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Kalluri L, Griggs JA, Janorkar AV, Xu X, Chandran R, Mei H, Nobles KP, Yang S, Alberto L, Duan Y. Preparation and optimization of an eggshell membrane-based biomaterial for GTR applications. Dent Mater 2024; 40:728-738. [PMID: 38401993 DOI: 10.1016/j.dental.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/20/2023] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Guided Tissue Regeneration (GTR) is a popular clinical procedure for periodontal tissue regeneration. However, its key component, the barrier membrane, is largely collagen-based and is still quite expensive, posing a financial burden to the patients as well as healthcare systems and negatively impacting the patient's decision-making. Thus, our aim is to prepare a novel biomimetic GTR membrane utilizing a natural biomaterial, soluble eggshell membrane protein (SEP), which is economical as it comes from an abundant industrial waste from food and poultry industries, unlike collagen. Additive polymer, poly (lactic-co-glycolic acid) (PLGA), and a bioceramic, nano-hydroxyapatite (HAp), were added to improve its mechanical and biological properties. METHODS For this barrier membrane preparation, we initially screened the significant factors affecting its mechanical properties using Taguchi orthogonal array design and further optimized the significant factors using response surface methodology. Furthermore, this membrane was characterized using SEM, EDAX, and ATR-FTIR, and tested for proliferation activity of human periodontal ligament fibroblasts (HPLFs). RESULTS Optimization using response surface methodology predicted that the maximal tensile strength of 3.1 MPa and modulus of 39.9 MPa could be obtained at membrane composition of 8.9 wt% PLGA, 7.2 wt% of SEP, and 2 wt% HAp. Optimized PLGA/SEP/HAp membrane specimens that were electrospun on a static collector showed higher proliferation activity of HPLFs compared to tissue culture polystyrene and a commercial collagen membrane. SIGNIFICANCE From the results observed, we can conclude that SEP-based nanofibrous GTR membrane could be a promising, environment-friendly, and cost-effective alternative for commercial collagen-based GTR membrane products.
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Affiliation(s)
- Lohitha Kalluri
- Department of Biomedical Materials Science, School of Dentistry, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Jason A Griggs
- Department of Biomedical Materials Science, School of Dentistry, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Amol V Janorkar
- Department of Biomedical Materials Science, School of Dentistry, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Xiaoming Xu
- Department of Oral and Craniofacial Biology, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, LA 70119, USA
| | - Ravi Chandran
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Hao Mei
- Department of Data Science, School of Population Health, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kadie P Nobles
- Department of Biomedical Materials Science, School of Dentistry, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Shan Yang
- Department of Chemistry, Physics, and Atmospheric Sciences, Jackson State University, Jackson, MS 39217, USA
| | - Laura Alberto
- Department of Biomedical Materials Science, School of Dentistry, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Yuanyuan Duan
- Department of Biomedical Materials Science, School of Dentistry, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Kim TJ, Littlejohn CG, Richey KH, Falsafi N, Li C, Wang TJ, Lander B, Chang YC. A Modern Approach to Treat Molar/Incisor Pattern Periodontitis-Review. J Clin Med 2023; 12:6107. [PMID: 37763046 PMCID: PMC10531571 DOI: 10.3390/jcm12186107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Molar-incisor pattern periodontitis (MIPP) is a severe form of periodontal disease characterized by rapid attachment loss and bone destruction affecting the molars and incisors. Formerly referred to as aggressive periodontitis, the terminology for this condition was revised after the 2017 workshop on the classification of periodontal and peri-implant diseases and conditions. Despite the modification in nomenclature, the treatment strategies for MIPP remain a critical area of investigation. The core principles of MIPP treatment involve controlling local and systemic risk factors, managing inflammation, and arresting disease progression. Traditional non-surgical periodontal therapy, including scaling and root planing, is commonly employed as an initial step together with the prescription of antibiotics. Surgical intervention may be necessary to address the severe attachment loss. Surgical techniques like resective and regenerative procedures can aid in achieving periodontal health and improving esthetic outcomes. This review article aims to provide an overview of the current understanding and advancements in the treatment modalities of MIPP. Through an extensive analysis of the existing literature, we discuss various modern therapeutic approaches that have been explored for managing this challenging periodontal condition.
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Affiliation(s)
- Taewan J. Kim
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, 240 S 40th Street, Philadelphia, PA 19104, USA; (T.J.K.); (C.G.L.); (K.H.R.); (N.F.); (T.-J.W.); (B.L.)
| | - Caroline G. Littlejohn
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, 240 S 40th Street, Philadelphia, PA 19104, USA; (T.J.K.); (C.G.L.); (K.H.R.); (N.F.); (T.-J.W.); (B.L.)
| | - Kristen H. Richey
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, 240 S 40th Street, Philadelphia, PA 19104, USA; (T.J.K.); (C.G.L.); (K.H.R.); (N.F.); (T.-J.W.); (B.L.)
| | - Neda Falsafi
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, 240 S 40th Street, Philadelphia, PA 19104, USA; (T.J.K.); (C.G.L.); (K.H.R.); (N.F.); (T.-J.W.); (B.L.)
| | - Chenshuang Li
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, 240 S 40th Street, Philadelphia, PA 19104, USA;
| | - Tun-Jan Wang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, 240 S 40th Street, Philadelphia, PA 19104, USA; (T.J.K.); (C.G.L.); (K.H.R.); (N.F.); (T.-J.W.); (B.L.)
| | - Bradley Lander
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, 240 S 40th Street, Philadelphia, PA 19104, USA; (T.J.K.); (C.G.L.); (K.H.R.); (N.F.); (T.-J.W.); (B.L.)
| | - Yu-Cheng Chang
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, 240 S 40th Street, Philadelphia, PA 19104, USA; (T.J.K.); (C.G.L.); (K.H.R.); (N.F.); (T.-J.W.); (B.L.)
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Brodzikowska A, Górski B, Szerszeń M, Sanz M. Efficacy of Guided Tissue Regeneration Using Frozen Radiation-Sterilized Allogenic Bone Graft as Bone Replacement Graft Compared with Deproteinized Bovine Bone Mineral in the Treatment of Periodontal Intra-Bony Defects: Randomized Controlled Trial. J Clin Med 2023; 12:jcm12041396. [PMID: 36835930 PMCID: PMC9964170 DOI: 10.3390/jcm12041396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
(1) Background: The aim of this study was to compare the clinical and radiographic outcomes of guided tissue regeneration (GTR) using two biomaterials as bone replacement grafts in the treatment of periodontal intra-bony defects. (2) Methods: Using a split-mouth design, 30 periodontal intra-bony defects were treated with either frozen radiation-sterilized allogenic bone grafts (FRSABG tests) or deproteinized bovine bone mineral (DBBM, controls) combined with a bioabsorbable collagen membrane in 15 patients. Clinical attachment level gains (CAL-G), probing pocket depth reductions (PPD-R), and radiographic changes in linear defect fill (LDF) were evaluated 12 months postoperatively. (3) Results: The CAL, PPD, and LDF values improved significantly in both groups 12 months after the surgery. However, in the test group, the PPD-R and LDF values were significantly higher compared to the controls (PPD-R 4.66 mm versus 3.57 mm, p = 0.0429; LDF 5.22 mm versus 4.33, p = 0.0478, respectively). Regression analysis showed that baseline CAL was a significant predictor for PPD-R (p = 0.0434), while the baseline radiographic angle was a predictor for CAL-G (p = 0.0026) and LDF (p = 0.064). (4) Conclusions: Both replacement grafts when used for GTR with a bioabsorbable collagen membrane yielded successful clinical benefits in teeth with deep intra-bony defects 12 months postoperatively. The use of FRSABG significantly enhanced PPD reduction and LDF.
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Affiliation(s)
- Aniela Brodzikowska
- Department of Conservative Dentistry, Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence: ; Tel.: +48-501019990
| | - Bartłomiej Górski
- Department of Periodontal and Oral Mucosa Diseases, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Marcin Szerszeń
- Department of Prosthodontics, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Mariano Sanz
- ETEP Research Group, Department of Dental Clinical Specialties, Faculty of Odontology, University Complutense of Madrid, 28040 Madrid, Spain
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Huang HL, Ma YH, Tu CC, Chang PC. Radiographic Evaluation of Regeneration Strategies for the Treatment of Advanced Mandibular Furcation Defects: A Retrospective Study. MEMBRANES 2022; 12:membranes12020219. [PMID: 35207140 PMCID: PMC8880529 DOI: 10.3390/membranes12020219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 01/10/2023]
Abstract
Teeth with furcation involvement (FI) present a higher risk of loss and are difficult to maintain. This study evaluated the efficacy of furcation defect regeneration (FDR) as a regeneration strategy. Pre-operative and 6-month postoperative radiographs were collected from patients receiving regeneration therapy for mandibular teeth with degree II and early degree III FI. The linear furcation involvement (LFI), ratio of LFI (RLI), LFI and RLI adjusted bythe alveolar bone crest (ABC), and radiographic intensity were assessed. The effects of demographic characteristics, regeneration treatment strategies, the relationship between furcation and ABC, and adjacent intrabony defect regeneration (AIDR) were evaluated using a generalized linear model and logistic regression. The results demonstrated that 1.5 mm adjusted LFI and 40% adjusted RLI were achieved in both pure furcation defects and combined furcation–angular defects by the combination of bone replacement grafts (BRG) and enamel matrix derivatives (EMD) or collagen membrane (CM); deproteinized bovine bone matrix (DBBM) showed a superior outcome among BRG. In combined furcation–angular defects, EMD appeared more beneficial than CM, and AIDR significantly promoted adjusted LFI and RLI. In conclusion, DBBM with EMD or CM was effective for FDR, and AIDR had a positive effect on FDR in the combined furcation–angular defect.
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Affiliation(s)
- Hsiang-Ling Huang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10048, Taiwan; (H.-L.H.); (C.-C.T.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Yun-Han Ma
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Che-Chang Tu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10048, Taiwan; (H.-L.H.); (C.-C.T.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
| | - Po-Chun Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10048, Taiwan; (H.-L.H.); (C.-C.T.)
- Department of Dentistry, National Taiwan University Hospital, Taipei 10048, Taiwan;
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence:
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Immuno-histopathologic evaluation of mineralized plasmatic matrix in the management of horizontal ridge defects in a canine model (a split-mouth comparative study). Odontology 2022; 110:523-534. [PMID: 34988770 PMCID: PMC9170670 DOI: 10.1007/s10266-021-00684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022]
Abstract
Our research aimed to investigate the effect of combining biphasic calcium phosphate (BCP) alloplast with mineralized plasmatic matrix (MPM) as compared with platelet-rich fibrin (PRF) on the quality and quantity of bone formation and maturation at surgically created horizontal critical-sized ridge defects (HRDs) in a canine model. We used a split-mouth design using the third and fourth mandibular premolars of the mongrel dogs. Twelve defects on the left side (experimental group, I) were managed with MPM composite mixed with BCP alloplast, MPM compact layer. On the right side (control group, II), another 12 defects were managed with PRF mixed with BCP alloplast, followed by the application of PRF compact strips. Finally, both were covered by a collagen membrane. Dogs were euthanized at 4, 8, and 12 weeks, and the studied defects were processed to evaluate treatment outcome, including mean percentage of bone surface area, collagen percentage, and osteopontin (OPN) immunoreaction. Our results revealed that the mean percentage of bone surface area was significantly increased in the experimental group treated with MPM at all time intervals as compared with the PRF group. Decreased collagen percentage and increased OPN immunoreactivity showed significant results in the MPM group as compared with PRF at 4 and 8 weeks postoperatively, respectively. In conclusion, MPM accelerates the formation of superior new bone quality when used in the treatment of HRDs.
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Shahmirzadi S, Maghsoodi-Zahedi T, Saadat S, Demirturk Kocasarac H, Rezvan M, Katkar RA, Nair MK. Assessment of alveolar bone changes in response to minimally invasive periodontal surgery: A cone-beam computed tomographic evaluation. Imaging Sci Dent 2022; 53:1-9. [PMID: 37006791 PMCID: PMC10060762 DOI: 10.5624/isd.20220053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to evaluate 3-dimensional cone-beam computed tomography (CBCT) images of alveolar bone changes in patients who underwent minimally invasive periodontal surgery-namely, the pinhole surgical technique (PST). Materials and Methods Alveolar bone height was measured and compared on CBCT images of 254 teeth from 23 consecutive patients with Miller class I, II, or III recession who had undergone PST. No patient with active periodontal disease was selected for surgery. Two different methods were used to assess the alveolar bone changes postoperatively. In both methods, the distance between the apex of the tooth and the mid-buccal alveolar crestal bone on pre- and post-surgical CBCT studies was measured. Results An average alveolar bone gain >0.5 mm following PST was identified using CBCT (P=0.05). None of the demographic variables, including sex, age, and time since surgery, had any significant effect on bone gain during follow-up, which ranged from 8 months to 3 years. Conclusion PST appears to be a promising treatment modality for recession that results in stable clinical outcomes and may lead to some level of resolution on the bone level. More long-term studies must be done to evaluate the impact of this novel technique on bone remodeling and to assess sustained bone levels within a larger study population.
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Affiliation(s)
- Solaleh Shahmirzadi
- Division of Oral and Maxillofacial Radiology, Department of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, TX, USA
| | | | - Sarang Saadat
- Department of Comprehensive Dentistry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Husniye Demirturk Kocasarac
- Division of Oral and Maxillofacial Radiology, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA
| | | | - Rujuta A. Katkar
- Division of Oral and Maxillofacial Radiology, Department of Comprehensive Dentistry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Madhu K. Nair
- Division of Oral and Maxillofacial Radiology, Department of Diagnostic Sciences, Texas A&M College of Dentistry, Dallas, TX, USA
- Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
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Fileto Mazzonetto AL, Casarin RCV, Santamaria MP, Andere NMRB, Araújo CF, Videira Clima da Silva R, Purisaca JEV, Sallum EA, Sallum AW. Clinical, radiographic, and patient-centered outcomes after use of enamel matrix proteins for the treatment of intrabony defects in patients with aggressive periodontitis: A 12-month multicenter clinical trial. J Periodontol 2020; 92:995-1006. [PMID: 33107596 DOI: 10.1002/jper.20-0493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical, radiographic and patient-centered results of enamel matrix derivative (EMD) therapy in intrabony defects in aggressive periodontitis (AgP) patients and compare them with those in chronic periodontitis (CP) patients. METHODS Sixty intrabony defects in AgP and CP patients associated with ≥ 6 mm residual probing pocket depth (PPD) were included and randomly assigned to one of three groups: AgP+CS (conservative surgery) (n = 20); AgP+CS/EMD (n = 20); CP+CS/EMD (n = 20). Clinical parameters were measured at baseline and after 6 and 12 months. Defect resolution (DR) and bone filling (BF) were used for radiographic analysis. The quality of life was recorded at baseline and 6 months using OHIP-14 and VAS scale in the early post-therapy period. RESULTS PPD and relative clinical attachment level (rCAL) improved for all groups during follow-up (P ≤ 0.05), and AgP+CS/EMD presented a higher rCAL gain (2.4 ± 1.0 mm) when compared to AgP control patients (1.6 ± 1.6 mm, P ≤ 0.05) after 12 months. No difference was observed between AgP+CS/EMD and CP+CS/EMD groups (P > 0.05). No radiographic differences were observed among groups at any time point (P > 0.05). All the groups reported a positive impact on OHIP-14 total score, without differences among them. CONCLUSIONS EMD therapy of intrabony defects promotes additional benefits in AgP patients, presenting a similar regeneration rate compared to CP patients, and has proven to be a viable therapy for the treatment of individuals with AgP.
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Affiliation(s)
| | | | | | | | - Cássia Fernandes Araújo
- Department of Diagnosis and Surgery, State University of São Paulo, São José dos Campos, Brazil
| | | | | | - Enilson Antonio Sallum
- Department of Prosthesis and Periodontology, State University of Campinas, Piracicaba, Brazil
| | - Antonio Wilson Sallum
- Department of Prosthesis and Periodontology, State University of Campinas, Piracicaba, Brazil
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Effect of systemic antibiotics on the outcomes of regenerative periodontal surgery in intrabony defects: a randomized, controlled, clinical study. Clin Oral Investig 2020; 25:2959-2968. [PMID: 33048260 PMCID: PMC8060211 DOI: 10.1007/s00784-020-03616-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/01/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To assess the potential influence of systemic antibiotic administration on the healing of periodontal intrabony defects treated with deproteinized bovine bone mineral (DBBM) and collagen membrane. MATERIALS AND METHODS Forty-one intrabony defects were treated by means of DBBM and collagen membrane (GTR). Postoperatively, the patients received either systemic antibiotics (i.e., 1 g of amoxicillin, twice daily for 7 days) (test) or no antibiotics (control). Clinical attachment level (CAL), probing depth (PD), and gingival recession (GR) were measured at baseline and at 1 year following regenerative surgery. The depth of the intrabony component (INTRA DD) and its width (INTRA DW) were measured during surgery and after 1 year at reentry. The depth (RxD) and width (RxW) of the intrabony defects were evaluated radiographically at baseline and at 1 year. RESULTS No adverse events were observed in any of the two groups throughout the entire study period. In the test group, mean CAL changed from 8.7 ± 1.4 mm at baseline to 5.0 ± 1.7 mm at 1 year (p < 0.0001), while PD decreased from 7.8 ± 1.5 mm at baseline to 4.0 ± 0.9 mm at 1 year (p < 0.0001). In the control group, mean CAL changed from 8.6 ± 1.9 mm to 5.9 ± 1.6 mm (p < 0.001) and mean PD improved from 7.4 ± 1.3 mm to 4.1 ± 1.3 mm (p < 0.001). Mean CAL gain measured 3.6 ± 1.6 mm in the test and 2.7 ± 1.6 mm in the control group, respectively. Defect fill (i.e., INTRA DD gain) at re-entry measured 3.7 ± 1.8 mm in the test and 2.7 ± 2.1 mm in the control group. A CAL gain of ≥ 3 mm was measured in 76% of the defects in the test group and in 40% of the defects in the control group, respectively. In both groups, all evaluated clinical and radiographic parameters improved statistically significantly compared with baseline, but no statistically significant differences were found between the two groups. CONCLUSIONS Within their limits, the present study has failed to show any substantial added clinical benefits following the postoperative administration of amoxicillin in conjunction with regenerative periodontal surgery using DBBM and GTR. CLINICAL RELEVANCE The post-surgically administration of systemic antibiotics does not seem to be necessary following regenerative periodontal surgery.
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Liang Y, Luan X, Liu X. Recent advances in periodontal regeneration: A biomaterial perspective. Bioact Mater 2020; 5:297-308. [PMID: 32154444 PMCID: PMC7052441 DOI: 10.1016/j.bioactmat.2020.02.012] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022] Open
Abstract
Periodontal disease (PD) is one of the most common inflammatory oral diseases, affecting approximately 47% of adults aged 30 years or older in the United States. If not treated properly, PD leads to degradation of periodontal tissues, causing tooth movement, and eventually tooth loss. Conventional clinical therapy for PD aims at eliminating infectious sources, and reducing inflammation to arrest disease progression, which cannot achieve the regeneration of lost periodontal tissues. Over the past two decades, various regenerative periodontal therapies, such as guided tissue regeneration (GTR), enamel matrix derivative, bone grafts, growth factor delivery, and the combination of cells and growth factors with matrix-based scaffolds have been developed to target the restoration of lost tooth-supporting tissues, including periodontal ligament, alveolar bone, and cementum. This review discusses recent progresses of periodontal regeneration using tissue-engineering and regenerative medicine approaches. Specifically, we focus on the advances of biomaterials and controlled drug delivery for periodontal regeneration in recent years. Special attention is given to the development of advanced bio-inspired scaffolding biomaterials and temporospatial control of multi-drug delivery for the regeneration of cementum-periodontal ligament-alveolar bone complex. Challenges and future perspectives are presented to provide inspiration for the design and development of innovative biomaterials and delivery system for new regenerative periodontal therapy.
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Affiliation(s)
- Yongxi Liang
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX, 75246, USA
| | - Xianghong Luan
- Department of Periodontics, Texas A&M University College of Dentistry, Dallas, TX, 75246, USA
| | - Xiaohua Liu
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX, 75246, USA
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Díaz-Faes L, Fernández-Somoano A, Magán-Fernández A, Mesa F. Efficacy of regenerative therapy in aggressive periodontitis: a systematic review and meta-analysis of randomised controlled clinical trials. Clin Oral Investig 2020; 24:1369-1378. [PMID: 32060656 DOI: 10.1007/s00784-020-03237-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/04/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To analyse evidence regarding the efficacy of periodontal regenerative procedures in intrabony defects in patients treated for aggressive periodontitis (AgP). MATERIAL AND METHODS A systematic search of the literature for randomised controlled clinical trials including patients treated for aggressive periodontitis that compared a group treated with regenerative therapy with another group treated with surgical debridement alone was conducted by two independent reviewers. RESULTS Six studies were included in the meta-analysis of clinical and/or radiographic parameters at 6 and 12 months. Probing pocket depth was smaller at 6 months in patients treated with regenerative therapies compared with those treated with regular debridement (1.00 mm, p < 0.001, 95% CI (0.67, 1.34)). At 12 months this difference was more marked (0.41 mm, p = 0.12, 95% CI (- 0.10, 0.91)). The distance between the cemento-enamel junction and the alveolar crest at both 6 (1.36 mm, p < 0.001, 95% CI (1.03, 1.68)) and 12 months (0.90 mm, p = 0.01, 95% CI (0.24, 1.56)) was smaller in the group treated with regeneration. CONCLUSIONS The use of biomaterials for regenerative therapy in AgP may be more effective than surgical debridement. Better outcomes were observed in terms of probing pocket depth and distance between the cemento-enamel junction and the alveolar crest at 6 months. Regeneration should be considered as a therapy to prevent tooth loss, although more studies with larger sample size and longer follow-up are needed. CLINICAL RELEVANCE Periodontal regeneration is effective in the treatment of intrabony defects in patients with AgP, as it leads to better outcomes in clinical and radiographic parameters.
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Affiliation(s)
- Lucía Díaz-Faes
- Department of Periodontics, Faculty of Dentistry, University of Granada, Granada, Spain.
| | - Ana Fernández-Somoano
- Department of Medicine, University of Oviedo, Oviedo, Asturias, Spain
- Biomedical Research Consortium in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
| | | | - Francisco Mesa
- Department of Periodontics, Faculty of Dentistry, University of Granada, Granada, Spain
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Górski B, Jalowski S, Górska R, Zaremba M. Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: a 4-year follow-up of a randomized controlled trial. Clin Oral Investig 2019; 24:1183-1196. [PMID: 31324986 DOI: 10.1007/s00784-019-02982-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE (1) To assess long-term outcomes 4 years following guided tissue regeneration (GTR) of intrabony defects in patients diagnosed with aggressive periodontitis (AgP) and (2) to identify predictors of clinical attachment level (CAL) gain and bone/graft density gain. MATERIALS AND METHODS In 15 patients, two deep intrabony defects were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). After 4 years, clinical and radiographic outcomes were evaluated and compared with outcomes at baseline and after 1 year. RESULTS After 4 years, 14 test sites and 13 control sites were available for analysis. One tooth was lost as a result of root fracture. There were significant improvements in all evaluated parameters after 1 and 4 years in relation to baseline, but no differences were observed between tests and controls. However, some non-significant changes were found between 1 and 4 years. Regression analyses showed that recurrence of periodontitis was a significant predictor for CAL gain (p = 0.001) and bone/graft density gain (p = 0.024) from 1 to 4 years. CONCLUSIONS GTR of intrabony defects in AgP with either standard or modified CM yielded similarly successful and maintainable clinical benefits for compromised teeth 4 years following the surgery. The use of MPM showed no additional benefit. CLINICAL RELEVANCE This study demonstrates that most of the positive outcomes of GTR in AgP may be preserved over 4 years. Periodontitis recurrence might influence long-term outcomes.
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Affiliation(s)
- Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Miodowa St 18, 00-246, Warsaw, Poland.
| | - Stanisław Jalowski
- Department of Dental and Maxillofacial Radiology, Medical University of Warsaw, Nowogrodzka St 59, 02-006, Warsaw, Poland
| | - Renata Górska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Miodowa St 18, 00-246, Warsaw, Poland
| | - Maciej Zaremba
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Miodowa St 18, 00-246, Warsaw, Poland
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12
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Rakmanee T, Calciolari E, Olsen I, Darbar U, Griffiths GS, Petrie A, Donos N. Expression of growth mediators in the gingival crevicular fluid of patients with aggressive periodontitis undergoing periodontal surgery. Clin Oral Investig 2018; 23:3307-3318. [DOI: 10.1007/s00784-018-2752-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
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Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: subtraction radiography outcomes, prognostic variables, and patient morbidity. Clin Oral Investig 2018; 23:3005-3020. [PMID: 30374832 PMCID: PMC7398389 DOI: 10.1007/s00784-018-2712-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
Abstract
Objectives The main objectives of this study were (1) to evaluate bone/graft density alterations by digital subtraction radiography; (2) to determine factors associated with favorable clinical and radiographic outcomes, and (3) to report on patient morbidity after guided tissue regeneration (GTR) in aggressive periodontitis (AgP) patients. Materials and methods Adapting a split-mouth design, 30 comparative intrabony defects in 15 patients were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). The time period of observation was 12 months. Results There were significant improvements in clinical and radiographic parameters within each group, without intergroup differences. However, higher PPD reduction for three-wall defects was noted in MPM sites (5.22 versus 3.62 mm; p = 0.033). Moreover, a significant gain in bone/graft density of 4.9% from 6 to 12 months post-operatively was observed in test sites. Multivariate analysis demonstrated that morphology of intrabony defects was a predictor of CAL gain (p = 0.06), while independent prognostic variables effecting changes in bone/graft density were radiographic defect depth (p = 0.025) and radiographic angle (p = 0.033). The majority of patients reported some discomfort, pain, and edema with mild intensity without any significant differences between treatment modalities. Conclusions This study demonstrated enhanced bone/graft density gain after GTR with MPM, which may indicate greater area of new bone formation. Independent variables effecting treatment outcomes were intrabony defect morphology, radiographic defect depth, and radiographic angle. Clinical relevance This study supports the regenerative treatment of intrabony defects in AgP patients and identifies some variables with prognostic value.
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14
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Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: a 12-month randomized controlled trial. Clin Oral Investig 2018; 22:2819-2828. [PMID: 29411112 DOI: 10.1007/s00784-018-2368-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 01/25/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the clinical and radiographic efficacy of guided tissue regeneration with a modified perforated collagen membrane (MPM) or standard collagen membrane (CM) in the treatment of intrabony defects in patients with aggressive periodontitis (AgP). MATERIALS AND METHODS Fifteen AgP patients were included in the study. Two single intrabony defects of at least 3 mm depth with ≥ 6 mm probing pocket depth (PPD) from each patient were randomly assigned to either xenogenic graft plus MPM (test group) or xenogenic graft plus CM (control group). PPD, clinical attachment level (CAL), and gingival recession (GR) were recorded at baseline and at 12 months. The radiographic assessments included the measurements of defect depth (DD), change in alveolar crest position (ACP), linear defect fill (LDF), and percentage defect fill (%DF). RESULTS After treatment, PPD, CAL, DD, and ACP values improved significantly in both groups, without statistical differences between them. However, with respect to LDF and %DF, the 12-month radiographic analysis at MPM-treated sites showed a significant improvement compared to the 6-month outcomes, that was not observed at control sites (additional LDF of 0.4 ± 0.5 mm, p = 0.010 and %DF of 6.4 ± 7.6%, p = 0.025). CONCLUSIONS Both strategies proved effective in the treatment of intrabony defects in patients with AgP. Nonetheless, enhanced LDF and %DF 12 months postoperatively at MPM-treated sites may stem from cellular and molecular migration from the periosteum and overlying gingival connective tissue through barrier's pores. CLINICAL RELEVANCE Modification of CM may have positive ramifications on periodontal regeneration.
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Corbella S, Weinstein R, Francetti L, Taschieri S, Del Fabbro M. Periodontal regeneration in aggressive periodontitis patients: A systematic review of the literature. ACTA ACUST UNITED AC 2016; 8. [DOI: 10.1111/jicd.12245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Stefano Corbella
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Roberto Weinstein
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences; Università degli Studi di Milano; Milan Italy
- IRCCS Istituto Ortopedico Galeazzi; Milan Italy
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