Abstract
ObjectivesThe main objectives of this study were (1) to evaluate bone/graft density alterations by digital subtraction radiography; (2) to determine factors associated with favorable clinical and radiographic outcomes, and (3) to report on patient morbidity after guided tissue regeneration (GTR) in aggressive periodontitis (AgP) patients.Materials and methodsAdapting a split-mouth design, 30 comparative intrabony defects in 15 patients were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). The time period of observation was 12 months.ResultsThere were significant improvements in clinical and radiographic parameters within each group, without intergroup differences. However, higher PPD reduction for three-wall defects was noted in MPM sites (5.22 versus 3.62 mm; p = 0.033). Moreover, a significant gain in bone/graft density of 4.9% from 6 to 12 months post-operatively was observed in test sites. Multivariate analysis demonstrated that morphology of intrabony defects was a predictor of CAL gain (p = 0.06), while independent prognostic variables effecting changes in bone/graft density were radiographic defect depth (p = 0.025) and radiographic angle (p = 0.033). The majority of patients reported some discomfort, pain, and edema with mild intensity without any significant differences between treatment modalities.ConclusionsThis study demonstrated enhanced bone/graft density gain after GTR with MPM, which may indicate greater area of new bone formation. Independent variables effecting treatment outcomes were intrabony defect morphology, radiographic defect depth, and radiographic angle.Clinical relevanceThis study supports the regenerative treatment of intrabony defects in AgP patients and identifies some variables with prognostic value.
Highlights
The main features of aggressive periodontitis (AgP) are rapid rate of disease progression, a discrepancy between the amount of local factors versus periodontal destruction, absence of any systemic involvement and familial aggregation [1]
Analysis of the gingival crevicular fluid in sites treated with modified perforated collagen membranes (MPM) showed elevated concentration of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF), and platelet-derived growth factor-BB (PDGF-BB), which enhanced the clinical outcomes of periodontal regeneration [29, 30]
0.86 [0.78–0.93] ± 0.08 0.765 n number of defects, PPD probing pocket depth, CAL clinical attachment level, type A one-wall and two-wall defects, type B three-wall defects; p intergroup comparison of change *Shows significant differences (p < 0.05) between the data at 12 months post-surgery and the values at baseline between test and control a The means with 95% confidence intervals (CIs) [in brackets] and ± SD of probing values at baseline and 12 months post-operatively b The results show the means with 95% CI [in brackets] and ± SD of the changes in subtraction radiography outcomes 12 months post-operatively relative to baseline
Summary
The main features of aggressive periodontitis (AgP) are rapid rate of disease progression, a discrepancy between the amount of local factors versus periodontal destruction, absence of any systemic involvement and familial aggregation [1]. Clin Oral Invest (2019) 23:3005–3020 tissue regeneration (GTR), which aims at restoring lost periodontal tissue. In this procedure, a biocompatible barrier membrane is placed between a surgical flap and root surface to conduct cell recruitment in a selective manner. Gingival mesenchymal stem/ progenitor cells (GMSCs) demonstrated osteogenic potential in the presence of inflammation [8]. In addition to their great efficiency in bone reconstruction and repair for clinical use [9, 10], GMSCs participated in recruitment of bone progenitor cells and other endogenous MSCs, showing unique immunomodulatory and anti-inflammatory functions [11]. Barrier placement in GTR procedures excludes any contribution of MSCs and biologic mediators from the periosteum and gingival connective tissue, which might affect the favorable outcomes of regenerative procedures in intrabony defects
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