are reviewed in this paper include the use of particulate bone grafts and bone graft substitutes, barrier membranes for guided bone regeneration, autogenous and allogenic block grafts, and the application of distraction osteogenesis. CONCLUSIONS Many different techniques exist for effective bone augmentation. The approach is largely dependent on the extent of the defect and specific procedures to be performed for the implant reconstruction. It is most appropriate to use an evidenced-based approach when a treatment plan is being developed for bone augmentation cases.
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Duskova M, Leamerova E, Sosna B, Gojis O. Guided Tissue Regeneration, Barrier Membranes and Reconstruction of the Cleft Maxillary Alveolus. J Craniofac Surg 2006; 17:1153-60. [PMID: 17119421 DOI: 10.1097/01.scs.0000236435.90097.7b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The use of barrier membranes for bone regeneration is especially beneficial in the case of severely affected soft tissue. One useful indication may be the formation of an effective shell for bone grafts in maxilla cleft defect reconstruction. When selecting a proper material for clinical use, one must consider the safety record, the resorption time and route of elimination, the time of the maintained barrier function, the necessary time of mechanical strength, and costs. Two resorbable collagen membranes, one of single-layer and one of double-layer material, were tested in vitro and in vivo. The tested single-layer membrane is less expensive, but it is also less handling than the double-layer membrane. In vitro, samples were incubated in simulated surgical wound. A complete unambiguous picture of disintegration was not proved histologically in either material in six investigation terms (1-6 weeks). In vivo the effect of the assessed membranes was verified on a group of patients (N = 45) with a cleft. Materials were applied in the reconstruction of the alveolar defect by cancellous bone grafts. The influence on the course of healing was not stated as statistically significant. However, with respect to the costs of double layer membrane, this material was used in the most severe cases.
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Affiliation(s)
- Marketa Duskova
- Department of Plastic Surgery, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.
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Lynch SE, Lavin PT, Genco RJ, Beasley WG, Wisner-Lynch LA. New composite endpoints to assess efficacy in periodontal therapy clinical trials. J Periodontol 2006; 77:1314-22. [PMID: 16881800 DOI: 10.1902/jop.2006.050275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Clinical attachment level (CAL) and bone height (radiographic or clinical) are two well-accepted endpoint measures for periodontal clinical trials; however, neither one has been shown to be more predictive of long-term success than the other. We propose using a composite endpoint analysis combining clinical and radiological parameters to assess the beneficial effects on both hard and soft tissues following periodontal therapy using a single statistical test. To address this need, two composite endpoint alternatives are offered as a yardstick for clinical success; each includes the improvement in CAL and either improvement in linear bone growth or percent bone fill. METHODS The data for composite endpoint analyses were derived from a clinical trial evaluating two concentrations of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) with beta-tricalcium phosphate (beta-TCP) compared to beta-TCP plus buffer as follows: group I, beta-TCP + 0.3 mg/ml rhPDGF-BB; group II, beta-TCP + 1.0 mg/ml rhPDGF-BB; and group III, beta-TCP + buffer. The construction of composite endpoints was based on the greatest values for change, accepted by the U.S. Food and Drug Administration (FDA), for clinical attachment level (DeltaCAL), mean change in radiographic linear bone gain (LBG), and mean radiographic percent bone fill (%BF), with the following dual standards defining a successful clinical result: CAL gain > or =2.67 mm and radiographic LBG > or =1.1 mm at 6 months and CAL gain > or =2.67 mm and radiographic %BF > or =14.1% at 6 months. RESULTS Group I (beta-TCP + 0.3 mg/ml rhPDGF-BB) demonstrated statistically significant differences from group III (active control) for both composite endpoints. For the CAL/LBG composite endpoint, 61.7% of sites in group I versus 30.4% of sites in group III met the composite endpoint benchmarks (P <0.001). For the CAL/%BF composite endpoint, 70% of sites in group I versus 44.6% of sites in group III met the composite endpoint benchmarks (P = 0.003). A non-significant trend was observed for group II versus group III with 37.9% (P = 0.20) and 55.2% (P = 0.13) of sites meeting the CAL/LBG and CAL/%BF composite endpoints, respectively. These results are further emphasized by findings demonstrating a low correlation between the individual efficacy endpoints (DeltaCAL and %BF; DeltaCAL and LBG) for each of the three treatment groups. CONCLUSIONS Composite endpoints are advantageous in periodontal clinical trials where no single efficacy endpoint has been established as the most important. A composite endpoint, combining outcome measures of both hard and soft tissue components of the periodontium, may be preferable for assessing efficacy of periodontal regenerative therapies. Two composite endpoints are offered to meet this need.
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Abstract
Guided bone regeneration is a well-established technique used for augmentation of deficient alveolar ridges. Predictable regeneration requires both a high level of technical skill and a thorough understanding of underlying principles of wound healing. This article describes the 4 major biologic principles (i.e., PASS) necessary for predictable bone regeneration: primary wound closure to ensure undisturbed and uninterrupted wound healing, angiogenesis to provide necessary blood supply and undifferentiated mesenchymal cells, space maintenance/creation to facilitate adequate space for bone ingrowth, and stability of wound and implant to induce blood clot formation and uneventful healing events. In addition, a novel flap design and clinical cases using this principle are presented.
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Affiliation(s)
- Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA.
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Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, McAllister BS, Murphy KS, McClain PK, Nevins ML, Paquette DW, Han TJ, Reddy MS, Lavin PT, Genco RJ, Lynch SE. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol 2006; 76:2205-15. [PMID: 16332231 DOI: 10.1902/jop.2005.76.12.2205] [Citation(s) in RCA: 312] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Growth factors are generally accepted to be essential mediators of tissue repair via well-established mechanisms of action that include stimulatory effects on angiogenesis and cellular proliferation, ingrowth, differentiation, and matrix biosynthesis. The aim of this study was to evaluate in a large-scale, prospective, blinded, and randomized controlled clinical trial the safety and effectiveness of purified recombinant human platelet-derived growth factor (rhPDGF-BB) mixed with a synthetic beta-tricalcium phosphate (beta-TCP) matrix for the treatment of advanced periodontal osseous defects at 6 months of healing. METHODS Eleven clinical centers enrolled 180 subjects, each requiring surgical treatment of a 4 mm or greater intrabony periodontal defect and meeting all inclusion and exclusion criteria. Subjects were randomized into one of three treatment groups: 1) beta-TCP + 0.3 mg/ml rhPDGF-BB in buffer; 2) beta-TCP + 1.0 mg/ml rhPDGF-BB in buffer; and 3) beta-TCP + buffer (active control). Safety data were assessed by the frequency and severity of adverse events. Effectiveness measurements included clinical attachment levels (CAL) and gingival recession (GR) measured clinically and linear bone growth (LBG) and percent bone fill (% BF) as assessed radiographically by an independent centralized radiology review center. The area under the curve (AUC), an assessment of the rate of healing, was also calculated for CAL measurements. The surgeons, clinical and radiographic evaluators, patients, and study sponsor were all masked with respect to treatment groups. RESULTS CAL gain was significantly greater at 3 months for group 1 (rhPDGF 0.3 mg/ml) compared to group 3 (beta-TCP + buffer) (3.8 versus 3.3 mm; P = 0.032), although by 6 months, this finding was not statistically significant (P = 0.11). This early acceleration of CAL gain led to group 1 exhibiting a significantly greater rate of CAL gain between baseline and 6 months than group 3 as assessed by the AUC (68.4- versus 60.1-mm weeks; P = 0.033). rhPDGF (0.3 mg/ml)-treated sites also had significantly greater linear bone gain (2.6 versus 0.9 mm, respectively; P < 0.001) and percent defect fill (57% versus 18%, respectively; P < 0.001) than the sites receiving the bone substitute with buffer at 6 months. There was less GR at 3 months in group 1 compared to group 3 (P = 0.04); at 6 months, GR for group 1 remained unchanged, whereas there was a slight gain in gingival height for group 3 resulting in comparable GR. There were no serious adverse events attributable to any of the treatments. CONCLUSIONS To our knowledge, this study is the largest prospective, randomized, triple-blinded, and controlled pivotal clinical trial reported to date assessing a putative periodontal regenerative and wound healing therapy. The study demonstrated that the use of rhPDGF-BB was safe and effective in the treatment of periodontal osseous defects. Treatment with rhPDGF-BB stimulated a significant increase in the rate of CAL gain, reduced gingival recession at 3 months post-surgery, and improved bone fill as compared to a beta-TCP bone substitute at 6 months.
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Affiliation(s)
- Myron Nevins
- Harvard School of Dental Medicine, Boston, MA, USA
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Tsao YP, Neiva R, Al-Shammari K, Oh TJ, Wang HL. Effects of a Mineralized Human Cancellous Bone Allograft in Regeneration of Mandibular Class II Furcation Defects. J Periodontol 2006; 77:416-25. [PMID: 16512756 DOI: 10.1902/jop.2006.050109] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A solvent-preserved, mineralized human cancellous bone allograft (MBA) was recently developed. However, its effect in regenerating furcation defects remains to be determined. Hence, the aim of the study is to evaluate the effects of this newly introduced MBA, with and without a bioabsorbable collagen membrane, for the treatment of mandibular class II furcation defects. METHODS Thirty subjects with Hamp's Class II buccal or lingual furcation defects in lower molars were randomly assigned to open flap debridement (OFD), MBA, or MBA with a bioabsorbable collagen membrane (guided tissue regeneration [GTR]+MBA) groups. Clinical and defect measurements were obtained at the initial visit and at 6-month reentry surgeries. The data were analyzed for intra- and intergroup comparisons and associations of treatment with probability of clinical improvement. RESULTS Out of a total of 30 subjects, 27 individuals completed the study. Vertical bone fill (VBF) was -1.6+/-2.1 mm in OFD, 1.9+/-1.4 mm in MBA, and 0.7+/-0.9 mm in GTR+MBA groups. VBF in MBA and GTR + MBA groups was significantly higher than that in the OFD group (P<0.05). Horizontal bone fill (HBF) was 0.2+/-1.7 mm, 1.1+/-0.9 mm, and 1.1+/-0.9 mm for OFD, MBA, and GTR+MBA groups, respectively. However, HBF, recession, clinical attachment level gain, and probing depth reduction at furcations showed no differences among groups. CONCLUSIONS Results obtained from this study indicate that solvent-preserved, mineralized human cancellous allograft, with or without collagen membrane, can significantly improve bone fill in mandibular Class II furcation defects. In addition, initial vertical defect depth was found to be the only factor that was associated with a higher probability of clinical improvement.
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Affiliation(s)
- Yi-Pin Tsao
- Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA
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Taguchi Y, Amizuka N, Nakadate M, Ohnishi H, Fujii N, Oda K, Nomura S, Maeda T. A histological evaluation for guided bone regeneration induced by a collagenous membrane. Biomaterials 2005; 26:6158-66. [PMID: 15885767 DOI: 10.1016/j.biomaterials.2005.03.023] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 03/23/2005] [Indexed: 11/30/2022]
Abstract
This study was designed to evaluate the histological changes during ossification and cellular events including osteogenic differentiation responding to collagenous bioresorbable membranes utilized for GBR. Standardized artificial bony defects were prepared at rat maxillae, and covered with a collagenous bioresorbable membrane. These animals were sacrificed at 1, 2, 3 and 4 weeks after the GBR-operation. The paraffin sections were subject to tartrate resistant acid phosphatase (TRAP) enzyme histochemistry and immunohistochemistry for alkaline phosphatase (ALP), osteopontin (OP) and osteocalcin (OC). In the first week of the experimental group, woven bone with ALP-positive osteoblasts occupied the lower half of the cavity. The collagenous membrane included numerous ALP-negative cells and OP-immunoreactive extracellular matrices. At 2 weeks, the ALP-, OP- and OC-immunoreactivity came to be recognizable in the region of collagenous membrane. Since ALP-negative soft tissue separated the collagenous membrane and the new bone originating from the cavity bottom, the collagenous membrane appeared to induce osteogenesis in situ. At 3 weeks, numerous collagen fibers of the membrane were embedded in the adjacent bone matrix. At 4 weeks, the membrane-associated and the cavity-derived bones had completely integrated, showing the same height of the periosteal ridge as the surrounding alveolar bones. The collagen fibers of a GBR-membrane appear to participate in osteogenic differentiation.
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Affiliation(s)
- Yuya Taguchi
- Division of Oral Anatomy, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Wang HL, Greenwell H, Fiorellini J, Giannobile W, Offenbacher S, Salkin L, Townsend C, Sheridan P, Genco RJ. Position Paper: Periodontal Regeneration. J Periodontol 2005; 76:1601-22. [PMID: 16171453 DOI: 10.1902/jop.2005.76.9.1601] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Untreated periodontal disease leads to tooth loss through destruction of the attachment apparatus and tooth-supporting structures. The goals of periodontal therapy include not only the arrest of periodontal disease progression,but also the regeneration of structures lost to disease where appropriate. Conventional surgical approaches (e.g., flap debridement) continue to offer time-tested and reliable methods to access root surfaces,reduce periodontal pockets, and attain improved periodontal form/architecture. However, these techniques offer only limited potential towards recovering tissues destroyed during earlier disease phases. Recently, surgical procedures aimed at greater and more predictable regeneration of periodontal tissues and functional attachment close to their original level have been developed, analyzed, and employed in clinical practice. This paper provides a review of the current understanding of the mechanisms, cells, and factors required for regeneration of the periodontium and of procedures used to restore periodontal tissues around natural teeth. Targeted audiences for this paper are periodontists and/or researchers with an interest in improving the predictability of regenerative procedures. This paper replaces the version published in 1993.
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Wang HL, Cooke J. Periodontal regeneration techniques for treatment of periodontal diseases. Dent Clin North Am 2005; 49:637-59, vii. [PMID: 15978245 DOI: 10.1016/j.cden.2005.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The ultimate goal of periodontal therapy is the regeneration of structures lost to disease. Conventional surgical approaches such as open-flap debridement offer only limited regeneration potential.Currently, surgical procedures for predictable regeneration of periodontal tissues are being developed, analyzed, and employed in clinical practice. This article addresses current trends in periodontal regeneration. Various materials/agents such as bone replacement grafts, barrier membranes, and biologic modifiers currently used for the regeneration of periodontal infrabony and furcation defects are discussed.
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Affiliation(s)
- Hom-Lay Wang
- Department of Periodontics/Prevention/Geriatrics, School of Dentistry, University of Michigan, 1011 North University Avenue, Ann Arbor, MI 48109-1078, USA.
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Villaça JH, Rodrigues DC, Novaes AB, Taba M, Souza SLS, Grisi MFM. Root Trunk Concavities as a Risk Factor for Regenerative Procedures of Class II Furcation Lesions in Humans. J Periodontol 2004; 75:1493-9. [PMID: 15633326 DOI: 10.1902/jop.2004.75.11.1493] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the influence of root trunk concavities on guided tissue regeneration in humans and to determine if a modification in membrane design could improve the results. METHODS Ten patients who provided 10 pairs of similar Class II furcation defects were recruited for the study. Each defect was randomly assigned to treatment with either a normal expanded polytetrafluoroethylene (ePTFE) membrane (NM) or a modified ePTFE membrane (MM). The MM were made by removing the collar from an NM, cutting it into 2 mm segments, and suturing each of the segments to the collar of each MM. Following basic therapy, baseline clinical measurements were recorded using an acrylic stent, including probing depth (PD) and clinical attachment level (CAL). Full flaps were elevated, the defects were carefully debrided, and the root surfaces were decontaminated with manual and ultrasonic instruments. Hard tissue measurements were performed during surgery to determine vertical (VD) and horizontal defect (HD) depths. Then, NM and MM were sutured to their corresponding tooth and the flaps sutured. Membranes remained in position for 6 weeks. After 1 year, all sites were re-entered and soft and hard tissue measurements were recorded. RESULTS After 1 year, there were no statistically significant differences (Mann-Whitney test) between NM and MM groups in percentages of PD reduction (P= 0.27), CAL change (P= 0.26), or VD resolution (P = 0.13). However, percentage of HD resolution (NM: 24.3+/-11.8; MM: 44.8+/-16.0) was significantly different between groups (P= 0.008). CONCLUSIONS The modified membranes resulted in greater horizontal resolution of Class II furcation defects. The collars of the membranes should be modified to improve results when root trunk concavities are present.
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Affiliation(s)
- José Henrique Villaça
- Department of Bucco-Maxillofacial Surgery and Traumatology and Periodontology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Meyle J, Gonzales JR, Bödeker RH, Hoffmann T, Richter S, Heinz B, Arjomand M, Reich E, Sculean A, Jepsen K, Jepsen S. A Randomized Clinical Trial Comparing Enamel Matrix Derivative and Membrane Treatment of Buccal Class II Furcation Involvement in Mandibular Molars. Part II: Secondary Outcomes. J Periodontol 2004; 75:1188-95. [PMID: 15515332 DOI: 10.1902/jop.2004.75.9.1188] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This multicenter, randomized trial compared enamel matrix derivative (EMD) with barrier membranes for the treatment of Class II mandibular furcations with regard to secondary outcomes. The influence of furcation morphology on the effectiveness of either treatment was also evaluated. METHODS Forty-eight patients (age range 28 to 73 years; 22 females, 26 males) with buccal Class II furcation involvements in both contralateral lower first or second molars were included. After initial periodontal treatment, defects were randomized to either EMD or bioabsorbable guided tissue regeneration (GTR) barrier. Study design and the results for the primary parameter were previously described. Results of the following secondary outcome variables are reported here: changes of the hard tissue boundaries describing the anatomical situation of the furcation defect and changes in the following clinical parameters between baseline and 14 months: plaque, level of gingival margin, probing depth, bleeding on probing, attachment level, and bone sounding at five sites/tooth at the buccal side. Descriptive statistics were applied for changes in clinical parameters and measurements of hard tissue boundaries. The differences observed under treatment with EMD or membrane were analyzed by means of the Wilcoxon two-sample test. The difference between the effect of the EMD and membrane treatment was estimated by means of the Hodges-Lehmann estimator. RESULTS Overall, similar healing results were observed for both treatments. However, there was slightly more recession in the mid-furcation site following membrane treatment (P = 0.04). Additionally, different treatment effects could be detected for the distances from the stent or cemento-enamel junction (CEJ) to the buccal bone crest, mid-distal root (Pstent = 0.01; PCEJ = 0.07) and for the distance from the stent or CEJ to the buccal bone crest, mid-mesial root (Pstent = 0.01; PCEJ = 0.01). There was no measurable bone resorption in EMD sites, whereas a slight resorption occurred with membrane treatment. Furcation morphology at the time of surgery was not associated with clinical outcome, irrespective of the treatment. CONCLUSION With regard to secondary outcome parameters, enamel matrix derivative treatment led to a similar regenerative result as the membrane procedure.
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Affiliation(s)
- Jörg Meyle
- Department of Periodontology, University of Giessen, Giessen, Germany.
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Hou LT, Yan JJ, Tsai AYM, Lao CS, Lin SJ, Liu CM. Polymer-assisted regeneration therapy with Atrisorb barriers in human periodontal intrabony defects. J Clin Periodontol 2004; 31:68-74. [PMID: 15058377 DOI: 10.1111/j.0303-6979.2004.00436.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This study compared clinical results of 40 periodontal osseous defects treated by two types of absorbable barrier materials. MATERIAL AND METHODS Thirty patients (23 males and seven females) suffering from moderate to advanced periodontitis (with comparable osseous defects) were randomly assigned to receive either Atrisorb barrier (n = 22; group A) or Resolut XT barrier (n = 18; group B) therapy. Periodontal phase I treatment and oral hygiene instruction were performed before periodontal surgery. Papillary preservation, partial thickness flap, citric acid root conditioning, and decortication procedures were applied during the operation. Bone defects were filled with demineralized freeze-dried bone allograft and minocycline mixture (4:1 ratio). Postoperative care included 0.10% chlorhexidine rinse daily and antibiotic medication for 2 weeks. Clinical assessments including probing depth (PD), clinical attachment level (CAL), gingival recession (GR), plaque index (PII), gingival index (GI), and radiographic examinations were taken at the baseline, preoperatively and at 3 and 6 months after regenerative surgery. RESULTS Six months following therapy, both Atrisorb and Resolut XT groups had achieved comparable clinical improvement in pocket reduction (3.9 versus 4.4 mm), attachment tissue gain (clinical attachment gain; 3.5 versus 3.6 mm), and reduction in the GI and in the PII. Within-group comparisons showed significant attachment gain and pocket reduction between baseline data and those at both 3 and 6 months postoperatively (p < 0.01). There were no statistically significant differences in any measured data between groups A and B. CONCLUSIONS The results of this study indicate that a comparable and favorable regeneration of periodontal defects can be achieved with both Atrisorb and Resolut XT barriers. Further long-term study and histologic observations of tissue healing are needed to evaluate whether Atrisorb is promising for clinical use.
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Affiliation(s)
- Lein-Tuan Hou
- Department of Periodontology, Graduate Institute of Clinical Dentistry, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Jepsen S, Eberhard J, Herrera D, Needleman I. A systematic review of guided tissue regeneration for periodontal furcation defects. What is the effect of guided tissue regeneration compared with surgical debridement in the treatment of furcation defects? J Clin Periodontol 2003; 29 Suppl 3:103-16; discussion 160-2. [PMID: 12787212 DOI: 10.1034/j.1600-051x.29.s3.6.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To systematically review the evidence of effectiveness of guided tissue regeneration (GTR) for furcation defects. BACKGROUND The evidence for the effectiveness of GTR in furcation defects has not yet been systematically appraised. METHODS We searched for randomized controlled trials with at least 6 months' follow-up comparing GTR with surgical debridement (open flap debridement, OFD). Data sources included electronic databases, hand-searched journals and contact with experts. Screening, data abstraction and quality assessment were conducted independently by multiple reviewers. The primary outcome measure was reduction in open horizontal furcation depth, secondary outcomes were frequency of furcation closure, gain in horizontal and vertical probing attachment and reduction of vertical probing depth. RESULTS For the primary outcome, reduction in horizontal furcation depth assessed during re-entry, the weighted mean difference between GTR and control was 1.51 mm (95% CI [0.39-2.62], chi-square for heterogeneity 67.6 (df = 3), P < 0.001) in mandibular class II furcations, 1.05 mm (95% CI [0.46-1.64, chi-square for heterogeneity 34.9 (df = 3), P < 0.001) in maxillary class II furcations, and 0.87 mm (95% CI [-0.08-1.82], chi-square for heterogeneity 0.1 (df = 4), P = 0.991) in studies that had combined mandibular and maxillary class II furcations. For the secondary outcomes, GTR treatment led to significantly better results than open flap debridement. No meta-analysis could be performed for frequency of furcation closure because of sparse data. CONCLUSIONS Overall, GTR was consistently more effective than OFD in reducing open horizontal furcation depths, horizontal and vertical attachment levels and pocket depths for mandibular or maxillary class II furcation defects. However, these improvements were modest, variable and there was only a limited number of studies available to appraise the effects, thus limiting general conclusions about the clinical benefit of GTR. Future studies should aim to identify factors associated with achieving consistent and more pronounced benefits over open flap debridement.
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Affiliation(s)
- Søren Jepsen
- Department of Periodontology, School of Dentistry, University of Kiel, Gemany.
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Zahedi CS, Miremadi SA, Brunel G, Rompen E, Bernard JP, Benque E. Guided tissue regeneration in human Class II furcation defects using a diphenylphosphorylazide-cross-linked collagen membrane: a consecutive case series. J Periodontol 2003; 74:1071-9. [PMID: 12931772 DOI: 10.1902/jop.2003.74.7.1071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several bioabsorbable collagen membranes are either currently available or under investigation for use in guided tissue regeneration (GTR) procedures. The aim of this 12-month reentry study was to evaluate a diphenylphosphorylazide (DPPA)-cross-linked bovine type I collagen membrane in the healing of mandibular Class II furcation defects. The DPPA technique prevents the inclusion of foreign cytotoxic cross-linking substances in the reticulated molecules, thus providing a more biocompatible product. METHODS Forty non-smoking periodontally compromised adult subjects volunteered for this study, and one defect was randomly selected in each patient. At baseline, plaque index (PI), gingival index (GI), probing depth (PD), gingival margin location (GML), clinical attachment level (CAL), and width of the attached gingiva (AG) were measured. Intrasurgical hard tissue measurements consisted of the vertical open probing attachment level (V-OPAL) and horizontal open probing attachment level (H-OPAL), as well as furcation entrance width (FW) and height (FH) and subclassification of defects according to vertical bone loss. All soft tissue measurements were repeated 12 months after membrane placement using conservative flap reentry surgeries; hard tissue parameters were also assessed at this time. RESULTS DPPA-cross-linked collagen membranes demonstrated good handling characteristics, and no postoperative adverse tissue reactions or clinically detectable localized allergic responses were observed. GI and PI remained low during the entire study period. When the one year reentry values were compared to the baseline measurements, a significant reduction in PD (1.9 +/- 1.4), FW (2.1 +/- 1.7), FH (2.9 +/- 1.6), and gain in CAL (1.7 +/- 1.5), V-OPAL (2.1 +/- 1.9), and H-OPAL (4.7 +/- 1.4) were observed (P < or = 0.05). However, there were no significant differences in GML or AG. Hard tissue improvements resulted in the complete closure of 30% (12) of the defects, and transformation of 67.5% (27) of the defects to Class I, while one defect remained a Class II (2.5%). CONCLUSIONS Based on this 12-month clinical reentry study, a DPPA-cross-linked collagen membrane could be beneficial in GTR treatment of Class II mandibular furcation involvements, both in terms of soft and hard tissue improvements.
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Affiliation(s)
- Charles S Zahedi
- Department of Advanced Periodontics and Implant Surgery, School of Dentistry, Loma Linda University, Loma Linda, CA 92354, USA.
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