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.

Impact of peri-implant keratinized mucosa width on the long-term reconstructive outcomes of peri-implantitis: A retrospective analysis with a follow-up up to 10 years.

To investigate the effect of mid-buccal peri-implant keratinized mucosa width (KMW) ≥2 mm or peri-implant KMW >0 mm and <2 mm on the long-term outcomes of peri-implantitis reconstructive treatment. Twenty-nine patients (40 implants; mean follow-up: 9.2 ± 1.4 years) with at least one implant affected by peri-implantitis and surgically treated through a reconstructive procedure followed by a submerged healing were included. Patients were categorized according to their initial KMW: Group 1 (KMW ≥2 mm) and Group 2 (KMW >0 mm and <2 mm). Peri-implant clinical and radiographic parameters and a dedicated composite outcome were assessed at different follow-up visits during supportive peri-implant therapy for up to 10 years. Regression analyses were utilized to identify possible risk/predictive indicators for probing pocket depth (PPD) change and treatment success at the latest follow-up. The mean PPD did not exhibit any statistical difference from the baseline to the latest follow-up between the groups at both patient and implant levels. Long-term treatment success was 46.6% (Group 1) and 42.6% (Group 2) at patient level, it was 42.8% (Group 1) and 33.3% (Group 2), respectively, at implant level (p > 0.05). Group 1 demonstrated significantly higher vertical defect depth reduction than Group 2 (p = 0.018). Presence of buccal bony wall and mean PPD at the baseline were found to be associated with mean PPD change, while KMW at 6 months following surgery was identified as the only significant indicator for treatment success (p < 0.05). Implants with KMW ≥2 mm did not present significantly better long-term clinical outcomes following reconstructive therapy than those exhibiting KMW >0 mm and <2 mm. However, KMW values at the end of healing phase following a submerged approach had a significant impact on long-term treatment success.

Healing of induced tongue defects using erythropoietin hydrogel (an experimental study on rats)

BackgroundTongue is complex muscular organ that may be affected by recurrent or chronic ulcerations and malignances that require effective treatment to enhance healing and tissue regeneration. So, this study aimed to evaluate the efficiency of erythropoietin (EPO) hydrogel as an anti-inflammatory and an inducer of neovascularization during healing of induced rats’ tongue defects.MethodsThirty six rats were divided into three groups; Group I (negative control): tongues were left without ulceration and received no treatment, Group II (positive control): tongue defects were prepared on the tongues’ dorsal surfaces, measuring (5 mm × 2 mm) using a tissue punch rotary drill for standardization, and left untreated, Group III (EPO group): tongue defects were prepared as in group II, then injected circumferentially around wound margins with a single high dose of EPO hydrogel of 5000 U/kg on the day of defect preparation. Animals were euthanized on seventh and fourteenth days after treatment, tongue specimens were collected, and paraffin blocks were prepared and processed for histological assessment by hematoxylin and eosin stain and immunohistochemical evaluation of anti-iNOS and anti-VEGF followed by histomorphometrical analysis and the relevant statistical tests.ResultsAt both time points, the EPO treated group showed significantly enhanced tissue regeneration marked by the histologically better regenerated tissue with well developed, thick walled and well-organized blood vessels and significant reduction in defect depth compared to positive control group. EPO group also showed significant decrease in iNOS and significant increase in VEGF antibodies indicating its anti-inflammatory and neovascularization effects respectively.ConclusionEPO treatment can significantly accelerate regeneration and filling of tongue defects by reducing tissue inflammation and enhancing neovascularization. Therefore, EPO could be a potential therapeutic strategy for accelerating healing of tongue ulcers. However, further investigations are required to optimize the dose and unravel any potential side effects before its clinical application.

Clinical and Radiographic Evaluation of Calcium Phosphate-Poly(lactide-co-glycolide) Graft in Regeneration of Intrabony Defects: Randomized Control Trial.

This study aims to evaluate the efficacy of calcium phosphate-poly(lactide-co-glycolide) composite graft in the regeneration of intrabony defects in chronic periodontitis patients over a period of 12 months. A total of 11 systemically healthy chronic periodontitis patients with 22 graftable sites were treated with calcium phosphate cement (CPC) bone graft (control group) and CPC-poly(lactic-co-glycolic acid)(PLGA) composite (test group) after flap reflection and debridement. Clinical parameters such as probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at baseline and 3, 6, 9, and 12 months. Bone probing depth (BPD) and radiographic parameters such as defect depth (DD), changes in alveolar crest level (ALR), defect depth reduction (DDR), and percentage in defect depth reduction (PDDR) were calculated at baseline, and 6 and 12 months. The data were recorded and statistically analyzed. On intragroup comparison, there was a significant improvement in all the parameters over a period of 1 year (clinically and radiographically). However, there was no statistically significant difference between the two groups in any of the parameters though there was a slightly higher bone fill noted in the test group. Even though the CPC-PLGA composite bone graft showed a slight improvement in clinical and radiographic parameters as compared to the CPC graft, it was not statistically significant. A major drawback of Calcium Phosphate cements as bone grafts is their poor degradability. The PLGA microspheres degrade to expose macropores and interconnected pores in the graft substrate which in turn would promote the ingrowth of osteoblasts. Also, this composite graft is mouldable, and resorbable and has been shown to snugly fit into the defects making them a suitable scaffold material. How to cite this article: Ojha M, Pawar Chandrashekara Rao D, Gowda V. Clinical and Radiographic Evaluation of Calcium Phosphate-Poly(lactide-co-glycolide) Graft in Regeneration of Intrabony Defects: Randomized Control Trial. J Contemp Dent Pract 2023;24(12):921-927.

Long-term results of regenerative treatment of intrabony defects: a cohort study with 5-year follow-up

BackgroundThe aim of this retrospective cohort study was to evaluate the long-term clinical and radiographic outcomes and survival of teeth in periodontal regenerative treatment of intrabony defects using combined enamel matrix protein derivative (EMD) and deproteinized porcine bone mineral (DPBM) compared to EMD alone.MethodsA total of 333 intrabony defects in 176 patients (mean age: 54.7 ± 8.9 years) were followed-up for 58.6 ± 11.2 (range, 25–78) months after periodontal regenerative treatment. Changes in clinical (pocket probing depth and clinical attachment level) and radiographic (defect depth and defect width) parameters were analyzed using serial periapical radiographs. Kaplan–Meier and multivariate Cox proportional-hazards regression analyses for tooth loss were also performed.ResultsCompared to periodontal surgery with EMD alone with a mean follow-up of 5 years, combined EMD and DPBM showed significantly better gain in clinical attachment level (EMD and DPBM: 2.8 ± 2.3 mm vs. EMD alone: 2.2 ± 2.2 mm) and reduction in probing pocket depth (EMD and DPBM: 2.8 ± 1.8 mm vs. EMD alone: 2.3 ± 1.8 mm), defect depth (EMD and DPBM: 2.5 ± 2.4 mm vs. EMD alone: 2.0 ± 2.4 mm) and defect width (EMD and DPBM: 0.6 ± 1.0 mm vs. EMD alone: 0.2 ± 1.3 mm). The overall survival rates of the teeth were 91.48% and 95.20% in the patient- and tooth-based analyses, respectively, showing no statistically significant difference.ConclusionsWithin the limitations of the current study, combined EMD and DPBM offered additional clinical and radiographic benefits over a mean of 5 years compared to EMD alone. However, tooth loss did not differ significantly between the two groups.Clinical relevanceCompared to EMD alone, combined EMD and DPBM for intrabony defects has additional clinical advantages; however, patient- and tooth-related risk factors must be considered when performing periodontal regenerative surgery.

Platelet Rich Fibrin Matrix (PRFM) and Peripheral Blood Mesenchymal Stem Cells (PBMSCs) in the management of intraosseous defects - A randomized clinical trial.

A combination of peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix (PRFM) could be a probable periodontal regenerative material with the synergy of the added benefits of each material. This randomized controlled clinical trial aimed to evaluate the regenerative capacity of supercell (PRFM and PBMSCs) compared with that of PRFM alone in human periodontal mandibular intraosseous defects (IOD). This study included 17 patients of both sexes (12 men, 5 women) aged 30-55 years (mean age = 37.7±4.4 years) who fulfilled the inclusion criteria (radiographic and clinical evaluation for bilateral IOD with probing pocket depth (PPD ≥ 6 mm). A split-mouth design was used in each patient. A total of 34 sites in the mandibular arch randomly received PRFM alone + open flap debridement (OFD) [Control sites] or supercell (PRFM+PBMSCs) + OFD [Test sites]. The clinical parameters plaque index (PI), gingival index (GI), PPD, clinical attachment level (CAL), and in the radiographic parameters; defect depth (DD) and defect fill percentage (DFP) were recorded at baseline, 3 and 6 months postoperatively. Early wound healing index (EHI) was used at 1 week to assess wound healing ability. At 6 months, radiographic parameters revealed significant reduction in DD (P<0.001) and significant DFP values in the test group compared with the control group. The supercell showed significant improvement in PPD and CAL at the end of 6 months (P<0.001). EHI scores at 1 week showed no statistically significant difference between the test and control groups. Supercell can be considered a regenerative material in the treatment of periodontal IODs.

Assessment of bone defect morphology for the adjunctive use of bone grafting combined with enamel matrix derivative: A 3-year cohort study.

There have been limited studies with statistically sufficient sample sizes for assessment of suitable bone defect morphology for combination therapy with enamel matrix derivative (EMD) and bone grafting. The aim of this study was to investigate the appropriate feature of intrabony defects, such as bone defect angle (DA) and the containment by bony wall, for yielding the additional benefit of bone grafting in combination with periodontal regenerative therapy using EMD. Following periodontal regenerative therapy using EMD with or without autologous bone grafting, 282 intrabony defects of 177 participants were maintained for 3 years. Multilevel linear regression analysis was performed to evaluate the radiographic bony defect depth (RBD) reduction after adjusting for confounders. The baseline parameters, except for the proportion of contained bony defects and tooth mobility, did not differ significantly between the groups with and without bone grafts. There was no significant difference in the improvement of clinical parameters between the groups. The 1- and 3-year reduction of RBD showed significant inverse correlations with preoperative DA only in the group without bone graft. Furthermore, multivariate analysis showed a significant interaction between DA at baseline ≥40° and adjunctive bone grafting in the reduction of RBD, regardless of the number of bony walls. Adjunctive autologous bone grafting with enamel matrix derivative might be significantly beneficial for defect depth improvement in the case of DA at baseline ≥40°.

Comparative evaluation of platelet rich fibrin matrix (PRFM) membrane and collagen membrane with demineralized freeze-dried bone allograft (DFDBA) in the treatment of mandibular class II furcation defects: A randomized controlled trial

Aim- The aim of the study was to compare the effectiveness of platelet rich fibrin matrix (PRFM) membrane with collagen membrane (Colo Gide) in combination with demineralized freeze-dried bone allograft (DFDBA) in the treatment of mandibular Class II furcation defects. Methods- This randomized, parallel designed, controlled, clinical investigation was conducted in 24 subjects (15 male and 9 female) having Class II furcation defects either buccally or lingually. The test group was treated with DFDBA and PRFM membrane while the control group was treated with DFDBA and collagen membrane. The clinical measurements such as plaque index (PI), papillary bleeding index (PBI), pocket probing depth (PPD), relative attachment level (R-CAL) and relative gingival marginal level (R-GML) were measured at baseline and six months. Radiographic parameters, such as vertical defect depth (VDD), horizontal defect depth (HDD) and defect width (DW) were measured using cone beam computed tomography taken at baseline, three and six months. Student’s paired t-test was utilized to analyse data from the day of surgery to six months. A comparison of both groups at baseline and six months was achieved by student’s unpaired t-test. Result-10 sites in test group (83.33%) showed the advancement from class II to class I compared to eight sites in control (66.66%). Remaining defects in test group n=2 (16.66%) and control group n=4 (33.33%) showed marked reduction in horizontal defect depth compared to baseline. No complete closure of the defect was seen in either group. Conclusion- When treating class II furcation defects, the use of PRFM membrane combined with DFDBA seems to be advantages with regards to collagen membrane. The presented set up seems feasible with regards to randomization, acceptance, retention and achievement of satisfactory outcomes.

Efficacy of concentrated growth factor (CGF) in the surgical treatment of oral diseases: a systematic review and meta-analysis

BackgroundConcentrated growth factor (CGF), a new autologous platelet concentrate, has been widely investigated to the adjunctive treatment of oral diseases. This study aims to evaluate the efficacy of CGF in the surgical treatment of oral diseases.MethodsMEDLINE, Web of Science, Scopus, Cochrane, and EMBASE databases were searched up to July 2023. Only randomized clinical trials were included. The methodologic quality was evaluated by the Cochrane Risk of Bias Tool. RevMan 5.4 software was used for data analysis.ResultsIn the treatment of periodontal intrabony defects, bone graft combined with CGF was significantly superior to bone graft (P < 0.01), with mean intrabony defect depth reduction of 1.41 mm and mean clinical attachment level gain of 0.55 mm. In the regenerative surgery of furcation defects, the effect of CGF group was significantly better than control group (P < 0.0001), with mean probing depth reduction of 0.99 mm, vertical bone gain of 0.25 mm, and horizontal bone gain of 0.34 mm. CGF combined with coronally advanced flap (CAF) was more effective than CAF alone (mean keratinized tissue width increase of 0.41 mm, mean gingival thickness increase of 0.26 mm, P < 0.00001), but less effective than connective tissue graft (CTG) combined with CAF (mean root coverage difference of -15.1%, mean gingival thickness difference of -0.5 mm, P < 0.0001). In the alveolar ridge preservation, additional use of CGF reduced horizontal bone resorption by 1.41 mm and buccal vertical bone resorption by 1.01 mm compared to control group (P < 0.0001). The VAS score of CGF group was significantly lower than that of the control group at the 1st and 7th day after oral surgery (P < 0.0001).ConclusionsCGF can exert a positive adjunctive effect for the regenerative surgery of periodontal intrabony defects, furcation defects, and alveolar ridge preservation procedure. CGF combined with CAF has a better therapeutic effect on gingival recession compared to CAF alone, although it is not as effective as CTG combined with CAF. CGF could promote postoperative healing and pain relief in oral surgery within a week. There is currently not enough evidence to support the clinical benefits of CGF in other oral surgeries.

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.

Evaluation of PRF and PLA-PGA Membrane Along with Hydroxyapatite Crystal Collagen Fibers Bone Graft in the Treatment of Infrabony Defects.

The present study was carried out to compare the effectiveness of leukocyte platelet-rich fibrin (L-PRF) membrane and polylactic acid-polyglycolic acid (PLA-PGA) membrane along with hydroxyapatite crystal collagen fibers bone graft in the treatment of human infrabony defects using cone beam computed tomography. A total of 28 systemically healthy patients was chosen which were found appropriate after initial therapy. Each group comprises of 14 defects, according to randomized parallel design. The group A was managed by hydroxyapatite crystal collagen fibers bone graft in conjunction with L-PRF membrane, while group B was treated by hydroxyapatite crystal collagen fibers bone graft in conjunction with PLA-PGA membrane. Clinical and radiographic measurements were recorded at baseline and 6 months postoperatively. Statically significant difference was seen in mean probing pocket depth (PPD), mean R-CAL, and DD from baseline to 6 months in group A and group B but there was no statically significant difference in mean PPD reduction (0.35 ± 1.90 mm), mean R-CAL gain (0.28 ± 1.85 mm) and DD reduction (0.12 ± 1.42 mm) seen at 6 months when compared between both the groups. At 6 months post-surgery both treatment modalities demonstrated statistically significant improvements with regards to CAL gains, PPD reduction, and reduction in radiographic defect depth. Platelet-rich fibrin (PRF) membrane and PLA-PGA membrane along with hydroxyapatite crystal collagen fibers bone graft are useful in the treatment of infrabony defect. Platelet-rich fibrin membrane with hydroxyapatite crystal collagen fibers bone graft have shown to be better in regeneration of bony defect as PRF membrane has growth factors which help in bone regeneration.

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.

Network meta-analysis of platelet-rich fibrin in periodontal intrabony defects.

To evaluate the effect of platelet-rich fibrin alone or in combination with different biomaterials for the treatment of periodontal intra-bony defect. Up to April 2022, Cochrane library, Medline, EMBASE, and Web of Science databases were searched for randomized clinical trials. The outcomes of interest were probing pocket depth reduction, clinical attachment level gain, bone gain, and bone defect depth reduction. Bayesian network meta-analysis with 95% credible intervals was calculated. Thirty-eight studies with 1157 participants were included. Platelet-rich fibrin alone or platelet-rich fibrin +biomaterials showed a statistically significant difference when compared with open flap debridement (p < 0.05, low to high certainty evidence). Neither biomaterials alone nor platelet-rich fibrin +biomaterials showed a statistically significant difference when compared to platelet-rich fibrin alone (p > 0.05, very low to high certainty evidence). Platelet-rich fibrin +biomaterials showed insignificant differences as compared to biomaterials alone (p > 0.05, very low to high certainty evidence). Allograft +collagen membrane ranked the best in probing pocket depth reduction while platelet-rich fibrin +hydroxyapatite ranked the best in bone gain. It seems that (1) platelet-rich fibrin with/without biomaterials were more effective than open flap debridement. (2) Platelet-rich fibrin alone provides a comparable effect to biomaterials alone and platelet-rich fibrin +biomaterials. (3) Platelet-rich fibrin +biomaterials provide a comparable effect to biomaterials alone. Although allograft +collagen membrane and platelet-rich fibrin +hydroxyapatite ranked the best in terms of probing pocket depth reduction and bone gain respectively, the difference between different regenerative therapies remains insignificant, and therefore, further studies are still needed to confirm these results.

A comparative study of demineralized freeze-dried bone allograft alone and with 1% metformin in the treatment of intrabony defects in patients with chronic periodontitis: A randomized clinical trial.

Periodontal disease is ubiquitous and its treatment requires a detailed treatment plan. Biomaterials are often used along with demineralized freeze-dried bone allograft (DFDBA) for periodontal regeneration. One percent metformin has evolved as a regeneration material. This study was initiated to assess and compare the regenerative potential of DFDBA alone and with 1% metformin in the treatment of intrabony defects in subjects with chronic periodontitis. 20 sites with intrabony defects were diagnosed of which 10 were assigned to Group A (1% Metformin + DFDBA) and 10 to Group B (DFDBA alone). Clinical parameters were measured at baseline, 3, 6, and 9 months postoperatively, whereas radiographic parameters were measured at baseline and 9 months postoperatively, and data were statistically analyzed. Both the groups showed a statistically significant improvement in probing pocket depth and relative attachment level at 9 months. Radiographically, a statistically significant reduction in defect depth was seen in both the groups at 9 months. There was no statistically significant difference between the two groups as far as crestal bone loss is concerned. No statistically significant difference was seen for clinical and radiographic parameters between the test and control groups. The addition of 1% metformin to DFDBA did not have any additional benefits in the treatment of subjects with defects which are intrabony.

The Adjunctive Use of Leucocyte- and Platelet-Rich Fibrin in Periodontal Endosseous and Furcation Defects: A Systematic Review and Meta-Analysis.

The aim of this systematic review of randomized controlled trials was to evaluate the adjunctive use of leucocyte- and platelet-rich fibrin (L-PRF) in periodontal endosseous and furcation defects, as compared without L-PRF. The endosseous defect group was subclassified into: L-PRF/open flap debridement (L-PRF/OFD) versus OFD, L-PRF/osseous graft (L-PRF/OG) versus OG, L-PRF/Emdogain (L-PRF/EMD) versus EMD, and L-PRF/guided tissue regeneration (L-PRF/GTR) versus GTR. The furcation defect group was subclassified into L-PRF/OFD versus OFD, and L-PRF/OG versus OG. Mean difference, 95% confidence intervals and forest plots were calculated for probing pocket depth (PPD), clinical attachment level (CAL) and radiographic defect depth (DD). Nineteen studies concerning systemically healthy non-smokers were included. The results of this systematic review and meta-analysis showed in two- and/or three-wall endosseous defects that the adjunctive use of L-PRF to OFD or OG was significantly beneficial for PPD reduction, CAL gain and DD reduction, as compared without L-PRF. Furthermore, the data showed that for two- and/or three-wall endosseous defects, the adjunctive use of L-PRF to GTR was significantly beneficial for CAL and DD improvement, whereas adding L-PRF to EMD had no significant effect, and that for class II furcation defects, the addition of L-PRF to OFD was significantly beneficial for PPD, CAL and DD improvement, whereas the addition of L-PRF to OG was significantly clinically beneficial. In conclusion, this systematic review and meta-analysis found that there was significant clinical and radiographic additive effectiveness of L-PRF to OFD and to OG in two- and/or three-wall periodontal endosseous defects of systemically healthy non-smokers, as compared without L-PRF.

Cell-based therapies for the surgical treatment of periodontal intrabony defects: a systematic review.

The aim of the study is to investigate the efficacy of cell-based therapy in the surgical treatment of periodontal intrabony defects. PRISMA guidelines were followed, and the study protocol was regis-tered in PROSPERO. Electronic and hand searches were carried out on electronic databases and major international journals of periodontology. All randomized clinical trials (RCTs) comparing cell-based therapies com-bined with surgery to surgery alone for the treatment of periodontal intrabony defects were considered. Quality assessment was performed using the Cochrane Risk of Bias Tool for randomized clinical trials (RoB 2). Quantitative evaluation of data was performed by meta-analysis. Five hundred twenty-eight records were initially screened and 5 RCTs fulfilling the eligibility criteria were included. Periodontal ligament stem cells, dental pulp stem cells, periosteum-derived stem cells, gingival fibroblasts and their associated stem cells were used in combination with different surgical techniques to treat intrabony periodontal defects. Meta-analysis showed a statistically signif-icant effect in favor of cell-based groups for clinical attachment level gain (p=0.004), with a difference in means of 1.7 mm (95% CI 0.5; 2.9). This was replicated for intrabony defect depth reduction (p=0.006), with a difference in means of 1.3 (95% CI 0.4; 2.3). Cell-based therapies have been positively applied for the surgical treatment of intrabony periodontal defects with promising results. However, the results obtained should be interpreted with caution due to the low number of available RCTs, the study design heterogeneity, and the limited extension of the follow-up.

Management of Grade II Furcation Defect in Mandibular Molars with Allograft and Alloplastic Bone Graft: A Clinico- Radiographic Study

Aim: The present study was carried out to compare clinically and radiographically the efficacy of regenerative potential of Demineralizedfreeze-dried bone allograft (DFDBA) and Bioactive glass putty (Novabone© dental putty) in mandibular grade II furcation defects. Methods: In 34 Patients, 60 mandibular grade II furcation defects were treated using DFDBA and Bioactive glass putty. 30 furcations were treated using DFDBA, while bioactive glass putty was used to treat remaining 30 furcation defect. Clinical parameters evaluated were Plaque index (PI), Gingival index (GI), Probing pocket depth (PPD), Relative vertical attachment level (RVAL), Relative horizontal attachment level (RHAL) at baseline, 3 months and 6 months. Radiographic parameters recorded were linear measurement of defect depth and bone density in gray scale at baseline and 6 months. Results: Both the group showed significant reduction in mean (P≤0.05) GI, PI, PPD, RVAL and RHAL at 6 months. Group I showed greater reduction in PPD. Radiographic evaluation showed significant (P≤0.05) reduction in defect depth and increase in bone density in both groups. Conclusions: Bioactive glass putty showed comparable regeneration to that of DFDBA in the treatment of mandibular grade II furcation defect. Additional putty consistency of bioactive glass makes it easier and more convenient to use.

Treatment of infra-bony periodontal defects using a collagen membrane and a bone substitute of equine origin – a pilot study

Introduction One of the main goals of periodontal treatment is the regeneration of lost tissues, in order to improve the prognosis of the involved teeth [1–3]. Guided tissue regeneration (GTR) involves the use of a barrier with or without the use of bone substitutes [4]. Given the great diversity and constant evolution of materials, it is necessary to maintain a permanent evaluation of their clinical effectiveness. This study intends to evaluate the success and predictability of GTR using a new membrane and bone substitute of equine origin (Heart® and Mix Granules® – Bioteck SpA, Turin, Italy), in the treatment of infra-bony defects with two or three walls [5]. Materials and methods This study was approved by Egas Moniz Ethics Committee and all patients signed an informed consent form. Patients were selected among those referred to the Department of Periodontology/EMDC, with indication for surgical periodontal treatment, presence of 2–3-wall infra-bony defects, probing depth (PD) ≥ 5 mm, infra-bony component ≥4 mm deep (evaluated radiographically) and attached gingiva ≥2 mm. Exclusion criteria were: cases with PIaque Index (PI) >20%, smokers, extension of the defect to the furcation zone, mobility grade III, endodontic pathology, diabetes or other pathologies that interfere with bone remodelling and metabolism or contraindicate periodontal surgery. All surgeries were performed by the same operator. The clinicians involved in the evaluation of the results had no intervention in surgery. The following clinical and radiographic parameters were evaluated at one, three and six months after surgery: PI, Gingival Index (GI), Probing pocket depth (PPD), Bleeding on Probing (BoP); Gingival recession (GR), height of keratinised gingiva (KG) and radiographic angle of the defect (RAD). In addition, the presence of possible intra-surgical or post-operative complications was also evaluated. The assessment of the defect depth reduction was based on standardised periapical radiographs obtained through the use of an individualised device (parallelizer). Results A total of six participants (83% females, 17% males), with a mean age of 61.6 (± 8.1) years, were enrolled in the study. The number of defect walls was: 3 walls (50%), 2 walls (33.3%) and 2/3 walls (16.7%). After six months, an average clinical attachment level gain of 3.3 (± 1.4) mm, mean radiographic bone filling of 72 (± 29%) and a BoP reduction of 66.6% were observed. RAD average was 21.3 (± 1.2°) and GR changed from 2.2 to 2.7 mm. Membrane exposure was observed in 33.3% of the cases, however, there were no cases of infection or severe pain. Discussion and conclusions The use of collagen membranes and corticocancellous bone grafts of equine origin seems to be a viable alternative in the regeneration of infra-bony periodontal defects.

Use of Platelet-Rich Fibrin in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis.

Background Platelet-rich fibrin (PRF) is a kind of autologous platelet concentrate which is easy to obtain and cheap. In recent years, it has been studied to improve the effect of periodontal regeneration. However, few studies have systematically evaluated the complementary effect of PRF in the treatment of intrabony defects. The present review is aimed at systematically assessing the effects of PRF on clinical and radiological outcomes of the surgical treatment of periodontal intrabony defects. Methods The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews) as CRD42020206056. An electronic search was conducted in MEDLINE, Cochrane, and EMBASE databases. Only randomized clinical trials were selected. Systematically healthy patients with two or three walls of intrabony defects were considered. Intrabony defect (IBD) depth reduction and bone fill (BF) % were set as primary outcomes while probing depth (PD) reduction, clinical attachment level (CAL) gain, and gingival margin level (GML) gain were considered as the secondary outcome. When possible, a meta-analysis was performed. Results Eighteen articles fulfilled the inclusion criteria, and seventeen studies were quantitatively analyzed. Of 17 studies, four were rated as high risk of bias and thirteen as the moderate risk of bias. Two comparisons were set: (1) open flap debridement (OFD) combined with PRF and OFD alone and (2) bone grafting (BG) combined with PRF and BG alone. Compared to OFD alone, OFD+PRF showed significantly greater in all primary and secondary outcomes. Compared to BG alone, BG+PRF showed significantly greater in IBD depth reduction, PD reduction, CAL gain, and GML gain. Conclusions The use of PRF was significantly effective in the treatment of periodontal intrabony defects. The benefit of OFD+PRF may be greater than BG+PRF. PRF can promote early wound healing in periodontal surgery. As all included studies were not at low risk of bias, well-designed RCTs having a high methodological quality are needed to clarify the additional effectiveness of PRF in the treatment of intrabony defects in the future.

Clinical evaluation and comparison of platelet-rich fibrin and injectable platelet-rich fibrin (sticky bone) in the treatment of intrabony defects

Introduction: Periodontal regeneration aims to regenerate the lost periodontium, and platelet concentrates are frequently used in the medical fields to improve the healing and promote tissue regeneration. Objective: The aim of the study was to evaluate the efficacy of injectable platelet-rich fibrin (i-PRF) (sticky bone) in comparison to platelet-rich fibrin (PRF) in the treatment of intrabony defects. Materials and Methods: A total of 54 sites treated were divided into three groups (Group I – open flap debridement [OFD alone], Group II – OFD with i-PRF [sticky bone], and Group III – OFD with PRF) in moderate-to-severe periodontitis. The clinical parameters assessed were plaque index, gingival index, probing pocket depth (PPD), relative attachment level, and defect depth reduction at baseline, 3, 6 and 9 months. Results: Nine months postoperatively, a significant improvement in clinical and radiographic parameters was observed from baseline in all three groups. However, Group II and Group III showed better results in all the parameters compared to Group I. Nine months postoperatively, the defect depth reduction was: OFD - 41.59%, i-PRF - 72.75%. and PRF - 62.11%. Conclusion: PC (i-PRF [sticky bone] and PRF) have shown better clinical and radiographic outcomes than OFD in the treatment of intrabony defects in chronic periodontitis.