Periodontal Surgery Research Articles

The Effect of Platelet-Rich Fibrin (PRF) in Accelerating Periodontal Regeneration: A Randomized Controlled Clinical Trial

ABSTRACT Background: Regeneration of periodontal tissues is an essential component in treating periodontal disease, and there is an increasing focus on biological agents that might improve the healing process. Materials and Methods: The randomized controlled clinical study included a cohort of 60 individuals diagnosed with chronic periodontitis. Each participant was randomly allocated to one of two groups: the experimental group (n = 30), which underwent PRF in combination with traditional open flap debridement (OFD), and the control group (n = 30), which received OFD alone. Clinical criteria such as probing pocket depth (PPD), clinical attachment level (CAL), and bone fill percentage were assessed at baseline and after 6 months. Furthermore, cone-beam computed tomography (CBCT) was used to evaluate bone regrowth radiographically. Results: Following a period of 6 months, the experimental group had a notable decrease in postpartum depression (mean decrease of 4.2 mm) and an increase in central artery ligation (mean increase of 3.5 mm) compared to the control group, which had a mean decrease in postpartum depression of 2.8 mm and a mean increase in central artery ligation of 2.1 mm. The test group had a notably greater proportion of bone fill (45%) in comparison to the control group (30%). Further radiographic study verified enhanced bone regeneration in the areas treated with PRF. Conclusion: The use of Platelet-Rich Fibrin (PRF) in combination with traditional periodontal surgery greatly expedites the process of periodontal regeneration, as shown by notable enhancements in clinical indicators and bone regeneration.

“Liver Clots” in Periodontology: A 10‐Year Clinical Experience

ABSTRACTObjectives“Liver clots” are an uncommon complication following periodontal surgery, characterized by their distinctive gelatinous consistency and color resembling 'liver' tissue. Despite anecdotal reports, there is a lack of comprehensive evidence in the literature regarding its incidence, etiopathogenesis and optimal management strategies. This study aimed to address this knowledge gap by retrospectively analyzing cases to provide insights into this unusual post‐operative complication.Materials and MethodsIn this retrospective descriptive study, data spanning a decade (June 2013–June 2024) were collected from various dental centres. The data included patient demographics, medical history, surgical procedures performed, occurrence of “liver clot” formation, management measures and treatment outcomes.ResultsThe 10‐year retrospective data revealed a 2.03% incidence of “liver clots” among various periodontal procedures. The highest occurrence was observed following dental extractions, followed by periodontal surgical procedures. The observations also indicated a higher frequency in systemically healthy individuals.Conclusion“Liver clot” formation is a rare, but specific complication after periodontal surgery. Minimally invasive management approaches are effective, highlighting the importance of vigilance and prompt intervention for optimal patient outcomes. Further research is warranted to elucidate the exact etiopathogenesis and to establish evidence‐based management protocols for this unusual complication.

Treating apical fenestration in a previously endodontically treated tooth

Apical fenestration is a defect in the alveolar cortical plate, exposing the root without involving the alveolar bone margin, often linked to trauma, periodontal disease, and orthodontic treatment, leading to symptoms such as pain and abscesses from endodontic infections. This case report describes managing a mucosal fenestration in an endodontically treated tooth with nonsurgical root canal therapy and periodontal surgery. A 44-year-old male presented with mucosal fenestration and pain in the upper front jaw due to trauma and an inadequately treated root canal. Examination revealed an ill-fitting crown and an open apex with periapical radiolucency. Treatment included scaling, root planing, nonsurgical root canal therapy, apexification using Biodentine, and obturation with bioceramic sealer. Persistent fenestration necessitated periodontal surgery to remove extruded material and place an alloplastic graft. Apical fenestrations, although uncommon, require coordinated endodontic and periodontal treatment for successful outcomes.

Trends in Prescribing Systemic Antibiotics by Libyan Dentists and Periodontists

Antibiotic prescription is a common practice in everyday dentistry. Although antibiotics play a crucial role in managing periodontal disease, the threat of antibiotic resistance is an issue that requires more exploration. The aim of this study was to describe the patterns of prescribing systemic antibiotics treating periodontal and peri-implant diseases among Libyan dentists and periodontists. An online cross-sectional survey was designed to investigate the patterns and perspectives of antibiotic prescription. Indication parameters and timing of prescription that were analysed included: chronic gingivitis, chronic periodontitis, aggressive periodontitis, acute gingival and periodontal conditions, periodontal surgery, implant placement surgery, peri-implantitis treatment, and antibiotic prophylaxis for infective endocarditis. Out of the 3000 registered Libyan dentists, only 181 participated in the study. Systemic antibiotic prescription patterns varied markedly for different periodontal or peri-implant diseases among respondents. 72.29% of the respondents reported prescribing systemic antibiotics for the treatment of aggressive periodontitis, while 34.93% prescribed them for chronic periodontitis, 10.24% for chronic gingivitis, 71.15% for periodontal surgery, 64.64% for implant placement surgery, and 67.95% for peri-implanttitis treatment. The most commonly prescribed systemic antibiotics were amoxicillin, the combination of amoxicillin with metronidazole, and clavulanate potassium. This study revealed a high prevalence of overuse and misuse of systemic antibiotics in dental practice. Furthermore, it emphasizes the necessity of improving antimicrobial resistance awareness among Libyan dentists and incorporating antimicrobial stewardship.

Performance of ChatGPT and Dental Students on Concepts of Periodontal Surgery.

As a large language model, chat generative pretrained transformer (ChatGPT) has provided a valuable tool for various medical scenarios with its interactive dialogue-based interface. However, there is a lack of studies on ChatGPT's effectiveness in handling dental tasks. This study aimed to compare the knowledge and comprehension abilities of ChatGPT-3.5/4 with that of dental students about periodontal surgery. A total of 134 dental students participated in this study. We designed a questionnaire consisting of four questions about the inclination for ChatGPT, 25 multiple-choice, and one open-ended question. As the comparison of ChatGPT-3.5 and 4, the question about the inclination was removed, and the rest was the same. The response time of ChatGPT-3.5 and 4 as well as the comparison of ChatGPT-3.5 and 4' performances with dental students were measured. Regarding students' feedback on the open-ended question, we also compared the outcomes of ChatGPT-4' and teacher's review. On average, ChatGPT-3.5 and 4 required 3.63 ± 1.18 s (95% confidence interval [CI], 3.14, 4.11) and 12.49 ± 7.29 s (95% CI, 9.48, 15.50), respectively (p < 0.001) for each multiple-choice question. For these 25 questions, the accuracy was 21.51 ± 2.72, 14 and 20 for students, ChatGPT-3.5 and 4, respectively. Furthermore, the outcomes of ChatGPT-4's review were consistent with that of teacher's review. For dental examinations related to periodontal surgery, ChatGPT's accuracy was not yet comparable to that of the students. Nevertheless, ChatGPT shows promise in assisting students with the curriculum and helping practitioners with clinical letters and reviews of students' textual descriptions.

A Contemporary Approach: Presentation of 4 Cases with the Entire Papilla Preservation (EPP) Technique

Regeneration of periodontal tissue is a primary goal of periodontal treatment. Periodontal regeneration approaches are widely used in the treatment of intraosseous defects. However, the success of these techniques depends on many factors, including surgical considerations. Failures in wound closure in the interdental region, which are surgical factors, have led to the development of papilla preservation techniques. The entire papilla preservation technique (EPP) maintains the integrity of the papilla associated with the defect. This technique stabilizes the blood clot with intact gingiva, preventing wound exposure and contamination. EPP is performed in intra-osseous defects through a short buccal vertical incision, without incising the papilla of the involved tooth. A full-thickness buccal flap is lifted from the incision to the relevant papilla and a tunnel extending under the papilla is prepared. The papilla is also lifted to full thickness. The defect is cleaned of granulation tissue and the wound is closed primarily with or without biomaterial application. In this report, we present 4 cases, 3 in the anterior maxilla and 1 in the mandibular premolar region, undergoing periodontal surgery with EPP with biomaterial application with a 3-month follow-up. In all cases, soft tissue healing was uncomplicated and radiographs showed bone filling at 3 months. EPP has a high success rate in periodontal regeneration by providing complete nutrition of the interdental papilla through natural, continuous vascular support in intraosseous defects.

Evaluating the effect of photobiomodulation with 1064 nm diode laser on postoperative pain and wound healing in periodontal flap surgery: a clinical study

Evaluating the effect of photobiomodulation with 1064 nm diode laser on postoperative pain and wound healing in periodontal flap surgery: a clinical study

A Blissful Role of Probiotic Therapy as an Adjunct to Periodontal Surgery in the Treatment of Periodontitis

A Blissful Role of Probiotic Therapy as an Adjunct to Periodontal Surgery in the Treatment of Periodontitis

The impact of intravenous versus submucosal dexamethasone on short-term patient response: A randomized controlled trial.

The purpose of this randomized, cross-over trial was to determine if a preoperative dose of dexamethasone administered submucosally is as effective as intravenous (IV) dexamethasone in reducing pain, swelling, and analgesic consumption after periodontal flap surgery. Thirty-nine patients planned for two similar flap surgeries under IV sedation were included. Before the first surgery, patients were randomized to receive 8mg of IV or submucosal dexamethasone. Via the alternate route, 0.9% sodium chloride (placebo) was administered. Dexamethasone was administered via the opposite route during the second surgery. A standardized regimen of 600mg ibuprofen and 325mg acetaminophen was used to manage postoperative pain. Patients recorded pain and swelling levels on a 21-point numerical rating scale (NRS-21) and a four-point visual rating scale (VRS-4), as well as analgesic usage via a phone application at 12, 24, 48, 72, and 168h postoperatively. While NRS-21 and VRS-4 data suggest a trend toward decreased pain and swelling with IV administration, there were no significant differences in analgesic usage or pain at any time and a significant difference in swelling only at 72 h in favor of IV administration (p=0.047). There was no significant difference in pain or analgesic usage following periodontal flap surgery comparing IV and submucosal dexamethasone. A statistically significant difference in swelling between groups at 72 h is likely of limited clinical relevance. Submucosal dexamethasone is an effective way to mitigate pain following periodontal surgery, particularly when IV access for sedation is not required.

Comparative Evaluation of Laser System to Conventional Surgical Approaches in Periodontal Healing Using Optical Coherence Tomography

Background: Optical coherence tomography (OCT) is an emerging, radiation-free diagnostic tool in dentistry, providing high-resolution, real-time imaging of both hard and soft tissues, including periodontal areas, for more accurate postoperative evaluations. This study aims to investigate the efficacy of OCT on periodontal tissues in animals by comparing the healing effects of laser therapy with those of conventional surgical instruments. Methods: Six rabbits underwent periodontal surgery using a laser, scalpel, and punch to perform an apically positioned flap on the mandibular anterior incisors and to create a tongue ulcer on the dorsal surface of the tongue. Visual and OCT evaluations were conducted on days 1, 2, 3, 7, and 14. Results: In periodontal surgery, the laser exhibited slightly faster healing compared to other methods. In tongue ulcer formation, the scalpel and punch groups demonstrated slightly faster healing than that of the laser. However, both methods ultimately showed similar healing outcomes. Conclusions: In the dental field, OCT is emerging as a valuable tool for assessing healing, including early stages of healing, in periodontal therapy.

Treatment of Pyogenic Granuloma with Periodontal Surgery

Treatment of Pyogenic Granuloma with Periodontal Surgery

Quality of minimally invasive periodontal surgery videos on youtube

Quality of minimally invasive periodontal surgery videos on youtube

Prosthodontic rehabilitation with crown lengthening by guided periodontal surgery

Prosthodontic rehabilitation with crown lengthening by guided periodontal surgery

The Evaluation of Wound Healing Following Periodontal Surgery Varied Across Different Dental Specialties Using a Modified Early Wound Healing Index

The Evaluation of Wound Healing Following Periodontal Surgery Varied Across Different Dental Specialties Using a Modified Early Wound Healing Index

Introduction and overview on autogenous Platelet concentrates.

This special issue on autologous platelet concentrates (APCs) provides clinicians with an overview on the current understanding of the use of these biomaterials for soft and hard-tissue regeneration. The included papers summarize scientific evidence and the clinical findings, presented in simple tables that outline potential benefits including Patient Reported Outcome Measures (PROMs). This approach enables clinicians to assess clinical relevance and researchers to identify significant gaps in the literature. The first part provides a comprehensive summary of the basic science surrounding APC, with particular focus on their preparation methods. Clear recommendations are outlined, which are crucial for obtaining high-quality APCs, alongside an exploration of how APCs may influence both soft and hard tissue healing processes. Part 2 delves into the clinical evidence for the potential benefits of APCs across a range of applications: alveolar ridge preservation, sinus floor elevation, periodontal plastic surgery, guided tissue regeneration, guided bone regeneration, the healing of Medication-Related Osteonecrosis of the Jaw (MRONJ), and endodontic surgery. In the part 3, the discussion turns to the effects of APCs on the healing of extra-oral wounds, including diabetic foot ulcers, venous leg ulcers, pressure injuries, burns, and more. For those clinicians persuaded by the evidence, the fourth section offers a detailed, step-by-step flowchart for each treatment modality, providing a clear guide for clinical application.

Correction of midline diastema and severe gingival recession with periodontal surgery and orthodontic treatment: A case report with 20 years of follow-up

Correction of midline diastema and severe gingival recession with periodontal surgery and orthodontic treatment: A case report with 20 years of follow-up

Digital photometric analysis as a non-invasive method to determine gingival phenotype: A comparative study

ObjectiveIdentification of periodontal phenotype is critical in clinical practice. Thick and thin tissues respond differently to inflammation, and trauma. It significantly influences the outcomes of restorative treatment, regenerative therapy, and success of implants and periodontal surgery. Periodontal phenotype can be assessed via invasive or non-invasive methods. This study aimed to establish the reliability of non-invasive methods in determining gingival phenotypes in comparison with validated methods. MethodsThis preapproved cross-sectional observational study was conducted at Batterjee Medical College in Saudi Arabia. The participants were conveniently sampled based on the inclusion criteria. The clinical study utilized Colorvue® biotype probes to evaluate gingival tissue phenotype in the region of interest, intraoral digital scanner (IOS) (iTero® scanner), and digital photography. Densitometric acquisition of photographs and intraoral scans was performed using Adobe Photoshop to quantify three-dimensional color measurements expressed in Delta E values (ΔE). Furthermore, patient-reported experience measures (PREMs) were used to evaluate anxiety and pain perception. Values of p < 0.05 were considered statistically significant. ResultsThe analysis of color difference values (ΔE) revealed significant variations in color perception across methods for the thin, medium and very thick groups, indicating perceptible color differences (p < 0.001). The assessment of anxiety levels indicated a statistically significant decrease in stress levels in favor of the IOS method for the medium phenotype. Furthermore, perceived pain was significantly lower with the IOS method than with the probing method for all phenotypes. ConclusionDensitometric analysis of standardized clinical photographs and intraoral scans of the marginal gingiva offers a promising, non-invasive, less stressful, and virtually non-painful method of periodontal phenotype evaluation with reliable numerical outputs. Furthermore, these data may be used to feed AI systems, where machines can learn to recognize color differences and possibly deduce phenotype assessments.

Determining the Frequency, Severity and Complications After Periodontal Surgeries

Determining the Frequency, Severity and Complications After Periodontal Surgeries

From Healing to Regeneration: A Comprehensive Review of the Efficacy of Platelet-Rich Fibrin in Periodontal Plastic Surgery Procedures.

This review examines platelet-rich fibrin (PRF) efficacy in periodontal plastic surgery, highlighting its crucial role in promoting periodontal regeneration and healing. Various forms of PRF are discussed, like leukocyte- and platelet-rich fibrin, advanced PRF, and injectable PRF, in addition to their application in different periodontal procedures such as root coverage and increasing the width of keratinized tissue surrounding the teeth. This review emphasizes the biological benefits of PRF, such as faster wound healing, reduced postsurgical pain, and better management of bleeding. The presence of growth factors, cytokines, and leukocytes in PRF significantly aids in promoting tissue regeneration, thereby improving the clinical outcomes of periodontal therapy. This review also provides recommendations for further research using standardized PRF protocols to optimize the benefits of PRF in clinical practice.

Effects of ascorbic acid augmented albumin platelet-rich fibrin on the wound healing activity of human gingival fibroblasts: an in vitro trial.

The current in vitro study aimed to assess the effects of ascorbic acid augmented albumin platelet-rich fibrin (AA Alb-PRF) on the wound healing activity of human gingival fibroblasts (HGFs) purported to be a regenerative biomaterial in surgical procedures. All assays were performed on three HGF groups, group I: complete media; group II: Alb-PRF, and group III: AA Alb- PRF. Alb-PRF was prepared following the protocol by Fujioka-Kobayashi et al. (2021). For preparation of AA Alb-PRF, 2,500 μg AA was added to the blood pre-centrifugation. All groups were subjected to 3-(4,5-dimethythiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay to estimate cell viability and proliferation, scratch assay for migration (0, 4, 12, and 24 hours) and transwell migration assay for chemotactic migration assessment (24 hours). Outcome variables were optical density (OD) for MTT assay, percentage of wound closure in scratch assay, and number of migrated cells in transwell migration assay. One-way ANOVA for MTT and transwell migration assays and two-way ANOVA for scratch assay with Bonferroni correction were performed with significance set at P<0.05. Cell viability and proliferation (OD: 0.684±0.003 and proliferation: 28%) and wound closure (49.92%±1.62% at 4 hours and 61.39%±0.88% at 12 hours) were significantly higher in group III, while group II demonstrated the maximum number of HGFs migrating across the transwell membrane (9.25±2.49) with P<0.05. HGFs demonstrated a significant increase in viability and proliferation along with rapid wound closure in the presence AA Alb-PRF compared to Alb-PRF alone, indicating additional beneficial effects of AA. Thus, AA Alb-PRF potentiates the wound healing activity of HGFs and could be employed in oral, maxillofacial, and periodontal surgeries as a regenerative biomaterial.