Healing Of Intrabony Defects Research Articles

Healing of intrabony defects using a novel human recombinant amelogenin: a preclinical study.

To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing/regeneration in intrabony defects. Intrabony defects were surgically created in the mandible of 3 minipigs. Twelve defects were randomly treated with either rAmelX and carrier (test group) or with the carrier only (control group). At 3 months following reconstructive surgery, the animals were euthanized, and the tissues histologically processed. Thereafter, descriptive histology, histometry, and statistical analyses were performed. Postoperative clinical healing was uneventful. At the defect level, no adverse reactions (e.g., suppuration, abscess formation, unusual inflammatory reaction) were observed with a good biocompatibility of the tested products. The test group yielded higher values for new cementum formation (4.81 ± 1.17 mm) compared to the control group (4.39 ± 1.71 mm) without reaching statistical significance (p=0.937). Moreover, regrowth of new bone was greater in the test compared to the control group (3.51 mm and 2.97 mm, respectively, p=0.309). The present results provided for the first-time histologic evidence for periodontal regeneration following the use of rAmelX in intrabony defects, thus pointing to the potential of this novel recombinant amelogenin as a possible alternative to regenerative materials from animal origins.

Intrabony defect management with a bone graft (hydroxyapatite and β-tricalcium phosphate) alone and in combination with a diode laser: A randomized control trial.

The current research was conducted to evaluate the use of a diode laser and a bone graft (hydroxyapatite [HA] + β-tricalcium phosphate [β-TCP]) in healing of intrabony defects. In this split-mouth evaluation, 40 patients with bilateral intrabony defects were treated with, Group I (control) - bone graft alone (HA + β-TCP) and Group II, (test) - bone graft with a diode laser. The clinical and radiologic parameters of all patients, such as plaque index (PI), probing depth (PD), gingival index (GI), gingival recession (GR), and relative clinical attachment level (RCAL) were recorded at baseline, after 3 months and after 6 months. Reductions in PI, PD, GI, GR, and RCAL were found after 6 months. Furthermore, significant differences were displayed in the intra-group comparison while those of the inter-group evaluation (P > 0.05) were insignificant. In both groups, considerable decrease in intrabony pockets was discovered; however, the inter-group comparison was insignificant in relation to GR and RCAL.

The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial

ObjectivesMinimally invasive flap designs have been introduced to enhance blood clot stability and support wound healing. Limited data appear to suggest, that in intrabony defects, better clinical outcomes can be achieved by means of minimally invasive flap compared to more extended flaps. The aim of this study was to evaluate the healing of intrabony defects treated with either minimally invasive surgical flaps or with modified or simplified papilla preservation techniques in conjunction with the application of an enamel matrix derivative (EMD).Materials and methodsForty-seven subjects were randomly assigned to either test (N = 23) or control (N = 24) procedures. In the test group, the intrabony defects were accessed by means of either minimally invasive surgical technique (MIST) or modified minimally invasive surgical technique (M-MIST) according to the defect localization while the defects in the control group were treated with either the modified or simplified papilla preservation (MPP) or the simplified papilla preservation technique (SPP). EMD was used as regenerative material in all defects. The following clinical parameters were recorded at baseline and after 12 months: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depths (PD), clinical attachment level (CAL), and gingival recession (GR). Early healing index (EHI) score was assessed in both groups 1 week following the surgery. CAL gain was set as primary outcome.ResultsAfter 12 months follow-up, the CAL gain was 4.09 ± 1.68 mm in test group and 3.79 ± 1.67 mm in control group, while the PD reduction was 4.52 ± 1.34 mm and 4.04 ± 1.62 mm for test and control sites. In both groups, a minimal GR increase (0.35 ± 1.11 mm and 0.25 ± 1.03 mm) was noted. No residual PDs ≥ 6 mm were recorded in both groups. CAL gains of 4–5 mm were achieved in 30.4% and in 29.2% of test and control group, respectively. Moreover, CAL gains ≥ 6 mm were recorded in 21.7% of experimental sites and in 20.8% of control sites. No statistically significant differences in any of the evaluated parameters were found between the test and control procedures (P > 0.05). After 1 week post-surgery, a statistically significant difference (P < 0.05) between the groups was found in terms of EHI score.ConclusionsWithin the limits of this pilot RCT, the results have failed to show any differences in the measured parameters following treatment of intrabony defects with EMD, irrespective of the employed surgical technique.Clinical relevanceIn intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements.

Healing of intrabony defects following regenerative surgery by means of single-flap approach in conjunction with either hyaluronic acid or an enamel matrix derivative: a 24-month randomized controlled clinical trial

ObjectivesThe aim of this randomized controlled clinical trial was to compare the clinical outcomes obtained in intrabony defects following regenerative periodontal surgery using the single-flap approach (SFA) in conjunction with either hyaluronic acid (HA) or enamel matrix derivative (EMD).Materials and methodsThirty-two intrabony defects in 32 healthy subjects were randomly assigned: HA (test group) or EMD (control group). Clinical attachment level (CAL), probing depth (PD), gingival recession (REC), and bleeding on probing (BOP) were recorded at baseline,12, 18, and 24 months after surgery.ResultsAt 24 months, both treatments resulted in statistically significant clinical improvements evidenced by PD-reduction and CAL-gain (p<0.001). The mean CAL-gain was 2.19±1.11 mm in the test and 2.94±1.12 mm in the control sites (p=0.067). PD-reduction was statistically significantly higher for the control group (4.5±0.97 mm) than the test group (3.31±0.70 mm), (p=0.001). CAL-gain ≤ 3 mm was observed in 87.5% and in 62.5% of the test and control sites, respectively. Test sites showed slightly lower REC values than the control sites. No statistically significant differences were found for BOP between treatments.ConclusionsThe present findings indicate that both treatments led to statistically significant clinical improvements compared to baseline, although the application of EMD resulted in statistically significantly higher PD-reduction compared to the use of HA.Clinical relevanceThe use of HA in conjunction with a SFA resulted in significant PD-reduction and CAL-gain, pointing to the potential clinical relevance of this material in regenerative periodontal surgery.

Effect of combining platelet-rich fibrin with synthetic bone graft on the healing of intrabony defects after apicectomy in dogs with periapical pathosis

Introduction: An apicectomy is traditionally a surgical endodontic procedure that deals with the local excision of the root tip and periapical pathosis of failed conventional root canal treatment. The proper healing of the intrabony defects plays a crucial role in the success of endodontic surgery. This study evaluates the role of platelet rich fibrin (PRF) in conjunction with synthetic bone graft on the healing of intrabony defects after apicectomy in dogs with induced periapical lesion. Materials and Methods: Induced periapical pathosis and root canal obturation were carried out in 36 mandibular premolar dogs, teeth, then treated with either apicectomy (Group I) or apicectomy followed by application of PRF and synthetic bone graft (Group II). The periapical healing of both groups was evaluated by radiography and histopathology after 1 month (subgroup A) and 3 months (subgroup B). The periapical bone density, percentage of difference in radiodensity, inflammatory cell count, and percentage of new bone formation were measured. The quantitative data of both groups were statistically analyzed. The P Results: There were significant differences between both groups in periapical radiodensity, percentage of difference in radiodensity, mean inflammatory cell count, and percentage of new bone formation in both subgroups (P Conclusions: Using of PRF in conjuction with the synthetic bone graft enhances the healing of periapical intrabony defects after apicectomy in dogs' teeth.

The Usage of Low Level Laser Therapy Bio Stimulation and Bone Grafting in Accelerating the Healing of chronic intra-Osseous Defects: Vivo Study

The application of LLLT has become popular in the promotion of wound healing and reduction of pain following nonsurgical and surgical procedures. The aim of this article was to evaluate the efficiency of an SBX putty nano-bone graft with and without applying LLLT in accelerating the bone formation of the intra-bony defects through apical curettage without apicoectomy. In this study a total of 30 upper anterior maxillary teeth with periapical lesions. Patients were divided into two equal groups: Group I: apical curettage without apicoectomy and applying SBX putty nano-bone graft inside the intra-bony defects (n=15). Group II: apical curettage without apicoectomy, applying SBX putty nano-bone graft inside the intra-bony defects and then treating the defect with LLLT (n=15). CBCT was taken to determine the approximate size of periapical radiolucencies, All patients were followed up using CBCT for 1 year for evaluation of the size of the radiolucent area and bone density. Results showed that the differences in bone density measured on the panoramic as well as the cross-sectional views at all time intervals were non-significant (p<0.05) Conclusion: The Use of both SBX nano-bone graft and LLLT is considered an optimum choice for accelerating the healing of intra-bony defects.

PC207: Healing of intrabony defects following treatment with PRG or EMD (seven years follow‐up): a retrospective case series

PC207: Healing of intrabony defects following treatment with PRG or EMD (seven years follow‐up): a retrospective case series

O063: The effect of guided tissue regeneration and early orthodontic treatment on the healing of intrabony defects. /Preliminary results of an ongoing prospective randomized‐controlled trial/

O063: The effect of guided tissue regeneration and early orthodontic treatment on the healing of intrabony defects. /Preliminary results of an ongoing prospective randomized‐controlled trial/

Effect of Platelet Rich Fibrin on the Healing of Intra-bony Defects: A Clinical Study

Objectives: The aim of the present study was to evaluate the effect of platelet rich fibrin (PRF) on the healing of intra-bony defects. This evaluation was accomplished Clinically and radiograp- hically on patients.Subjects and Methods: A total of twenty one intra-bony defects in 14 patients were randomly divided into three groups; group A, treated with minced PRF placed insidethe defects and covered with a PRF membrane, group B, treated with minced PRF placed in the defects and covered with a collagen membrane and group C, treated with xenograft placed in the defects and covered with a collagen membrane (control group). Clinical parameters including probing pocket depth (PPD), clinical attachment level (CAL) and radiographic parameters including linear radiographic measurements were measured at day of surgery (baseline) then 6 months post-operatively in all groups.Results: Clinical and radiographic results showed statistically significant differencesbetween baseline and post operatively in all the groups. However inter-group comparisons showed no statistically significant differences after 6 months.Conclusion: The use of PRF as a regenerative material in managing periodontal intrabonydefects resulted in pocket depth reduction, clinical attachment gain and defect fill with comparable results to bone graft and collagen membrane.

Healing of two-wall intra-bony defects treated with a novel EMD-liquid-A pre-clinical study in monkeys.

To investigate the effect of a novel enamel matrix derivative formulation (EMD-liquid or Osteogain) combined with an absorbable collagen sponge (ACS) on periodontal wound healing in intra-bony defects in monkeys. Chronic two-wall intra-bony defects were created at the distal aspect of eight teeth in three monkeys (Macaca fascicularis). The 24 defects were randomly assigned to one of the following treatments: (i) open flap debridement (OFD)+ACS alone, (ii) OFD+Emdogain+ACS (Emdogain/ACS), (iii) OFD+Osteogain +ACS (Osteogain/ACS) or (iv) OFD alone. At 4months, the animals were euthanized for histologic evaluation. Osteogain/ACS resulted in more consistent formation of cementum, periodontal ligament and bone with limited epithelial proliferation compared to OFD alone, Emdogain/ACS and OFD+ACS. Among the four treatment groups, the Osteogain/ACS group demonstrated the highest amount of regenerated tissues. However, complete periodontal regeneration was not observed in any of the defects in the four groups. The present findings indicate that in two-wall intra-bony defects, reconstructive surgery with Osteogain/ACS appears to be a promising novel approach for facilitating periodontal wound healing/regeneration, thus warranting further clinical testing.

Effects of Enamel Matrix Derivative and Basic Fibroblast Growth Factor with β–Tricalcium Phosphate on Periodontal Regeneration in One-Wall Intrabony Defects: An Experimental Study in Dogs

This study evaluated the effects of enamel matrix derivative (EMD) and basic fibroblast growth factor (bFGF) with μ-tricalcium phosphate (μ-TCP) on periodontal healing in intrabony defects in dogs. One-wall intrabony defects created in dogs were treated with μ-TCP alone (μ-TCP), EMD with μ-TCP (EMD/μ-TCP), bFGF with μ-TCP (bFGF/μ-TCP), and a combination of each (EMD/bFGF/μ-TCP). The amount of new bone formation was not significant for any group. The EMD/bFGF/μ-TCP group induced significantly greater new cementum formation than the μ-TCP and bFGF/μ-TCP groups and, although not significantly, formed more new cementum than the EMD/μ-TCP group. These findings indicate that EMD/bFGF/μ-TCP treatment is effective for cementum regeneration.

Evaluation of the polylactide-polyglycolide copolymer Fisiograft® in the treatment of intrabony defects: Clinical and radiographic results of a pilot study

Aim: To evaluate the efficacy of the polylactide-polyglycolide copolymer Fisiograft® as a bone graft material in the treatment of interproximal intrabony defects clinically and radiographically. Methods: A total of 22 intrabony defects in 8 patients with chronic periodontitis (4 males and 4 females) aged 20 to 55 years were recruited and divided equally into two groups: control (open flap debridement alone) and experimental (open flap debridement with Fisiograft®). Recordings of probing pocket depth (PPD), clinical attachment level (CAL), gingival margin position (GMP) and radiovisiographic assessment was done at baseline and 6 months. Results: Statistical analysis was done by Wilcoxon Signed Rank test for intra-group comparisons and Mann-Whitney U-test for inter-group comparisons. The clinical parameters PPD, CAL and GMP were found to be statistically significant (p<0.05) within each group. Inter-group comparison showed only the CAL gain to be statistically significant (p<0.01). In relation to hard tissue changes, statistically significant (p=0.05) result was seen for the percent filling of the original defect, comparing the experimental and control groups 6 months postoperatively. Conclusions: Placement of Fisiograft® resulted in better healing of intrabony defects as assessed clinically and radiographically when compared to open flap debridement alone.

Effect of plasma rich in growth factors on the healing of intrabony defects in human: a comparative clinical trial

Background and aims. A combination of guided tissue regeneration (GTR), bovine porous bone mineral (BPBM), and platelet rich plasma has been already applied for the regeneration of intrabony defects. The aim of this study was to determine the role of plasma rich in growth factor (PRGF) alone in the periodontal regeneration of intrabony defects in humans as compared with BPBM/GTR Technique. Materials and methods. In this split-mouth clinical trial, nine advanced periodontal patients with 20 intrabony defects were randomly treated with a combination of either BPBM/GTR (control) or PRGF (test). Periodontal parameters including gingival recession, probing depth (PD), gingival index (GI), plaque index (PI), and relative clinical attachment level (CAL) were evaluated at baseline and 6 months post-operatively. Results. No difference was observed at baseline between the two groups. At 6-month post-treatment, both techniques demonstrated significant reduction in CAL, PD and GI. The mean pocket depth reduction in control group was 4.1 ± 1.52 mm and 4.5 ± 1.5 mm on buccal and lingual sites, respectively (P < 0.0001); and 3.6 ± 0.9 mm in the test group. The changes in CAL in the deepest part of the defect were 3.06 ± 1.79 mm and 2.33 ± 0.78 mm for test and control groups, respectively. No statistically significant difference was detected between the two groups after 6 months. Conclusion. According to the results, the use of PRGF alone, similar to BPBM/GTR improves clinical parameters and plays a significant role in PD reduction and CAL gain.

Effect of combined therapeutical methods on healing of intrabony defects in regenerative periodontal surgery

Effect of combined therapeutical methods on healing of intrabony defects in regenerative periodontal surgery

Effect of combined therapeutical methods on healing of intrabony defects in regenerative periodontal surgery

Several methods are available to enhance the healing and regeneration of periodontal tissues after surgical therapy of intrabony defects. The main indications for the use of combined regenerative procedures are the extent and morphology of the osseous lesions. The six studies of the present dissertation focused on the clinical effect of different barrier techniques, bone substitutes, enamel matrix derivatives and a growth factors containing adjuvant used in various combinations on the healing of severe periodontal intrabony impairments. Synthetic, xenogenetic and autologous materials were used in these randomized clinical studies. Mechanical barriers (polytetrafluoroethylene and collagen membranes) for GTR, biological barriers/enamel matrix proteins (EMD), synthetic (β-TCP) and xenogeneic (NBM) bone grafts and autologous platelet-rich plasma (PRP) were combined in the test and control groups of the trials. The main clinical variable was the clinical attachment level (CAL) and the subsidiary one was the probing pocket depth (PPD), estimated at baseline and after one year. The summation of the results after the statistical analysis takes cognizance of the followings: a) Each of the eleven regenerative methods evaluated (ten combined procedures) leads to significant CAL gain and PPD decrease. b) Using β-TCP or NBM with EMD or with PRP + GTR and GTR’s, the difference between the parameters of the test and control groups were not statistically significant. c) It was confirmed in four studies that the addition of PRP to graft materials has not increased significantly the positive outcomes independent of the type of barrier or graft. d) Adding platelet-rich plasma to natural bone mineral, no benefit was observed from the point of view of the clinical variables. e) The polypeptide proteins of the platelet-rich plasma do not enhance the clinical regenerative effect of enamel matrix proteins. In conclusion, the option of the periodontal surgeons between these methods depends mainly on the defect morphology, the patient’s approach to the different types of materials, the medical concept of the physician, the technical possibilities and the clinical experience of the periodontist.

Healing of intrabony defects following treatment with an oily calcium hydroxide suspension (Osteoinductal). A controlled clinical study

The purpose of the present clinical study was to evaluate the healing of deep intrabony defects following the application of an oily calcium hydroxide suspension (OCHS). Thirty patients suffering from chronic periodontitis, each of whom displayed one intrabony defect, were randomly treated with access flap surgery (AFS) and the application of OCHS (test) or with AFS alone (control). The following clinical parameters were recorded at baseline and at 6 months after therapy: plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL). No differences in any of the investigated parameters were observed at baseline between the two groups. At 6 months after therapy, the test group showed a reduction in mean PD from 7.7+/-1.5 to 2.9+/-0.9 mm (P<0.001) and a change in mean CAL from 9.6+/-2.1 to 5.5+/-2.5 mm (P<0.001). In the control group, the mean PD was reduced from 6.9+/-0.9 to 3.7+/-0.9 mm (P<0.001) and the mean CAL changed from 8.5+/-2.5 to 6.4+/-2.7 mm (P<0.001). OCHS resulted in statistically significant higher PD reductions (P<0.01) and CAL gains (P<0.05) than AFS alone. Within the limits of the present study, it can be concluded that: (1) at 6 months after surgery both therapies resulted in statistically significant PD reductions and CAL gains and (2) treatment with OCHS resulted in statistically significant higher CAL gains than treatment with AFS alone.