Defect Depth Reduction Research Articles

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.

Additive effectiveness of autologous platelet-rich fibrin in the treatment of intrabony defects: A PRISMA-compliant meta-analysis.

Background:This meta-analysis was performed to determine the additive effectiveness of autologous platelet-rich fibrin in the treatment of intrabony defects in chronic periodontitis patients.Methods:Pertinent studies were identified by a search in Medline, EMBASE, the Web of Science, and the Cochrane Library. The trials searched were evaluated for eligibility. Cochrane Collaboration's Review Manager software was used to perform the meta-analyses.Results:Twelve eligible clinical trials were included. Pooled data found that adjunctive platelet-rich fibrin exactly yielded a significantly superior probing depth reduction compared with open flap debridement alone (weighted mean difference, 1.01; 95% confidence interval 0.95–1.08; P < .00001). The clinical attachment level (CAL) gain after treatment for 9 months was higher in patients treated with platelet-rich fibrin plus open flap debridement group than in open flap debridement-treated patients (weighted mean difference, 1.29; 95% confidence interval 0.96– 1.61; P < .00001). Similarly, the meta-analysis demonstrated that platelet-rich fibrin was superior to single open flap debridement with respect to gingival marginal level change (weighted mean difference, 0.45; 95% confidence interval 0.31–0.58; P < .00001). Regarding the hard tissue radiographic parameters, including defect depth reduction and percentage of fill defects in bone, adjunctive platelet-rich fibrin yielded significantly superior results compared with open flap debridement alone.Conclusion:Adjunctive use of platelet-rich fibrin with open flap debridement significantly improves fill defects when compared to open flap debridement alone. However, additional powered studies with much larger sample sizes are needed to obtain a more concrete conclusion.

Evaluation of Clinical Effectiveness of Bioactive - Glass and Platelet - Rich Fibrin in the Management of Intrabony Defects - A Comparative Study

Background: Platelet-Rich Fibrin (PRF), the second-generation platelet concentrate has various fringe benefits over other platelet concentrates. Just finite number of research works have concentrated on the utilization of PRF in combination with various kinds of bone grafts in intra-bony defects. Objective: The primary intention of this study was to determine the clinical and radiographical efficacy of Bioactive-glass with and without autologous PRF in the management of three-wall vertical defects. Methods: Twenty intrabony defects were arbitrarily chosen and treated either with Bioactive Glass (BG) alone or in mix with PRF (PRF/BG). Clinical parameters were documented preoperatively (baseline) and at six months post-operatively. Radiographic analysis was performed at baseline, third and sixth-month intervals. Results: The study outcome demonstrated that both treatment approaches were effectual. Significant decrease in the mean probing depth and gain in clinical attachment was observed in BG+PRF and BG groups as compared to baseline but was statistically insignificant at 6 months. (p=0.475, p=0.245 respectively). Radiographically, reduction in defect depth was significantly greater in BG+PRF group than BG group (p=0.007) at 6 months. Conclusion: Within the limitation of the current study, it is proposed that both treatment modalities are effective in the management of 3-wall intra-bony defects. The outcomes additionally uncovered that incorporation of PRF with BG has more successful and promising results. Hence in future, clinical trials with bigger sample size may be employed to further explore the potential benefits of PRF as a sole grafting material.

Long-term stability of intrabony defects treated with minimally invasive non-surgical therapy.

The aim of this study was to assess the stability over time of periodontal intrabony defects treated with minimally invasive non-surgical therapy (MINST) and supportive periodontal therapy (SPT). Clinical and radiographic analysis was carried out in 21 intrabony defects treated with MINST in 14 consecutive patients included in a prospective study and reassessed after 5years of SPT. Baseline, 1- and 5-year radiographs were analysed, and bone levels were compared by multilevel linear regression adjusted by latent variable method. None of the 21 teeth with intrabony defects was lost at 5years. Average probing pocket depth, clinical attachment level and radiographic intrabony vertical defect depth reductions were 3.6, 3.5 and 2.6mm, respectively, 5years after treatment (p<0.001 compared with baseline). Further non-statistically significant reductions were seen in clinical and radiographic measures between 1 and 5years. Deeper initial defects and narrower angles were predictive of a bigger reduction in defect depth (p<0.001 and p=0.017, respectively). Clinical and radiographic improvements in intrabony defects after MINST seen at 1year are stable up to 5years, bringing evidence to support its long-term efficacy for the treatment of intrabony defects in non-smokers.

One percent alendronate and aloe vera gel local host modulating agents in chronic periodontitis patients with class II furcation defects: A randomized, controlled clinical trial.

Alendronate (ALN) has antiresorptive and osteostimulative properties. The major component of aloe vera (AV) gel is acemannan, which has been found to have osteogenic properties. The aim of the present study is to explore the effectiveness of 1% ALN and AV gel as an adjunct to scaling and root planing (SRP) in chronic periodontitis patients with class II furcation defects. Ninety volunteers were randomly assigned to three treatment groups: (a) SRP plus placebo gel; (b) SRP plus 1% ALN gel; and (c) SRP plus AV gel. Clinical and radiographic parameters were recorded at baseline and at 6 and 12months. The mean probing depth reduction and relative horizontal clinical attachment level (CAL) and relative vertical CAL gains were greater in the ALN group than in the AV and placebo groups at 6 and 12months. Furthermore, a significantly greater mean percentage of defect depth reduction (DDR) was found in the ALN group (38.09±9.53, 44.86±6.29) than the AV groups (11.94±15.10, 14.59±25.49) at 6 and 12months, respectively. ALN showed significant improvement in all clinical parameters, along with greater DDR, compared to AV in the treatment of class II furcation defects as an adjunct to SRP.

Periodontal Diseases/Treatment and Bisphosphonates

Host response against bacteria or their toxins eventually play a major role in alveolar bone destruction observed in periodontitis. Because of the role in bone resorption, bisphosphonates were applied as adjunct to non-surgical therapy. This review highlights the effects of bisphosphonates on clinical parameters as adjunct to periodontal treatment. Significant clinical and radiographic effects were observed in animal and human study models. In recent studies, local usage of the bisphosphonate gels was examined in periodontitis patients to prevent the systemic side effects. The mean pocket depth reduction, clinical attachment level gain, and the percentage of defect depth reduction were greater in bisphosphonate group. Bisphosphonates appear to be effective in improving clinical outcomes of periodontal treatment. However, the clinical relevance still remains controversial because of the differences in methodology in the studies. New evidences from high-quality clinical trials are required to clear the clinical application of bisphosphonates as adjunct to non-surgical periodontal treatment in periodontitis.

A randomized controlled clinical trial evaluating the efficacy of zoledronate gel as a local drug delivery system in the treatment of chronic periodontitis: A clinical and radiological correlation.

Background:This study aimed to evaluate the efficacy of local drug delivery system of zoledronate (ZLN) gel as an adjunct to scaling and root planing (SRP) for the treatment of human periodontal intrabony defects clinically and radiographically.Materials and Methods:Forty intrabony defects (three walled and combined defects without involving furcation) in moderate to severely affected forty chronic periodontitis patients (range, 30–50 years) were randomly divided into two groups and treated either with 0.05% ZLN gel (ZLN n = 20; 1 dropout) or placebo gel (control group [CG] n = 20) after SRP. Clinical parameters such as plaque index (PI), gingival index (GI), tooth-specific pocket probing depth (Ts PPD), and clinical attachment levels (TsCAL) were assessed at baseline and at 3 and 6 months using occlusal acrylic stent. Radiographic parameters were assessed at baseline and 6 months, utilizing “ONIS 2.5 PROFESSIONAL” and “SYNGO” software compatible with DentaScan to measure the volumetric bone changes in intrabony defects.Results:In intragroup comparisons, both groups showed significant PI and GI reduction (P < 0.001) after treatment at 3 and 6 months. In intergroup comparisons, Ts PPD reduction and Ts CAL gain were significant only in ZLN at 6 months from both baseline and 3 months. Radiographically, significant reduction in defect depth and buccolingual width with volumetric defect gain of 40.24% ± 7.44% in ZLN compared to insignificant gain of 1.60% ± 4.06% in CG was observed at 6 months.Conclusion:ZLN gel applied subgingivally in intrabony defects resulted in significant improvements both clinically and radiographically.

Targeted rework strategies for powder bed additive manufacture

A major factor limiting the adoption of powder-bed-fusion additive manufacturing for production of parts is the control of build process defects and the effect these have upon the certification of parts for structural applications. In response to this, new methods for detecting defects and to monitor process performance are being developed. However, effective utilisation of such methods to rework parts in process has yet to be demonstrated.This study investigates the use of spatially resolved acoustic spectroscopy (SRAS) scan data to inform repair strategies within a commercial selective laser melting machine. New methodologies which allow for rework of the most common defects observed in selective laser melting (SLM) manufacturing are proposed and demonstrated. Three rework methodologies are applied to targeted surface breaking pores: a hatch pattern, a spiral pattern and a single shot exposure. The work presented shows that it is possible to correct surface breaking pores using targeted re-melting, reducing the depth of defects whilst minimising changes in local texture. For the hatch rework and spiral rework, a reduction in defect depth of 50% and 31% were observed, respectively, however, no improvement was seen after the single shot exposures. This work is part of a programme to develop a method by which defects can be detected and the part reworked in-process during SLM to enable defect specification targets to be met. Although further work in developing build-characterise-rework strategies for integrated and targeted defect correction is needed, the feasibility of the underlying method of identifying and selectively reworking to reduce a defect has now been demonstrated for the first time.

Platelet-Rich Fibrin in Regeneration of Intrabony Defects: A Randomized Controlled Trial.

Platelet-rich fibrin (PRF) is an autologous non-transfusional hemo-component with a high concentration of platelets. It incorporates leukocytes, platelets, and growth factors within the dense fibrin matrix and can be used as healing biomaterial. This study assesses the adjunctive use of PRF in regenerative management of intrabony defects in comparison with open flap debridement (OFD). Twenty-six bilateral defects (13 per group) in 13 patients were randomized as either PRF (test group) or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and bone PD were recorded. Reduction in defect depth and percentage of bone fill was assessed radiographically. Primary outcomes assessed were changes in PD, CAL, and percentage of bone fill, and they were assessed at 6, 9, and 12 months. Secondary outcome was assessment of wound healing using a wound healing index (WHI). The PRF group showed significant improvement in clinical parameters compared with the control group at 6, 9, and 12 months. The PRF group showed a bone fill of 45.18% ± 7.57%, which was statistically significant compared with 21.6% ± 9.3% seen in the control group at the end of the study period. The PRF group also showed significant soft tissue healing and reduction in PD. WHI also showed significant advantages for the PRF group. The adjunctive use of PRF to conventional OFD may be potentially used in the treatment of intrabony defects.

Efficacy of 1% Metformin Gel in Patients With Moderate and Severe Chronic Periodontitis: A Randomized Controlled Clinical Trial.

The aim of this study is to investigate efficacy of metformin (MF) 1% gel as an adjunct to scaling and root planing (SRP) in the treatment of moderate and severe chronic periodontitis (CP). Seventy patients were categorized into two treatment groups: 1) SRP plus 1% MF and 2) SRP plus placebo. Clinical parameters were recorded at baseline and 3, 6, and 9 months. They included plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). Radiologic assessment of intrabony defects (IBDs) and percentage defect depth reduction (DDR%) was done at baseline and 6- and 9-month intervals using computer-aided software. PD, CAL, and DDR% were evaluated in two subgroups in both the placebo and MF group: 1) initial PD of 5 to 7 mm and 2) initial PD of >7 mm. Mean PD reduction and mean CAL gain was found to be greater in the MF group than the placebo group at all visits. Clinical parameters (PD, CAL) in both subgroups, with initial PDs of 5 to 7 and >7 mm, showed significant improvement in the 1% MF group compared with the placebo group. A significantly greater mean DDR% was found in the MF group than the placebo group at 6 and 9 months in both subgroups, 5 to 7 and >7 mm of initial PD. There was a greater decrease in PD and more CAL gain with significant IBD depth reduction at sites treated with SRP plus locally delivered MF in patients with CP in both initial PD = 5 to 7 and >7 mm subgroups compared with placebo.

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.

1.2% Rosuvastatin and 1.2% Atorvastatin Gel Local Drug Delivery and Redelivery in the Treatment of Class II Furcation Defects: A Randomized Controlled Clinical Trial.

Statins are one of the lipid-lowering drugs that help in reducing cholesterol levels in the body by specifically inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase, which is a rate-limiting enzyme for cholesterol synthesis. Rosuvastatin (RSV) and atorvastatin (ATV) have shown bone stimulatory and anti-inflammatory effects. The present study aims to explore efficacy of 1.2% RSV and 1.2% ATV gels as a local drug delivery and redelivery system adjunct to scaling and root planing (SRP) for treatment of Class II furcation defects. Ninety patients with mandibular buccal Class II furcation defects were randomly allocated to three treatment groups: 1) SRP with placebo gel (group 1); 2) SRP with 1.2% RSV gel (group 2); and 3) SRP with 1.2% ATV gel (group 3). Clinical and radiographic parameters were recorded at baseline and after 6 months. Gels were redelivered at the respective sites at a 6-month recall appointment. All clinical and radiographic parameters were recorded again after 3 months (i.e., 9 months from baseline). Greater mean probing depth (PD) reduction and greater mean gain in relative vertical clinical attachment level (CAL) and relative horizontal CAL were seen in the RSV group than in the ATV group at 6 and 9 months. Significantly greater mean percentage of defect depth reduction (DDR) was found in the RSV group (30.80% ± 8.35%, 41.86% ± 6.76%) than in the ATV group (25.54% ± 8.89%, 34.31% ± 8.04%) at 6 and 9 months, respectively. The RSV group shows significant improvement in all clinical parameters and significantly greater DDR compared with the ATV group in treatment of mandibular Class II furcation defects as an adjunct to SRP.

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.

Evaluation of platelet-rich plasma alone or in combination with demineralized freeze dried bone allograft in treatment of periodontal infrabony defects: A comparative clinical trial.

Aims:The use of platelet-rich plasma (PRP) alone in periodontal defects has been controversial and inconclusive. Hence, the present study was designed with the aim to assess the clinical and radiographic effectiveness of PRP alone in infrabony defects.Materials and Methods:Thirty infrabony defects were treated with either autologous PRP with open flap debridement (OFD) or autologous PRP + demineralized freeze dried bone graft (DFDBA) with OFD or OFD alone. Clinical parameters recorded were gingival index, plaque index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). Radiographic parameters included defect depth reduction, defect resolution, and crestal bone level. All the parameters were recorded at baseline and 12 months postoperatively.Results:Mean PD reduction and CAL gain were greater in PRP + DFDBA (4.88 ± 1.12 mm and 4.26 ± 1.85 mm) and PRP (4.86 ± 2.12 mm and 4.10 ± 1.47 mm) groups than the control group (2.69 ± 1.37 mm and 1.27 ± 0.89 mm).Conclusions:Within the limits of the study, all the three groups showed significant improvement in clinical parameters from baseline to postoperative 12 months. The amount of defect depth reduction and defect resolution treated with PRP alone group were significantly < PRP + DFDBA. The results pertaining to these parameters were significantly better than the control group.

Comparative evaluation of the efficacy of synthetic nanocrystalline hydroxyapatite bone graft (Ostim®) and synthetic microcrystalline hydroxyapatite bone graft (Osteogen®) in the treatment of human periodontal intrabony defects: A clinical and denta scan study.

Background:To evaluate the relative efficacy of synthetic nanocrystalline hydroxyapatite (HA) (Ostim®) and microcrystalline HA (Osteogen®) bone grafts in the treatment of human periodontal intrabony defects clinically and radiographically through denta scan.Materials and Methods:Ten chronic periodontitis patients with bilateral intrabony periodontal defects of ≥2 mm radiographic defect depth below 55 years of age were selected randomly and treated with synthetic nanocrystalline HA (Ostim®) or synthetic microcrystalline HA (Osteogen®) bone graft. Clinical parameters including probing depth (PD) and clinical attachment level (CAL) were measured preoperatively and postoperatively at 3 and 6 months for each of the defects using an occlusal acrylic stent. Radiographic parameters were measured with the help of denta scan preoperatively and postoperatively at 6 months.Results:At 6 months following therapy, the Osteogen® group showed a reduction in mean PD from 11.10 ± 1.663 to 8.50 ± 0.850 mm and a change in mean CAL from 6.30 ± 1.160 to 3.40 ± 0.516 mm, whereas in the Ostim® group, the mean PD decreased from 11.20 ± 0.919 to 8.30 ± 0.823 mm and mean CAL decreased from 6.10 ± 0.738 to 3.30 ± 0.483 mm. At 6 months following therapy, denta scan showed a reduction in mean intrabony defect depth in the Osteogen® group from 2.54 ± 0.786 to 1.01 ± 0.448 mm, whereas in the Ostim® group, it was 2.71 ± 0.650 mm to 1.12 ± 0.563 mm.Conclusion:It was concluded that both the HA bone grafts produced statistically significant reduction in pocket depth, in the depth of osseous lesion, and a statistically significant gain in attachment level, irrespective of their physico-chemical properties.

The Effect of an Er,Cr:YSGG Laser in the Management of Intrabony Defects Associated with Chronic Periodontitis Using Minimally Invasive Closed Flap Surgery. A Case Series.

Aims: This is an extended case series of patients treated with an Erbium, Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser as an adjunct to scaling for the management of intrabony defects. Materials & methods: 46 patients with 79 angular intrabony defects associated with pocket depths of >5mm, and a mean age of 53 ± 9 years presenting with chronic periodontitis were included in the analysis. All patients underwent a localized minimally invasive closed flap surgery utilizing Er,Cr:YSGG laser therapy. Final radiographs and pocket depths were compared to pretreatment measurements with a time period of 8 ± 3 months. Results: Treatment resulted in significant overall pocket depth reduction. The mean pre-op probing depth was 8.1 ± 1.9mm, reducing to 2.4 ± 0.9mm post-treatment. Bony infill of the defects was visible radiographically and there was an increase in overall radiographic coronal osseous height compared to a pre-treatment baseline. Radiographs of 15 of the defects were available for further measurements after >12 months, and showed in these sites there was a significant reduction in intrabony defect depth, but no change in suprabony bone height. 9 of the 15 sites showed 50% or more, bony infill of the intrabony defect. Conclusions: The results demonstrate that the utilization of an Er,Cr:YSGG laser in a closed flap approach with chronic periodontitis may be of significant clinical benefit. Further studies using this laser surgical protocol are required to test these observations in well-designed randomized controlled trials.