Significant Probing Depth Reduction Research Articles

Clinical and Patient‐Centered Outcomes After Minimally Invasive Non‐Surgical or Surgical Approaches for the Treatment of Intrabony Defects: A Randomized Clinical Trial

The present study aims to compare the performance of minimally invasive non-surgical and surgical approaches for the therapy of intrabony defects. Twenty-nine patients who presented with intrabony defects were randomly assigned to: 1) a minimally invasive non-surgical technique (MINST) group, or 2) minimally invasive surgical technique (MIST) group. The chair time of each therapeutic procedure was calculated. The probing depth (PD), position of the gingival margin (PGM) and relative clinical attachment level (RCAL) were evaluated at 3 and 6 months after treatments. The patient perception of discomfort/pain experienced during and after therapy and patient satisfaction regarding treatments were also evaluated. Significant PD reductions, RCAL gains, and no changes in the PGM were obtained at 3 and 6 months in MINST and MIST groups (P <0.05). No differences were observed between groups at any time points (P >0.05). Patient-oriented outcomes did not demonstrate differences between therapeutic approaches (P >0.05). Significant higher chair times were required in the MIST group than in the MINST group (P <0.05). Minimally invasive non-surgical and surgical approaches were successfully used for the treatment of intrabony defects and achieved periodontal health in association with negligible morbidity and suitable patient satisfaction. However, non-surgical therapeutic modality presented an advantage in terms of a reduction of treatment chair time.

Recombinant Human Bone Morphogenetic Protein‐2 for Peri‐Implant Bone Regeneration: A Case Report

Currently, clinicians have a limited treatment arsenal in the repair of peri-implant defects. The aim of the present report is to present the clinical results of treating a dental implant using recombinant human bone morphogenetic protein (rhBMP)-2 in an elderly patient. A 75-year-old man presented for routine dental prophylaxis. Clinical and radiographic examination revealed significant loss of attachment and bone loss around an implant replacing the maxillary left first molar. The patient did not report any symptoms, and the implant showed no signs of mobility. Because of the severity of the defect, regenerative treatment using a combination of rhBMP-2 and freeze-dried bone allograft was used. The patient was followed for 80 weeks postoperatively. By 28 weeks, significant probing depth reduction and radiographic bone fill was observed, and the original implant crown was replaced. From 28 weeks postoperatively to 80 weeks, no significant clinical or radiographic changes were observed. rhBMP-2 represents a potential therapeutic modality for severe peri-implant hard tissue loss. Future studies should examine parameters, such as surgical technique, to maximize the rhBMP-2-driven regenerative outcomes.

The Role of Enamel Matrix Derivative Protein in Minimally Invasive Surgery in Treating Intrabony Defects in Single‐Rooted Teeth: A Randomized Clinical Trial

This study investigates the impact of enamel matrix derivative (EMD) proteins on the outcome of a minimally invasive surgical technique (MIST) for the treatment of intrabony defects. Thirty patients who presented with intrabony defects were randomly assigned to treatment with: 1) MIST plus EMD or 2) MIST alone. Probing depth (PD), position of the gingival margin (PGM), and relative clinical attachment level (RCAL) were evaluated at 3 and 6 months after treatment. Radiographs and markers in gingival crevicular fluid associated with periodontal regeneration were also evaluated. Significant PD reductions, RCAL gains, and no changes in PGM were obtained at 3 and 6 months in both groups. Clinical and radiographic evaluations and levels of mediators of wound healing did not present differences between therapies at any time. The use of EMD did not provide superior benefits on the outcome of the minimally invasive surgical approach for the treatment of intrabony defects.

Effect of plasma rich in growth factors on the healing of intrabony defects in human: a comparative clinical trial

Background and aims. A combination of guided tissue regeneration (GTR), bovine porous bone mineral (BPBM), and platelet rich plasma has been already applied for the regeneration of intrabony defects. The aim of this study was to determine the role of plasma rich in growth factor (PRGF) alone in the periodontal regeneration of intrabony defects in humans as compared with BPBM/GTR Technique. Materials and methods. In this split-mouth clinical trial, nine advanced periodontal patients with 20 intrabony defects were randomly treated with a combination of either BPBM/GTR (control) or PRGF (test). Periodontal parameters including gingival recession, probing depth (PD), gingival index (GI), plaque index (PI), and relative clinical attachment level (CAL) were evaluated at baseline and 6 months post-operatively. Results. No difference was observed at baseline between the two groups. At 6-month post-treatment, both techniques demonstrated significant reduction in CAL, PD and GI. The mean pocket depth reduction in control group was 4.1 ± 1.52 mm and 4.5 ± 1.5 mm on buccal and lingual sites, respectively (P < 0.0001); and 3.6 ± 0.9 mm in the test group. The changes in CAL in the deepest part of the defect were 3.06 ± 1.79 mm and 2.33 ± 0.78 mm for test and control groups, respectively. No statistically significant difference was detected between the two groups after 6 months. Conclusion. According to the results, the use of PRGF alone, similar to BPBM/GTR improves clinical parameters and plays a significant role in PD reduction and CAL gain.

Evaluation of the relative efficacy of an alloplast used alone and in conjunction with an osteoclast inhibitor in the treatment of human periodontal infrabony defects: A clinical and radiological study

Mucoperiosteal flap surgery stimulates varying amounts of alveolar bone loss due to accelerated osteoclastic activity [Regional Accelerated Phenomenon (RAP)]. Alendronate sodium inhibits osteoclastic activity and is thought to result in a net increase in osteoblastic activity. We undertook a preliminary study evaluating the effect of adjunctive use of topically delivered bisphosphonate alendronate (ALN) along with regenerative bone graft material in the treatment of periodontal infrabony defects. Fifteen patients with two-walled or three-walled infrabony defects were selected. In each patient, the infrabony defect of one side of arch was designated as group A (control site) and received hydroxyapatite (HA) bone graft material, while the infrabony defect on the contralateral side of same arch was designated as group B (test site) and received HA+200 μg drug solution of ALN. Both the groups exhibited a highly significant reduction in probing depth and gain in clinical attachment level and linear bone fill at the end of 24 weeks. Comparative evaluation between the study groups revealed a statistically nonsignificant reduction in probing depth (P=0.128NS) and mean gain in attachment level (P=0.218NS). However, there was a statistically significant gain in linear bone fill (P=0.040*) in group B as compared to group A. The results suggest that use of ALN along with graft material led to enhanced linear bone fill at the surgical site. This research provides a clue that bone-targeting properties of bisphosphonates can be harnessed along with regenerative materials to potentiate osseous regeneration.

Clinical evaluation of guided tissue regeneration combined with autogenous bone or autogenous bone mixed with bioactive glass in intrabony defects

Conflicting data exist on the combined use of grafting materials and barrier membranes in comparison to guided tissue regeneration (GTR) with membrane alone. The aim of the present study was to compare the clinical outcomes of GTR with collagen membrane (CM) alone (control group) or CM combined with autogenous bone graft (test group 1) or autogenous bone mixed with bioactive glass (test group 2) in intrabony defects. A total of 32 intraosseous defects in 22 subjects were treated randomly. After 6 months, significant probing depth reduction, clinical attachment level gain (CAL) and defect resolution were observed in all groups with significantly greater improvements in the test groups. There was no significant difference between the two test groups in any parameter. Results of the present study suggest that autogenous bone can be mixed with bioactive glass if the amount of the harvested bone is not sufficient.

Comparative evaluation of bovine porous bone mineral

Background:The aim of the present clinical study was to compare the efficacy of bovine porous bone mineral (BPBM) with and without platelet-rich plasma (PRP) for the treatment of periodontal intrabony defects.Materials and Methods:Twenty eight identical bilateral periodontal intrabony defects were selected from 14 chronic periodontitis patients. The subjects were randomly assigned to test group (BPBM+PRP) or the control group (BPBM). The clinical, radiographic, and intrasurgical (re-entry) measurements were made at baseline and at 9 months postoperatively.Results:Both treatment modalities resulted in significant reduction in probing depth and gain in clinical attachment level as compared to baseline values. The probing depth reduction was 6.20±1.40 mm in BPBM and 6.60±1.43 mm for the BPBM/PRP-treated sites. The gain in clinical attachment level observed was 4.16±1.05 mm for BPBM and 4.70±0.76 mm for the BPBM/PRP group. Radiographically, there was a significant defect fill (3.83±1.01 mm) for the BPBM group and (4.04±1.77 mm) in the BPBM/PRP group. Similar trend was observed between the two groups in relation to intrasurgical parameters.Conclusions:The combination therapy (BPBM+PRP) showed more favorable clinical outcome in the treatment of intrabony defects than the BPBM alone group, although the mean difference between the two groups was statistically nonsignificant.

Flapless Technique for Periodontal Bone Grafts in Treatment of Severe Periodontitis. Presentation and Long-Term Retrospective Study

The goal of this study was to retrospectively evaluate the clinical outcomes of the Flapless technique in treatment of severe periodontitis after three year. A non-aggressive technique for periodontal bone grafts was developed and tested on 19 subjects. The technique involved scaling and root planing, and the insertion of single grains of bone mineral through the crevicular space into the pocket until it’s completely fi lled. All patients received monthly periodontal maintenance therapy for six months and then every three months for 2.5 years. Clinical parameters were assessed at baseline and after three years; these included probing depth (PD), clinical attachment level (CAL), and gingival recession (GR); the presence of bone defects was determined radiographically. The signifi cance of the data was confi rmed statistically. There was signifi cant reduction in PD (4.9mm, P<0.005) and CAL gain (3.73mm, P<0.005), and a slight increase of in GR (1.16mm, P<0.005). After six months, it led to radiographic resolution of osseous lesions. Flapless Technique resulted in clinically relevant amounts of CAL gains, shallow pockets, minimal gingival recession, and radiographic osseous defect fi ll. This minimally invasive approach offers an effi cient, safe and well-tolerated alternative for the longterm treatment of severe periodontitis in interproximal pockets of single-rooted teeth.

Clinical Evaluation of a Biphasic Calcium Composite Grafting Material in the Treatment of Human Periodontal Intrabony Defects: A 12‐Month Randomized Controlled Clinical Trial

The aim of this study was to compare the clinical outcome of a novel biphasic calcium composite (BCC) biomaterial versus autogenous bone spongiosa (ABS) or open flap debridement (OFD) for the treatment of intrabony periodontal defects. Forty-five subjects with at least one intrabony defect with a probing depth (PD) >or=7 mm and a vertical radiographic bone loss >or=3 mm were enrolled in the study. Subjects were randomly assigned to treatment with BCC (n = 15), ABS (n = 15), or OFD (n = 15). Clinical parameters were recorded at baseline and 12 months after surgery and included the plaque index, gingival index, PD, clinical attachment level (CAL), and gingival recession. In all treatment groups, significant PD reductions and CAL gains occurred during the study period (P <0.0001). At 12 months, patients treated with BCC exhibited a mean PD reduction of 3.6 +/- 0.7 mm and a mean CAL gain of 3.0 +/- 0.8 mm compared to baseline. Corresponding values for patients treated with ABS were 3.4 +/- 0.8 mm and 2.9 +/- 0.9 mm, whereas OFD sites produced values of 2.8 +/- 0.8 mm and 1.6 +/- 0.7 mm. Compared to OFD, the additional CAL gain was significantly greater in patients treated with BCC (P = 0.002) and ABS (P = 0.001). The additional PD reduction was significant for the BCC group (P = 0.011) and borderline significant for the ABS group (P = 0.059). There were no significant differences of PD and CAL changes between BCC and ABS groups. The clinical benefits of BCC were equivalent to ABS and superior to OFD alone. BCC may be an appropriate alternative to conventional graft materials.

Effect of Platelet‐Rich Plasma on the Healing of Intrabony Defects Treated With an Anorganic Bovine Bone Mineral: A Pilot Study

Periodontal therapy using the combination of platelet-rich plasma (PRP) and different grafting materials has been suggested as a modality to enhance the outcome of regenerative surgery. In most clinical studies, a barrier membrane was used to cover the defects, and thus, the effects of PRP may have been masked by the effects of the barrier. The data from controlled clinical studies evaluating the effect of regenerative therapy using various grafting materials with or without PRP are still limited. The purpose of this study was to clinically compare the healing of intrabony defects treated with either a combination of an anorganic bovine bone mineral (ABBM) and PRP to those obtained with ABBM alone. Thirty patients with advanced chronic periodontal disease and displaying one intrabony defect were randomly treated with PRP + ABBM or ABBM alone. The following clinical parameters were evaluated at baseline and 1 year after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL. No statistical significant differences in any of the investigated parameters between the two groups were observed at baseline. Healing was uneventful in all patients. In the PRP + ABBM group, mean PD decreased from 8.6 +/- 1.8 mm to 3.4 +/- 1.4 mm (P <0.001) and mean CAL changed from 9.9 +/- 1.7 mm to 5.3 +/- 1.8 mm (P <0.001). In the ABBM group, mean PD decreased from 8.5 +/- 2.0 mm to 3.2 +/- 1.3 mm (P <0.001) and mean CAL changed from 9.6 +/- 1.9 mm to 4.9 +/- 1.5 mm (P <0.001). CAL gains >or=3 mm were measured in 80% (12 of 15 defects) of cases treated with PRP + ABBM and in 87% (13 of 15 defects) of cases treated with ABBM alone. No statistically significant differences in any of the investigated parameters were observed between the two groups at the 1-year reevaluation. Within the limits of the present study, it can be concluded that 1) at 1 year after regenerative surgery with PRP + ABBM and ABBM alone, significant PD reductions and CAL gains were found, and 2) the use of PRP failed to improve the results obtained with ABBM alone.

Non‐Surgical Periodontal Therapy Lowers Serum Inflammatory Markers: A Pilot Study

Evidence suggests an association between periodontal disease and coronary heart disease (CHD). C-reactive protein (CRP), fibrinogen, and white blood cell (WBC) counts are markers of inflammation, and their systemic levels have been associated with CHD risk. This pilot study investigated the effect of non-surgical periodontal therapy on systemic levels of CRP, fibrinogen, and WBC counts in subjects with CHD or no CHD (NCHD). Twenty-seven angiographically defined patients with CHD and 18 subjects with NCHD aged >or=40 years were recruited for the study. Periodontal disease was measured through the clinical parameters bleeding on probing (BOP) and probing depth (PD). All subjects received non-surgical periodontal therapy that included oral hygiene instructions and subgingival scaling and root planing. Systemic levels of inflammatory markers (CRP, fibrinogen, and WBC counts) were measured prior to and 1 month after periodontal therapy. Seventeen subjects with CHD and 11 subjects with NCHD completed the study. Subjects with CHD or NCHD experienced significant reductions in BOP (59% and 34%, respectively; P <0.05) and PD (41% and 35%, respectively; P <0.05), with non-significant intergroup differences (P >0.05). In all subjects, CRP, fibrinogen, and WBC counts were reduced significantly (21% to 40%) after periodontal therapy (P <0.05). Periodontal treatment resulted in significant decreases in BOP and PD and lowered serum inflammatory markers in patients with CHD or NCHD. This may result in a decreased risk for CHD in the treated patients. These findings will allow pursuit of a large-scale randomized intervention trial in this population.

An evaluation of bovine derived xenograft with and without a bioabsorbable collagen membrane in the treatment of mandibular Class II furcation defects

The aim of this study was to compare the clinical outcomes of applying Bio-Oss, an anorganic bovine bone xenograft (control group) to the combined use of Bio-Oss and Bio-Gide (a bioabsorbable collagen membrane) (test group) in human mandibular Class II furcation defects. A total of 18 furcations (8 tests and 10 controls) in 14 patients suffering from chronic periodontitis were treated in this randomized clinical trial. Open vertical and horizontal furcation depths (OVFD and OHFD), vertical and horizontal clinical attachment levels (VCAL, HCAL), probing depth (PD) and free gingival marginal level (GML) were among the clinical parameters measured prior and six months after treatment, at re-entry surgery. The data were analysed by statistical tests while a p value less than 0.05 was considered significant. At the surgical re-entry, the mean reduction for OVFD of the control and test groups was 1.9 +/- 1.3 and 2.1 +/- 1.0, and for OHFD 2.1 +/- 0.7 and 2.4 +/- 1.3, respectively. The control and test treatments resulted in significant reductions in PD, VCAL and HCAL measurements at re-entry but there was no statistically significant difference between the two treatments in all soft and hard tissues measurements. This clinical trial failed to demonstrate the superiority of the combined use of Bio-Gide and Bio-Oss to the use of Bio-Oss alone, although both therapies resulted in significant gains in attachment level and bone fill.

Guided Tissue Regeneration–Based Root Coverage With a Platelet Concentrate Graft: A 3‐Year Follow‐Up Case Series

A platelet concentrate graft (PCG) was applied underneath the barrier membrane in guided tissue regeneration (GTR)-based root coverage procedures. The purpose of this case study was to assess the effectiveness of the technique and the long-term outcomes. Thirty-seven Miller Class I or II recession defects in six patients were treated using the PCG and a collagen membrane covered by an advanced mucogingival flap. Clinical parameters, such as vertical gingival recession depth (VRD), clinical attachment level (CAL), probing depth (PD), and width of keratinized tissue (WKT), were recorded presurgery (at baseline [BL]) and at 6 and 36 months of follow-up. The Wilcoxon signed-rank test and the Mann-Whitney test were used to assess statistical significance (alpha = 0.05). Between BL and 6 months, there was a statistically significant reduction in VRD (from 2.81 +/- 0.88 mm to 0.30 +/- 0.48 mm) and PD (from 2.59 +/- 0.50 mm to 1.14 +/- 0.35 mm), as well as an improvement in CAL (from 5.41 +/- 0.86 mm to 1.43 +/- 0.66 mm). These results remained stable over the following 30 months. There was no statistically significant change in WKT during the initial 6 months; however, the increase in WKT was statistically significant at the 36-month follow-up. When comparing the healing between the maxillary and mandibular teeth at 6 months, the VRD reduction was statistically significantly greater in the maxillary teeth, but the difference was not statistically significant 30 months later. The average root coverage at 6 and 36 months was 89.86% +/- 15.85% and 85.86% +/- 18.16%, respectively, with complete root coverage in 24 (64.86%) and 21 (56.76%) of the 37 teeth. The GTR-based technique using PCG was effective in reducing gingival recession. The outcomes remained stable for 3 years.

Prevention of Mandibular Third Molar Extraction‐Associated Periodontal Defects: A Comparative Study

Extraction of deep-impacted mandibular third molars may lead to periodontal defects at the distal surface of the adjacent second molar. The purpose of this study was to compare the ability of three regenerative approaches to prevent third molar extraction-related periodontal defects. Forty-five patients with bilateral osseous or soft tissue-impacted lower third molars were selected to participate in the study. Inclusion criteria were the presence of a pocket that was located distally to the mandibular second molar with a probing depth (PD) >or=7 mm and with a probing clinical attachment level (CAL) >or=6 mm. Ninety third molar impactions were used and were randomly assigned to three equal treatment groups (30 each): bovine porous bone mineral (BPBM) alone, BPBM plus collagen membrane (CM), and an untreated control group. Clinical and radiographic measurements were recorded at 3, 6, 9, 12, 18, 24, 36, 48, 60, and 72 months after the surgery. BPBM or BPBM + CM resulted in a significant reduction in PD and gain in CAL compared to the control group at all time points. BPBM + CM had the best outcome for the prevention of a second-molar periodontal defect. The application of BPBM, with or without a collagen membrane, can be a viable and stable treatment to alleviate the periodontal defects that are often associated with impacted mandibular third molar extractions.

Enamel Matrix Derivative Versus Bioactive Ceramic Filler in the Treatment of Intrabony Defects: 12‐Month Results

This study examined the clinical efficacy of enamel matrix derivative (EMD) and bioactive ceramic filler (BCF) in the treatment of intrabony periodontal defects and evaluated factors influencing the treatment outcome. Thirteen chronic periodontitis patients, 41 to 74 years of age, who had two proximal intrabony defects in different jaw quadrants with > or =3 mm vertical radiographic bone loss were selected for this study. After initial therapy, the sites in each patient were randomly assigned to EMD or BCF treatment. Clinical attachment level (CAL), probing depth (PD), tooth mobility (TM), gingival recession (GR), bleeding on probing, and dental plaque were recorded at baseline and at 6 and 12 months. At surgery, the intrabony component was characterized by recording the number of bony walls, distance in millimeters from the buccal crest (BC) to the most apical point of the defect, distance from the cemento-enamel junction (CEJ) to the BC, and the mesio-distal width of the defect at the level of the bony crest. BCF treatment resulted in a significant gain in proximal CAL (P = 0.005) and a reduction in proximal PD at 6 months (P <0.001), but there was no further improvement from 6 to 12 months. Paired comparisons by time for the EMD group revealed a significant reduction in proximal PD at 12 months (P = 0.001), whereas the gain in proximal CAL approached significance (P = 0.056). Mean GR increased significantly from baseline to 6 months in both groups (P = 0.001). Regression analysis revealed that within the EMD group, smoking and TM negatively influenced the gain of attachment, whereas within the BCF group, gingival recession increased with age, increasing CEJ to BC distance, and increasing mesial-distal width of the defect. The gain in proximal attachment after treating intrabony defects by flap surgery with BCF was significant (P = 0.004) and twice that following treatment with EMD (P = 0.056). Patient and site variables affected the clinical outcome differently.

Moxifloxacin as an Adjunctive Antibiotic in the Treatment of Severe Chronic Periodontitis

The impact of moxifloxacin (MOX) was analyzed in the treatment of severe chronic periodontitis. In a randomized, prospective, clinical multicenter trial, 92 subjects with severe chronic periodontitis were treated with scaling and root planing (SRP) alone (control group; n = 21), SRP plus adjunctive doxycycline (DOX group; n = 36), or SRP plus adjunctive MOX (MOX group; n = 35). Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded at baseline and at 3, 6, and 12 months after non-surgical periodontal treatment. The load of periodontopathogens, the level of interleukin-8, and the activities of granulocyte elastase and myeloperoxidase were also measured. All three procedures led to significant reductions in PD, CAL, and BOP. PD reduction was significantly greater (P <0.05) in the MOX group (2.46 +/- 1.17 mm at 6 months and 2.84 +/- 1.53 mm at 12 months) compared to the DOX group (1.85 +/- 1.24 mm and 2.19 +/- 1.13 mm at 6 and 12 months, respectively) and the controls (1.77 +/- 0.57 mm and 1.86 +/- 0.56 mm at 6 and 12 months, respectively). Only in the MOX group was the load of all investigated bacteria and all inflammatory parameters reduced at each appointment compared to baseline. The adjunctive application of antibiotics improved the treatment outcome in subjects with severe chronic periodontitis. MOX seemed to be more effective than DOX and might be an alternative drug in the treatment of periodontal diseases.

The Effects of a Calorie‐Reduced Diet on Periodontal Inflammation and Disease in a Non‐Human Primate Model

Low-calorie diets are commonplace for reducing body weight. However, no information is available on the effects of a reduced-calorie diet on periodontal inflammation and disease. The purpose of this study was to evaluate the clinical effects of a long-term calorie-restriction (CR) diet on periodontitis in an animal model of periodontitis. Periodontitis was induced in 55 young, healthy, adult rhesus monkeys (Macaca mulatta) by tying 2.0 silk ligatures at the gingival margins of maxillary premolar/molar teeth. Animals on a CR diet (30% CR; N = 23) were compared to ad libitum diet controls (N = 32). Clinical measures, including the plaque index (PI), probing depth (PD), clinical attachment level (CAL), modified gingival index (GI), and bleeding on probing (BOP) were recorded at baseline and 1, 2, and 3 months after ligature placement. Significant effects of CR were observed on the development of inflammation and the progression of periodontal destruction in this model. Compared to controls, CR resulted in a significant reduction in ligature-induced GI (P <0.0001), BOP (P <0.0015), PD (P <0.0016), and CAL (P <0.0038). Periodontal destruction, as measured by CAL, progressed significantly more slowly in the CR animals than in the controls (P <0.001). These clinical findings are consistent with available evidence that CR has anti-inflammatory effects. Moreover, these experimental findings are the first observations, to the best of our knowledge, that CR dampens the inflammatory response and reduces active periodontal breakdown associated with an acute microbial challenge.

Effect of Platelet‐Rich Plasma on the Healing of Intrabony Defects Treated With Beta Tricalcium Phosphate and Expanded Polytetrafluoroethylene Membranes

Regenerative periodontal therapy using platelet-rich plasma (PRP) and different types of bone substitutes with or without guided tissue regeneration (GTR) has been proposed as a modality to enhance the outcome of regenerative surgery. However, there are limited data from controlled clinical studies evaluating the effect of PRP on the healing of deep intrabony defects treated with a combination of bone substitutes and GTR. The aim of this study was to clinically evaluate the effect of PRP on the healing of deep intrabony defects treated with beta tricalcium phosphate (beta-TCP) and GTR by means of a non-bioresorbable expanded polytetrafluoroethylene membrane. Twenty-eight subjects with advanced chronic periodontal disease and displaying one intrabony defect were treated randomly with a combination of PRP + beta-TCP + GTR or beta-TCP + GTR. Plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL) were evaluated at baseline and at 1 year after treatment. CAL was the primary outcome variable. No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all subjects. At 1 year after therapy, the sites treated with PRP + beta-TCP + GTR showed a reduction in mean PD from 9.1 +/- 0.6 mm to 3.3 +/- 0.5 mm (P <0.001) and a change in mean CAL from 10.1 +/- 1.3 mm to 5.7 +/- 1.1 mm (P <0.001). In the group treated with beta-TCP + GTR, mean PD was reduced from 9.0 +/- 0.8 mm to 3.6 +/- 0.9 mm (P <0.001), and the mean CAL changed from 9.9 +/- 1.0 mm to 5.9 +/- 1.2 mm (P <0.001). In both groups, all sites gained > or =3 mm of CAL. CAL gains > or =4 mm were noted in 86% (12 of 14 defects) of the cases treated with PRP + beta-TCP + GTR and in 79% (11 of 14 defects) of those treated with beta-TCP + GTR. No statistically significant differences in any of the investigated parameters were observed between the two groups at the 1-year reevaluation. At 1 year after surgery, both therapies resulted in significant PD reductions and CAL gains.

Evaluation of the regenerative potential of 25% doxycycline-loaded biodegradable membrane vs biodegradable membrane alone in the treatment of human periodontal infrabony defects: A clinical and radiological study

Microbial colonization of the barrier membranes used for guided tissue regeneration is inevitable and can lead to delayed healing. Antimicrobial coating of the membrane with 25% doxycycline paste has been attempted to prevent infection and achieve enhanced regeneration in periodontal infrabony defects. Twenty-four patients with 2-walled or 3-walled infrabony defects were selected and randomly divided into two equal groups. Infrabony defects of group A were treated with a biodegradable membrane coated with 25% doxycycline while those of group B were treated with membrane alone. Clinical assessment of probing depth and attachment level and radiographic evaluation of the defect depth was done preoperatively and at 12 and 24 weeks postoperatively. The relative efficacy of the two treatment modalities were evaluated using the paired Student's t- test and the comparative evaluation between the two groups was done using the independent Student's t -test. Both the groups exhibited a highly significant reduction in probing depth and gain in clinical attachment level and linear bone fill at the end of 24 weeks. Comparative evaluation between the two study groups revealed a significant reduction in probing depth ( P = 0.016 FNx01 ) and linear bone fill ( P = 0.02 FNx01 ) in group A as compared to group B. Mean gain in attachment level was greater for group A than for group B but the difference was statistically nonsignificant ( P = 0.065 NS ). The results suggest that doxycycline is beneficial in reducing membrane-associated infection and can potentiate regeneration through host modulation.

Comparison of Injectable Calcium Phosphate Bone Cement Grafting and Open Flap Debridement in Periodontal Intrabony Defects: A Randomized Clinical Trial

Regeneration of lost periodontium is the ultimate goal of periodontal therapy. Bone grafts, guided tissue regeneration, and application of growth factors are used for periodontal regeneration. This study aimed to evaluate the clinical efficacy of a new, injectable calcium phosphate bone cement (CPC) in human periodontal intrabony defects. Thirty subjects (mean age, 53.4 +/- 9.1 years) with periodontitis and narrow intrabony defects were enrolled in the study. Subjects were classified randomly into the CPC graft group (N = 15) or the open flap debridement (OFD) alone group (N = 15). Clinical measurements were performed at baseline and at 3, 6, 9, and 12 months; radiographs were taken at baseline, 2 weeks, and 6 and 12 months after surgery. The Student t test was used for statistical analysis. In the CPC group, six cases showed exposure or loss of the CPC within 12 months, whereas the remaining nine cases (CPC-R group) showed no adverse reaction, including infection or suppuration. Overall, CPC-R and OFD treatment groups exhibited a significant reduction in probing depth and a significant gain in clinical attachment level at 3, 6, 9, and 12 months compared to baseline values. However, there were no significant differences in any of the clinical parameters between the groups. In the CPC-R group, radiographic bone level gain appeared to be greater than in the OFD group. The present study failed to demonstrate any superior clinical outcomes for the CPC group compared to the OFD group; however, radiographs revealed more favorable results in the CPC-R group. The filling volume and stiffness of CPC may compromise the clinical outcomes for periodontal intrabony defects.