Periodontal Infrabony Defects Research Articles

ROLE OF HYALURONIC ACID IN PERIODONTAL BONE REGENERATION

Hyaluronic acid is a natural component of extra cellular matrix in both soft and hard periodontal tissues .Hyaluronic acid is located in both mineralised tissues (i.e cementum and alveolar bone) and non mineralised tissues (i.e gingiva and periodontal ligament) .Hyaluronic acid due to its anti-inflammatory ,anti -edematous ,anti- bacterial ,stimulation of angiogenic effects and osteoconductive effects has the potential to regulate periodontal tissue regeneration .Along with these properties , its role in modulation of wound healing makes it an adjunct to surgical and non surgical periodontal therapy.The use of Hyaluronic acid to treat periodontal bone defects has been shown to accelerate bone regeneration owing to its osteoconductive potential ,proliferation and differentiation of mesenchymal cells ,and regulating activities of osteoblast ,fibroblast ,cementoblast along with enhancement of osteogenetic effect of bone morphogenetic protein -2 in periodontal regeneration .This review examines the current literature favouring the use of hyaluronic acid in the regeneration of periodontal infrabony defects.

A Comparative Evaluation of Advanced Platelet-Rich Fibrin Combined With Demineralized Freeze-Dried Bone Allograft and Demineralized Freeze-Dried Bone Allograft Alone in the Treatment of Periodontal Infrabony Defects: A Clinical and Radiographic Study.

Aim Allografts, autografts, alloplast and xenografts are frequently used for periodontal regeneration. The aim of this study was to determine the efficacy of advanced platelet-rich fibrin (A-PRF) in combination with demineralized freeze-dried bone allograft (DFDBA) andDFDBA alone in periodontal infrabony defects. Methodology This was a split-mouth design study where 20 infrabony defects in 10 patients were included. Patients were randomly divided into two groups, where DFDBA allograft and A-PRF were used in the test group, while the DFDBA allograft alone was used in the control group. Furthermore, the results were evaluated at baseline, three, and nine months, respectively, in terms of clinical and radiographic parameters. Data were analysed with an unpaired t-test at the significance level of P < 0.05 (statistically significant). Results Both treatments showed reduced clinical and radiographic parameters from baseline to nine months. There was a non-significant difference in the plaque index (PI), bleeding on probing (BOP), clinical attachment level (CAL), and radiographic defect fill (RDF). In comparison to the control group (3.40 ± 0.516), the probing pocket depth (PPD) in the test group at nine months (3.22 ± 0.422) was statistically significant showing reduction in the PPD (P = 0.042). Conclusion Within its limitations, the study showed that A-PRF plus DFDBA and DFDBA alone treatment modalities reduced clinical and radiographic parameters from baseline, at 9 months; however, the inclusion of A-PRF did not substantially improve the treatment outcome when comparing both the groups, except for the probing pocket depth after nine months.

Influence of physicochemical characteristics of calcium phosphate-based biomaterials in cranio-maxillofacial bone regeneration. A systematic literature review and meta-analysis of preclinical models

ObjectivesCalcium phosphate-based biomaterials (CaP) are the most widely used biomaterials to enhance bone regeneration in the treatment of alveolar bone deficiencies, cranio-maxillofacial and periodontal infrabony defects, with positive preclinical and clinical results reported. This systematic review aimed to assess the influence of the physicochemical properties of CaP biomaterials on the performance of bone regeneration in preclinical animal models. MethodsThe PubMed, EMBASE and Web of Science databases were searched to retrieve the preclinical studies investigating physicochemical characteristics of CaP biomaterials. The studies were screened for inclusion based on intervention (physicochemical characterization and in vivo evaluation) and reported measurable outcomes. ResultsA total of 1532 articles were retrieved and 58 studies were ultimately included in the systematic review. A wide range of physicochemical characteristics of CaP biomaterials was found to be assessed in the included studies. Despite a high degree of heterogeneity, the meta-analysis was performed on 39 studies and evidenced significant effects of biomaterial characteristics on their bone regeneration outcomes. The study specifically showed that macropore size, Ca/P ratio, and compressive strength exerted significant influence on the formation of newly regenerated bone. Moreover, factors such as particle size, Ca/P ratio, and surface area were found to impact bone-to-material contact during the regeneration process. In terms of biodegradability, the amount of residual graft was determined by macropore size, particle size, and compressive strength. ConclusionThe systematic review showed that the physicochemical characteristics of CaP biomaterials are highly determining for scaffold's performance, emphasizing its usefulness in designing the next generation of bone scaffolds to target higher rates of regeneration.

Clinical and Radiological Benefits of Hyaluronic Acid in Periodontal Infrabony Defects: A Systematic Review and Meta-analysis

Purpose:There is no consensus on the clinical and radiological benefits of hyaluronic acid (HA) in patients with periodontitis having infrabony defects. Hence, this study examined the effects of HA in periodontitis patients with infrabony defects through a comprehensive systematic review process.Methodology:A systematic literature search was performed using PubMed/Medline, Scopus, Embase and Cochrane Library from inception to March 2022. Randomized or non-randomized clinical trials and single-arm clinical trials that assessed the clinical and radiological benefits of HA in periodontitis patients with infrabony defects with a minimum of 6 months follow-up were included in this study. Surgical regenerative therapy was considered as the comparator. The Cochrane risk of bias assessment tool and Downs and Black checklist was used for the quality assessment of randomized and non-randomized interventional studies, respectively. A subgroup and sensitivity analyses were performed to explore the heterogeneity and robustness of the findings, respectively.Results:A total of 13 out of 725 studies were included in this systematic review, of which 9 were considered for meta-analysis. The meta-analysis indicated significant benefits of HA in terms of reduction in probing pocket depth (SMD: 1.12 mm; 95% CI: 0.60-1.65; 9 studies), bone defect depth (SMD: 1.04mm; 95%CI: 0.62-1.47; 3 studies) and gain in clinical attachment level (1.04 mm; 95% CI: 0.33-2.47; 8 studies). Overall, the quality of included studies was good.Conclusion:The current evidence indicates that the administration of HA in the periodontal regenerative treatment of infrabony defects was significantly effective in increasing clinical attachment levels and reducing probing pocket and bone defect depth.

Clinical and Radiological Benefits of Hyaluronic Acid in Periodontal Infrabony Defects: A Systematic Review and Meta-analysis

Purpose: There is no consensus on the clinical and radiological benefits of hyaluronic acid (HA) in patients with periodontitis having infrabony defects. Hence, this study examined the effects of HA in periodontitis patients with infrabony defects through a comprehensive systematic review process. Methodology: A systematic literature search was performed using PubMed/Medline, Scopus, Embase and Cochrane Library from inception to March 2022. Randomized or non-randomized clinical trials and single-arm clinical trials that assessed the clinical and radiological benefits of HA in periodontitis patients with infrabony defects with a minimum of 6 months follow-up were included in this study. Surgical regenerative therapy was considered as the comparator. The Cochrane risk of bias assessment tool and Downs and Black checklist was used for the quality assessment of randomized and non-randomized interventional studies, respectively. A subgroup and sensitivity analyses were performed to explore the heterogeneity and robustness of the findings, respectively. Results: A total of 13 out of 725 studies were included in this systematic review, of which 9 were considered for meta-analysis. The meta-analysis indicated significant benefits of HA in terms of reduction in probing pocket depth (SMD: 1.12mm; 95%CI: 0.60-1.65; 9 studies), bone defect depth (SMD: 1.04mm; 95%CI: 0.62-1.47; 3 studies) and gain in clinical attachment level (SMD: 1.40 mm; 95%CI: 0.33-2.47; 8 studies). Overall, the quality of included studies was good. Conclusion: The current evidence indicates that the administration of HA in the periodontal regenerative treatment of infrabony defects was significantly effective in increasing clinical attachment levels and reducing probing pocket and bone defect depth.

Comparison of Clinical Parameters between the Treatment of Infrabony Defects with and without Concentrated Growth Factors in Open Flap Debridement: In vivo Study

Introduction:This study aimed to clinically and radiographically compare the regenerative effects of open flap debridement alone and in combination with concentrated growth factor (CGF) in the treatment of periodontal three-walled infrabony defects.Materials and Methods:Fifteen patients who fulfilled the inclusion criteria were selected from the outpatient department of periodontology. A split-mouth study was conducted and bilateral or contralateral defects were divided into two groups using computer-generated randomisation sheets-control site (open flap debridement alone) and case site (open flap debridement with CGF). Clinical parameters were assessed at baseline, 1 month, 3 months and 6 months. Radiographic parameters were assessed at baseline and 6 months postoperatively.Results:At 3 and 6 months postoperatively, the test group showed statistically significant improvement in clinical parameters as compared to the control group. At 6 months postoperatively, the test group showed improved bone fill as compared to the control group.Conclusion:Present study indicates that CGF, as a biological material has the property to enhance wound healing and result in mean pocket depth reduction of periodontal infrabony defects. In addition, long-term, multicentered randomised, controlled clinical researches will be required to better understand the clinical and radiographic effects of CGF on periodontal regeneration.

THE EFFECT DIRECTION SHOULD BE TAKEN INTO ACCOUNT WHEN ASSESSING SMALL-STUDY EFFECTS.

Studies with statistically significant results are frequently more likely to be published than those with non-significant results. This phenomenon leads to publication bias or small-study effects and can seriously affect the validity of the conclusion from systematic reviews and meta-analyses. Small-study effects typically appear in a specific direction, depending on whether the outcome of interest is beneficial or harmful, but this direction is rarely taken into account in conventional methods. We propose to use directional tests to assess potential small-study effects. The tests are built on a one-sided testing framework based on the existing Egger's regression test. We performed simulation studies to compare the proposed one-sided regression tests, conventional two-sided regression tests, as well as two other competitive methods (Begg's rank test and the trim-and-fill method). Their performance was measured by type I error rates and statistical power. Three real-world meta-analyses on measurements of infrabony periodontal defects were also used to examine the various methods' performance. Based on simulation studies, the one-sided tests could have considerably higher statistical power than competing methods, particularly their two-sided counterparts. Their type I error rates were generally controlled well. In the case study of the three real-world meta-analyses, by accounting for the favored direction of effects, the one-sided tests could rule out potential false-positive conclusions about small-study effects. They also are more powerful in assessing small-study effects than the conventional two-sided tests when true small-study effects likely exist. We recommend researchers incorporate the potential favored direction of effects into the assessment of small-study effects.

Comparison of the Clinical and Radiographical Outcomes of Regenerative Surgery and Open Flap Debridement in the Treatment of Shallow No-Contentive Periodontal Infra-Bony Defects

Comparison of the Clinical and Radiographical Outcomes of Regenerative Surgery and Open Flap Debridement in the Treatment of Shallow No-Contentive Periodontal Infra-Bony Defects

Effectiveness of platelet rich fibrin alone or in combination with bone grafts in the treatment of infrabony defects: Systematic review and metanalysis

This systematic review aimed to investigate the effectiveness of PRF alone or in combination with bone grafts in enhancement of tissue/bone formation in infrabony defects. A search was performed in electronic databases (i.e. Pubmed/MEDLINE, EMBASE, Cochrane, Clinical trials.org) in order to identify Randomized Control Trials (RCTs). The last electronic search was run on 24 August 2021 From the search, 21 articles fulfilled the inclusion criteria and were quantitatively analyzed. In total, there were 13 articles with low risk of bias, 4 with some concerns and 4 with high risk. The meta-analysis showed that there was a statistically significant benefit from the use of PRF alone or in combination with bone graft after 6 months follow up in clinical attachment level (CAL), periodontal probing depth (PPD) and bone fill (BF). However, there was not a significant difference in CAL and PPD after 9 months In summary the use of PRF was effective in the treatment of periodontal infrabony defects especially in CAL and BF after 6 months follow up. From the interpretation of the results, we indicate that the combination of PRF with grafting materials may accelerate the bone healing process in the treatment of intrabony defects.

Comparative Evaluation of Injectable Platelet Rich Fibrin (I-PRF) with DFDBA and Titatium Prepared Platelet Rich Fibrin (T-PRF) with DFDBA In The Treatment of Infrabony Defects In Chronic Periodontitis Patients - A Clinico-Radiographical Study

Objectives: The main objective of this study was to evaluate the efficacy of Titanium prepared platelet-rich Fibrin (T-PRF) and Injectable Platelet Rich Fibrin (I-PRF) with demineralized freeze-dried bone allograft (DFDBA) in order to improve the clinical and radiographic results obtained in treatment of periodontal infrabony defects.&#x0D; Materials and Methods: This split-mouth randomized controlled clinical trial was conducted on 30 subjects with two comparable bilateral infrabony defects. Plaque Index(PI), Gingival Index(GI) Clinical attachment level (CAL), Periodontal Pocket depth (PD), as well as radiographic parameters IOPA including the radiographic defect size, were measured at six months post-operatively.&#x0D; Results: The mean reductions in PD and CAL were 4.0±0.77 mm and 2.5±0.68 mm in sites treated with I-PRF+DFDBA, respectively (P&lt;0.05); these reductions were 4.2±0.86 mm and 3.1±0.62 mm, respectively in T-PRF+DFDBA group (P&lt;0.05). Radiographic evaluation revealed reduction in the radiographic defect size in the I-PRF+DFDBA and T-PRF+DFDBA sites. Statistically, there were no significant differences between the two treatment modalities.?&#x0D; Conclusion: This study showed that both treatments resulted in significant improvement in the probing depth reduction, clinical attachment level gain and radiographic size of the infrabony defect at six months after surgery. I-PRF with DFDBA membrane in treatment of infrabony osseous defect showed more defect fill followed by T- PRF along with DFDBA membrane.

Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis.

A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects. A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration. A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p<0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p<0.01) and radiographic bone fill/gain (p<0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor. Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.

Comparative Evaluation of Regenerative Potential of Infrabony Periodontal Defects by Using Xenograft in Combination with 1% Alendronate and 1% Metformin Gels

Background: Deficiency of the alveolar bone is one of the trademarks of periodontitis. Thus, agents that have osteogenic potential play a meritorious role in disease prevention. There is evidence, that pharmacological agents such as Alendronate (ALN) and Metformin (MF) have such potential in bone regeneration. Objectives: The main aim of this study was to assess the competency of Xenograft (XG) alone and in combination with 1% ALN and 1% MF in the regeneration of periodontal bone defects. Materials and Methods: In this randomized interventional study, total of 36 infrabony defects were randomly assigned to three groups, each group comprised of 12 infrabony defects: Group I with 1% ALN gel + XG (test), II with 1% MF gel + XG (test) and III with only XG (active control). This was a split-mouth study. Clinical criteria such as pocket depth (PD), relative vertical clinical attachment level (RVCAL) were assessed. A radiographic parameter like linear bone growth (LBG) was measured with the help of a grid. The microbial count (MC) was estimated with the plaque sample. All the specifications were calculated before the beginning of the study and at 6 months. Statistical analysis was performed using the Chi-square and paired t-test. Results: The mean reduction of PD, gain in RVCAL, LBG and MC was statistically significant within the groups (P &lt; 0.05) from baseline to 6 months. However, MC was insignificant in Group III (P = 0.294) within the group but was significant on the intergroup comparison. Conclusions: Overall, significant results were found in all three groups. Using XG alone as well as in combination with 1% ALN and 1% MF has given appreciable results.

Outcomes of reconstructive periodontal surgery with different types of barrier membranes

Relevance. Reconstructive periodontal surgery is one of the most effective methods of restoring tooth-supporting apparatus damaged by microbial inflammation and destruction. For this purpose, they use non-resorbable and resorbable biomaterials, which act as a temporary barrier between the tissues with different mitotic potential during early healing. Since the properties of barrier membranes determine the degree of invasiveness and postoperative morbidity, and, finally, the success of the surgery, it is relevant to study the outcomes of periodontal reconstruction with one of the modern collagen membranes cross-linked by ribose.Purpose. To comparatively assess the outcomes of periodontal reconstructions with a resorbable and non-resorbable barrier material.Material and methods. The study is a prospective randomized blind controlled clinical trial. The study included 37 patients (14 men, 23 women) aged 45-65 years, who, after the initial therapy, underwent 62 guided tissue regenerations using e-PTFE and resorbable collagen membrane cross-linked by ribose. The study compared the clinical and radiographic results before and 18 months after the surgery. We evaluated the probing depth (periodontal pocket), gingival recession level, loss of clinical attachment level, width and height of periodontal infrabony defects, gain in clinical attachment level. The material was statistically processed using StatSoft STATISTICA 10.0.1011 for Windows. The statistical unit is a periodontal defect.Results. In the postoperative period, the main (31%) and control (42%) groups exhibited the areas of membrane exposure; 16 periodontal defects, only in the control group, demonstrated the extensive membrane exposure, of which 11 membranes were prematurely removed due to infection of the reconstruction site. In the main group, fibrin allowed exposed area healing in the usual time without medical assistance. After 18 months, the gain in the clinical attachment level was 3.5 mm in the main group versus 2.8 mm in the control group (at p=0.03) with a significant decrease in the probing depth compared to that before treatment; the level of recession also changed positively, although not significantly. The type of periodontal defect (the parameter is higher in three-wall and two-wall defects) appeared to remarkably influence the gain in clinical attachment level.Conclusion. The study evidenced that the resorbable cross-linked collagen membrane demonstrated clinically acceptable outcome of the damaged periodontium reconstruction due to, first of all, increased predictability of the course of the early postoperative period, a significant reduction in morbidity and invasiveness of intervention.

ACCURACY OF CLINICAL AND RADIOGRAPHIC MEASUREMENTS OF PERIODONTAL INFRABONY DEFECTS OF DIAGNOSTIC TEST ACCURACY (DTA) STUDIES: A SYSTEMATIC REVIEW AND META-ANALYSIS.

The aim of this study was to determine the accuracy of clinical and radiographic measurements of infrabony periodontal defects. The MEDLINE-Pubmed and Cochrane-CENTRAL electronic databases were searched from initiation to May 2020. The inclusion criteria were clinical trials, human subjects with at least one infrabony defect, measurements of clinical attachment level (CAL), radiographic bone level (rBL), and intraoperative bone level (iBL) used as the reference standard. In total, 11 studies including 17 comparisons were included in this meta-analysis. All 17 comparisons showed that the values of the CAL and rBL measurements underestimated the iBL values. For CAL, the analysis showed a significant difference of means of -1.22 (P < .00001; 95%CI: [-1.49; -0.95]) and for rBL -1.10 (P < .00001; 95%CI: [-1.34; -0.85]). No significant DiffM were observed between the CAL and rBL measurements (DiffM -0.05; P = .76; 95%CI: [-0.39; 0.28]). The results of this systematic review and meta-analysis show that both clinical and radiographic measurements substantially underestimate the bone level when compared to intraoperative level measurements. However, there was no significant difference in the results between the clinical attachment level measurements and the radiographic observation.

The granulation tissue preservation technique in regenerative periodontal surgery-a randomized controlled clinical trial.

ObjectivesTo investigate if the application of the granulation tissue preservation technique (GTPT) in regenerative therapy of infrabony periodontal defects results in more clinical attachment level (CAL) gain and more radiographic bone gain (RBG) than the conventional resective approach 12 months after surgery.Materials and methodsForty patients exhibiting at least one infrabony defect with a probing pocket depth (PPD) ≥6 mm and a radiographic infrabony component (INFRAX‐ray) ≥3 mm were randomly treated with the GTPT (test group) or the double‐flap approach with resection of the defect‐filling granulation tissue (control group). Enamel matrix derivatives were applied in both groups. Clinical and radiographic parameters were recorded at baseline (t0), 6 months (t1), and 12 months (t2) after surgery. The primary outcome variable was CAL gain between t0 and t2.ResultsWhen all patients were considered, ΔCALt0–t2 did not differ significantly between the two groups (p = .160). Significant PPD reduction (test group: 4.38 ± 1.36 mm; control group: 4.06 ± 2.38 mm), CAL gain (test group: 3.75 ± 1.24 mm; control group: 2.88 ± 2.09 mm), and RBG (test group: 3.06 ± 1.74 mm; control group: 3.27 ± 2.19 mm) were achieved at t2 in both groups. Using multivariate linear regression, PPDt0 and group were identified as variables with the greatest influence on ΔCALt0–t2. PPDt0 and INFRAX‐ray were identified as variables with the greatest influence on RBGt0–t2. Patients with a defect angle >22° showed significantly more CAL gain in the test group (t0–t1: 3.08 ± 1.38 mm; t0–t2: 3.62 ± 0.96 mm) than in the control group (t0–t1: 1.77 ± 1.54 mm; t0–t2: 2.18 ± 1.83 mm).ConclusionsRegarding all patients, the study failed to show significant differences between the test and control groups. However, the GTPT appears to lead to more CAL gain in noncontaining infrabony defects.

Polymer-Based Bone Substitutes in Periodontal Infrabony Defects: A Systematic Evaluation of Clinical Studies.

Background and Objectives: The aim was to systematically review the available literature regarding the use of polymers as a bone substitute for the treatment of periodontal infrabony defect. Materials and methods: Three databases (PubMed, Scopus and Web of Science) were searched to find all relevant studies published in English from inception until September 2021 using a combination of keywords. The inclusion criteria consisted of human clinical studies which reported the use of a polymer-based bone substitute in the treatment of infrabony defects. Results: 164 studies were provided from the databases. Of these, five articles were eligible and reported favorable outcome in terms of probing depth, clinical attachment gain and defect fill at the follow-up (3 months and 6 months). Conclusions: Polymer based-bone substitutes may represent a useful alternative in treating infrabony defects. Due to the limited number of studies, more research is needed to sustain the advantages of these products.

Intra Oral Digital Radiography versus Cone Beam Computed Tomography for Detection of Infra Bony Periodontal Defects.

Intra Oral Digital Radiography versus Cone Beam Computed Tomography for Detection of Infra Bony Periodontal Defects.

Role of platelet-rich plasma in maxillofacial surgery

Platelet-rich plasma (PRP) has been reported as an efficacious modality that can enhance the process of wound healing and tissue regeneration and has been validated in different medical settings, including cardiovascular surgery, otolaryngology, head and neck surgery, and maxillofacial surgery. In dental and oral surgery settings, PRP has been reported as an efficacious approach with favorable outcomes in different settings. Some of these procedures include surgical repair of the alveolar cleft, mandibular reconstruction, ablative surgical procedures, placement of osseointegrated implants, periodontal plastic surgery, and management of infrabony periodontal defects. In the present study, we aim to discuss the role and mechanisms that PRP plays in the settings of maxillofacial surgery based on evidence from the relevant studies in the literature. Evidence indicates the wide acceptance of the modality, which has been proven to increase the rate of wound healing and reduce the frequency of pain and swelling. The administration of PRP has been reported to dispense with the need for invasive approaches that might be furtherly associated with complications and different morbidities. However, in most of the favorable events where the PRP administration of was associated with enhanced outcomes, the modality was used in combination with another therapeutic approach. Therefore, further research is needed to validate the efficacy of the modality in the different settings.

Effectiveness of beta-tricalcium phosphate in comparison with other materials in treating periodontal infra-bony defects around natural teeth: a systematic review and meta-analysis

BackgroundBeta-tricalcium phosphate in regenerative surgery has shown promising results in terms of bone gain and new vital bone formation; however, several studies have contradicted this finding. The aim of this study was to evaluate the effectiveness of beta-tricalcium phosphate compared to other grafting materials in the regeneration of periodontal infra-bony defects.MethodsElectronic database (Cochrane, MEDLINE, PubMed, Embase, Science Citation Index Expanded) and manual searches for related data were performed up until March 2020. The outcomes were pocket depth reduction, clinical attachment level gain, and amount of bone fill.ResultsFive studies were selected based on the inclusion criteria. Bone regeneration with beta-tricalcium phosphate was observed to be superior to that with debridement alone but showed comparable results to other bone graft materials in terms of pocket depth reduction, clinical attachment level gain, and bone fill. Regenerative procedures for periodontal infra-bony defects that used beta-tricalcium phosphate in combination with other growth factors yielded superior outcomes. The meta-analysis revealed that for cases with two-wall defects, the use of beta-tricalcium phosphate yielded statistically significant differences in pocket depth reduction and clinical attachment level gain, but not in bone fill.ConclusionsBeta-tricalcium phosphate appears to be a promising material for use in periodontal infra-bony defect regeneration around natural teeth. However, randomized clinical trials with larger sample sizes and more controlled study designs are needed to support these findings.

Treatment of infra-bony periodontal defects using a collagen membrane and a bone substitute of equine origin – a pilot study

Introduction One of the main goals of periodontal treatment is the regeneration of lost tissues, in order to improve the prognosis of the involved teeth [1–3]. Guided tissue regeneration (GTR) involves the use of a barrier with or without the use of bone substitutes [4]. Given the great diversity and constant evolution of materials, it is necessary to maintain a permanent evaluation of their clinical effectiveness. This study intends to evaluate the success and predictability of GTR using a new membrane and bone substitute of equine origin (Heart® and Mix Granules® – Bioteck SpA, Turin, Italy), in the treatment of infra-bony defects with two or three walls [5]. Materials and methods This study was approved by Egas Moniz Ethics Committee and all patients signed an informed consent form. Patients were selected among those referred to the Department of Periodontology/EMDC, with indication for surgical periodontal treatment, presence of 2–3-wall infra-bony defects, probing depth (PD) ≥ 5 mm, infra-bony component ≥4 mm deep (evaluated radiographically) and attached gingiva ≥2 mm. Exclusion criteria were: cases with PIaque Index (PI) >20%, smokers, extension of the defect to the furcation zone, mobility grade III, endodontic pathology, diabetes or other pathologies that interfere with bone remodelling and metabolism or contraindicate periodontal surgery. All surgeries were performed by the same operator. The clinicians involved in the evaluation of the results had no intervention in surgery. The following clinical and radiographic parameters were evaluated at one, three and six months after surgery: PI, Gingival Index (GI), Probing pocket depth (PPD), Bleeding on Probing (BoP); Gingival recession (GR), height of keratinised gingiva (KG) and radiographic angle of the defect (RAD). In addition, the presence of possible intra-surgical or post-operative complications was also evaluated. The assessment of the defect depth reduction was based on standardised periapical radiographs obtained through the use of an individualised device (parallelizer). Results A total of six participants (83% females, 17% males), with a mean age of 61.6 (± 8.1) years, were enrolled in the study. The number of defect walls was: 3 walls (50%), 2 walls (33.3%) and 2/3 walls (16.7%). After six months, an average clinical attachment level gain of 3.3 (± 1.4) mm, mean radiographic bone filling of 72 (± 29%) and a BoP reduction of 66.6% were observed. RAD average was 21.3 (± 1.2°) and GR changed from 2.2 to 2.7 mm. Membrane exposure was observed in 33.3% of the cases, however, there were no cases of infection or severe pain. Discussion and conclusions The use of collagen membranes and corticocancellous bone grafts of equine origin seems to be a viable alternative in the regeneration of infra-bony periodontal defects.