1
|
Ibrahim AA, Tawfik OK, ElNahass H. Partial (incomplete) removal of granulation tissue using modified minimally invasive surgical technique in treatment of infrabony defects (randomized control clinical trial). BMC Surg 2024; 24:230. [PMID: 39135196 PMCID: PMC11318119 DOI: 10.1186/s12893-024-02509-w] [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: 09/06/2023] [Accepted: 07/22/2024] [Indexed: 08/15/2024] Open
Abstract
AIM This study aims to compare the clinical and radiographic outcomes after complete versus incomplete removal of granulation tissue (GT) during modified minimally invasive surgical technique (M-MIST) for management of periodontitis patients with deep pockets associated with infra-bony defects. METHODOLOGY Ten patients with a total of 14 deep non-resolving pockets (≥ 5 mm) associated with a vertical infra-bony defect were recruited for this study. They were randomized into 2 groups; a test group with incomplete removal of GT and a control group with complete removal of GT. Clinical parameters of clinical attachment level (CAL), residual probing depth (rPD) and buccal recession (Rec.) were recorded every 3 months. Radiographic periapicals were taken at baseline, 6 and 9 months. The significance level was set to 0.05. RESULTS None of the results showed statistical significance between the 2 groups (p > 0.05). The test group showed less CAL gain (2 ± 0.87 mm, p = 0.062), more reduction in rPD (3.1 ± 0.96 mm, p = 0.017) and more recession (0.857 ± 0.26 mm, p = 0.017) than control group CAL gain (2.4 ± 0.58 mm, p = 0.009), rPD reduction (2.9 ± 0.3 mm, p = 0.001) and recession (0.5 ± 0.34 mm, p = 0.203) respectively. Control group had linear reduction in depth defect (DD) (0.68 ± 0.287, p = 0.064) compared to an increase in DD in test group (-0.59 ± 0.5, p = 0.914). CONCLUSIONS No statistical significance were observed in healing parameters between complete removal of GT in M-MIST and incomplete (partial) removal of GT of deep pockets with infra-bony defects both clinically and radiographically. Further studies with larger samples are needed to confirm the results.
Collapse
Affiliation(s)
- Ahmed Adel Ibrahim
- Faculty of Dentistry, Cairo University, 5 Mostasmr Al sagheer st, Sheikh Zayed, Giza, Egypt.
| | | | - Hani ElNahass
- Periodontology department, Cairo University, Giza, Egypt
| |
Collapse
|
2
|
Miron RJ. Optimized bone grafting. Periodontol 2000 2024; 94:143-160. [PMID: 37610202 DOI: 10.1111/prd.12517] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
Bone grafting is routinely performed in periodontology and oral surgery to fill bone voids. While autogenous bone is considered the gold standard because of its regenerative properties, allografts and xenografts have more commonly been utilized owing to their availability as well as their differential regenerative/biomechanical properties. In particular, xenografts are sintered at high temperatures, which allows for their slower degradation and resorption rates and/or nonresorbable features. As a result, clinicians have combined xenografts with other classes of bone grafts (most notably allografts and autografts in various ratios) for procedures requiring better long-term stability, such as contour grafting, sinus elevation procedures, and vertical bone augmentations. This review addresses the regenerative properties of each class of bone grafts and then highlights the importance of understanding each of their biomechanical and regenerative properties for clinical applications, including extraction site management, contour augmentation, sinus grafting, and horizontal and vertical augmentation procedures. Thereafter, an introduction toward the novel production of nonresorbable bone allografts (NRBAs) via high-temperature sintering is presented. These NRBAs not only pose the advantage of being more biocompatible than xenografts owing to their origin (human vs. animal bone) but also display nonresorbable properties similar to those of xenografts. Thus, while packaging allografts with xenografts in premixtures specific to various clinical indications has never been permitted owing to cross-species contamination and FDA/CE requirements, the discovery and production of NRBAs allows premixing with standard allografts in various ratios without regulatory restrictions. Therefore, premixtures of allografts with NRBAs can be produced in various ratios for specific indications (e.g., a 1:1 ratio similar to an allograft/xenograft mixture for sinus grafting) without the need for purchasing separate classes of bone grafts. This optimized form of bone grafting could theoretically provide clinicians more precise ratios without the need to purchase separate bone grafts. This review highlights the future potential for simplified and optimized bone grafting in periodontology and implant dentistry.
Collapse
Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Galarraga-Vinueza ME, Barootchi S, Nevins ML, Nevins M, Miron RJ, Tavelli L. Twenty-five years of recombinant human growth factors rhPDGF-BB and rhBMP-2 in oral hard and soft tissue regeneration. Periodontol 2000 2024; 94:483-509. [PMID: 37681552 DOI: 10.1111/prd.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Contemporary oral tissue engineering strategies involve recombinant human growth factor approaches to stimulate diverse cellular processes including cell differentiation, migration, recruitment, and proliferation at grafted areas. Recombinant human growth factor applications in oral hard and soft tissue regeneration have been progressively researched over the last 25 years. Growth factor-mediated surgical approaches aim to accelerate healing, tissue reconstruction, and patient recovery. Thus, regenerative approaches involving growth factors such as recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and recombinant human bone morphogenetic proteins (rhBMPs) have shown certain advantages over invasive traditional surgical approaches in severe hard and soft tissue defects. Several clinical studies assessed the outcomes of rhBMP-2 in diverse clinical applications for implant site development and bone augmentation. Current evidence regarding the clinical benefits of rhBMP-2 compared to conventional therapies is inconclusive. Nevertheless, it seems that rhBMP-2 can promote faster wound healing processes and enhance de novo bone formation, which may be particularly favorable in patients with compromised bone healing capacity or limited donor sites. rhPDGF-BB has been extensively applied for periodontal regenerative procedures and for the treatment of gingival recessions, showing consistent and positive outcomes. Nevertheless, current evidence regarding its benefits at implant and edentulous sites is limited. The present review explores and depicts the current applications, outcomes, and evidence-based clinical recommendations of rhPDGF-BB and rhBMPs for oral tissue regeneration.
Collapse
Affiliation(s)
- Maria Elisa Galarraga-Vinueza
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA
- School of Dentistry, Universidad de las Américas (UDLA), Quito, Ecuador
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Marc L Nevins
- Division of Periodontology, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Myron Nevins
- Division of Periodontology, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Lorenzo Tavelli
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Division of Periodontology, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Abd El-Azeem SH, Khalil AA, Ibrahim MAM, Gamal AY. The use of integrin binding domain loaded hydrogel (RGD) with minimally invasive surgical technique in treatment of periodontal intrabony defect: a randomized clinical and biochemical study. J Appl Oral Sci 2023; 31:e20230263. [PMID: 38126565 PMCID: PMC10786453 DOI: 10.1590/1678-7757-2023-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/17/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Periodontal regeneration faces multiple challenges, the most important being cellular insufficiency. In an attempt to improve defect cellularity, we aimed to demonstrate enhancing cellular attraction using arginine-glycine-aspartic acid (RGD) adhesion molecule legend blended hydrogel within the intrabony defects. METHODOLOGY Forty-five intrabony defects were selected from patients with stage III or IV - grade A or B periodontitis and divided randomly into three equal groups of 15 each: group1 (G1): received minimally invasive surgical technique (MIST) alone, group2 (G2): received MIST and placebo hydrogel injection, and group3 (G3): were treated with MIST and RGD hydrogel injection. Primary outcomes 6 months following therapy were; defect base fill (DBF) and defect width measurement (DW); secondary outcomes were clinical attachment level (CAL), pocket depth (PD), plaque index (PI), gingival index (GI), and biochemical analysis of bone morphogenetic protein (BMP-2) evaluated at 1,7,14 and 21 days following therapy. RESULTS Significant improvements in DBF, CAL, and PD were observed in the three studied groups 6 months following therapy compared to baseline (p<0.05). A significant improvement in DBF was reported in G3 compared to G1 and 2 (p=0.005). Additionally, a significantly higher CAL gain was reported in G3 compared to that of G1 (p=0.02). Group 3 was associated with a significantly higher level of BMP-2 compared to G1 and G2 in all reported periods. CONCLUSION RGD peptide carried on a hydrogel delivery agent and contained with a minimally invasive flap could be a reliable option in improving the outcomes of periodontal therapy.
Collapse
Affiliation(s)
- Shaimaa Hamdy Abd El-Azeem
- Nahda University, Faculty of Dentistry Oral Medicine, Oral Diagnosis and Periodontology Department, Beni Swef, Egypt
| | - Ahmed Abdallah Khalil
- Minia University, Faculty of Dentistry Oral Medicine, Oral Diagnosis and Periodontology Department, Minia, Egypt
| | | | - Ahmed Y Gamal
- Ain Shams Universit, Faculty of Dentistry Oral Medicine, Oral Diagnosis and Periodontology Department, Cairo, Egypt
- Misr University for Science and Technology, Faculty of Dentistry, Cairo, Egypt
| |
Collapse
|
5
|
Tavelli L, Barootchi S, Rasperini G, Giannobile WV. Clinical and patient-reported outcomes of tissue engineering strategies for periodontal and peri-implant reconstruction. Periodontol 2000 2023; 91:217-269. [PMID: 36166659 PMCID: PMC10040478 DOI: 10.1111/prd.12446] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/25/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
Scientific advancements in biomaterials, cellular therapies, and growth factors have brought new therapeutic options for periodontal and peri-implant reconstructive procedures. These tissue engineering strategies involve the enrichment of scaffolds with living cells or signaling molecules and aim at mimicking the cascades of wound healing events and the clinical outcomes of conventional autogenous grafts, without the need for donor tissue. Several tissue engineering strategies have been explored over the years for a variety of clinical scenarios, including periodontal regeneration, treatment of gingival recessions/mucogingival conditions, alveolar ridge preservation, bone augmentation procedures, sinus floor elevation, and peri-implant bone regeneration therapies. The goal of this article was to review the tissue engineering strategies that have been performed for periodontal and peri-implant reconstruction and implant site development, and to evaluate their safety, invasiveness, efficacy, and patient-reported outcomes. A detailed systematic search was conducted to identify eligible randomized controlled trials reporting the outcomes of tissue engineering strategies utilized for the aforementioned indications. A total of 128 trials were ultimately included in this review for a detailed qualitative analysis. Commonly performed tissue engineering strategies involved scaffolds enriched with mesenchymal or somatic cells (cell-based tissue engineering strategies), or more often scaffolds loaded with signaling molecules/growth factors (signaling molecule-based tissue engineering strategies). These approaches were found to be safe when utilized for periodontal and peri-implant reconstruction therapies and implant site development. Tissue engineering strategies demonstrated either similar or superior clinical outcomes than conventional approaches for the treatment of infrabony and furcation defects, alveolar ridge preservation, and sinus floor augmentation. Tissue engineering strategies can promote higher root coverage, keratinized tissue width, and gingival thickness gain than scaffolds alone can, and they can often obtain similar mean root coverage compared with autogenous grafts. There is some evidence suggesting that tissue engineering strategies can have a positive effect on patient morbidity, their preference, esthetics, and quality of life when utilized for the treatment of mucogingival deformities. Similarly, tissue engineering strategies can reduce the invasiveness and complications of autogenous graft-based staged bone augmentation. More studies incorporating patient-reported outcomes are needed to understand the cost-benefits of tissue engineering strategies compared with traditional treatments.
Collapse
Affiliation(s)
- Lorenzo Tavelli
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Shayan Barootchi
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- IRCCS Foundation Polyclinic Ca’ Granda, University of Milan, Milan, Italy
| | | |
Collapse
|
6
|
Tavelli L, Chen CYJ, Barootchi S, Kim DM. Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis. J Periodontol 2022; 93:1803-1826. [PMID: 36279121 DOI: 10.1002/jper.22-0120] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects. METHODS A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration. RESULTS A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor. CONCLUSIONS Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.
Collapse
Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Chia-Yu Jennifer Chen
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - David M Kim
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Silviya S, C.M. A, Prakash P, Bahammam SA, Bahammam MA, Almarghlani A, Assaggaf M, Kamil MA, Subramanian S, Balaji TM, Patil S. The Efficacy of Low-Level Laser Therapy Combined with Single Flap Periodontal Surgery in the Management of Intrabony Periodontal Defects: A Randomized Controlled Trial. Healthcare (Basel) 2022; 10:healthcare10071301. [PMID: 35885827 PMCID: PMC9320605 DOI: 10.3390/healthcare10071301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed at assessing the clinical outcomes of the Single Flap Approach (SFA) with the additional use of Low-level laser therapy (LLLT). The defects were treated as per the principles of SFA, whereby 20 defects received only SFA (control group) and 20 defects received additional LLLT for bio stimulation/bio modulation (test group). Stable primary closure of the flaps was obtained with vertical internal mattress sutures. Plaque indices (FMPS), clinical attachment levels (CAL), probing pocket depth (PPD), and gingival bleeding scores (FMBS) were calculated at baseline, and at the 3rd and 6th months in both groups. An EHI score of 1 was observed at all sites except for two, where a score of 2 in the control group at week 2 was observed. In the test group, the PPD reduction at 6 months was 3.60 ± 0.95 and in the control group it was 3.75 ± 0.91 mm. CAL gain at 6 months was 2.70 ± 1.36 mm and 3.45 ± 1.2 mm in the test group and showed no statistical significance. These data suggested the positive effect of LLLT over CAL gain; thus, LLLT may be combined with SFA to potentially enhance the early wound healing and higher clinical outcomes in terms of increase in CAL and decrease in PPD.
Collapse
Affiliation(s)
- S. Silviya
- Department of Periodontics, SRM Dental College and Hospital, Ramapuram, Chennai 600089, India; (S.S.); (A.C.M.); (S.S.)
| | - Anitha C.M.
- Department of Periodontics, SRM Dental College and Hospital, Ramapuram, Chennai 600089, India; (S.S.); (A.C.M.); (S.S.)
| | - P.S.G. Prakash
- Department of Periodontics, SRM Dental College and Hospital, Ramapuram, Chennai 600089, India; (S.S.); (A.C.M.); (S.S.)
- Correspondence: (P.S.G.P.); (S.P.)
| | - Sarah Ahmed Bahammam
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, Taibah University, Medina 42353, Saudi Arabia;
| | - Maha A. Bahammam
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah 80209, Saudi Arabia; (M.A.B.); (A.A.); (M.A.)
- Executive Presidency of Academic Affairs, Saudi Commission for Health Specialties, Riyadh 11614, Saudi Arabia
| | - Ammar Almarghlani
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah 80209, Saudi Arabia; (M.A.B.); (A.A.); (M.A.)
| | - Mohammad Assaggaf
- Department of Periodontology, Faculty of Dentistry, King Abdulaziz University, Jeddah 80209, Saudi Arabia; (M.A.B.); (A.A.); (M.A.)
| | - Mona Awad Kamil
- Department of Preventive Dental Science, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia;
| | - Sangeetha Subramanian
- Department of Periodontics, SRM Dental College and Hospital, Ramapuram, Chennai 600089, India; (S.S.); (A.C.M.); (S.S.)
| | | | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia
- Correspondence: (P.S.G.P.); (S.P.)
| |
Collapse
|
8
|
Cortellini P, Cortellini S, Bonaccini D, Tonetti MS. Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs. J Clin Periodontol 2022; 49:528-536. [PMID: 35415940 DOI: 10.1111/jcpe.13627] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 01/09/2023]
Abstract
AIM The modified minimally invasive surgical technique (M-MIST) optimizes wound stability in the treatment of intrabony defects. Short-term observations show similar results as with flap alone or adjunctive regenerative materials. This study aims to compare the stability of the long-term outcomes, complication-free survival, and costs of the three treatment options. MATERIALS AND METHODS Forty-five intrabony defects in 45 patients were randomized to M-MIST alone (N = 15), combined with enamel matrix derivative (M-MIST + EMD, N = 15), or EMD plus bone-mineral-derived xenograph (M-MIST + EMD + BMDX, N = 15). Supportive periodontal care (SPC) and necessary re-treatment were provided for 10 years. RESULTS Three subjects were lost to follow-up. Clinical attachment level differences between 1 and 10 years were -0.1 ± 0.7 mm for M-MIST, -0.1 ± 0.8 mm for M-MIST + EMD, and -0.3 ± 0.6 mm for M-MIST + EMD + BMDX (p > .05 for within- and between-group differences). Four episodes of recurrence occurred in the M-MIST group, four in the M-MIST + EMD group, and five in the M-MIST + EMD + BMDX group. No significant differences in complication-free survival were observed between the three groups (p = .47). Complication-free survival was 7.46 years (95% confidence interval: 7.05-7.87) for the whole population. The M-MIST + EMD + BMDX group lost one treated tooth. Data indicated no significant inter-group difference of the total cost of recurrence over 10 years. When the baseline cost of treatment was considered, the total cost was lower for M-MIST alone. CONCLUSIONS Teeth with deep pockets associated with intrabony defects can be successfully maintained over the long term with either M-MIST alone or by adding a regenerative material in the context of a careful SPC programme. M-MIST alone provided similar short- and long-term benefits as regeneration, at a lower cost. These findings need to be confirmed in larger, independent studies.
Collapse
Affiliation(s)
- Pierpaolo Cortellini
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy.,European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Private Practice, Florence, Italy.,Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium
| | - Simone Cortellini
- Department of Oral Health Sciences, KU Leuven and Dentistry (Periodontology), University Hospitals Leuven, Leuven, Belgium.,Private Practice, The Hague, The Netherlands
| | | | - Maurizio S Tonetti
- Accademia Toscana di Ricerca Odontostomatologica (ATRO), Florence, Italy.,European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Shanghai PerioImplant Innovation Center, Department of Oral and Maxillofacial Implantology, Shanghai Ninth People Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center of Oral Diseases, National Center of Stomatology, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
9
|
Thamaraiselvan M, Narayan S, Soundarajan S. Minimally invasive surgery periodontal therapy for the treatment of intrabony periodontal defects: A systematic review. Contemp Clin Dent 2022; 13:101-107. [PMID: 35846580 PMCID: PMC9285832 DOI: 10.4103/ccd.ccd_1046_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/26/2020] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Minimally invasive therapeutic approaches have become the standard of care for many medical procedures. Conventional periodontal surgical therapies involve extensive tissue reflection, resulting in increased morbidity which stands to reason out that Minimally invasive surgery (MIS) approach for periodontal therapy would result in less morbidity and better esthetics for the patient. Thus, the aim of this review is to assess the clinical efficacy of MIS periodontal therapy compared to conventional access flap surgery for the treatment of intrabony periodontal defects. Materials and Methods: An electronic and manual search was done to identify and collect studies evaluating MIS periodontal therapy for the treatment of intrabony periodontal defects in terms of periodontal probing depth (PPD) reduction, clinical attachment level (CAL) gain, and gingival recession (REC) with a minimum of 6 month follow-up published in English. Six studies which satisfied the inclusion criteria were included for the review and the data extracted. Results: The six included studies contributed to a total of 193 patients who underwent 93 MIS therapies for treating intrabony defects with at least a 6-month follow-up. Clinical evaluation showed a PPD reduction ranging from 3.55 ± 0.88 mm to 5.2 ± 1.6 mm, while CAL gain ranged from 2.82 ± 1.19 mm to 4.5 ± 1.1 mm, while the change in gingival margin level ranged from 0.06 mm to 0.5 mm. Only one study directly compared single flap approach (SFA) (a type of MIS) to double flap approach (papilla preservation flap) which reported PPD reduction and CAL gain to be better in SFA. Conclusion: Even though the above evidence compels us to believe that minimally invasive periodontal surgery is less invasive, less time consuming, and less morbid, the lack of enough studies directly comparing MIS with conventional access flap surgeries suggest that these conclusions are arbitrary. Thus, there is currently an absence of adequate evidence to substantiate the beneficial effect of minimally invasive periodontal surgical approach compared to a conventional access flap surgery for the treatment of intrabony periodontal defects.
Collapse
|
10
|
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.
Collapse
|
11
|
Liu B, Ouyang X, Kang J, Zhou S, Suo C, Xu L, Liu J, Liu W. Efficacy of periodontal minimally invasive surgery with and without regenerative materials for treatment of intrabony defect: a randomized clinical trial. Clin Oral Investig 2021; 26:1613-1623. [PMID: 34414521 DOI: 10.1007/s00784-021-04134-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/06/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The minimally invasive surgical technique was modified in suture (MISTms) in this study. The trial was to determine the efficacy of MISTms with and without regenerative materials for the treatment of intrabony defect and to identify factors influencing 1-year clinical attachment level (CAL) gain. METHODS Thirty-six patients with interdental intrabony defects were randomly assigned to MISTms (MISTms alone, 18) or MISTms plus deproteinized bovine bone mineral and collagen membrane (MISTms combined, 18). Wound healing was evaluated by early healing index (EHI) at 1, 2, 3, and 6 weeks. Probing depth (PD), CAL, gingival recession, radiographic defect depth, and distance from the base of defect to the cementoenamel junction were recorded at baseline and 1 year postoperatively. A one-year composite outcome measure based on the combination of CAL gain and post-surgery PD was evaluated. Factors influencing 1-year CAL gain were analyzed. RESULTS Fifteen patients in MISTms-alone and 16 in the MISTms-combined group finished the study. The MISTms-alone group showed significantly better wound healing at 1 week. CAL significantly gained in the MISTms-alone and MISTms-combined group, with 2.53 ± 1.80 mm and 2.00 ± 1.38 mm respectively. The radiographic bone gain was 3.00 ± 1.56 mm and 3.85 ± 1.69 mm respectively. However, there were no significant differences between the two groups about 1-year outcomes. Lower EHI (optimal wound healing) and more baseline CAL positively influenced 1-year CAL gain. CONCLUSIONS MISTms is an effective treatment for intrabony defects. The regenerative materials do not show an additional effect on 1-year outcomes. Early wound healing and baseline CAL are factors influencing 1-year CAL gain. CLINICAL RELEVANCE MISTms with and without regenerative materials are both effective treatments for intrabony defect. TRIAL REGISTRATION ClinicalTrials.gov Identifier: ChiCTR2100043272.
Collapse
Affiliation(s)
- Bei Liu
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Xiangying Ouyang
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China.
| | - Jun Kang
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Shuangying Zhou
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Chao Suo
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Lingqiao Xu
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Jianru Liu
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| | - Wenyi Liu
- Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, 22 Zhongguancun South Avenue, Haidian District, Beijing, 100081, People's Republic of China
| |
Collapse
|
12
|
Panda S, Khijmatgar S, Das M, Arbildo-Vega H, Del Fabbro M. Recombinant Human Derived Growth and Differentiating Factors in treatment of periodontal intrabony defects: Systematic review and network meta-analysis. J Tissue Eng Regen Med 2021; 15:900-914. [PMID: 34370897 DOI: 10.1002/term.3236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/17/2021] [Accepted: 07/22/2021] [Indexed: 11/07/2022]
Abstract
The introduction of recombinant human growth and differentiation factors (rhGFs) for intrabony defects regeneration has represented a considerable breakthrough in recent years. However, they have been used in different concentrations, doses and combined with various scaffolds, and there is no evidence on which the most effective formulation for periodontal regeneration is. Therefore, we aimed to evaluate and rank the various formulations of such bioactive agents through network meta-analysis of clinical studies. The protocol registration was done on PROSPERO with registration ID CRD42020213753. To report NMA, we followed PRISMA guidelines and searched PUBMED, Embase, Web of Science and Cochrane Central electronic databases. Studies were screened based on specific inclusion criteria. Primary outcomes extracted from included studies were the most common indexes for periodontal regeneration (PPD, CAL, %bone filling). The NMA analysis included network plots, contribution plots, inconsistency plots (if eligible to form the loop), predictive interval plots, SUCRA rankings and multidimensional scale ranking (MDS) plots. SUCRA would demonstrate the rankings of multiple competing bioactive agents based on their best performance. Twelve clinical studies for qualitative and quantitative analysis were considered. Network meta-analysis found that rhFGF + hydroxyapatite was ranked highest in PPD and CAL outcome. rhPDGF-BB+β-tricalcium phosphate was ranked highest in the percentage of bone filling. In addition, all bioactive agents performed better than control groups without rhGFs. Despite clear benefits deriving from rhGFs for periodontal regeneration, the present results should be interpreted with caution due to several confounding factors affecting the outcome. Nevertheless, further well designed randomized clinical trials will allow establishing guidelines for an appropriate indication of the use of rhGFs.
Collapse
Affiliation(s)
- Sourav Panda
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Department of Oral Biology and Genomic Studies, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, India
| | - Mohit Das
- Department of Periodontics and Oral Implantology, Institute of Dental Sciences, Siksha O Anusandhan (Deemed to be) University, Bhubaneswar, Odisha, India
| | - Heber Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo, Peru
- Department of General Dentistry, Dentistry School, Universidad Particular de Chiclayo, Chiclayo, Peru
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| |
Collapse
|
13
|
Ng E, Tay JRH, Ong MMA. Minimally Invasive Periodontology: A Treatment Philosophy and Suggested Approach. Int J Dent 2021; 2021:2810264. [PMID: 34257659 PMCID: PMC8245214 DOI: 10.1155/2021/2810264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 01/20/2023] Open
Abstract
Severe periodontitis is a highly prevalent dental disease. With the advent of implant dentistry, teeth are often extracted and replaced. Periodontal surgery, where indicated, could also result in increased trauma to the patient. This literature review discusses different treatment modalities for periodontitis and proposes a treatment approach emphasizing maximum preservation of teeth while minimizing morbidity to the patient. Scientific articles were retrieved from the MEDLINE/PubMed database up to January 2021 to identify appropriate articles that addressed the objectives of this review. This was supplemented with hand searching using reference lists from relevant articles. As tooth prognostication does not have a high predictive value, a more conservative approach in extracting teeth should be abided by. This may involve repeated rounds of nonsurgical periodontal therapy, and adjuncts such as locally delivered statin gels and subantimicrobial-dose doxycycline appear to be effective. Periodontal surgery should not be carried out at an early phase in therapy as improvements in nonsurgical therapy may be observed up to 12 months from initial treatment. Periodontal surgery, where indicated, should also be minimally invasive, with periodontal regeneration being shown to be effective over 20 years of follow-up. Biomarkers provide an opportunity for early detection of disease activity and personalised treatment. Quality of life is proposed as an alternative end point to the traditional biomedical paradigm focused on the disease state and clinical outcomes. In summary, minimally invasive therapy aims to preserve health and function of the natural dentition, thus improving the quality of life for patients with periodontitis.
Collapse
Affiliation(s)
- Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - Marianne Meng Ann Ong
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| |
Collapse
|
14
|
Pardo-Zamora G, Moreno-Rodríguez JA, Ortiz-Ruíz AJ. Non-Incised Papilla Surgical Approach and Leukocyte Platelet-Rich Fibrin in Periodontal Reconstruction of Deep Intrabony Defects: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052465. [PMID: 33802261 PMCID: PMC7967597 DOI: 10.3390/ijerph18052465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/18/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
We present the preliminary results of the treatment of teeth with a deep, non-contained periodontal residual defect, vestibular bone dehiscence, and soft tissue recession, by combining an apical non-incised papilla surgical approach (NIPSA) to the defect and leukocyte platelet-rich fibrin (L-PRF) in the vestibular aspect. Four patients (upper left first premolar, upper left central incisor, upper right central incisor and upper right lateral incisor) have been treated. At one year of follow up, all cases showed a considerable reduction in the periodontal pocket depth, a gain in clinical attachment and no bleeding on probing, as well as an improvement in the marginal soft tissue minimizing soft tissue contraction (recession and/or loss of papilla) and improving soft tissue architecture. NIPSA plus L-PRF seem to improve clinical outcomes in deep non-contained intrabony defects associated with soft tissue recession.
Collapse
|
15
|
Zhang C, Zhang H, Yue Z, Miao L, Han Y, Liu K, Hou J. Modified minimally invasive surgical technique plus Bio-Oss Collagen for regenerative therapy of isolated interdental intrabony defects: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e040046. [PMID: 33303446 PMCID: PMC7733185 DOI: 10.1136/bmjopen-2020-040046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Periodontal regeneration surgery has been widely used to deal with intrabony defects. Modified minimally invasive surgical technique (M-MIST) is designed to deal with isolated interdental intrabony defects, and has achieved satisfactory periodontal regenerative effect. Bio-Oss Collagen, as a bioactive material, has been applied for periodontal regeneration. It is similar to human cancellous bone, with the ability to promote bone formation; furthermore, it has exceptional plasticity and spatial stability. The combination of different materials and techniques has become a research hotspot in recent years. By combining the superiority of regeneration technology and materials, better regenerative effect can be achieved. This study will search for differences between M-MIST combined with Bio-Oss Collagen, and M-MIST alone in regeneration therapy for intrabony defects. METHODS AND ANALYSIS The present research is designed as a two-group parallel randomised controlled trial. The total number of patients is 40. The patients will be randomly assigned to two groups, with 20 participants in each group, for further periodontal regenerative surgery. Test group: M-MIST plus Bio-Oss Collagen. CONTROL GROUP M-MIST. After 12 months, the measurement indices will be recorded; these will include clinical attachment gain and radiographical intrabony defect depth change as the primary results, and secondary outcomes of full-mouth plaque scores, probing depth, full-mouth bleeding scores, gingival recession, mobility, gingival papilla height and Visual Analogue Scale. The paired samples t-test will be applied to detect any difference between baseline and 1-year registrations. A general linear model will be performed to study the relationship between the secondary and the primary outcome. ETHICS AND DISSEMINATION The present research has received approval from the Ethics Committee of Peking University School and Hospital of Stomatology (PKUSSIRB-202053002). Data of the present research will be registered with the International Clinical Trials Registry Platform. Additionally, we will disseminate the results through scientific dental journals. TRIAL REGISTRATION NUMBER ChiCTR-2000030851. PROTOCOL VERSION Protocol Version 4, 14 July 2020.
Collapse
Affiliation(s)
- Churen Zhang
- Department of Periodontology, Peking University School and Hospital of Stomatology and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Haidong Zhang
- Department of Periodontology, Peking University School and Hospital of Stomatology and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Zhaoguo Yue
- Department of Periodontology, Peking University School and Hospital of Stomatology and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Lili Miao
- Department of Periodontology, Peking University School and Hospital of Stomatology and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ye Han
- Department of Periodontology, Peking University School and Hospital of Stomatology and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Kaining Liu
- Department of Periodontology, Peking University School and Hospital of Stomatology and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Jianxia Hou
- Department of Periodontology, Peking University School and Hospital of Stomatology and National Engineering Laboratory for Digital and Material Technology of Stomatology and Beijing Key Laboratory of Digital Stomatology, Beijing, China
| |
Collapse
|
16
|
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
| |
Collapse
|
17
|
Clementini M, Ambrosi A, Cicciarelli V, De Risi V, Sanctis M. Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta‐analysis. J Clin Periodontol 2019; 46:1236-1253. [DOI: 10.1111/jcpe.13201] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/17/2019] [Accepted: 09/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Marco Clementini
- Department of Periodontology Università Vita‐Salute San Raffaele Milano Italy
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery Università Vita‐Salute San Raffaele Milano Italy
| | - Valerio Cicciarelli
- Department of Periodontology Università Vita‐Salute San Raffaele Milano Italy
| | | | - Massimo Sanctis
- Department of Periodontology Università Vita‐Salute San Raffaele Milano Italy
| |
Collapse
|
18
|
Ahmad N, Tewari S, Narula SC, Sharma RK, Tanwar N. Platelet-rich fibrin along with a modified minimally invasive surgical technique for the treatment of intrabony defects: a randomized clinical trial. J Periodontal Implant Sci 2019; 49:355-365. [PMID: 31886028 PMCID: PMC6920033 DOI: 10.5051/jpis.2019.49.6.355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022] Open
Abstract
Purpose The modified minimally invasive surgical technique (M-MIST) has been successfully employed to achieve periodontal regeneration. Platelet-rich fibrin (PRF) is known to enhance wound healing through the release of growth factors. This study aimed to observe the outcomes of periodontal surgery when M-MIST was used with or without PRF for the treatment of isolated intrabony defects. Methods This randomized clinical trial was conducted on 36 systemically healthy patients, who had chronic periodontitis associated with a single-site buccal probing pocket depth (PPD) and clinical attachment level of ≥5 mm. Patients were randomly divided into 2 groups: the test group treated with M-MIST and PRF, and the control group treated with M-MIST alone. The primary periodontal parameters analyzed were PPD, relative attachment level (RAL), and relative gingival margin level. The radiographic parameters analyzed were change in alveolar crest position (C-ACP), linear bone growth (LBG), and percentage bone fill (%BF). Patients were followed up to 6 months post-surgery. Results Intragroup comparisons at 3 and 6 months showed consistently significant improvements in PPD and RAL in both the groups. In intergroup comparisons, the improvement in PPD reduction, gain in RAL, and the level of the gingival margin was similar in both groups at 3 and 6 months of follow-up. Furthermore, an intergroup comparison of radiographic parameters also demonstrated similar improvements in C-ACP, LBG, and %BF at 6 months of follow-up. Conclusions M-MIST with or without PRF yielded comparable periodontal tissue healing in terms of improvements in periodontal and radiographic parameters. Further investigation is required to confirm the beneficial effects of PRF with M-MIST. Trial Registration ClinicalTrials.gov Identifier: NCT03169920.
Collapse
Affiliation(s)
- Nabila Ahmad
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Shikha Tewari
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Satish Chander Narula
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Rajinder Kumar Sharma
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Nishi Tanwar
- Department of Periodontics and Oral Implantology, Post Graduate Institute of Dental Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| |
Collapse
|
19
|
Nibali L, Koidou V, Salomone S, Hamborg T, Allaker R, Ezra R, Zou L, Tsakos G, Gkranias N, Donos N. Minimally invasive non-surgical vs. surgical approach for periodontal intrabony defects: a randomised controlled trial. Trials 2019; 20:461. [PMID: 31351492 PMCID: PMC6660941 DOI: 10.1186/s13063-019-3544-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/29/2019] [Indexed: 12/03/2022] Open
Abstract
Background Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent studies have suggested that a minimally invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally invasive surgical therapy, M-MIST) for the treatment of intrabony defects. Methods This is a parallel-group, single-centre, examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25–70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥ 1 ‘intrabony defect’ with probing pocket depth (PPD) > 5 mm and intrabony defect depth ≥ 3 mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment level change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes. Discussion This study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures. Trial registration ClinicalTrials.gov, NCT03797807. Registered on 9 January 2019.
Collapse
Affiliation(s)
- L Nibali
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK. .,Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
| | - V Koidou
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - S Salomone
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - T Hamborg
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Queen Mary University of London (QMUL), London, UK
| | - R Allaker
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - R Ezra
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - L Zou
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - G Tsakos
- Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - N Gkranias
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - N Donos
- Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| |
Collapse
|
20
|
Setzer FC, Shou H, Kulwattanaporn P, Kohli MR, Karabucak B. Outcome of Crown and Root Resection: A Systematic Review and Meta-analysis of the Literature. J Endod 2019; 45:6-19. [DOI: 10.1016/j.joen.2018.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/14/2018] [Accepted: 10/07/2018] [Indexed: 01/11/2023]
|
21
|
Trombelli L, Simonelli A, Minenna L, Vecchiatini R, Farina R. Simplified procedures to treat periodontal intraosseous defects in esthetic areas. Periodontol 2000 2018; 77:93-110. [DOI: 10.1111/prd.12213] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Effects of Immobilizations of rhBMP-2 and/or rhPDGF-BB on Titanium Implant Surfaces on Osseointegration and Bone Regeneration. COATINGS 2017. [DOI: 10.3390/coatings8010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
23
|
Evaluation of Recombinant Human FGF-2 and PDGF-BB in Periodontal Regeneration: A Systematic Review and Meta-Analysis. Sci Rep 2017; 7:65. [PMID: 28246406 PMCID: PMC5427916 DOI: 10.1038/s41598-017-00113-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/07/2017] [Indexed: 02/05/2023] Open
Abstract
The prognosis for successful treatment of periodontal diseases is generally poor. Current therapeutic strategies often fail to regenerate infected periodontium. Recently an alternative strategy has been developed that combines conventional treatment with the application of recombinant human growth factors (rhGFs). But ambiguities in existed studies on the clinical efficacy of rhGFs do not permit either the identification of the specific growth factors effective for therapeutic interventions or the optimal concentration of them. Neither is it known whether the same rhGF can stimulate regeneration of both soft tissue and bone, or whether different patient populations call for differential use of the growth factors. In order to explore these issues, a meta-analysis was carried out. Particular attention was given to the therapeutic impact of fibroblast growth factor 2(FGF-2) and platelet derived growth factor BB (PDGF-BB). Our findings indicate that 0.3% rhFGF-2 and 0.3 mg/ml rhPDGF-BB show a greater capacity for periodontal regeneration than other concentrations and superiority to control groups with statistical significance. In the case of patients suffering only from gingival recession, however, the application of rhPDGF-BB produces no significant regenerative advantage. The findings of this study can potentially endow clinicians with guidelines for the appropriate application of these two rhGFs.
Collapse
|
24
|
Chandradas ND, Ravindra S, Rangaraju VM, Jain S, Dasappa S. Efficacy of platelet rich fibrin in the treatment of human intrabony defects with or without bone graft: A randomized controlled trial. J Int Soc Prev Community Dent 2016; 6:S153-9. [PMID: 27652249 PMCID: PMC5022394 DOI: 10.4103/2231-0762.189753] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: To evaluate the efficacy of platelet rich fibrin (PRF) with or without bone graft [demineralized bone matrix (DBM) graft] in the treatment of intrabony defects based on clinical and radiographic parameters. Materials and Methods: Thirty six intrabony defects in 36 patients were randomly divided into three different groups and were treated with group A (PRF with DBM) or group B (PRF alone) or group C [open flap debridement (OFD)]. Clinical parameters such as plaque index (PI), gingival index (GI), probing depth (PD), relative attachment level (RAL), and gingival recession (GR) were assessed at baseline and 9 months postoperatively; radiographic parameters such as linear bone growth (LBG) and percentage in bone fill (%BF) were calculated by using the image analysis software. Comparisons of groups were analyzed using Kruskal–Wallis analysis of variance test. Pair-wise comparison of groups was done by Mann-Whitney U test. Results: Mean PD reduction and RAL gain were greater in group A (4.25 ± 1.48, 3.92 ± 0.90) and group B (3.82 ± 0.75, 3.27 ± 0.65) than control (3.00 ± 1.21, 2.25 ± 0.62). Furthermore, statistically significant improvement in LBG and %BF was found in group A (3.47 ± 0.53, 61.53 ± 4.54) compared to group B (2.55 ± 0.61, 49.60 ± 14.08) and group C (1.21 ± 0.80, 24.69 ± 15.59). Conclusions: The study demonstrated that PRF improves clinical and radiological parameters compared to OFD alone in intrabony defects. Addition of DBM enhances the effects of PRF in RAL gain and radiographic defect fill.
Collapse
Affiliation(s)
- Nikhil D Chandradas
- Department of Periodontics, Sree Mookambika Institute of Dental Sciences, Padanilam, Kulasekharam, Kanyakumari, India
| | - Shivamurthy Ravindra
- Department of Periodontics, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, India
| | - Vivekananda M Rangaraju
- Department of Periodontics, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, India
| | - Sheetal Jain
- Sumukha Orofacial and Dental Care, Hassan, Karnataka, India
| | - Shivaprasad Dasappa
- Department of Periodontics, Sri Hasanamba Dental College and Hospital, Vidyanagar, Hassan, India
| |
Collapse
|
25
|
Liu S, Hu B, Zhang Y, Li W, Song J. Minimally Invasive Surgery Combined with Regenerative Biomaterials in Treating Intra-Bony Defects: A Meta-Analysis. PLoS One 2016; 11:e0147001. [PMID: 26785405 PMCID: PMC4718618 DOI: 10.1371/journal.pone.0147001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 12/26/2015] [Indexed: 11/23/2022] Open
Abstract
Background With the popularity of minimally invasive surgery (MIS) in periodontics, numerous publications have evaluated the benefits of MIS with or without various regenerative biomaterials in the treatment of periodontal intra-bony defects. However, it is unclear if it is necessary to use biomaterials in MIS. Thus, we conducted a meta-analysis of randomized clinical trials in patients with intra-bony defects to compare the clinical outcomes of MIS with regenerative biomaterials for MIS alone. Methods The authors retrieved English publications on relevant studies from Cochrane CENTRAL, PubMed, Medline, Embase, Clinical Evidence, and ClinicalTrails.gov (up to June 30, 2015). The main clinical outcomes were the reduction of probing pocket depths (PPDs), gain of clinical attachment level (CAL), recession of gingival margin (REC) and radiographic bone fill. Review Manager 5.2 (Cochrane Collaboration, Oxford, England) was used to calculate the heterogeneity and mean differences of the main clinical outcomes. Results In total, 464 studies in the literature were identified but only four were ultimately feasible. The results showed no significant difference regarding CAL gain (P = 0.32) and PPD reduction (P = 0.40) as well as REC increase (P = 0.81) and radiographic bone fill (P = 0.64) between the MIS plus biomaterials group and the MIS alone group. Conclusions The meta-analysis suggested no significant difference in treatment of intra-bony defects between the MIS plus biomaterials group and the MIS alone group, indicating that it is important to take costs and benefits into consideration when a decision is made about a therapeutic approach. There needs to be an in-depth exploration of the induction of intrinsic tissue healing of MIS without biomaterials to achieve optimal outcomes.
Collapse
Affiliation(s)
- Shan Liu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Bo Hu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, United States of America
| | - Wenyang Li
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
- * E-mail:
| |
Collapse
|
26
|
Khoshkam V, Chan HL, Lin GH, Mailoa J, Giannobile WV, Wang HL, Oh TJ. Outcomes of regenerative treatment with rhPDGF-BB and rhFGF-2 for periodontal intra-bony defects: a systematic review and meta-analysis. J Clin Periodontol 2015; 42:272-80. [DOI: 10.1111/jcpe.12354] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Vahid Khoshkam
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
- Currently Advanced Periodontology Program; Herman Ostrow School of Dentistry; University of Southern California; Los Angeles CA USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - Guo-Hao Lin
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - James Mailoa
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - William V. Giannobile
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - Tae-Ju Oh
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| |
Collapse
|
27
|
Zhang Y, Miron RJ, Li S, Shi B, Sculean A, Cheng X. Novel MesoPorous BioGlass/silk scaffold containing adPDGF-B and adBMP7 for the repair of periodontal defects in beagle dogs. J Clin Periodontol 2015; 42:262-71. [DOI: 10.1111/jcpe.12364] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Yufeng Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education; School & Hospital of Stomatology; Wuhan University; Wuhan China
- Department of Oral Implantology; School of Stomatology; Wuhan University; Wuhan China
| | - Richard J. Miron
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education; School & Hospital of Stomatology; Wuhan University; Wuhan China
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Sue Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education; School & Hospital of Stomatology; Wuhan University; Wuhan China
| | - Bin Shi
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education; School & Hospital of Stomatology; Wuhan University; Wuhan China
- Department of Oral Implantology; School of Stomatology; Wuhan University; Wuhan China
| | - Anton Sculean
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Xiangrong Cheng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education; School & Hospital of Stomatology; Wuhan University; Wuhan China
| |
Collapse
|
28
|
Donovan TE, Marzola R, Becker W, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP. Annual review of selected scientific literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2014; 112:1038-87. [PMID: 25443419 DOI: 10.1016/j.prosdent.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Terence E Donovan
- Chair, Committee on Scientific Investigation, American Academy of Restorative Dentistry (AARD); Professor and Section Head for Biomaterials, Department of Operative Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - William Becker
- Clinical Professor, Advanced Education in Prosthodontics, Herman Ostrow School of Dentistry, University of Southern California; private practice, Tucson, Ariz
| | - David R Cagna
- Associate Dean, Professor and Director, Advanced Prosthodontics, University of Tennessee, Health Science Center, College of Dentistry, Memphis, Tenn
| | | | | | | | | |
Collapse
|
29
|
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.
Collapse
|
30
|
Harrel SK, Abraham CM, Rivera-Hidalgo F, Shulman JD, Nunn ME. Videoscope-assisted minimally invasive periodontal surgery (V-MIS). J Clin Periodontol 2014; 41:900-7. [PMID: 25039580 DOI: 10.1111/jcpe.12294] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Abstract
AIM Small incision surgery has become routine in many areas of medicine but has not been widely accepted in periodontal therapy. A videoscope to assist minimally invasive surgery (MIS) has been developed. The clinical outcomes from MIS performed using this videoscope (V-MIS) are reported. MATERIALS AND METHODS Patients were evaluated for residual defects following non-surgical therapy consisting of root planing with local anaesthetic. Thirty patients having 110 sites with residual pocket probing depth (PPD) of at least 5 mm, 2 mm loss of clinical attachment level (CAL), and radiographic evidence of bone loss were surgically treated. V-MIS was performed utilizing the videoscope for surgical visualization. RESULTS At re-evaluation 6 months post surgery, there was a statistically significant improvement (p < .001) in mean PPD and CAL (PPD 3.88 ± 1.02 mm, CAL 4.04 ± 1.38 mm) in 1, 2, and 3 wall defects. All PPD at re-evaluation were 3 mm or less. There was a mean post-surgical increase in soft tissue height (0.13 ± 0.61 mm, p = 0.168) with a decrease in recession. CONCLUSIONS The improvement in PPD and CAL from V-MIS, in the authors' opinion, appears to be favourable when compared to previously reported results of periodontal regenerative surgery. The lack of post-surgical recession following V-MIS has not been reported with traditional regenerative surgery.
Collapse
Affiliation(s)
- Stephen K Harrel
- Texas A&M University, Baylor College of Dentistry, Dallas, TX, USA
| | | | | | | | | |
Collapse
|
31
|
Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e3182a6a18b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Harrel SK, Wilson TG, Rivera-Hidalgo F. A videoscope for use in minimally invasive periodontal surgery. J Clin Periodontol 2013; 40:868-74. [PMID: 23782239 DOI: 10.1111/jcpe.12125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Minimally invasive periodontal procedures have been reported to produce excellent clinical results. Visualization during minimally invasive procedures has traditionally been obtained by the use of surgical telescopes, surgical microscopes, glass fibre endoscopes or a combination of these devices. All of these methods for visualization are less than fully satisfactory due to problems with access, magnification and blurred imaging. CLINICAL INNOVATION A videoscope for use with minimally invasive periodontal procedures has been developed to overcome some of the difficulties that exist with current visualization approaches. This videoscope incorporates a gas shielding technology that eliminates the problems of fogging and fouling of the optics of the videoscope that has previously prevented the successful application of endoscopic visualization to periodontal surgery. In addition, as part of the gas shielding technology the videoscope also includes a moveable retractor specifically adapted for minimally invasive surgery. DISCUSSION The clinical use of the videoscope during minimally invasive periodontal surgery is demonstrated and discussed. CONCLUSION The videoscope with gas shielding alleviates many of the difficulties associated with visualization during minimally invasive periodontal surgery.
Collapse
Affiliation(s)
- Stephen K Harrel
- Baylor College of Dentistry Texas A&M Health Science Center, Dallas, TX 75229, USA.
| | | | | |
Collapse
|
33
|
Surgical Approaches Based on Biological Objectives: GTR versus GBR Techniques. Int J Dent 2013; 2013:521547. [PMID: 23843792 PMCID: PMC3697289 DOI: 10.1155/2013/521547] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/30/2013] [Accepted: 05/19/2013] [Indexed: 01/07/2023] Open
Abstract
Guided tissue regenerative (GTR) therapies are performed to regenerate the previously lost tooth supporting structure, thus maintaining the aesthetics and masticatory function of the available dentition. Alveolar ridge augmentation procedures (GBR) intend to regain the alveolar bone lost following tooth extraction and/or periodontal disease. Several biomaterials and surgical approaches have been proposed. In this paper we report biomaterials and surgical techniques used for periodontal and bone regenerative procedures. Particular attention will be adopted to highlight the biological basis for the different therapeutic approaches.
Collapse
|