Treatment Of Periodontal Infrabony Defects Research Articles

Effectiveness of platelet rich fibrin alone or in combination with bone grafts in the treatment of infrabony defects: Systematic review and metanalysis

This systematic review aimed to investigate the effectiveness of PRF alone or in combination with bone grafts in enhancement of tissue/bone formation in infrabony defects. A search was performed in electronic databases (i.e. Pubmed/MEDLINE, EMBASE, Cochrane, Clinical trials.org) in order to identify Randomized Control Trials (RCTs). The last electronic search was run on 24 August 2021 From the search, 21 articles fulfilled the inclusion criteria and were quantitatively analyzed. In total, there were 13 articles with low risk of bias, 4 with some concerns and 4 with high risk. The meta-analysis showed that there was a statistically significant benefit from the use of PRF alone or in combination with bone graft after 6 months follow up in clinical attachment level (CAL), periodontal probing depth (PPD) and bone fill (BF). However, there was not a significant difference in CAL and PPD after 9 months In summary the use of PRF was effective in the treatment of periodontal infrabony defects especially in CAL and BF after 6 months follow up. From the interpretation of the results, we indicate that the combination of PRF with grafting materials may accelerate the bone healing process in the treatment of intrabony defects.

Comparative Evaluation of Injectable Platelet Rich Fibrin (I-PRF) with DFDBA and Titatium Prepared Platelet Rich Fibrin (T-PRF) with DFDBA In The Treatment of Infrabony Defects In Chronic Periodontitis Patients - A Clinico-Radiographical Study

Objectives: The main objective of this study was to evaluate the efficacy of Titanium prepared platelet-rich Fibrin (T-PRF) and Injectable Platelet Rich Fibrin (I-PRF) with demineralized freeze-dried bone allograft (DFDBA) in order to improve the clinical and radiographic results obtained in treatment of periodontal infrabony defects.
 Materials and Methods: This split-mouth randomized controlled clinical trial was conducted on 30 subjects with two comparable bilateral infrabony defects. Plaque Index(PI), Gingival Index(GI) Clinical attachment level (CAL), Periodontal Pocket depth (PD), as well as radiographic parameters IOPA including the radiographic defect size, were measured at six months post-operatively.
 Results: The mean reductions in PD and CAL were 4.0±0.77 mm and 2.5±0.68 mm in sites treated with I-PRF+DFDBA, respectively (P<0.05); these reductions were 4.2±0.86 mm and 3.1±0.62 mm, respectively in T-PRF+DFDBA group (P<0.05). Radiographic evaluation revealed reduction in the radiographic defect size in the I-PRF+DFDBA and T-PRF+DFDBA sites. Statistically, there were no significant differences between the two treatment modalities.?
 Conclusion: This study showed that both treatments resulted in significant improvement in the probing depth reduction, clinical attachment level gain and radiographic size of the infrabony defect at six months after surgery. I-PRF with DFDBA membrane in treatment of infrabony osseous defect showed more defect fill followed by T- PRF along with DFDBA membrane.

Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis.

A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects. A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration. A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p<0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p<0.01) and radiographic bone fill/gain (p<0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor. Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.

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.

Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta-analysis.

To assess the effectiveness, in terms of clinical performance and patient perception, of minimally invasive periodontal surgeries (MIPSs), and to compare MIPSs to traditional surgery in the treatment of periodontal infrabony defects. An electronic search and a manual search were carried out to identify studies investigating clinical (CAL, PPD, REC), radiographic (bone fill) and patient's centred (VAS) outcomes at least 6months after MIPSs. A linear mixed-effect model was used for meta-analysis. Subgroup analyses were performed according to the study quality (RCT or case series). A meta-analysis assessing differences in clinical parameters between MIPSs and traditional flaps was also performed. Meta-analysis from the 18 included studies revealed a PPD reduction of 4.24mm (95% CI=3.79-4.69mm), a CAL gain of 3.89mm (95% CI=3.42-4.35mm), a REC increase of 0.44mm (95% CI=0.11-0.77mm), a radiographic bone fill gain of 58.25% (95% CI=42.30%-74.21%) and a VAS value of 1.16 (95% CI=0.78-1.54). Based on 2 RCTs, MIPSs are more effective than traditional surgery for PPD reduction (0.93mm, 95% CI=1.71-0.15) and CAL gain (1mm, 95% CI=1.75-.24). Minimally invasive periodontal surgeries may be considered for the treatment of periodontal infrabony defects. However, the real effect cannot be systematically evaluated due to the paucity of studies comparing MIPSs to traditional flap for periodontal reconstructive surgery.

WITHDRAWN: Guided tissue regeneration for periodontal infra-bony defects.

WITHDRAWN: Guided tissue regeneration for periodontal infra-bony defects.

A Comparative Study of The Effect of Demineralized Bone Matrix with and Without Low Level Laser Therapy on The Treatment of Periodontal Infra-Bony Defects (Randomized Clinical Trial)

Objective: This study aimed at comparing clinically and radiographically the therapeutic effect of low level laser therapy and demineralized bone matrix, used in management of periodontal intrabony defect. Subjects and methods: Thirty two non-smoking patients aged between 28-51 years with severe chronic periodontitis participated in this randomized clinical study. Patients were randomly assigned into one of 2 groups (16 patients each): demineralized bone grafting alone of the intrabony defect, control group (Group I), demineralized bone grafting and the application of low level laser therapy (LLLT) (Group II). Clinical and radiographic parameters including plaque index, bleeding index, probing depth, clinical attachment level (CAL) and intrabony defect depth were reassessed at 6 months after surgery. Results: Specifically, LLLT treated sites (Group II) showed statistically significant differences regarding pocket depth and CAL compared with Group I. Intrabony defect depth was significantly reduced for LLLT group compared to that of Group I control. Conclusion: The use of LLLT as an adjunct with demineralized bone matrix (DBM) in the treatment of intrabony defects was more significant in improving the probing depth, CAL and intrabony defect depth than using DBM alone.

O061: Biphasic calcium sulphate and xenograft combination in a minimally invasive treatment of periodontal infrabony defects – A randomized clinical trial

O061: Biphasic calcium sulphate and xenograft combination in a minimally invasive treatment of periodontal infrabony defects – A randomized clinical trial

Regenerative potential of subepithelial connective tissue graft in the treatment of periodontal infrabony defects.

Background:Due to high prevalence and progression of infrabony defects lead to increase in the possibility of tooth loss. Various regenerative techniques such as guided tissue regeneration, bone grafts, and biomimetic agents have been proposed. Subepithelial connective tissue graft (SCTG) is an autogenous membrane, which contains mesenchymal cells and has osteogenic, chondrogenic, and osteoblastic activities. The present study investigates the effective application of SCTG as an autogenous barrier membrane in the treatment of periodontal infrabony defect.Materials and Methods:Ten patients in the age group of 30–45 years suffering from chronic periodontitis with clinical and radiographic evidence of vertical defects were selected for the study. Clinical parameters evaluated were gingival index, plaque index, probing pocket depth, clinical attachment level, and gingival recession. These parameters were assessed at baseline, 6 and 9 months. Radiographic parameter (defect fill) was evaluated at baseline, 6, and 9 months postoperatively. Sites were treated with PERIOGLAS® and connective tissue graft. Statistical analysis was done using paired t-test.Results:All the patients finished the study. A significant improvement was observed regarding clinical parameters from baseline to 9 months. The radiographic defect fill was seen in all the cases at the end of 9 months, which was statistically significant in comparison with baseline scores.Conclusion:SCTG could be effectively used as a barrier membrane for the treatment of periodontal infrabony defects.

CLINICAL AND RADIOGRAPHIC EVALUATION OF DEMINERALIZED FREEZE-DRIED BONE ALLOGRAFT PLUS HYALOURONIC ACID VERSUS DEMINERALIZED FREEZE-DRIED BONE ALLOGRAFT PLUS PLATELET-RICH PLASMA FOR THE TREATMENT OF PERIODONTAL INTRABONY DEFECTS – A RANDOMIZED BLIND STUDY

Objectives: The present study aimed to evaluate the effect of ; 1- combined demineralized freez dried bone allograft( DFDBA)plus hyaluronic acid(HA) compared to DFDBA alone, and 2) combined DFDBA/HA compared to DFDBA /PRP in treatment of periodontal infrabony defects(PIDs). Subjects and methods:45 infrabony defects in subjects with chronic periodontitis were randomly divided into 3 groups treated with, group 1: DFDBA/HA, group 2: DFDBA/PRP and group 3: DFDBA alone. Clinical and radiographic measurements were made at baseline and 12 months after surgery. ANOVA followed by Tukey’s post hoc test were used to analyze the data. Results: A statistically significant improvement in clinical attachment level( Cal) and pocket depth ( PD) as well as radiographic bone fill were reported in group 1 and 2 compared to DFDBA alone( p ≤ 0.05), a non significant difference was reported between group 1 and group 2 regarding clinical and radiographic parameters(p > 0.05).Conclusion : Results of the present investigation suggests that the combination of DFDBA/HA is more effective both clinically and radiographically than DFDBA alone in treatment of PIDs and that both HA and PRP combined with DFDBA are equally effective in treatment of these defects.

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.

Combination of bone allograft, barrier membrane and doxycycline in the treatment of infrabony periodontal defects: A comparative trial.

AimThe purpose of the present study was to compare the regenerative potential of noncontained periodontal infrabony defects treated with decalcified freeze-dried bone allograft (DFDBA) and barrier membrane with or without local doxycycline.MethodsThis study included 48 one- or two-wall infrabony defects from 24 patients (age: 30–65 years) seeking treatment for chronic periodontitis. Defects were randomly divided into two groups and were treated with a combination of DFDBA and barrier membrane, either alone (combined treatment group) or with local doxycycline (combined treatment + doxycycline group). At baseline (before surgery) and 3 and 6 months after surgery, the pocket probing depth (PPD), clinical attachment level (CAL), radiological bone fill (RBF), and alveolar height reduction (AHR) were recorded. Analysis of variance and the Newman–Keuls post hoc test were used for statistical analysis. A two-tailed p-value of less than 0.05 was considered to be statistically significant.ResultsIn the combined treatment group, the PPD reduction was 2.00 ± 0.38 mm (32%), CAL gain was 1.25 ± 0.31 mm (17.9%), and RBF was 0.75 ± 0.31 mm (20.7%) after 6 months. In the combined treatment + doxycycline group, these values were 2.75 ± 0.37 mm (44%), 1.5 ± 0.27 mm (21.1%), and 1.13 ± 0.23 mm (28.1%), respectively. AHR values for the groups without and with doxycycline were 12.5% and 9.4%, respectively.ConclusionThere was no significant difference in the regeneration of noncontained periodontal infrabony defects between groups treated with DFDBA and barrier membrane with or without doxycycline.

Platelet rich fibrin combined with decalcified freeze-dried bone allograft for the treatment of human intrabony periodontal defects: a randomized split mouth clinical trail

Objective. Polypeptide growth factors of platelet rich fibrin (PRF) have the potential to regenerate periodontal tissues. Osteoinductive property of demineralized freeze-dried bone allograft (DFDBA) has been successfully utilized in periodontal regeneration. The aim of the present randomized, split mouth, clinical trial was to determine the additive effects of PRF with a DFDBA in the treatment of human intrabony periodontal defects. Materials and methods. Sixty interproximal infrabony defects in 30 healthy, non-smoker patients diagnosed with chronic periodontitis were randomly assigned to PRF/DFDBA group or the DFDBA/saline. Clinical [pocket depth (PD), clinical attachment level (CAL) and gingival recession (REC)] and radiographic (bone fill, defect resolution and alveolar crest resorption) measurements were made at baseline and at a 12-month evaluation. Results. Compared with baseline, 12-month results indicated that both treatment modalities resulted in significant changes in all clinical and radiographic parameters. However, the PRP/DFDBA group exhibited statistically significantly greater changes compared with the DFDBA/saline group in PD (4.15 ± 0.84 vs 3.60 ± 0.51 mm), CAL (3.73 ± 0.74 vs 2.61 ± 0.68 mm), REC (0.47 ± 0.56 vs 1.00 ± 0.61 mm), bone fill (3.50 ± 0.67 vs 2.49 ± 0.64 mm) and defect resolution (3.73 ± 0.63 vs 2.75 ± 0.57 mm). Conclusion. Observations indicate that a combination of PRF and DFDBA is more effective than DFDBA with saline for the treatment of infrabony periodontal defects.

The use of nanocrystalline and two other forms of calcium sulfate in the treatment of infrabony defects: A clinical and radiographic study.

Background:Calcium sulphate(CS) is one of the oldest alloplastic graft materials used because of its biocompatibility, handling characteristics, porosity, different rates of dissolution, chemico-physical resemblance to bone mineral, ability to induce release of growth factors and potentially unlimited supply at a modest cost. Aim of the study was to evaluate the efficacy of 3 forms of calcium sulphate i.e. Nanogen (nCS)(+), BoneGen(+) and Dentogen(+) in treatment of infrabony defects and to compare their efficacy as bone grafting substitutes.Materials and Methods:A prospective randomized, double blind controlled study was conducted on 45 sites from 16 subjects having Moderate to Advanced Periodontitis who were divided into 3 groups i.e. Group I (Nanogen), Group II (Dentogen) and Group III (BoneGen) clinical along with radiographic measurements were taken at baseline, 6 and 12 months postoperatively.Results:There was no significant inter-group difference in mean clinical attachment level (CAL) values at different time intervals whereas Intra-group changes in CAL at 6 and 12 months as compared to baseline were significant statistically. In Group I, changes in CAL between 6 and 12 months were found to be statistically significant in comparison with Group II and III.Conclusion:Both Nanogen and BoneGen TR can be considered valuable options in the treatment of infra-bony periodontal defects. The faster degradation of Dentogen may negatively affect its bone regeneration potential.

Evaluation of OSSIFI® as Alloplastic Bone Graft Material in Treatment of Periodontal Infrabony Defects.

The shift in therapeutic concepts from resection to regeneration has significantly impacted the practice of periodontology. Human studies have revealed that hydroxyapatite bone cement holds great promise as a grafting alloplastic material. To evaluate the efficacy of OSSIFI(®) (combined beta tricalcium phosphate plus hydroxyapatite) in the treatment of periodontal infrabony defects. Ten study subjects were selected and divided into two groups. Group I (PD>7mm) and Group II (PD≤ 7mm). Both Groups I and II were treated by regenerative periodontal surgery using OSSIFI(®) as graft material. Plaque index, gingival index, pocket depth, clinical attachment levels were recorded clinically and bone fill, radiographically, at baseline, three months and six months. Statistically significant reduction in pocket depth, plaque index, gingival index was seen after six months. There was significant bone fill seen from 3-6months with significant gain in clinical attachment levels.

Histological evaluation of a biomimetic material in bone regeneration after one year from graft

The use of substitute materials is one of the solutions used in periodontology for the reconstruction of intrabony defects. Advances in scientific research gave rise to a new generation of biomaterials of synthetic origin stoichiometrically unstable and therefore really absorbable. Our research is directed precisely towards a biomaterial synthesis, Engipore® (Finceramica, Faenza, Italy) which is a bone substitute of the latest hydroxyapatite-based generation, that possesses chemical and morphological properties similar to those of natural bone in the treatment of infrabony periodontal defects. Aim of this study was to evaluate the efficacy of Engipore® in the treatment of intrabony periodontal defects. The study was conducted on 100 parodontopatics patients, which had gingival pockets of at least infrabonies 8/10 mm. The histological evaluation was performed with samples after one year from the graft. The histological samples collected after one year showed an abundant new bone formation, with mature lamellar bone tissue surrounding the residual particles of Engipore® that appear completely osteointegrated. The surrounding connective tissue shows no signs of inflammation. The results obtained in our research demonstrated that, after a proper selection of patients and lesions, and applying an adequate surgical technique, this type of biomaterial in the treatment of periodontal defects acts in an optimal manner as a filler inducing the formation of new bone as evidenced by histological examinations.

A clinical and radiological evaluation of the relative efficacy of demineralized freeze-dried bone allograft versus anorganic bovine bone xenograft in the treatment of human infrabony periodontal defects: A 6 months follow-up study

Background:The ultimate goal of periodontal therapy entails regeneration of the periodontal tissues lost as a consequence of periodontitis. Predictable correction of vertical osseous defects has however posed as a constant therapeutic challenge. The aim of our present study is to evaluate the relative efficacy of demineralized freeze-dried bone allograft (DFDBA) vs anorganic bovine bone xenograft (ABBX) in the treatment of human infrabony periodontal defects.Materials and Methods:15 patients with 30 bilaterally symmetrical defect sites in either of the arches, in the age group of 25-50 years were selected as part of split-mouth study design. Defect-A (right side) was grafted with DFDBA while Defect-B (left side) was grafted with ABBX. Various clinical and radiographic parameters viz. probing depth(PD), clinical attachment level(CAL) and linear bone fill were recorded preoperatively, 12- & 24-weeks postoperatively.Results:Both defect-A & defect-B sites exhibited a highly significant reduction in probing depth, and gain in clinical attachment level and linear bone fill at 12-weeks & at the end of 24-weeks. Comparative evaluation between the study groups revealed a statistically non-significant reduction in probing depth (P<0.1) and mean gain in linear bone fill (P<0.1). However, there was a statistically significant gain in clinical attachment level (P<0.05) in Defect-A (CD=0.356) as compared to Defect-B (CD=0.346).Conclusions:Within the limits of this study, both the materials viz. ABBX and DFDBA are beneficial for the treatment of periodontal infrabony defects. Both the materials were found to be equally effective in all respects except the gain in attachment level, which was found to be more with DFDBA. Long-term studies are suggested to evaluate further the relative efficacy of the two grafts.

Absorbable Collagen Membranes for Periodontal Regeneration

Guided tissue regeneration (GTR) with bioabsorbable collagen membranes (CM) is commonly used for the treatment of periodontal defects. The objective of this systematic review of randomized clinical trials was to assess the clinical efficacy of GTR procedures with CM, with or without bone substitutes, in periodontal infrabony defects compared with that of open flap debridement (OFD) alone. Primary outcomes were tooth loss and gain in clinical attachment level (CAL). Screening of records, data extraction, and risk-of-bias assessments were performed by two reviewers. Weighted mean differences were estimated by random effects meta-analysis. We included 21 reports on 17 trials. Risk of bias was generally high. No data were available for the primary outcome tooth loss. The summary treatment effect for change in CAL for GTR with CM compared with OFD was 1.58 mm (95% CI, 1.27 to 1.88). Despite large between-trial heterogeneity (I2 = 75%, p < .001), all trials favored GTR over OFD. No differences in treatment effects were detected between trials of GTR with CM alone and trials of GTR with CM in combination with bone substitutes (p for interaction, .31). GTR with CM, with or without substitutes, may result in improved clinical outcomes compared with those achieved with OFD alone. Our findings support GTR with CM for the treatment of infrabony periodontal defects.

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

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

Clinical and Radiographical Evaluation of the Use of Platelet Rich Fibrine Membrane and Autogen Bone Graft in Regenerative Treatment of Periodontal Infrabony Defects. Case Series

Blood sourced biomaterials have recently been used as grafting material in various surgical procedures. Platelet rich fibrine (PRF) is a second generation platelet concentrate, and it is so easily produced biomaterial as it is obtained without biochemical manipulation of blood. In this case series, regenerative treatment of the teeth with infrabony periodontal defects depending on advanced localized periodontal disease with the combination of autogen bone graft and PRF membrane was presented. Pre- and post-operative clinical and radiographical comparisons showed that using of PRF as a membrane was successful for periodontal healing and bone formation in infrabony periodontal defects. Key words: Platelet rich fibrine, infrabony defect, periodontal regeneration