Abstract
Objective: To systematically evaluate the effect of adjuncts with demineralized freeze dried bone in the treatment of intrabony defects in terms of clinical and radiological outcomes. Methods: A search was conducted for randomized controlled trials in cases of chronic periodontitis to evaluate the effect of adjuncts with demineralized freeze dried bone in the treatment of intrabony defects. The electronic databases like PUBMED and the Cochrane Central Register of Controlled Trials were used as data sources. Gain in clinical attachment level was considered as the primary outcome variable while Pocket depth reduction and Radiological bone fill were considered to be the secondary outcome variables. Results: Of all the articles screened, seven controlled human clinical trials met the eligibility criteria and provided clinical and radiological outcome data on the effectiveness of adjuncts with Demineralized Freeze Dried Bone Allograft (DFDBA) in the treatment of intrabony defects. Amongst the above mentioned seven trials, three controlled clinical trial showed significant results while four controlled clinical trials did not show significant results. From this systematic review, it can be concluded that the treatment with Autologous Platelet Concentrate (PRP) in combined with DFDBA showed significant results in probing pocket depth reduction and clinical attachment level gain. Cyclosporine A in combination with DFDBA showed significant radiological bone fill and Enamel Matrix Derivative (EMD) in combination with DFDBA with 12 months followup showed significant soft tissue and hard tissue healing. Conclusion: PRP in combination with DFDBA showed significant results in probing pocket depth reduction and clinical attachment level gain. Cyclosporine with DFDBA showed significant radiological bone fill and EMD in combination to DFDBA with 12 months follow-up showed significant soft tissue and hard tissue healing. However, long term studies are needed to clarify the effectiveness of adjuncts with DFDBA in the treatment of intrabony defect.
Highlights
Regeneration has been defined as the reproduction or reconstitution of a lost or injured part to restore the architecture and function of the periodontium. (American Academy of Periodontology, 1992)
Following search terms alone and in combination were used by means of PUBMED search builder: “demineralized freeze dried bone allograft”, “DFDBA”, allograft, allogenic graft material, allogenic graft material, “infra bony defects”, “intrabony defects”, “two-walled defects”, “three-walled defects”, osseous defects, angular defects, vertical defects, apico-coronal defects, walled defects, adjuncts, adjuvants, emdogain, Enamel Matrix Derivative (EMD), platelet rich fibrin, PRF, platelet rich plasma, Platelet rich protein (PRP), autologous platelet concentrate, guided tissue regeneration, Guided tissue regeneration (GTR), barrier membrane, resorbable membrane, non-resorbable membrane, growth factor, signaling molecule, platelet derived growth factor, platelet-derived growth factor (PDGF), bone morphogenic protein, BMP, root conditioning, root biomodification, immunosuppressive drugs, tetracycline, citric acid, EDTA, probing depth, clinical attachment level, radiological defect depth, bone fill
PRP used in combination to DFDBA showed significant soft tissue healing while cyclosporine, in combination with DFDBA showed significant hard tissue healing
Summary
Regeneration has been defined as the reproduction or reconstitution of a lost or injured part to restore the architecture and function of the periodontium. (American Academy of Periodontology, 1992). The goal of periodontal therapy has always been the regeneration of lost attachment apparatus. The objective of periodontal reconstructive therapy is to regenerate all the tissues of the periodontium, including a functional periodontal ligament, alveolar bone and cementum. There are various treatment modalities available for periodontal regenerative therapy, inclusive of bone graft, guided tissue regeneration, growth factors, or combination of two or more of the above listed approaches. The use of DFDBA in periodontal defects has become popular since studies have reported defect fill of greater than 50% in majority of the treated sites. When placed in infrabony defects, DFDBA demonstrated significantly more new cementum, new connective tissue, and bone formation in infrabony defects grafted with DFDBA than in non-grafted sites. Allografts, in general, have osteoinductive potential which induces bone formation due to the influence of bone induction proteins (BMPs). The primary action of BMPs is to differentiate the mesenchymal precursor cells
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