Periodontal Intrabony Defects Research Articles

Treatment of intrabony periodontal defects using rhFGF-2 in combination with deproteinized bovine bone mineral or rhFGF-2 alone: A 6-month randomized controlled trial.

AimTo evaluate the use of recombinant human fibroblast growth factor (rhFGF)‐2 in combination with deproteinized bovine bone mineral (DBBM) compared with rhFGF‐2 alone, in the treatment of intrabony periodontal defects.Materials and MethodsPatients with periodontitis who had received initial periodontal therapy and had intrabony defects of ≥ 3 mm in depth were enrolled. Sites were randomly assigned to receive a commercial formulation of 0.3% rhFGF‐2 + DBBM (test) or rhFGF‐2 alone (control). Clinical parameters and a patient‐reported outcome measure (PROM) were evaluated at baseline and at 3 and 6 months postoperatively.ResultsTwenty‐two sites in each group were evaluated. A significant improvement in clinical attachment level (CAL) from baseline was observed in both groups at 6 months postoperatively. CAL gain was 3.16 ± 1.45 mm in the test group and 2.77 ± 1.15 mm in the control group, showing no significant difference between groups. Radiographic bone fill was significantly greater in the test group (47.2%) than in the control group (29.3%). No significant difference in PROM between groups was observed.ConclusionsAt 6 months, no significant difference in CAL gain or PROM between the two treatments was observed, although combination therapy yielded an enhanced radiographic outcome.

Comparative study of DFDBA and FDBA block grafts in combination with chorion membrane for the treatment of periodontal intra-bony defects at 12months post surgery.

The goal of periodontal therapy is to prevent periodontal disease progression and to regenerate lost periodontal tissues. Various bone grafts are used alone or in combination with other treatment modalities for periodontal therapy. In literature no reports are presented with block allografts in the treatment of intrabony defects in periodontitis. Hence the study aimed to evaluate and compare clinically and radiographically freeze dried bone and demineralized freeze dried bone block allografts with chorion membrane in intra-bony defects at 12months post-surgery. Eighteen intra-bony defects (9 intra patient pairs) in 9 patients with chronic periodontitis were randomly assigned to group 1 (FDBA + Chorion membrane) and group 2 (DFDBA + Chorion membrane) for periodontal therapy. Clinical and radiographic (RVG) measurements were made at base line and 12months. Data obtained was subjected to statistical analysis. At 12months on intra-group comparison both the groups showed statistically significant improvement in the plaque and gingival indices with reduction in the mobility, probing pocket depth and gain in clinical attachment (p value<0.001). Radiographs showed significant bone fill and increased bone density (p value<0.001). On inter-group comparison no statistical difference were observed at 12months in clinical parameters and bone fill among both the groups. However, group 1 (FDBA) showed increase in the bone density which was statistically significant (p value<0.001). The use of the FDBA and DFDBA block allografts showed significant improvement in the periodontal prognosis of teeth with intra-bony defects. Within the limitation of the present study, both the groups showed similar results with significant increase in bone density in FDBA group.

Clinical and radiographic evaluation of amnion chorion membrane and demineralized bone matrix putty allograft for management of periodontal intrabony defects: a randomized clinical trial.

The aim of this trial was to compare the clinical and radiographic outcomes of amnion chorion membrane (ACM) with demineralized bone matrix (DBM) in a putty form in management of periodontal intrabony defects. Twenty-two participants with severe chronic periodontitis and intrabony defects, were randomly assigned in two equal parallel groups. Each group was treated with open flap debridement (OFD) and ACM or OFD and DBM putty. Plaque index, gingival index, pocket depth (PD), clinical attachment level (CAL) and radiographic measurement of bone defect area (BDA) were recorded at baseline, 3 and 6months postoperatively. Both ACM and DBM putty demonstrated significant improvement in all clinical and radiographic outcomes at 6months compared to baseline values. However, no significant difference was observed between the two treatment modalities when compared at different time intervals. Six months postoperatively, ACM showed 3.18 ± 0.85mm, PD reduction and 2.25 ± 0.75mm CAL gain, while DBM putty revealed 3.45 ± 1.08mm PD reduction and 2.73 ± 0.85mm CAL gain. Radiographic assessment showed that mean baseline BDA for ACM group was 10.39 ± 3.86mm2, which significantly reduced to 5.21 ± 2.38 after 6months. Mean BDA mm2 in DBM putty group also significantly improved after 6months, 5.35 ± 3.63mm2 when compared to baseline values 9.80 ± 5.77mm2. Both ACM barrier and DBM putty allograft provided significant improvement in clinical and radiographic outcomes after 6months, yet no significant differences were noticed between them. This trial implied that both biomaterials have a potential regenerative capacity in treating periodontal intrabony defects.

Actual quantitative attachment gain secondary to use of autologous platelet concentrates in the treatment of intrabony defects: A meta-analysis.

Background:There are no authoritative meta-analyses and no clear quantitative assessments available estimating effects of open flap debridement (OFD) combined with platelet-rich fibrin (PRF) or platelet-rich plasma (PRP) over and above that of OFD. This study evaluated the actual quantitative mean gain for various clinical (clinical attachment level [CAL], probing pocket depth [PPD] and gingival marginal level [GML]) and radiographic (intrabony defect depth [IBD]) parameters of Platelet Concentrates- PCs (PRP/PRF) as sole grafting material along with OFD and OFD alone in the treatment of intrabony defects.Materials and Methods:A detailed electronic search was carried out in PUBMED/MEDLINE, COCHRANE, EBSCOHOST, and Google Scholar databases by unifying related search terms with additional hand searches in select specialty journals up to May 2017. The eligibility criteria included human randomized clinical trials, either of a parallel group or a split-mouth design with follow-up period of at least 6 months. Periodontal intrabony defects with radiographic IBD ≥3 mm with corresponding CAL ≥5 mm were included. For the meta-analysis, the inverse variance method was used in fixed- or random-effect models.Results:Actual quantitative mean gains were calculated for OFD with PRF/PRP (CAL = 1.1 mm, IBD = 1.68 mm, PPD = 0.97 mm and GML = 0.48 mm) over and above that of OFD alone.Conclusion:Because of very high heterogeneity, the results may not be dependable. Apart from gains in radiographic bone fill, all other periodontal clinical parameters showed negligible gains. Using PRF technologies in periodontal intrabony defects may not be of great clinical significance over and above that of OFD alone, the effect sizes are also not large enough.

The Combined Effect of Bioactive Glass and Platelet-Rich Fibrin in Treating Human Periodontal Intrabony Defects - A Clinicoradiographic Study.

Background:Platelets are richest source for cytokine and growth factors which are two important components for the re-establishment of bone and maturation of the soft tissue.Aims and Objective:The additive effect of PRF along with a synthetic bone graft material in treating human intrabony periodontal defects has been evaluated in this study. The appropriate use of platelet-rich fibrin (PRF) as an alternate comfortable graft material to restore the lost periodontal tissues has been well documented and has given clinically promising outcome.Materials and Method:Platelet-rich fibrin (PRF) is prepared from patient's own blood which is autologous in nature. Perio Glas (PG) is an easy to use synthetic absorbable osteostimulative as well as osteoconductive bone graft material. The selected 30 sites were randomly divided into two groups such as Test (15 sites using PRF) and Control (15 sites without PRF).Results:At the end of Six months, the post-operative evaluations revealed significant reduction in PPD and gain in CAL. Radiographic evidence of bone formation was also noticed. The incorporation of PRF with synthetic bone graft (perioglas) produces effective and rapid periodontal regeneration with improved healing in intrabony osseous defects. The PRF group showed a mean Radiographic Defect Fill (RDL) of 1.24 ± 0.04 compared with 0.79 ± 0.07 of control group which is statistically significant.Conclusion:This combination technique can be used as an alternate grafting modality for the treatment of intrabony periodontal defects with satisfactory clinical consequences.

Clinical evaluation of oily calcium hydroxide suspension alone and in combination with β-tricalcium phosphate in the treatment of periodontal intrabony defects

Background: An oily calcium hydroxide suspension (OCHS) has been proved to be efficient in promoting bone regeneration in periodontal intrabony defects. However, the outcome of regenerative therapy using an OCHS as an adjunct to open-flap debridement is believed to be compromised by its low consistency. Thus, the present study was carried out to evaluate an OCHS alone and in combination with β-tricalcium phosphate (β-TCP) as a bone graft material in the treatment of periodontal intrabony defects. Materials and Methods: Twenty-six intrabony defects in 10 patients were divided into experimental and control sites. The experimental sites were debrided and grafted with a combination of OCHS and β-TCP. The control sites were debrided and grafted with OCHS alone. Probing pocket depth (PPD), clinical attachment level (CAL), and gingival margin position were recorded at baseline and at 3, 6, and 9 months. Results: No differences in any of the investigated parameters were observed at the baseline between the two groups. At 9 months postoperatively, the experimental group showed a reduction in mean PPD from 7.56 ± 1.15 to 4.19 ± 1.42 mm (P Conclusion: Overall, both therapies led to significant PPD reduction and CAL gain. The combination of an OCHS and β-TCP as a bone graft material was more effective in terms of improving clinical parameters than OCHS alone.

Clinical and radiographic evaluation of applying 1% metformin biofilm with plasma rich in growth factor (PRGF) for treatment of two-wall intrabony periodontal defects: A randomized clinical trial.

Background. The ultimate aim of periodontal treatment is to regenerate periodontium and regenerative treatment after that. The aim of this study was to evaluate the effect of PRGF with 1% metformin biofilm in the treatment of two-wall intrabony periodontal defects. Methods. In this clinical trial, 8 patients with moderate chronic periodontitis and two-wall intrabony defect were selected. The defects were assigned to 4 groups: debridement, 1% metformin, PRGF, PRGF and metformin. The parameters of vertical probing depth, vertical clinical attachment level and gingival index were measured at baseline, immediately before surgery, and 3 and 6 months after surgery. In addition, the radiographic changes were evaluated with digital subtraction radiography before and 6 months after surgery. Analysis of the results was performed with repeated measurements, Friedman test and chisquared test. Results. All the groups exhibited improvements in all the clinical parameters after 6 months. Inter-group comparison of GI, CAL and PPD parameters revealed no statistically significant differences. Radiographic changes in the group of 1% metformin with PRGF revealed statistically significant differences compared with other groups; however, there were no statistically significant differences in other groups. Conclusion. Application of PRGF with 1% metformin in intrabony two-wall periodontal defects was effective in improving the clinical parameters but this effect revealed no difference compared with other groups; however, in terms of radiographic changes significant improvements were noted

A Study to Evaluate the Efficacy of Platelet Rich Fibrin with Nanocrystalline Beta-Tricalcium Phosphate in the Treatment of Periodontal Intrabony Defects

Background: Presently, there is no gold-standard regenerative material for the treatment of periodontal intrabony defects. The use of bone grafts in combination with guided tissue regeneration membrane is a predictable treatment option but is expensive. Platelet concentrates are increasingly being used due to their ease of use and cost-effectiveness. Aims: The objective of the present study is to compare clinically and also by Cone Beam Computed Tomography (CBCT), the effect of platelet-rich fibrin combined with synthetic beta-tricalcium phosphate to synthetic beta-tricalcium phosphate alone in the treatment of periodontal intrabony defects. Materials and Methods: 10 patients possessing 2 almost identical interproximal intrabony defects in either side of mandible were selected and the defects were further divided into 2 groups randomly: Control Group A (Beta-tricalcium phosphate placed) and Test Group B (Beta-tricalcium phosphate with platelet-rich fibrin placed). Regeneration of soft tissue and hard tissue (using CBCT) were evaluated after 6 months from baseline in both groups. Statistical Analysis Used: The intragroup and intergroup comparisons were done using Paired and student t-test. Results: Intragroup showed significant improvement in both soft tissue and hard tissue parameters. Mean of all parameters was better in the test group; however, the intergroup difference was not statistically significant. Conclusions: Within the limitations of the present study, the use of beta-tricalcium phosphate bone graft combined with platelet-rich fibrin and beta-tricalcium phosphate bone graft alone are both equally effective for the treatment of periodontal intrabony defects.

Clinical and radiographic evaluations of periodontal intrabony defects treated with enamel matrix derivative: a report of two cases

Clinical and radiographic evaluations of periodontal intrabony defects treated with enamel matrix derivative: a report of two cases

Effects of recombinant human bone morphogenetic protein-2 compared to other biomaterials in the treatment of intrabony defects in periodontitis patients: A systematic review.

Background:Bone morphogenetic proteins have a powerful osteoinductive capacity and have been used as a new adjunct to graft materials for bone regeneration. The objectives of this systematic review are to assess the amount of radiographic bone fill, clinical attachment level (CAL) gain, and reduction in pocket depth (PD) in patients with intrabony defects in periodontitis patients following the use of recombinant human bone morphogenetic protein-2 (rhBMP-2).Materials and Methods:Electronic bibliographic databases search of Medline, Science Direct, and Google Scholar was made from January 1980 to December 2017. Studies using rhBMP-2 to treat periodontal intrabony defects of the maxillary or mandibular region with follow-up period of at least 6 months were searched. Two reviewers performed the systematic review using the PRISMA Statement for reporting and the Cochrane risk-of-bias tool was used for quality assessment.Results:It was found that rhBMP-2 showed statistically significant results with respect to radiographic defect resolution, CAL, and PD reduction at 9 months compared to open-flap debridement but showed statistically significant results only with respect to radiographic bone fill when compared with platelet-rich fibrin at 6 months.Conclusion:The rhBMP-2 may provide a promising alternative to traditional grafting procedures therapy that can enhance periodontal regeneration in patients having intrabony defects. Due to limited human studies, it can be concluded that no definitive evidence exists to ascertain the effectiveness of rhBMP-2 in the treatment of intrabony defects in periodontal diseases.

Platelet Rich Fibrin and Bone Graft in the Treatment of Intrabony Defect in Periodontitis Patients

Background: Porous hydroxyapatite and β-tricalcium phosphate (β-TCP + HA) bone grafting material has resulted in clinically acceptable responses when used to fill the periodontal intrabony defects. PRF is an autologous leukocyte and platelet preparation that concentrates various polypeptide growth factors which therefore holds potential to be used as regenerative treatment for periodontal defects.&#x0D; Aim: The purpose of this study was to evaluate clinical and radiographic outcomes in periodontal intrabony defects treated with platelet rich fibrin compared to alloplastic bone graft material.&#x0D; Materials and Methods: Twenty subjects (10 subject per group, one site/subject) were treated either with platelet rich fibrin or alloplastic bone graft (30% β-TCP+ 70% HA). Primary clinical parameters: PD, CAL were taken at baseline, three months, six months and nine months post-operatively. Standardised radiographic data were collected at baseline, six months and nine months postoperatively.&#x0D; Results: Preoperative parameters were similar for both groups. Postsurgical measurements revealed a greater reduction in pocket depth in bone graft group (2.5 mm), greater CAL gain (2.2 mm) and greater defect fill (1.30 mm) as compared to platelet rich fibrin group (1.50 mm, 1.6 mm and 0.80 mm respectively ) at nine months.&#x0D; Conclusion: Treatment of intrabony defects with alloplast (30% β TCP+ 70% HA) or platelet rich fibrin both resulted in a significant probing depth reduction, CAL gain and bone depth reduction, with significantly better improvement in bone graft group.

Kronik Periodontitisli Bir Hastada Kemik İçi Defektlerin Rejeneratif Tedavisi: Vaka Raporu

New attachment achieved by conventional periodontal surgery performed to gain access to diseased root surfaces and to remove local factors such as plaque and endotoxins, usually results in the formation of long junctional epithelium. On the contrary, guided tissue regeneration procedure in which a barrier is utilized to exclude gingival epithelium and connective tissue from the root surface, has been shown to partially regenerate lost periodontal tissues. This case report presents regenerative periodontal treatment of a 38-year old female attending with a complaint of painless swelling in the mandibular left second molar region. The patient was diagnosed as chronic periodontitis based on clinical and radiographic findings and intrabony defects were observed at teeth #14, #15, #16, #25 and #37. After initial periodontal treatment, flap operation with the principles of guided tissue regeneration was performed for treatment of intrabony defects. After 4-year follow-up period, evidence of bone fill and no sign of recurrence were seen at defect sites. It was concluded that regenerative treatment of intrabony periodontal defects by the use of bovine xenograft and collagen membrane combination provides favourable clinical and radiographic outcomes in chronic periodontitis patients and could be maintained up to 4 years successfully.

Clinical and radiographic evaluation and comparison of bioactive bone alloplast morsels when used alone and in combination with platelet-rich fibrin in the treatment of periodontal intrabony defects-A randomized controlled trial.

The present study aims to evaluate and compare the clinical and radiographic changes obtained through Bioactive Glass (BG) with and without autologous platelet-rich fibrin (PRF) in the treatment of intrabony defects in chronic periodontitis patients. The present study was a split-mouth randomized controlled clinical trial comprising 20 chronic periodontitis patients (mean age: 35.9 years) having at least one pair of bilateral intrabony defect. Group 1 included 20 sites treated with a combination of BG and autologous PRF whereas 20 sites in Group 2 were treated with BG alone. Probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession (GR) were evaluated at 3 and 6 months and bone fill at 6 months by using cone beam computed tomography (CBCT) analysis. Primary study outcomes were changes in PPD, CAL, GR, and bone fill. CAL gain was greater in Group 1 (5.05 ± 1.09mm) when compared with Group 2 (4.2 ± 1.70mm). Furthermore, a significantly greater bone fill was found in Group 1. At 6 months, statistically significant reduction in PPD in Group 1 and Group 2 was evident. BG morsel when used in combination with PRF is found to be more effective in gain in CAL, reduction in PPD and achieving greater bone fill as compared with treatment with BG alone in periodontal intrabony defects and is indicative of enhanced periodontal regeneration.

Long-term stability of intrabony defects treated with minimally invasive non-surgical therapy.

The aim of this study was to assess the stability over time of periodontal intrabony defects treated with minimally invasive non-surgical therapy (MINST) and supportive periodontal therapy (SPT). Clinical and radiographic analysis was carried out in 21 intrabony defects treated with MINST in 14 consecutive patients included in a prospective study and reassessed after 5years of SPT. Baseline, 1- and 5-year radiographs were analysed, and bone levels were compared by multilevel linear regression adjusted by latent variable method. None of the 21 teeth with intrabony defects was lost at 5years. Average probing pocket depth, clinical attachment level and radiographic intrabony vertical defect depth reductions were 3.6, 3.5 and 2.6mm, respectively, 5years after treatment (p<0.001 compared with baseline). Further non-statistically significant reductions were seen in clinical and radiographic measures between 1 and 5years. Deeper initial defects and narrower angles were predictive of a bigger reduction in defect depth (p<0.001 and p=0.017, respectively). Clinical and radiographic improvements in intrabony defects after MINST seen at 1year are stable up to 5years, bringing evidence to support its long-term efficacy for the treatment of intrabony defects in non-smokers.

Assessment of Osteocalcin in Gingival Crevicular Fluid Around Bony Defect Treated with Platelet Rich Fibrin system

Purpose: to evaluate the effect of PRF system (PRF mixed with bone graft) in the regeneration of intra-bony defects by assessing osteocalcin in gingival Crevicular fluid. This study was accomplished on periodontal clinical and Radiographic evaluation.Subjects and Methods: A randomized double blind, split-mouth study was undergone on 12 patients with twenty four intrabony defects the selected defects were randomly divided into Group I (Test group): including eight defects that received PRF mixed with grafting material. Group II (Collagen group): including eight defects that received collagen membrane and PRF mixed with grafting material and Group III (Control group): including eight defects that received open flap debridement only. All subjects were put on a recall schedule where the clinical parameters (PI, GI, PD and CAL) and radiographic assessment(Alveolar bone height and bone density) were measured and recorded at base line and six months postoperatively. Results: Clinical outcomes in defects treated with collagen membrane and PRF mixed with grafting material (group II) showed more pocket reduction, greater gain in attachment level compared to other groups. However, better improvement in radiographic parameters was observed in defects treated with PRF mixed with grafting material (group I). Regarding mean osteocalcin concentration, defects treated with collagen membrane and PRF mixed with grafting material (group II) reported maximum reduction at the end of the study. Conclusions: The use of PRF as a regenerative material in managing periodontal intrabony defects resulted in pocket depth reduction, clinical attachment gain and defect fill with comparable results to bone graft and collagen membrane.

Comparison the efficacy of Nano-crystalline and Micro-Crystalline Forms of Calcium Sulfate Bone Grafts in the treatment of the Periodontal Intrabony Defect.

Comparison the efficacy of Nano-crystalline and Micro-Crystalline Forms of Calcium Sulfate Bone Grafts in the treatment of the Periodontal Intrabony Defect.

O084: Alveolar bone marrow mesenchymal stem cells (aBM‐MSCs) as a cell source for the reconstruction of intrabony periodontal defects. A 12‐month randomised controlled clinical trial

O084: Alveolar bone marrow mesenchymal stem cells (aBM‐MSCs) as a cell source for the reconstruction of intrabony periodontal defects. A 12‐month randomised controlled clinical trial

PC203: Enamel matrix derivate for intrabony periodontal defects

PC203: Enamel matrix derivate for intrabony periodontal defects

PC215: Periodontal intrabony defects treated with regenerative therapy Emdogain: over 9 years long term results and teeth survival rate – a multicenter retrospective study in private practices

PC215: Periodontal intrabony defects treated with regenerative therapy Emdogain: over 9 years long term results and teeth survival rate – a multicenter retrospective study in private practices

PR362: One year re‐entry results of minimally invasive surgical technique with or without regenerative materials for periodontal intrabony defect treatment

PR362: One year re‐entry results of minimally invasive surgical technique with or without regenerative materials for periodontal intrabony defect treatment