Infrabony Defects Research Articles

Spontaneous bone regeneration after surgical extraction of a horizontally impacted mandibular third molar: a retrospective panoramic radiograph analysis

BackgroundThe mandibular third molar (M3) is typically the last permanent tooth to erupt because of insufficient space and thick soft tissues covering its surface. Problems such as alveolar bone loss, development of a periodontal pocket, exposure of cementum, gingival recession, and dental caries can be found in the adjacent second molars (M2) following M3 extraction. The specific aims of the study were to assess the amount and rate of bone regeneration on the distal surface of M2 and to evaluate the aspects of bone regeneration in terms of varying degree of impaction.MethodsFour series of panoramic radiographic images were obtained from the selected cases, including images from the first visit, immediately after extraction, 6 weeks, and 6 months after extraction. ImageJ software® (NIH, USA) was used to measure linear distance from the region of interest to the distal root of the adjacent M2. Radiographic infrabony defect (RID) values were calculated from the measured radiographic bone height and cementoenamel junction with distortion compensation. Repeated measures of analysis of variance and one-way analysis of variance were conducted to analyze the statistical significant difference between RID and time, and a Spearman correlation test was conducted to assess the relationship between Pederson’s difficulty index (DI) and RID.ResultsA large RID (> 6 mm) can be reduced gradually and consistently over time. More than half of the samples recovered nearly to their normal healthy condition (RID ≤ 3 mm) by the 6-month follow-up. DI affected the first 6 weeks of post-extraction period and only showed a significant positive correlation with respect to the difference between baseline and final RID.ConclusionsAdditional treatments on M2 for a minimum of 6 months after an M3 extraction could be recommended. Although DI may affect bone regeneration during the early healing period, further study is required to elucidate any possible factors associated with the healing process. The DI does not cause any long-term adverse effects on bone regeneration after surgical extraction.

Does a combination of platelet‐rich plasma and decalcified freeze‐dried bone allograft offer advantages over decalcified freeze‐dried bone allograft alone when using pocket depth and clinical attachment level as markers for periodontal healing? A literature review

The aim of the present study was to investigate whether a combination of platelet-rich plasma (PRP) and decalcified freeze-dried bone allograft (DFDBA) offers advantages over DFDBA and saline in infrabony defects. The objectives were to primarily evaluate changes in clinical attachment level (CAL) and secondarily changes in pocket depth (PD). A search was performed of electronic databases (Medline, PubMed, Embase, The Cochrane Central Register of Controlled Trials, and Web of Science), as well as hand searching and reference list searching. Only randomized, controlled trials published up until 30 March 2018 were included that had a follow-up period of at least 6months. Four papers met the eligibility criteria and were critically appraised using the Consolidated Standards of Reporting Trials statement and put through the Cochrane Collaboration's tool for assessing risk of bias. In three of the four studies, clinically and significantly greater CAL gains and PD reductions were observed in patients who received PRP and DFDBA in comparison to those who received DFDBA and saline (P<0.05). Methodological heterogeneity existed among the studies, especially in the preparation of PRP and the type of infrabony defect. This made it difficult to draw clear conclusions, but despite this, the studies could still be regarded, as significant as they showed a low risk of bias.

Comparative evaluation of open flap debridement alone and in combination with anorganic bone matrix/cell-binding peptide in the treatment of human infrabony defects: A randomized clinical trial.

Background:The synthetic anorganic bone matrix/cell-binding peptide (ABM/P-15) has displayed an increased fibroblast migration and attachment with bone graft material, thus enhancing periodontal regeneration. The objective of the present study was to evaluate and to correlate the efficacy of open flap debridement (OFD) with and without ABM/P-15 in the treatment of human infrabony periodontal defects.Materials and Methods:A total of 20 chronic periodontitis patients with equal number infrabony defects were randomly selected and assigned into two groups depending on the treatment received: Control group (treated with OFD) and Test group (treated with OFD + ABM/P-15). Clinical parameters recorded included plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), gingival recession, and radiographic defect depth (RDD) which were evaluated at baseline and 6 months postsurgically.Results:When compared to baseline, both the treatment groups demonstrated improvements in the clinical parameters at 6 months. Test group exhibited a mean PPD reduction of 4.15 ± 1.04 mm, CAL gain of 3.10 ± 1.42 mm, and reduction in RDD of 1.90 ± 0.72 mm postoperatively at 6 months. In contrast to Control group, the Test group showed greater reduction in PPD (P < 0.05) which was statistically significant, greater CAL gain and greater mean RDD reduction (P < 0.001) which was highly significant.Conclusion:In the surgical management of periodontal infrabony defects, Test group elicited in statistically significant PPD reduction, CAL gain, and better infrabony defect fill at 6 months’ postoperatively.

A Clinical and Radiographic Evaluation of the Efficacy of Nanohydroxyapatite (Sybograf™) versus Bioactive Calcium Phosphosilicate Putty (Novabone®) in the Treatment of Human Periodontal Infrabony Defects: A Randomized Clinical Trial.

Aim:The aim of this study is to compare and to evaluate clinically and radiographically the bone regeneration and the amount of bone fill (BL) between nanocrystalline hydroxyapatite (Nc-HA) (Sybograf™) and bioactive synthetic NovaBone Putty in the treatment of intrabony component of periodontal osseous defects.Materials and Methods:Twenty sites in 20 patients, within the age range of 25–55 years, showing intrabony defects were selected and divided into Group I (Nc-HA) and Group II (Bioactive synthetic NovaBone Putty). All the selected sites were assessed with the clinical and radiographic parameters such as plaque index, gingival index, sulcus bleeding index, probing pocket depth, clinical attachment level, gingival recession, and radiographic BL. All the clinical and radiographic parameter values obtained at different intervals (baseline, 3, and 6 and 9 months) were subjected to statistical analysis.Results:A statistically significant reduction in pocket depth of 4.400 ± 0.843 mm (Group I), 3.800 ± 0.789 mm (Group II) and gain in clinical attachment level of 6.2 mm (Group I), 5.9 mm (Group II) were recorded at the end of the study. A slight increase in gingival recession was observed. The mean percentage changes in the amount of radiographic BL of Group II and Group I were significant, However, when compared between the groups, there is no significant difference in BL observed.Conclusion:Both the graft materials appear to have nearly comparable effects, with nanocrystalline hydroxyapatite (Sybograf™), displaying slightly superior effect over bioactive glass especially in relation to clinical parameters. However, long-term, controlled clinical trials are required to confirm these findings.

Comparative study using autologous platelet-rich fibrin and titanium prepared platelet-rich fibrin in the treatment of infrabony defects: An in vitro and in vivo study.

Background:The platelet concentrates had been pioneered to be used in regenerative medicine since above a decade.Aims and Objectives:To compare the autologous platelet rich fibrin (PRF) and titanium prepared platelet rich fibrin (T-PRF) in the treatment of infrabony defects, clinically and radiographically and to compare the histologic difference between PRF and T-PRF by light microscopy and scanning electron microscopy (SEM).Materials and Methods:The present study is a split mouth randomised controlled trial study in which 20 sites were selected and randomly assigned equally into 10 sites each in group A [Test group=T-PRF] and group B [Control group=PRF]. Clinical parameters were evaluated at baseline,3 months and 9 months. Radiographic parameters were evaluated at baseline and 9 months. Histologic differences between light microscopy and SEM for both PRF and T-PRF was studied after sequential processing.Results:There was marked reduction in Probing Pocket depth and gain in Clinical Attachment Level in both the T-PRF and PRF groups from baseline to 9 months in intragroup comparisons. However, on intergroup comparisons, no statistical significance was seen. Radiographically, mean defect depths for both the groups showed statistically significant reduction from baseline values to 9 months on intragroup comparisons but not on intergroup comparisons. In-vitro evaluation, on both light and scanning electron microscopy, T-PRF showed denser fibril meshwork as compared to PRF.Conclusion:The clinical parameters and radiographic outcomes showed marked improvement at 9 months with both PRF and T-PRF in the treatment of infrabony defects from baseline values in intragroup comparison. However, statistically efficacy of T-PRF was not seen to be superior to that of PRF both clinically and radiographically. Histologic evaluation showed T-PRF had denser fibrils as compared to PRF in both light and scanning electron microscopy.

Comparative evaluation of platelet rich fibrin and advanced platelet rich fibrin in management of periodontal infrabony defect: A clinical radiographic study

Comparative evaluation of platelet rich fibrin and advanced platelet rich fibrin in management of periodontal infrabony defect: A clinical radiographic study

Autologous platelet concentrates for treating periodontal infrabony defects.

Autologous platelet concentrates for treating periodontal infrabony defects.

Ultrasonic Surgical Aspirator to Treat Deep Infrabony Defects: A New Flapless Minimally Invasive Approach.

The primary outcome of the present study was to assess the percentage of pocket closure, and the secondary aim was to evaluate the clinical performance in terms of clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction, and gingival recession (REC) after the use of cavitron ultrasonic surgical aspirator (CUSA) in deep infrabony defects. Fourteen deep infrabony defects in 11 patients who were previously treated with active periodontal therapy followed by one year of supportive periodontal therapy (at least three sessions) were additionally treated by the aid of CUSA. Eighty-six percent of the initial defects (12 out of 14) resulted in a PD < 5 mm, showing complete resolution six months after CUSA treatment, without any adverse event and with negligible pain (VAS from 0 to 3). CUSA showed potential as a method to promote pocket healing, reduce PPD, and increase clinical attachment (P < 0.001) in deep infrabony defects. This trial is registered with ClinicalTrials.gov NCT03567161.

Staging and grading of periodontitis: Framework and proposal of a new classification and case definition

Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier. The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.

PR363: Open flap debridement and guided tissue regeneration in infrabony defects: 20 years results

PR363: Open flap debridement and guided tissue regeneration in infrabony defects: 20 years results

Staging and grading of periodontitis: Framework and proposal of a new classification and case definition.

Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance. Evidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis. The manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis-associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A-C). Risk factor analysis is used as grade modifier. The paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.

PC371: Surgical treatment of infrabony bone defect before implant placement: a case report

PC371: Surgical treatment of infrabony bone defect before implant placement: a case report

PD029: Evaluation of efficiency of PRF in the treatment of infrabony defects

PD029: Evaluation of efficiency of PRF in the treatment of infrabony defects

O061: Biphasic calcium sulphate and xenograft combination in a minimally invasive treatment of periodontal infrabony defects – A randomized clinical trial

O061: Biphasic calcium sulphate and xenograft combination in a minimally invasive treatment of periodontal infrabony defects – A randomized clinical trial

PD190: Combination of MIST approach and L‐PRF with and without bone grafts substitutes in the treatment of infrabony defects

PD190: Combination of MIST approach and L‐PRF with and without bone grafts substitutes in the treatment of infrabony defects

Effectiveness of Platelet Rich Plasma and Bone Graft in the Treatment of Intrabony Defects: A Clinico-radiographic Study.

Background & Objectives:Periodontal disease is characterized by the presence of gingival inflammation, periodontal pocket formation, loss of connective tissue attachment and alveolar bone around the affected tooth. Different modalities have been employed in the treatment and regeneration of periodontal defects which include the use of bone grafts, PRP and other growth factors.The purpose of this prospective, randomized controlled study was to compare the regenerative efficacy of PRP and bonegraft in intrabony periodontal defects.Methodology:This randomized control trial was carried out in the Department of Periodontics & Oral Implantology, Kalinga Institute of Dental Sciences and Hospital, KIIT University, Bhubaneswar. The study sample included 20 periodontal infrabony defects in 20 patients, 12 males and 8 females. The patients were aged between 25 -45 years(with mean age of 35 years). The 20 sites selected for the study were was randomly divided into 2 groups of 10 sites each. Group A: PRP alone, Group B: Bone Graft.Statistical Anaysis & Results: Statistical Analysis Was Done Using SPSS (Version 18.0):Statistical analysis was done usingpaired ‘t’ tests and ANOVA that revealed a significant reduction ingingival index, plaque index, probing pocket depth and gain in clinical attachment level at various time intervalswithin both the groups. Radiographic evaluation revealed statistically significant defect fill (p<0.001) at the end of 6months within both the groups. However, there was astatistically significant difference seen in group B radiographically, when compared to group A.Conclusion:Both the groups showed promising results in enhancing periodontal regeneration; however the resultswith bonegraftwere comparatively better, although not statistically significant when compared to PRP alone.

Management of Periodontal Infrabony Defects by Guided Tissue Regeneration alone or in Combination with Deproteinized Bovine Bone

Abstract Aim: To compare the contribution of combined guided tissue regeneration and deproteinated bovine bone (EnterOss) and guided tissue regeneration alone to the outcomes of the treatment of infrabony defects. Materials and Methods: A total of sixteen patients of both sexes satisfying the criteria of chronic periodontitis and each of whom displayed one infrabony defect were randomly assigned to two groups, i.e. either treated with EnterOss and guided tissue regeneration (GTR) (group A) or with (GTR) alone (group B), in this parallel-arm study. The soft tissue and hard tissue measurements, including probing pocket depth (PD), clinical attachment level (CAL), and bone mineral density were recorded at baseline and 3,6 and 12 months after surgery. The differences with a P < 0.05 were considered significant. Results: Results showed that the combined group showed significant difference when compared with GTR alone, in relation to the degree of periodontal pocket, clinical attachment loss, and bone density. While in relation to Plaque and Gingival indices there is no significant difference between the two groups. Conclusion: The findings of this study suggest that, combination of deproteinated bovine bone and biocollagen membrane could be considered as an option in the treatment of infrabony defects. GTR alone gives acceptable clinical results in the treatment of infrabony defects. Combination of deproteinated bovine bone and biocollagen membrane resulted in significant clinical results in the treatment of infrabony defects.

Effect of titanium-prepared platelet-rich fibrin treatment on the angiogenic biomarkers in gingival crevicular fluid in infrabony defects of patients with chronic periodontitis: A randomized controlled clinical trial.

The aim of this double-blinded, randomized, controlled clinical study was to investigate the effect of titanium-prepared platelet-rich fibrin (T-PRF) treatment on the angiogenic biomarkers in gingival crevicular fluid (GCF) in infrabony defects of patients with chronic periodontitis. Twenty five systemically healthy participants who complied with inclusion criteria with periodontal infrabony defects were recruited. In each patient, the infrabony defect of one side of arch was designated as control group (allograft), whereas the infrabony defect on the contralateral side of same arch was designated as test group (allograft + T-PRF). The therapy methods (test or control) were randomly decided. GCF samples were collected at baseline (presurgery) and then the 3rd, 7th, 14th, and 30th days after surgery. Platelet-derived growth factor (PDGF)-BB, vascular endothelial growth factor (VEGF)-A, fibroblast growth factor (FGF)-2, anjiogenin (ANG), angiostatin (ANT) in the GCF samples were measured using human enzyme-linked immunosorbent assay kits. In both groups, total amounts of PDGF-BB, VEGF-A, FGF-2, ANG, and ANT peaked in the GCF samples obtained at the early postoperative day (day 3) and decreased over time in the samples obtained at the 7th, 14th, and 30th days postsurgery. There were no significant differences between groups for the total amounts of PDGF-BB, VEGF-A, FGF-2, ANG, and ANT at all evaluation periods. Application of T-PRF combined with allograft in infrabony defects of patients with chronic periodontitis had no significant effects on angiogenic biomarkers in GCF.

Comparison of conventional imaging techniques and CBCT for periodontal evaluation: A systematic review.

PurposeThis study aimed to carry out a systematic review of studies in the literature comparing conventional imaging techniques with cone-beam computed tomography in terms of the role of these techniques for assessing any of the following periodontal conditions and parameters: infrabony defects, furcation involvement, height of the alveolar bone crest, and the periodontal ligament space.Materials and MethodsInterventional and observational studies comparing conventional imaging techniques with cone-beam computed tomography were considered eligible for inclusion. The MEDLINE and Embase databases were searched for articles published through 2017. The PRISMA statement was followed during data assessment and extraction.ResultsThe search strategy yielded 351 publications. An initial screening of the publications was performed using abstracts and key words, and after the application of exclusion criteria, 13 studies were finally identified as eligible for review.ConclusionThese studies revealed cone-beam computed tomography to be the best imaging technique to assess infrabony defects, furcation lesions, the height of the alveolar bone crest, and the periodontal ligament space.

Adjunctive Platelet-Rich Plasma (PRP) in Infrabony Regenerative Treatment: A Systematic Review and RCT's Meta-Analysis.

Background and Objective The purpose of this study was to highlight the clinical performance of platelet-rich plasma (PRP) used as an adjunctive tool for regeneration in infrabony periodontal defects using different biomaterials or performing different surgical flap approaches. Comparative evaluation of main clinical outcomes as probing pocket depth reduction, clinical attachment gain, and recession reduction with and without the use of PRP has been analysed. Materials and Methods According to the focused question, an electronic and hand searching has been performed up to December 2016. From a batch of 73 articles, the selection strategy and Jadad quality assessment led us to include 15 studies for the meta-analysis. Results Despite the high heterogeneity found and the lack of complete data regarding the selected clinical outcomes, a comparative analysis has been possible by the categorization of used biomaterials and surgical flap approaches. This method led us to observe the best performance of grafts with the use of adjunctive PRP in CAL gain and PPD reduction. No difference has been outlined with a specific surgical flap. Conclusions Although PRP is considered a cheap and patient's derived growth factor, the not conclusive data reported would suggest that its use in addition to bone substitutes could be of some clinical benefit in the regenerative treatment of infrabony defects. Clinical Relevance This systematic review was intended to sort out the huge controversial debate in the field about the possible use of PRP in regenerative surgery in infrabony defect. The clinical relevance of using blood-borne growth factors to conventional procedures is effective as these could determine a better performance and outcomes despite the surgical approach adopted and limit the use of additional biomaterials for the blood clot stabilization.