Intraosseous Defects Research Articles

A Contemporary Approach: Presentation of 4 Cases with the Entire Papilla Preservation (EPP) Technique

Regeneration of periodontal tissue is a primary goal of periodontal treatment. Periodontal regeneration approaches are widely used in the treatment of intraosseous defects. However, the success of these techniques depends on many factors, including surgical considerations. Failures in wound closure in the interdental region, which are surgical factors, have led to the development of papilla preservation techniques. The entire papilla preservation technique (EPP) maintains the integrity of the papilla associated with the defect. This technique stabilizes the blood clot with intact gingiva, preventing wound exposure and contamination. EPP is performed in intra-osseous defects through a short buccal vertical incision, without incising the papilla of the involved tooth. A full-thickness buccal flap is lifted from the incision to the relevant papilla and a tunnel extending under the papilla is prepared. The papilla is also lifted to full thickness. The defect is cleaned of granulation tissue and the wound is closed primarily with or without biomaterial application. In this report, we present 4 cases, 3 in the anterior maxilla and 1 in the mandibular premolar region, undergoing periodontal surgery with EPP with biomaterial application with a 3-month follow-up. In all cases, soft tissue healing was uncomplicated and radiographs showed bone filling at 3 months. EPP has a high success rate in periodontal regeneration by providing complete nutrition of the interdental papilla through natural, continuous vascular support in intraosseous defects.

Guided Bone Regeneration for the Treatment of Peri-Implantitis: Clinical Case Report

Periodontal disease is characterized as an inflammatory process that damages the periodontal lining and/or support tissues. Peri-implantitis is among the periodontal alterations, being caused by bacterial biofilm causing loss of underlying bone insertion, leading to modifications in its architecture that form intraosseous defects of various types. For the treatment of peri-implantitis there are non-surgical, surgical, resective, regenerative, combined techniques and the decision-making will depend on the degree of the bone defect. Therefore, guided bone regeneration (GBR) is an efficient and simple technique for bone augmentation, which is widely used to restructure bone defects that occur in the alveolar ridge and in the peri-implant region. Biomaterials are alternatives to be used in guided bone regeneration due to their excellent biocompatibility, osteoinductive properties, low degradation rate and their hydrophilicity, which collaborates with the absorption of blood cells and proteins that will help in osseointegration. Female, 58-year-old normosistemic patient, attended a private dental office complaining of pain, bad smell, bleeding and bad taste in the peri-implant region referring to element 25, on its distal face to the mesial face of the element tooth 26. After imaging exams, periodontal probing and the patient's past history, extraction of element 26 was performed, decontamination protocol of the implant surface of 25 through mechanical, chemical and physical means performing antimicrobial photodynamic therapy and finally, a guided bone regeneration was performed, using the allogeneic bone grafting technique associated with a polytetrafluoroethylene membrane in its expanded form (e-PTFE) for recovery of the bone defect and alveolar preservation. Thus, guided bone regeneration has shown high success rates and greater predictability when well indicated and performed, making it important for the maintenance of periodontal and peri-implant health.

Recombinant human fibroblast growth factor and autogenous bone for periodontal regeneration: Alone or in combination? A randomized clinical trial

AbstractAimTo compare the outcomes of therapy using recombinant human fibroblast growth factor (rhFGF)‐2 combined with autologous bone grafting (ABG) therapy with those of rhFGF‐2 alone and ABG alone in the treatment of periodontal intraosseous defects.MethodsPeriodontal intraosseous defects were randomized to receive rhFGF‐2 therapy + ABG, rhFGF‐2 therapy alone, or ABG alone. Periodontal examination and periapical radiography were performed preoperatively and at 3, 6, and 12 months postoperatively.ResultsAt the 12 months follow‐up, all three groups showed significant improvement in the clinical attachment level (CAL): 5.6 ± 1.6, 5.8 ± 1.7, and 5.2 ± 1.6 mm in the rhFGF‐2 + ABG, rhFGF‐2 alone, and ABG alone groups, respectively, with no significant inter‐group differences (p < .05). rhFGF‐2 therapy (alone or in combination) resulted in greater bone defect filling (BDF) (2.3 ± 1.2 mm and 2.6 ± 1.9 mm, respectively) than ABG therapy alone (1.2 ± 1.2 mm). Gingival recession was lesser in the ABG alone (1.2 ± 1.1 mm) and rhFGF‐2 + ABG groups (1.4 ± 0.8 mm) than in the rhFGF‐2 alone group (2.2 ± 1.2 mm).ConclusionThe results of this study showed that at 12 months postoperatively, all treatments resulted in statistically significant clinical improvements compared to the baseline. From these results, it can be concluded that rhFGF‐2 promotes hard tissue regeneration in intraosseous defects.

A finite element analysis of periodontal ligament fluid mechanics response to occlusal loading based on hydro-mechanical coupling model

ObjectiveConsidering fluid stimulation is one of the essential biomechanical signals for periodontal tissues, this study aims to characterizing fluid mechanics response during occlusal loading by a hydro-mechanical coupling model for periodontal ligament. DesignModels simulating periodontium with normal bone height and with intraosseous defects were built with three mechanical modules: tooth, periodontal ligament and alveolar bone. Tooth was modeled as linear elastic, and periodontal ligament and alveolar bone as a hydro-mechanical coupling model. Transient analyses under dynamic occlusal loading were performed. Fluid dynamics within periodontal ligament space was simulated and visualized by post-processing module. ResultsReciprocating oscillatory flow occurred within the periodontal ligament under occlusal loading. Higher pore pressure and fluid velocity were observed in furcation and apical regions compared to mid-root and cervical regions. Intraosseous defects increased pore pressure and fluid velocity within the periodontal ligament, most significantly near the defect. ConclusionBased on the results of the hydro-mechanical coupling model, significant oscillatory fluid motion is observed within the periodontal ligament under occlusal loading. Particularly, higher fluid velocity is evident in the furcation and apical areas. Additionally, Intraosseous defects significantly enhance fluid motion within the periodontal ligament.

Current Concepts for the Treatment of Peri-implant Disease.

Peri-implant diseases are defined as bacterial plaque-induced inflammatory conditions affecting implant-surrounding tissues and are classified as peri-implant mucositis and peri-implantitis. Peri-implant mucositis is characterized by an inflammatory lesion that resides in the soft tissue compartment, whereas at peri-implantitis sites the lesions also feature progressive loss of implant-supporting bone. Inflammation resolution and disease progression arrestment are the main therapeutic endpoints of the treatment of peri-implant diseases. The present position paper displays the current evidence and clinical recommendations of the European Association for Osseointegration for the treatment of peri-implant diseases. Mechanical biofilm removal along with the reinforcement of patient-administered oral hygiene is considered the standard treatment for managing peri-implant mucositis. It is recommended to assess the outcomes of peri-implant mucositis treatment 2 to 3 months after therapy, and repeated intervention should be considered in the absence of treatment success. Peri-implantitis treatment should follow a stepwise treatment approach, starting with nonsurgical treatment followed by surgical intervention, if that is not sufficient. Surgical peri-implantitis therapies include nonreconstructive, reconstructive, and combined treatment modalities. Implantoplasty may be advocated for the treatment of supracrestal peri-implant defects, whereas reconstructive therapy is indicated at peri-implantitis sites featuring intraosseous defects with a depth ≥ 3 mm. Adjunctive reconstructive measures may be beneficial in enhancing radiographic defect fill and maintaining postoperative soft tissue levels, which may have a great impact in esthetic cases. The adjunctive use of systemic antibiotics during surgical therapy does not seem to improve the clinical outcomes. Regular supportive peri-implant therapy with biofilm removal should be an integral part of the treatment protocol for peri-implant diseases. In the presence of advanced bone loss around implants that do not play a strategic role in masticatory function, implant removal may be considered immediately.

Entire papilla preservation technique for treatment of periodontal intrabony defects: a series of cases.

Periodontitis is characterized by bone resorption. Vertical bone loss results in an intraosseous defect. Multiple surgical approaches for treating intrabony defects have shown different grades of effectiveness. Recently, the entire papilla preservation technique has been proposed, improving clinical parameters, such as pocket depth and clinical attachment level. This series of cases aimed to describe the use of the entire papilla preservation surgical technique without using biomaterials to regenerate periodontal intrabony defects. The influence on the clinical periodontal parameters and radiographic parameters was measured through CBCT, the latter not described until now, and analyzed the possible postoperative complications. A total of six intrabony periodontal defects associated with at least one periodontal pocket with probing depths equal to or greater than 6 mm were treated with the entire papilla preservation technique. The clinical and radiographic parameters were evaluated at the beginning and 6 months after surgery. The mean probing pocket depth reduction was 4.00 ± 0.63 mm, the mean clinical attachment level gain was 3.67 ± 1.03 mm, and the mean radiographic intrabony filling was 2.41 ± 2.03 mm. Early healing was uneventful; the mean visual analog scale at 7 days was 0. This minimally invasive technique results in an improvement in clinical and radiographic parameters, the latter showing a filling of the bone defect observed during the 6-month evaluation after surgical treatment. These results confirm the importance of clot and flap stability in regenerating intraosseous defects.

Prehydrated collagenated cortico-cancellous heterologous bone gel and papillae tunneling for isolated intrabony defects: 12-month noninferiority trial.

This study assessed the effectiveness of prehydrated collagenated xenogenic bone gel and a collagenated cortico-cancellous heterologous bone mixture in conjunction with papillae tunneling techniques (PTT) for treating isolated periodontal intraosseous defects. Twenty patients with periodontitis stage III/IV and at least one deep isolated interdental 2/3-wall intraosseous defect were included in the study. Surgical incisions were made vertically at the adjacent tooth or horizontally at the mucogingival junction. A full-thickness flap was then carefully lifted under the papillae using special tunneling instruments. The root surfaces were completely cleaned, and the defects were randomly filled with either prehydrated collagenated bone gel (test group; n = 10) or collagenated cortico-cancellous heterologous bone mixture (control group; n = 10). Wounds were closed with microsurgical sutures. We predicted that the lower 95% confidence interval for the difference between the two procedures would exceed a prespecified noninferiority threshold. All wounds closed sufficiently to prevent biomaterial exposure. The test and control groups showed similar mean pocket depth reduction (3.5 ± 1.0vs. 3.9 ± 1.7 mm; p = 0.52), similar gingival recession (-0.10 ± 0.99vs. 0.2 ± 0.8 mm; p = 0.46), and similar clinical attachment gain (3.6 ± 1.51vs. 3.7 ± 1.8 mm; p = 0.89) at the 12-month follow-up. All results were below the noninferiority margin of the sample. At 12 months, prehydrated collagenous bone gel performed similarly to collagenous heterologous bone granules in the treatment of intraosseous lesions with PTT. In addition, both biomaterials preserved soft tissue with minimal further recession at 1 year. When combined with PTT, collagenous xenogeneic bone granules and prehydrated collagenous bone gel achieve comparable clinical outcomes in intrabony defects.The study was registered under the NCT04782921 on ClinicalTrails.

Rejuvenation of bone volume with CGF and i-PRF in intra-osseous defects.

The risk of further periodontal breakdown increases with a deep intrabony defect. Non-surgical periodontal therapy could pose a challenge and surgical intervention is mainly required to manage the defect. Autologous platelet concentrates such as Injectable platelet rich fibrin (i-PRF) and concentrated growth factor (CGF) may improve surgical outcome due to its enrichment with growth factors. Total of 04 patients involved in this study. After conventional flap debridement of intrabony defects, CGF is placed in 2 patients and the other 2 patients received i-PRF in their respective intrabony defects. Volumetric analysis was done pre-operative and 6 months post operatively in both the groups. Bone volume is significantly increased in both CGF and i-PRF group but higher in CGF group when compared to i-PRF group has high regenerative and reconstructive growth factors which helps aids in early and high bone fill when compared to i-PRF.

Morphological characteristics of femoral neck fractures in young and middle-aged population: a retrospective descriptive study

BackgroundA understanding of morphological characteristics are important to femoral neck fractures (FNFs) resulting in high rates of complications in the young and middle-aged adults and the detailed data is lack in the literature. We aimed to report on the detailed morphological characteristics and the relationship between them in young and middle-aged adults with femoral neck fractures (FNFs).MethodsThe postoperative CT images of one hundred and fifty-two adults with FNFs were retrospectively reviewed. After image standardization, morphological characteristics including fracture orientation, cortex comminution, and intraosseous bone defects were measured and analyzed. Additionally, the distribution and correlation of these morphological features were analyzed using Pauwels classification, the right angle of the neck axis (VNA) classification, and the anteromedial oblique angle (AMA).ResultsPauwels III fractures accounted for approximately half (55.2%) of the FNFs analyzed. Pauwels II and III could be detected in all four VNA types, and the distribution of the Pauwels types in VNA classification showed significant differences (χ2 = 106.363, p < 0.001). The VNA (9.0° ± 12.1) showed positive correlation with the neck-shaft angle (139.5° ± 6.3) and modified Pauwels angle (49.8° ± 10.6) (r = 0.441, r = 0.855, all p < 0.001). Cortical comminutions were commonly observed in the posterior (86.7%) and the inferior (80.7%). AMAs within the cases without posterior and inferior cortex comminutions were significantly larger than those with comminution (t = 2.594, 2.1196; p = 0.01, 0.036), but no difference could be detected after the AMA being divided into three groups (< 85°, 85°-95°, > 95°). The MPA, VNA and AMA of the group with an intraosseous defect were significantly different compared with those without (t = 2.847, 2.314, 2.268; p = 0.005, 0.022,0.025). The incidence of intraosseous defects within the groups with coronal and axial cortex comminutions were significantly higher than those within the groups without comminutions (χ2 = 34.87, 25.303; p < 0.001).ConclusionsThe present study highlights the morphological diversity and complexity within FNFs in young and middle-aged adults, which allows for more accurate simulation of FNF patterns in the future biomechanical studies.

The Last Molar - Entire Pad Preservation Technique (L-EPPT) as a Regenerative Surgical Approach for Combined Distal Intrabony Defects and Furcation Involvement: Case Reports.

Primary wound closure is the most important factor in successful periodontal tissue regeneration when using biomaterials. However, in the distal region of the last molar, there is concern that direct surgical access to an intraosseous defect may induce the leakage of biomaterials, impair the blood supply, and make healing difficult. This case series introduces the last molar-entire pad preservation technique (L-EPPT), which was designed to preserve the gingiva of the last molar centrum and secure the operative field of the furcation and distal bone defects, thereby providing an optimal environment for wound healing for regenerative therapy. This technique for preservation of the distal gingiva was applied in two cases involving the combination of a buccal class II furcation defect and a 2-3-wall intrabony defect in the last molar for the use of a combination of bone graft and enamel matrix derivatives in periodontal regeneration. Clinical outcomes were recorded at 18 months (case 1) and 8 months (case 2) after surgery. In both cases, the class II furcation defects were completely closed, and the probing pocket depth was improved to < 3 mm with no bleeding on probing. Further research is warranted to verify the efficacy of this technique.

Platelet Rich Fibrin Matrix (PRFM) and Peripheral Blood Mesenchymal Stem Cells (PBMSCs) in the management of intraosseous defects - A randomized clinical trial.

A combination of peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix (PRFM) could be a probable periodontal regenerative material with the synergy of the added benefits of each material. This randomized controlled clinical trial aimed to evaluate the regenerative capacity of supercell (PRFM and PBMSCs) compared with that of PRFM alone in human periodontal mandibular intraosseous defects (IOD). This study included 17 patients of both sexes (12 men, 5 women) aged 30-55 years (mean age = 37.7±4.4 years) who fulfilled the inclusion criteria (radiographic and clinical evaluation for bilateral IOD with probing pocket depth (PPD ≥ 6 mm). A split-mouth design was used in each patient. A total of 34 sites in the mandibular arch randomly received PRFM alone + open flap debridement (OFD) [Control sites] or supercell (PRFM+PBMSCs) + OFD [Test sites]. The clinical parameters plaque index (PI), gingival index (GI), PPD, clinical attachment level (CAL), and in the radiographic parameters; defect depth (DD) and defect fill percentage (DFP) were recorded at baseline, 3 and 6 months postoperatively. Early wound healing index (EHI) was used at 1 week to assess wound healing ability. At 6 months, radiographic parameters revealed significant reduction in DD (P<0.001) and significant DFP values in the test group compared with the control group. The supercell showed significant improvement in PPD and CAL at the end of 6 months (P<0.001). EHI scores at 1 week showed no statistically significant difference between the test and control groups. Supercell can be considered a regenerative material in the treatment of periodontal IODs.

Efficacy of Eggshell-Derived Calcium Phosphate Cement Over Synthetic Hydroxyapatite in Intraosseous Defects: A Randomized Controlled Split-mouth Trial [Retracted/Withdrawn

The author has decided to retract this article in order to conduct further studies and provide an updated version.

Effect of gamma and Ultraviolet-C sterilization on BMP-7 level of indigenously prepared demineralized freeze-dried bone allograft.

The presence of bone morphogenetic proteins in demineralized freeze-dried bone allograft (DFDBA) are responsible for developing hard tissues in intraosseous defects. The most common mode of sterilization of bone allografts, i.e., Gamma rays, have dramatic effects on the structural and biological properties of DFDBA, leading to loss of BMPs. Ultraviolet-C radiation is a newer approach to sterilize biodegradable scaffolds, which is simple to use and ensures efficient sterilization.However, UV-C radiation has not yet been effectively studied to sterilize bone allografts. This study aimed to compare and evaluate the effectiveness of Gamma and Ultraviolet-C rays in sterilizing indigenously prepared DFDBA and assess their effect on the quantity of BMP-7 present in the allograft. DFDBA samples from non-irradiated, gamma irradiated, and UV-C irradiated groups were tested for BMP-7 level and samples sterilized with gamma and UV-C rays were analysed for sterility testing.The estimated mean BMP-7 level was highest in non-irradiated DFDBA samples, followed by UV-C irradiated, and the lowest in gamma irradiated samples. Our study concluded that UV-C rays effectively sterilized DFDBA as indicated by negative sterility test and comprised lesser degradation of BMP-7 than gamma irradiation.

Consideration of The Distal Intraosseous Defects of The Mandibular Second Molars: Case Series

Consideration of The Distal Intraosseous Defects of The Mandibular Second Molars: Case Series

Treatment of furcation defects using various bone grafts and guided tissue regeneration membranes: A review on single-center institutional studies

Abstract Bone formation in class II furcation is least due to the morphology of the root in case of multirooted teeth performed by conventional procedure. Hence, various bone grafts with membranes have been tried in the current study to evaluate its efficacy by comparing test and control groups. This collection of research from a single center presents a bone graft and guided tissue regeneration (GTR) membrane-based furcation therapy. Bio-Oss and Bio-Gide, PerioGlas and Atrisorb, Periobone G and Resolut XT, as well as PepGen P-15 and Atrisorb, were among the bone graft materials used, both with and without the GTR barrier. Patients were divided into four groups based on the periodontal regenerative materials used. A periodontal flap procedure was performed where periodontal intraosseous defect along with furcation defects were present. The results show that the bone formation in the furcation area was more with Group C (Periobone G and Resolut XT) as compared to the least amount of bone formation in Group A (Bio-Oss and Bio-Gide) in the test group, and this same group shows least bone formation in control. To conclude, clinical outcomes observed with the combined use of Atrisorb as a GTR barrier and PerioGlas as a bone graft material improved the clinical measurements of furcation defect depth compared to the use of PerioGlas alone.

Absence of Progressive Bone Loss Following Peri-Implantitis Surgical Therapy with Implantoplasty: A Case Series

Background: Peri-implantitis, a bacteria-associated inflammatory disease, is characterized by inflammation of the peri-implant mucosa and progressive loss of the supporting bone, thereby reducing the chances of dental implant survival. The absence of progressive marginal bone loss is crucial for implant success. The aim of this study is to assess the peri-implantitis resolution by measuring the absence of progressive bone loss rate around the implant over a period of one year to more than three years after surgical reconstructive (REC) treatment, apically repositioned flap (ARP) surgery, or combined (COM) treatment of peri-implantitis with implantoplasty. Methods: Peri-implantitis patients, that underwent surgical therapy with implantoplasty and that enrolled in a regular peri-implant supportive care program with a follow up of ≥12 months, were recruited in this study. ARP, REC, or COM surgical therapy was performed depending on the anatomy of the bone defect. For REC and COM groups, intraosseous defects were filled with a bone substitute. The ARP group consisted of an apically positioned flap without osseous surgery. Absence of progressive marginal bone loss was evaluated on radiographs of the treated implants. Results: A total of 57 patients (91 implants) were included. The study occurred over a follow-up period of 12 to 42 months (mean = 24 months). The surgical treatment with implantoplasty yielded an absence of progressive bone loss rate of 96.7% at implant level (100% REC, 98% COM, 92.9% ARP) and 96.5% at patient level. Three implants had to be removed in two patients due to relapse or progression of peri-implantitis. Conclusions: This case series demonstrated that implantoplasty during surgical treatment of peri-implantitis lesions resulted in favorable biological conditions to maintain functional implants with 96.7% of implants that did not show bone loss over time from one year to more than three years.

Effects of combined application of fibroblast growth factor (FGF)-2 and carbonate apatite for tissue regeneration in a beagle dog model of one-wall periodontal defect

There has been an increasing desire for the development of predictive periodontal regenerative therapy for severe periodontitis. In this study, we investigated the effect of the combined use of fibroblast growth factor-2 (FGF-2), a drug for periodontal regeneration approved in Japan, and carbonated apatite (CO3Ap), bioresorbable and osteoconductive scaffold, on periodontal regeneration in beagle dog model of one-wall periodontal defect (severe intraosseous defect) for 24 weeks in comparison with CO3Ap or vehicle alone. One-wall periodontal defects were created (mesiodistal width×depth: 4×4mm) on the mesial portion of the mandibular first molar (M1) of beagle dogs on both side. Mixture of FGF-2 and CO3Ap, vehicle and CO3Ap, or vehicle alone were administered to the defects and designated as groups FGF-2+CO3Ap, CO3Ap, and control, respectively. To assess the periodontal regeneration, radiographic analysis over time for 24 weeks, and micro computed tomography (μCT) and histological evaluation at 6 and 24 weeks were performed. For the regenerated tissue in the defect site, the mineral content of the FGF-2+CO3Ap group was higher than that of the CO3Ap group in the radiographic analysis at 6-24 weeks. In the context of new bone formation and replacement, the FGF-2+CO3Ap group exhibited significantly greater new bone volume and smaller CO3Ap volume than the CO3Ap group in the μCT analysis at 6 and 24 weeks. Furthermore, the density of the new bone in the FGF-2+CO3Ap group at 24 weeks was similar to those in the control and CO3Ap groups. Histological evaluation revealed that the length of the new periodontal ligament and cementum in the FGF-2+CO3Ap group was greater than that in the CO3Ap group at 6 weeks. We also examined the effect of the combined use of the FGF-2 and CO3Ap on the existing bone adjacent to the defect and demonstrated that the existing bone height and volume in the FGF-2+CO3Ap group remained significantly greater than those in the CO3Ap group. This study demonstrated that the combination of FGF-2 and CO3Ap was effective not only in enhancing new bone formation and replacing scaffold but also in maintaining the existing bone adjacent to the defect site in a beagle dog model of one-wall periodontal defect. Additionally, new periodontal tissues induced by FGF-2 and CO3Ap may follow a maturation process similar to that formed by spontaneous healing. This suggests that the combined use of FGF-2 and CO3Ap would promote periodontal regeneration in severe bony defects of periodontitis patient.

Prognostic value of a composite outcome measure for periodontal stability following periodontal regenerative treatment: A retrospective analysis at 4 years.

Recently, a composite outcome measure (COM) was proposed to describe the short-term results of periodontal regenerative treatment. The present retrospective study aimed at evaluating the prognostic value of COM on clinical attachment level (CAL) change over a 4-year period of supportive periodontal care (SPC). Seventy-four intraosseous defects in 59 patients were evaluated at 6 months and 4 years following regenerative treatment. Based on 6-month CAL change and probing depth (PD), defects were classified as: COM1 (CAL gain ≥3mm, PD ≤4mm); COM2 (CAL gain<3mm, PD ≤4mm); COM3 (CAL gain ≥3mm, PD>4mm); or COM4 (CAL gain<3mm, PD>4mm). COM groups were compared for "stability" (i.e., CAL gain, no change in CAL or CAL loss<1mm) at 4 years. Also, groups were compared for mean change in PD and CAL, need for surgical retreatment, and tooth survival. At 4 years, the proportion of stable defects in COM1, COM2, COM3, and COM4 group was 69.2%, 75%, 50%, and 28.6%, respectively, with a substantially higher probability for a defect to show stability for COM1, COM2, and COM3 compared with COM4 (odds ratio 4.6, 9.1, and 2.4, respectively). Although higher prevalence of surgical reinterventions and lower tooth survival were observed in COM4, no significant differences were detected among COM groups. COM may be of value in predicting CAL change at sites undergoing SPC following periodontal regenerative surgery. Studies on larger cohorts, however, are needed to substantiate the present findings.

Radiographic angle width as predictor of clinical outcomes following regenerative periodontal therapy with enamel matrix derivative. A retrospective cohort study with a mean follow-up of at least 10 years.

To assess the association between the baseline radiographic defect angle and the long-term clinical outcomes following periodontal regenerative therapy with enamel matrix derivative (EMD). Baseline periapical radiographs obtained from a cohort of patients treated with periodontal regenerative therapy were digitized and the radiographic angle width between the root surface and the bony wall of the adjacent intraosseous defect was calculated and reported (in degrees). Changes in pocket probing depth (PD) and clinical attachment level (CAL) were assessed and reported (in mm). Clinical outcomes were evaluated at baseline (T0), 6 months following therapy (T1), and at the latest follow-up (T2). Thirty-eight defects in 26 patients enrolled in supportive periodontal care for a mean period of 10.4 years (range 8.0 to 15.5 years) were available for analysis. The mean PD change between T0 and T2 was 2.33 ± 1.66 mm at teeth with a defect angle width < 20 degrees and 0.86 ± 1.66 mm at teeth with a defect angle width > 30 degrees (P = .021). When the baseline radiographic angle width was < 20 degrees the probability of obtaining a CAL gain > 3 mm was 1.5-times higher (95% CI 0.19 to 13.8) at T1 and 2.5-times higher (95% CI 0.40 to 15.6) at T2 compared with defects with a radiographic angle width > 30 degrees. Within their limitations, these results indicate that pretherapeutic measurement of the radiographic defect angle width might provide relevant information on the short-/long-term clinical outcomes following regenerative periodontal therapy with EMD.

Retracted: Observation on the Effect of Bone Grafting Alone and Guided Tissue Regeneration Combined with Bone Grafting to Repair Periodontal Intraosseous Defects.

[This retracts the article DOI: 10.1155/2021/1743677.].