Putty Form Research Articles

The outcome of apical surgery in teeth treated using TotalFill® RRM putty as a root‐end filling material during apical surgery: Case report series

AbstractObjectiveTo assess the success of apical surgery procedures performed using TotalFill® Root Repair Material putty (Schöttlander, Letchworth, UK) as a root‐end filling material.Materials and methodsThis case series consisting of 29 teeth in 22 patients highlights the use of TotalFill RRM putty as a root‐end filling material treated at the Edinburgh Dental Institute by Registrars and Consultants, from 1st January 2017 and 13th March 2019. The outcome was assessed clinically and radiographically over 30 months following the completion of treatment.ResultsApical surgery is an option to manage cases of failed endodontic treatment and survival rates in the region of 90% have been reported for teeth following the procedure. Root end filling following retrograde preparation forms an integral part of the procedure. Mineral Trioxide Aggregate (MTA) has been considered the gold standard material for this purpose for a number of years but has some associated handling and placement difficulties. Newer bioceramic materials in putty form have been designed to overcome these difficulties whilst retaining advantageous biological properties.ConclusionThe overall survival rate of teeth in the series was 93%, with a success rate of 86%. Due to its improved handling properties and similar clinical performance, this material may prove a useful tool in the apical surgery armamentarium.

Preparation and Characterization of Moldable Demineralized Bone Matrix/Calcium Sulfate Composite Bone Graft Materials.

Demineralized bone matrix (DBM) is a decalcified allo/xenograft retaining collagen and noncollagenous proteins, which has been extensively used because of its osteoconductive and osteoinductive properties. Calcium sulfate (CaSO4, CS) is a synthetic bone substitute used in bone healing with biocompatible, nontoxic, bioabsorbable, osteoconductive, and good mechanical characteristics. This study aims to prepare a DBM/CS composite bone graft material in a moldable putty form without compromising the peculiar properties of DBM and CS. For this purpose, firstly, porcine femur was defatted using chloroform/methanol and extracted by acid for demineralization, then freeze-dried and milled/sieved to obtain DBM powder. Secondly, the α-form and β-form of calcium sulfate hemihydrate (CaSO4·0.5H2O, CSH) were produced by heating gypsum (CaSO4·2H2O). The morphology and particle sizes of α- and β-CSH were obtained by SEM, and their chemical properties were confirmed by EDS, FTIR and XRD. Furthermore, the DBM-based graft was mixed with α- or β-CSH at a ratio of 9:1, and glycerol/4% HPMC was added as a carrier to produce a putty. DBM/CSH putty possesses a low washout rate, good mechanical strength and biocompatibility. In conclusion, we believe that the moldable DBM/CSH composite putty developed in this study could be a promising substitute for the currently available bone grafts, and might have practical application in the orthopedics field as a potential bone void filler.

Evaluation of Socket Preservation Using A Synthetic Nanocrystalline Hydroxyapatite

Aim: This study was designed to evaluate the socket preservation using a synthetic nanocrystalline hydroxyapatite followed by collagen membrane. Subjects and methods: Fourteen patients were selected from Oral and Maxillofacial clinic of the Faculty of Oral and Dental Medicine, Al-Azhar University, Cairo, Boys. Extraction of tooth of lower premolar area was done to all participants. Then they were divided into 2 groups, where 7 sockets were preserved and the 7 were kept as control. After tooth extraction in the test group nanobone putty form was grafted into the socket. An additional covering was performed by a collagen membrane. A cone beam computed tomography (CBCT) radiograph at 3 and 6 months were done to assess bone density and socket dimensions. All readings were recorded and analyzed statistically. Results: Among the study group, there is a high statistically significant difference between the three measurements (soon after extraction, after 3- and 6- months from operation) as regards the mean of bone density and the three dimensions .Conclusion: Nano hydroxyapatite together with collagen membrane to seal the socket accelerates the formation of bone filling in the extracted bony socket

Evaluation of the Effect of Bone Grafts in Different Sizes and Forms Used During Alveolar Split Osteotomy on the Implant Stability

Objective: To compare the effects of filling bone gap between implants with bone graft materials of different sizes and forms of primary stability after alveolar split osteotomy process. Materials and Methods: Materials and Methods: Fourty fresh ribs were divided into four main groups. The groups created are based on the xenograft material of different sizes and forms; group Putty (P): Group applied Putty (form) graft (granule size 0.25– 1 mm), group Small (S): Group applied Small particle graft (granule size 0.25– 1 mm) group, group Large (L): Group applied Large particle graft (granule size 1– 2 mm), control group (C): classified as group where no bone graft was applied. Bone expansion was performed using piezosurgery. In all groups, two implants were inserted into the each rib after alveolar crest expansions. The gap between implants (outside the control group) was filled with bone graft materials of different forms and sizes (large, small, putty). The primary stability values of the implants were measured with in the direction of the bucco-lingual (BL) and mesio-distal (MD) by the ISQ (implant stability quotient) and compared between groups. Results: The primary stability values measured in the BL direction are higher than the primary stability values measured in the MD direction and values are statistically significant difference. There is no statistically significant difference between the 1st and 2nd implants in each group (C, P, S, L) for their measured values in both BL direction and MD direction. Conclusion: According to the ISQ values used to evaluate primary stability, it was found that the graft materials of different sizes used in our study did not cause a significant difference for the primary stability of the implants.

In vivo comparison of a granular and putty form of a sintered and a non-sintered silica-enhanced hydroxyapatite bone substitute material.

Improved handling characteristics of bone substitute materials may facilitate surgical handling. However, the respective modifications should not alter the biological activity. For comparison of a granular and a putty form of two silica-enhanced bone substitute materials, in 30 rabbits, bilateral bone defects were created in the femoral condyle and randomly filled with (1) sintered, silica-enhanced (0.8 wt%) hydroxyapatite (ACg, n = 15); (2) ACg plus resorbable polymer (ACp, n = 15); (3) non-sintered silica-enhanced hydroxyapatite (hydroxyapatite/SiO2 ratio:61:39 wt%; NBg, n = 15); and (4) NBg plus matrix of resorbable polymer (NBp, n = 15). After 4, 8, and 12 weeks, respectively, new-formed bone, remaining bone substitute materials, and amount of soft tissue were quantified histomorphometrically. After four weeks, new-formed bone was increased for NBg/NBp in which NBp showed significantly less remaining bone substitute materials when compared to ACg. After two months, the highest amount of new-formed bone and the least remaining bone substitute materials were seen for NBg and NBp. ACp had less remaining bone substitute material when compared to ACg. In addition, amount of soft tissue was significantly enhanced in NBp when compared to ACg and NBg. After 12 weeks, NBp had significantly lower remaining bone substitute material when compared to ACg. Amount of soft tissue was significantly increased in NBp when compared to ACg and NBg. In accordance, based on an early increase of new-formed bone, a lower amount of remaining bone substitute material, and as well as a distinct degradation, superiority of the non-sintered bone substitute material to the sintered bone substitute material was seen. The effect of the resorbable polymer to each bone substitute material can be supposed to be rather marginal.

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.

Biphasic calcium phosphate with submicron surface topography in an Ovine model of instrumented posterolateral spinal fusion.

As spinal fusions require large volumes of bone graft, different bone graft substitutes are being investigated as alternatives. A subclass of calcium phosphate materials with submicron surface topography has been shown to be a highly effective bone graft substitute. In this work, a commercially available biphasic calcium phosphate (BCP) with submicron surface topography (MagnetOs; Kuros Biosciences BV) was evaluated in an Ovine model of instrumented posterolateral fusion. The material was implanted stand‐alone, either as granules (BCPgranules) or as granules embedded within a fast‐resorbing polymeric carrier (BCPputty) and compared to autograft bone (AG). Twenty‐five adult, female Merino sheep underwent posterolateral fusion at L2‐3 and L4‐5 levels with instrumentation. After 6, 12, and 26 weeks, outcomes were evaluated by manual palpation, range of motion (ROM) testing, micro‐computed tomography, histology and histomorphometry. Fusion assessment by manual palpation 12 weeks after implantation revealed 100% fusion rates in all treatment groups. The three treatment groups showed a significant decrease in lateral bending at the fusion levels at 12 weeks (P < 0.05) and 26 weeks (P < 0.001) compared to the 6 week time‐point. Flexion‐extension and axial rotation were also reduced over time, but statistical significance was only reached in flexion‐extension for AG and BCPputty between the 6 and 26 week time‐points (P < 0.05). No significant differences in ROM were observed between the treatment groups at any of the time‐points investigated. Histological assessment at 12 weeks showed fusion rates of 75%, 92%, and 83% for AG, BCPgranules and BCPputty, respectively. The fusion rates were further increased 26 weeks postimplantation. Similar trends of bone growth were observed by histomorphometry. The fusion mass consisted of at least 55% bone for all treatment groups 26 weeks after implantation. These results suggest that this BCP with submicron surface topography, in granules or putty form, is a promising alternative to autograft for spinal fusion.

Histomorphometric Comparison of Bone Regeneration in Critical-Sized Bone Defects Using Demineralized Bone Matrix, Platelet-Rich Fibrin, and Hyaluronic Acid as Bone Substitutes.

To compare bone regeneration in the critical-sized bone defects grafted with demineralized bone matrix, platelet-rich fibrin, and hyaluronic acid in rats. Forty Wistar Albino rats allocated into 4 experimental groups: platelet-rich fibrin (PRF) group, noncross-linked hyaluronic acid gel (HA) group, demineralized bone matrix in putty form (DBM) group, and control group. A critical-sized defect of 8 mm was formed involving the sagittal suture for each rat under anesthetic induction. All animals were sacrificed at 21st day after surgery and histomorphometric parameters of total horizontal length (THL) and total vertical length (TVL) of newly produced bone and longest bone trabecula (LBT) were measured in the histologic slides. The difference between experimental groups for these parameters was analyzed. There was statistically significant difference in THL and LBT but not in TVL. Total horizontal length was significantly increased in DBM group compared with control and HA groups (P < 0.05). There was also statistically significant increase in THL in PRF group compared with control group (P < 0.05). Longest bone trabecula significantly increased in DBM group compared with HA group (P < 0.05). There was also statistically significant increase in HA group compared with control group (P < 0.05) and LBT significantly increased in PRF group compared with HA group (P < 0.05). The sole usage of HA does not effectively increase bone regeneration when compared with DBM and PRF. The DBM and PRF do not have superiority to each other in the bone regeneration while they are superior to HA.

Bone Tissue Engineering Under Xenogeneic-Free Conditions in a Large Animal Model as a Basis for Early Clinical Applicability.

For decades, researchers have been developing a range of promising strategies in bone tissue engineering with the aim of producing a significant clinical benefit over existing therapies. However, a major problem concerns the traditional use of xenogeneic substances for the expansion of cells, which complicates direct clinical transfer. The study's aim was to establish a totally autologous sheep model as a basis for further preclinical studies and future clinical application. Ovine mesenchymal stromal cells (MSC) were cultivated in different concentrations (0%, 2%, 5%, 10%, and 25%) of either autologous serum (AS) or fetal calf serum (FCS). With an increase of serum concentration, enhanced metabolic activity and proliferation could be observed. There were minor differences between MSC cultivated in AS or FCS, comparing gene and protein expression of osteogenic and stem cell markers, morphology, and osteogenic differentiation. MSC implanted subcutaneously in the sheep model, together with a nanostructured bone substitute, either in stable block or moldable putty form, induced similar vascularization and remodeling of the bone substitute irrespective of cultivation of MSC in AS or FCS and osteogenic differentiation. The bone substitute in block form together with MSC proved particularly advantageous in the induction of ectopic bone formation compared to the cell-free control and putty form. It could be demonstrated that AS is suitable for replacement of FCS for cultivation of ovine MSC for bone tissue engineering purposes. Substantial progress has been made in the development of a strictly xenogeneic-free preclinical animal model to bring future clinical application of bone tissue engineering strategies within reach.

EVALUATION OF COLLAGENATED CORTICO-CANCELLOUS XENOGRAFT PLUS LEUKOCYTE-PLATELET RICH FIBRIN AS A GRAFT MATERIAL PRIOR TO DENTAL IMPLANTATION (COMPARATIVE CLINICAL, RADIOGRAPHICAL & HISTOLOGICAL STUDY)

The dimensions of the alveolar bone are of great importance from both esthetic and implant planning reasons. The preservation of bone volume immediately after tooth removal might be necessary to optimize the success of implant placement in terms of esthetics and function. This study was conducted to investigate histologically, clinically & radiographically, the potential of combination of xenogenic cortico – cancellous bone graft and platelet Rich Fibrin (PRF) as a socket graft material to enhance bone regeneration after tooth extraction and in a trial to minimize the alveolar ridge collapse prior to placement of dental implant placed in the maxilla. This study included 15 females (12 females and 3 males) healthy patients, they were free from any systemic disease or disorders that could affect the healing of bone. The patients were selected from the outpatient clinic of Oral and Maxillofacial Surgery Department; Faculty of Oral & Dental Medicine, Cairo University. The patient’s age ranged from 20 to 40 years. The need for extraction of unrepairable maxillary posterior teeth was determined by clinical and radiographic examination. The xenogenic cortico-cancellous bone graft was dispensed in a ready made syringe in putty form. The platelet rich fibrin preparation requires an adequate centrifuge, needle and 10 ml blood collection tubes. The whole blood is drawn into the tubes without anticoagulant (as bovine thrombin) and is immediately centrifuged at 3000 rpm for 10minutes. The result is a fibrin clot containing the platelets located in the middle of the tube, just between the red blood cell layer at the bottom and a cellular plasma at the top. Teeth were extracted atraumatically, by using a surgical bur to separate the roots of the choosable maxillary posterior teeth. Each root was removed separately. Then the sockets were debrided and irrigated with sterile saline solution. Immediately after extraction of teeth, the teeth sockets were grafted with a combination of xenogenic cortico – cancellous bone graft and platelet- rich fibrin and sutured with figure 8 sutures. The radiographic follow up intervals was performed using digital panoramic radiography, done after extraction of the tooth immediately at baseline

KALP CERRAHİSİNDE DEMİNERALİZE KEMİK MATRİKSİ’NİN MEDİAN STERNOTOMİ İYİLEŞMESİ ÜZERİNE ETKİSİ

OZET Yaslanmaya bagli sternumdaki incelme, kemik iyilesmesini zorlastirmakta ve sternumun tespitlendigi yerden kaymasina neden olabilmektedir. Calismamizda demineralize kemik matriksinin sternum iyilesmesi uzerindeki etkisini arastirdik. Bu amacla Ondokuz Mayis Universitesi Tip Fakultesi Kalp ve Damar Cerrahisi Kliniginde, Kasim 2009 – Ekim 2010 tarihleri arasinda median sternotomi yapilan, yaslari 65 ve uzerinde 24 hasta calismaya alindi. Hastalar randomize olarak Grup I (n=12) calisma grubu ve Grup II (n=12) kontrol grubu olarak ikiye ayrildi. Calisma grubundaki hastalara sternumun her iki tarafinin me-dullasina 1 cc’lik demineralize kemik matriksinin macun formu suruldu. Kontrol grubuna herhangi bir madde tatbik edilmedi. Operasyon bitiminde her iki gruptaki hastalarin ster¬numlari standart olarak celik tellerle birlestirildi. Tum hastalara preoperatif donemde ve postoperatif 8. haftada bilgisayarli tomografi cekildi. Bu tomografilerde Hounsfield uni¬tesi olarak olculen sternumdaki kemik yogunluklari birbirleriyle karsilastirildi. Calisma¬ya alinan hastalarin 11’i erkek ve 13’u kadindi. Hastalarin preoperatif ve postoperatif or¬talama sternum dansitesi degerleri karsilastirildiginda, calisma grubu icin p=0,001<0,05 ve kontrol grubu icin p=0,000<0,05 oldugu saptandi. Calisma ve kontrol grubundaki has¬talarin postoperatif 8. haftada olculen sternum yogunluklari birbiriyle karsilastirildiginda ise her iki grup arasinda istatistiksel farklilik olmadigi goruldu. Sternotomi iyilesmesinde bircok faktor rol oynamaktadir. Bu calismanin sonucunda yasli hastalarda demineralize kemik matriksi uygulamasinin sternum iyilesmesini hizlandirici bir etkisinin olmadigini, ancak bu maddenin sternumdaki tellerin zamanla kemigi kesmesine bagli kemikte mey¬dana gelebilecek ayrilma ve kirilmalari uzun donemde onleyebilecegini dusunmekteyiz. Effect of demineralized bone matrix on recovery of median sternotomy in heart surgery ABSTRACT Stenosis of secondary sternum, causes to ageing, and this ageing makes difficult the re¬covery of bones, and can cause to sliding of sternum from the area that was determined. In our research, we searched that the effect of demineralized bone matrix on recover of sternum that contains noncollagen proteins like osteocalcin, osteonectin and osteopontin that has feature of osteoconductive and osteoinductive. With this purpose, in the clinic of Ondokuz Mayis University department of cardiovascular surgery between November 2009 and October 2010, 24 patients whose ages 65 and 65+ were included into the survey. These patients were randomly divided into two groups, Group I was study group (n=12) and Group II was control group (n=12). To the first group (study group), at the end of the operation, the putty form of demineralized bone matrix (1 cc) was applied to both sides of medulla of sternum. Any substances weren’t applied to the second group (control group). At the end of the operation, sternums of the patients in a standard way was com¬bined with steel wires. All patients had axial reconstruction tomography in preoperative period and 8th week in postoperative period. In these tomographies, density of bones in sternum which was measured as Hounsfield Unit (HU), was compared with each others. 24 patients, 11 of them were male and 13 of them were female. In this measurements, the density of sternum of patients which was measured in preoperative and postoperative pe¬riod, were compared with each other; It was diagnosed that for study group p=0.001<0.05 and for control group p=0.000<0.05. While the density of sternum of patients in studygroup and control group which was measured in 8th week of postoperative period was compared, any statistical differences were not found between both groups. In the end of this research, we think that demineralized bone matrix which is applied to aged patients who have got osteoporotic fragile medulla defection, has not got any accelerate effect on healing of sternum; but in the long term, this substances can prevent breaks seen on bones because of the wires on sternum that cut bones in time. J. Exp. Clin. Med., 2011; 28:141-144

A sequential approach in treatment of perio-endo lesion

The success of a combined periodontal and endodontic lesion depends on the elimination of both of these disease processes. In the case of a combined endo-perio lesion, the endodontic therapy results in healing of the endodontic component of involvement while the prognosis of tooth would finally depend on the healing of the periodontal structures. This case report evaluates the efficacy of bioactive glass in the management of furcation defect associated with an endo-perio lesion in a right mandibular first molar. A 22-year-old male patient with an endo-perio lesion in the right mandibular first molar was initially treated with endodontic therapy. Following the endodontic treatment, the furcation defect was treated using bioactive glass in a putty form. At the end of 9 months, there was a gain in the clinical attachment level and reduction in probing depth. Radiographic evidence showed that there was a significant bony fill.

Radiologic Evaluation of Putty Versus Powder Form of Demineralized Bone Matrix in Sinus Floor Elevation

The aim of this study was to evaluate differences in ossification of the 2 forms of demineralized bone matrix (DBM)-putty and powder-radiographically, using digital densitometry on panoramic radiographs in maxillary sinus floor augmentation procedures. Twelve subjects needing bilateral maxillary sinus floor augmentation for the placement of osseointegrated implants were included in this study. The left and right maxillary sinuses were augmented in the same session in each patient using the 2 preferred forms of DBM-putty and powder-during the same session. One sinus was augmented with DBM putty form and the other sinus was augmented with DBM powder form randomly. Every patient had a total of 4 panoramic radiographs taken, preoperatively and in the first, third, and sixth month postoperatively. The densitometry measurements were taken from each step of the aluminium step-wedge, from both sinuses from different points a total of 3 times, and the average of these measurements was calculated. The amount of mineralization in each graft material in every radiograph was clarified by the appearance of a difference in the equivalent aluminium thickness, and the obtained results were statistically evaluated. The results showed that there were no significant differences between two graft materials statistically. These two graft materials could be good alternatives in sinus lifting procedures because of less morbidity, lower price, and good ossification. The results indicate that 2 different types of DBM achieved good ossification in the sinus lifting procedure, and there is not a considerable distinction in these 2 forms.

Comparison of applying particulate demineralized bone matrix (DBM), putty DBM and open flap debridement in periodontal horizontal bone defects. A 12‐month longitudinal, multi‐center, triple‐blind, split‐mouth, randomized, controlled clinical study. Part 1 – clinical and radiographic evaluation

Putty form graft materials may have additional favourable effects when compared with particulate ones in periodontal bone defects. The purpose of this study was to assess clinical and also radiographic changes following application of (i) putty form demineralized bone matrix (DBM), (ii) particulate form DBM and (iii) open flap debridement (control), using modified curtain suturing technique in the treatment of interproximal suprabony (horizontal) defects. Twenty-five chronic periodontitis patients with 125 sites (radiologically >or=4 mm horizontal bone defect) were selected to participate in this triple-blind, split mouth, randomized, controlled clinical trial. Putty and particulate form DBM grafts were placed at experimental sites. Clinical measurements included probing depth (PD), relative attachment level (RAL), gingival recession and bone probing depth (BPD) were made at baseline and repeated 12 months after the operations. Standardized digital radiographs were also taken to measure radiographic bone level (RBL) at baseline and 12 months later to be compared in a software. Probing depth reductions and RAL gains were significantly improved in all treatment groups (P < 0.001). No significant differences in soft tissue parameters were found among three groups (P > 0.05). Bone probing depth measurements indicated comparable significant bone gain in graft applied groups (P < 0.01) and a significant bone resorption in open flap debridement group (P < 0.01). Radiographic evaluation did not show any significant bone gain or resorption in all treatment groups (P > 0.05). The results of this study indicate that either putty or particulate DBM demonstrates similar enhancements in soft and hard tissue parameters. Applying putty or particulate form DBM results with slight bone formation when compared with open flap debridement in horizontal bone defects at 1-year post-operative examination according to BPD measurements.

Comparison of applying particulate demineralized bone matrix (DBM), putty DBM and open flap debridement in periodontal horizontal bone defects. A 12‐month longitudinal, multi‐centre, triple‐blind, split‐mouth, randomized, controlled clinical study. Part 2 – evaluation of the interdental soft tissue

To date, there have been many studies clinically evaluating periodontal regenerative procedures by the help of routinely used hard and soft tissue parameters; however, these parameters are not capable of assessing interdental soft tissue located above the regenerative periodontal surgery area. The purpose of this study was to assess interproximal soft tissue changes following application of (i) particulate form demineralized bone matrix (DBM), (ii) putty form DBM and (ii) open flap debridement (OFD, control), using modified curtain technique in the treatment of interproximal suprabony (horizontal) defects located in anterior maxillary region, as previously reported. Twenty-five chronic periodontitis patients with 125 interproximal surgery sites (radiologically >or=4 mm horizontal bone defect) were also participate in this second stage of the triple-blind, split mouth, randomized, controlled clinical trial. Surgery sites were assessed by (i) plaque index (PI), (ii) gingival index (GI), (iii) the presence of interdental soft tissue clefts or craters and (iv) the loss of interdental papilla height by using papilla presence index (PPI), during the healing period. At the baseline and 3, 6, 9 and 12 months after the operations, these measurements were repeated. In all groups, there is a significant increase in the prevalence of soft tissue cleft and crater formation (P < 0.01), with increase in PI and GI scores at interdental soft tissue defect areas (P < 0.001), 3 months after the operations. There was also an increase in PPI scores after the operations in all treatment groups (P < 0.01). Three procedures affected the interproximal soft tissues similarly. There was no significant difference among groups in terms of all parameters (P > 0.05). Particulate DBM, putty DBM and OFD demostrated similar interproximal soft tissue changes especially increasing interproximal PI and GI scores in 3 months follow-up.

Experimental Intrabony and Periodontal Defects Treated With Natural Mineral Combined With a Synthetic Cell‐Binding Peptide in the Canine: Morphometric Evaluations

A synthetic peptide (P-15) analog of collagen added to anorganic bovine bone mineral (ABM) has recently been used as an enhanced bone graft material (ABM/P-15). The objective of this study was to test the contribution of ABM/P-15 in a new putty form (PEP) in two experimental membrane-protected defects: periodontal and intrabony. Its efficacy as filler biomaterial in guided tissue regeneration (GTR) and guided bone regeneration (GBR) procedures was evaluated histologically and morphometrically. In the maxillary canines, a facial mucoperiosteal flap was raised bilaterally in nine dogs. Two circular defects, 5 mm in diameter and 2 mm in depth, were made on each side: a fenestrated periodontal on the canine root and an intrabony in the alveolar diastema, anteriorly. PEP particles filled both defects on one side; the contralateral side was blood filled (control). All surgical sites were covered with a bioabsorbable membrane. Histologically, at 4 months, tissue blocks were made using the cutting/grinding non-decalcification method followed by morphometric analysis. In the periodontal fenestration root surface, the linear percentage of new cementum (%CEM), area percentage of new bone (%NB), and residual biomaterial particles (%PEP) were calculated. These same measurements were calculated at the intrabony sites, except cementum. The amount of direct NB to PEP contact was measured to assess the osteoconductivity level (OSC). The Pearson correlation test was used to evaluate any significant relationship between the different measured parameters. In the grafted and non-grafted fenestration root surface defects, %CEM averaged 59.5% and 73.9% (P <0.02), respectively; %NB averaged 36.1% and 31.4%, respectively; and %PEP averaged 20.6%. The mean percentage of OSC was 52.4%. In the intrabony grafted and non-grafted sites, %NB averaged 50.7% and 60.1%, respectively (P <0.02). Residual %PEP averaged 26.1%, and OSC averaged 35.6%. At the intrabony sites, higher %NB and lower %OSC were found compared to the fenestration sites (P <0.001 and P <0.03, respectively). Correlation analysis showed a negative correlation between %NB and %PEP at the fenestration defects. In between the two defect types, %OSC was significantly correlated (P <0.05). ABM/P-15 putty showed osteoconductive and biocompatible qualities. However, at 4 months in this model, no enhanced regeneration was present compared to a higher CEM and NB growth detected at non-grafted membrane-protected sites.

Periodontal Regeneration With Peptide‐Enhanced Anorganic Bone Matrix in Particulate and Putty Form in Dogs

Peptide-enhanced (using the peptide 15 [P-15] synthetic peptide) anorganic bone matrix (ABM) particulate (PPart) grafts have demonstrated clinical and histologic success in human periodontal defects. Dispersion of ABM/P-15 in sodium hyaluronate carrier (PPutty) improves the handling properties of the graft material. The healing of ABM/P-15 particulate and ABM/P-15 putty was compared in critical-sized fenestration defects in 16 mongrel dogs. After full thickness flap reflection, 7 mm diameter fenestrations were made with a trephine in the mid-root of both maxillary canines in each dog. Bone, periodontal ligament, and cementum were removed as completely as possible with hand root planing within the trephine-produced notches. By random allocation, each defect was filled with PPart or PPutty, and the flaps were closed with sutures. One dog contributing two defects served as a negative control. Block sections were retrieved at 3 and 8 weeks for histologic processing. Three 6-mu step serial sections in the center of the defects were used for analysis. Parameters measured included the original length of the wound, linear amount of periodontal regeneration including new cementum, bone and connective tissue, and area measurements of new bone and remaining particles. PPutty and PPart results were compared for significant differences using the Wilcoxon rank sum test. Clinical healing was uneventful in all cases. There was no evidence of inflammation or adverse tissue reactions with either material. The controls showed minimal regeneration at the periphery of the defect. Histomorphometric evaluation of the grafted defects revealed the following: at 3 weeks, there was minimal new bone formation (occupying 4.2% of the grafted area for the PPutty and 1.2% for the PPart). The grafted particles occupied 21.2% and 35.6% of the area for the PPutty and PPart, respectively (P = 0.039). At 8 weeks, there was a tendency for greater new bone formation compared to 3 weeks with both materials. There was significantly more new bone with the PPutty (49.3%) compared to the PPart (14.8%) (P = 0.045). The grafted particles occupied 7.9% and 17% of the grafted area for the PPutty and PPart, respectively (no significant difference). There were no significant differences for any of the linear measurements. ABM/P-15 PPutty had superior handling characteristics. Both ABM/P-15 materials yielded satisfactory healing and resulted in the greater regeneration of fenestration defects in dogs at 8 weeks compared to controls. In addition, AMB/P-15 putty resulted in more bone formation compared to ABM/P-15 particulate.

Tissue response to a newly developed calcium phosphate cement containing succinic acid and carboxymethyl-chitin.

We developed a new calcium phosphate cement containing succinic acid and carboxymethyl-chitin in the liquid component. In this study, the biocompatibility and osteoconductivity of this new cement were investigated. After mixing, cement in putty form was implanted immediately between the periosteum and parietal bone and in the subcutaneous tissues of rats. In control cement, distilled water was used instead of the liquid component. In addition to histological evaluations, analyses with X-ray diffraction and Fourier transform infrared were performed for the subcutaneously implanted cements. Histological examination showed slight inflammation around the new cement on the bone and in the subcutaneous tissue at 1 week after surgery. At 2 weeks, the cement was partially bound to the parietal bone. The extent of the surface of the new cement directly in contact with the bone increased with time, and most of the undersurface of the new cement bound to the host parietal bone by 8 weeks. Analysis by X-ray diffraction showed that the new cement in the subcutaneous tissue was transformed into hydroxyapatite by 8 weeks. These results indicate that this new calcium phosphate cement is useful as a bone substitute material.