Periodontal Regenerative Therapy Research Articles

Establishment of Periodontal Ligament Stem Cell-like Cells Derived from Feeder-Free Cultured Induced Pluripotent Stem Cells.

The periodontal ligament (PDL) is a fibrous connective tissue that connects the cementum of the root to the alveolar bone. PDL stem cells (PDLSCs) contained in the PDL can differentiate into cementoblasts, osteoblasts, and PDL fibroblasts, with essential roles in periodontal tissue regeneration. Therefore, PDLSCs are expected to be useful in periodontal tissue regeneration therapy. In a previous study, we differentiated induced pluripotent stem cells (iPSCs) into PDLSC-like cells (iPDLSCs), which expressed PDL-related markers and mesenchymal stem cell (MSC) markers; they also exhibited high proliferation and multipotency. However, the iPSCs used in this differentiation method were cultured on mouse embryonic fibroblasts; thus, they constituted on-feeder iPSCs (OF-iPSCs). Considering the risk of contamination with feeder cell-derived components, iPDLSCs differentiated from OF-iPSCs (ie, OF-iPDLSCs) are unsuitable for clinical applications. In this study, we aimed to obtain PDLSC-like cells from feeder-free iPSCs (FF-iPSCs) using OF-iPDLSC differentiation method. First, we differentiated FF-iPSCs into neural crest cell-like cells (FF-iNCCs) and confirmed that FF-iNCCs expressed NCC markers (eg, Nestin and p75NTR). Then, we cultured FF-iNCCs on human primary PDL cell-derived extracellular matrix for 2 weeks; the resulting cells were named FF-iPDLSCs. FF-iPDLSCs exhibited higher expression of PDL-related and MSC markers compared with OF-iPDLSCs. FF-iPDLSCs also demonstrated proliferation and multipotency in vitro. Finally, we analyzed the ability of FF-iPDLSCs to form periodontal tissue invivo upon subcutaneous transplantation with β-tricalcium phosphate scaffolds into dorsal tissues of immunodeficient mice. Eight weeks after transplantation, FF-iPDLSCs had formed osteocalcin-positive bone/cementum-like tissues and collagen 1-positive PDL-like fibers. These results suggested that we successfully obtained PDLSC-like cells from FF-iPSCs. Our findings will contribute to the development of novel periodontal regeneration therapies.

Preclinical Evaluation of a Poly (Lactic Acid/Caprolactone) Bilayer Membrane and a Carbonate Apatite for Periodontal Regeneration: A Canine One-Wall Intrabony Defect Model.

This preclinical study aimed to evaluate the periodontal tissue regenerative capacities of poly (lactic acid/caprolactone) (PLCL) bilayer membrane in one-wall intrabony defects in dogs. No study has assessed the efficacy of PLCL bilayer membrane for periodontal regeneration therapy despite the fact that PLCL bilayer membrane has proved efficient for bone regeneration. In five beagle dogs, the bilateral mandibular second and fourth premolars were extracted 8 weeks before the experimental surgery. Standardized bone defects (5 mm in height and 6 mm in width) were surgically created on the mesial and distal roots of the bilateral third premolars in the mandible. The test groups were set up as follows: (i) carbonate apatite (CO3Ap) + PLCL, (ii) CO3Ap, (iii) xenograft (DBBM) + collagen membrane (CM), and (iv) DBBM. The control group was left empty. Radiological, histologic and histomorphometric characteristics were compared 8 weeks after surgery. No infectious complications were detected at any of the tested sites. The test groups exhibited a greater height and volume of the newly formed bone than the control group. They also showed a greater height of the newly formed cementum than the control group. However, the results were not statistically significant. The newly formed periodontal ligaments were inserted into newly formed bone and cementum in the test groups. The combined use of PLCL bilayer membrane and CO3Ap demonstrated comparable performance for periodontal tissue regeneration in one-wall intrabony defects compared to conventional therapies.

Periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF)-2 in combination with carbonate apatite granules or rhFGF-2 alone: 12-month randomized controlled trial.

This randomized controlled trial compared the outcomes of recombinant human fibroblast growth factor (rhFGF)-2 plus carbonate apatite (CO3Ap) granules with rhFGF-2 alone in the treatment of intrabony periodontal defects. Patients with Stage III Grade B/C periodontitis who had completed initial periodontal therapy and had intrabony defects with a depth of ≥ 3mm were included. Defects were treated solely with rhFGF-2 (control) or rhFGF-2 plus CO3Ap (test). Periodontal parameters and a patient-reported outcome measure (PROM) were assessed at baseline, at 6, 9 and 12 months postoperatively. The primary outcome was the change in clinical attachment level (CAL) from baseline to 12 months postoperatively. Using the Friedman test with Dunn's post-test, intragroup data were compared over time, and Mann-Whitney U test was used to assess intergroup data at each time point. Forty-eight sites in 38 patients were subjected to analysis. At 12 months postoperatively, CAL in both groups showed a significant improvement from baseline (p < 0.001). CAL gain was 3.4 ± 1.3mm in the test group and 3.2 ± 1.2mm in the control group, with no significant intergroup difference (p = 0.567). Radiographic bone fill in the test group (67.2%) was significantly greater than in the control group (32.4%) (p < 0.001). PROM scores showed no difference between groups. At 12 months, the outcomes including CAL gain and PROM showed no significant differences between groups, although the combination treatment enhanced radiographic bone fill. The use of rhFGF-2 (with/without CO3Ap) could lead to significant improvement in clinical parameters in the treatment of intrabony periodontal defects. The benefit of adding CO3Ap to rhFGF-2 therapy needs further evaluation. The University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) : UMIN000040783.

Combined endodontic and regenerative periodontal therapy for managing questionable mandibular anterior teeth with radicular cysts

Abstract Endodontic microsurgery (EMS) presents a great treatment option for unresolved periradicular pathologies, typically involving the removal of the apical root portion and adjacent inflamed tissues. This case report describes the management of persistent periapical lesions in the lower anterior teeth of a 32-year-old male. Root canal treatment was completed 4 years before presentation. The patient presented to the clinic with tooth mobility and mild discomfort and large radiographical periapical radiolucency. The case was diagnosed with previously treated with asymptomatic apical periodontitis. EMS was performed in conjunction with periodontal-guided tissue regeneration that includes bone graft and resorbable membrane and the teeth showed favorable resolution of the symptoms. Histopathological analysis showed the presence of a radicular cyst. After 3 years of follow-up, cone-beam computed tomography and periapical radiographs demonstrated substantial lesion regression and favorable outcome. This case report offering promising insights into the synergistic potential of combined endodontic and regenerative periodontal therapy in cases with unresolved periapical lesion with extensive bone destruction.

CCKR signaling map, G-Protein bindings, hormonal regulation, and neural mechanisms may influence the osteogenic/cementogenic differentiation potential of hPDLSCs

ObjectivePeriodontal regeneration poses challenges due to the periodontium's complexity, relying on mesenchymal cells from the periodontal ligament (hPDLSCs) to regenerate hard tissues like bone and cementum. While some hPDLSCs have high regeneration potential (HOP-hPDLSCs), most are low potential (LOP-hPDLSCs). This study analyzed hPDLSCs from a single donor to minimize inter-individual variability and focus on key differences in differentiation potentials. DesignThis study used RNA-seq, genomic databases, and bioinformatics tools to explore signaling pathways (SPs), biological processes (BPs), and molecular functions (MFs) guiding HOP cells to mineralized matrix production. It also investigated limitations of LOP cells and strategies for enhancing their osteo/cementogenesis. ResultsIn basal conditions, HOP exhibited a multifunctional gene network with higher expression of genes related to osteo/cementogenesis, cell differentiation, immune modulation, stress response, and hormonal regulation. In contrast, LOP focused on steroid hormone biosynthesis and nucleic acid maintenance. During osteo/cementogenic induction, HOP showed strong modulation of genes related to angiogenesis, cell division, mesenchymal differentiation, and extracellular matrix production. LOP demonstrated neural synaptic-related processes and preserved cellular cytoskeleton integrity. CCKR map signaling and G-protein receptor bindings gained significance during osteo/cementogenesis in HOP-hPDLSCs. Both HOP and LOP shared common BPs related to gastrointestinal and reproductive system development. ConclusionThe osteo/cementogenic differentiation of HOP cells may be regulated by CCKR signaling, G-protein bindings, and specific hormonal regulation. LOP cells seem committed to neural mechanisms. This study sheds light on hPDLSCs' complex characteristics, offering a deeper understanding of their differentiation potential for future periodontal regeneration research and therapies.

Patient-reported outcome measures and health economics in regenerative periodontal therapy: A systematic review and meta-analysis.

Understanding patient responses to periodontal regeneration is crucial. This systematic review and meta-analysis addressed two key questions: (a) the impact of periodontal regeneration on patient-reported outcome measures (PROMs) for intrabony and furcation involvement and (b) the cost-effectiveness of periodontal regeneration for treating periodontal defects. Twenty-four studies were included, with 20 randomized clinical trials (RCTs) reporting patient-reported outcomes and five (three RCTs and two economic model-based studies) reporting cost-effectiveness outcomes. Results favored regeneration therapy over conventional flap surgery for intrabony defects, showing improvements in qualitative (i.e., amount of regenerated attachment apparatus) and quantitative parameters (i.e., probing and radiographic parameters). In terms of PROMs, regenerative treatments involving barrier membranes resulted in longer chair times and higher rates of complications (such as membrane exposure or edema) compared to flap with biologic agents or access flap alone. Despite this, oral health-related quality of life improved after both regenerative and extraction procedures. Economically, regeneration remained favorable compared to extraction and replacement or open flap debridement alone for periodontal defects. Single-flap variants in open flap debridement yielded similar outcomes to regenerative treatment, offering a potentially cost-effective option. Nevertheless, further discussion on the benefits of less-invasive flap designs is needed due to the lack of histological evaluation.

Periodontal plastic surgery and regenerative periodontal surgery in a forty-seven-year-old patient with cleft lip and palate

Cleft lip and palate represent one of the most prevalent congenital malformations in humans, with an estimated prevalence of 0.45 per 1,000 individuals. During childhood and adolescence, affected patients undergo lengthy and complicated interdisciplinary treatment including treatment from specialists in pediatric medicine, oral and maxillofacial surgery, orthodontics, and otorhinolaryngology. The patient exhibited scarred adhesions with localized mucogingival deformities of the premaxilla (region 12 − 11), bilateral cleft lip and palate, and a complex underlying one-wall intrabony osseous defect on tooth 11, in addition to hard- and soft-tissue deficiencies at the dental implant in region 12. Following the administration of localized anti-infective periodontal therapy, regenerative periodontal surgery, regenerative surgical therapy of periimplantitis, and periodontal plastic surgery were performed. This resulted in a long-term, stable improvement in the clinical situation. Regenerative periodontal therapy and periodontal plastic surgery in patients with palato-alveolar cleft present a significant challenge due to the poor condition of the mucosa and gingiva adjacent to the defect and the insufficient bone dimensions. For this reason, it seems beneficial to include the periodontist in the interdisciplinary treatment team of a patient with cleft lip and palate from the outset. It is recommended that the patient be provided with dental prophylaxis measures and receive individualized oral hygiene instructions in addition to the main maxillofacial and orthodontic treatment. This approach would facilitate the identification of mucogingival issues at an early stage and the implementation of appropriate treatment.

Root surface biomodification in periodontal therapy: Biological rationale and clinical applications.

Regenerative periodontal therapy aims to form new cementum, periodontal ligament, and alveolar bone, all sealed by gingival tissue. The root surface acts as the wound margin during this regeneration process. Root surface biomodification (root conditioning/root decontamination), therefore, seems instrumental in promoting surface decontamination and enhancing tissue attachment by removing the smear layer, exposing collagen fibrils, and facilitating blood clot formation and stabilization. This review attempted to provide an all-encompassing, evidence-based assessment of the role of root surface biomodification in regenerative periodontal therapy, particularly in intrabony defects, furcation defects, and root coverage procedures. The reviewed evidence suggested that root conditioning agents, whether used independently or in conjunction with bone graft materials, biological agents, membranes, or connective tissue grafts, do not offer any clinical advantage regarding clinical attachment gain. Thus, integrating chemical methods with the mechanical root instrumentation process does not necessarily contribute to superior clinical outcomes.

Factors associated with furcation involvement and fixed prostheses: A cross-sectional study.

The study aims to explore the relationship between horizontal and vertical furcation involvement (FI) in teeth with or without a single unit fixed prosthesis (FP). Adult subjects presenting to the periodontics department requiring cone beam computed tomography (CBCT) analysis were recruited for this study. 79 patients, with a total of 200 teeth, were split into two groups based on the presence or absence of FP within the same patient. Our analysis considered patient-level factors like smoking, diabetes, and periodontal severity and tooth-level factors including root trunk length (RTL), probing depth (PD), periodontal supracrestal tissue height (STH), supracrestal tissue attachment (STH-PD), interproximal bone distance (IPBD) to the cementoenamel junction (CEJ) (control) or crown margin (Test), and the distance from the furcation to the CEJ (control) or crown margin (Test). Subsequently, we developed a predictive model for FI. The presence of a prosthesis had a significant association with FI, with an odds ratio (OR) of 12.8 (p < 0.001). Other factors significantly correlated with FI were periodontitis (OR = 10.9; p = 0.006), buccal furcation site (OR = 5.70; p < 0.001), and PD (OR = 1.90; p = 0.027). FP placement increased IPBD by 1.08mm (p < 0.001). The predictive model built for FI demonstrated a sensitivity of 92.9% and a specificity of 66.7%. Fixed prosthesis significantly influenced FI only in periodontitis patients. Factors such as periodontitis Stage, probing depth, and buccal site contribute to FI. The high sensitivity of the predictive model highlights the importance of considering these correlations during treatment planning. Comprehending FI factors is vital for devising customised treatment plans to halt disease progression and enhance outcomes of periodontal regenerative therapies.

Clinical efficacy of titanium prepared platelet rich fibrin in periodontal regeneration: A systematic review and meta-analysis.

Periodontal regeneration therapies frequently involve autologous platelet concentrates (APCs). They can be used in sinus lift surgeries and socket preservation, among other clinical settings. Platelet rich fibrin (PRF) membrane has been used to treat gingival recession in individuals or groups of individuals using a coronally progressed or lateral pedicle flap. In the treatment of mixed periodontic endodontic lesion/furcation defect, PRF functions as a healing and interpositional biomaterial, filling a cystic cavity. PRF is known to help the bone regeneration process. In the last few years, efforts have been made to enhance the PRFs characteristics and quality. One of them is titanium platelet rich fibrin (T-PRF). Third-generation platelet concentrate no longer contains silica, and its preparation in glass vacuum containers, that no longer creates any known concerns. The effectiveness PRF's has been evaluated in connective tissue and bone repair. The aim of this study is to compare T-PRF to other platelet concentrates and different treatment modalities for periodontal regenerative procedures. A protocol of this systematic review have been registered in prospero (CRD42022293545). The online database searched were PUBMED, COCHRANE for published articles up to November 2022 without language restrictions. Studies in trial registers, handsearching, bibliographic references of relevant articles were also checked. Data collection and analysis was done by individual authors. Independent eligibility assessments were conducted by four review authors. Then, using the standard Cochrane methodology, four review authors extracted the data and evaluated the risk of bias for individual studies. We developed "Summary of findings" tables and used GRADE to evaluate the evidence. Three studies were included for meta-analysis. Results of meta-analysis supported that T-PRF is effective for correction of both hard and soft tissue defects. The overall qualitative and quantitative analysis suggest that T-PRF has superior structural properties and thicker fibrin network for ensuring predictable success periodontal regenerative procedures.

Hydrogels promote periodontal regeneration.

Periodontal defects involve the damage and loss of periodontal tissue, primarily caused by periodontitis. This inflammatory disease, resulting from various factors, can lead to irreversible harm to the tissues supporting the teeth if not treated effectively, potentially resulting in tooth loss or loosening. Such outcomes significantly impact a patient's facial appearance and their ability to eat and speak. Current clinical treatments for periodontitis, including surgery, root planing, and various types of curettage, as well as local antibiotic injections, aim to mitigate symptoms and halt disease progression. However, these methods fall short of fully restoring the original structure and functionality of the affected tissue, due to the complex and deep structure of periodontal pockets and the intricate nature of the supporting tissue. To overcome these limitations, numerous biomaterials have been explored for periodontal tissue regeneration, with hydrogels being particularly noteworthy. Hydrogels are favored in research for their exceptional absorption capacity, biodegradability, and tunable mechanical properties. They have shown promise as barrier membranes, scaffolds, carriers for cell transplantation and drug delivery systems in periodontal regeneration therapy. The review concludes by discussing the ongoing challenges and future prospects for hydrogel applications in periodontal treatment.

Orally Derived Stem Cell-Based Therapy in Periodontal Regeneration: A Systematic Review and Meta-Analysis of Randomized Clinical Studies.

The present systematic review was performed to assess the application of orally derived stem cells in periodontal regenerative therapy, and because of this, the following PICO question was proposed: "In patients with periodontitis, can the adjunctive use of orally derived stem cells provide additional clinical and radiographic benefits for periodontal regeneration?". Randomized clinical studies were electronically and manually searched up until December 2023. Quantitative analyses were performed with the aim of evaluating the mean differences (MDs) between the treatment and control groups in terms of clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction, gingival recession (GR), and radiographic bone gain (RBG) using random effect models. A total of seven studies were selected for the systematic review. Meta-analyses excluding studies with a high risk of bias highlighted a non-statistically significant result for the use of stem cells when compared to the control groups in terms of CAL gain [MD = 1.05; 95% CI (-0.88, 2.97) p = 0.29] and PPD reduction [MD = 1.32; 95% CI (-0.25, 2.88) p = 0.10]. The same also applied to GR [MD = -0.08; 95% CI (-0.79, 0.63) p = 0.83] and RBG [MD = 0.50; 95% CI (-0.88, 1.88) p = 0.48]. Based on the high heterogeneity, there is not enough evidence to consider the adjunctive application of orally derived mesenchymal stem cells as a preferential approach for periodontal regenerative treatment, as compared to standard procedures.

Effects of mechanical loading on matrix homeostasis and differentiation potential of periodontal ligament cells: A scoping review.

Various mechanical loadings, including mechanical stress, orthodontics forces, and masticatory force, affect the functions of periodontal ligament cells. Regulation of periodontal tissue destruction, formation, and differentiation functions are crucial processes for periodontal regeneration therapy. Numerous studies have reported that different types of mechanical loading play a role in maintaining periodontal tissue matrix homeostasis, and osteogenic differentiation of the periodontal ligament cells. This scoping review aims to evaluate the studies regarding the effects of various mechanical loadings on the secretion of extracellular matrix (ECM) components, regulation of the balance between formation and destruction of periodontal tissue matrix, osteogenic differentiation, and multiple differentiation functions of the periodontal ligament. An electronic search for this review has been conducted on two databases; MEDLINE via PubMed and SCOPUS. Study selection criteria included original research written in English that reported the effects of different mechanical loadings on matrix homeostasis and differentiation potential of periodontal ligament cells. The final 204 articles were mainly included in the present scoping review. Mechanical forces of the appropriate magnitude, duration, and pattern have a positive influence on the secretion of ECM components such as collagen, as well as regulate the secretion of matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases. Additionally, these forces regulate a balance between osteoblastic and osteoclast differentiation. Conversely, incorrect mechanical loadings can lead to abnormal formation and destruction of both soft and hard tissue. This review provides additional insight into how mechanical loadings impact ECM homeostasis and multiple differentiation functions of periodontal ligament cells (PDLCs), thus making it valuable for regenerative periodontal treatment. In combination with advancing technologies, the utilization of ECM components, application of different aspects of mechanical force, and differentiation potential of PDLCs could bring potential benefits to future periodontal regeneration therapy.

Comparison of the clinical efficacy of bone grafting and bone grafting combined with guided tissue regeneration in periodontal regenerative therapy: a meta-analysis.

This study aims to compare the clinical efficacy of simple bone grafting and bone grafting combined with guided tissue regeneration (GTR) in periodontal regenerative therapy. The authors systematically searched PubMed, the Web of Science, The National Library of Medicine, the China National Knowledge Infrastructure database and the Wanfang database and collected randomized controlled trials relating to bone graft co-guided tissue regeneration. The retrieval was conducted between January 1990 and December 2022. This study included relevant literature about the clinical efficacy of bone grafting combined with GTR according to the population, intervention, control and outcomes principle and excluded studies using other materials in addition to bone graft and membrane materials. After independently screening the literature, extracting the data and evaluating the risk of bias in the included studies, data analysis was performed using RevMan 5.3 software. Results: Eighteen studies met the inclusion criteria, and, after further evaluation, a total of 327 teeth that were featured in 15 articles were finally included for meta-analysis. The meta-analysis showed that there was no significant statistical difference in clinical attachment level, probing depth and bone gain between the test group (bone grafting with GTR) and the control group (bone grafting only) at 6 months after the operation (p > 0.05). In terms of gingival recession (GR), the use of non-resorbable membranes produced more recession in the test group compared with the control group (p < 0.05), whereas the use of resorbable membranes produced less recession (p < 0.05). Both simple bone grafting and bone grafting combined with membrane materials have good clinical efficacy in periodontal regenerative therapy, and no significant difference in clinical efficacy is indicated between the two, with the exception of GR.

COMBINATION OF REGENERATIVE THERAPY AND FREE GINGIVAL GRAFT IN STAGE IV PERIODONTITIS: CASE REPORT

Introduction: Periodontal regenerative therapy can be used to repair damaged periodontal tissues caused by periodontitis. The combination of regenerative periodontal surgery and FGG (Free Gingival Graft) is expected to accelerate the regeneration of periodontal tissue. Case : A 37-year-old woman came with complaints of loose lower front teeth, frequent bleeding and pain when eating and drinking. The complaint was felt since 1 year ago. Clinical examination obtained an average pocket depth of 6 mm and an average second degree of tooth mobility. On radiographic examination found bone damage horizontally. Case Management: The patient received root planing scaling and occlusion adjustment, followed by dental periodontal surgery 42,41,31,32. Stage II surgery for recession closure therapy with FGG was carried out three months after stage 1 surgery was performed. Discussion: Regenerative periodontal surgery is performed to produce new periodontal tissue growth and restore connective tissue attachment to the teeth. Free Gingival Graft is performed to increase gingival keratinization and improve patient esthetics. Conclusion and Suggestions: The combination of regenerative periodontal surgery and FGG for the treatment of periodontitis cases involving severe bone destruction gives good results of periodontal tissue healing by alveolar bone healing and regeneration and quite good aesthetics.

Autologous platelet concentrates in regenerative dentistry - A narrative literature review. Part II: clinical application of PRF in periodontology and implantology

The clinical impact of platelet-rich fibrin (PRF) and plasma rich in growth factors (PRGF®) respectively has been studied extensively in the field of regenerative dentistry during the last two decades. Literature supports evidence for additional benefits in regenerative periodontal therapy, alveolar ridge preservation, management of extraction sockets, implantology including guided bone regeneration as well as defect management in oral surgery. Regarding gingival wound healing and soft tissue regeneration, there is sufficient evidence for their positive effects which have been confirmed in several systematic reviews. The effects seem less clear in conjunction with osseous regenerative treatments, where the inter-study heterogenity in terms of different PRF-protocols, indications and application forms might hinder a systematic comparison. Nevertheless there is evidence that PRF might have beneficial effects on hard-tissue or its regeneration respectively.For being able to facilitate conclusions in systematic reviews, precise reporting of the used PRF-protocols is mandatory for future (clinical) research in the field of autologous platelet concentrates.

Knowledge, perceptions, and preferences for bone grafts in periodontal regenerative therapy (Indonesian society of periodontology study)

Objective: To evaluate the knowledge, perceptions, and preferences of Indonesian periodontists and resident students regarding the use of bone transplants in periodontal regeneration treatment. Material and Methods: This is a cross-sectional descriptive study using questionnaires given to members of The Indonesian Society of Periodontology. Results: All respondents had various knowledge and preferences regarding using bone grafts in periodontal regenerative therapy. Oral hygiene and radiographic appearance are parameters that must be evaluated before regenerative procedures. The most widely chosen graft is the xenograft due to better results, biocompatibility, and bioactivity of the material. Cost is the main reason why the respondents do not use bone grafts. Bone grafts are often combined with the GTR and membrane techniques, and the granular form is the most frequently used form of graft. Bone grafts are often used in periodontitis cases with vertical bone loss followed by implant placement. Conclusion: Xenografts are the most widely used bone graft material in Indonesia. There was no statistically significant difference between the two groups' perceptions of using bone grafts in periodontal regenerative therapy. Respondents were more satisfied with using bone grafts than with other materials.

Predictive factors of periodontal regeneration outcomes using rhFGF-2: A case-control study.

This study aimed to investigate the factors influencing the clinical outcomes of regenerative therapy using recombinant human fibroblast growth factor-2 (rhFGF-2). rhFGF-2 promotes periodontal regeneration, and identifying the factors influencing this regeneration is important for optimizing the effectiveness of rhFGF-2. This study used a hospital information-integrated database to identify patients who underwent periodontal regenerative therapy with rhFGF-2. Factors included age, smoking status, diabetes mellitus (DM), periodontal inflamed surface area (PISA) at the initial visit, whether the most posterior tooth was involved or not, and preoperative radiological bone defect angle. Periodontal regenerative therapy outcomes were defined as good if radiographic bone fill ≥35% or periodontal pocket closure at 9-15 months after surgery. Bone fill rate (%) and periodontal pocket depth (mm) were also used as outcome measures. Factors were evaluated by simple regression analysis, and then the association between factors and the outcomes was determined by multivariate analysis. PISA and age at the first visit did not significantly influence the success or failure of bone fill rate byrhFGF-2. However, DM, radiographic bone defect angle, and the most posterior tooth significantly influenced the regenerative effect (success/failure in bone fill) of rhFGF-2. The most posterior tooth was significantly associated with bone fill rate by rhFGF-2. Examination of the association between pocket closure and factors shows that the most posterior tooth significantly influenced. The most posterior tooth and preoperative PPD were significantly associated with pocket reduction depth. For the most posterior tooth, a significantly higher bone regeneration rate (p < .05) was observed with a combination of autologous bone graft and rhFGF-2 than with rhFGF-2 alone, and the effect was significant in multivariate analysis. The radiographic bone defect angle, the involvement of most posterior teeth, and the presence of DM influenced the effectiveness of rhFGF-2 in periodontal regeneration. However, PISA values and age at the initial visit had no significant effect.

Octacalcium phosphate collagen composite for periodontal regeneration in a canine one-wall intrabony defect.

This study aimed to evaluate the regenerative capacities of octacalcium phosphate collagen composite (OCP/Col) in one-wall intrabony defects in dogs. The background data discuss the present state of the field: No study has assessed the efficacy of OCP/Col for periodontal regeneration therapy despite the fact that OCP/Col has proved to be efficient for bone regeneration. In six beagle dogs, the mandibular left third premolars were extracted 12 weeks before the experimental surgery. Standardized bone defects (5 mm in height and 4 mm in width) were simulated on the distal surface of the second premolars and mesially on the fourth premolars. The defect was filled with either OCP/Col (experimental group) or left empty (control group). Histological and histomorphometric characteristics were compared 8 weeks after surgery. No infectious or ankylotic complications were detected at any of the tested sites. The experimental group exhibited a significantly greater volume, height, and area of newly formed bone than the control group. The former also showed a greater height of the newly formed cementum than the latter, although the results were not statistically significant. The newly formed periodontal ligaments were inserted into newly formed bone and cementum in the experimental group. OCP/Col demonstrated high efficacy for bone and periodontal tissue regeneration that can be successfully applied for one-wall intrabony defects.

Orthodontic tooth movement after periodontal regeneration of intrabony defects.

The prevalence of intrabony defects in patients with advanced periodontitis stages III and IV is high. These patients usually need both periodontal treatment and orthodontic therapy, including tooth movement through bone defects, to improve masticatory function, aesthetics, and overall quality of life. Clinical practice guidelines recommend periodontal regenerative surgical interventions to resolve these defects and propose initiating orthodontic tooth movement (OTM) once periodontal therapy goals have been met. Surgical interventions using various regenerative technologies like barrier membranes and enamel matrix proteins, combined or not with bone replacement grafts, have proven effective in regenerating lost periodontal tissues. However, the combination of periodontal and orthodontic treatments requires consideration of how periodontal regenerative therapies influence OTM. Studies suggest that regenerated bone may differ in density, composition, vascularity, and cellular activity, potentially affecting the speed and efficiency of OTM, and potential root resorption of moved teeth. Understanding the sequence and timing of implementing OTM after regenerative periodontal interventions is crucial due to their interlinked processes of bone resorption and formation. This narrative review aims to uncover scientific evidence regarding these combined treatments, examining the impacts of different regenerative technologies on OTM and delineating their advantages, limitations, and best practices.