Freeze-dried Bone Allograft Research Articles

Volumetric Assessment of Regenerative Efficacy of Demineralized Freeze-Dried Bone Allograft With or Without Amnion Membrane in Grade II Furcation Defects: A Cone Beam Computed Tomography Study.

Volumetric changes were evaluated to assess the regenerative efficacy of demineralized freeze-dried bone allograft (DFDBA) with and without amnion membrane (AM) in Grade II furcation defects both clinically and radiographically using cone beam computed tomography (CBCT). Sites were randomly assigned to Group I (DFDBA) and Group II (DFDBA + AM). Clinical parameters such as probing pocket depth, clinical attachment level, gingival recession, and horizontal probing depth were assessed at baseline, 3 months, and 6 months. Radiographic dimensions of the defect height, width, depth, and volume were assessed at baseline and 6 months postoperatively. DFDBA used with AM resulted in significant improvement in clinical and radiographic parameters when compared with DFDBA alone. The mean reductions in radiographic volume of the defect were 11.15 ± 6.39 mL for Group I and 17.02 ± 10.86 mL for Group II. Greater reduction in volume indicated a greater amount of healed regenerated tissue in Group II patients.

Evaluation of Healing at Molar Extraction Sites With and Without Ridge Preservation: A Randomized Controlled Clinical Trial.

To date, limited evidence is available specifically evaluating ridge preservation (RP) and implant placement in molar sites. The primary aim of this study is to radiographically compare alveolar ridge changes with and without RP with cone-beam computed tomography (CBCT). This parallel, two-arm randomized clinical trial included 40 patients evenly distributed between two treatment groups. After molar extraction, sites were allowed to heal naturally or received RP with freeze-dried bone allograft covered by a non-resorbable dense polytetrafluoroethylene membrane. CBCT scans were taken immediately and 3 months postextraction, and then a dental implant was placed. Width and height measurements were made radiographically. Significantly greater loss in alveolar ridge height was found in molar sites allowed to heal without RP on the buccal aspect of the socket (RP: -1.12 ± 1.60 mm versus no RP: -2.60 ± 2.06 mm, P = 0.01). No significant difference in ridge width loss was found between groups. Two-thirds ridge width reduction was experienced on the buccal aspect in sites without RP, but width loss was evenly distributed between buccal and lingual aspects when RP was performed. Bone grafting at time of placement was required in 25% of implants in the group without RP versus 10% of implants in the RP group. In molar extraction sites without RP, significantly more reduction in ridge height occurred, and the majority of ridge width loss was localized to the buccal aspect. When RP was performed, ridge width loss was not significantly decreased, but the loss was evenly distributed between facial and lingual aspects of the extraction site.

Comparative Alveolar Ridge Preservation Using Allogenous Tooth Graft versus Free-dried Bone Allograft: A Randomized, Controlled, Prospective, Clinical Pilot Study.

Background:For the first time in India, allografts from human extracted teeth were prepared. A randomized, prospective, clinicoradiographical, histological study was conducted to evaluate their efficacy in comparison with freeze-dried bone allograft (FDBA) in alveolar ridge preservation.Materials and Methods:Graft preparation: with written consent, teeth were collected from three donors (full mouth extraction cases). Once donors’ serums were tested negative for HIV, HBV, HCV, and Venereal disease research laboratory (VDRL), mineralized whole tooth allograft (WTA) and dentin allograft (DA) were prepared using the standard protocol of Tissue Bank at Tata Memorial Hospital, Mumbai, India.Study Design:In this randomized controlled trial, 15 patients undergoing extraction of at least four teeth were selected. In each patient after atraumatic extractions, one socket was grafted with WTA, second with DA, third with FDBA, and fourth was left ungrafted (control site). All the sites were covered with chorion membrane. To estimate three-dimensional alveolar crest changes, cone beam computed tomography scans were taken immediately after grafting and 4 months postoperatively. Bone biopsies using 3 mm trephine bur were obtained from four patients at the time of implant placement and evaluated histologically.Results:Clinically uneventful healing was observed at all sites. Compared to other sites, WTA and DA consistently showed superior results demonstrating least reduction in alveolar crest height and width which was statistically significant (P < 0.05). Between WTA and DA sites, there was no statistically significant difference. Histological analysis also confirmed more new bone formation at WTA and DA sites.Conclusions:Rather than disposing extracted human teeth as a biomedical waste (common practice), they can be collected from suitable systemically healthy donors. With the help of tissue bank, they can be processed into an allograft, serving as an excellent alternative to conventional allografts.

Efficacy of decalcified freeze-dried bone allograft in the regeneration of small osseous defect: A comparative study.

Aim:To access the efficacy of decalcified freeze-dried bone allograft (DFDBA) in the regeneration of bone following small osseous defect in minor oral surgery.Objectives:To evaluate the ability of DFDBA to enhance the rate of wound healing and assess radiographic bone density, pain, and infection preoperatively and postoperatively.Materials and Methods:Twenty patients with cysts were assessed. Ten patients were filled with DFDBA (Group 1) and ten without bone graft (Group 2), respectively. Radiographic bone density was assessed on preoperative, intraoperative, and postoperative radiographs on 1st day, 3rd month, and at 6th month using Adobe Photoshop CS6 - Grayscale histogram.Results:Bone density in Group 1 was found to be significantly higher than in Group 2 on 3rd and 6th month postoperatively with a P = 0.024 and P = 0.016 which was statistically significant. The percentage increase in bone density between both the group was determined and yielded no difference over a period of time, but the difference in percentage increase was markedly higher in Group 1 compared to Group 2 at all the time intervals.Conclusion:Bone formed as depicted by bone density is significantly higher when DFDBA is used in small bony defects.

Innovative Periodontal Surgery by Monocortical Corticotomy in Management of Bimaxillary Protrusion Cases: A Clinical Study

ABSTRACT Periodontal accelerated osteogenic orthodontics (PAOO) is a procedure applying the clinical science of alveolar corticotomy, particulate bone grafting, and the application of orthodontic forces, for accentuated tooth movement. This is theoretically based on the bone healing pattern known as the regional acceleratory phenomenon (RAP). A series of 12 cases, including 8 females and 4 males, were included in the study. The cases were referred from the Department of Orthodontia to the Department of Periodontology, ADC (R&amp;R), having bimaxillary protrusion with an increased overjet. After initial orthodontic alignment, buccal corticotomy procedure was planned. A full-thickness mucoperiosteal flap was reflected from maxillary canine to canine beyond the root apices. Vertical corticotomy cuts were given in the alveolar bone with piezo blades 2 mm apical to the crestal bone in the inter-radicular space midway between the root prominences and were joined by the horizontal cuts apically. Demineralized freeze-dried bone allograft (DFDBA) was placed in the surgical area. The flaps were sutured and pack was placed. Orthodontic retraction was started 2 weeks after the corticotomy procedure. Using this procedure, the treatment objectives were met in just half to one-third of the reported conventional treatment time and the large overjet was reduced to normal. Pre- and posttreatment clinical parameters were recorded, statistically analyzed, and corroborated with similar orthodontic treatment procedures without the use of the corticotomy technique. The present periodontal (PDL) intervention results in quick and stable results for the correction of bimaxillary protrusion cases. It enhances the esthetics and posttreatment orthodontic stability. How to cite this article Panwar M, Dubey D, Kosala M. Innovative Periodontal Surgery by Monocortical Corticotomy in Management of Bimaxillary Protrusion Cases: A Clinical Study. Int J Experiment Dent Sci 2017;6(2):55-60.

Dentascan an excellent tool for assessment of variations in the management of periodontal defects.

Background:The purpose of the present study was to envisage the effectiveness of demineralized freeze-dried bone allograft (DFDBA) and bovine bone graft (BBG) for promoting defect fill in periodontal intrabony defects using dentascan.Materials and Methods:A total of 13 subjects (15 intrabony defects) aged between 24 and 56 years affected by moderate to severe periodontitis were randomly divided into Control (CG) and Test groups (TG1 and TG2). In CG only debridement, TG1 debridement plus DFDBA, and TG2 debridement plus BBG were performed. The clinical parameters probing pocket depth (PPD), clinical attachment level (CAL) was used. The radiological analysis was done by dentascan, which is a single-slice spiral computed tomographic scanner. Six months after, regenerative treatment clinical measurements were recorded. The bone fill was assessed using Dentascan as previously mentioned.Results:PPD reduction and CAL gain were significant in all the groups after 6 months whereas, on intergroup comparisons, insignificant finding was observed both at baseline and after 6 months. Coronoapical bone status decreased significantly in all groups, buccolingual measurements decreased significantly in TG1 and TG2, but no such trend was seen in CG. Significant reduction in mesiodistal bone status was noticed only in TG1 whereas insignificant on intergroup comparisons.Conclusion:Dentascan-based analysis attested that DFDBA was superior to BBG.

Contemporary guided bone regeneration therapy for unaesthetic anterior peri-implantitis case

Background: Dental implant is one of an alternative solutions reconstruction therapy for missing teeth. Complication of dental implant could occurs and leading to implant failure. In order to restore the complication, surgical treatment with guided bone regeneration (GBR) is indicated. The potential use of bone substitutes is widely known to be able to regenerate the bone surrounding the implant and maintain bone volume. Purpose: The study aimed to demonstrate the effectiveness of implant-bone fully coverage by using sandwich technique of biphasic calcium phosphate (BCP) and demineralized freeze-dried bone allografts (DFDBA) bone substitutes combined with collagen resorbable membrane. Case: A 24-year-old male came with diagnosis of peri-implantitis on implant #11. Clinical finding indicated that implant thread was exposed on the labial aspect. Case management: After initial therapy including oral hygiene improvement performed, an operator did a contemporary GBR to correct the defect. Bone graft materials used were 40% β-tri calcium phosphate (β-TCP)-60% hydroxyapatite (HA) on the outer layer and DFDBA on the inner layer of the defect. Resorbable collagen membrane was used to cover the graft. Conclusion: GBR with sandwich technique could serve as one of the treatment choices for correcting an exposed anterior implant that would enhance the successful aesthetic outcome.

Demineralized Freeze Dried Bone Allograft With Amniotic Membrane in the Treatment of Periodontal Intrabony Defects - 12 Month Randomized Controlled Clinical Trial.

The goal of randomized controlled clinical study was to compare the clinical and radiological outcomes of the combination of Open flap debridement, Amniotic membrane and Demineralized Freeze Dried bone Allograft with Open flap debridement and Demineralized Freeze Dried bone Allograft alone in the management of periodontal intrabony defects. 10 patients with bilaterally similar intrabony defects were selected. Each of the intrabony defects were randomly allocated for control and test groups. Control group (n= 10) received open flap debridement (OFD) and Demineralized Freeze Dried bone Allograft (DFDBA) while the test group (n=10) received OFD, DFDBA and Amniotic membrane. Pocket Probing Depth reduction (PPD), Clinical Attachment Level (CAL) gain and radiographic bone gain were assessed. Both the groups demonstrated statistically significant PPD reduction, CAL gain and radiographic bone gain. The Intrabony defect (IBD) reduction of 1.78 ± 0.04 mm in radiovisiography (RVG) and 2.02 ± 0.83 mm in cone beam computed tomography (CBCT) with defect resolution of 58.28 % (RVG) and 58.24 % (CBCT) was noted in test group when compared to control group. All the parameters measured showed similar improvement such as PPD reduction, CAL gain, IBD reduction and defect resolution with OFD + DFDBA + AM and OFD + DFDBA, no statistical significant difference was observed between the two groups .

Clinical and Radiographic Evaluation of Demineralized Freeze-Dried Bone Allograft Versus Platelet-Rich Fibrin for the Treatment of Periodontal Intrabony Defects in Humans.

A wide variety of materials have been proposed for treatment of periodontal intrabony defects (IBDs); recently, platelet-rich fibrin (PRF) has been suggested as a grafting material. The aim of this study is to report changes in clinical attachment level (CAL) and bone fill of periodontal IBDs treated with demineralized freeze-dried bone allograft (DFDBA) compared with PRF in humans. Thirty-six patients completed the study protocol. Each patient contributed a single IBD, which was randomized to receive either DFDBA or PRF. Clinical and standardized radiographic data were collected at baseline and 6 months after treatment. Primary outcome measures included: 1) radiographic bone fill as measured from the cemento-enamel junction to base of bony defect and 2) change in CAL. Both treatment groups had significant gains in CAL as well as bone fill, with no significant differences in outcomes between groups. DFDBA had a mean CAL gain of 1.16 ± 1.33 mm, mean clinical bone fill of 1.53 ± 1.64 mm, and mean radiographic bone fill of 1.14 ± 0.88 mm. PRF had a mean CAL gain of 1.03 ± 0.86 mm, mean clinical bone fill of 1.35 ± 1.60 mm, and mean radiographic bone fill of 1.10 ± 1.01 mm. Treatment of IBDs with either DFDBA or PRF resulted in a significant gain in CAL as well as bone fill after 6 months of healing, with no significant difference between materials.

Recombinant human bone morphogenetic protein (rhBMP)9 induces osteoblast differentiation when combined with demineralized freeze-dried bone allografts (DFDBAs) or biphasic calcium phosphate (BCP).

Recently, recombinant human bone morphogenetic protein 9 (rhBMP9) has been characterized as one of the most osteogenic growth factors among the 15 human BMPs. The aim of the present study was to investigate the effects of rhBMP9 in comparison to the clinically utilized rhBMP2 on in vitro cell behavior when combined with two bone graft materials including demineralized freeze-dried bone allografts (DFDBAs) and biphasic calcium phosphate (BCP). The absorption and release kinetics of rhBMPs from DFDBA and BCP were investigated by ELISA. Moreover, murine bone stromal ST2 cell behavior was investigated on DFDBA or BCP seeded on (1) graft only, (2) rhBMP2 (10ng/ml), (3) rhBMP2 (100ng/ml), (4) rhBMP9 (10ng/ml), and (5) rhBMP9 (100ng/ml). The effects of rhBMPs on DFDBA and BCP were assessed for cell adhesion, proliferation, and osteoblast differentiation by alkaline phosphatase (ALP) activity, alizarin red staining, and real-time PCR for genes encoding Runx2, ALP, and bone sialoprotein (BSP). While both BMPs were gradually released from DFDBA and BCP over time, significantly higher adsorption was observed on BCP when compared to DFDBA. Cell attachment and proliferation was higher on BCP with little influence of either rhBMP2/9. Despite rhBMPs having relatively no effect on cell attachment/proliferation, a pronounced and marked effect was observed on osteoblast differentiation for both rhBMP2/9. Interestingly, it was observed that rhBMP9 induced significantly higher ALP activity, alizarin red staining, and messenger RNA (mRNA) levels of ALP and BSP when compared to rhBMP2. Our results also revealed higher differentiation for rhBMP2/9 with BCP when compared to DFDBA most likely as a result of higher growth factor adsorption. While both rhBMP2/9 combined with DFDBA or BCP induced osteoblast differentiation, rhBMP9 induced greater osteoblast differentiation when compared to rhBMP2. rhBMP9 may be a recombinant growth factor with higher potential to induce new bone formation when compared to rhBMP2. Further in vivo studies are necessary to characterize its regenerative potential in various animal models.

Biologics and Cell Therapy Tissue Engineering Approaches for the Management of the Edentulous Maxilla: A Systematic Review.

The aim of this systematic review was to evaluate current and emerging regenerative approaches for implant site development in the edentulous atrophic maxilla using tissue engineering and regenerative medicine (TERM) principles and to identify priorities for future research. Two independent examiners conducted a comprehensive search using specific keywords to identify original clinical studies using TERM for implant site development in the edentulous atrophic maxilla including indications for alveolar ridge preservation, horizontal alveolar augmentation, maxillary sinus augmentation, and augmentation of severe vertical or combined defects. Endpoints included clinical, radiographic, histologic, and patient-centered outcomes. The initial search identified 3,061 articles. The final selection included 89 articles, of which 12 evaluated alveolar ridge preservation, 6 horizontal defects, 61 maxillary sinus augmentation, and 11 management of severe vertical or combined defects. A summary of the main findings relative to the effect of TERM-based approaches applied for implant site development in the atrophic maxillary segments is presented. Marked heterogeneity among included studies prevented meaningful quantitative analysis. The following relevant effects of TERM-based therapies for site development in the edentulous atrophic maxilla were observed: (1) recombinant human bone morphogenetic protein-2 in an absorbable collagen sponge carrier increased bone augmentation; (2) recombinant human platelet-derived growth factor BB in combination with freeze-dried bone allograft or beta tricalcium phosphate accelerated bone formation through accelerated remodeling of carrier biomaterials; (3) autologous cell therapy enhanced clinical and radiographic outcomes; (4) autologous cell therapy in alveolar ridge preservation provided superior histomorphometric outcomes (vital bone formation) at 6 weeks; and (5) platelet-rich plasma formulations combined with autologous bone grafts for maxillary sinus augmentation increased radiographic density and accelerated bone mineralization at 6 months. Clinical success has been demonstrated with the application of different TERM modalities for implant site development in the edentulous atrophic maxilla. However, indications are narrow and further study is needed. Clinical trials assessing meaningful outcomes, involving larger populations, and with longer follow-up are warranted to discern the effectiveness of the achieved results compared with a valid control.

Effect of Healing Time on New Bone Formation After Tooth Extraction and Ridge Preservation With Demineralized Freeze‐Dried Bone Allograft: A Randomized Controlled Clinical Trial

Clinicians and patients continually search for procedures to decrease time from tooth extraction to restoration. Evidence to date is limited concerning timing of ridge preservation healing and reentry for implant placement. The first objective of this study is to histologically evaluate new bone formation 8 to 10 weeks versus 18 to 20 weeks after extraction of non-molar teeth and ridge preservation using demineralized freeze-dried bone allograft (DFDBA). The second objective is to compare dimensional changes including ridge width and height at the two healing time points. Forty-four patients had tooth extraction and ridge preservation with DFDBA that was obtained from a single donor. Clinical measurements were made to evaluate ridge height and width. Patients were randomly allocated to short-term (8 to 10 weeks) and long-term (18 to 20 weeks) healing groups. Sites were reentered at the appropriate healing time, core biopsy was obtained, and a dental implant was placed. The same ridge dimensions were measured at time of implant placement. Histomorphometric analysis was performed to determine percentage of new vital bone formation, residual graft, and connective tissue (CT)/other. A significantly higher percentage (47.41%) of new vital bone formation was found in the long-term healing group compared with the short-term healing group (32.63%) (P = 0.01). There was no significant difference in percentage of residual graft, percentage of CT/other, or ridge dimensional changes. This study indicates significantly greater new vital bone formation occurs after tooth extraction and ridge preservation with DFDBA when sites healed for 18 to 20 weeks compared with 8 to 10 weeks prior to dental implant placement.

Response of Dental Pulp Stem Cells to Synthetic, Allograft, and Xenograft Bone Scaffolds.

Different degrees of clinical success have been reported for synthetic, allograft, and xenograft bone substitutes in human trials. Although these substitutes have been clinically investigated, their in vitro effects on cell differentiation remain unclear. Proliferation, differentiation, and attachment of dental pulp stem cells (DPSCs) to β-tricalcium phosphate (β-TCP), freeze-dried bone allograft (FDBA), and deproteinized bovine bone mineral (DBBM) were compared in this study. MTT assay, measurement of total DNA, and reverse transcriptase polymerase chain reaction were performed. β-TCP had the highest potential for DPSC attachment and proliferation, while FDBA induced osteoblastic differentiation of DPSCs. Further in vivo investigations are necessary to select a clinically appropriate scaffold.

Histomorphometric Evaluation of Bone Formation in Peri-Implant Defects Treated With Different Regeneration Techniques: An Experimental Study in a Rabbit Model

The aim of this study was to investigate the healing of artificially created peri-implant circumferential bone defects using three bone-regeneration techniques. Rabbit tibias (24 rabbits), in which bone defects (9-mm diameter, 4-mm depth) were created and implant beds (3-mm diameter, 6-mm depth) were prepared in the middle of the created defects, were used as the experimental model. Dental implants (3.0 × 10mm) were inserted, and the peri-implant bone defects were grafted with demineralized freeze-dried bone allograft (DFDBA) plus saline solution, DFDBA plus platelet-rich fibrin (PRF), or DFDBA plus rifamycin. After 4weeks, the animals were euthanized and the implants with surrounding bone were removed. Undecalcified histomorphometric examinations with toluidine blue staining were performed, and the bone-to-implant contact (BIC) and percentage of new bone formation were evaluated. The BIC was 50.94% ± 24.39% in the DFDBA-plus-saline solution group, 60.07% ± 4.91% in the DFDBA-plus-rifamycin group, and 73.43% ± 3.86% in the DFDBA-plus-PRF group. The percentage of new bone formation at the defect area was 37.61% ± 1.70% in the DFDBA-plus-saline solution group, 48.51% ± 2.80% in the DFDBA-plus-rifamycin group, and 63.09% ± 2.10% in the DFDBA-plus-PRF group. In terms of new bone formation and BIC, the DFDBA-plus-PRF and DFDBA-plus-rifamycin groups were significantly different from the DFDBA-plus-saline solution group. The difference between the DFDBA-plus-PRF and DFDBA-plus-rifamycin groups was also statistically significant. The addition of PRF or rifamycin to DFDBA had a significant positive effect on bone healing in peri-implant bone defects. The DFDBA-plus-PRF group showed the highest percentages of new bone formation and BIC.

Management of a Previously Treated, Calcified, and Dilacerated Maxillary Lateral Incisor: A Combined Nonsurgical/Surgical Approach Assisted by Cone-beam Computed Tomography

Teeth with calcified canals, dilacerated roots, and associated large periradicular lesions involving both cortical plates pose a challenge to dentists. In addition to the nonsurgical endodontic treatment, such teeth may require surgical intervention with concomitant use of bone grafting materials and barrier techniques. These techniques, when combined with the use of a host modulating agent such as platelet-rich fibrin (PRF), may improve the chances of success. A 26-year-old woman was referred for dental treatment with a recurrence of an intraoral sinus tract 2 months after periradicular surgery in the upper anterior region. Clinical and radiographic examinations revealed a calcified and perforated maxillary left lateral incisor with a severely dilacerated root as well as an associated large radiolucent lesion surrounding the roots of the maxillary left central and lateral incisors. A cone-beam computed tomographic scan of the anterior maxilla showed erosion of the labial and palatal cortical plates in the same region. A calcified canal in the lateral incisor was negotiated up to the straight line portion of the canal. Periradicular surgery with root-end resection was performed, and root-end filling was performed with mineral trioxide aggregate. The perforation present on the middle third of the labial surface of the root was repaired with mineral trioxide aggregate, and the canal was cleaned, shaped, and obturated. A PRF scaffold was prepared and used with a collagen membrane and a freeze-dried bone allograft. Follow-up visits after 3 months, 6 months, and 1 year revealed satisfactory clinical and radiographic healing. The combined use of nonsurgical and surgical modes of treatment cannot be overemphasized in this case. The use of PRF along with a bone graft and a barrier membrane may have enhanced the speed of healing and the resolution of periradicular radiolucency by enhancing bone regeneration.

Prospective Clinical and Radiographic Study of Alveolar Ridge Preservation Combining Freeze-Dried Bone Allograft With Two Xenogeneic Collagen Matrices.

Tooth extractions are followed by significant dimensional changes in the alveolar crest that may preclude implant placement. This randomized, controlled, prospective compares the preservation of soft and hard tissue dimensional changes after alveolar ridge preservation (ARP) using two membranes consisting of collagen matrix (CM) or extracellular matrix (ECM) as barriers over freeze-dried bone allograft (FDBA). Standardized clinical and radiographic measurements of soft and hard tissues were recorded by means of a stent before and 4 months after ARP. The surgery entailed sulcular incisions with minimal flap elevation and repositioning without advancement. Of 11 patients in the CM group and 12 in the ECM group who completed the study, gingival thickness (GT) increased from 0.1 to 0.2 mm for both groups along with a 0.5-mm decrease in the width of keratinized tissue after healing. Reductions in ridge width were most pronounced on the coronal aspect, 1.8 mm for CM and 2.0 mm for ECM, whereas vertical reduction was most pronounced on the buccal aspect, 0.7 to 1.0 mm. Differences between groups were not statistically significant. However, significant correlation for changes in GT (P = 0.001) and crestal bone width (P = 0.002) with preoperative buccal plate thickness (BPT) was observed. Both xenogeneic collagen matrices combined with FDBA were effective in maintaining soft tissues and minimizing ridge resorption in all dimensions after ARP. BPT was an important determinant for amount of change in crestal GT and ridge width.

Efetividade da utilização de enxertos ósseos desmineralizados liofilizados no tratamento de defeitos intraósseos – uma revisão sistemática

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.

Treatment of large bone defects with a novel biological transport disc in non-vascular transport distraction osteogenesis

The aim of this study was to investigate a potential novel biological transport disc that avoids secondary injury to the body and facilitates bone healing. Twenty-seven dogs were divided randomly into three groups: group A were treated with human bone morphogenetic protein 2 (BMP-2) modified bone mesenchymal stem cell (BMSC) sheets combined with freeze-dried bone allograft as biological transport disc; group B were treated with BMSC sheets combined with freeze-dried bone allograft as transport disc (control); and group C were treated with direct extension only (blank). There were nine dogs in each group. Non-vascular transport distraction osteogenesis was performed in groups A and B to repair the mandibular bone defects, and in group C only mandibular truncation surgery was performed. The regeneration of bone was evaluated through X-ray, haematoxylin and eosin assay, and immunohistochemistry. After 2, 4, and 8 weeks of distraction, new bone density values in group A were 49.00±1.16, 66.63±2.62, and 72.78±2.67, respectively, and these were significantly different to values in groups B (P=0.0005, P=0.0004, P=0.0012) and C (P<0.0005, P=0.0001, P=0.0003). The average grey value for BMP-2 expression in group A after 4 weeks of distraction was 195.63±4.45, which was significantly different when compared to groups B (P=0.0022) and C (P=0.0006). This novel biological transport disc represents an effective non-secondary injury method to enhance new bone formation in non-vascular transport distraction osteogenesis.

Socket preservation using freeze-dried bone allograft with and without plasma rich in growth factors in dogs.

Plasma rich in growth factors (PRGF) and freeze-dried bone allograft (FDBA) are shown to promote bone healing. This study was aimed to histologically and histomorphometrically investigate the effect of combined use of PRGF and FDBA on bone formation, and compare it to FDBA alone and control group. The distal roots of the lower premolars were extracted bilaterally in four female dogs. Sockets were randomly divided into FDBA + PRGF, FDBA, and control groups. Two dogs were sacrificed after 2 weeks and two dogs were sacrificed after 4 weeks. Sockets were assessed histologically and histomorphometrically. Data were analyzed by Kruskal-Wallis test followed by Mann-Whitney U-tests utilizing the SPSS software version 20. P < 0.05 was considered statistically significant. While the difference in density of fibrous tissue in three groups was not statistically significant (P = 0.343), the bone density in grafted groups was significantly higher than the control group (P = 0.021). The least decrease in all socket dimensions was observed in the FDBA group. However, these differences were only significant in coronal portion at week 4. Regarding socket dimensions and bone density, the difference between FDBA and FDBA+PRGF groups was not significant in middle and apical portions. The superiority of PRGF+FDBA overFDBA in socket preservation cannot be concluded from this experiment.

Evaluation of platelet-rich plasma alone or in combination with demineralized freeze dried bone allograft in treatment of periodontal infrabony defects: A comparative clinical trial.

Aims:The use of platelet-rich plasma (PRP) alone in periodontal defects has been controversial and inconclusive. Hence, the present study was designed with the aim to assess the clinical and radiographic effectiveness of PRP alone in infrabony defects.Materials and Methods:Thirty infrabony defects were treated with either autologous PRP with open flap debridement (OFD) or autologous PRP + demineralized freeze dried bone graft (DFDBA) with OFD or OFD alone. Clinical parameters recorded were gingival index, plaque index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). Radiographic parameters included defect depth reduction, defect resolution, and crestal bone level. All the parameters were recorded at baseline and 12 months postoperatively.Results:Mean PD reduction and CAL gain were greater in PRP + DFDBA (4.88 ± 1.12 mm and 4.26 ± 1.85 mm) and PRP (4.86 ± 2.12 mm and 4.10 ± 1.47 mm) groups than the control group (2.69 ± 1.37 mm and 1.27 ± 0.89 mm).Conclusions:Within the limits of the study, all the three groups showed significant improvement in clinical parameters from baseline to postoperative 12 months. The amount of defect depth reduction and defect resolution treated with PRP alone group were significantly < PRP + DFDBA. The results pertaining to these parameters were significantly better than the control group.