Periodontal Wound Research Articles

Evaluation and Comparison of Postoperative Healing with and without Periodontal Dressing in Patients Undergoing Periodontal Therapy: A Systematic Review

Background: Wound healing is a multifactorial process, and the wound environment is in a constant state of flux. Periodontal wound healing can be hampered by a number of local factors and to minimize this, the practice of application of periodontal dressings was undertaken. Materials and Methods: This systematic review aims to gather and evaluate all available data about postoperative healing with and without periodontal dressings in patients undergoing periodontal therapy. An extensive search was conducted using databases such as PubMed/MEDLINE, Cochrane, EBSCO, CTRI, and hand search of a list of archived articles published from January 1974 to June 2022. Randomized controlled trials were searched, using plaque index, sulcular bleeding index, postoperative bleeding, swelling, volume of gingival crevicular fluid, gingival inflammation, pocket depth, pain and the outcomes were evaluated with a minimum follow-up of 24 h. The risk of bias was estimated after data extraction. Results: The results from our systematic review showed that periodontal dressings do not help in healing after routine flap surgeries, and hence, its use is restricted. Periodontal dressings lead to plaque accumulation, which in turn causes inflammation and irritates the healing tissues. Periodontal dressings may be placed after certain procedures such as apically displaced flaps, free gingival graft surgeries, and also procedures where protection of denuded bone is needed. Conclusion: Periodontal dressings are not indicated after flap surgeries. However, their usage after certain procedures such as apically displaced flaps, free gingival graft surgeries, and procedures where protection of denuded bone is required is recommended.

The Role of Sodium Fluoride Mouthwash in Regulating FGF-2 and TGF-β Expression in Human Gingival Fibroblasts.

Sodium fluoride (NaF) is a fluoride application recommended by the World Health Organization for its efficacy and safety in preventing dental caries. Gingival fibroblasts that constitute the majority of connective tissue cells play a major role in wound healing via the expression of growth factors, including fibroblast growth factor-2 (FGF-2) and transforming growth factor-beta (TGF-β). This study examined the effect of NaF mouthwash on FGF-2 and TGF-β expression in human gingival fibroblasts (HGnFs). Fibroblasts were exposed to a medium with 225 ppmF NaF for 1 min, then switched to either 15 ppmF NaF for continuous stimulation or no NaF for transient stimulation. Continuous NaF stimulation significantly increased the gene and protein expression of FGF-2 and TGF-β in HGnFs compared to controls, suggesting NaF's potential role in modulating periodontal tissue wound healing. Signaling pathway investigations showed the involvement of heterotrimeric GTP-binding proteins, calcium/calmodulin-dependent kinase II (CaMKII), and extracellular signal-regulated kinase (ERK) phosphorylation. Inhibiting CaMKII reduced NaF-induced FGF-2 and TGF-β expression, while ERK phosphorylation increased after NaF stimulation. These results highlight NaF mouthwash's potential in promoting wound healing in extraction sockets, particularly during the mixed dentition period. Understanding NaF's effects is clinically relevant due to the common use of fluoride products.

A comprehensive review on natural macromolecular biopolymers for biomedical applications: Recent advancements, current challenges, and future outlooks

Versatile material properties coupled with high degree of biocompatibility and biodegradability has made biopolymers as potential candidates for diverse applications in the biomedical field. Natural biopolymers derived from various plant, animal and microbial sources with different biochemical compositions are extensively used in biomaterial industry with or without further medication to their native form. Biopolymeric biomaterials have been employed in a wide range of biomedical applications like tissue engineering, drug delivery, bone regeneration, wound dressings and cardiovascular surgery. Carbohydrate based biopolymers and protein based biopolymers are extensively used for several applications in the biomedical field including cartilage regeneration, periodontal tissue regeneration, bone regeneration, corneal regeneration, drug delivery and wound healing. This review work presents a comprehensive outlook on the applications of various biopolymers in biomedical field. The work elaborates the biochemistry of these polymers with special focus on their crucial properties in the biomedical industry. Further a detailed description on the most recent application of various biopolymers in the biomedical filed is presented in this review. This work further summarizes the current challenges and future prospects in the use of biopolymers in biomedical field.

The Role of Pericyte Migration and Osteogenesis in Periodontitis

A ligature-induced periodontitis model was established in wild-type and CD146CreERT2; RosatdTomato mice to explore the function of pericytes in alveolar bone formation. We found that during periodontitis progression and periodontal wound healing, CD146+/NG2+ pericytes were enriched in the periodontal tissue areas, which could migrate to the alveolar bone surface and colocalize with ALP+/OCN+ osteoblasts. Chemokine C-X-C motif receptor 4 (CXCR4) inhibition using AMD3100 blocked CD146-Cre+ pericyte migration and osteogenesis, as well as further exacerbated periodontitis-associated bone loss. Next, primary pericytes were sorted out by magnetic-activated cell sorting and demonstrated that C-X-C motif chemokine ligand 12 (CXCL12) promotes pericyte migration and osteogenesis via CXCL12-CXCR4-Rac1 signaling. Finally, the local administration of an adeno-associated virus for Rac1 overexpression in NG2+ pericytes promotes osteoblast differentiation of pericytes and increases alveolar bone volume in periodontitis. Thus, our results provided the evidence that pericytes may migrate and osteogenesis via the CXCL12-CXCR4-Rac1 axis during the pathological process of periodontitis.

Early periodontal wound healing after chlorhexidine rinsing: a randomized clinical trial

ObjectivesThis single-center randomized, parallel design, clinical trial with a 2-week follow-up involved patients affected by periodontitis undergoing periodontal surgery. The aim was to evaluate periodontal surgical wound healing with the use of chlorhexidine-based mouth rinses versus an untreated control group.Materials and methodsPeriodontal surgery was performed following a standardized protocol. Patients were randomly prescribed i) chlorhexidine (CHX) + anti-discoloration system (ADS) + hyaluronic acid (HA), ii) CHX + ADS or iii) no treatment (control group). Plaque score, gingival inflammation, and Early Healing Index (EHI), assessing the degree of wound closure and the presence of fibrin and necrosis, were evaluated at 3, 7 and 14 days after surgery.ResultsIn total, 33 patients were enrolled. Patients were comparable at baseline for all measured clinical parameters. At 3-days wound healing was significantly improved in all patients treated with CHX + ADS-based mouth rinses with a lower EHI score at the interdental papillae compared with control group (p < 0.01). CHX + ADS + HA group presented improved healing across all time points in terms of EHI, plaque containment, and gingival inflammation when compared to control group (p < 0.01).ConclusionsThe usage of CHX-ADS following periodontal surgery improved early wound healing, reduced plaque accumulation and gingival inflammation. During the early post-operative period the adjunct of HA further improved soft tissue closure.Clinical relevanceThis study aims at evaluating the response of gingival tissues to mouth rinsing with chlorhexidine and anti-discoloration system (CHX + ADS) or CHX + ADS + hyaluronic acid (CHX + ADS + HA) versus no rinse in terms of healing of the periodontal surgical wound. CHX + ADS mouth rinses enhanced early soft tissue closure after periodontal surgery and contributed to the reduction in plaque accumulation and gingival inflammation. The adjunct of HA may be beneficial especially in the early post-operative period. CHX + ADS administration following periodontal surgery may improve soft tissue healing in the first two post-operative weeks.

Preparation and Characterization of Ferulic Acid Hydrogel and Its Application as a Local Drug Delivery Agent in Periodontitis.

Introduction Periodontitis, a persistent inflammatory condition, impacts the tissues supporting teeth. Beyond mechanically eradicating the biofilm, additional host-modulating agents can aid in the treatment of periodontitis. Among these, gels are a very popular choice for use in the field of dentistry as these systems boast high biocompatibility and bioadhesiveness. These qualities make them easily administered and fabricated. They aretypically placed into the periodontal site via wide-port needle syringes. Many investigations have demonstrated that hydrogels possess the ability for controlled drug release and aid in periodontal wound healing. Hence, this study aimed to develop a ferulic acid hydrogel and assess its effectiveness for managing periodontitis. Materials and methods Ferulic acid hydrogel was prepared followed by haemolysis assay and biocompatibility assay. After the in vitro analysis, a clinical trial was conducted: 20 patients were divided into Group A (comprising patients in whom scaling and root planing (SRP) was done) and Group B (comprising patients in whom SRP along with hydrogel application was done). Each patient's pocket depth (PD), clinical attachment loss (CAL), gingival index (GI), and plaque index (PI) were recorded at baseline and at three months. Intergroup and intragroup comparisons of the parameters were made. Results Ferulic acid hydrogels exhibit a minimal ratio of red blood cell destruction, indicating their low haemolytic activity. Beyond 94 hours, ferulic acid hydrogel demonstrates minimal toxicity towards human fibroblasts, suggesting it has good biocompatibility. When clinical parameters were compared after three months of treatment with SRP alone, significant reductions were observed in all parameters. However, when hydrogel application was done along with SRP, greater reduction was seen in terms of all clinical parameters indicating the efficacy of the ferulic acid hydrogel as an adjunct. Conclusion Ferulic acid has distinct haemolytic activity as well as good biocompatibility. Its use also led to a considerable reduction in all clinical parameters, necessitating its role as a local drug delivery agent in the treatment of periodontitis.

Periodontal granulation tissue - To remove or not to remove, that is the question.

Formation of granulation tissue is a fundamental phase in periodontal wound healing with subsequent maturation leading to regeneration or repair. However, persistently inflamed granulation tissue presents in osseous defects as a result of periodontitis and is routinely disrupted and discarded with non-surgical and surgical therapy to facilitate wound healing or improve chances of regeneration. Histological assessment suggests that granulation tissue from periodontitis-affected sites is effectively a chronic inflammatory tissue resulting from impaired wound healing due to persistence of bacterial dysbiotic bioflim. Nevertheless, the immunomodulatory potential and stem cell characteristics in granulation tissue have also raised speculation about the tissue's regenerative potential. This has led to the conception and recent implementation of surgical techniques which preserve granulation tissue with the intention of enhancing innate regenerative potential and improve clinical outcomes. As knowledge of fundamental cellular and molecular functions regulating periodontitis-affected granulation tissue is still scarce, this review aimed to provide a summary of current understanding of granulation tissue in the context of periodontal wound healing. This may provide new insights into clinical practice related to the management of granulation tissue and stimulate further investigation.

Histological evaluation of nonsurgical periodontal treatment with and without the use of sodium hypochlorite / amino acids and cross-linked hyaluronic acid gels in dogs

ObjectivesTo evaluate periodontal wound healing following scaling and root planing (SRP) in conjunction with the application of sodium hypochlorite/amino acids and cross-linked hyaluronic acid (xHyA) gels in dogs.Materials and MethodsIn four beagle dogs, 2-wall intrabony defects were created and metal strips were placed around the teeth. Clinical parameters were measured 4 weeks after plaque accumulation. The experimental root surfaces were subjected to SRP with either the subgingival application of a sodium hypochlorite/amino acid gel and a xHyA gel (test group) or SRP alone (control group) using a split-mouth design. Clinical parameters were re-evaluated at 6 weeks. The animals were sacrificed at 8 weeks for histological analysis.ResultsThe test group showed significant improvements in all clinical parameters compared to the control group. Histologically, the test group exhibited statistically significantly greater new bone formation [i.e., length of newly formed bone, new bone area] compared with the control group (p < 0.05). Furthermore, statistically significantly greater formation of new attachment [i.e., linear length of new cementum adjacently to newly formed bone with inserting collagen fibers] and new cementum was detected in the test group compared with the control group at 8 weeks (p < 0.05 and p < 0.01, respectively).ConclusionThe adjunctive subgingival application of sodium hypochlorite/amino acid and xHyA gels to SRP offers an innovative novel approach to enhance periodontal wound healing/regeneration.Clinical relevanceThe present findings have for the first-time shown histologic evidence for periodontal regeneration in support of this novel treatment modality.

Does Full-Mouth Disinfection Influence the Size of the Periodontal Inflammatory Burden and the Level of hsCRP?

To investigate the effect of full-mouth disinfection on the sizes of the periodontal wound and periodontal inflammatory burden and whether it leads to a decrease in C-reactive protein (CRP) levels. The study included 20 systemically healthy subjects (11 women and 9 men) 30 to 68 years old with localised or generalised periodontitis (stage III, grade C). The sizes of the periodontal wound and periodontal inflammatory burden were measured with the web application "Periodontalwound", which is based on measurements of average tooth cervices, as well as probing depths and bleeding on probing assessed at six sites around each tooth present in the oral cavity. The levels of hsCRP (high-sensitivity CRP) were measured with an immunochemical method. All three parameters were measured before initial treatment and 3 months after therapy. Full-mouth disinfection included removal of plaque and calculus with ultrasonic and hand instruments in one session. The results showed a statistically significant decrease in the size of the periodontal wound (p < 0.001), a statistically significant decrease in the size of periodontal inflammatory burden (p < 0.001), and a decrease in hsCRP levels 3 months after therapy. Full-mouth disinfection leads to a decrease in the periodontal wound and periodontal inflammatory burden size, as well as a decrease in the levels of hsCRP in patients with localised or generalised periodontitis (stage III, grade C).

To Evaluate the Effect of Vitamin B Complex on Wound Healing – A Clinical and Microbiological Study

ABSTRACT Background: The purpose of this study is to explore the effect of vitamin B complex supplementation following periodontal flap surgery on clinical and microbiological parameters. Materials and Methods: A randomized controlled trial on 10 patients with periodontitis in split-mouth design was undertaken to find the effect of vitamin B complex supplementation with open flap debridement on periodontal wound healing. Multiplex polymerase chain reaction (PCR) for Tannerella forsythus and Porphyromonas gingivalis was done using subgingival plaque samples at 0 and 90th day. Results: The results showed a significant reduction (P &lt; 0.01) of clinical (plaque index, gingival index, gingival bleeding index, probing pocket depth, and relative attachment level) and microbial profile in both treatment groups, whereas on intergroup analysis, more reduction in all clinical parameters were observed in the test group, but statistically, the results were insignificant.

Integrated strategies for the clinical correlation, prevention and management of chronic oral infections, wounds and arteriosclerotic occlusion in lower extremities

AbstractThis study explores the intricate relationship between chronic periodontitis (CP) and its implications for wound healing, particularly in the context of arteriosclerotic occlusion (ASO) in the lower extremities. A cohort of 90 individuals was categorized into three groups: those with CP, those with both CP and ASO (ASO + CP) and a healthy control group. Comprehensive assessments including oral examinations, blood tests and questionnaires were conducted. Key oral health indicators such as probing depth (PD), bleeding on probing (BOP) and periodontal inflammatory surface area (PISA) were evaluated to gauge the severity of periodontal wounds. The study found that the ASO + CP group showed a significantly higher number of missing teeth and increased PD compared to the CP group (p &lt; 0.05). Both CP and ASO + CP groups exhibited elevated PD, BOP and PISA compared to the control group (p &lt; 0.05), indicating exacerbated periodontal wounds. Serum analyses showed heightened total cholesterol (TC) and high‐sensitivity C‐reactive protein (hs‐CRP) levels in the ASO + CP group, suggesting a stronger inflammatory response and potential for atherogenesis. Interestingly, FPG and triglycerides (TG) levels did not significantly vary across groups (p &gt; 0.05). Regression analysis identified PD (β = 2.271, p &lt; 0.001) and PISA (β = 0.027, p = 0.001) as significant predictors for ASO presence in CP patients. The findings underscore the clinical correlation between chronic oral wounds in CP and the development of ASO in lower extremities, highlighting the critical need for integrated management strategies focusing on periodontal health to prevent and manage such complex conditions effectively. Elevated inflammatory markers in the ASO + CP group further reinforce the necessity for vigilant monitoring and targeted interventions in these patients.

Characterization of Chitosan-Gallic Acid Graft Copolymer for Periodontal Dressing Hydrogel Application.

The postoperative periodontal wound is in a complex physiological environment; the bacteria accumulation, the saliva stimulation, and the food residues retention will aggravate the wound deterioration. Commercial periodontal dressings have been widely used for postoperative periodontal treatment, and there still exists some problems, such as poor biocompatibility, weak adhesion, insufficient antibacterial, and anti-inflammatory properties. In this study, a chitosan-gallic acid graft copolymer (CS-GA) is synthesized as a potential periodontal dressing hydrogel. CS-GA possesses high swelling rate, adjustable degradability, self-healing ability, biocompatibility, strong adhesion ability, high mechanical properties and toughness. Furthermore, CS-GA has good scavenging ability for ·OH, O2 - , and 1 O2. And CS-GA has good inhibition effect on different bacterial through bacterial membranes damage. CS-GA can stop bleeding in a short time and adsorb erythrocytes to form physical blood clots to enhance the hemostatic performance. In addition, CS-GA can reduce inflammatory factors expressions, increase collagen fibers deposition, and neovascularization to promote wounds healing, which makes it as a potential periodontal dressing for postoperative tissue restoration.

Latest update on the use of recombinant growth factors for periodontal regeneration: existing evidence and clinical applications.

Growth factors were introduced to increase predictability in periodontal regeneration and have since been widely applied in dentistry. This narrative review article highlights histological and latest findings of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and recombinant human fibroblast growth factor-2 (rhFGF-2) for periodontal regeneration. rhPDGF-BB enhances the proliferation and chemotaxis of periodontal ligament and alveolar bone cells. The optimal dose for rhPDGF-BB, in combination with beta-tricalcium phosphate, is 0.3 mg/ml. It is approved in the United States, Canada, and Taiwan for use in periodontal regeneration and treatment of gingival recession. rhFGF-2 promotes periodontal wound healing through mitogenic and angiogenic effects on mesenchymal cells in the periodontal ligament. It is approved in Japan at an optimal dose of 0.3% for periodontal regeneration in intrabony defects. Both recombinant growth factors show histological evidence of new bone, cementum, and periodontal ligament. Clinical studies demonstrate improved clinical attachment levels and defect resolution for treating intrabony and furcation periodontal defects. Presented clinical cases and consensus reports may serve as a reference for clinicians. rhPDGF-BB and rhFGF-2 are safe and effective biologics that can be applied to improve the outcomes of periodontal regeneration.

Dental Drug Delivery System used in Periodontitis

Periodontitis, a condition affecting the teeth’s supporting structures, affects people of all ages, ethnicities, races, and genders. There is a well-established link involving microbial infection and the progression of gum diseases and tooth cavities. There are different types of periodontal diseases caused by microbial infection. Aggressive periodontitis can be localized or generalized. Periodontal infection has been successfully treated with antibacterial medicines. The effectiveness of mechanical plaque debridement and regular use of topical and systemic medicines is limited due to a lack of access to infecting organisms into the periodontal tissues. Systemically administered drugs achieve effective concentration at the infected area, but only for a small period, necessitating multiple doses over extensive periods of time. Antimicrobials delivered locally have being studied to see if they can overcome the limits of conventional therapy. Anti-bacterial is delivered using prolonged release formulations. Anti-bacterial is increasingly being delivered at the infection site (periodontal pocket) through sustained release formulations. This review discusses the main drug delivery system used in periodontal disease, their advantages and evaluations. The usage of collagen dental cones after an infected tooth has been extracted is also discussed in this review. Periodontal regeneration, soft-tissue restoration, and wound healing are all aided by dental cones containing antibacterial and biodegradable polymers.

Evaluation and comparison of the efficacy of autologous fibrin glue with 4-0 silk sutures in periodontal flap closure and wound healing - A split mouth randomized controlled trial.

Fibrin glue has shown to be a pioneering remedy to overcome the inconvenience of suturing. Autologous products reduce the risk of contamination and immunological responses compared to commercial fibrin glue. Hence using autologous fibrin glue (AFG) as a tissue sealant in periodontal flap closure would be of added value for a predictable outcome. To evaluate and compare the efficacy of AFG with 4-0 silk sutures in periodontal flap closure and healing. Total of 17 patients diagnosed with generalized periodontitis in the age group of 18 to 60years with probing pocket depth of ≥ 6mm and clinical attachment level of ≥5mm in at least two quadrants were categorized into test group (AFG) and control group (4-0 silk sutures). Primary outcome measures [modified gingival index (MGI), early wound index (EHI) and interleukin 1 beta (IL-1ß) and secondary outcome measures (oral hygiene index, plaque index and visual analog scale (VAS) were recorded at baseline, 1, 2, 3 and 4 weeks. A statistically significant reduction of IL-1ß value (p =.005); MGI (p = .02); EHI (p = .004), VAS scores (p < .001) and a positive Spearman's correlation (rho = 0.15) was seen between EHI scores & IL-1ß levels in test group at 1week period in comparison to control group. AFG showed promising results as an alternative to sutures. The use of AFG significantly improved clinical parameters and reduced the levels of pro-inflammatory cytokines making it an effective adhesive with healing properties in the era of suture-less periodontal flap surgery.

Characterization of the soft-tissue wall lining residual periodontal pockets and implications in periodontal wound healing

AimTo characterize the soft-tissue wall of remaining periodontal pockets for wound healing-related parameters versus healthy gingival crevices in the same individuals.Materials and methodsGingival tissues collected from the diseased interface of pockets (GT biopsies) and from healthy gingival crevices (G biopsies) were subjected to RT2-profiler PCR Array for wound healing-related markers and network analysis of differentially expressed genes. Lymphangiogenesis-related gene expression was determined by qRT-PCR. The migration potential of mesenchymal stem cells isolated from GT biopsies (GT-MSCs) and G biopsies (G-MSCs) was evaluated by the scratch- and the transwell migration assays. The total collagen protein content was determined in GT-MSCs and G-MSCs homogenates.ResultsGene-ontology analysis on significantly upregulated genes expressed in GT biopsies revealed enrichment of several genes involved in processes related to matrix remodeling, collagen deposition, and integrin signaling. No significantly expressed genes were seen in G biopsies. Regarding lymphangiogenesis-related genes, GT biopsies demonstrated greater expression for PROX1 than G biopsies (p = 0.05). Lower migration potential (p < 0.001), yet greater production of collagen protein (p = 0.05), was found for GT-MSCs over G-MSCs.ConclusionDifferential expression patterns of various molecular pathways in biopsies and cell cultures of diseased versus healthy gingival tissues indicate a potential of the former for tissue remodeling and repair.Clinical relevanceIn the course of periodontitis, granulation tissue is formed within a periodontal defect in an attempt to reconstruct the site. Following treatment procedures periodontal granulation tissue remains inflamed but appears to retain healing potential.

Histological evaluation following treatment of recession-type defects with coronally advanced flap and a novel human recombinant amelogenin.

To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing / regeneration in recession-type defects. A total of 17 gingival recession-type defects were surgically created in the maxilla of three minipigs. The defects were randomly treated with a coronally advanced flap (CAF) and either rAmelX (test), or a CAF and placebo (control). At three months following reconstructive surgery, the animals were euthanized, and the healing outcomes histologically evaluated. The test group yielded statistically significantly (p = 0.047) greater formation of cementum with inserting collagen fibers compared with the control group (i.e., 4.38mm ± 0.36mm vs. 3.48mm ± 1.13mm). Bone formation measured 2.15mm ± 0.8mm in the test group and 2.24mm ± 1.23mm in the control group, respectively, without a statistically significant difference (p = 0.94). The present data have provided for the first-time evidence for the potential of rAmelX to promote regeneration of periodontal ligament and root cementum in recession-type defects, thus warranting further preclinical and clinical testing. The present results set the basis for the potential clinical application of rAmelX in reconstructive periodontal surgery.

Evaluation of hyaluronic acid gel with or without acellular dermal matrix allograft in the treatment of class II furcation defects in dogs: A histologic and histomorphometric study

AimTo evaluate the histologic and histomorphometric effects of hyaluronic acid (HA) gel with or without acellular dermal matrix allograft (ADMA) on periodontal regeneration in Class II furcation defects in dogs. Materials and methodsClass II furcation defects were surgically created in the mandibular first and second premolars bilaterally in eight beagle dogs. The Class II furcation defects were assigned randomly, using the split-mouth design, into the test and control sides. The teeth on the test sides were equally and randomly divided into the HA/ADMA group (n = 8) treated with 0.8% HA gel followed by ADMA, and the HA-only group (n = 8) treated with 0.8% HA only. The furcation defects of the control sides (n = 16) were subjected to open flap debridement (OFD group). The animals were euthanized for histologic and histomorphometric analyses after one month (n = 4) and three months (n = 4). ResultsAt one month, the newly formed bone area (NFBA) was larger in the HA/ADMA (6.23 ± 1.41 mm2) and HA-only (5.90 ± 1.43 mm2) groups than in the OFD group (2.42 ± 1.62 mm2) (p < 0.05). The newly formed cementum (NFAC) and periodontal ligament (NFPL) were similar in the HA/ADMA and HA-only groups but significantly lesser in the OFD group (p < 0.05.) At three months, the NFBA, NFAC, and NFPL were greater in the HA/ADMA group than in the HA-only group (p < 0.05). New regenerative tissue was significantly greater in both the test groups than in the OFD group (p < 0.05), while epithelial downgrowth predominated the healing in the latter. ConclusionsThese results suggest that HA with ADMA positively affects the periodontal regeneration and wound healing in Class II furcation defects.

A Comprehensive Review on Periodontal Wound Healing: Mechanisms, Factors Affecting and Therapeutic Approaches

A Comprehensive Review on Periodontal Wound Healing: Mechanisms, Factors Affecting and Therapeutic Approaches

Periodontal wound healing with hyaluronic acid alone or in conjunction with bovine bone graft in the treatment of class II furcation defects: A histologic and histomorphometric study

Periodontal wound healing with hyaluronic acid alone or in conjunction with bovine bone graft in the treatment of class II furcation defects: A histologic and histomorphometric study