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Imber JC, Imber LC, Roccuzzo A, Stähli A, Muñoz F, Weusmann J, Bosshardt DD, Sculean A. Preclinical evaluation of a new synthetic carbonate apatite bone substitute on periodontal regeneration in intrabony defects. J Periodontal Res 2024; 59:42-52. [PMID: 37997207 DOI: 10.1111/jre.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 08/28/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To evaluate the potential of a novel synthetic carbonate apatite bone substitute (CO3 Ap-BS) on periodontal regeneration. BACKGROUND The use of various synthetic bone substitutes as a monotherapy for periodontal regeneration mainly results in a reparative healing pattern. Since xenografts or allografts are not always accepted by patients for various reasons, a synthetic alternative would be desirable. METHODS Acute-type 3-wall intrabony defects were surgically created in 4 female beagle dogs. Defects were randomly allocated and filled with CO3 Ap-BS (test) and deproteinized bovine bone mineral (DBBM) or left empty (control). After 8 weeks, the retrieved specimens were scanned by micro-CT, and the percentages of new bone, bone substitute, and soft tissues were evaluated. Thereafter, the tissues were histologically and histometrically analyzed. RESULTS Healing was uneventful in all animals, and defects were present without any signs of adverse events. Formation of periodontal ligament and cementum occurred to varying extent in all groups without statistically significant differences between the groups. Residues of both bone substitutes were still present and showed integration into new bone. Histometry and micro-CT revealed that the total mineralized area or volume was higher with the use of CO3 Ap-BS compared to control (66.06 ± 9.34%, 36.11 ± 6.40%; p = .014, or 69.74 ± 2.95%, 42.68 ± 8.68%; p = .014). The percentage of bone substitute surface covered by new bone was higher for CO3 Ap-BS (47.22 ± 3.96%) than for DBBM (16.69 ± 5.66, p = .114). CONCLUSIONS CO3 Ap-BS and DBBM demonstrated similar effects on periodontal regeneration. However, away from the root surface, more new bone, total mineralized area/volume, and higher osteoconductivity were observed for the CO3 Ap-BS group compared to the DBBM group. These findings point to the potential of CO3 Ap-BS for periodontal and bone regeneration.
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Affiliation(s)
- Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Larissa Carmela Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Fernando Muñoz
- Department of Veterinary Clinical Sciences, University of Santiago de Compostela, Ibonelab SL, Lugo, Spain
| | - Jens Weusmann
- Department of Periodontology and Operative Dentistry, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Dieter Daniel Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Sugaya H, Kurashige Y, Suzuki K, Sakakibara S, Fujita Y, Islam ST, Nezu T, Ito S, Abiko Y, Saitoh M. Regaining enamel color quality using enamel matrix derivative. Med Mol Morphol 2023; 56:116-127. [PMID: 36622467 PMCID: PMC10188587 DOI: 10.1007/s00795-022-00346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/22/2022] [Indexed: 01/10/2023]
Abstract
This study aimed to demonstrate and compare the accuracy of tooth shade selection due to the remineralized enamel crystal with enamel matrix derivative (EMD) in vitro. Etched enamel slices were immersed in four types of mineralization buffers for 16 h. Sodium fluoride (NaF) was added to final concentrations of 1-100 ppm with the mineralization buffer that demonstrated the highest mineralization efficiency. EMD was added to the mineralization buffer containing NaF to see if it has any remineralization capacities. The remineralized enamel crystal was analyzed by SEM and XRD. The tooth shade was evaluated by CIE L*a*b*. The results showed that, without NaF, plate-like nanocrystals were formed on the enamel surface, but with NaF, needle-like nanocrystals were formed. By adding EMD, a layer of well-compacted hydroxyapatite crystals was successfully precipitated onto the natural enamel surface. No significant differences were observed in the L* value of the mineralization surface pre-etching and after mineralization buffer containing NaF and EMD. A new method has been developed to recover the color quality of enamel, as well as to mineralize the tooth enamel by constructing hydroxyapatite crystals with mineralization buffers containing NaF and EMD on the etched tooth surface.
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Affiliation(s)
- Hiroyuki Sugaya
- Division of Pediatric, Dentistry School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu, Ishikari, Hokkaido, 061-0293, Japan
| | - Yoshihito Kurashige
- Division of Pediatric, Dentistry School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu, Ishikari, Hokkaido, 061-0293, Japan
| | - Kai Suzuki
- Division of Pediatric, Dentistry School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu, Ishikari, Hokkaido, 061-0293, Japan
| | - Sayaka Sakakibara
- Division of Pediatric, Dentistry School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu, Ishikari, Hokkaido, 061-0293, Japan
| | - Yusuke Fujita
- Division of Pediatric, Dentistry School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu, Ishikari, Hokkaido, 061-0293, Japan
| | - Syed Taufiqul Islam
- Division of Pediatric, Dentistry School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu, Ishikari, Hokkaido, 061-0293, Japan
| | - Takashi Nezu
- Division of Biomaterials and Bioengineering, School of Dentistry, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Shuichi Ito
- Division of Dental Education Development, School of Dentistry, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Yoshihiro Abiko
- Division of Oral Medicine and Pathology, Dentistry School of Dentistry, Health Sciences University of Hokkaido, Tobetsu, Japan
| | - Masato Saitoh
- Division of Pediatric, Dentistry School of Dentistry, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu, Ishikari, Hokkaido, 061-0293, Japan.
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Lyu H, Zhou X, Qian Y, Liu X, Gopinathan G, Pandya M, Qin C, Luan X, Diekwisch TG. Long-acting PFI-2 small molecule release and multilayer scaffold design achieve extensive new formation of complex periodontal tissues with unprecedented fidelity. Biomaterials 2022; 290:121819. [DOI: 10.1016/j.biomaterials.2022.121819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/20/2022] [Accepted: 09/19/2022] [Indexed: 11/02/2022]
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The predictive performance of surgical treatment in upper molars with combined bony defect and furcation involvement: a retrospective cohort study. BMC Oral Health 2022; 22:156. [PMID: 35524218 PMCID: PMC9074367 DOI: 10.1186/s12903-022-02196-0] [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: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the impact of combined defects, bony destruction and furcation involvement, on disease resolution after surgery in terms of pocket elimination, absence of inflammation, furcation improvement and predictive performance. METHODS Combined bony (intrabony (+) or (-)) and furcation defects (FI degree 1 or 2) at maxillary molars in patients diagnosed as periodontitis stage III to IV, being through periodontal surgery and at least 6 months follow-up were retrospectively screened. Cumulative predictability (CR, %), failure of treatment and the change of clinical parameters from baseline at pre-operative visit to the latest maintenance care, including pocket depth (PD), horizontal and vertical furcation involvement (FI) were analyzed. Failure of treatment with low predictability was defined as residual PD > 4 mm with bleeding on probing during maintenance period. RESULTS Thirty-three patients with fifty-one combined defects were included. Statistical analysis showed significant overall PD reduction and FI improvement (p < 0.001). Combined FI degree 2 with intrabony (+) defects revealed more horizontal furcation improvement compared with FI degree 2 with suprabony defect (p = 0.007). However, type of combined defects was not relevant to CR (p = 0.702) and PD reduction (p = 0.707). Among all parameters, baseline PD with proximal FI degree 2 was indicated to failure of treatment. CONCLUSIONS Different types of combined defects, deep baseline pocket and proximal FI degree 2 would compromise the predictability of treatment outcomes in upper molars. Nevertheless, the combination of surgical treatment and strict maintenance care could still yield high predictability and survival rate. TRIAL REGISTRATION retrospectively registered.
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Enamel matrix derivative as adjunctive to non-surgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials. Clin Oral Investig 2022; 26:4263-4280. [PMID: 35389113 PMCID: PMC9203394 DOI: 10.1007/s00784-022-04474-1] [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: 02/01/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022]
Abstract
Objectives To assess the potential additional benefit of the local application of enamel matrix derivative (EMD) on the clinical outcomes following non-surgical periodontal therapy (NSPT) (steps 1 and 2 periodontal therapy). Materials and Methods A systematic literature search was performed in several electronic databases, including Medline/PubMed, Embase, The Cochrane Register of Central Trials (CENTRAL), LILACS, and grey literature. Only randomized controlled clinical trials (RCTs) were eligible for inclusion. Clinical attachment level (CAL) change (primary outcome), probing pocket depth (PPD), and bleeding on probing (BoP) reductions (secondary outcomes) were evaluated. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the quality of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated using a random-effect model for amount of mean CAL and PPD change. Results Six RCTs were included for the qualitative analysis, while data from 4 studies were used for meta-analysis. Overall analysis of CAL gain (3 studies) and PPD reduction (4 studies) presented WMD of 0.14 mm (p = 0.74; CI 95% − 0.66; 0.94) and 0.46 mm (p = 0.25; CI 95% − 0.33; 1.26) in favor of NSPT + EMD compared to NSPT alone respectively. Statistical heterogeneity was found to be high in both cases (I2 = 79% and 87%, respectively). Conclusions Within their limitations, the present data indicate that the local application of EMD does not lead to additional clinical benefits after 3 to 12 months when used as an adjunctive to NSPT. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of EMD. Clinical relevance The adjunctive use of EMD to NSPT does not seem to additionally improve the clinical outcomes obtained with NSPT alone. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-022-04474-1.
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Fraser D, Caton J, Benoit DSW. Periodontal Wound Healing and Regeneration: Insights for Engineering New Therapeutic Approaches. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.815810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Periodontitis is a widespread inflammatory disease that leads to loss of the tooth supporting periodontal tissues. The few therapies available to regenerate periodontal tissues have high costs and inherent limitations, inspiring the development of new approaches. Studies have shown that periodontal tissues have an inherent capacity for regeneration, driven by multipotent cells residing in the periodontal ligament (PDL). The purpose of this review is to describe the current understanding of the mechanisms driving periodontal wound healing and regeneration that can inform the development of new treatment approaches. The biologic basis underlying established therapies such as guided tissue regeneration (GTR) and growth factor delivery are reviewed, along with examples of biomaterials that have been engineered to improve the effectiveness of these approaches. Emerging therapies such as those targeting Wnt signaling, periodontal cell delivery or recruitment, and tissue engineered scaffolds are described in the context of periodontal wound healing, using key in vivo studies to illustrate the impact these approaches can have on the formation of new cementum, alveolar bone, and PDL. Finally, design principles for engineering new therapies are suggested which build on current knowledge of periodontal wound healing and regeneration.
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Hong HH, Chou TA, Hong A, Huang YF, Yen TH, Liang CH, Hong A, Hsiao HY, Nien CY. Calcitriol and enamel matrix derivative differentially regulated cementoinduction and mineralization in human periodontal ligament-derived cells. J Periodontol 2021; 93:1553-1565. [PMID: 34837709 DOI: 10.1002/jper.21-0435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/11/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUNDS Alveolar bone and cementum share many biological and developmental similarities. The mineralizing effect of calcitriol has been previously reported. Yet, its cementoinductivity has not been confirmed. This study evaluated the potential cementoinductivity effect of calcitriol and enamel matrix derivative (EMD) on human periodontal ligament-ligament derived cells (hPDCs). METHODS Human PDCs obtained from extracted third molars or premolars were cultured with calcitriol, or EMD. Cementogenic gene expression was examined using RT-qPCR. Expression analysis also included cementoblast-specific markers, Cementum Protein 1 (CEMP1), cementum attachment protein (CAP), and recently reported cementoblast-enriched genes, secreted frizzled related protein 1 (SFRP1), and Dickkopf-related protein 1 (DKK1). Mineralization capacities were evaluated by alkaline phosphatase (ALP) activity, Alizarin Red and Von Kossa staining followed by scanning electron microscope imaging and element mapping. RESULTS Among tested conditions, 10 nM calcitriol enhanced most cementogenic gene expression, Trans-forming growth factor-β1 (TGF-β1), bone morphogenetic proteins (BMP-2 and BMP-4), Core-binding factor subunit alpha-1/Runt-related transcription factor 2 (Cbfa1/RUNX2), Type I collagen (Col-1), Alkaline phosphatase (ALP), Bone sialoprotein (BSP), osteopontin (OPN/SPP1), osteocalcin (OCN), CEMP1 and CAP, and Wnt signaling negative modulators, SFRP1 and DKK1, along with highest ALP activity and mineralization formation in hPDCs. However, only moderate CEMP-1 protein was observed. In contrast, EMD stimulated stronger CEMP-1 and CAP protein, but presented weaker mineralization capacity, hinting at the possibility that strong stimulation of mineralization might dominate cemetogenic specific factors and vice versa. CONCLUSION Calcitriol demonstrated not only great osteoinductivity, but also the potential to induce cementogenic gene expression by initiating hPDC differentiation and promoting mineralization. Compared to calcitriol, EMD promoted cementoinductivity in hPDCs at a later time point via highly expressed CEMP1 and CAP protein, but with less mineralization. Thus, calcitriol and EMD could provide differential enhancement of cementoinduction and mineralization, likely acting at various differentiation stages. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hsiang-Hsi Hong
- Department of Periodontics, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Ting-An Chou
- Department of Periodontics, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Adrienne Hong
- Valley Consortium for Medical Education, Family Medicine Residency, University of California Davis, Modesto, CA, United States
| | - Yi-Fang Huang
- Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Dentistry, College of Oral medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Chao-Hua Liang
- Department of Prosthodontics, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Alex Hong
- Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hui-Yi Hsiao
- Center for tissue engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Yi Nien
- Department of Life Sciences, National Central University, Taoyuan, Taiwan
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Treatment of intrabony periodontal defects in controlled diabetic patients with an enamel matrix derivative: a split-mouth randomized clinical trial. Clin Oral Investig 2021; 26:2479-2489. [PMID: 34643808 DOI: 10.1007/s00784-021-04215-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/26/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This split-mouth randomized controlled trial aimed to evaluate the effect of enamel matrix derivative (EMD) associated with a simplified papilla preservation flap (SPPF) compared to SPPF alone in the surgical treatment of intrabony defects (ID) in type 2 diabetic mellitus (T2DM) patients. MATERIAL AND METHODS Thirteen patients with controlled T2DM presenting with ID in at least two quadrants were included. In each patient, the test site (TS) was treated with SPPF plus EMD, whereas the control site (CS) was treated only with SPPF. Prior to surgery and at 6 months after intervention, the following parameters were evaluated: clinical attachment level (CAL), probing pocket depth (PPD), and gingival recession (GR). RESULTS The TS and CS demonstrated a mean CAL gain of 3.31 ± 0.96 mm and 1.61 ± 1.12 mm, and a PPD reduction from 8.15 ± 0.98 to 3.00 ± 0.57 mm and 7.53 ± 0.96 to 4.69 ± 0.63 mm after 6 months, respectively. In both sites, the mean CAL gain and PPD reduction improved significantly after 6 months compared to baseline; however, the improvement was higher in the TS (p < 0.001). CONCLUSIONS Both surgical procedures presented with clinical improvements in controlled T2DM patients. However, the additional use of EMD showed enhanced clinical results after 6 months with regard to CAL gain and PPD reduction. CLINICAL RELEVANCE This study showed a better PPD reduction and CAL gain when an EMD was applied in addition to SPPF. Therefore, EMD may be used to enhance clinical outcomes in periodontal ID of controlled T2DM patients.
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Cheng L, Li Y, Xia Q, Meng M, Ye Z, Tang Z, Feng H, Chen X, Chen H, Zeng X, Luo Y, Dong Q. Enamel matrix derivative (EMD) enhances the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Bioengineered 2021; 12:7033-7045. [PMID: 34587869 PMCID: PMC8806549 DOI: 10.1080/21655979.2021.1971504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To investigate the EMD's capacity in BMSCs osteogenic differentiation. In vivo and in vitro, BMSCs were treated with EMD, scanning electron microscopy, and Alizarin Red staining were used to detect the changes in the osteogenic ability of BMSCs, and the proliferation ability of BMSCs was evaluated by CCK8. In addition, by adding xav939, a typical inhibitor of Wnt/β-catenin signaling pathway, the regulatory function of Wnt/β-catenin signaling was clarified. The results showed that EMD promote cell proliferation and 25 μg/ml EMD had the most significant effect. Cells inducing osteogenesis for 2 and 3 even 4 weeks, the cell staining is deeper in EMD treated group than that of the control (P < 0.05) by alizarin Red staining, suggesting more mineralization of BMSCs. In vivo implanting the titanium plate wrapped with 25 μg/ml EMD treated-BMSC film into nude mice for 8 weeks, more nodules were formed on the surface of the titanium plate than that the control (P < 0.05). HE showed that there is a little blue-violet immature bone-like tissue block. Besides, the expression of RUNX Family Transcription Factor 2 (Runx2), Osterix, Osteocalcin (OCN), collagen I (COLI), alkaline phosphatase (ALP) and β-catenin were inhibited in xav939 group (P < 0.05); Inversely, all were activated in EMD group (P < 0.05). In conclusion, EMD promoted the proliferation and osteogenic differentiation of BMSCs. EMD's function on BMSCs might be associated with the Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Lu Cheng
- Department of Prosthodontics, Guiyang Hospital of Stomatology, Guiyang, Gsuizhou Province, 550002, People's Republic of China
| | - Ying Li
- Department of Prosthodonticsand Oral Implantology, Stomatological hospital of Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
| | - Qian Xia
- Department of Prosthodonticsand Oral Implantology, Stomatological hospital of Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
| | - MaoHua Meng
- Department of Prosthodontics, School of Stomatology, Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
| | - ZhaoYang Ye
- Clinical Research Center, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
| | - ZhengLong Tang
- Department of Prosthodontics, School of Stomatology, Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China.,Department of Prosthodonticsand Oral Implantology, Stomatological hospital of Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
| | - HongChao Feng
- Department of Oral and Maxillofacial Surgery, Guiyang Hospital of Stomatology, Guiyang, Guizhou Province, 550002, People's Republic of China
| | - Xin Chen
- Department of Prosthodontics, School of Stomatology, Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
| | - HeLin Chen
- Department of Prosthodonticsand Oral Implantology, Stomatological hospital of Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
| | - Xiao Zeng
- Department of Prosthodonticsand Oral Implantology, Stomatological hospital of Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
| | - Yi Luo
- Department of Prosthodontics, Guiyang Hospital of Stomatology, Guiyang, Gsuizhou Province, 550002, People's Republic of China
| | - Qiang Dong
- Department of Prosthodontics, School of Stomatology, Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China.,Department of Prosthodonticsand Oral Implantology, Stomatological hospital of Guizhou Medical University, Guiyang, Guizhou Province, 550004, People's Republic of China
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Roina Y, Auber F, Hocquet D, Herlem G. ePTFE-based biomedical devices: An overview of surgical efficiency. J Biomed Mater Res B Appl Biomater 2021; 110:302-320. [PMID: 34520627 DOI: 10.1002/jbm.b.34928] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 12/19/2022]
Abstract
Polytetrafluoroethylene (PTFE) is a ubiquitous material used for implants and medical devices in general because of its high biocompatibility and inertness: blood vessel, heart, table jawbone, nose, eyes, or abdominal wall can benefit from its properties in case of disease or injury. Its expanded version, ePTFE is an improved version of PTFE with better mechanical properties, which extends its medical applications. A material as frequently used as ePTFE with these exceptional properties deserves a review of its main uses, developments, and possibility of improvements. In this systematic review, we examined clinical trials related to ePTFE-based medical devices from the literature. Then, we excluded all trials using ePTFE as a control to test other devices. ePTFE-coated stents, hemodialysis and bypass grafts, guided bone and tissue regeneration membranes, hernia and heart repair and other devices are reviewed. The rates of success using these devices and their efficiency compared to other materials used for the same purposes are reported. ePTFE appears to be more or just as efficient compared to them. Some success rates remain low, suggesting the need of improvement ePTFE for medical applications.
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Affiliation(s)
- Yaëlle Roina
- Nanomedicine Lab EA4662, Bat. E, Université de Franche-Comté, UFR Sciences & Techniques, Besançon Cedex, France
| | - Frédéric Auber
- Nanomedicine Lab EA4662, Bat. E, Université de Franche-Comté, UFR Sciences & Techniques, Besançon Cedex, France
| | - Didier Hocquet
- Hygiène Hospitalière, UMR CNRS 6249, Université de Bourgogne Franche-Comté, Besançon, France
| | - Guillaume Herlem
- Nanomedicine Lab EA4662, Bat. E, Université de Franche-Comté, UFR Sciences & Techniques, Besançon Cedex, France
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The role of surgical flap design (minimally invasive flap vs. extended flap with papilla preservation) on the healing of intrabony defects treated with an enamel matrix derivative: a 12-month two-center randomized controlled clinical trial. Clin Oral Investig 2021; 26:1811-1821. [PMID: 34491446 PMCID: PMC8816368 DOI: 10.1007/s00784-021-04155-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023]
Abstract
Objectives Minimally invasive flap designs have been introduced to enhance blood clot stability and support wound healing. Limited data appear to suggest, that in intrabony defects, better clinical outcomes can be achieved by means of minimally invasive flap compared to more extended flaps. The aim of this study was to evaluate the healing of intrabony defects treated with either minimally invasive surgical flaps or with modified or simplified papilla preservation techniques in conjunction with the application of an enamel matrix derivative (EMD). Materials and methods Forty-seven subjects were randomly assigned to either test (N = 23) or control (N = 24) procedures. In the test group, the intrabony defects were accessed by means of either minimally invasive surgical technique (MIST) or modified minimally invasive surgical technique (M-MIST) according to the defect localization while the defects in the control group were treated with either the modified or simplified papilla preservation (MPP) or the simplified papilla preservation technique (SPP). EMD was used as regenerative material in all defects. The following clinical parameters were recorded at baseline and after 12 months: full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depths (PD), clinical attachment level (CAL), and gingival recession (GR). Early healing index (EHI) score was assessed in both groups 1 week following the surgery. CAL gain was set as primary outcome. Results After 12 months follow-up, the CAL gain was 4.09 ± 1.68 mm in test group and 3.79 ± 1.67 mm in control group, while the PD reduction was 4.52 ± 1.34 mm and 4.04 ± 1.62 mm for test and control sites. In both groups, a minimal GR increase (0.35 ± 1.11 mm and 0.25 ± 1.03 mm) was noted. No residual PDs ≥ 6 mm were recorded in both groups. CAL gains of 4–5 mm were achieved in 30.4% and in 29.2% of test and control group, respectively. Moreover, CAL gains ≥ 6 mm were recorded in 21.7% of experimental sites and in 20.8% of control sites. No statistically significant differences in any of the evaluated parameters were found between the test and control procedures (P > 0.05). After 1 week post-surgery, a statistically significant difference (P < 0.05) between the groups was found in terms of EHI score. Conclusions Within the limits of this pilot RCT, the results have failed to show any differences in the measured parameters following treatment of intrabony defects with EMD, irrespective of the employed surgical technique. Clinical relevance In intrabony defects, the application of EMD in conjunction with either MIST/M-MIST or M-PPT/SPPT resulted in substantial clinical improvements. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04155-5.
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De Ry SP, Roccuzzo A, Lang NP, Sculean A, Salvi GE. Long-term clinical outcomes of periodontal regeneration with Enamel Matrix Derivative (EMD): a retrospective cohort study with a mean follow-up of 10 years. J Periodontol 2021; 93:548-559. [PMID: 34258767 PMCID: PMC9373923 DOI: 10.1002/jper.21-0347] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/10/2021] [Accepted: 07/10/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the large body of evidence on the efficacy of Enamel Matrix Derivative (EMD) in the treatment of periodontal intrabony defects, few studies reported long-term data (≥ 10-year). METHODS Periodontal patients treated with regenerative surgery with EMD between 1999 and 2012 were invited to participate in a clinical examination. The following clinical parameters were recorded and compared at baseline (T0), 6 months after surgery (T1) and after at least 8 years of follow-up (T2): probing depth (PD), gingival recession (GR), clinical attachment level (CAL), plaque and bleeding scores. The primary outcome variable was CAL change. RESULTS Forty-one patients with 75 treated teeth were available for analysis. Out of these, 68 (tooth survival rate: 90.7%) reached the latest follow-up with a mean observation period of 10.3 years (range: 8.0-21.3). The most frequent reason for tooth loss was recurrence of periodontal disease. Tooth survival curves showed a statistically significant difference between smokers and non-smokers (p = 0.028). Mean CAL changed from 8.43 ± 1.86 (T0) to 6.47 ± 1.70 (T1) (p<0.001) and to 5.91 ± 1.83 (T2) (p<0.001). At T1, a CAL gain of ≥3 mm was measured in 35% of the defects while at T2 it was detected in 51% of cases. CONCLUSIONS Within their limitations, the present results have shown that in intrabony defects, the clinical improvements obtained following regenerative surgery with EMD can be maintained on a mean period of 10 years. Smoking status and maxillary molars were correlated with an increased risk for tooth and CAL loss, respectively. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Siro P De Ry
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Niklaus P Lang
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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13
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Jung J, Park JS, Dard M, Al-Nawas B, Kwon YD. Effect of enamel matrix derivative liquid combined with synthetic bone substitute on bone regeneration in a rabbit calvarial model. Clin Oral Investig 2020; 25:547-554. [PMID: 32740811 DOI: 10.1007/s00784-020-03473-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/24/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to verify the effectiveness of EMD-liquid in combination with a synthetic bone substitute in a rabbit calvarial model. MATERIAL AND METHODS Four 7-mm outer diameter circular slits were created in the calvaria of 10 New Zealand white rabbits, and polycarbonate cylinders were inserted into the slits. Two experimental groups were established: (1) EMD-liquid + bone substitute (Osteon III®; biphasic calcium phosphate (BCP), β-TCP/HA = 40:60) and (2) saline + bone substitute (Osteon III®; BCP). The cylinders were filled with saturated graft materials and covered with polycarbonate caps. Micro-CT and histomorphometric evaluation were conducted. RESULTS In the histomorphometric analysis, new bone formation was significantly higher in the bone substitute (BS) + EMD-liquid group than in the BS only group at both 5 and 10 weeks (p < 0.01). There were statistically significant differences in the material area between the bone substitute and bone substitute + EMD-liquid groups at only 5 weeks (p < 0.05). The BS + EMD-liquid group demonstrated reduced material area to a greater extent. In micro-CT analysis, the BS + EMD-liquid group (27.04 ± 8.06 at 5 weeks, 28.49 ± 9.22 at 10 weeks) showed a significantly higher percentage of mineralized tissue volume at both 5 and 10 weeks (p < 0.05) than the BS only group. CONCLUSION EMD-liquid enhances new bone formation when combined with BCP bone substitute in an animal model. Moreover, the EMD-liquid + BS has significantly lesser material area than BS alone, indicating accelerated graft degradation. Further studies on types of graft materials are required to verify the effect of EMD-liquid and to optimize its regenerative potential. CLINICAL RELEVANCE This study suggests that EMD-liquid may have beneficial effect on bone regeneration with synthetic bone substitute.
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Affiliation(s)
- Junho Jung
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Jung Soo Park
- Department of Periodontology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Michel Dard
- Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University, College of Dental Medicine, New York, NY, USA
| | - Bilal Al-Nawas
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.,Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Yong-Dae Kwon
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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14
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Jasa EE, Gradoville JM, Christiansen MM, Samson KK, Reinhardt RA, Payne JB, Killeen AC. Effects of enamel matrix derivative on clinical and inflammatory outcomes in periodontal maintenance patients: Randomized controlled clinical trial. J Periodontol 2020; 91:1400-1408. [PMID: 32182380 DOI: 10.1002/jper.19-0623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/13/2020] [Accepted: 02/27/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Efficient methods to treat persistent pockets during periodontal maintenance therapy (PMT) require further investigation. The hypothesis of this randomized controlled clinical trial was that local application of enamel matrix derivative (EMD) added to papilla reflection/root preparation (PR/RP) could enhance clinical and inflammatory outcomes, primarily clinical attachment level (CAL). METHODS Fifty PMT patients with generalized stage III-IV, grade B periodontitis presenting with a 6- to 9-mm interproximal PD were randomly allocated to (PR/RP+EMD; n = 24) and control (PR/RP+saline; n = 26) therapies by sex and smoking status. Roots were treated with reflection of interproximal papillae, root planing assisted with endoscope evaluation, and acid etching, followed by EMD or saline application. Probing depth (PD), CAL, plaque index (PI), and interproximal bone height were evaluated at baseline and 12-months post-therapy. Gingival crevicular fluid, bleeding on probing (BOP), and interleukin-1β were tested (ELISA) at baseline, 2 weeks, and 6 and 12 months. Groups were compared over time and between groups with Wilcoxon Rank Sum and t-tests. RESULTS Both PR/RP+ EMD and PR/RP+S resulted in significant improvements in clinical outcomes (PD and CAL, BOP) from baseline to 12 months. No significant differences were found in clinical or inflammatory outcomes between the experimental and control groups. CONCLUSIONS The addition of EMD to PR/RP does not significantly improve clinical or inflammatory outcomes compared with PR/RP alone during periodontal maintenance therapy.
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Affiliation(s)
- Erica E Jasa
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Jessica M Gradoville
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Mary M Christiansen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Kaeli K Samson
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE
| | - Richard A Reinhardt
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Jeffrey B Payne
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
| | - Amy C Killeen
- Department of Surgical Specialties, University of Nebraska Medical Center College of Dentistry, Lincoln, NE
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15
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Aslan S, Buduneli N, Cortellini P. Clinical outcomes of the entire papilla preservation technique with and without biomaterials in the treatment of isolated intrabony defects: A randomized controlled clinical trial. J Clin Periodontol 2020; 47:470-478. [DOI: 10.1111/jcpe.13255] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/26/2019] [Accepted: 01/04/2020] [Indexed: 12/01/2022]
Affiliation(s)
| | - Nurcan Buduneli
- Department of Periodontology School of Dentistry Ege University İzmir Turkey
| | - Pierpaolo Cortellini
- Accademia Toscana di Ricerca Odontostomatologica (ATRO) Florence Italy
- European Research Group on Periodontology (ERGOPERIO) Berne Switzerland
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16
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Abdul Rahman N, Nickles K, Gallenbach K, Dannewitz B, Ramich T, Scharf S, Röllke L, Schacher B, Eickholz P. Five-year stability of clinical attachment after regenerative treatment of infrabony defects compared to controls. J Clin Periodontol 2019; 46:650-658. [PMID: 30972774 DOI: 10.1111/jcpe.13105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/12/2019] [Accepted: 03/31/2019] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the stability of attachment achieved in infrabony defects by regenerative treatment over 60 ± 12 months compared to control teeth. METHODS Patients treated regeneratively in at least one infrabony defect between 2004 and 2010 were screened for this retrospective cohort study. Complete examinations available for baseline, 12 and 60 ± 12 months after surgery, and a respective control tooth without treatment, provided eligibility for analysis. RESULTS Twenty-seven patients (age 58 ± 11.7 years; 12 females, five smokers) were included, each contributing one infrabony defect and one control tooth. Regenerative therapy resulted in significant attachment gain (2.7 ± 1.6 mm; p < 0.001) after 1 and (3.0 ± 2.2 mm; p < 0.001) 5 years. Control teeth were stable (vertical probing attachment level [PAL-V] change: 1 year: 0 ± 0.8 mm; 5 years: -0.2 ± 1.2 mm). The study did not detect any significant change of PAL-V from 1 to 5 years after surgery for regenerative (-0.3 ± 2.4 mm) and control teeth (-0.2 ± 1.4 mm). Multivariate analysis associated smoking and generalized recurrence of periodontitis (amount of sites with PPD > 5 mm) with attachment loss. CONCLUSIONS PAL-V achieved by regenerative therapy in infrabony defects is as stable over 5 years as periodontally reduced but gingivally healthy or gingivitis sites. Smoking and periodontitis recurrence are associated with attachment loss.
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Affiliation(s)
- Natalie Abdul Rahman
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Katrin Nickles
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Kerstin Gallenbach
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Bettina Dannewitz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Tatjana Ramich
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Susanne Scharf
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Lasse Röllke
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Beate Schacher
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany
| | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University, Frankfurt, Frankfurt am Main, Germany
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17
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Rojas MA, Marini L, Pilloni A, Sahrmann P. Early wound healing outcomes after regenerative periodontal surgery with enamel matrix derivatives or guided tissue regeneration: a systematic review. BMC Oral Health 2019; 19:76. [PMID: 31064353 PMCID: PMC6505273 DOI: 10.1186/s12903-019-0766-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Proper wound healing after regenerative surgical procedures is an essential issue for clinical success. Guided tissue regeneration (GTR) and application of enamel matrix derivatives (EMD) are common means to regenerate periodontal tissues. Both methods bear considerable advantages due to their special characteristics, but also go along with certain disadvantages. Today, there is no consensus in the literature whether GTR or EMD show better results regarding early wound healing, which is considered a crucial stage in periodontal regeneration. Therefore, the aim of the present systematic review was to compare the early wound healing after regenerative periodontal surgery with either EMD or GTR treatment. METHODS An electronic literature search in PubMed was performed to identify randomized clinical trials (RCTs) or clinical trials (CTs) comparing regenerative surgery employing EMD and/or GTR in patients with chronic periodontitis. Among the finally included studies, a qualitative and quantitative data extraction regarding early wound healing parameters was performed. Primary outcome parameters were early wound healing index (EWH), flap dehiscence, membrane exposure, suppuration and abscess formation during the first 6 weeks. As secondary parameters, swelling and allergic reactions were assessed. RESULTS Seven studies reporting 220 intrabony periodontal defects in 199 patients were analysed. Flap dehiscence was observed in two studies in 12% of the GTR treated sites and in 10.3% of those treated with EMD. Membrane exposure was evaluated in five studies and was registered in the 28.8% of the defects, while no dehiscence was reported on the EMD group. Swelling was reported only in one study in 8/16 GTR sites and 7/16 EMD sites. Due to considerable heterogeneity of parameters no meta-analysis was possible. CONCLUSIONS Due to considerable heterogeneity of the published studies a clear beneficial effect of the EMD on the early wound healing outcomes after surgical treatment of periodontal intrabony defects cannot be confirmed. Standardized RCT studies are needed in order to allow for proper comparison of early wound healing after both types of surgical approaches.
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Affiliation(s)
- M. A. Rojas
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
| | - L. Marini
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
| | - A. Pilloni
- Section of Periodontics, Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
| | - P. Sahrmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
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18
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Artzi Z, Sudri S, Platner O, Kozlovsky A. Regeneration of the Periodontal Apparatus in Aggressive Periodontitis Patients. Dent J (Basel) 2019; 7:E29. [PMID: 30857253 PMCID: PMC6473354 DOI: 10.3390/dj7010029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/09/2019] [Accepted: 02/22/2019] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study is to evaluate and compare, retrospectively, the outcome of two different periodontal regeneration procedures in patients suffering from aggressive periodontitis (AgP). Twenty-eight patients were diagnosed with AgP, suffering from several intra-bony defects (IBD); that were treated by one of two periodontal regeneration techniques randomly assigned to each patient: a. guided tissue regeneration (GTR) or b. an application of extracted enamel matrix derivatives (EMD) combined with demineralized bone xenograft particles (DBX). Probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession were recorded. Pre-treatment and follow-up (up to 10 years from the surgery) recordings were analyzed statistically within and between groups. A significant reduction was shown at time on PPD and CAL values, however, not between subject groups. CAL values decreased in all sites. At the EMD group (44 sites), CAL gain was 1.92 mm (±1.68) from pre-treatment to follow-up (p < 0.001) and at the GTR group (12 sites) CAL gain of 2.27 (±1.82) mm. In conclusion, 1⁻10 years observations have shown that surgical treatment of AgP patients by either GTR or by application of EMD/DBX results in similar successful clinical results.
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Affiliation(s)
- Zvi Artzi
- Department of Periodontology and Oral Implantology, Tel Aviv University, Tel Aviv-Yafo 69979, Israel.
| | - Shiran Sudri
- Department of Periodontology and Oral Implantology, Tel Aviv University, Tel Aviv-Yafo 69979, Israel.
| | - Ori Platner
- Department of Periodontology and Oral Implantology, Tel Aviv University, Tel Aviv-Yafo 69979, Israel.
| | - Avital Kozlovsky
- Department of Periodontology and Oral Implantology, Tel Aviv University, Tel Aviv-Yafo 69979, Israel.
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19
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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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20
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Clinical usability of aspartate aminotransferase to evaluate the prognosis of periodontal regeneration therapies: prospective, longitudinal study. Odontology 2017; 106:306-315. [DOI: 10.1007/s10266-017-0328-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 10/19/2017] [Indexed: 01/23/2023]
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21
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Shirakata Y, Miron RJ, Shinohara Y, Nakamura T, Sena K, Horai N, Bosshardt DD, Noguchi K, Sculean A. Healing of two-wall intra-bony defects treated with a novel EMD-liquid-A pre-clinical study in monkeys. J Clin Periodontol 2017; 44:1264-1273. [PMID: 28965367 DOI: 10.1111/jcpe.12825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 01/26/2023]
Abstract
AIM To investigate the effect of a novel enamel matrix derivative formulation (EMD-liquid or Osteogain) combined with an absorbable collagen sponge (ACS) on periodontal wound healing in intra-bony defects in monkeys. MATERIALS AND METHODS Chronic two-wall intra-bony defects were created at the distal aspect of eight teeth in three monkeys (Macaca fascicularis). The 24 defects were randomly assigned to one of the following treatments: (i) open flap debridement (OFD) + ACS alone, (ii) OFD + Emdogain + ACS (Emdogain/ACS), (iii) OFD + Osteogain + ACS (Osteogain/ACS) or (iv) OFD alone. At 4 months, the animals were euthanized for histologic evaluation. RESULTS Osteogain/ACS resulted in more consistent formation of cementum, periodontal ligament and bone with limited epithelial proliferation compared to OFD alone, Emdogain/ACS and OFD + ACS. Among the four treatment groups, the Osteogain/ACS group demonstrated the highest amount of regenerated tissues. However, complete periodontal regeneration was not observed in any of the defects in the four groups. CONCLUSIONS The present findings indicate that in two-wall intra-bony defects, reconstructive surgery with Osteogain/ACS appears to be a promising novel approach for facilitating periodontal wound healing/regeneration, thus warranting further clinical testing.
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Affiliation(s)
- Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Richard J Miron
- Department of Periodontology, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.,Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Yukiya Shinohara
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Toshiaki Nakamura
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kotaro Sena
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naoto Horai
- Shin Nippon Biomedical Laboratories, Ltd, Kagoshima, Japan
| | - Dieter D Bosshardt
- Robert K. Schenk Laboratory of Oral Histology, University of Bern, Bern, Switzerland
| | - Kazuyuki Noguchi
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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22
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Aslan S, Buduneli N, Cortellini P. Entire papilla preservation technique in the regenerative treatment of deep intrabony defects: 1-Year results. J Clin Periodontol 2017; 44:926-932. [DOI: 10.1111/jcpe.12780] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 01/22/2023]
Affiliation(s)
| | - Nurcan Buduneli
- Department of Periodontology; School of Dentistry; Ege University; Izmir Turkey
| | - Pierpaolo Cortellini
- Accademia Toscana di Ricerca Odontostomatologica (ATRO); Florence Italy
- European Research Group on Periodontology (ERGOPERIO); Berne Switzerland
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23
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Kaner D, Soudan M, Zhao H, Gaßmann G, Schönhauser A, Friedmann A. Early Healing Events after Periodontal Surgery: Observations on Soft Tissue Healing, Microcirculation, and Wound Fluid Cytokine Levels. Int J Mol Sci 2017; 18:ijms18020283. [PMID: 28134829 PMCID: PMC5343819 DOI: 10.3390/ijms18020283] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/19/2017] [Indexed: 12/17/2022] Open
Abstract
Early wound healing after periodontal surgery with or without enamel matrix derivative/biphasic calcium phosphate (EMD/BCP) was characterized in terms of soft tissue closure, changes of microcirculation, and expression of pro- and anti-inflammatory cytokines in gingival crevicular fluid/wound fluid (GCF/WF). Periodontal surgery was carried out in 30 patients (18 patients: application of EMD/BCP for regeneration of bony defects; 12 patients: surgical crown lengthening (SCL)). Healthy sites were observed as untreated controls. GCF/WF samples were collected during two post-surgical weeks. Flap microcirculation was measured using laser Doppler flowmetry (LDF). Soft tissue healing was evaluated after two weeks. GCF/WF levels of interleukin 1β (IL-1β), tumour necrosis factor (TNF-α), IL-6, and IL-10 were determined using a multiplex immunoassay. Surgery caused similar reductions of flap microcirculation followed by recovery within two weeks in both EMD/BCP and SCL groups. GCF/WF and pro-inflammatory cytokine levels were immediately increased after surgery, and returned only partially to baseline levels within the two-week observation period. Levels of IL-10 were temporarily reduced in all surgical sites. Flap dehiscence caused prolonged elevated levels of GCF/WF, IL-1β, and TNF-α. These findings show that periodontal surgery triggers an immediate inflammatory reaction corresponding to the early inflammatory phase of wound healing, and these inflammation measures are temporary in case of maintained closure of the flap. However, flap dehiscence causes prolonged inflammatory exudation from the periodontal wound. If the biological pre-conditions for periodontal wound healing are considered important for the clinical outcome, care should be taken to maintain primary closure of the flap.
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Affiliation(s)
- Doğan Kaner
- Department of Periodontology, Witten/Herdecke University, 58455 Witten, Germany.
| | - Mouaz Soudan
- Department of Periodontology, Witten/Herdecke University, 58455 Witten, Germany.
| | - Han Zhao
- Multi-Disciplinary Treatment Center, Beijing Stomatological Hospital, Capital Medical University, Beijing 100050, China.
| | - Georg Gaßmann
- Hochschule, University of applied sciences, 50670 Cologne, Germany.
| | - Anna Schönhauser
- Department of Periodontology, Witten/Herdecke University, 58455 Witten, Germany.
| | - Anton Friedmann
- Department of Periodontology, Witten/Herdecke University, 58455 Witten, Germany.
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24
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Awada T, Kunimatsu R, Yoshimi Y, Hirose N, Mitsuyoshi T, Sumi K, Tanimoto K. Effects of C-terminal amelogenin peptides on the metabolism of osteoblasts. Biochem Biophys Res Commun 2017; 482:1154-1159. [DOI: 10.1016/j.bbrc.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
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25
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Abstract
Experimental studies have shown a great potential for periodontal regeneration. The limitations of periodontal regeneration largely depend on the regenerative potential at the root surface. Cellular intrinsic fiber cementum (CIFC), so-called bone-like tissue, may form instead of the desired acellular extrinsic fiber cementum (AEFC), and the interfacial tissue bonding may be weak. The periodontal ligament harbors progenitor cells that can differentiate into periodontal ligament fibroblasts, osteoblasts, and cementoblasts, but their precise location is unknown. It is also not known whether osteoblasts and cementoblasts arise from a common precursor cell line, or whether distinct precursor cell lines exist. Thus, there is limited knowledge about how cell diversity evolves in the space between the developing root and the alveolar bone. This review supports the hypothesis that AEFC is a unique tissue, while CIFC and bone share some similarities. Morphologically, functionally, and biochemically, however, CIFC is distinctly different from any bone type. There are several lines of evidence to propose that cementoblasts that produce both AEFC and CIFC are unique phenotypes that are unrelated to osteoblasts. Cementum attachment protein appears to be cementum-specific, and the expression of two proteoglycans, fibromodulin and lumican, appears to be stronger in CIFC than in bone. A theory is presented that may help explain how cell diversity evolves in the periodontal ligament. It proposes that Hertwig’s epithelial root sheath and cells derived from it play an essential role in the development and maintenance of the periodontium. The role of enamel matrix proteins in cementoblast and osteoblast differentiation and their potential use for tissue engineering are discussed.
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Affiliation(s)
- D D Bosshardt
- Department of Periodontology and Fixed Prosthodontics, School of Dental Medicine, University of Berne, Freiburgstrasse 7, CH-3010 Berne, Switzerland.
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26
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Isehed C, Holmlund A, Renvert S, Svenson B, Johansson I, Lundberg P. Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of peri-implantitis. A randomized controlled trial. J Clin Periodontol 2016; 43:863-73. [PMID: 27418458 DOI: 10.1111/jcpe.12583] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This randomized clinical trial aimed at comparing radiological, clinical and microbial effects of surgical treatment of peri-implantitis alone or in combination with enamel matrix derivative (EMD). METHODS Twenty-six subjects were treated with open flap debridement and decontamination of the implant surfaces with gauze and saline preceding adjunctive EMD or no EMD. Bone level (BL) change was primary outcome and secondary outcomes were changes in pocket depth (PD), plaque, pus, bleeding and the microbiota of the peri-implant biofilm analyzed by the Human Oral Microbe Identification Microarray over a time period of 12 months. RESULTS In multivariate modelling, increased marginal BL at implant site was significantly associated with EMD, the number of osseous walls in the peri-implant bone defect and a Gram+/aerobic microbial flora, whereas reduced BL was associated with a Gram-/anaerobic microbial flora and presence of bleeding and pus, with a cross-validated predictive capacity (Q(2) ) of 36.4%. Similar, but statistically non-significant, trends were seen for BL, PD, plaque, pus and bleeding in univariate analysis. CONCLUSION Adjunctive EMD to surgical treatment of peri-implantitis was associated with prevalence of Gram+/aerobic bacteria during the follow-up period and increased marginal BL 12 months after treatment.
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Affiliation(s)
- Catrine Isehed
- Department of Odontology/Molecular Periodontology, Umeå University, Umeå, Sweden.,Department of Periodontology, Gävle County Hospital, Gävle, Sweden.,Center for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Anders Holmlund
- Department of Periodontology, Gävle County Hospital, Gävle, Sweden.,Center for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Stefan Renvert
- Department of Health Sciences, Kristianstad University, Kristianstad, Sweden.,School of Dental Sciences, Trinity College, Dublin, Ireland.,Blekinge Institute of Technology, Karlskrona, Sweden
| | - Björn Svenson
- Department of Oral Radiology, Postgraduate Dental Education Center, Örebro, Sweden.,Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Pernilla Lundberg
- Department of Odontology/Molecular Periodontology, Umeå University, Umeå, Sweden.
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Groeger S, Windhorst A, Meyle J. Influence of Enamel Matrix Derivative on Human Epithelial Cells In Vitro. J Periodontol 2016; 87:1217-27. [PMID: 27315393 DOI: 10.1902/jop.2016.160088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND In periodontal therapy enamel matrix derivative (EMD) has been successfully used for tissue regeneration by altering activity of various cells involved in periodontal regeneration. Studies have focused primarily on clinical parameters and outcome. Effects of EMD on oral epithelial cells are of crucial importance in order to understand the biology of regeneration. Aims of this study are to investigate proliferative and cytotoxic effects of EMD on oral epithelial cells and their possible influences on epithelial barrier function. METHODS SCC-25 cells, a human squamous cell carcinoma cell line, and primary keratinocytes were either treated with EMD dissolved in culture medium or added to wells/inserts precoated with EMD. Cells were incubated for 24, 48, and 72 hours. Proliferation rate was analyzed measuring the 5-bromo-2'-deoxyuridine nucleotide uptake. Cytotoxic effects of EMD treatment were sampled by lactate dehydrogenase release. Alterations of the epithelial barrier function induced by EMD were investigated by analysis of transepithelial electrical resistance (TER). RESULTS Statistically significant inhibitory effects of both malignant and primary cell proliferation could be demonstrated by precoating culture plate wells with EMD. No cytotoxic effects caused by EMD were detected. Precoating of inserts with EMD induced a significant increase of TER and barrier function. CONCLUSIONS This investigation compares applying EMD in solution to cells with precoating of wells with EMD. When precoating of wells was used solely, inhibition of cell proliferation was evident. Precoating may represent more suitable clinical usage. Furthermore, prelayering EMD induced an increase of TER of primary cells. These results suggest EMD may enhance barrier function.
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Affiliation(s)
- Sabine Groeger
- Department of Periodontology, Justus Liebig University, Giessen, Germany
| | - Anita Windhorst
- Department of Medical Statistics and Informatics, Justus Liebig University
| | - Joerg Meyle
- Department of Periodontology, Justus Liebig University, Giessen, Germany
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Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, Donos N, Lyngstadaas SP, Deschner J, Dard M, Stavropoulos A, Zhang Y, Trombelli L, Kasaj A, Shirakata Y, Cortellini P, Tonetti M, Rasperini G, Jepsen S, Bosshardt DD. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol 2016; 43:668-83. [PMID: 26987551 DOI: 10.1111/jcpe.12546] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 12/27/2022]
Abstract
BACGROUND On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20 years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarström demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibres, and new alveolar bone formation. This pioneering work and vision by Lars Hammarström has paved the way to an enormous amount of publications related to its biological basis and clinical use. Twenty years later, it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium. AIMS This review article aims to: (1) provide the biological background necessary to understand the rational for the use of EMD for periodontal regeneration, (2) present animal and human histological evidence of periodontal regeneration following EMD application, (3) provide clinically relevant indications for the use of EMD and (4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, Nova Southeastern University, Fort Lauderdale, Florida, USA.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - David L Cochran
- Department of Periodontics, Dental School, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stuart Froum
- Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlos Nemcovsky
- Department of Periodontology and Dental Implantology, Dental School, Tel-Aviv University, Tel-Aviv, Israel
| | - Nikos Donos
- Department of Periodontology, Queen Marry University of London, London, UK
| | | | - James Deschner
- Section of Experimental Dento-Maxillo-Facial Medicine, University of Bonn, Bonn, Germany
| | - Michel Dard
- New York University, College of Dentistry, New York, NY, USA
| | | | - Yufeng Zhang
- Department of Oral Implantology, Wuhan University, Wuhan, China
| | - Leonardo Trombelli
- Department of Periodotology, Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Adrian Kasaj
- Department of Operative Dentistry and Periodontology, University Medical Center, Mainz, Germany
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPerio), Genova, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Foundation IRCCS Ca' Granda Polyclinic, Milan, Italy
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Lim HC, Lee JS, Jung UW, Choi SH. Bone Regenerative Potential of Enamel Matrix Protein in the Circumferential Defect Around a Dental Implant. IMPLANT DENT 2016; 25:179-85. [DOI: 10.1097/id.0000000000000383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Zanatta FB, de Souza FG, Pinto TMP, Antoniazzi RP, Rösing CK. Do the clinical effects of enamel matrix derivatives in infrabony defects decrease overtime? A systematic review and meta-analysis. Braz Dent J 2015; 24:446-55. [PMID: 24474283 DOI: 10.1590/0103-6440201302192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/13/2013] [Indexed: 11/22/2022] Open
Abstract
Previous systematic reviews have demonstrated better results with enamel matrix derivative proteins (EMDP) as compared with open flap debridement (OFD) for the management of infrabony periodontal defects (IPD). The aim of this study was to determine whether these differences vary according to the follow-up and quality of the studies. Cochrane Central Register of Controlled Trials, Medline/PubMed, Lilacs, Embase and Web of Science electronic databases were searched up to August 2013 for randomized clinical trials.Eligible outcomes were changes in probing depth (PD), clinical attachment level (CAL),gingival recession (GR) and bone changes (BC). Studies with follow-up of 12 months showed differences of 0.97 mm (CI95% 0.52 - 1.43) and 1.19 mm (CI95% 0.77 - 1.60) for PD and CAL, respectively, favorable for EMDP. Studies with follow-up ≥ 24 months presented advantages of 1.11 mm (CI95% 0.74 -1.48) for CAL and 0.83 mm (CI95% 0.19 -1.48) for PD,with use of EMDP. Considering the quality of studies, those with low risk of bias showed lower difference between groups, presenting 0.8 mm (CI95% 0.24-1.36) for CAL, favorable for EMDP and without differences for PS (0.51 mm, CI95% -0.21 - 1.23). In conclusion, follow-up time (< or > 2 years) and the risk of bias influence the results of treatment with EMDP in IPD.
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Regenerative Therapies in the Treatment of Intrabony Defects Show High Clinical Efficacy. J Evid Based Dent Pract 2015; 15:108-12. [DOI: 10.1016/j.jebdp.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Hoffmann T, Al-Machot E, Meyle J, Jervøe-Storm PM, Jepsen S. Three-year results following regenerative periodontal surgery of advanced intrabony defects with enamel matrix derivative alone or combined with a synthetic bone graft. Clin Oral Investig 2015; 20:357-64. [DOI: 10.1007/s00784-015-1522-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 06/30/2015] [Indexed: 01/08/2023]
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33
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Artzi Z, Tal H, Platner O, Wasersprung N, Weinberg E, Slutzkey S, Gozali N, Carmeli G, Herzberg R, Kozlovsky A. Deproteinized bovine bone in association with guided tissue regeneration or enamel matrix derivatives procedures in aggressive periodontitis patients: a 1-year retrospective study. J Clin Periodontol 2015; 42:547-56. [DOI: 10.1111/jcpe.12413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Zvi Artzi
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Haim Tal
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Ori Platner
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Nadav Wasersprung
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Evgeny Weinberg
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Shimshon Slutzkey
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Nir Gozali
- Currently in Private Practice; Herzliya Israel
| | | | | | - Avital Kozlovsky
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
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34
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Sculean A, Nikolidakis D, Nikou G, Ivanovic A, Chapple ILC, Stavropoulos A. Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review. Periodontol 2000 2015; 68:182-216. [DOI: 10.1111/prd.12086] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2014] [Indexed: 11/29/2022]
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35
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Cortellini P, Tonetti MS. Clinical concepts for regenerative therapy in intrabony defects. Periodontol 2000 2015; 68:282-307. [DOI: 10.1111/prd.12048] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 12/14/2022]
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36
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Miron RJ, Bosshardt DD, Buser D, Zhang Y, Tugulu S, Gemperli A, Dard M, Caluseru OM, Chandad F, Sculean A. Comparison of the Capacity of Enamel Matrix Derivative Gel and Enamel Matrix Derivative in Liquid Formulation to Adsorb to Bone Grafting Materials. J Periodontol 2015; 86:578-87. [DOI: 10.1902/jop.2015.140538] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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37
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Park SH, Choi H, Han JS, Park YB. Comparative study of decalcification versus nondecalcification for histological evaluation of one-wall periodontal intrabony defects in dogs. Microsc Res Tech 2014; 78:94-104. [DOI: 10.1002/jemt.22449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/06/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Sang-Hyun Park
- Oral Science Research Center, Yonsei University College of Dentistry; Seoul Republic of Korea
| | - HyunMin Choi
- Department of Prosthodontics; Oral Science Research Center, Yonsei University College of Dentistry; Seoul Republic of Korea
| | - Jin-Soo Han
- Department of Laboratory Animal Medicine; The Institute for the 3Rs, College of Veterinary Medicine and The Institute for the Veterinary Medicine, Konkuk Univerisity; Seoul Republic of Korea
| | - Young-Bum Park
- Department of Prosthodontics; Oral Science Research Center, Yonsei University College of Dentistry; Seoul Republic of Korea
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38
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Kao RT, Nares S, Reynolds MA. Periodontal regeneration - intrabony defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2014; 86:S77-104. [PMID: 25216204 DOI: 10.1902/jop.2015.130685] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous systematic reviews of periodontal regeneration with bone replacement grafts and guided tissue regeneration (GTR) were defined as state of the art for clinical periodontal regeneration as of 2002. METHODS The purpose of this systematic review is to update those consensus reports by reviewing periodontal regeneration approaches developed for the correction of intrabony defects with the focus on patient-, tooth-, and site-centered factors, surgical approaches, surgical determinants, and biologics. This review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews. A computerized search of the PubMed and Cochrane databases was performed to evaluate the clinically available regenerative approaches for intrabony defects. The search included screening of original reports, review articles, and reference lists of retrieved articles and hand searches of selected journals. All searches were focused on clinically available regenerative approaches with histologic evidence of periodontal regeneration in humans published in English. For topics in which the literature is lacking, non-randomized observational and experimental animal model studies were used. Therapeutic endpoints examined included changes in clinical attachment level, changes in bone level/fill, and probing depth. For purposes of analysis, change in bone fill was used as the primary outcome measure, except in cases in which this information was not available. The SORT (Strength of Recommendation Taxonomy) grading scale was used in evaluating the body of knowledge. RESULTS 1) Fifty-eight studies provided data on patient, tooth, and surgical-site considerations in the treatment of intrabony defects. 2) Forty-five controlled studies provided outcome analysis on the use of biologics for the treatment of intrabony defects. CONCLUSIONS 1) Biologics (enamel matrix derivative and recombinant human platelet-derived growth factor-BB plus β-tricalcium phosphate) are generally comparable with demineralized freeze-dried bone allograft and GTR and superior to open flap debridement procedures in improving clinical parameters in the treatment of intrabony defects. 2) Histologic evidence of regeneration has been demonstrated with laser therapy; however, data are limited on clinical predictability and effectiveness. 3) Clinical outcomes appear most appreciably influenced by patient behaviors and surgical approach rather than by tooth and defect characteristics. 4) Long-term studies indicate that improvements in clinical parameters are maintainable up to 10 years, even in severely compromised teeth, consistent with a favorable/good long-term prognosis.
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Iorio-Siciliano V, Andreuccetti G, Blasi A, Matarasso M, Sculean A, Salvi GE. Clinical outcomes following regenerative therapy of non-contained intrabony defects using a deproteinized bovine bone mineral combined with either enamel matrix derivative or collagen membrane. J Periodontol 2014; 85:1342-50. [PMID: 24835417 DOI: 10.1902/jop.2014.130420] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The purpose of this study is to compare clinical outcomes in the treatment of deep non-contained intrabony defects (i.e., with ≥70% 1-wall component and a residual 2- to 3-wall component in the most apical part) using deproteinized bovine bone mineral (DBBM) combined with either enamel matrix protein derivative (EMD) or collagen membrane (CM). METHODS Forty patients with multiple intrabony defects were enrolled. Only one non-contained defect per patient with an intrabony depth ≥3 mm located in the interproximal area of single- and multirooted teeth was randomly assigned to the treatment with either EMD + DBBM (test: n = 20) or CM + DBBM (control: n = 20). At baseline and after 12 months, clinical parameters including probing depth (PD) and clinical attachment level (CAL) were recorded. The primary outcome variable was the change in CAL between baseline and 12 months. RESULTS At baseline, the intrabony component of the defects amounted to 6.1 ± 1.9 mm for EMD + DBBM and 6.0 ± 1.9 mm for CM + DBBM sites (P = 0.81). The mean CAL gain at sites treated with EMD + DBBM was not statistically significantly different (P = 0.82) compared with CM + DBBM (3.8 ± 1.5 versus 3.7 ± 1.2 mm). No statistically significant difference (P = 0.62) was observed comparing the frequency of CAL gain ≥4 mm between EMD + DBBM (60%) and CM + DBBM (50%) or comparing the frequency of residual PD ≥6 mm between EMD + DBBM (5%) and CM + DBBM (15%) (P = 0.21). CONCLUSION Within the limitations of the present study, regenerative therapy using either EMD + DBBM or CM + DBBM yielded comparable clinical outcomes in deep non-contained intrabony defects after 12 months.
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Affiliation(s)
- Vincenzo Iorio-Siciliano
- University of Naples "Federico II," Department of Dental and Maxillofacial Sciences, Naples, Italy
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40
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Mitani A, Takasu H, Horibe T, Furuta H, Nagasaka T, Aino M, Fukuda M, Fujimura T, Mogi M, Noguchi T. Five-year clinical results for treatment of intrabony defects with EMD, guided tissue regeneration and open-flap debridement: a case series. J Periodontal Res 2014; 50:123-30. [DOI: 10.1111/jre.12188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Mitani
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - H. Takasu
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - T. Horibe
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - H. Furuta
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - T. Nagasaka
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - M. Aino
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - M. Fukuda
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - T. Fujimura
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
| | - M. Mogi
- Department of Medicinal Biochemistry; School of Pharmacy; Aichi Gakuin University; Nagoya Japan
| | - T. Noguchi
- Department of Periodontology; School of Dentistry; Aichi Gakuin University; Nagoya Japan
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Wu SM, Chiu HC, Chin YT, Lin HY, Chiang CY, Tu HP, Fu MMJ, Fu E. Effects of enamel matrix derivative on the proliferation and osteogenic differentiation of human gingival mesenchymal stem cells. Stem Cell Res Ther 2014; 5:52. [PMID: 24739572 PMCID: PMC4076631 DOI: 10.1186/scrt441] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 01/28/2014] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Gingiva-derived mesenchymal stem cells (GMSCs) have recently been harvested and applied for rebuilding lost periodontal tissue. Enamel matrix derivative (EMD) has been used for periodontal regeneration and the formation of new cementum with inserting collagen fibers; however, alveolar bone formation is minimal. Recently, EMD has been shown to enhance the proliferation and mineralization of human bone marrow mesenchymal stem cells. Because the gingival flap is the major component to cover the surgical wound, the effects of EMD on the proliferation and mineralization of GMSCs were evaluated in the present study. METHODS After single cell suspension, the GMSCs were isolated from the connective tissues of human gingiva. The colony forming unit assay of the isolated GMSCs was measured. The expression of stem cell markers was examined by flow cytometry. The cellular telomerase activity was identified by polymerase chain reaction (PCR). The osteogenic, adipogenic and neural differentiations of the GMSCs were further examined. The cell proliferation was determined by MTS assay, while the expression of mRNA and protein for mineralization (including core binding factor alpha, cbfα-1; alkaline phosphatase, ALP; and osteocalcin, OC; ameloblastin, AMBN) were analyzed by real time-PCR, enzyme activity and confocal laser scanning microscopy. RESULTS The cell colonies could be easily identified and the colony forming rates and the telomerase activities increased after passaging. The GMSCs expressed high levels of surface markers for CD73, CD90, and CD105, but showed low expression of STRO-1. Osteogenic, adipogenic and neural differentiations were successfully induced. The proliferation of GMSCs was increased after EMD treatment. ALP mRNA was significantly augmented by treating with EMD for 3 hours, whereas AMBN mRNA was significantly increased at 6 hours after EMD treatment. The gene expression of OC was enhanced at the dose of 100 μg/ml EMD at day 3. Increased protein expression for cbfα-1 at day 3, for ALP at day 5 and 7, and for OC at week 4 after the EMD treatments were observed. CONCLUSIONS Human GMSCs could be successfully isolated and identified. EMD treatments not only induced the proliferation of GMSCs but also enhanced their osteogenic differentiation after induction.
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Yaghobee S, Samadi N, Khorsand A, Ghahroudi AAR, Kadkhodazadeh M. Comparison of the penetration and passage of Streptococcus mutans and Aggregatibacter actinomycetemcomitans through membranes loaded with tetracycline, amoxicillin, and chlorhexidine: an in vitro study. J Basic Clin Physiol Pharmacol 2014; 25:87-97. [PMID: 24423468 DOI: 10.1515/jbcpp-2013-0039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 05/14/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND This study aimed at comparing the colonization and passage of Streptococcus mutans and Aggregatibacter actinomycetemcomitans (Aa) through polytetrafluoroethylene (PTFE) and acellular dermal matrix (ADM) membranes loaded with tetracycline, amoxicillin, and chlorhexidine. METHODS In this in vitro study, PTFE and ADM membranes were loaded with tetracycline, amoxicillin, and chlorhexidine. The colonization and crossing of S. mutans and Aa through these membranes were evaluated using vials containing culture medium. Three-way analysis of variance and Tukey's honestly significant difference test were used for the statistical analyses (p<0.05). RESULTS The membranes loaded with antimicrobial agents significantly decreased bacterial passage compared with the control membranes (not loaded with antimicrobial agents). Significant differences were also detected between membranes in their inhibitory properties (p=0.011). PTFE membrane had higher barrier effect than ADM. Tetracycline had greater antibacterial activity against both species compared with amoxicillin (p=0.021) but had no significant difference with chlorhexidine in this respect (p=0.068). The antimicrobial efficacy of chlorhexidine was in between those of tetracycline and amoxicillin, but the difference between amoxicillin and chlorhexidine in this respect was not statistically significant (p=0.992). Aa had better penetration into the membranes compared with S. mutans. CONCLUSIONS The study results demonstrated that the penetration of S. mutans and Aa decreased into the membranes loaded with tetracycline, amoxicillin, and chlorhexidine and PTFE membrane had a greater barrier effect than ADM. Loading membranes with antimicrobial agents can effectively reduce membrane-associated infections during regenerative procedures.
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Yen CC, Tu YK, Chen TH, Lu HK. Comparison of treatment effects of guided tissue regeneration on infrabony lesions between animal and human studies: a systematic review and meta-analysis. J Periodontal Res 2013; 49:415-24. [PMID: 24111550 DOI: 10.1111/jre.12130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE For ethical reasons it is becoming increasingly more difficult to obtain, from clinical studies, histological data on infrabony defects treated with guided tissue regeneration (GTR) techniques. The aim of this systematic review was to find the value of extrapolating animal data on treatment of periodontal infrabony lesions, using GTR only or GTR + bone grafts, to human clinical results. MATERIAL AND METHODS Searches of the PubMed and Cochrane databases were combined with hand searching of articles published from 1 January 1969 to 1 August 2012. The search included any type of barrier membrane, with or without grafted materials, used to treat periodontal infrabony lesions. All studies with histological or re-entry methodology outcome parameters that evaluated bone-filling and/or new-cementum-formation ratios from a defect depth were collected. When comparing animal and human outcomes, a meta-analysis was used to evaluate the bone-filling ratio, but only a descriptive analysis of the histological studies was performed. RESULTS In total, 22 studies were selected for the meta-analysis. In the GTR + bone graft groups the weighted-average bone-filling ratios were 52% (95% CI: 18-85%) in animals and 57% (95% CI: 30-83%) in humans, which were not statistically significantly different (p = 0.825). Similar results were found in the GTR-only groups, in which the weighted-average bone-filling ratios were 54% (95% CI: 37-72%) in animals and 59% (95% CI: 42-77%) in humans (p = 0.703). New-cementum formation of GTR only and GTR + bone grafts showed comparable ratio outcomes, and both were superior to the control group in animals only (p = 0.042). CONCLUSION Although quality assessments differed between animal and human studies, our analysis indicated that animal models and human results showed similar bone-filling ratios in infrabony defects treated with GTR only or with GTR + bone grafting.
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Affiliation(s)
- C-C Yen
- Department of Periodontology, College of Oral Medicine, Taipei Medical University, Taipei Medical University Hospital, Taipei, Taiwan
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Bhutda G, Deo V. Five years clinical results following treatment of human intra-bony defects with an enamel matrix derivative: a randomized controlled trial. Acta Odontol Scand 2013; 71:764-70. [PMID: 23078573 DOI: 10.3109/00016357.2012.728245] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Emdogain® represents an extracellular matrix derivative that controls and promotes periodontal regeneration. Several studies have demonstrated that the treatment of periodontal defects with Emdogain® leads to improvements in clinical parameters. However, long-time clinical trials establishing clinical usefulness of Emdogain® are scarce. Therefore, the present randomized split mouth, controlled study was undertaken to evaluate the effectiveness of Emdogain® as an adjunct to open flap debridement for the treatment of intra-bony defects over a period of 5 years. MATERIALS AND METHODS The study population consisted of 15 chronic periodontitis patients with bilateral interproximal osseous defects. The test group was treated by open flap debridement with EDTA 24% (PrefGel®) followed by enamel matrix derivative (Emdogain®). The control group was treated by open flap debridement with EDTA 24% (PrefGel®). RESULTS After 1 and 5 years, both the test and control groups showed significant mean PPD reduction. A greater reduction in mean Probing Pocket Depth (PPD) was observed in the test group (3.84 ± 1.05) as compared to the control group (1.92 ± 0.35). The mean Clinical Attachment Level (CAL) gain of 3.18 ± 0.87 mm was observed in the test group, while the control group displayed mean CAL gain of 1.60 ± 0.54 mm. The observed differences were found to be statistically significant in both the groups (p < 0.05). Percentage bone fill was significantly increased at 12 months post-surgery in test group (66.66 ± 7.8%) as compared to control group (31.71 ± 4.1%). CONCLUSION The treatment with Emdogain resulted in a significantly higher CAL gain and PPD reduction in comparison with OFD and PrefGel®.
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Amin HD, Olsen I, Knowles JC, Dard M, Donos N. Effects of enamel matrix proteins on multi-lineage differentiation of periodontal ligament cells in vitro. Acta Biomater 2013; 9:4796-805. [PMID: 22985741 DOI: 10.1016/j.actbio.2012.09.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/03/2012] [Accepted: 09/10/2012] [Indexed: 12/13/2022]
Abstract
The adult periodontal ligament (PDL) is considered to contain progenitor cells that are involved in the healing of periodontal wounds. Treatment with enamel matrix derivative (EMD), a heat-treated preparation derived from enamel matrix proteins (EMPs), has been shown to be of some clinical benefit in eliciting periodontal regeneration in vivo. Although there is extensive information available about the effects of EMD on periodontal regeneration, the precise influence of this material on alveolar bone and the formation of blood vessels and proprioceptive sensory nerves, prominent features of functionally active periodontal tissue, remain unclear. The aim of the present study was therefore to examine the effects of EMD on the ability of human periodontal ligament cells (HPCs) to undergo multi-lineage differentiation in vitro. Our results showed that HPCs treated with EMD under non-selective growth conditions did not show any evidence of osteogenic, adipogenic, chondrogenic, neovasculogenic, neurogenic and gliogenic "terminal" differentiation. In contrast, under selective lineage-specific culture conditions, EMD up-regulated osteogenic, chondrogenic and neovasculogenic genes and "terminal" differentiation, but suppressed adipogenesis, neurogenesis and gliogenesis. These findings thus demonstrate for the first time that EMD can differentially modulate the multi-lineage differentiation of HPCs in vitro.
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Affiliation(s)
- Harsh D Amin
- Division of Biomaterials and Tissue Engineering, Department of Clinical Research, UCL Eastman Dental Institute, University College London, London, UK
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Döri F, Arweiler NB, Szántó E, Agics A, Gera I, Sculean A. Ten-year results following treatment of intrabony defects with an enamel matrix protein derivative combined with either a natural bone mineral or a β-tricalcium phosphate. J Periodontol 2012; 84:749-57. [PMID: 22873657 DOI: 10.1902/jop.2012.120238] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or β-tricalcium phosphate (β-TCP). METHODS Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + β-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + β-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + β-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + β-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years. CONCLUSION Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + β-TCP can be maintained over a period of 10 years.
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Affiliation(s)
- Ferenc Döri
- Department of Periodontology, Semmelweis University, Budapest, Hungary
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Mueller VT, Welch K, Bratu DC, Wang HL. Early and late studies of EMD use in periodontal intrabony defects. J Periodontal Res 2012; 48:117-25. [PMID: 22860751 DOI: 10.1111/j.1600-0765.2012.01510.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The clinical efficacy of EMDs for the treatment of periodontal infrabony defects has been reported. However, recent publications have questioned the validity of results from early findings. Hence, the purpose of this study was to compare the results obtained from early and late studies when EMD was used as an adjunct in treating human intrabony defects during flap surgery. The aim of this meta-analysis was to evaluate the validity of results published from early studies compared with those published from later studies. MATERIAL AND METHODS PubMed and MEDLINE searches were performed. The evaluation period was 1997-2010 and it was divided into two groups of equal periods of time: early studies (1997-2003) and late studies (2004-2010). The clinical parameters assessed were clinical attachment level (CAL), probing pocket depth and bone gain (BG; measured as a percentage or in mm). RESULTS No statistically significant difference was found between the results obtained from early studies (1997-2003) and late studies (2004-2010) with regards to CAL gain, probing pocket depth reduction and BG. Nonetheless, both study periods showed a benefit for using EMD to treat periodontal infrabony defects when compared with the groups without EMD during open flap surgery. CONCLUSIONS The results obtained from this study failed to show any potential differences between the results published from early studies and late studies with regards to the clinical effectiveness of EMD in treating periodontal infrabony defects.
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Affiliation(s)
- V T Mueller
- Graduate Periodontics, School of Dentistry, University of Michigan, Ann Arbor, MI 48109-1078, USA
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Miron RJ, Bosshardt DD, Laugisch O, Katsaros C, Buser D, Sculean A. Enamel Matrix Protein Adsorption to Root Surfaces in the Presence or Absence of Human Blood. J Periodontol 2012; 83:885-92. [DOI: 10.1902/jop.2011.110404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Miron RJ, D. Bosshardt D, Hedbom E, Zhang Y, Haenni B, Buser D, Sculean A. Adsorption of Enamel Matrix Proteins to a Bovine-Derived Bone Grafting Material and Its Regulation of Cell Adhesion, Proliferation, and Differentiation. J Periodontol 2012; 83:936-47. [DOI: 10.1902/jop.2011.110480] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste. Clin Oral Investig 2012; 17:423-30. [DOI: 10.1007/s00784-012-0739-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 04/12/2012] [Indexed: 11/27/2022]
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