Periodontal Intrabony Defects Research Articles

Periodontal bone regeneration in intrabony defects using osteoconductive bone graft versus combination of osteoconductive and osteostimulative bone graft: A comparative study.

Bone loss is one of the hallmarks of periodontitis. Hence, a major focus of research into periodontal regeneration has concentrated on the initiation of Osteogenesis. Osteoinduction requires the differentiation of mesenchymal cells into osteoblasts with subsequent formation of new bone. The present study has been carried out to evaluate periodontal bone regeneration in intrabony defects using osteostimulative oleaginous calcium hydroxide suspension Osteora(®) (Metacura, Germany) in combination with osteoconductive bone graft Ossifi™ (Equinox Medical Technologies, Holland). A total of 22 sites in patients within the age range of 25-50 years, with intrabony defects were selected and divided into two groups (Group A and Group B) by using the split-mouth design technique. All the selected sites were assessed with the clinical parameters such as - Plaque Index, Gingival Index, Sulcus Bleeding Index, Periodontal Probing Depth, Clinical Attachment Level, Gingival Recession and radiographic parameter to assess the amount of Defect Fill. Mann-Whitey U-test and Wilcoxon Signed Rank Test has been used to find the significance of study parameters on continuous scale for the comparison between the mesial and distal bone levels. P < 0.05 was considered to be statistically significant. Osteora(®) in combination with osteoconductive Ossifi™ showed better regenerative potential and more significant amount of bone fill in periodontal intrabony defects than when Ossifi™ was used alone (P = 0.039). Osteora(®) can be used as an adjunct to osteoconductive bone grafts, as an osteo-stimulating agent in the treatment of periodontal intrabony defects.

Evaluation of intrabony defects treated with platelet-rich fibrin or autogenous bone graft: A comparative analysis.

Objective:The primary objective of this study was to compare clinically and radiographically the efficacy of autologous platelet rich fibrin (PRF) and autogenous bone graft (ABG) obtained using bone scrapper in the treatment of intrabony periodontal defects.Materials and Methods:Thirty-eight intrabony defects (IBDs) were treated with either open flap debridement (OFD) with PRF or OFD with ABG. Clinical parameters were recorded at baseline and 6 months postoperatively. The defect-fill and defect resolution at baseline and 6 months were calculated radiographically (intraoral periapical radiographs [IOPA] and orthopantomogram [OPG]).Results:Significant probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, defect fill and defect resolution at both PRF and ABG treated sites with OFD was observed. However, inter-group comparison was non-significant (P > 0.05). The bivariate correlation results revealed that any of the two radiographic techniques (IOPA and OPG) can be used for analysis of the regenerative therapy in IBDs.Conclusion:The use of either PRF or ABG were effective in the treatment of three wall IBDs with an uneventful healing of the sites.

Clinical and radiographic evaluation of nanocrystalline hydroxyapatite with or without platelet-rich fibrin membrane in the treatment of periodontal intrabony defects.

Background:Nano-sized ceramics may represent a promising class of bone graft substitutes due to their improved osseointegrative properties. Nanocrystalline hydroxyapatite (NcHA) binds to bone and stimulate bone healing by stimulation of osteoblast activity. Platelet-rich fibrin (PRF), an intimate assembly of cytokines, glycan chains, and structural glycoproteins enmeshed within a slowly polymerized fibrin network, has the potential to accelerate soft and hard tissue healing. The present study aims to explore the clinical and radiographical outcome of NcHA bone graft with or without PRF, in the treatment of intrabony periodontal defects.Materials and Methods:In a split-mouth study design, 20 patients having two almost identical intrabony defects with clinical probing depth of at least 6 mm were selected for the study. Selected sites were randomly divided into two groups. In Group I, mucoperiosteal flap elevation followed by the placement of NcHA was done. In Group II, mucoperiosteal flap elevation, followed by the placement of NcHA with PRF was done. Clinical and radiographic parameters were recorded at baseline and at 6-month postoperatively.Results:Both treatment groups showed a significant probing pocket depth (PPD) reduction, clinical attachment gain, increase bone density 6-month after surgery compared with baseline. However, there was a significantly greater PPD reduction and clinical attachment gain when PRF was added to NcHA.Conclusion:The NcHA bone graft in combination with PRF demonstrated clinical advantages beyond that achieved by the NcHA alone.

Clinical and radiographic evaluation of periodontal intrabony defects by open flap surgery alone or in combination with Biocollagen(®) membrane: A randomized clinical trial.

Background:Guided tissue regeneration (GTR) is often incorporated in regenerative periodontal surgical procedures. However, the actual benefits of adding GTR to such a procedure remain undocumented. The purpose of this randomized controlled trial was to investigate the contribution of GTR to the outcomes of open flap debridement (OFD) in the treatment of intrabony defects.Materials and Methods:A total of 16 patients of both sexes satisfying the criteria of chronic periodontitis and each of whom displayed one intrabony defect were randomly assigned to two groups, i.e. either treated with open flap surgery and GTR (group 1) or with open flap surgery alone (group 2), in this parallel-arm study. The soft tissue and hard tissue measurements, including probing pocket depth (PD), clinical attachment level (CAL), and bone mineral density were recorded at baseline and 3,6 and 12 months after surgery. The differences with a P < 0.05 were considered significant.Results:Results showed that the membrane group showed significant difference when compared with open flap surgery alone, in relation to the degree of periodontal pocket, clinical attachment loss, and bone density.Conclusion:The findings of this study suggest that biocollagen membrane could be considered as an option in the treatment of intrabony defects. Biocollagen membrane alone gives favorable clinical results in the treatment of intrabony defects. Open flap debridement resulted in acceptable clinical results in the treatment of intrabony defects.

Treatment of periodontal intrabony defects with platelet-rich fibrin and porous hydroxyapatite bone graft: A comparative clinical and radiographic study using Dentascan

Objective: The aim of the present study was to compare autologous platelet-rich fibrin (PRF) combined with a porous hydroxyapatite bone graft to porous hydroxyapatite bone graft alone in the treatment of periodontal intrabony defects clinically and radiographically using Dentascan. Materials and Methods: In a split-mouth study design, 10 patients suffering from generalized chronic periodontitis, having two almost identical intrabony defects with probing pocket depth of at least 5 mm were selected for the study and randomly divided into two groups. In Group I periodontal flap surgery followed by placement of porous hydroxyapatite bone graft was done and in Group II, periodontal flap surgery followed by placement of a homogenous mixture of PRF and porous hydroxyapatite bone graft was done. All the clinical parameters were recorded at baseline, 3 and 6 months postoperatively and radiographic parameters were recorded at baseline and 6 months postoperatively. Results: There was statistically significant reduction in probing pocket depth and gain in clinical attachment level in both groups. On comparison Group II showed statistically significant more probing pocket depth reduction than Group I at all-time intervals. There was statistically significant mean defect fill and mean defect resolution observed in both groups at all-time intervals. However, the intergroup comparison was statistically nonsignificant. Conclusion : Within limits of the study it may be concluded that a combination of PRF with porous hydroxyapatite bone graft demonstrated better results as compared to porous hydroxyapatite bone graft alone in the treatment of periodontal intrabony defects. Spiral multislice computed tomography equipped Dentascan provides three-dimensional images of excellent quality for evaluating the morphology of the periodontal bone defects. Its use in ascertaining the various defect parameters in the periodontal treatment of intrabony defects is promising.

Use of Fibrin Sealant in Guided Tissue Regeneration of Intrabony Defect

Background: The treatment of periodontal intrabony defect can be a challenge to clinicians especially with the use of barrier membrane in guided tissue regeneration (GTR). The mechanical and biological regenerative potential of barrier membrane could be enhanced with the use of fibrin sealant. The purpose of this case report was to describe a surgical procedure achieving regeneration with fibrin sealant application in combination with guided tissue regeneration (GTR) to eliminate intrabony defect. Methods: A 21 year old systemically healthy female had the complaint of swelling and bleeding from gingiva in maxillary anterior region since 6 months. On clinical examination, there was a high frenal attachment penetrating deep into the palatine papilla leading to midline diastema. The papilla caused opening of the gingival margin in the palatine region leading to pocket formation in mesial side of 7 mm and 5 mm in relation to 21, 12. Radiographic examination revealed an intrabony defect in the same region. Due to persistence of pocket after frenum excision, surgical treatment for GTR was planned with use of bio-resorbable collagen membrane and fibrin sealant application. Results: The patient was followed for 9 months post-operatively. Reduction in probing depth was observed in 6 month and radiographic bone fill at 9 months. The probing depth was reduced to 3 mm in relation to 21 and 12. The gingival tissues appeared healthy with no bleeding on probing or gingival recession. Conclusion: This case report shows the possibility of achieving periodontal regeneration over a localized intrabony defect with the combined use of GTR membrane and fibrin sealant. An adjunctive regenerative technique is presented that allowed space making, stabilization of membrane, early wound healing as well as local taxis of growth factors for regeneration of periodontal tissues. Clinical implication: The use of fibrin sealant boosted the regenerative potential of barrier membrane showing potential of new bone formation and early wound healing.

Periodontal tissue regeneration using enzymatically solidified chitosan hydrogels with or without cell loading.

This study is aimed to evaluate the in vivo biocompatibility and periodontal regenerative potential of enzymatically solidified chitosan hydrogels with or without incorporated periodontal ligament cells (PDLCs). To this end, chitosan hydrogels, with (n=8; CHIT+CELL) or without (n=8; CHIT) fluorescently labeled PDLCs, were prepared and transplanted into rat intrabony periodontal defects; untreated defects were used as empty controls (n=8; EMPTY). After 4 weeks, maxillae were harvested, decalcified, and used for histological, histomorphometrical, and immunohistochemical assessments. The results showed that PDLCs remained viable upon encapsulation within chitosan hydrogels before transplantation. Histological analysis demonstrated that the chitosan hydrogels were largely degraded after 4 weeks of implantation, without any adverse reaction in the surrounding tissue. In terms of periodontal regeneration, alveolar bone height, alveolar bone area, and epithelial downgrowth were comparable for CHIT, CHIT+CELL, as well as EMPTY groups. In contrast, both CHIT and CHIT+CELL showed a significant increase in functional ligament length compared with EMPTY. From a cellular perspective, the contribution of chitosan hydrogel-incorporated cells to the periodontal regeneration could not be ascertained, as no signal from transplanted PDLCs could be detected at 4 weeks posttransplantation. The results demonstrated that enzymatically solidified chitosan hydrogels are highly biocompatible and biodegradable. Moreover, chitosan hydrogels without cell loading can improve periodontal regeneration in terms of functional ligament length, indicating the great potential of this hydrogel in clinical applications. Further work on the use of chitosan hydrogels as cell carriers is required.

Treatment of periodontal intrabony defects using β-TCP alone or in combination with rhPDGF-BB: a randomized controlled clinical and radiographic study.

The need to increase the predictability of periodontal regeneration has encouraged clinicians and researchers to employ cell-stimulating proteins in combination with osteoconductive scaffolds, based on the principles of tissue engineering. The purpose of this clinical and radiographic study was to compare the regenerative potential of the combination of β-tricalcium phosphate (β-TCP) and recombinant human platelet-derived growth factor BB (rhPDGF-BB) in the grafting of intraosseous defects with the established technique of bone grafting with (β-TCP alone. A total of 30 sites from 15 patients with infrabony defects in two different quadrants were selected, and the sites were randomly divided into test sites (rhPDGF + β-TCP) and control sites (β-TCP alone) using a split-mouth design. Clinical parameters, including probing pocket depth, clinical attachment level, and gingival recession, were recorded at baseline, 6 months, and 9 months. Radiographic evaluation was carried out to evaluate defect fill, change in alveolar crest height, and percentage of defect fill at baseline, 6 months, and 9 months. Both the experimental groups showed statistically significant reduction in probing pocket depth and gain in clinical attachment level. On intergroup comparison, sites treated with rhPDGF + β-TCP demonstrated a significantly greater pocket depth reduction (P < .05) and greater gain in clinical attachment level (P < .01). Mean percentage defect fill was significantly greater in test sites as compared with control sites at 6 and 9 months (P < .01). rhPDGF + β-TCP-treated sites demonstrated a significant gain in mean alveolar crest height at 6 and 9 months (P < .05), while β-TCP-treated sites demonstrated crestal resorption. Both groups demonstrated potential in enhancing periodontal regeneration; however, on comparison between the two groups, the results obtained by rhPDGF + β-TCP were significantly better with respect to both clinical and radiographic parameters.

Comparative study of decalcification versus nondecalcification for histological evaluation of one-wall periodontal intrabony defects in dogs.

Biological reactions between biomaterials and surrounding tissues, analyzed by histology, may be important predictors of clinical healing pattern and selection of slide preparation techniques requires a careful consideration regarding sample properties. In this study, we compared histology of bone specimens prepared with or without decalcification and performed histological and histomorphometrical assessments. For the histological evaluation, one-wall intrabony defects were created around the mandibular molars of six adult dogs, filled with biphasic calcium phosphate, synthetic bone graft material/recombinant human bone morphogenic protein-2, and healing pattern was histologically evaluated at 4 and 12 weeks. New bone formation in 5 × 4 × 4 mm defects and the length of new cementum, connective tissue attachments around the teeth and number of osteoclasts were measured by histomorphometric analysis. After decalcification, new cementum was easily observed and was significantly increased at week 4. In nondecalcified samples, significantly increased connective tissue attachments were seen at week 12. After 12 weeks, the number of countable multinucleated osteoclasts was significantly increased by 62% in nondecalcified versus calcified tissue sections (P = 0.030). Histomorphometric results may be significantly affected by histological preparation method and therefore, selecting the most appropriate histological preparation method is essential for reliable diagnosis and evaluation of bony samples in studies analyzing tissue regeneration.

Platelet-rich plasma combined with decalcified freeze-dried bone allograft for the treatment of noncontained human intrabony periodontal defects: a randomized controlled split-mouth study.

The aim of the present randomized split-mouth clinical trial was to compare plateletrich plasma (PRP) combined with a demineralized freeze-dried bone allograft (DFDBA) to DFDBA with a saline solution in the treatment of noncontained human periodontal intrabony defects. Forty-eight noncontained interproximal intrabony defects in 24 healthy nonsmoking patients diagnosed with chronic periodontitis were randomly assigned to the test group (PRP/DFDBA) or the control group (DFDBA/saline). Clinical (probing pocket depth, clinical attachment level [CAL], and gingival recession [REC]) and radiographic (bone fill, defect resolution, and alveolar crest resorption) measurements were made at baseline and at a 12-month evaluation. Compared with baseline, 12-month results indicated that both treatment modalities resulted in significant changes in all clinical and radiographic parameters. However, the test group exhibited statistically significantly greater changes compared with the control group in CAL (3.15 ± 0.50 versus 2.40 ± 0.61 mm), REC (0.54 ± 0.59 versus 1.23 ± 0.47 mm), bone fill (3.02 ± 0.50 versus 2.37 ± 0.47 mm), and defect resolution (3.29 ± 0.53 versus 2.69 ± 0.38 mm). Findings indicate that a combination of PRP and DFDBA is more effective than DFDBA with saline for the treatment of noncontained intrabony defects.

Intrabony defects and non-surgical treatment.

Periodontitis can lead to vertical bone loss with the creation of 'intrabony defects', associated with higher risk of progression if left untreated. Intrabony defects are considered candidates for periodontal surgical procedures, in order to arrest disease progression and achieve bone regeneration. This paper brings forward anecdotal and scientific evidence from the literature to describe how even non-surgical periodontal treatment can result in clinical and radiographic resolution of periodontal intrabony defects.

Enamel matrix derivative in combination with bone grafts: A review of the literature.

Over 15 years have passed since an enamel matrix derivative (EMD) was introduced as a biologic agent capable of periodontal regeneration. Histologic and controlled clinical studies have provided evidence for periodontal regeneration and substantial clinical improvements following its use. The purpose of this review article was to perform a systematic review comparing the eff ect of EMD when used alone or in combination with various types of bone grafting material. A literature search was conducted on several medical databases including Medline, EMBASE, LILACS, and CENTRAL. For study inclusion, all studies that used EMD in combination with a bone graft were included. In the initial search, a total of 820 articles were found, 71 of which were selected for this review article. Studies were divided into in vitro, in vivo, and clinical studies. The clinical studies were subdivided into four subgroups to determine the eff ect of EMD in combination with autogenous bone, allografts, xenografts, and alloplasts. The analysis from the present study demonstrates that while EMD in combination with certain bone grafts is able to improve the regeneration of periodontal intrabony and furcation defects, direct evidence supporting the combination approach is still missing. Further controlled clinical trials are required to explain the large variability that exists amongst the conducted studies.

Which biomaterials may promote periodontal regeneration in intrabony periodontal defects? A systematic review of preclinical studies.

To systematically analyze the regenerative effect of the available biomaterials either alone or in various combinations for the treatment of periodontal intrabony defects as evaluated in preclinical histologic studies. A protocol covered all aspects of the systematic review methodology. A literature search was performed in Medline, including hand searching. Combinations of searching terms and several criteria were applied for study identification, selection, and inclusion. The preliminary outcome variable was periodontal regeneration after reconstructive surgery obtained with the various regenerative materials, as demonstrated through histologic/ histomorphometric analysis. New periodontal ligament, new cementum, and new bone formation as a linear measurement in mm or as a percentage of the instrumented root length were recorded. Data were extracted based on the general characteristics, study characteristics, methodologic characteristics, and conclusions. Study selection was limited to preclinical studies involving histologic analysis, evaluating the use of potential regenerative materials (ie, barrier membranes, grafting materials, or growth factors/proteins) for the treatment of periodontal intrabony defects. Any type of biomaterial alone or in various combinations was considered. All studies reporting histologic outcome measures with a healing period of at least 6 weeks were included. A meta-analysis was not possible due to the heterogeneity of the data. Flap surgery in conjunction with most of the evaluated biomaterials used either alone or in various combinations has been shown to promote periodontal regeneration to a greater extent than control therapy (flap surgery without biomaterials). Among the used biomaterials, autografts revealed the most favorable outcomes, whereas the use of most biologic factors showed inferior results compared to flap surgery.

Effect of Low-Level Laser on Guided Tissue Regeneration Performed with Equine Bone and Membrane in the Treatment of İntrabony Defects: A Clinical Study

The purpose of the present study was to evaluate the clinical results of guided tissue regeneration (GTR) after the application of equine bone and membrane alone or combined with low-level laser therapy (LLLT) for the treatment of periodontal defects. This study was an intra-individual longitudinal study of 6 months' duration conducted using a split-mouth and randomized design. In 13 periodontitis patients with bilateral intrabony periodontal defects, while one defect site was treated with GTR plus LLLT (1064 nm, 100 mW, with energy density of 4 J/cm(2)), the contralateral defect site was treated with guided GTR alone. GTR was performed with a combination of equine bone and membrane. LLLT was used both intra- and postoperatively. Clinical probing depth (PPD), clinical attachment level (CAL), clinical gingival recession level (REC), plaque index (PI) score, and sulcus blooding index (SBI) score were recorded at the time of surgery, and at the 3rd and 6th months after operation. The treatment of periodontal intrabony defects with equine bone and membrane in the operation of GTR alone or GTR plus LLLT in combination led to statistically significant PPD reduction, CAL gain, and lower SBI score at the end of the study (p<0.05). In addition, between the two groups, GTR plus LLLT resulted in statistically significant lower REC (p=0.025), lower SBI (p=0.008) score, more reduction of PPD (p=0.009) and CAL gain (p=0.002) compared with GTR alone at 6th month control. This study showed that GTR is an effective treatment for periodontal regeneration, and that LLLT may improve the effects of GTR in the treatment of periodontal defects.

Isolation and Assessment of Mesenchymal Stem Cells Derived From Bone Marrow: Histologic and Histomorphometric Study in a Canine Periodontal Defect

The aim of the present study was to investigate an isolation procedure to culture mesenchymal stem cells derived from bone marrow and evaluate their potential in periodontal regeneration. Potential stem cells from bone marrow, aspirated from the iliac crest of nine mongrel canines 1 to 2 years of age, were cultivated. After the examination of surface epitopes of the isolated cells, the total RNA from osteogenic, adipogenic, and chondrogenic cell cultures were analyzed by reverse transcription polymerase chain reaction (RT-PCR) to confirm stem cell gene expressions. 2 × 10(7) mL of the stem cells were loaded on 0.2 mL of anorganic bovine bone mineral (ABBM) granules. In each animal, bilateral acute/chronic intrabony periodontal defects were created surgically and by placement of ligatures around the cervical aspect of the teeth. At week 5, after flap debridement, the bilateral defects were randomly assigned to 2 treatment groups: the control group received ABBM, and the test group received BMSCs-loaded ABBM. Eight weeks after transplantation, regenerative parameters were analyzed histologically and histometrically. The RNA expressions confirmed the cultivation of mesenchymal stem cell. More new cementum and periodontal ligament (PDL) were measured in the test group (cementum: 3.33 ± 0.94 vs 2.03 ± 1.30, P = 0.027; PDL: 2.69 ± 0.73 vs 1.53 ± 1.21, P = 0.026). New bone formation was similar in both groups (2.70 ± 0.86 vs 1.99 ± 1.31; P = 0.193). Mesenchymal stem cells derived from bone marrow should be considered a promising technique for use in patients with periodontal attachment loss and merits further investigations.

Comparative study of two collagen membranes for guided tissue regeneration therapy in periodontal intrabony defects: a randomized clinical trial.

PurposeThe purpose of this study was to assess and compare the clinical and radiographic outcomes of guided tissue regeneration therapy for human periodontal intrabony defects using two different collagen membranes: a porous nonchemical cross-linking collagen membrane (NC) and a bilayer collagen membrane (BC).MethodsThirty subjects were randomly assigned and divided into the following 3 groups: a test group (NC+BM), in which a NC was used with xenograft bone mineral (BM), a positive control group (BC+BM), in which a BC was used with xenograft BM, and a negative control group (BM), in which only xenograft BM was used. The following clinical measurements were taken at baseline and 3 months after surgery: plaque index, gingival index, probing pocket depth, gingival recession, and clinical attachment level. Radiographic analysis was performed at baseline, 1 week and 3 months after surgery.ResultsMembrane exposure was not observed in any cases. Significant probing depth reduction, attachment-level gain and bone fill were observed for both test and control groups compared to baseline at 3 months after surgery (P<0.05). However, there were no statistically significant differences in clinical improvement and radiographic bone fill between treatment protocols (P>0.05).ConclusionsWithin the limitations of this study, the results suggest that both NC and BC were comparable in terms of clinical and radiographic outcomes for the treatment of periodontal intrabony defects in human subjects.Graphical

A comparative evaluation of platelet-rich plasma in combination with demineralized freeze-dried bone allograft and DFDBA alone in the treatment of periodontal intrabony defects: A clinicoradiographic study.

Background:The aim of the present clinical trial was to compare PRP combined with a DFDBA to DFDBA mixed with a normal saline solution in the treatment of human intrabony defects.Materials and Methods:Twenty interproximal intrabony osseous defects in twenty non-smoking, healthy subjects diagnosed with chronic periodontitis were treated in this study. Ten subjects each were randomly assigned to the test group (PRP + DFDBA) or the control group (DFDBA + saline). Clinical and radiographic measurements were made at baseline, three month and at six-month evaluation.Results:The results at three and six months, when compared to the baseline, indicated that both treatment modalities resulted in significant changes in all clinical parameters (gingival index, bleeding on probing, probing depth, clinical attachment level and gingival recession; P < 0.01) and radiographic parameters (hard-tissue fill and bone-depth reduction; P < 0.01). However, the test group exhibited statistically significantly greater changes compared to the control group in plaque index at three months (P = 0.00), probing depth reduction at 6 months (P = 0.02) and the radiographic defect fill at 6 months (P = 0.01).Conclusions:Treatment with a combination of PRP and DFDBA led to a statistically significantly greater improvement in plaque index at 3 months, probing depth at 6 months and radiographic defect fill at 6 months in intrabony periodontal defects as compared to DFDBA with normal saline.

Comparison of β-tricalcium phosphate and autogenous bone graft with bioabsorbable membrane and autogenous bone graft in the treatment of intrabony periodontal defects: A clinico-radiographic study

Aim: The aim of this study was to compare clinically and radiographically, the regenerative potential of β- tricalcium phosphate and autogenous bone graft with a bioabsorbable membrane and autogenous bone graft in the treatment of intrabony periodontal defects. Materials and Methods: A total of 24 sites from 12 patients showing bilateral or contralateral intrabony defects were selected and randomly divided into experimental site A (CERASORB® + autogenous bone graft) and experimental site B (BIOMEND™ + autogenous bone graft) by using the split mouth design. Clinical parameters like plaque index, was recorded at 1, 3, 6, 12 months and probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession were recorded at baseline, 6 and 12 months along with radiographs to evaluate defect fill, change in alveolar crest height and percentage of defect fill. Statistical Analysis: For intragroup variations-Student paired t-test, for comparison between the two groups-unpaired t-test and for the comparison of plaque index at different time intervals-Wilcoxon matched pairs test were used. Results: Both groups showed clinically and statistically significant reduction in PPD and gain in CAL with no statistical significance. Radiographically, in site A there was significant defect fill of 69.58% and 79.24% at 6 and 12 months. In site B, a defect fill of 71.29% and 82.77% was seen at 6 and 12 months. Conclusion: Both groups showed the potential of enhancing the periodontal regeneration; however, on comparison between the two groups, the results obtained of the BIOMEND™ + autogenous bone graft group were slightly better, although statistically not significant.

Comparison of Nano-Sized Hydroxyapatite and β-Tricalcium Phosphate in the Treatment of Human Periodontal Intrabony Defects.

Since the advent of nanotechnology, various materials have been introduced for the treatment of the bone defects which have shown promising results. The purpose of this study was to compare the effect of nano-sized Hydroxyapatite (NHA) and β-Tricalcium Phosphate (β-TCP) in the treatment of human periodontal defects. Tweleve patients with a total of 24 sites which were almost identical as determined clinically and radiographically were selected for the study. The selected sites were treated with access flap surgery were divided into two groups: Group I was treated with NHA and Group II treated with β-TCP. Following clinical and radiographic parameters were recorded at baseline, 3 months and 6 months post operatively: 1) Probing pocket depth (PPD); 2)Clinical attachment level (CAL); 3) Gingival recession (GR); 4) Radiographic Defect Depth. Groups showed statistically significant improvements in soft and hard tissue parameters after 3 months and 6 months. Greater reduction in PPD, gain in CAL and Radiographic Defect Fill (RDF) was seen in Group I after three months whereas after six months were no statistically significant difference was seen with regard to soft and hard tissue measurements. Within limits of the study, both NHA and β-TCP have proved to be beneficial in the management of periodontal defects. Treatment of intrabony periodontal defects with NHA leads to significant improvement in early clinical and radiographic outcomes as compared to β-TCP.

Clinical evaluation of hydroxyapatite and β-tricalcium phosphate composite graft in the treatment of intrabony periodontal defect: A clinico-radiographic study.

Background and Objective:Hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) grafts have shown to be effective in promoting the clinical signs of periodontal regeneration in intrabony defects. The aim of our study was to clinically and radiographically evaluate the efficacy of HA and β-TCP composite bone graft material in the treatment of intrabony three-wall defect.Materials and Methods:Twenty patients participated in this study. Interproximal bony defects were surgically treated with a combination of HA–βTCP (biphasic calcium phosphate). Changes in clinical parameters such as gingival status, probing pocket depth, clinical attachment, and radiographic estimation of the amount of bone fill were evaluated after 6 months postoperatively.Statistical Analysis Used:Student's “t” test.Results:This treatment modality resulted in significant pocket depth reduction and clinical attachment gain which were observed to be 2.938 mm (47.04%) and 3.188 mm (29.09%), respectively. The defect fill as seen radiographically was 3.204 mm (63.195%). All the differences were highly significant and in favor of postoperative group.Conclusion:The results of this study suggest that HA–βTCP (biphasic calcium phosphate) provides an added regenerative effect in promoting the clinical resolution of intrabony three-wall defects in patients with periodontitis.