Periodontal Defects Research Articles

LepR-expressing cells are a critical population in periodontal healing post periodontitis.

Identification of promising seed cells plays a pivotal role in achieving tissue regeneration. This study demonstrated that LepR-expressing cells (LepR+ cells) are required for maintaining periodontal homeostasis at the adult stage. We further investigated how LepR+ cells behave in periodontal healing using a ligature-induced periodontitis (PD) and a self-healing murine model with LepRCre/+; R26RtdTomato/+ mice. Lineage tracing experiments revealed that the largely suppressed osteogenic ability of LepR+ cells results from periodontal inflammation. Periodontal defects were partially recovered when the ligature was removed, in which the osteogenic differentiation of LepR+ cell lineage was promoted and contributed to the newly formed alveolar bone. A cell ablation model established with LepRCre/+; R26RtdTomato/+; R26RDTA/+ mice further proved that LepR+ cells are an important cell source of newly formed alveolar bone. Expressions of β-catenin and LEF1 in LepR+ cells were upregulated when the inflammatory stimuli were removed, which are consistent with the functional changes observed during periodontal healing. Furthermore, the conditional upregulation of WNT signaling or the application of sclerostin neutralized antibody promoted the osteogenic function of LepR+ cells. In contrast, the specific knockdown of β-catenin in LepR+ human periodontal ligament cells with small interfering RNA caused arrested osteogenic function. Our findings identified the LepR+ cell lineage as a critical cell population for endogenous periodontal healing post PD, which is regulated by the WNT signaling pathway, making it a promising seed cell population in periodontal tissue regeneration.

Polyphenols-based intelligent oral barrier membranes for periodontal bone defect reconstruction

Abstract Periodontitis-induced periodontal bone defects significantly impact patients’ daily lives. The guided tissue regeneration and guided bone regeneration techniques, which are based on barrier membranes, have brought hope for the regeneration of periodontal bone defects. However, traditional barrier membranes lack antimicrobial properties and cannot effectively regulate the complex oxidative stress microenvironment in periodontal bone defect areas, leading to unsatisfactory outcomes in promoting periodontal bone regeneration. To address these issues, our study selected the collagen barrier membrane as the substrate material and synthesized a novel barrier membrane (PO/4-BPBA/Mino@COL, PBMC) with an intelligent antimicrobial coating through a simple layer-by-layer assembly method, incorporating reactive oxygen species (ROS)-scavenging components, commercial dual-functional linkers and antimicrobial building blocks. Experimental results indicated that PBMC exhibited good degradability, hydrophilicity and ROS-responsiveness, allowing for the slow and controlled release of antimicrobial drugs. The outstanding antibacterial, antioxidant and biocompatibility properties of PBMC contributed to resistance to periodontal pathogen infection and regulation of the oxidative balance, while enhancing the migration and osteogenic differentiation of human periodontal ligament stem cells. Finally, using a rat periodontal bone defect model, the therapeutic effect of PBMC in promoting periodontal bone regeneration under infection conditions was confirmed. In summary, the novel barrier membranes designed in this study have significant potential for clinical application and provide a reference for the design of future periodontal regenerative functional materials.

Clinical and radiographic evaluation of Bio-Oss granules and Bio-Oss Collagen in the treatment of periodontal intrabony defects: a retrospective cohort study.

This retrospective study aimed to analyze the clinical efficacy of two regenerative surgical methods - Bio-Oss granules combined with barrier membranes and Bio-Oss Collagen alone - and to help clinicians achieve better periodontal regeneration outcomes in the specific periodontal condition. Patients who underwent periodontal regeneration surgery from January 2018 to April 2022 were retrospectively screened, and their clinical and radiographic outcomes at 6 months postoperatively were analyzed. The probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival recession (GR), distance from the cemento-enamel junction to the bottom of the bone defect (CEJ-BD), and depth of intrabony defects (INFRA) were recorded before the operation (T0) and 6 months after it (T1), and subsequently compared. In total, 143 patients were included - 77 were placed in the Bio-Oss group and 66 were placed in the Bio-Oss Collagen group. All indicators, including PD and CAL at T1, showed significant differences compared to baseline, for both groups (P<0.001). PD reduction was greater in the group receiving the Bio-Oss Collagen treatment (P=0.042). Furthermore, in cases when the baseline PD range was 7-11 mm and the age range was 35-50 years, PD reduction was more significant for patients receiving the Bio-Oss Collagen treatment (P=0.031, 0.023). A linear regression analysis indicated that postoperative PD and CAL were positively correlated with baseline values, and that the efficacy tended to decrease with increasing age. Both the use of Bio-Oss Collagen alone and the use of Bio-Oss granules combined with barrier membranes resulted in significant effects in the treatment of periodontal intrabony defects. The Bio-Oss Collagen treatment generated more improvements in PD than the Bio-Oss granules combined with barrier membranes, particularly within the baseline PD range of 7-11 mm and the 35-50 years age group. Additionally, age was the main factor influencing the effectiveness of regenerative surgery for intrabony defects: older individuals exhibited fewer improvements.

Impact of Specialized Pro-Resolving Lipid Mediators on Craniofacial and Alveolar Bone Regeneration: Scoping Review.

Craniofacial bone defects caused by tumors, trauma, long-term tooth loss, or periodontal disease are a major challenge in the field of tissue engineering. In periodontitis and peri-implantitis, reconstructive therapy is also a major challenge for the dental surgeon. Lipoxins, resolvins, protectins, and maresins, known as specialized pro-resolving lipid mediators (SPMs), have been widely studied in the field of dental, oral, and craniofacial research for bone regeneration for their actions in restoring tissue homeostasis and promoting tissue healing and regeneration. Therefore, this study focuses on a survey of the use of SPMs for craniofacial and alveolar bone regeneration. Thus, electronic searches of five databases were performed to identify pre-clinical studies that evaluated the actions of SMPs on craniofacial and alveolar bone regeneration. Of the 523 articles retrieved from the electronic databases, 19 were included in the analysis. Resolvin (Rv) E1 was the mostly assessed SPM (n=8), followed by maresins (Ma) R1 (n=3), lipoxins (Lx) A4 (n=3), RvD1 (n=3), RvD2 (n=1), LxB4 (n=1), and maresin (M)-CTR3 (n=1). Meta-analysis showed that SPMs increased the newly formed bone by 14.85% compared to the control group (p<0.00001), decreased the area of the remaining defect by 0.35 mm2 (p<0.00001), and decreased the linear distance between the defect to the bone crest by 0.53 mm (p<0.00001). RvE1 reduced inflammatory bone resorption in periodontal defects and calvarial osteolysis and enhanced bone regeneration when RvE1 was combined with a bovine bone graft. RvD2 induced active resolution of inflammation and tissue regeneration in periapical lesions, while RvD1 controlled the inflammatory microenvironment in calvarial defects in rats, promoting bone healing and angiogenesis. MaR1 induced the proliferation and migration of mesenchymal stem cells, osteogenesis, and angiogenesis in calvarial defects, and benzo (b)-LxA4 and LxA4 promoted bone regeneration calvarial and alveolar bone defects in rats, inducing regeneration under inflammatory conditions. In summary, SPMs have emerged as pivotal contributors to the resolution of inflammation and the facilitation of bone neoformation within craniofacial and alveolar bone defects. These results are based on pre-clinical studies, in vivo and in vitro, and provide an updated review regarding the impact of SPMs in tissue engineering.

The effect of titanium-platelet rich fibrin on periodontal intrabony defects: A randomized controlled split-mouth clinical study.

This study aimed to determine the contribution of titanium prepared platelet-rich fibrin (T-PRF) with open flap debridement (OFD) on clinical, biochemical and radiographic measurements of periodontal regeneration. Twenty periodontitis patients with bilateral intrabony defects and stage III grade A periodontitis were included in the study. A total of 40 defects were randomly selected for OFD alone (control group, n = 20) or combined OFD+ T-PRF (test group, n = 20). Clinical and radiographic parameters (at baseline and nine months after surgery), and growth factor levels in gingival crevicular fluid (at baseline and at two, four, six, and twelve weeks after surgical treatment) were also evaluated. Considering the clinical parameters, alterations in probing pocket depth, gingival marginal level and clinical endpoint in the test regions treated with T-PRF significantly improved (P<0.05). Fibroblast growth factor-2 and platelet-derived growth factor-BB levels between the two groups in the second and fourth weeks were also significantly different (P<0.05). Furthermore, the receptor activator of nuclear factor κB ligand/osteoprotegerin ratio between the groups was significantly different in the second, fourth, sixth, and twelfth weeks (P<0.05). The bone-filling rate was also significantly greater in the test group than in the control group (P <0.001). Compared with OFD alone, combining T-PRF with the procedure was more successful with regards to clinical, radiographic, and biochemical measurements of periodontal regeneration.

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.

Comparative evaluation of the effectiveness of concentrated growth factor alone and in combination with diode laser application in the treatment of intrabony periodontal defects: A clinical and radiographic split-mouth study.

Applying autologous growth factors and diode laser in periodontal therapy enhances fibroblast-mediated new attachment and osteoblastic differentiation. Hence, this study compared and evaluated the effectiveness of concentrated growth factor (CGF) alone and with diode laser application in managing intrabony periodontal defects. Ten patients with stage III periodontitis were included in this study. All the patients underwent an open flap debridement (OFD) procedure followed by CGF membrane placement in the intrabony defect in site A, whereas, in site B, after OFD, all the patients underwent diode laser irradiation before CGF membrane placement. Plaque and gingival bleeding index (PI & GBI), PPD, and clinical attachment level (CAL) were evaluated at baseline and 3 and 6 months later. Bone fill (BF), BF%, bone crest changes (BCC), and BCC% were assessed radiographically at six months postoperatively. Significant reductions in PI and GBI scores, probing pocket depth (PPD), and CAL gain were observed at both sites 3 and 6 months from baseline. A significant reduction in PPD and CAL gain was noted between sites, which were higher in site B than in site A with a mean difference of 0.70±0.05 mm and 1.30±0.18 mm, 0.90±1.89 mm at 3 and 6 months, respectively. Radiographic measurement showed better BF, BF%, BCC, and BCC% at both sites at six months, which were higher at site B than at site A but statistically insignificant. The combination of CGF and diode laser application has demonstrated successful and promising results in terms of regeneration, improving the clinical and radiographic parameters.

Regenerativna parodontalna terapija - II deo

Introduction: The periodontal diseases lead to the morphological and functional disintegration of the tooth-supporting apparatus, and a basic concept of surgical periodontal therapy is the elimination of periodontal pockets with the bone remodelling and creating the physiological architecture at a more apical level, thereby achieving better conditions for dental plaque control. The progenitor cell population in the periodontal ligament is served for the reconstruction of lost epithelial attachment. Guided Tissue Regeneration (GTR) is a procedure that allows for the repair of a periodontal defect by cells capable of creating new connective tissue attachment and alveolar bone, and the aim is a minimization of postoperative gingival recession. The objectives of GTR are the creation of a new epithelial attachment, an increase in the bone level, and the minimization of postoperative gingival recession. Aim: Presentation of modern approaches, materials, prognostic factors as well as complications of periodontal therapy that are focused on attachment regeneration and complete reconstruction of periodontal tissue. Conclusion: The difference in terms of outcomes of regenerative periodontal therapy relates to the degree of patient's cooperation with the therapist, the level of oral hygiene, the selection of an appropriate bone defect, as well as the methods of surgery. The high level of dental plaque control, elimination of pathogenic microflora and intensive antimicrobial periodontal therapy improve the outcome of periodontal regenerative therapy.

Improving astaxanthin-loaded chitosan/polyvinyl alcohol/graphene oxide nanofiber membranes and their application in periodontitis

Periodontitis is a chronic inflammatory disease primarily driven by host inflammation and plaque-induced immune responses. Controlling the host inflammatory response and improving the periodontal inflammatory microenvironment are crucial to promoting periodontal tissue regeneration. In this study, the blended nanofiber membranes previously prepared by our research group were improved, and we developed multifunctional chitosan/polyvinyl alcohol/graphene oxide/astaxanthin coaxial nanofiber membranes. Scanning electron microscopy showed that the prepared nanofibers had a smooth surface and a uniform diameter distribution. The mechanical property test results showed that the coaxial nanofiber membranes exhibited higher tensile strength compared to the blended nanofiber membranes, which increased from 4.50 ± 0.32 and 3.70 ± 0.45 MPa to 7.12 ± 0.22 and 5.62 ± 0.79 MPa respectively. Drug release studies indicated that the “shell-core” structure of coaxial nanofibers significantly reduced the initial burst release of astaxanthin (ASTA), with only 13.49 % and 10.71 % release in the first 24 h, and drug release lasted for over a week. Animal experiments confirmed that the coaxial nanofiber membranes loaded with ASTA promoted periodontal bone defect repair while inhibiting periodontal inflammation. In conclusion, the prepared coaxial nanofiber membranes are a promising sustained-release drug system for treating periodontitis.

Sustained delivery of chemically modified mRNA encoding amelogenin from self-assembling hydrogels for periodontal regeneration

Periodontitis is a growing clinical problem worldwide. Despite various approaches that have been devoted to repairing periodontal defects, the clinical outcomes are still limited due to the decline in tissue regenerative potential after periodontitis. Fortunately, chemically modified mRNA (modRNA)-based therapeutics have emerged as a promising strategy to combat incurable diseases. However, the use of modRNA for treating periodontitis is rare and challenging. Herein, a novel therapeutic mRNA platform that allows for sustained delivery and targeted osteogenesis and cementogenesis was developed for periodontal regeneration by combining a self-assembling PLA-PEG-PLA hydrogel and newly synthesized modRNA encoding amelogenin (AMELX) via in vitro transcription. The thermosensitive PLA-PEG-PLA hydrogel significantly prevented modRNA degradation and prolonged the release of encapsulated modRNA by forming an in situ hydrogel depot at 37 °C, resulting in sustained and strong expression of AMELX in human periodontal ligament stem cells (PDLSCs). Moreover, the AMELX modRNA exhibited a great capacity for promoting osteogenesis and cementogenesis of PDLSCs, as evidenced by elevated alkaline phosphatase (ALP) activity, calcium nodule formation, and osteogenesis- and cementogenesis-related gene expression (e.g., ALP, BMP2, CAP, BSP, COL1A1). As a result, after a single local injection, the PLA-PEG-PLA hydrogel enabled AMELX modRNA to persist and release at the defect site, thus successfully regenerating bone and periodontal ligament tissues in periodontal defects of rats. These findings provide a new approach for treating periodontal defects using self-assembling hydrogels to enable safe and effective delivery of AMELX modRNA, thereby offering various possibilities for functional tissue reconstruction with mRNA therapeutics.

The potential of nano graphene oxide and chlorhexidine composite membranes for use as a surface layer in functionally graded membranes for periodontal lesions

Membranes have been used for treating periodontal defects and play a crucial role in guided bone regeneration applications. Nano graphene oxide have been exploited in tissue engineering due to its biomechanical properties. Its composite formulations with hydroxyapatite and chitosan with controlled degradation could aid in becoming part of a surface layer in a functionally graded membrane. The aim of the study was to synthesize chitosan and composite formulations of nano graphene oxide, hydroxyapatite and chlorhexidine digluconate using solvent casting technique and to characterize the physiochemical, mechanical, water vapor transmission rate (barrier), degradation and antimicrobial potential of the membranes. Altogether four different membranes were prepared (CH, CCG, 3511 and 3322). Results revealed the chemical interactions of hydroxyapatite, chitosan and nanographene oxide due to inter and intra molecular hydrogen bonding. The tensile strength of 3322 (33.72 ± 6.3 MPa) and 3511 (32.06 ± 5.4 MPa) was higher than CH (27.46 ± 9.6 MPa). CCG showed the lowest water vapor transmission rate (0.23 ± 0.01 g/h.m2) but the highest weight loss at day 14 (76.6 %). 3511 showed a higher drug release after 72 h (55.6 %) Significant biofilm growth inhibition was observed for all membranes. 3511 showed complete inhibition against A. actinomycetemcomitans. Detailed characterization of the synthesized membranes revealed that 3511 composite membrane proved to be a promising candidate for use as a surface layer of membranes for guided bone regeneration of periodontal lesions.Graphical

E7-Conjugated Bio-Inspired Microspheres as a Biological Barrier for Guided Tissue Regeneration.

Guided tissue regeneration (GTR), which is based on creating a physical barrier to prevent the downgrowth of epithelial and connective tissues into the defect site, has been widely used in clinical practice for periodontal regeneration for many years. However, its outcomes remain variable due to highly specific indications, the demand for proficient surgical skills, and frequent occurrence of complications. In this study, we developed a new GTR biomaterial that acts as a biological barrier for epithelial cells and fibroblasts while also serving as a scaffold for bone marrow-derived mesenchymal stem cells (BMSCs) and periodontal ligament stem cells (PDLSCs). This innovative GTR biomaterial is bioinspired injectable microspheres that are self-assembled from nanofibers, and their surfaces are conjugated with E7, a short peptide that selectively promotes BMSC and PDLSC adhesion but inhibits the attachment and spreading of epithelial cells and gingival fibroblasts. The selective affinity afforded by E7 on the surfaces of the nanofibrous microspheres facilitated the colonization of BMSCs in the periodontal defect, thereby substantially improving functional periodontal regeneration, as evidenced by enhanced new bone formation, reduced root exposure, and diminished attachment loss. The remarkable superiority of the bioinspired microspheres over conventional GTR materials in promoting periodontal regeneration underscores the potential of this innovative approach to enhance the efficacy of functional periodontal tissue regeneration.

Platelet Concentrates for Regeneration and Treatment of the Hard and Soft Tissues

As a result of a high density and consequences of periodontal recessions, this study aims to compare the effect of different types of platelet concentrates used to treat hard and soft oral tissue defects. For the purpose of methodology, clinical trials which treat the peri-implant and periodontal defects with platelet concentrates, compared with conventional treatments were searched in PubMed/Medline, EMBASE, Cochrane Oral Health Group, and Lilacs. No statistical differences were found in the main outcomes for the analyzed variables: probing depth, clinical attachment level, root coverage, coronal advance flap, keratinized gingival width. There were only found significant differences in the access flap variable, solely and related with platelet concentrates. To sum up, seems to be beneficial for the treatment of periodontal and peri-implant defects the utilization of platelet rich pplasma (PRP), platelet rich fibrin (PRF) and leucocyte platelet rich fibrin (L-PRF). Nevertheless, in order to analyze the biological behavior of this blood products it is imperative to perform further investigations of this subject.

An injectable gel based on photo-cross-linkable hyaluronic acid and mesoporous bioactive glass nanoparticles for periodontitis treatment

Guided bone regeneration (GBR) is an effective strategy to promote periodontal tissue repair. The current study aimed to develop an injectable gel for GBR, composed of photo-cross-linkable hyaluronic acid and mesoporous bioactive glass nanoparticles (MBGNs) loaded with antibacterial minocycline hydrochloride (MNCl). Hyaluronic acid modified with methacrylic anhydride (MHA) that could be cross-linked under UV irradiation was first synthesized. Dynamic rheological evaluation of MHA under UV was carried out to determine its in-situ gelling feasibility and stability. Morphological and mechanical characterization was performed to determine the optimal concentration of MHA gels. Sol-gel derived MBGNs loaded with MNCl were further incorporated into MHA gels to obtain the injectable drug-loaded MBGN-MNCl/MHA gels. In vitro antibacterial, anti-inflammatory and osteogenic effects of this gel were evaluated. It was shown that the MHA gel obtained from 3 % MHA under UV treatment of 30s exhibited a suitable porous structure with a compressive strength of 100 kPa. MBGNs with particle size of ∼120 nm and mesopores were confirmed by TEM and SEM. MBGNs had a loading capacity of ∼120 mg/g for MNCl, exhibiting a sustained release behavior. The MBGN-MNCl/MHA gel was shown to effectively inhibit the proliferation of Streptococcus mutans and the expression of pro-inflammatory factors IL-6 and TNF-α by macrophages. It could on the other hand significantly promote the expression of osteogenic-related genes ALP, Runx2, OPN, and osterix of MC3T3-E1 cells. In conclusion, the current design using photo-crosslinkable MHA gel embedded with MNCl loaded MBGNs can serve as a promising injectable formulation for GBR treatment of irregular periodontal defects.

Barrier membranes for periodontal guided bone regeneration: a potential therapeutic strategy

Periodontal disease is one of the most common oral diseases with the highest incidence world-wide. In particular, the treatment of periodontal bone defects caused by periodontitis has attracted extensive attention. Guided bone regeneration (GBR) has been recognized as advanced treatment techniques for periodontal bone defects. GBR technique relies on the application of barrier membranes to protect the bone defects. The commonly used GBR membranes are resorbable and non-resorbable. Resorbable GBR membranes are divided into natural polymer resorbable membranes and synthetic polymer resorbable membranes. Each has its advantages and disadvantages. The current research focuses on exploring and improving its preparation and application. This review summarizes the recent literature on the application of GBR membranes to promote the regeneration of periodontal bone defects, elaborates on GBR development strategies, specific applications, and the progress of inducing periodontal bone regeneration to provide a theoretical basis and ideas for the future application of GBR membranes to promote the repair of periodontal bone defects.

Clinical and radiographic evaluation of the use of PRF, CGF, and autogenous bone in the treatment of periodontal intrabony defects: Treatment of periodontal defect by using autologous products.

The purpose of this randomized clinical study was to clinically evaluate and compare the efficiencies of platelet-rich fibrin (PRF), concentrated growth factor (CGF) and autogenous bone graft (ABG) in the treatment of intrabony pockets and to assess the alveolar bone gain (AB gain) radiographically (panoramic and CBCT images). Eighty intrabony pockets were divided into four groups: ojnly open flap debridement (OFD), OFD+PRF, OFD+CGF and OFD+ABG; each group consisted of 20 defects. Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and tooth mobility (TM) by using Periotest M device were evaluated. Radiographic images were also taken to evaluate the AB gain. PRF was produced using a protocol of 2,700 RPM for 12 min and the relative centrifugal force (RCF) was evaluated. CGF was prepared as follows: 2min 2700rpm, 4min 2400rpm, 4min 2700rpm, 3min 3000rpm. The study results revealed a similar improvement in PI and GI values in all groups (p>0.05). There was a statistically significant decrease in PD and CAL in favor of ABG group at day 180 in comparison with other groups (p=0.001). There was also a statistically significant decrease in TM and alveolar bone height loss (ABHL), whereby the AB gain gradually increased among the groups with the best group being ABG, followed by CGF, PRF, and control groups, respectively (p=0.001). The study results support the treatment of periodontal intrabony pockets using OFD in combination with ABG, CGF, and PRF, as ABG showed the best results followed by CGF and PRF.

Single-flap approach versus without concentrate growth factor in the treatment of periodontal supra-osseous defects: A randomized controlled clinical trial

ObjectivesWe aimed to compare treatment outcomes of periodontal supra-bony defects using single flap (SFA) plus concentrate growth factor versus SFA alone. Methods32 supra-bony periodontal defects were randomly assigned to test and control groups. Outcome variables were clinical attachment level (primary outcome). Probing pocket depths, gingival recessions, bone gain, post-surgical pain using visual analogue scale and wound healing index were recorded as secondary outcomes. Clinical and radiographic assessments were recorded at baseline and 6 months after treatment, whereas pain score and wound healing index were recorded within 10 days after surgery. ResultsTest group showed a significant improvement in all tested parameters compared to control group (P-value ≤ 0.05). Better patient centered outcomes (wound healing and pain scores) were highly achieved in the test group compared to controls. ConclusionThe tested combined approach offers better periodontal and patient centered treatment outcomes in management of periodontal supra-bony defects.

Bone regeneration property of tooth-derived bone substitute prepared chairside for periodontal bone defects: an experimental study

BackgroundPeriodontitis often leads to progressive destruction and loss of alveolar bone, the reconstruction of which remains difficult in periodontal therapy. As a novel bone graft material, tooth-derived bone substitute (TDBS) processed from extracted teeth has been previously reported about its osteoconductivity and promising results in bone regeneration. This study was to investigate the biological effects and bone regeneration properties of TDBS in vitro and in vivo using rat periodontal bone defect model.MethodsThree groups of materials were used in the experiments: TDBS, TDBS treated with ethylene diamine tetraacetic acid (EDTA) (TDBS-E), and allogeneic bone materials. Calcium (Ca) and phosphate (P) ion dissolutions were quantified by spectrophotometer for seven days. The releases of bone morphogenetic protein-2 (BMP-2) and transforming growth factor-β1 (TGF-β1) were identified by enzyme-linked immunosorbent assay (ELISA). Human osteoblast proliferation, migration, and differentiation were detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cell counting, alkaline phosphatase activity (ALP), and alizarin red staining (ARS), respectively. Furthermore, the osteogenic effects of TDBS on periodontal furcation bone defects were evaluated at eight weeks postoperatively using micro-computed tomography (Micro-CT) and histological analysis.ResultsThe dissolution of both Ca and P ions in TDBS increased over time. The BMP-2 released from TDBS was significantly higher than that from TDBS-E and allografts, while the TGF-β1 release from TDBS and TDBS-E groups was higher than that in the allografts. The TDBS-E group could induce the highest level of osteoblast proliferation compared to other groups. Cell migration with allografts co-culture was significantly induced compared to the blank control. However, all groups demonstrated similar positive effects on osteoblast differentiation. Furthermore, in the periodontal model, all materials could effectively enhance bone regeneration in the furcation defect.ConclusionsThe TDBS prepared chairside as an autogenous bone graft, demonstrating osteoinductivity, which enhances the osteogenic biological characteristics. Therefore, TDBS is suggested as an economical and biocompatible material for periodontal bone regeneration.

VISTA approach in conjunction with enamel matrix derivative, cortico-cancellous bone, and connective tissue graft for periodontal defect surgery: A case series.

The biggest challenge during periodontal regeneration in the anterior region is the prevention of soft-tissue recession. Minimally invasive surgeries, particularly papilla preservation techniques and soft-tissue augmentation, may significantly reduce such postoperative soft-tissue recession. This article presents the vestibular incision subperiosteal tunnel access approach for periodontal regeneration in the anterior region. A subperiosteal tunnel prepared from a single vertical vestibular incision adjacent to the defect is used for debridement, enamel matrix derivative application, defect grafting with cortico-cancellous tuberosity bone, and insertion of the connective tissue graft. Evaluation of six cases with up to 6 years of follow-up showed improvements in all clinical parameters. The probing pocket depth improved from 8.2±0.75 mm initially to 2.7±0.52 mm at follow-up, clinical attachment level improved from 8.5±0.83 mm initially to 2.7±0.52 mm at follow-up, and midfacial gingival recession of 1 mm at two sites was corrected. The papillae were stable at all sites, with an average distance of 4.8 mm from the incisal edge to the papilla tip. This technique seems to be a promising approach for achieving both esthetic and functional goals of periodontal regenerative surgery. However, experience in performing microsurgeries and harvesting tuberosity tissues may be a limitation.

Hierarchically patterned triple-layered gelatin-based electrospun membrane functionalized by cell-specific extracellular matrix for periodontal regeneration

ObjectivesRegenerating the periodontium poses a critical challenge in oral medicine. To repair various periodontal defects, it is necessary to adopt a bio-scaffold that provides both the architecture and bioactive cues for local stem cells to migrate, reside, proliferate, and differentiate. The objective of this study is to combine a cell-specific decellularized extracellular matrix (ECM) and a biomimetic electrospinning scaffold to regenerate severely destructed periodontium. MethodsSEM, water contact angle (WCA), live/dead staining, swelling ratio, tensile test and immune-fluorescent staining were used to define the suitable topography for certain dental stem cells seeding and culturing. Transwell assay, CCK-8, Alizarin Red staining and PCR immune-fluorescent staining were used to determine ideal cell-specific ECM for PDLSCs/BMSCs migration, viability, and oriented differentiation. A biodegradable triple-layered electrospun scaffold (TLS) was fabricated by electrospinning with aligned fibers on both surfaces and a polyporous structure in the middle. The morphology and inter-porous structure of the TLS were characterized by SEM and mercury intrusion porosimetry (MIP). The surface of the TLS was functionalized with cell-specific ECM (Bi-ECM-TLS) through decellularization of the cell sheets cultured on the scaffold. The regenerative outcome of Bi-ECM-TLS was assessed by an in-situ rat periodontal defect model. Micro-CT, HE-staining, Masson’s trichome staining, Sirius Red staining and Immunofluorescent staining were used for histological analysis. ResultsAligned Gelatin/PCL fibrous membrane (GPA) was most effective for both PDLSCs and BMSCs in culture with WCA around 50 degrees and better mechanical strength than the rest. MSCs favored the same type of ECM (cell-specific ECM), and their regenerative properties were effectively induced with better chemotaxis, proliferative and differentiating behaviors. TLS characterization showed that TLS possessed aligned-random-aligned structure and inter-porous structure. In a rat model of periodontal defects, the TLS functionalized by BMSC-specific ECM for bone regeneration and PDLSC-specific ECM demonstrated highest BV/TV ratio, best bone structure and ligament fiber orientation and blood vessel formation, suggesting optimal performance in regenerating both alveolar bone and periodontal ligaments over TLS, single-ECM loaded TLS and r-Bi-ECM-TLS. SignificanceThis study highlights the importance of combining a cell-specific decellularized ECM and a biomimetic electrospinning scaffold for targeted periodontal tissue regeneration, with potential implications for periodontal tissue engineering and improved patient outcomes.