Management Of Intrabony Defects Research Articles

Management of intrabony defects using enamel matrix derivative

Management of intrabony defects using enamel matrix derivative

Sub-gingival delivery of simvastatin and rosuvastatin for treatment of chronic periodontitis with diabetes mellitus: A randomized controlled clinical-radiographic pilot study.

Statins are lipid-lowering medications that work by blocking rate-limiting enzyme in cholesterol formation. In patients with Chronic periodontitis (CP) and Diabetes mellitus (DM), subgingival delivery of simvastatin (SMV) and rosuvastatin (RSV) have demonstrated to have bone-stimulatory and anti-inflammatory properties. The current study intended to assess and compare the efficacy of sub-gingivally delivered SMV gel and RSV gel as an adjunctive medication to scaling and root planing (SRP) in the management of intrabony defects in CP patients with type 2 DM. 30 patients with CP and type 2 DM were classified into three treatment groups - SRP+placebo, SRP +1.2% SMV and SRP +1.2% RSV. Clinical parameters: site-specific plaque index, modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment level (RAL) were documented at baseline, 3 and 6 months and radiographic parameter: intrabony defect depth (IBD) at baseline and 6 months post-treatment. - LDD of 1.2% SMV and 1.2% RSV demonstrated greater clinical and radiographic improvement than placebo, the improvement being statistically significant for PI, mSBI, and PPD for 1.2% SMV and statistically significant for all clinical and radiological parameters for the 1.2% RSV. 1.2% RSV demonstrated greater IBD fill and RAL gain than 1.2% SMV. - Localized sub-gingival delivery of statins was beneficial in the treatment intrabony defects in patients with CP and well-controlled type 2 DM. IBD fill and RAL gain were higher with 1.2% RSV than with 1.2% SMV.

Effect of Amnioguard and Biomesh GTR Membranes with Novabone Putty in the Treatment of Periodontal Osseous Defects—A Communication

(1) Background: Guided tissue regeneration was an effective surgical procedure in the management of intrabony defects and has undergone a number of changes in terms of materials and techniques. The aim of this study is to compare AmnioGuard and BioMesh in combination with NovaBone putty in intrabony defects. (2) Methodology: Ten patients who needed regenerative periodontal therapy were randomly allocated into two groups based on the inclusion criteria. These patients were subjected to phase I therapy followed by which Group A patients were treated with AmnioGuard + NovaBone putty whereas Group B with BioMesh + NovaBone putty. The clinical indices were obtained at baseline, 3 months and 6 months post-operatively while radiographic parameters were obtained at 6 months post-op. (3) Results & Conclusion: At six months after surgery, Group B (33% bone gain) showed a statistically significant change from Group A (16% bone gain) in both the clinical and radiographic measures (p < 0.05).

The use of Titanium Platelet-Rich Fibrin to Enhance the Treatment Outcome of Intrabony Defect in the Chronic Periodontitis Patients - A Systematic Review and Meta-Analysis

Aim and Objective: The aim and objective of the study are to ascertain the use of titanium platelet-rich fibrin (T-PRF) to enhance the treatment outcome of intrabony defect in the chronic periodontitis patients. Methodology: Data resources: Four databases MEDLINE (by PubMed), Cochrane database, EBSCO, and Google Scholar were explored to identify the studies in English from 2015 up to March 2021. An additional hand search of relevant journals was also done. All the reviewers screened the retrieved articles using the particular inclusion criteria. Randomized control trials evaluating the use of T-PRF to enhance the treatment outcome of intrabony defect in chronic periodontitis patients were included in the study. Outcome variables examined were probing pocket depth (PPD) reduction, relative attachment level (RAL) gain, change in gingival index (GI) and plaque index (PI), radiographic depth reduction. Statistical Analysis: Data were analyzed using Revman 5.3 software. The mean differences and 95% confidence interval were used to illustrate the estimate of effect size. Study Selection: five relevant articles were recognized for data procurement. A total of 138 patients had been appraised with confirmation of intrabony defects. In the included studies, age span of participants was between 20 and 59 years. Results: It displayed that the use of T-PRF induced a reduction in PPD, gain in RAL along with open flap debridement (OFD) in the management of intrabony defects. The use of T-PRF along with OFD and OFD only has equal effect on GI and PI. Conclusion: Thus, within the constraints of the study, it implies that T-PRF can be adapted contentedly in conjunction with OFD to deal with the intrabony defect.

Randomized, controlled clinical trial to evaluate efficacy of sticky bone and concentrated growth factor in the management of intrabony defects: 12 months follow-up study

Platelet derivatives are enriched growth factors that ameliorate various cellular processes in regeneration. The present clinical trial aimed to evaluate and compare the effects of sticky bone and concentrated growth factors (CGFs) in the treatment of intrabony osseous defects by cone-beam computed tomography (CBCT). The study included 20 patients having 40 intrabony defects. 20 sites each were included in both test group (Sticky bone) and Control group (CGF alone). The clinical parameters including probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline and 6 and 12 months posttherapy. The radiographic parameters including the depth, mesiodistal (MD), and the buccolingual (BL) width of the defect to assess the amount of bone fill were examined at baseline and after 12 months using CBCT. Twelve months posttherapy clinical results indicated a significant reduction of PPD and gain in CAL in both the study groups. Similar observations were recorded with CBCT radiographic parameters where the intrabony defect depth and MD defect width for the test group and control group significantly reduced after 12 months' posttherapy (P < 0.0001). However, no significant reduction in BL defect width was observed in control group (P = 0.577) in contrast to the test group (P = 0.028) after 12 months' posttherapy. Intrabony defects treated with sticky bone showed improved clinical and radiographic parameters indicative of enhanced periodontal regeneration as compared to CGF alone treated sites.

Effectiveness of Chitosan Nanohydrogel as a Bone Regenerative Material in Intrabony Defects in Patients With Chronic Periodontitis: A Randomized Clinical Trial

Aim: Different procedures have been attempted to regenerate intrabony defects in periodontitis but complete regeneration is still a herculean feat. Nanoparticles could prove to be advantageous because of their small size and increased surface area. The aim was to evaluate the effectiveness of a chitosan nanohydrogel as a periodontal regenerative material in the management of intrabony defects. Materials and Methods: Twenty patients within the age group of 30 to 60 years with intrabony defects &gt;3 mm and clinical attachment levels &gt;5 mm were selected. They were divided randomly into two groups: group-1, which received only open flap debridement with bone graft and acted as control, and group-2, which received open flap debridement, bone graft mixed with a chitosan nanohydrogel, and acted as the test site. Clinical and radiographic measurements were recorded at baseline, three months, and six months. Intragroup comparison was done using a paired t-test and intergroup comparison was done using an unpaired t-test with the statistical value set at P &lt; .05. Results: Chitosan hydrogel incorporated bone grafts showed improved bone regenerative potential. The mean reduction in clinical attachment level in group-2 (8.7 ± 0.6 to 1.6 ± 0.8) was significantly higher than that of group-1 (8.6 ± 0.5 to 2.4 ± 0.7). The mean reduction in probing depths in group-2 (test group) was significantly higher (8.3 ± 0.9 to 1.6 ± 0.8) when compared to group-1 (8 ± 0.8 to 2.3 ± 0.7). Significant amount of defect fill was obtained in both the groups from baseline to six-month period. Conclusion: Organic materials such as chitosan could have potential bone regenerative capacity.

Effect of Low-Level Laser Therapy and Platelet-Rich Fibrin on the Treatment of Intra-bony Defects

Introduction: Attempts to regenerate the periodontal osseous defect, which is lost as a result of periodontal disease, require the tapping of the innate healing potential of periodontium through appropriately designed therapeutic strategies. A multitude of grafted and non-grafted approaches have been used in the management of Intra-bony defects. However, they do not provide predictable periodontal regeneration. The aim of this study was to evaluate the combined effect of low-level laser therapy (LLLT) and platelet-rich fibrin (PRF), in site modulated intra-bony defects (decortication), which were accessed using a simplified papilla preservation flap (SPPF), on the clinical and radiographic outcomes of periodontal disease. Methods: A total of 30 patients with intra-bony defects were recruited for the study and randomly distributed in two groups (n=15). Test group sites were accessed with SPPF and the defects received intra-marrow Penetration (IMP) following debridement and were irradiated with a low-level laser followed by PRF grafting and suturing done. The control group defects were accessed with SPPF and grafted with PRF before being secured by sutures. The plaque and bleeding score, PPD, CAL, and the position of the gingival margin with radiographic defect depth were recorded and analyzed at baseline and six months post-intervention using the student's t test and Wilcoxon signed rank test. Results: The test group showed a clinically relevant increase in mean PPD reduction, CAL gain, and radiographic bone fill (3.6 ± 1.35 mm, 3.26 ± 1.16 mm and 2.44 ± 1.24 mm) compared to the control group (2.93 ±1.1 mm, 2.267 ± 1.33 mm and 1.26 ± 0.99 mm) six months post-intervention. However, intergroup comparison between the test and control groups did not show any statistically significant difference. Conclusion: These results highlights that test protocol had greater amelioration of the effects of periodontal disease and all the investigated clinical and radiographic parameters showed considerable improvement from baseline to 6 months within test and control group, but intergroup comparison between the test and control groups did not show any statistically significant difference, indicating statistical equivalence between the test and control protocol.

COMPARISON OF AUTOGENOUS PERIOSTEAL PEDICAL GRAFT AS A BARRIER AND BIORESORBABLE COLLAGEN MEMBRANE IN MANAGEMENT OF PERIODONTAL INTRABONY DEFECTS: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Introduction: The autogenous periosteal pedicle graft (PPG) has been viewed as having regenerative potential and provides adequate blood supply rich in growth factors. It also provides a rigid barrier maintaining the patency of the periodontal intrabony defect space for regenerative cell repopulation. Thus, PPG might be an alternative to currently available barrier membranes used for guided tissue regeneration (GTR). So, the aim of this study was to evaluate the clinical and radiographic outcomes of autogenous PPG as a barrier compared to bioresorbable collagen membrane (CM) for treating periodontal intra-bony defects.Materials and methods: Twenty chronic periodontitis patients having matched contralateral periodontal intrabony defects participated in this randomized controlled clinical trial. Using split-mouth design, defects were randomly treated with either autogenous PPG or bioresorbable CM (Bioteck®, Arcugnano VI, Italy). Clinical outcomes included; plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment level (CAL). Digital periapical radiographs and linear measurements were used to calculate the radiographic outcomes; bone defect area (BDA). Measurements were taken at the time of surgery (baseline) and 6-months postoperatively. Statistical analysis was conducted using Wilcoxon’s-Signed-Rank test.Results: At 6 months both treatments resulted in statistically significant improvement in all clinical and radiographic outcomes compared with baseline (P 0.05). Conclusion: Within the limitations of this study, it can be concluded that both the autogenous PPG and the bioresorbable CM improved clinical and radiographic outcomes and were effective GTR membranes in management of intra-bony defects.

Management of intrabony defects in periodontal disease

Intrabony periodontal defects present a clinical challenge in the treatment of periodontal disease and maintenance of compromised teeth. The management of such defects ranges from non-surgical mechanical debridement to modern minimally invasive regenerative surgery. The incidence of intrabony defects is discussed along with prognosis and likely outcomes of various treatment options. CPD/Clinical Relevance: Vertical or intrabony (IB) defects are a common occurrence in patients suffering from advanced periodontal disease. Primary care practitioners must be aware of possible treatment options in order to make suitable referrals when initial phases of treatment prove unsuccessful.

Evaluation of Clinical Effectiveness of Bioactive - Glass and Platelet - Rich Fibrin in the Management of Intrabony Defects - A Comparative Study

Background: Platelet-Rich Fibrin (PRF), the second-generation platelet concentrate has various fringe benefits over other platelet concentrates. Just finite number of research works have concentrated on the utilization of PRF in combination with various kinds of bone grafts in intra-bony defects. Objective: The primary intention of this study was to determine the clinical and radiographical efficacy of Bioactive-glass with and without autologous PRF in the management of three-wall vertical defects. Methods: Twenty intrabony defects were arbitrarily chosen and treated either with Bioactive Glass (BG) alone or in mix with PRF (PRF/BG). Clinical parameters were documented preoperatively (baseline) and at six months post-operatively. Radiographic analysis was performed at baseline, third and sixth-month intervals. Results: The study outcome demonstrated that both treatment approaches were effectual. Significant decrease in the mean probing depth and gain in clinical attachment was observed in BG+PRF and BG groups as compared to baseline but was statistically insignificant at 6 months. (p=0.475, p=0.245 respectively). Radiographically, reduction in defect depth was significantly greater in BG+PRF group than BG group (p=0.007) at 6 months. Conclusion: Within the limitation of the current study, it is proposed that both treatment modalities are effective in the management of 3-wall intra-bony defects. The outcomes additionally uncovered that incorporation of PRF with BG has more successful and promising results. Hence in future, clinical trials with bigger sample size may be employed to further explore the potential benefits of PRF as a sole grafting material.

Photoactivated disinfection using indocyanine green photosensitizer as an adjunct to regenerative periodontal therapy

Regenerative periodontal surgical procedures attempt to restore lost periodontal structure and functional attachment through the regeneration of cementum, periodontal ligament, and alveolar bone. Although meticulous debridement using surgical instrumentation reduces the bacterial burden, it fails to kill the periopathogens. To overcome this shortcoming, the development of alternative adjunctive or exclusive antibacterial therapeutic strategies, therefore, becomes important in the evolution of methods to control microbial growth in the oral cavity. The following case report explores the use of antimicrobial photodynamic therapy as an adjunct to regenerative periodontal therapy for the management of intrabony defects which was evaluated over a period of 6 months.

A Novel Approach Using 15% Natural Chitosan Gel in the Management of Intrabony Defects: A Pilot Study.

To evaluate the effectiveness of 15% chitosan in gel form as a periodontal regenerative material in the periodontal intrabony defects. A pilot study split-mouth design of 10 patients within the age group of 30 to 55 years with bilateral intrabony defects ≥ 3mm and clinical attachment levels (CAL) ≥ 5mm were selected. The test site received open flap debridement with 15% Chitosan gel as a regenerative material and the controlateral side that acted as a control received only open flap debridement. Clinical and radiographic measurements were recorded at baseline, and 3, 6 and 9 months after the treatment. Data revealed that there was a significant improvement in both clinical and radiographic parameters when intragroup comparison was performed. When intergroup comparison was done, there was a mean difference in CAL (5.8 ± 1.398 mm) and the depth of the intrabony defect (3.41 ± 1.17 mm) at 9 months when compared to baseline. Within the limitations of the study, it can be concluded that a 15% concentration of chitosan gel is a promising aid and could be used as an effective material in periodontal regeneration.

Clinical Efficacy of Subgingivally Delivered 1.2% Atorvastatin in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Atorvastatin (ATV) is a specific competitive inhibitor of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. Recently, statins have shown pleiotropic effects such as anti-inflammation and bone stimulation. The aim of the present study is to investigate the effectiveness of 1.2% ATV as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects (IBDs). Sixty individuals were randomized into two treatment groups: SRP plus 1.2% ATV and SRP plus placebo gel. At baseline and 3, 6, and 9 months, clinical parameters, which included modified sulcus bleeding index, plaque index, probing depth (PD), and clinical attachment level (CAL), were recorded at baseline. Radiologic assessment of IBD fill was done using computer-aided software at baseline and 6 and 9 months. Mean PD reduction and mean CAL gain were greater in the ATV group than the placebo group at 3, 6, and 9 months. A significantly greater mean percentage of radiographic bone fill was found in the ATV group (35.49% ± 5.50%) compared to the placebo group (1.82% ± 1.32%) after 9 months. ATV as an adjunct to SRP can provide a new direction in the management of IBDs.