Bioresorbable Collagen Membrane Research Articles

An Organic Mineral Adhesive Bone Graft: A Preclinical Study.

The development of a successful bone grafting technology with cohesive and adhesive properties has been an elusive goal for dental and orthopedic researchers. Tetracalcium phosphate combined with phosphoserine (TTCP-PS) is a synthetic, injectable, cohesive, self-setting, mineral-organic wet-field adhesive. The objective of this study was to evaluate four formulations of TTCP-PS in comparison to the conventional grafting materials, Bioglass and deproteinized cancellous bovine bone with a bioresorbable collagen membrane in standardized defects created in the angle of the rat mandible. Microcomputed tomography and histomorphometry were utilized to evaluate bone replacement with each of these materials after in vivo residence of either 4 or 12 weeks. The results of this study demonstrate that specific TTCP-PS formulations can form bone comparable to conventional materials in an osteopromotive mechanism but with the advantage of having cohesive and adhesive properties.

Comparative evaluation of the effectiveness of bioresorbable collagen membrane in combination with deproteinized bovine bone matrix xenograft (DBBM), and advanced platelet rich fibrin membrane in combination with deproteinized bovine bone matrix xenograft for periodontal regeneration

Introduction: Periodontitis is a chronic, multifactorial, inflammatory disease that leads to gradual loss of bone and periodontal attachment. Thus, periodontal surgery is required according to severity of diseases. The goal of periodontal reconstructive surgery is to regenerate soft and hard tissues destroyed during periodontal disease. Aim: To compare the effectiveness of bioresorbable collagen membrane in combination with Deproteinized Bovine Bone Matrix xenograft (group A); and Advanced Plasma rich fibrin(A-PRF) membrane in combination with Deproteinized Bovine Bone Matrix xenograft (group B) in the treatment of human infrabony defects. Methods: This randomised controlled trial will be carried out at the periodontics outpatient department. We will choose 24 patients with moderate to advanced chronic periodontitis who are otherwise systemically healthy. Infrabony defects will be treated by open flap debridement using bovine-derived xenograft and bioresorbable collagen membrane (group A) and open flap debridement using bovine-derived xenograft and A-PRF after the completion of first therapy (group B). At baseline and six months after undergoing periodontal surgery, probing pocket depth, clinical attachment level, radiographic bone fill, gingival recession, oral hygiene status, and gingival health will be measured. Expected results: It is suggested that Bioresorbable Collagen Membrane in combination with Deproteinized Bovine Bone Matrix xenograft will show better results as compared to Advanced Platelet Rich Fibrin Membrane with Deproteinized Bovine Bone Matrix Xenograft. Clinical trial registry of India (CTRI): REF/2023/05/066732. Protocol version: v1 (12/05/23)

Comparative evaluation of modified triangular coronally advanced Flap alone or in combination with platelet rich fibrin or type I collagen membrane for treatment of Miller’s Class I and Class II gingival recession

The study aimed to clinically evaluate the outcome of modified triangular coronally advanced flap (mtCAF) alone or in combination with platelet rich fibrin or type I collagen membrane in Miller’s Class I and Class II gingival recession. 45 sites with Millers Class I or II gingival recession were recruited and allocated into 3 groups with 15 sites each. Group 1: mtCAF alone, Group II: mtCAF with PRF and Group III: mtCAF with bioresorbable collagen membrane (Bio-Gide®). Standardized Clinical Parameters such asPlaque Index (PI), Gingival Index (GI), Pocket Probing Depth (PPD), Clinical attachment level (CAL), Gingival Recession Depth (GRD) and Keratinized Tissue Height (KTH) were measured at baseline and 6 months. All the three groups showed improvement in clinical parameters but it was not statistically significant. However, a significant increase in keratinized tissue height was seen in Group III as compared to Group I and Group II. Modified triangular coronally advanced flap (mtCAF) alone or in combination with PRF and collagen membrane showed good clinical outcomes but better results were obtained in terms of keratinized tissue when collagen membrane was used.

COMPARATIVE EVALUATION OF MODIFIED TRIANGULAR CORONALLY ADVANCED FLAP IN COMBINATION WITH PLATELET RICH FIBRIN OR TYPE I COLLAGEN MEMBRANE FOR TREATMENT OF MILLERS CLASS I AND CLASS II GINGIVAL RECESSION

Background: The study aimed to clinically evaluate the outcome of modified triangular coronally advanced flap (mtCAF) alone or in combination with platelet rich fibrin or type I collagen membrane in the treatment of Millers Class I and Class II gingival recession. Methods: 45 sites with Millers Class I or II gingival recession were recruited and allocated into 3 groups with 15 sites each. Group 1: mtCAF alone, Group II: mtCAF with PRF and Group III: mtCAF with bioresorbable collagen membrane (Bio-Gide®). Standardized Clinical Parameters such as Plaque Index (PI), Gingival Index (GI), Pocket Probing Depth (PPD), Clinical attachment level (CAL), Gingival Recession Depth (GRD) and Keratinized Tissue Height (KTH) were measured at baseline and 6 months. Result: All the three groups showed improvement in clinical parameters but it was not statistically significant. However, a significant increase in keratinized tissue height was seen in Group III as compared to Group I and Group II. Conclusion Modified triangular coronally advanced flap (mtCAF) alone or in combination with PRF and collagen membrane showed good clinical outcomes but better results were obtained in terms of keratinized tissue when collagen membrane was used.

A COMPARATIVE EVALUATION OF VESTIBULAR INCISION SUBPERIOSTEAL TUNNEL ACCESS (VISTA) VERSUS CORONALLY ADVANCED FLAP WITH COLLAGEN MEMBRANE FOR THE TREATMENT OF MILLERS CLASS I AND CLASS II GINGIVAL RECESSION: A CLINICAL STUDY

Background: Gingival recession is defined asThe displacement of soft tissue margin apical to CEJ with exposure of root surface. Factors such as abnormal tooth alignment in the arch, fenestration, dehiscence, faulty tooth brushing, periodontal diseases etc. are few of the causes of gingival recession. The aim of the present study was to compare the effectiveness of minimally invasive Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique and coronally advanced flap using a bioresorbable collagen membrane in Millers Class I and II gingival recessions Material and Methods: 20 sites with Millers Class I or II gingival recession were recruited and allocated into 2 groups with 10 sites each. Test group: VISTA with bioresorbable collagen membrane control group: CAF with bioresorbable collagen membrane. Plaque Index (PI), Gingival Index (GI), relative Clinical attachment level (CAL) Pocket Probing Depth (PPD) Recession Height (RH) and width of keratinized gingiva (WKG) Recession Width (RW) were measured at baseline 3 months and 6 months. Results: A significant improvement was found in all the clinical parameters in the Test group from baseline to 3 months and 6 months Recession width reduction was significantly more in the Test group as compared to Control group. Conclusion: Both the groups, viz: VISTA with resorbable collagen membrane and CAF with resorbable collagen membrane were effective in the treatment of Millers Class I and II gingival recessions VISTA being minimally invasive can be used for covering recession defects.

Recession coverage using coronally repositioned flap with bioresorbable collagen membrane

The Coronally Advanced flap is one of the most commonly used procedures for recession coverage because it is simple to perform and produces good results when compared to other techniques. In this case report, a 40-year-old male patient complained of receding gums and localized sensitivity to hot and cold in the upper left anterior tooth region, as well as aesthetic discomfort in the gingival recession site. The Coronally advanced flap with collagen membrane is used to treat the recession site, follow up of 3 months showed satisfactory results.

Bone Graft and Intraosseous Anchorage of Dental Implants for Reconstruction of the Residual Alveolar Ridge.

Background:Bone grafting aims at better dental implant osseointegration and preserves the remaining alveolar bone in the socket. The success of various bone grafting materials plays a vital role in assessing future implant function.Aims and Objectives:The present clinical trial was aimed at evaluating the results of guided bone regeneration (GBR) with and without the bioresorbable membrane in the dental implant placement.Materials and Methods:The 20 patients were divided into two groups (n = 10). First was Group I- GBR with bioresorbable collagen membrane (BioGide™) and second was Group II- GBR without membrane. Bone gain and bone levels were analyzed for both groups. All the collected data were analyzed statistically.Results:For Group I, bone levels at baseline were nonsignificant (P = 0.2188) Similarly, nonsignificant values were seen in both groups at 3 months with bone level values of 0.25 ± 0.17 and 0.38 ± 0.24 for Group I and Group II, respectively. Changes in the bone levels were found to be 2.45 ± 0.349 and 2.58 ± 0.304 from Group I and II, respectively, inferring the nonsignificant difference with P value of 0.3723. The percentage of bone gain for intergroup at the end of 3 months was 89.15% ±0.678 for Group I and 88.68% ± 0.503%; these values were statistically nonsignificant (P = 0.982).Conclusion:Nonsignificant difference was observed between the two groups with and without membrane in terms of changes in bone level, percentage of bone gain, and bone defect reduction. This study concludes that the use of bone grafts significantly improves residual alveolar ridge irrespective of membrane used.

Minimally invasive treatment of gingival recession by vestibular incision subperiosteal tunnel access technique with collagen membrane and advanced platelet-rich fibrin: A 6-month comparative clinical study.

Aim:The study aimed to assess the minimally invasive Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique for treatment of Millers Class I or Class II buccal gingival recession defects and to compare the effectiveness of a bioresorbable collagen membrane or advanced platelet rich fibrin (A-PRF).Methods and Material:20 sites with Millers Class I or II gingival recession were recruited and allocated into 2 groups with 10 sites each. Group 1: VISTA with A-PRF, Group 2: VISTA with with bioresorbable collagen membrane (Healiguide)®.Standardized Clinical Parameters:Plaque Index (PI), Gingival Index (GI), Clinical attachment level (CAL )Pocket Probing Depth (PPD) Recession Height (RH ) and width of keratinized gingiva (WKG) were measured at baseline 3 months and 6 months.Results:Both groups showed significant improvement in clinical parameters. However reduction in recession height and mean root coverage percentage was greater in A-PRF group after 6 months.Conclusions:VISTA with both A-PRF and Healiguide showed good clinical outcomes but better results were obtained when A-PRF was used.

Evaluation of Bovine Derived Xenograft Combined with Bioresorbable Collagen Membrane in Treatment of Intrabony Defects

Introduction: Treatment of periodontal diseases done by surgical therapy depends upon extent and severity of disease. The ultimate goal of periodontal reconstructive surgery is to regenerate tissues destroyed during periodontal disease.
 Objective: To evaluate the effectiveness of bovine-derived xenograft with collagen membrane in treatment of intrabony defects by comparing it with open flap debridement alone.
 Methods: This non-randomised controlled trial was conducted after ethical clearance, at Bir hospital from 2018 March to 2019 April. The study recruited 38 patients by convenience sampling, age from 25-44 years, with chronic periodontitis, and willing to sign informed consent. Intrabony defects were treated by open flap debridement with bovine-derived xenograft and bioresorbable collagen membrane (Test group) and open flap debridement alone (Control group). Probing pocket depth, clinical attachment level, gingival recession, oral hygiene status, and gingival status were assessed at baseline and six months.
 Results: Six months after therapy, in Test group probing pocket depth reduction was 5.2 mm and gain in mean clinical attachment level was 4.3 mm. In Control group, mean probing pocket depth reduction was 3.8 mm and mean gain in clinical attachment level was 2.7 mm. The test treatment resulted in statistically higher probing pocket depth reduction and clinical attachment level gain than Control group.
 Conclusion: Both therapies resulted in significant probing pocket depth reductions and clinical attachment gains, and treatment with open flap debridement with bovine-derived xenografts and collagen membrane resulted in significantly higher probing pocket depth reduction and clinical attachment gain than treatment with open flap debridement alone.

Comparative evaluation of bioabsorbable collagen membrane and platelet-rich fibrin membrane in the treatment of localized gingival recession: A randomized clinical trial

Aim: Gingival recession leads to root surface exposure and dentin hypersensitivity, which might cause an aesthetic impairment. This randomized trial was carried out for comparison and evaluation of the utility of bioresorbable collagen membrane (CM) and platelet-rich fibrin (PRF) membrane in the treatment of localized gingival recession. Materials and Methods: A total of 36 subjects having localized gingival recession were randomly allocated from Department of Periodontology, Jagadguru Sri Shivarathreeshwara Dental College and Hospital, Mysuru, Karnataka, India, in two treatment groups, namely coronally advanced flap (CAF) combined with bioresorbable CM and CAF combined with PRF membrane. Plaque index, recession height (REC) and width of keratinized gingiva, and clinical attachment level were recorded at baseline, 1, 3, and 5 years. Results: The primary outcomes of the study were REC and complete root coverage (CRC). In the CAF + CM group, at the baseline, the residual REC was 3.01 ± 0.98 mm, after 1 year, it was 1.15 ± 0.88 mm, and 5 years later, it was 1.10 ± 1.04 mm; and in the CAF + PRF group, at the baseline, REC was 2.90 ± 0.52 mm, after 1 year, it was 0.45 ± 0.67 mm, and after 5 years, it was 0.38 ± 0.56 mm. Follow-up of 5 years showed statistically significant differences between the groups. After 5 years of follow up, in CAF + CM group, 60% of teeth showed CRC, and in CAF + PRF membrane group, 70% of teeth showed CRC. When we considered REC, statistical significant difference was observed between both the groups for the localized recession treatment; after 5 years, percentage of teeth presenting CRC showed no significant difference. Follow-up of 5 years showed differences, which was statistically significant between the groups. Conclusion: Though the usage of both the membranes showed satisfactory results, the PRF membrane promised to be a better alternative to CM. Also, PRF membrane could be a cost-effective alternative in the treatment of localized gingival recessions.

Evaluation and comparison of the inverted periosteal flap and bioresorbable collagen membrane for socket preservation ‐ a randomized controlled trial

Evaluation and comparison of the inverted periosteal flap and bioresorbable collagen membrane for socket preservation ‐ a randomized controlled trial

COMPARISON OF AUTOGENOUS PERIOSTEAL PEDICAL GRAFT AS A BARRIER AND BIORESORBABLE COLLAGEN MEMBRANE IN MANAGEMENT OF PERIODONTAL INTRABONY DEFECTS: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Introduction: The autogenous periosteal pedicle graft (PPG) has been viewed as having regenerative potential and provides adequate blood supply rich in growth factors. It also provides a rigid barrier maintaining the patency of the periodontal intrabony defect space for regenerative cell repopulation. Thus, PPG might be an alternative to currently available barrier membranes used for guided tissue regeneration (GTR). So, the aim of this study was to evaluate the clinical and radiographic outcomes of autogenous PPG as a barrier compared to bioresorbable collagen membrane (CM) for treating periodontal intra-bony defects.Materials and methods: Twenty chronic periodontitis patients having matched contralateral periodontal intrabony defects participated in this randomized controlled clinical trial. Using split-mouth design, defects were randomly treated with either autogenous PPG or bioresorbable CM (Bioteck®, Arcugnano VI, Italy). Clinical outcomes included; plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment level (CAL). Digital periapical radiographs and linear measurements were used to calculate the radiographic outcomes; bone defect area (BDA). Measurements were taken at the time of surgery (baseline) and 6-months postoperatively. Statistical analysis was conducted using Wilcoxon’s-Signed-Rank test.Results: At 6 months both treatments resulted in statistically significant improvement in all clinical and radiographic outcomes compared with baseline (P 0.05). Conclusion: Within the limitations of this study, it can be concluded that both the autogenous PPG and the bioresorbable CM improved clinical and radiographic outcomes and were effective GTR membranes in management of intra-bony defects.

An Integrated modified lip repositioning using bioresorbable collagen membrane: A long-lasting auxiliary treatment approach for gummy smile

Excessive gingival display is one of the major causes of patient embarrassment. An imbalance in the gingiva–tooth ratio results in the dominance of gingival appearance often referred to as “gummy smile.” A normal gingival display between the inferior border of the upper lip and the gingival margin of the central incisors during a normal smile is 1–2 mm. In contrast, an excessive gingivae-to-lip distance of 4 mm or more is classified as an unattractive. The objective of lip repositioning surgery is surgical correction of unesthetic gummy smile by limiting the retraction of the elevator smile muscles resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display during smiling. This article presents a case of a gummy smile in which esthetic correction was achieved through periodontal plastic surgical procedure wherein 10–12 mm of partial-thickness flap was dissected apical to mucogingival junction sparing the midline maxillary labial frenum and placement of bioresorbable collagen membrane on excised area followed by approximation of flaps. This case with score 3 smile line was treated by lip repositioning technique with successful clinical outcome and enormous patient satisfaction. This technique holds importance as perioesthetics has become an integral part of periodontal treatment plan with the periodontist playing akey role to combat the patient's embarrassment.

Use of Fibrin Sealant in Guided Tissue Regeneration of Intrabony Defect

Background: The treatment of periodontal intrabony defect can be a challenge to clinicians especially with the use of barrier membrane in guided tissue regeneration (GTR). The mechanical and biological regenerative potential of barrier membrane could be enhanced with the use of fibrin sealant. The purpose of this case report was to describe a surgical procedure achieving regeneration with fibrin sealant application in combination with guided tissue regeneration (GTR) to eliminate intrabony defect. Methods: A 21 year old systemically healthy female had the complaint of swelling and bleeding from gingiva in maxillary anterior region since 6 months. On clinical examination, there was a high frenal attachment penetrating deep into the palatine papilla leading to midline diastema. The papilla caused opening of the gingival margin in the palatine region leading to pocket formation in mesial side of 7 mm and 5 mm in relation to 21, 12. Radiographic examination revealed an intrabony defect in the same region. Due to persistence of pocket after frenum excision, surgical treatment for GTR was planned with use of bio-resorbable collagen membrane and fibrin sealant application. Results: The patient was followed for 9 months post-operatively. Reduction in probing depth was observed in 6 month and radiographic bone fill at 9 months. The probing depth was reduced to 3 mm in relation to 21 and 12. The gingival tissues appeared healthy with no bleeding on probing or gingival recession. Conclusion: This case report shows the possibility of achieving periodontal regeneration over a localized intrabony defect with the combined use of GTR membrane and fibrin sealant. An adjunctive regenerative technique is presented that allowed space making, stabilization of membrane, early wound healing as well as local taxis of growth factors for regeneration of periodontal tissues. Clinical implication: The use of fibrin sealant boosted the regenerative potential of barrier membrane showing potential of new bone formation and early wound healing.

Evaluation of effectiveness of connective tissue graft as a barrier with bioresorbable collagen membrane in the treatment of mandibular Class II furcation defects in humans: 4-year clinical results.

Connective tissue grafts (CTGs) have been used as a barrier for closing mandibular Class II furcation defects. The present study compared long-term (48 months) effectiveness of CTG as a barrier with bioresorbable collagen membrane in the treatment of mandibular Class II furcation defects in humans. Twenty chronic periodontitis patients with a single Class II furcation defect on the buccal surface of mandibular teeth were included in the study. Vertical probing pocket depth (V-PPD), vertical relative attachment level (V-RAL), and relative gingival margin level (RGML) were recorded at baseline, 6 months, 12 months, and 48 months post-surgery. The mean V-PPD reductions observed in the test group and control group were statistically significant at all time intervals when compared with the baseline. Similarly, the mean V-RAL gain at 6 months, 12 months, and 48 months were statistically significant, compared with the baseline data in both the groups. At 48 months the difference in V-RAL gain between the groups was found to be statistically significant, with greater improvements in test group. Complete closure of furcation and improvement in horizontal classification were better in the test group than in the control group. It can be concluded that both treatment modalities result in improvement in clinical parameters. However, the results obtained with CTG appeared to be more stable.

Comparison of collagen membrane and bone substitute as a carrier for rhBMP‐2 in lateral onlay graft

To evaluate the bone regenerative effect of bioresorbable collagen membrane (CM) as a carrier for recombinant human bone morphogenetic protein-2 (rhBMP-2) when performing lateral onlay grafts using bovine hydroxyapatite incorporated with collagen matrix (BHC) in combination with CM in dogs. A guided bone regeneration (GBR) was performed at the buccal aspect of edentulous maxillary alveolar ridges in dogs (n = 5): (1) BHC group, in which rhBMP-2-loaded BHC was covered by a CM, and (2) CM group, in which BHC was covered by an rhBMP-2-loaded CM. A histologic and histometric analysis was performed after 8 weeks of healing. Both the BHC and CM groups exhibited substantial newly formed bone (NB). More NB was found in the CM group than in the BHC group without statistical significance. Most of the NB was in direct contact with the residual bone substitute in the BHC group, whereas the projections and islands of NB were observed in the spaces between the residual bone substitute clusters in the CM group. The bone-to-residual bone substitute contact ratio was significantly lower in the CM group than in the BHC group (P = 0.043). Within the limitations of this study, it can be concluded that rhBMP-2-loaded CM performed lateral onlay grafts as effectively as rhBMP-2-loaded BHC while showing less bone-residual bone substitute contact ratio in dogs. The loading of CMs with rhBMP-2 might therefore be a recommendable treatment option for facilitating lateral onlay graft combined with rhBMP-2.

Evaluation of a bioresorbable collagen membrane of fish origin in the treatment of periodontal intrabony defects: A prospective clinical study.

Recently, there has been interest in non-mammalian collagen sources such as fish collagen in the development of biomatrices and scaffolds for periodontal regeneration. In the present study, a novel collagen barrier membrane of fish origin was assessed in the treatment of periodontal intra-bony defects. Ten systemically healthy chronic periodontitis patients having an osseous defect in the mandibular posterior teeth were selected and following the open flap debridement, a collagen membrane was placed over the defect and the flap was sutured with interrupted sutures. Clinical parameters such as Plaque Index, Gingival Bleeding Index, probing pocket depth (PPD), relative attachment level (RAL), and recession (R) were recorded at baseline, 6 and 9 months, whereas radiographic evaluation was done to assess alveolar crestal bone level and defect depth fill at 6 and 9 months using Auto-computer aided design (ACAD) 2007 software. Statistical significance was set at 5% level of significance. There was statistical significant differences with respect to periodontal clinical parameters such as Plaque Index, Gingival Bleeding Index, PPD, RAL, and gingival recession assessed at baseline, at 6 and 9 months respectively (P < 0.05), and radiographic evaluation showed a defect fill of 58.62 median % at 9 months. This preliminary study has shown predictable results in using fish collagen membrane, for treating periodontal intra-bony defects. Further, long-term clinical trials are needed to validate the effectiveness of this membrane.

Clinical and radiographical evaluation of a bioresorbable collagen membrane of fish origin in the treatment of periodontal intrabony defects: A preliminary study.

Background:Recently, there has been interest in non-mammalian collagen sources such as fish collagen in periodontal regeneration. In the present study, collagen barrier membrane of fish origin was assessed in the treatment of periodontal intrabony defects.Materials and Methods:Ten systemically healthy chronic periodontitis patients having a paired osseous defect in the mandibular posterior teeth were selected and randomly assigned to receive a collagen membrane (test) or open flap debridement (control) in a split mouth design. Clinical parameters such as Plaque index, Gingival bleeding index, Probing pocket depth, Relative attachment level, and Recession were recorded at baseline, 3, 6, and at 9 months, while radiographic evaluation was done to assess alveolar crestal bone level and percentage of defect fill at 6 and 9 months using autoCAD 2007 software. Student's t test (two-tailed, dependent) was used to find the significance of study parameters on continuous scale. Significance was set at 5% level of significance. Wilcoxon signed rank test was used to find the significance of percentage change of defect fill.Results:The comparison between the two groups did not show any statistically significant differences in the parameters assessed (P > 0.05) but, within each group, clinical parameters showed statistically significant differences from baseline to 9 months (P < 0.05).Conclusion:Within the limits of the study, it can be inferred that no significant differences were found either by using collagen membrane of fish origin or open flap debridement in the treatment of periodontal intrabony defects.

Osteoblast proliferation and differentiation on a barrier membrane in combination with BMP2 and TGFβ1

Bioresorbable collagen membranes are routinely utilized in guided bone regeneration to selectively direct the growth and repopulation of bone cells in areas of insufficient volume. However, the exact nature by which alveolar osteoblasts react to barrier membranes as well as the effects following the addition of growth factors to the membranes are still poorly understood. The objective of the present study was therefore to investigate the effect of a bioresorbable collagen membrane soak-loaded in growth factors bone morphogenetic protein 2 (BMP2) or transforming growth factor β1 (TGFβ1) on osteoblast adhesion, proliferation, and differentiation. Prior to experimental seeding, membranes were soaked in either BMP2 or TGFβ1 at a concentration of 10ng/ml for 5min. Human osteoblasts adhered to all soak-loaded membranes as assessed by scanning electron microscopy. Growth factors BMP2 and TGFβ1 increased osteoblast proliferation at 3 or 5days post-seeding when compared to control collagen membranes. Analysis of real-time PCR revealed that administration of BMP2 increased osteoblast differentiation markers such as osterix, collagen I, and osteocalcin. BMP2 also increased mineralization of primary osteoblasts as demonstrated by alizarin red staining when compared to control and TGFβ1 soak-loaded membranes. The combination of a collagen barrier membrane with growth factors TGFβ1 and BMP2 significantly influenced adhesion, proliferation, and differentiation of primary human osteoblasts. The described in vitro effects following the combination of collagen barrier membranes with growth factors TGFβ1 and BMP2 provide further biologic support for the clinical application of this treatment strategy in guided bone regeneration procedures.

Nano‑crystalline hydroxyapatite bone graft combined with bioresorbable collagen membrane in the treatment of periodontal intrabony defects: A randomized controlled clinical trial

Aim:To evaluate the clinical outcome of nanocrystalline hydroxyapatite (NcHA) bonegraft (Sybograf®) in combination with collagen membrane (PerioCol®) compared with open flap debridement (OFD) only in the treatment of intrabony periodontal defects.Materials and Methods:Eighteen intrabony defects in 16 systemically healthy patients aged between 25-65 years, were randomly assigned to test and control groups. The Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession were recorded at baseline, and were reevaluated at 6 months. In addition to this, radiographic bone fill was assessed using digital software. At the test site NcHA bone graft and collagen membrane was placed, whereas at the control site only, OFD was done. Recall appointments were made at 7th day, 1st month, 3rd month, and 6th month.Results:The data were subjected to statistical analysis using the Mann-Whitney ‘U’ Test and Wilcoxon signed rank sum test. In the control group, the mean reduction of PPD was 3.22±1.09 mm and CAL gain was 2.78±1.09 mm. In the test group, the mean PPD reduction of 4.33±0.5 mm and mean gain in CAL was 3.78±0.66 mm at 6 months. The mean increase in gingival recession was 0.55±0.72 mm in test and 0.44±0.52 mm in control group.Conclusion:The NcHA bone graft in combination with collagen membrane demonstrated better clinical outcomes compared with OFD alone.