Relative Vertical Clinical Attachment Level Research Articles

Clinical and Radiographic Evaluation of Autologous Platelet-Rich Fibrin With or Without Demineralized Bone Matrix in the Treatment of Grade II Furcation Defects.

Introduction This study aims to differentiate the employment of demineralized bone matrix (DMBM; Osseograft, Advanced Biotech Products (P) Ltd, Chennai, India) and platelet-rich fibrin (PRF) alone to a composite graft consisting of both materials in the surgical actions toward the anomalies of the human periodontal furcation imperfection. Methods In a split-mouth study, 30 patients with mandibular molars affected by the furcation were allocated without conscious choice to test (PRF + DMBM, n = 30) or control (PRF, n = 30) categories. At the starting point, three months after surgery, and six months later, the following modifiable factors were evaluated: probing pocket depth (PPD), full-mouth plaque scores, full-mouth gingival scores, radiographic defect depth, relative vertical clinical attachment level (RVCAL), and relative horizontal clinical attachment level (RHCAL). Results Results at three and six months demonstrated substantial differences between baseline values for both treatment methods in clinical and X-ray imaging appraisal. Nonetheless, the PRF/DMBM group manifests statistically significantly soaring changes observed in comparison to the PRF group. Overall, the probing depth (PD) in the test site was significantly lower than that in the control site, showing a reduction of 68% (95% CI=41%, 95%, p<0.001). Conclusion Clinical indications significantly improved with PRF and DMBM combined instead of PRF alone. On radiographs, the test group also showed higher bone fill.

Comparative Evaluation of Regenerative Potential of Infrabony Periodontal Defects by Using Xenograft in Combination with 1% Alendronate and 1% Metformin Gels

Background: Deficiency of the alveolar bone is one of the trademarks of periodontitis. Thus, agents that have osteogenic potential play a meritorious role in disease prevention. There is evidence, that pharmacological agents such as Alendronate (ALN) and Metformin (MF) have such potential in bone regeneration. Objectives: The main aim of this study was to assess the competency of Xenograft (XG) alone and in combination with 1% ALN and 1% MF in the regeneration of periodontal bone defects. Materials and Methods: In this randomized interventional study, total of 36 infrabony defects were randomly assigned to three groups, each group comprised of 12 infrabony defects: Group I with 1% ALN gel + XG (test), II with 1% MF gel + XG (test) and III with only XG (active control). This was a split-mouth study. Clinical criteria such as pocket depth (PD), relative vertical clinical attachment level (RVCAL) were assessed. A radiographic parameter like linear bone growth (LBG) was measured with the help of a grid. The microbial count (MC) was estimated with the plaque sample. All the specifications were calculated before the beginning of the study and at 6 months. Statistical analysis was performed using the Chi-square and paired t-test. Results: The mean reduction of PD, gain in RVCAL, LBG and MC was statistically significant within the groups (P &lt; 0.05) from baseline to 6 months. However, MC was insignificant in Group III (P = 0.294) within the group but was significant on the intergroup comparison. Conclusions: Overall, significant results were found in all three groups. Using XG alone as well as in combination with 1% ALN and 1% MF has given appreciable results.

Clinical evaluation of mineral trioxide aggregate in the surgical management of degree I and degree II furcation defects

Background: Mineral trioxide aggregate (MTA) is known as a strong bioactive material which induces hard tissue formation. It does not get contaminated with tissue fluids or blood and has low cytotoxicity with good antibacterial effects. Objectives: This study aims to evaluate the clinical effectiveness of MTA in the surgical management of Degree I and Degree II furcation defects. Methods: Individuals were 15 patients exhibiting clinical and radiographic evidence of Degree I and Degree II furcation defects. The pocket probing depth, plaque index, gingival index, relative vertical clinical attachment level, relative horizontal clinical attachment level, and gingival recession level of subjects were recorded at baseline, 3 months, and 6 months. Data were analyzed at a significance level of P < 0.05 using paired t-test. Results: The purpose of this study was to maintain furcation involved teeth with the use of MTA. Regeneration of periodontal attachment apparatus by MTA was not the goal of the treatment technique used in this study. However, MTA application results improvement in the recorded clinical parameters. Conclusion: MTA is effective in obliterating the Degree I and Degree II furcation defects. There are no signs and symptoms of any adverse effect to this treatment.

Demineralized freeze-dried bone allograft with or without platelet-rich fibrin in the treatment of mandibular Degree II furcation defects: A clinical and cone beam computed tomography study.

Background:Currently, there is no gold-standard regenerative material for the treatment of furcation defects. The use of bone grafts in combination with guided tissue regeneration membrane is a predictable treatment option but is expensive. Platelet concentrates are increasingly being used owing to their ease of use and cost-effectiveness.Aims:The aim of this study is to evaluate the ability of platelet-rich fibrin (PRF) to augment the regenerative effects exerted by demineralized freeze-dried bone allograft (DFDBA) in the treatment of mandibular degree II furcation defects.Materials and Methods:Twenty-eight defects in 14 patients with bilateral Degree II mandibular furcation defects were included in the study. The test group was treated with a combination of DFDBA and PRF, while in the control group DFDBA was used alone. Clinical parameters such as probing depth, relative vertical clinical attachment level, relative horizontal clinical attachment level (RHCAL), gingival margin level (GML), plaque index, and sulcus bleeding index were measured at baseline and 6 months. Radiographic parameters, such as vertical defect depth, horizontal defect depth and defect fill, were measured using cone beam computed tomography, taken at baseline and 6 months.Statistical Analysis Used:The intragroup and intergroup comparisons were done using the paired t-test.Results:The intergroup comparison of mean change in the parameters showed, statistically significant difference in RHCAL (<0.001) and GML (0.014), and no significant difference in other parameters.Conclusions:Within the limitations of the present study, PRF seems to favor soft-tissue healing but has no additional benefit in bone regeneration when used in combination with DFDBA.

Comparative evaluation of platelet-rich fibrin membrane and collagen membrane along with demineralized freeze-dried bone allograft in Grade II furcation defects: A randomized controlled study.

Background:The management of the furcation areas in multirooted teeth is often challenging due to difficulty in access. Platelet-rich fibrin (PRF), a second-generation platelet concentrate, has shown to accelerate the healing of soft and hard tissues. This study was designed to evaluate the efficacy of autologous PRF as a membrane in treatment of Grade II furcation defects in molars as compared to collagen membrane along with demineralized freeze-dried bone allograft in both the groups.Materials and Methods:A split-mouth study was planned with 18 patients having 2 sites of Grade II furcation defects each. Random allocation of the defect site was done for the test and control group. Plaque index, probing depth (PD), relative vertical clinical attachment level (RVCAL), gingival marginal level, and radiographic bone levels were recorded at baseline, 3 months, and 6 months postoperatively.Results:Both the groups showed statistically significant outcomes in intragroup comparison from baseline to 3 and 6 months. However, there was no statistical difference between PRF membrane and collagen membrane groups on intergroup comparison.Conclusion:There was a significant reduction of PD, improvement in RVCAL, and defect fill with autogenous PRF as membrane. This indicates its role as a regenerative material in treating furcation defects, which can be used as alternative to other expensive membranes.

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.

Effect of Autologous Platelet Rich Fibrin in Human Mandibular Molar Grade II Furcation Defects- A Randomized Clinical Trial.

The Furcation of multirooted teeth is difficult region to gain access for treatment due to their complex anatomy. Modifications have been made in the periodontal instrument armamentarium to facilitate treatment of furcations. Moreover, many new materials have been introduced to attempt regeneration in the furcation defects. This study evaluated the role of Platelet Rich Fibrin (PRF) in comparison with allograft and Guided Tissue Regeneration (GTR) in the treatment of Grade II mandibular molar furcations. This was a parallel arm prospective randomized, interventional trial (NCT 02430519) conducted on 22 patients, with Grade II mandibular furcation defects. Patients were divided into two equal groups. Group A, were treated by the placement of PRF as a graft and as a membrane while in Group B, the defects were treated by the placement of allograft and Healiguide collagen membrane. Clinical parameters {Plaque Index (PI), Probing Depth (PD), Relative Vertical Clinical Attachment Level (RVCAL), Relative Horizontal Clinical Attachment Level (RHCAL), Gingival Marginal Level(GML), and amount of Bonefill using Radio-Visiography (RVGBF)}, were estimated at baseline and nine months postoperatively. Comparison between the groups was analysed by using independent sample t-test, whereas, paired t-test was used to assess the mean values within the groups. The intergroup comparison for PI, PD, RHCAL, GML, was statistically not significant. Pertaining to RVCAL, there was a statistically significant difference at nine months (p-value=0.04) in Group A. Also, there was a statistically significant difference related to RVGBF (p-value=0.006) in Group A at nine months. The efficacy of PRF should be ascertained by conducting more studies with a larger sample size, on a long term basis, in patients with molar Grade II furcation defects.

Enamel matrix protein derivative plus synthetic bone substitute for the treatment of mandibular Class II furcation defects: a case series.

The aim of this study is to report on the treatment of mandibular Class II furcation defects with enamel matrix protein derivative (EMD) combined with a βTCP/HA (β-tricalcium phosphate/hydroxyapatite) alloplastic material. Thirteen patients were selected. All patients were nonsmokers, systemically healthy, and diagnosed with chronic periodontitis; had not taken medications known to interfere with periodontal tissue health and healing; presented one Class II mandibular furcation defect with horizontal probing equal to or greater than 4 mm at buccal site. The clinical parameters evaluated were probing depth (PD), relative gingival margin position (RGMP), relative vertical clinical attachment level (RVCAL), and relative horizontal clinical attachment level (RHCAL). A paired Student t test was used to detect differences between the baseline and 6-month measurements, with the level of significance of .05. After 6 months, the treatment produced a statistically significant reduction in PD and a significant gain in RVCAL and RHCAL, but no observable change in RGMP. RVCAL ranged from 13.77 (± 1.31) at baseline to 12.15 (± 1.29) after 6 months, with a mean change of -1.62 ± 1.00 mm (P < .05). RHCAL ranged from 5.54 (± 0.75) to 2.92 (± 0.92), with a mean change of -2.62 ± 0.63 mm (P < .05). After 6 months, 76.92% of the patients improved their diagnosis to Class I furcation defects while 23.08% remained as Class II. The present study has shown that positive clinical results may be expected from the combined treatment of Class II furcation defects with EMD and βTCP/HA, especially considering the gain of horizontal attachment level. Despite this result, controlled clinical studies are needed to confirm our outcomes.

Comparative evaluation of autologous platelet‐rich fibrin and platelet‐rich plasma in the treatment of mandibular degree II furcation defects: a randomized controlled clinical trial

The treatment of molar furcation defects remains a considerable challenge in clinical practice. The identification of clinical measurements influential to treatment outcomes is critical to optimize the results of surgical periodontal therapy. The present study aimed to explore the clinical and radiographical effectiveness of autologous platelet-rich fibrin (PRF) and autologous platelet-rich plasma (PRP) in the treatment of mandibular degree II furcation defects in subjects with chronic periodontitis. Seventy-two mandibular degree II furcation defects were treated with either autologous PRF with open flap debridement (OFD; 24 defects) or autologous PRP with OFD (25), or OFD alone (23). Clinical and radiological parameters such as probing depth, relative vertical clinical attachment level and horizontal clinical attachment level along with gingival marginal level were recorded at baseline and 9mo postoperatively. All clinical and radiographic parameters showed statistically significant improvement at both the test sites (PRF with OFD and PRP with OFD) compared to those with OFD alone. Relative vertical clinical attachment level gain was also greater in PRF (2.87±0.85mm) and PRP (2.71±1.04mm) sites as compared to control site (1.37±0.58mm), and relative horizontal clinical attachment level gain was statistically significantly greater in both PRF and PRP than in the control group. The use of autologous PRF or PRP were both effective in the treatment of furcation defects with uneventful healing of sites.

The relationship between radiographic and clinical parameters in periodontal maintenance in class II furcation defects

The goal of the present study was to investigate the relationship between probing and radiographic parameters, and the reliability of repeated longitudinal periodontal probing measurements for early diagnosis of periodontal breakdown in class II furcation defects. Eighteen class II furcation defects in lower molars were included in this study. Standardized radiographs and clinical measurements, relative vertical clinical attachment level (CAL-v) and probing depth (PD) were obtained immediately before periodontal surgeries and at 6, 12, 18, and 24 months after surgery. A total of 72 pairs of radiographs were subtracted following correction for contrast and planar geometric discrepancies, and the bone loss/gain (in mm) was measured. There was no statistically significant correlation between CAL-v and bone height (BH) measurements. A statistically significant correlation for PD reduction at 24 months and BH increase at 18 months was found (r = 0.5, p &lt; 0.05). These results suggest that clinical measurements and radiographic bone height reflect different features of periodontal destruction and periodontal healing, and repeated longitudinal measurements of vertical clinical attachment level are not reliable for early diagnosis of periodontal breakdown in class II furcation defects.