Clinical and radiographic treatment evaluation of class III furcation defects using GTR with and without inorganic bone matrix

Research hotspots and trends of bone defects based on Web of Science: a bibliometric analysis

BACKGROUND

Bone defects can be seen everywhere in the clinic, but it is still a challenge for clinicians. Bibliometrics tool CiteSpace is based on the principle of "co-citation analysis theory" to reveal new technologies, hotspots, and trends in the medical field. In this study, CiteSpace was used to perform co-citation analysis on authors, countries (regions) and institutions, journals and cited journals, authors and cited literature, as well as keywords to reveal leaders, cooperative institutions, and research hotspots of bone defects and predict development trends.

METHOD

Data related to bone defect from 1994 to 2019 were retrieved from the Web of Science core collection; then, we use Excel to construct an exponential function to predict the number of annual publications; conduct a descriptive analysis on the top 10 journals with the largest number of publications; and perform co-citation analysis on authors, countries (regions) and institutions, journals and cited journals, authors and cited reference, and keywords using CiteSpace V5.5 and use the Burst Detection Algorithm to perform analysis on the countries (regions) and institutions and keywords, as well as cluster the keywords using log-likelihood ratio.

RESULTS

A total of 5193 studies were retrieved, and the number of annual publications of bone defects showed an exponential function Y = 1×10- 70e0.0829x (R2 = 0.9778). The high-yield author was Choi Seong-Ho at Yonsei University in South Korea. The high-yielding countries were the USA and Germany, and the high-yielding institutions were the Sao Paulo University and China and the Chinese Academy of Sciences which were the emerging research countries and institutions. The research results were mainly published in the fields of dentistry, bone, and metabolism. Among them, the Journal of Dental Research and Journal of Bone and Mineral Research were high-quality journals that report bone defect research, but the most cited journal was the Clinical Orthopaedics and Related Research. Hot keywords were regeneration, repair, in vitro, bone regeneration, reconstruction, and graft. The keywords that were strongly cited in 2010-2019 were transportation, osteogenic differentiation, proliferation, and biomaterials. After 2018, proliferation, osteogenic differentiation, stromal cells, transmission, and mechanical properties have become new vocabulary. The drug delivery, vascularization, osteogenic differentiation and biomaterial properties of bone defects were expected to be further studied.

CONCLUSION

The application of CiteSpace can reveal the leaders, cooperating institutions and research hotspots of bone defects and provide references for new technologies and further research directions.

Experimental and clinical studies on regenerative periodontal therapy

The recognition of a periodontal therapy as a regenerative procedure requires the demonstration of new cementum, periodontal ligament, and bone coronal to the base of the defect. A diversity of regenerative strategies has been evaluated, including root surface conditioning, bone grafts and bone substitute materials, guided tissue regeneration, enamel matrix proteins, growth/differentiation factors, combined therapies and, more recently, tissue-engineering approaches. The aim of this chapter of Periodontology 2000 is to review the research carried out in Latin America in the field of periodontal regeneration, focusing mainly on studies using preclinical models (animal models) and randomized controlled clinical trials. This review may help clinicians and researchers to evaluate the current status of the therapies available and to discuss the challenges that must be faced in order to achieve predictable periodontal regeneration in clinical practice.

Periodontal regeneration - furcation defects: a systematic review from the AAP Regeneration Workshop

BACKGROUND

The aim of this review is to present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy to provide clinical guidelines for the therapeutic management of furcation defects and to identify priorities for future research that may advance the understanding of periodontal regenerative medicine.

METHODS

A comprehensive search based on predetermined eligibility criteria was conducted to identify human original studies and systematic reviews on the topic of periodontal regeneration of furcation defects. Two reviewers independently screened the title and abstract of the entries yielded from the initial search. Subsequently, both reviewers read the full-text version of potentially eligible studies, made a final article selection, and extracted the data of the selected studies considering specific clinical scenarios. The clinical scenarios contemplated in this review included the following: 1) facial and interproximal Class I defects in maxillary molars; 2) facial and lingual Class I defects in mandibular molars; 3) facial and interproximal Class II furcation defects in maxillary molars; 4) facial and lingual Class II furcation defects in mandibular molars; 5) Class III furcation defects in maxillary molars; 6) Class III furcation defects in mandibular molars; and 7) Class I, II, or III furcation defects in maxillary premolars. Endpoints of interest included different clinical, radiographic, microbiologic, histologic, and patient-reported outcomes.

RESULTS

The initial search yielded a total of 1,500 entries. The final selection consisted of 150 articles, of which six were systematic reviews, 109 were clinical trials, 27 were case series, and eight were case reports. A summary of the main findings of previously published systematic reviews and the available evidence relative to the indication of regenerative approaches for the treatment of furcation defects compared with conventional surgical therapy are presented. Given the marked methodologic heterogeneity and the wide variety of materials and techniques applied in the selected clinical trials, the conduction of a meta-analysis was not viable.

CONCLUSIONS

On the basis of the reviewed evidence, the following conclusions can be drawn. 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial or interproximal and mandibular facial or lingual Class II furcation defects. 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the evidence is limited to one case report. 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in maxillary molars is limited to clinical case reports. 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy. 5) Future research efforts should be primarily directed toward the conduction of clinical trials to test novel regenerative approaches that place emphasis primarily on patient-reported outcomes and also on histologic demonstration of periodontal regeneration. Investigators should also focus on understanding the influence that local, systemic, and technical factors may have on the outcomes of regenerative therapy in furcation defects.

Unanswered Questions: Can Bone Lost from Furcations Be Regenerated?

Periodontal regeneration-treatment that results in new alveolar bone, cementum, and a functional periodontal ligament-is successful in class II furcation defects. This article examines one aspect of periodontal regeneration-alveolar bone growth in furcation defects-in trying to answer the question, Can bone lost from furcations be regenerated? The best evidence for bone growth is histology but there is limited histologic evidence for bone growth in human furcation defects. There is more evidence from intraoperative measurements for hard tissue growth in treated furcation defects, but the nature of the hard tissue needs to be determined histologically.

Use of cyanoacrylate as barrier in guided tissue regeneration in class II furcation defects

The guided bone regeneration (GBR) is a technique that uses resorbable and non-resorbable membranes in association with other filling biomaterials. GBR is one of the optional treatments for therapy of class II furcation defects. The current case report evaluates clinically and radiographically the use of the cyanoacrylate membrane (Glubran ®2) associated with organic bovine bone (GenOx) for the treatment of vestibular class II furcation defect on the lower left molar.

CONCLUSION

The GBR is an option in the treatment of vestibular class II furcation defects and cyanoacrylate surgical glue, acting as a mechanic barrier and providing an efficient stability for the graft.

Treatment of grade II furcation involvement using resorbable guided tissue regeneration membrane: A six-month study

Aims:

The present study was undertaken to evaluate the effectiveness of the combination of hydroxyapatite and β-tricalcium phosphate bone alloplast with bioresorbable guided tissue regeneration membrane for the treatment of mandibular grade II furcation defects.

Settings and Design:

A total of eight patients, four females and four males, in the age group of 18 to 65 years, with bilateral buccal grade II furcation defects in the mandibular molars, participated in the study.

Materials and Methods:

The following clinical measurements were recorded at baseline as well as three and six months post surgery: The Turesky-Gilmore-Glickman modification of the Quigley Hein plaque index, the Loe and Silness gingival index, Relative Clinical Attachment Level Vertical Probing Depth in the mid-furcation area, and Horizontal Probing Depth in the mid-furcation area.

Statistical analysis:

Pairwise comparisons within the groups were done by applying the independent student t test. Comparisons were also drawn between the test and the control groups by applying the independent student t test.

Results:

The mean gain in the relative clinical attachment levels in the test and control groups, at the end of six months, were 2.50 and 1.63 mm, respectively. The mean change in the horizontal probing depth values at the end of six months in the test and control groups were 2.88 and 1.63 mm, respectively. The mean reduction in the vertical probing depth values in the test and control groups were 1.50 and 1.38 mm, respectively.

Conclusions:

The resorbable GTR membrane with bone material was more effective than open debridement alone, in the treatment of furcation defects.

Comparative radiopacity of bone graft materials

The aim of this study was to investigate the radiopacity of bone graft materials (BGMs) in comparison with bovine mandibular cortical bone and human dentine. Eight samples of each material (8 mm in diameter and 3 mm in thickness) were prepared from Dexabone(®) (DB), Bio - Oss(®) (BO), 4BONE SBS (4B), KASIOS(®) TCP (KA), S.C. PONETI (PO), and Apatite-Wollastonite (AW). The optical densities of each material, along with one tooth section (human canine tooth 1 mm slice), bovine mandibular cortical bone (BC) samples, and an aluminum step wedge, were measured from radiographic images using a transmission densitometer. The data were analyzed by nonparametric one-way ANOVA (Kruskal-Wallis) and Duncan's multiple range tests for post hoc comparison (α = 0.05). BC and AW had statistically lower optical density values than BO, 4B and human dentine (p < 0.05). Among BGMs, AW (3.681 ± 0.409 mm eq Al) had the highest radiopacity values whereas BO (1.925 ± 0.176 mm eq Al) had the lowest one. The radiopacity values of DB and KA did not reveal a statistically significant difference when compared with other materials (p > 0.05). The radiopacity of all BGMs investigated seemed to be too low to be detected radiographically when placed in the mandibular cortical bone.

The bone formation capabilities of the anorganic bone matrix-synthetic cell-binding peptide 15 grafts in an animal periodontal model: a histologic and histomorphometric study in dogs

BACKGROUND

The aim of this study is to verify the regenerative potential of particulate anorganic bone matrix-synthetic peptide-15 (ABM-P-15) in class III furcation defects associated or not with expanded polytetrafluoroethylene membranes.

METHODS

Class III furcation defects were produced in the mandibular premolars (P2, P3, and P4) of six dogs and filled with impression material. The membranes and the bone grafts were inserted into P3 and P4, which were randomized to form the test and control groups, respectively; P2 was the negative control group. The animals were sacrificed 3 months post-treatment.

RESULTS

Histologically, the complete closure of class III furcation defects was not observed in any of the groups. Partial periodontal regeneration with similar morphologic characteristics among the groups was observed, however, through the formation of new cementum, periodontal ligament, and bone above the notch. Histologic analysis showed granules from the bone graft surrounded by immature bone matrix and encircled by newly formed tissue in the test group. The new bone formation area found in the negative control group was 2.28 + or - 2.49 mm(2) and in the test group it was 6.52 + or - 5.69 mm(2), which showed statistically significant differences for these groups considering this parameter (Friedman test P <0.05). There was no statistically significant difference among the negative control, control, and test groups for the other parameters.

CONCLUSIONS

The regenerative potential of ABM-P-15 was demonstrated through new bone formation circumscribing and above the graft particles. The new bone also was accompanied by the formation of new cementum and periodontal ligament fibers.

Treatment of Class III Furcation Defects With Expanded Polytetrafluoroethylene Membrane Associated or Not With Anorganic Bone Matrix/Synthetic Cell-Binding Peptide: A Histologic and Histomorphometric Study in Dogs

BACKGROUND

Up until now, no predictable periodontal regeneration of Class III furcation defects has been demonstrated after treatment with different available techniques. Recently, a bone graft enriched with a peptide was developed and has shown satisfactory results when applied in intrabony defects. The aim of this study was to compare the use of expanded polytetrafluoroethylene (ePTFE) membrane associated (test group) or not (control group) with anorganic bovine-derived bone matrix (ABM)/synthetic peptide, in the treatment of Class III furcation defects in dogs.

METHODS

Six mongrel dogs were used in this study, and the second and fourth mandibular lower premolars were extracted. Class III furcation defects were surgically created in the third premolars and filled with impression material. Afterwards, the defects were surgically assessed for debridement and root planing. Teeth were randomly assigned into test and control groups. The membranes were removed after 4 weeks, and the animals were sacrificed 12 weeks later.

RESULTS

Comparisons between groups by the Wilcoxon signed rank test showed no statistically significant differences in the parameters evaluated. In the control group, a new bone area (NBA) of 41.71%+/-24.07%, connective tissue area (CTA) of 36.34%+/-15.50%, and epithelium tissue area (ETA) of 9.39%+/-5.85% were observed. The new cementum extension (NCE) was 24.16%+/-13.18%. The test group presented an NBA of 31.84%+/-12.58%, CTA of 47.72%+/-11.33%, ETA of 9.17%+/-6.81%, and an NCE of 30.13%+/-16.43%.

CONCLUSION

There was no statistically significant difference between the two therapies: ePTFE membrane associated with ABM/synthetic peptide flow or ePTFE membrane only.

Potential efficacy of GTR and autogenous bone graft for autotransplantation to recipient sites with osseous defects: evaluation by re-entry procedure

This clinical study aimed to evaluate the effectiveness of guided tissue regeneration (GTR) or autogenous bone graft for autotransplantation to recipient sites with an osseous defect, based on a substantial assessment of bone regeneration using a re-entry procedure. Three cases of autotransplantation of a wisdom tooth to the position of first molar, in which moderate to extensive bone loss at the buccal alveolar plate was observed, were studied. Each tooth was transplanted with no additional treatment, or in conjunction with GTR or autogenous bone graft. Four to 20 months after surgery, a re-entry procedure was performed to visually examine healing. When GTR membrane coverage or bone graft was used, previously absent alveolar bony plates regenerated and the initially exposed roots were covered with newly formed bone, while no bone formation was observed in the case without any additional procedure. These results demonstrate that both GTR and autogenous bone graft are beneficial for obtaining bone regeneration in autotransplantation to defective recipient sites, contributing to retaining space and excluding the contact of gingival connective tissue with periodontal ligaments.