Radiographic Defect Depth Reduction Research Articles

Clinical and GCF outcomes of Minimally-invasive non-surgical periodontal therapy in teeth with bone loss to the apex. A prospective study

AimsThe aim of this prospective study was to assess the potential benefits of minimally-invasive non-surgical therapy (MINST) in the healing of intrabony defects reaching the apex. MethodsTwenty systemically healthy patients with stage III-IV periodontitis and with at least one tooth with an intrabony defect reaching the apex were included in the study. Step 1 and 2 periodontal therapy including MINST were provided to all patients and patients were then followed up to 12 months post-treatment. Clinical parameters, standardised periapical radiographs and gingival crevicular fluid (GCF) samples were collected at test and control sites. 31 biomarkers were analysed. ResultsThree cases did not have the 12-months review (2 drop-outs and 1 tooth lost due to fracture). Despite significant improvements in clinical and radiographic parameters, the majority of defects still had PPD>5mm at the 12-months reassessment, therefore needing further treatment, including endodontic treatment in some cases. A pattern of increase in GCF biomarkers associated with a senescent secretory phenotype was detected immediately after treatment in test sites, with a decrease up to 12 months. An increase in IL-1β and MMP-3 in particular seems to be associated with increased risk to need endodontic treatment post-MINST. ConclusionsThe treatment of teeth with unfavourable prognosis and bone loss to the apex with MINST leads to PPD reduction, CAL gain and reduction in radiographic defect depth 12 months after treatment. However, MINST alone may not be sufficient in terms of defects resolution in most of these cases. Clinical significanceThe treatment of teeth with unfavorable prognosis and bone loss to the apex (hopeless) using MINST may lead to consistent PPD reduction, CAL gain and radiographic defect depth reduction after 12 months. However, adjunctive therapies may be necessary to achieve endpoints of therapy in these defects. GCF biomarkers may clarify healing patterns.

A Comparison of the Effectiveness of Concentrated Growth Factors-Enriched Bone Graft Matrix (Sticky Bone) and Type-1 Collagen-Derived (DMBM) Xenograft Coated with a Resorbable-Guided Tissue Regeneration Membrane: A Clinico-Radiographic Study on Intrabony Defects

Background: The main goals of periodontal treatment are to gain access to the diseased areas, reduce pocket depth, stop the disease’s progression, and then repair the periodontal tissues that have been harmed by the disease process. Our study compared the efficacy of Type-1 collagen-derived (DMBM) Xenograft Coated with a resorbable-guided tissue regeneration (GTR) membrane and enriched bone graft matrix with concentrated growth factors (CGFs) (Sticky Bone) in the treatment of periodontal infrabony defects. Methodology: The study included 40 patients with periodontal infrabony defects who were systemically healthy. According to clinical and radiographic measurements, two groups to which the defects were randomly assigned at the time of surgery Group II Type-1 collagen-derived (DMBM) xenograft coated with a resorbable GTR membrane and Group I-enriched bone graft matrix with CGFs (Sticky Bone). Results: At the 6month examination, probing pocket depth reduction was moderately significant in the Group I (7.43 ± 1.51 mm to 3.00 ± 1.53 mm) compared with the Group II (7.14 ± 0.69 mm to 3.00 ± 1.53 mm). The mean gains of clinical attachment were 8.29 ± 1.98 mm to 3.86 ± 1.46 mm in the Group I and 7.85 ± 0.69 mm to 4.53 ± 1.113 mm in the Group II. Radiographic defect depth reduction was slightly greater in the Group I compared with the Group II. Conclusions: According to the findings of this study, treating infrabony defects with unfavorable architecture using a Sticky Bone with CGF membrane in combination with bone graft has significantly improved all clinical parameters tested when compared to using a GTR membrane.

Evaluating and Comparing the Effectiveness of Nano-HA and HA + β-TCP with A-PRF Clinically and Radiographically in the Treatment of Human Infrabony Defects.

To evaluate and compare the effectiveness of nanocrystalline hydroxyapatite (NcHA) with advanced platelet-rich fibrin (A-PRF) and hydroxyapatite-reinforced beta tricalcium phosphate (HA + β-TCP) with A-PRF in the treatment of human infrabony defects clinically and radiographically using cone-beam computed tomography (CBCT). There were a total of 28 defects, with 14 defects in the test and control groups, respectively. There were total 28 patients were involved in the study. The test group (group A) was treated with NHA and A-PRF, while the control group (group B) was treated with HA + β-TCP and A-PRF. Bone defect fill was the primary result of the investigation. Periodontal pocket depth (PPD), R-CAL, papillary bleeding index (PBI), and PI were the secondary outcome. Clinical and radiographic measurements were recorded at baseline and 6 months postoperatively. No significant difference was observed between the two groups in terms of PPD reduction (4.64 ± 0.74 mm vs 4.07 ± 0.99 mm), clinical attachment loss (CAL) gain (4.64 ± 0.74 mm vs 3.92 ± 0.99 mm) and radiographic defect depth reduction (2.41 ± 0.32 mm vs 2.40 ± 0.27 mm) for test and control groups, respectively. At 6-month post-surgery, both treatment modalities demonstrated statistically significant improvements with regard to CAL gains, PPD reduction, and reduction in radiographic defect depth. The NcHA and HA + β-TCP with A-PRF is a novel material used in the treatment of infrabony defect for periodontal regeneration. The NcHA and HA + β-TCP with A-PRF need to consider biomaterials for bone defect fill.

The association between early postoperative healing and the 12-month clinical and radiographic outcomes of guided tissue regeneration in aggressive periodontitis patients

This study evaluates the influence of early healing on clinical and radiological outcomes of guided tissue regeneration (GTR) procedures of vertical intrabony defects in patients with aggressive periodontitis (AgP) in a 12-month follow-up. The influence of patient-related, site-specific and technical aspects on optimal early wound healing was also assessed. This analysis included 25 patients with 61 intrabony defects. All sites were treated according to guidelines of minimally invasive surgical technique with the use of bone grafts and collagen membranes. Early post-operative healing was evaluated using the Early Wound-Healing Index (EHI). Changes in clinical and radiological parameters were assessed 12 months postoperatively. After 2 weeks, primary healing (EHI ≤3) was observed in 44 sites (72.13%) and secondary healing was present in 17 sites (22.87%) (EHI = 4). The presence of thin gingival phenotype was significantly associated with an increased risk of secondary healing (OR = 0.203; p = 0.014). At 12 months, GTR resulted in a significant clinical attachment level gain, as well as probing pocket depth reduction and radiographic defect depth reduction. Primary or secondary healing did not affect these outcomes. Thick gingival biotype might be a prerequisite for optimal early wound healing. However, the type of early healing seems not to affect the long-term outcomes after regenerative treatment in aggressive periodontitis patients.

Clinical efficacy of subgingivally-delivered 0.75% boric acid gel as an adjunct to mechanotherapy in chronic periodontitis: A randomized, controlled clinical trial.

Borinic acid quinoline esters are a recently-identified class of new antibacterial and anti-inflammatory compounds known to inhibit osteoclastic bone resorption. They have proposed to have osteostimulative properties by causing osteoblast differentiation in vivo and in vitro. The purpose of this double-masked, randomized, controlled clinical trial was to evaluate the effects of the subgingival delivery of boric acid gel as an adjunct to scaling and root planing (SRP) on clinical and radiographic parameters, and compare this method with SRP plus placebo gel alone in chronic periodontitis (CP) patients. Thirty-nine systemically-healthy patients with CP were included in the present study. They were divided into two groups: (a) SRP + 0.75% boric acid gel (BA group); and (b) SRP + placebo gel (placebo group). At baseline, 3 and 6months after treatment, clinical measurements, including plaque index, modified sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage change in radiographic defect depth reduction (DDR%) as radiographic parameters were assessed. The mean PD reduction and mean CAL gain were greater in the BA group than the placebo group at 3 and 6months. A significantly greater mean percentage of radiographic DDR% was found in the BA group (36.97±3.47%) compared to the placebo group (2.88±0.89%) after 6months. BA as an adjunct to SRP can provide a new insight into therapeutic strategies for the management of CP, but further clinical evaluations are needed.

Comparative evaluation of efficacy of subgingivally delivered 1.2% Atorvastatin and 1.2% Simvastatin in the treatment of intrabony defects in chronic periodontitis: a randomized controlled trial.

Background. Statins are the recently evolved agents that aid in periodontal regeneration and ultimately in attaining periodontal health. Atorvastatin (ATV) and Simvastatin (SMV) are specific competitive inhibitors of 3-hydroxy-2-methyl-glutaryl coenzyme A reductase. The current study was conducted to compare the effectiveness of 1.2% ATV and 1.2% SMV, in addition to scaling and root planing (SRP), in the treatment of intrabony defects in subjects with chronic periodontitis.Methods. Ninety-six individuals were categorized into three treatment groups: SRP plus 1.2% ATV, SRP plus 1.2% SMV and SRP plus placebo. Clinical parameters of full-mouth plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and relative attachment level (RAL) were recorded at baseline before SRP and at 3, 6 and 9 months. Bone fill was assessed using percentage radiographic defect depth reduction at baseline, 6 months and 9 months.Results. Both ATV and SMV showed significant PD reduction and RAL gain than placebo. ATV group showed greater mean PD reduction and mean RAL gain as compared to SMV group at 3, 6 and 9 months. Furthermore, ATV group sites exhibited a significantly greater percentage of radiographic defect depth reduction (33.23 ± 3.11%; 34.84 ± 3.07%) as compared to SMV (30.39 ± 3.36%; 32.15 ± 3.37%) at 6 and 9 months.Conclusion. ATV resulted in greater improvements in clinical parameters with higher percentage of radiographic defect depth reduction as compared to SMV in the treatment of intrabony defects in CP subjects.

Efficacy of Subgingivally Delivered 1.2% Atorvastatin in the Treatment of Chronic Periodontitis in Patients With Type 2 Diabetes Mellitus: A Randomized Controlled Clinical Trial.

The present study was designed to evaluate effectiveness of 1.2% atorvastatin (ATV) gel, as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects in chronic periodontitis (CP) in patients with type 2 diabetes mellitus (t2DM). Seventy-five patients were categorized into two treatment groups: 1) SRP plus 1.2% ATV and 2) SRP plus placebo. Clinical parameters including modified sulcus bleeding index, probing depth (PD), and relative attachment level (RAL) were recorded at baseline and 3, 6, and 9 months. Percentage radiographic defect depth reduction was evaluated using computer-aided software at baseline and 6 and 9 months. Mean PD reduction and mean RAL gain was greater in the ATV group than the placebo group at 3, 6, and 9 months. Furthermore, ATV group sites presented with a significantly greater percentage of radiographic defect depth reduction at 6 and 9 months. Locally delivered ATV was found to be effective in treatment of intrabony defects in CP in patients with t2DM.

Platelet-Rich Fibrin Combined With 1.2% Atorvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial.

Platelet-rich fibrin (PRF), a second-generation platelet concentrate, and atorvastatin (ATV), a potent member of the statin group, are known to promote tissue regeneration. The current study is designed to evaluate combined efficacy of PRF and 1.2% ATV gel with open flap debridement (OFD) in treatment of intrabony defects (IBDs) in individuals with chronic periodontitis (CP). Ninety-six individuals with single defects were categorized into three groups: 1) OFD with PRF; 2) OFD with PRF + 1.2% ATV; and 3) OFD alone. Clinical parameters: 1) site-specific plaque index; 2) modified sulcus bleeding index; 3) probing depth (PD); 4) relative clinical attachment level (rCAL); and 5) gingival marginal level were recorded at baseline before surgery and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated at baseline and 9 months. PRF + 1.2% ATV and PRF alone showed significantly greater PD reduction and rCAL gain compared with OFD alone at 9 months. Furthermore, PRF + 1.2% ATV showed a similar percentage radiographic defect depth reduction (50.96% ± 4.88%) compared with PRF alone (47.91% ± 4.79%), and a greater reduction compared with OFD alone (5.54% ± 1.71%) at 9 months. PRF + 1.2% ATV showed similar improvements in clinical parameters with a greater percentage radiographic defect depth reduction compared with PRF alone in treatment of IBDs in individuals with CP. Thus, 1.2% ATV failed to augment the regenerative potential of PRF alone in periodontal IBDs.

Adjunctive Effect of Autologus Platelet-Rich Fibrin to Barrier Membrane in the Treatment of Periodontal Intrabony Defects.

Autologous platelet-rich fibrin (PRF) and barrier membranes in the treatment of intrabony defects in chronic periodontitis patients have shown significant clinical benefits. This study evaluates the additive effect of autologous PRF in combination with a barrier membrane versus the use of barrier membrane alone for the treatment of intrabony defects in chronic periodontitis patients. A randomized split-mouth design was used. Sixteen patients with 32 paired intrabony defects were included. In each patient 1 defect was treated using a resorbable collagen membrane along with PRF (test group) and the other defect by guided tissue regeneration alone (control group). The following clinical parameters were measured at baseline and after 9 months: plaque index, modified sulcus bleeding index, probing pocket depth, clinical attachment level, and gingival marginal level. The radiographic defect depth was also assessed at baseline and after 9 months. Test group showed a statistically significant improvement for probing depth (P = 0.002), clinical attachment level (P = 0.001), and radiographic defect depth (P < 0.001) after 9 months as compared with the control sites. Radiographic defect depth reduction was 58.19 ± 13.24% in the test group as compared with 24.86 ± 9.94% reduction in the control group. The adjunctive use of PRF in combination with barrier membrane is more effective in the treatment of intrabony defects in chronic periodontitis as compared with barrier membrane alone.

Subgingivally delivered 1.2% atorvastatin in the treatment of chronic periodontitis among smokers: a randomized, controlled clinical trial.

Statins are known to have a beneficial effect in the treatment of chronic periodontitis (CP). The current study was designed to investigate the effectiveness of a 1.2% atorvastatin (ATV) local drug delivery system as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects (IBD) in CP among smokers. Seventy-one smokers with CP were categorized into two treatment groups: SRP + 1.2% ATV gel and SRP + placebo gel. Clinical parameters, modified sulcus bleeding index, probing depth, and clinical attachment level were recorded at baseline before SRP and at 3, 6, and 9 months. At baseline, 6 months, and 9 months, the percentage of radiographic defect depth reduction was determined using computer-aided software. The mean probing depth reduction and mean clinical attachment level gain were found to be greater in the ATV group than the placebo group at 3, 6, and 9 months. A significantly greater mean percentage of radiographic defect depth reduction was found in the ATV group compared to the placebo group after 9 months. The ATV local drug delivery as an adjunct to SRP can be used in the treatment of IBD in CP among smokers.

A comparative evaluation of the effectiveness of guided tissue regeneration by using a collagen membrane with or without decalcified freeze-dried bone allograft in the treatment of infrabony defects: A clinical and radiographic study.

Background:The present, randomized, controlled clinical and radiographic study was undertaken to compare the effectiveness of guided tissue regeneration (GTR) by using a collagen membrane barrier with or without decalcified freeze-dried bone allograft (DFDBA) in the treatment of periodontal infrabony defects characterized by unfavorable architecture.Materials and Methods:Sixteen systemically healthy patients with 20 periodontal infrabony defects were selected for the study. Each patient had at least ≥ 5 mm clinical probing pocket depth (PPD) at the selected site and depth of intrabony component ≥ 3 mm as assessed by clinical and radiographic measurements. Baseline measurements included plaque index, papillary bleeding index, PPD, gingival recession, clinical attachment level and radiographic defect depth (DD). At the time of surgery, the defects were randomly assigned to either the test group (collagen membrane plus DFDBA) or the control group (collagen membrane only).Results:At the 6-month examination, PPPD reduction was significantly greater in the GTR + DFDBA group (4.06 ± 0.38 mm) compared with the GTR group (3.2 ± 0.74 mm). The mean gains of clinical attachment were 3.54 ± 0.36 mm in the test group and 2.50 ± 0.74 mm in the control group. Radiographic DD reduction was similarly greater in the GTR + DFDBA group (2.40 ± 0.51 mm) compared with the GTR group (1.60 ± 0.51 mm).Conclusions:The results of the present study indicate that the use of a GTR membrane with bone graft has significantly improved all clinical parameters tested as compared with the use of bioresorbable membrane alone in the treatment of infrabony defects characterized by unfavorable architecture.