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Aimetti M, Stasikelyte M, Mariani GM, Cricenti L, Baima G, Romano F. The flapless approach with and without enamel matrix derivatives for the treatment of intrabony defects: A randomized controlled clinical trial. J Clin Periodontol 2024. [PMID: 38859627 DOI: 10.1111/jcpe.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/23/2024] [Accepted: 05/27/2024] [Indexed: 06/12/2024]
Abstract
AIM To compare the clinical and radiographic outcomes of flapless procedure alone or in combination with enamel matrix derivatives (EMD) in the treatment of deep intrabony defects. MATERIALS AND METHODS Forty-six patients re-evaluated after non-surgical therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Clinical measurements were recorded pre-surgery and at 6 and 12 months after surgery, and radiographic measurements were taken pre-surgery and after 12 months. RESULTS Forty-six patients completed the study. Improvements were observed in both groups at 12 months for mean clinical attachment level (CAL) gain, with significant differences between test (3.9 ± 1.1 mm) and control groups (3.0 ± 1.2) (p = .017). Probing pocket depth (PPD) reduction (4.0 ± 0.7 vs. 3.3 ± 1.4 mm) was also near to statistical significance (p = .051). Also, more sites achieved successful composite outcome measure (final PPD ≤ 4 mm and CAL gain ≥3 mm) for the regenerative treatment in the flapless + EMD group (82.6% vs. 52.2%; p = .028). In terms of radiographic outcomes, EMD yielded a greater defect bone fill than flapless treatment alone (3.0 ± 1.0 mm vs. 1.8 ± 1.5 mm; p < .001). CONCLUSIONS The additional application of EMD during the flapless procedure for intrabony defects slightly improved clinical and radiographic outcomes. CLINICALTRIALS gov identification number: NCT05456555.
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Affiliation(s)
- Mario Aimetti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Morta Stasikelyte
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Giulia Maria Mariani
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Luca Cricenti
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Giacomo Baima
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
| | - Federica Romano
- Department of Surgical Sciences, C.I.R. Dental School, University of Turin, Turin, Italy
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Cui Y, Mai Y, Liu X, Mu H. Clinical benefits of autologous platelet concentrate in periodontal intrabony defects: A network meta-analysis of randomized controlled trials. Eur J Oral Sci 2024; 132:e12978. [PMID: 38459610 DOI: 10.1111/eos.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/20/2024] [Indexed: 03/10/2024]
Abstract
This study aimed to compare clinical benefits of autologous platelet concentrate with other periodontal regenerative approaches in intrabony defects. An electronic and hand search of studies up to December 2022 was conducted. Randomized controlled trials with at least 6 months of follow-up were identified to compare autologous platelet concentrates with enamel matrix derivative, bone graft, guided tissue regeneration, and open-flap debridement. All approaches involved papilla preservation flap surgery. The outcomes included probing depth reduction, clinical attachment level gain, linear bone fill, and safety. A network meta-analysis and meta-regression were performed. Fifty-seven studies were included in five network meta-analyses. Autologous platelets concentrate and its adjunct treatments achieved significantly greater clinical and radiographic parameters than did open-flap debridement, and had comparable or better performance than other regenerative treatments. Platelet-rich fibrin showed superiority over platelet-rich plasma in probing depth reduction at 6-month follow-up. Minimal pain and improved wound healing were observed in the treatments with autologous platelet concentrate. Meta-regression showed that deeper baseline intrabony defects resulted in larger probing depth reductions, while smoking impaired the effectiveness of regenerative surgeries. Minimal invasive flap designs led to less effect of regenerative materials. Autologous platelet concentrate is a promising biomaterial in periodontal regeneration due to its convenience, safety, and biocompatibility characteristics.
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Affiliation(s)
- Yue Cui
- Department of Stomatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Yuhe Mai
- Department of Stomatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Xuewei Liu
- Department of Stomatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Hong Mu
- Department of Stomatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, P.R. China
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Shah P, Aghazadeh M, Rajasingh S, Dixon D, Jain V, Rajasingh J. Stem cells in regenerative dentistry: Current understanding and future directions. J Oral Biosci 2024; 66:288-299. [PMID: 38403241 DOI: 10.1016/j.job.2024.02.006] [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: 01/09/2024] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Regenerative dentistry aims to enhance the structure and function of oral tissues and organs. Modern tissue engineering harnesses cell and gene-based therapies to advance traditional treatment approaches. Studies have demonstrated the potential of mesenchymal stem cells (MSCs) in regenerative dentistry, with some progressing to clinical trials. This review comprehensively examines animal studies that have utilized MSCs for various therapeutic applications. Additionally, it seeks to bridge the gap between related findings and the practical implementation of MSC therapies, offering insights into the challenges and translational aspects involved in transitioning from preclinical research to clinical applications. HIGHLIGHTS To achieve this objective, we have focused on the protocols and achievements related to pulp-dentin, alveolar bone, and periodontal regeneration using dental-derived MSCs in both animal and clinical studies. Various types of MSCs, including dental-derived cells, bone-marrow stem cells, and umbilical cord stem cells, have been employed in root canals, periodontal defects, socket preservation, and sinus lift procedures. Results of such include significant hard tissue reconstruction, functional pulp regeneration, root elongation, periodontal ligament formation, and cementum deposition. However, cell-based treatments for tooth and periodontium regeneration are still in early stages. The increasing demand for stem cell therapies in personalized medicine underscores the need for scientists and responsible organizations to develop standardized treatment protocols that adhere to good manufacturing practices, ensuring high reproducibility, safety, and cost-efficiency. CONCLUSION Cell therapy in regenerative dentistry represents a growing industry with substantial benefits and unique challenges as it strives to establish sustainable, long-term, and effective oral tissue regeneration solutions.
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Affiliation(s)
- Pooja Shah
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marziyeh Aghazadeh
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sheeja Rajasingh
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Douglas Dixon
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Periodontology, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Vinay Jain
- Department of Prosthodontics, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Johnson Rajasingh
- Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Medicine-Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA.
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4
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Pabst A, Becker P, Götz W, Heimes D, Thiem DGE, Blatt S, Kämmerer PW. A comparative analysis of particulate bovine bone substitutes for oral regeneration: a narrative review. Int J Implant Dent 2024; 10:26. [PMID: 38801622 PMCID: PMC11130110 DOI: 10.1186/s40729-024-00544-z] [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: 04/15/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE Particulate bovine bone substitutes (BS) are commonly used in oral regeneration. However, more literature is needed focusing on comparative analyses among various particulate bovine BS. This study evaluates pre-clinical and clinical data of different particulate bovine BS in oral regeneration. METHODS A narrative review was conducted by screening the PubMed database Included in the review were pre-clinical and clinical studies until 2024 comparing a minimum of two distinct particulate bovine BS. In addition to examining general data concerning manufacturing and treatment processes, biological safety, physical and chemical characteristics, and graft resorption, particular emphasis was placed on assessing pre-clinical and clinical data related to ridge preservation, sinus floor elevation, peri-implant defects, and various forms of alveolar ridge augmentation utilizing particulate bovine BS. RESULTS Various treatment temperatures ranging from 300 to 1,250 °C and the employment of chemical cleaning steps were identified for the manufacturing process of particulate bovine BS deemed to possess biosecurity. A notable heterogeneity was observed in the physical and chemical characteristics of particulate bovine BS, with minimal or negligible graft resorption. Variations were evident in particle and pore sizes and the porosity of particulate bovine BS. Pre-clinical assessments noted a marginal inclination towards favorable outcomes for particulate bovine BS subjected to higher treatment temperatures. However, clinical data are insufficient. No distinctions were observed regarding ridge preservation, while slight advantages were noted for high-temperature treated particulate bovine BS in sinus floor elevation. CONCLUSIONS Subtle variances in both pre-clinical and clinical outcomes were observed in across various particulate bovine BS. Due to inadequate data, numerous considerations related to diverse particulate bovine BS, including peri-implant defects, must be more conclusive. Additional clinical studies are imperative to address these knowledge gaps effectively.
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Affiliation(s)
- Andreas Pabst
- Department of Oral and Maxillofacial Surgery, German Armed Forces Central Hospital, Rübenacherstraße 170, 56072, Koblenz, Germany
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Philipp Becker
- Department of Oral and Maxillofacial Surgery, German Armed Forces Central Hospital, Rübenacherstraße 170, 56072, Koblenz, Germany
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Werner Götz
- Department of Orthodontics, University Hospital Bonn, Welschnonnenstr. 17, 53111, Bonn, Germany
| | - Diana Heimes
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Daniel G E Thiem
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Sebastian Blatt
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery - Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
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Puletic M, Velikic G, Maric DM, Supic G, Maric DL, Radovic N, Avramov S, Vojvodic D. Clinical Efficacy of Extracellular Vesicle Therapy in Periodontitis: Reduced Inflammation and Enhanced Regeneration. Int J Mol Sci 2024; 25:5753. [PMID: 38891939 PMCID: PMC11171522 DOI: 10.3390/ijms25115753] [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: 04/27/2024] [Revised: 05/12/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Periodontitis, a prevalent inflammatory condition, affects the supporting structures of teeth, leading to significant oral health challenges. Traditional treatments have primarily focused on mechanical debridement, antimicrobial therapy, and surgery, which often fail to restore lost periodontal structures. Emerging as a novel approach in regenerative medicine, extracellular vesicle (EV) therapy, including exosomes, leverages nano-sized vesicles known for facilitating intercellular communication and modulating physiological and pathological processes. This study is a proof-of-concept type that evaluates the clinical efficacy of EV therapy as a non-surgical treatment for stage I-III periodontitis, focusing on its anti-inflammatory and regenerative potential. The research involved seven patients undergoing the therapy, and seven healthy individuals. Clinical parameters, including the plaque index, bleeding on probing, probing depth, and attachment level, were assessed alongside cytokine levels in the gingival crevicular fluid. The study found significant improvements in clinical parameters, and a marked reduction in pro-inflammatory cytokines post-treatment, matching the levels of healthy subjects, underscoring the therapy's ability to not only attenuate inflammation and enhance tissue regeneration, but also highlighting its potential in restoring periodontal health. This investigation illuminates the promising role of EV therapy in periodontal treatment, advocating for a shift towards therapies that halt disease progression and promote structural and functional restoration of periodontal tissues.
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Affiliation(s)
- Miljan Puletic
- Faculty of Stomatology Pancevo, University Business Academy, 26101 Pancevo, Serbia; (M.P.); (D.M.M.); (N.R.); (S.A.)
| | - Gordana Velikic
- Department for Research and Development, Clinic Orto MD-Parks Hospital, 21000 Novi Sad, Serbia
- Hajim School of Engineering, University of Rochester, Rochester, NY 14627, USA
| | - Dusan M. Maric
- Faculty of Stomatology Pancevo, University Business Academy, 26101 Pancevo, Serbia; (M.P.); (D.M.M.); (N.R.); (S.A.)
- Department for Research and Development, Clinic Orto MD-Parks Hospital, 21000 Novi Sad, Serbia
| | - Gordana Supic
- Institute for Medical Research, Military Medical Academy, 11000 Belgrade, Serbia; (G.S.); (D.V.)
- Medical Faculty of Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| | - Dusica L. Maric
- Department of Anatomy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Nikola Radovic
- Faculty of Stomatology Pancevo, University Business Academy, 26101 Pancevo, Serbia; (M.P.); (D.M.M.); (N.R.); (S.A.)
| | - Stevan Avramov
- Faculty of Stomatology Pancevo, University Business Academy, 26101 Pancevo, Serbia; (M.P.); (D.M.M.); (N.R.); (S.A.)
- Institute for Biological Research “Sinisa Stankovic”, National Institute of the Republic of Serbia, University of Belgrade, 11060 Belgrade, Serbia
| | - Danilo Vojvodic
- Institute for Medical Research, Military Medical Academy, 11000 Belgrade, Serbia; (G.S.); (D.V.)
- Medical Faculty of Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
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Huang TH, Chen JY, Suo WH, Shao WR, Huang CY, Li MT, Li YY, Li YH, Liang EL, Chen YH, Lee IT. Unlocking the Future of Periodontal Regeneration: An Interdisciplinary Approach to Tissue Engineering and Advanced Therapeutics. Biomedicines 2024; 12:1090. [PMID: 38791052 PMCID: PMC11118048 DOI: 10.3390/biomedicines12051090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Periodontal defects present a significant challenge in dentistry, necessitating innovative solutions for comprehensive regeneration. Traditional restoration methods have inherent limitations in achieving complete and functional periodontal tissue reconstruction. Tissue engineering, a multidisciplinary approach integrating cells, biomaterials, and bioactive factors, holds tremendous promise in addressing this challenge. Central to tissue engineering strategies are scaffolds, pivotal in supporting cell behavior and orchestrating tissue regeneration. Natural and synthetic materials have been extensively explored, each offering unique advantages in terms of biocompatibility and tunable properties. The integration of growth factors and stem cells further amplifies the regenerative potential, contributing to enhanced tissue healing and functional restoration. Despite significant progress, challenges persist. Achieving the seamless integration of regenerated tissues, establishing proper vascularization, and developing biomimetic scaffolds that faithfully replicate the natural periodontal environment are ongoing research endeavors. Collaborative efforts across diverse scientific disciplines are essential to overcoming these hurdles. This comprehensive review underscores the critical need for continued research and development in tissue engineering strategies for periodontal regeneration. By addressing current challenges and fostering interdisciplinary collaborations, we can unlock the full regenerative potential, paving the way for transformative advancements in periodontal care. This research not only enhances our understanding of periodontal tissues but also offers innovative approaches that can revolutionize dental therapies, improving patient outcomes and reshaping the future of periodontal treatments.
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Affiliation(s)
- Tsung-Hsi Huang
- Department of Orthopedic Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan; (T.-H.H.); (Y.-H.C.)
| | - Jui-Yi Chen
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Wei-Hsin Suo
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Wen-Rou Shao
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Chih-Ying Huang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Ming-Tse Li
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Yu-Ying Li
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Yuan-Hong Li
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - En-Lun Liang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
| | - Yu-Hsu Chen
- Department of Orthopedic Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330, Taiwan; (T.-H.H.); (Y.-H.C.)
- Department of Biology and Anatomy, National Defense Medical Center, Taipei 114, Taiwan
| | - I-Ta Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan; (J.-Y.C.); (W.-H.S.); (W.-R.S.); (C.-Y.H.); (M.-T.L.); (Y.-Y.L.); (Y.-H.L.); (E.-L.L.)
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De Lauretis A, Øvrebø Ø, Romandini M, Lyngstadaas SP, Rossi F, Haugen HJ. From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308848. [PMID: 38380549 PMCID: PMC11077667 DOI: 10.1002/advs.202308848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/23/2024] [Indexed: 02/22/2024]
Abstract
Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.
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Affiliation(s)
- Angela De Lauretis
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Øystein Øvrebø
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Mario Romandini
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Ståle Petter Lyngstadaas
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
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Peeran SW, Ramalingam K, Sethuraman S, Thiruneervannan M. Furcation Involvement in Periodontal Disease: A Narrative Review. Cureus 2024; 16:e55924. [PMID: 38601385 PMCID: PMC11004587 DOI: 10.7759/cureus.55924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Furcation-involved teeth, commonly seen in dental practice, have a higher likelihood of needing extraction as the severity of periodontal furcation involvement increases. Studies consistently show that periodontitis in teeth with multiple roots significantly increases the risk of tooth loss, especially in the area where the furcation is involved. These furcation defects pose a major problem for dentists because of their location, accessibility issues, and the unpredictable healing process. The biggest hurdle in treating furcation defects is their irregular shape, which makes it hard to achieve complete debridement. While various treatments have been explored, non-surgical methods have not shown much success. This article comprehensively provides a review and discussion on the classification, assessment, and treatment options, including surgical and non-surgical management of furcation-involved molar teeth. Properly understanding the severity of the disease and its confounding factors and managing and treating the lesions appropriately have been shown to impart satisfactory survival rates for these teeth. Enhancing the understanding of managing these teeth can also lead to better outcomes for patients.
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Affiliation(s)
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sathya Sethuraman
- Dentistry, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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9
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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.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
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10
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Daneshian Y, Lewallen EA, Badreldin AA, Dietz AB, Stein GS, Cool SM, Ryoo HM, Cho YD, van Wijnen AJ. Fundamentals and Translational Applications of Stem Cells and Biomaterials in Dental, Oral and Craniofacial Regenerative Medicine. Crit Rev Eukaryot Gene Expr 2024; 34:37-60. [PMID: 38912962 DOI: 10.1615/critreveukaryotgeneexpr.2024053036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Regenerative dental medicine continuously expands to improve treatments for prevalent clinical problems in dental and oral medicine. Stem cell based translational opportunities include regenerative therapies for tooth restoration, root canal therapy, and inflammatory processes (e.g., periodontitis). The potential of regenerative approaches relies on the biological properties of dental stem cells. These and other multipotent somatic mesenchymal stem cell (MSC) types can in principle be applied as either autologous or allogeneic sources in dental procedures. Dental stem cells have distinct developmental origins and biological markers that determine their translational utility. Dental regenerative medicine is supported by mechanistic knowledge of the molecular pathways that regulate dental stem cell growth and differentiation. Cell fate determination and lineage progression of dental stem cells is regulated by multiple cell signaling pathways (e.g., WNTs, BMPs) and epigenetic mechanisms, including DNA modifications, histone modifications, and non-coding RNAs (e.g., miRNAs and lncRNAs). This review also considers a broad range of novel approaches in which stem cells are applied in combination with biopolymers, ceramics, and composite materials, as well as small molecules (agonistic or anti-agonistic ligands) and natural compounds. Materials that mimic the microenvironment of the stem cell niche are also presented. Promising concepts in bone and dental tissue engineering continue to drive innovation in dental and non-dental restorative procedures.
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Affiliation(s)
- Yasaman Daneshian
- Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT, United States of America
| | - Eric A Lewallen
- Department of Biological Sciences, Hampton University, Hampton, VA, USA
| | - Amr A Badreldin
- Laboratory of Molecular Signaling, Division of Oral and Systemic Health Sciences, School of Dentistry, University of California Los Angeles, Los Angeles, CA, USA
| | - Allan B Dietz
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Gary S Stein
- Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT 05405; University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT 05405
| | - Simon M Cool
- School of Chemical Engineering, The University of Queensland, Brisbane, Queensland, Australia
| | - Hyun-Mo Ryoo
- School of Dentistry, Seoul National University, 28 Yeonkun-dong, Chongro-gu Seoul, 110-749, Republic of Korea
| | - Young Dan Cho
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University and Seoul National University Dental Hospital, 101 Daehak‑no, Jongno‑gu, Seoul 03080, Republic of Korea
| | - Andre J van Wijnen
- Department of Biochemistry, University of Vermont, Burlington, VT 05405, USA
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11
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Kudo M, Shirakata Y. Multidisciplinary approach involving strategic implant placement before orthodontic (SIMBO) treatment for generalized stage IV grade C periodontitis: A case report with 10-year follow-up. J ESTHET RESTOR DENT 2023; 35:1171-1185. [PMID: 37350421 DOI: 10.1111/jerd.13075] [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: 01/29/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The aim of this case report was to demonstrate the long-term effects of a multidisciplinary approach involving periodontal reconstructive surgery and strategic implant placement before orthodontic (SIMBO) treatment in a patient with severe periodontitis (e.g., stage IV/grade C). CLINICAL CONSIDERATIONS The patient presented with severe periodontitis and pathologic tooth migration (PTM) without stable occlusion or occlusal support. After performing cause-related therapy, periodontal regenerative surgery, pre-orthodontic posterior implant placement, and orthodontic treatment involving anterior implant placement with papilla reconstruction, the patient achieved full-mouth rehabilitation and improvement of dental and smile esthetics. The clinical and radiographic results obtained were maintained over a 10-year period. CONCLUSION Within the limits of this as a single case, multidisciplinary treatment involving the SIMBO approach appeared to allow long-term improvement of periodontal condition, stability of the dental arches and occlusion, and esthetics in a patient with severe periodontitis, PTM and posterior bite collapse. Future studies with more subjects are needed to evaluate and validate this approach. CLINICAL SIGNIFICANCE When addressing periodontal disease, SIMBO approach-based multidisciplinary treatment appears safe and effective as a clinical protocol for establishing esthetic and functional rehabilitation in generalized stage IV/grade C periodontitis.
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Affiliation(s)
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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12
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Matsuura T, Mikami R, Mizutani K, Shioyama H, Aoyama N, Suda T, Kusunoki Y, Takeda K, Izumi Y, Aida J, Aoki A, Iwata T. Assessment of bone defect morphology for the adjunctive use of bone grafting combined with enamel matrix derivative: A 3-year cohort study. J Periodontol 2023. [PMID: 38029354 DOI: 10.1002/jper.23-0538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND There have been limited studies with statistically sufficient sample sizes for assessment of suitable bone defect morphology for combination therapy with enamel matrix derivative (EMD) and bone grafting. The aim of this study was to investigate the appropriate feature of intrabony defects, such as bone defect angle (DA) and the containment by bony wall, for yielding the additional benefit of bone grafting in combination with periodontal regenerative therapy using EMD. METHODS Following periodontal regenerative therapy using EMD with or without autologous bone grafting, 282 intrabony defects of 177 participants were maintained for 3 years. Multilevel linear regression analysis was performed to evaluate the radiographic bony defect depth (RBD) reduction after adjusting for confounders. RESULTS The baseline parameters, except for the proportion of contained bony defects and tooth mobility, did not differ significantly between the groups with and without bone grafts. There was no significant difference in the improvement of clinical parameters between the groups. The 1- and 3-year reduction of RBD showed significant inverse correlations with preoperative DA only in the group without bone graft. Furthermore, multivariate analysis showed a significant interaction between DA at baseline ≥40° and adjunctive bone grafting in the reduction of RBD, regardless of the number of bony walls. CONCLUSION Adjunctive autologous bone grafting with enamel matrix derivative might be significantly beneficial for defect depth improvement in the case of DA at baseline ≥40°.
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Grants
- 20K18497 Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, Tokyo, Japan
- 19K10125 Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, Tokyo, Japan
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Affiliation(s)
- Takanori Matsuura
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, California, USA
| | - Risako Mikami
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidehiro Shioyama
- Department of Lifetime Oral Health Care Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norio Aoyama
- Department of Periodontology, Kanagawa Dental University, Kanagawa, Japan
| | - Tomonari Suda
- Department of Oral Surgery, Secomedic Hospital, Chiba, Japan
| | - Yukako Kusunoki
- Department of General Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kohei Takeda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Oral Care Periodontics Center, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Fukushima, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akira Aoki
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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13
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Bontá H, Bugiolachi J, Perrote CA, Sánchez LM, Pulitano Manisagian GE, Galli FG, Caride F. Alveolar ridge reconstruction with a digitally customized bone block allograft. Clin Adv Periodontics 2023. [PMID: 37957843 DOI: 10.1002/cap.10270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Reduced alveolar ridge volume is an often consequence after tooth loss, compromising implant placement and prosthetic rehabilitation. The digital customization of bone block allografts (BBA) is an alternative that incorporates advantages such as intimate contact with the recipient bed, increasing graft stability and reduced surgical time. In addition, enamel matrix derivate (EMD) has attracted interest for its effect on osteogenic gene expression and cell adhesion; few studies have focused on the benefits of bone regeneration with EMD. The aim of this case report is to present the reconstruction of a severely atrophic alveolar ridge defect with a digitally customized bone block allograft (CBBA) in combination with EMD as an adjuvant for bone regeneration and soft tissue healing. METHODS Initially, the digital planning and manufacture of the BBA was performed based on an initial cone beam computed tomography (CBCT) scan. EMD was applied to the recipient site and to the CBBA before graft fixation. After 6 months, bone biopsies were obtained on re-entry surgery for prosthetically guided implant placement. RESULTS Clinically, bone block showed good integration with the adjacent tissue and no signs of rejection or necrosis were found. On the histological evaluation, new bone was observed in intimate contact with the allograft and showed viable osteocytes and osteoblasts along its entire length. Residual allograft particles were observed to be highly osteoconductive. CONCLUSION According to the clinical and histological results presented, the digital customization of the BBA allows an ideal graft fit to the recipient bed with excellent results in bone regeneration.
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Affiliation(s)
- Hernán Bontá
- Department of Periodontology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Juliana Bugiolachi
- Department of Periodontology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Carla A Perrote
- Department of Periodontology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Luciana M Sánchez
- Department of Histology and Embryology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Gisela E Pulitano Manisagian
- Department of Histology and Embryology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Federico G Galli
- Department of Periodontology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
| | - Facundo Caride
- Department of Periodontology, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina
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14
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Wehner C, Tur D, Durstberger G, Laky M, Laky B, Andrukhov O, Moritz A, Rausch-Fan X. Effects of enamel matrix derivative in nonsurgical periodontal therapy on pro-inflammatory profiles, microbial environment and clinical outcome: a randomized clinical trial. Clin Oral Investig 2023; 27:6493-6502. [PMID: 37843637 PMCID: PMC10630232 DOI: 10.1007/s00784-023-05254-1] [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: 02/01/2023] [Accepted: 09/09/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES This study aimed to evaluate the impact of enamel matrix derivative (EMD) application following subgingival instrumentation of residual pockets in periodontitis patients on inflammatory host response, microbiological composition, and clinical outcome. METHODS In this double-blinded randomized controlled trial, a total of 22 patients with generalized periodontitis stage III or IV presenting with ≥ 6 mm probing pocket depth (PPD) at re-evaluation after initial periodontal therapy were included. Participants were randomly allocated at a 1:1 ratio to subgingival instrumentation with (EMD +) or without (EMD-) non-surgical EMD application into the pocket. PPD, clinical attachment level (CAL), bleeding on probing (BoP), plaque index (PI), as well as a panel of pro-inflammatory cytokines and periodontal pathogen count in the gingival crevicular fluid (GCF) of the respective sites were evaluated at baseline (T0) and six months afterwards (T1). RESULTS Both treatment groups showed a significant PPD reduction (EMD + 1.33 ± 1.15 mm, p < 0.001; EMD- 1.32 ± 1.01 mm, p < 0.001) as well as CAL gain (EMD + 1.13 ± 1.58 mm, p < 0.001; EMD- 0.47 ± 1.06 mm, p = 0.005) from T0 to T1. While no intergroup differences for PPD reduction were observed, CAL gain was higher in EMD + sites compared to EMD- (p = 0.009). No essential effects on cytokine expression as well as bacterial count were detected. CONCLUSIONS Application of EMD as an adjunct to subgingival instrumentation of residual pockets yielded benefits regarding CAL gain; however, effects on PPD reduction, inflammatory cytokines, and bacterial count were negligible. TRIAL REGISTRATION ClinicalTrials.gov (NCT04449393), registration date 26/06/2020. CLINICAL RELEVANCE Based on the obtained results, additional non-surgical EMD application compared to subgingival instrumentation alone showed no clinically relevant effects on treatment outcome and underlying biological mechanisms.
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Affiliation(s)
- Christian Wehner
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2A, 1090, Vienna, Austria
| | - Dino Tur
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2A, 1090, Vienna, Austria
| | - Gerlinde Durstberger
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2A, 1090, Vienna, Austria
| | - Markus Laky
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2A, 1090, Vienna, Austria
| | - Brenda Laky
- Austrian Research Group for Regenerative and Orthopedic Medicine (AURROM), Vienna, Austria
- MedSciCare, Vienna, Austria
| | - Oleh Andrukhov
- Competence Center for Periodontal Research, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2A, 1090, Vienna, Austria
| | - Andreas Moritz
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2A, 1090, Vienna, Austria
- Division for Dental Student Training and Patient Care, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2A, 1090, Vienna, Austria
| | - Xiaohui Rausch-Fan
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2A, 1090, Vienna, Austria.
- Clinical Research Center, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2A, 1090, Vienna, Austria.
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15
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Buranasin P, Kominato H, Mizutani K, Mikami R, Saito N, Takeda K, Iwata T. Influence of Reactive Oxygen Species on Wound Healing and Tissue Regeneration in Periodontal and Peri-Implant Tissues in Diabetic Patients. Antioxidants (Basel) 2023; 12:1787. [PMID: 37760090 PMCID: PMC10525304 DOI: 10.3390/antiox12091787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Diabetes mellitus (DM) is associated with periodontal disease. Clinically, periodontal treatment is less effective for patients with DM. Oxidative stress is one of the mechanisms that link DM to periodontitis. The production of reactive oxygen species (ROS) is increased in the periodontal tissues of patients with DM and is involved in the development of insulin resistance in periodontal tissues. Insulin resistance decreases Akt activation and inhibits cell proliferation and angiogenesis. This results in the deterioration of wound healing and tissue repair in periodontal tissues. Antioxidants and insulin resistance ameliorants may inhibit ROS production and improve wound healing, which is worsened by DM. This manuscript provides a comprehensive review of the most recent basic and clinical evidence regarding the generation of ROS in periodontal tissues resulting from microbial challenge and DM. This study also delves into the impact of oxidative stress on wound healing in the context of periodontal and dental implant therapies. Furthermore, it discusses the potential benefits of administering antioxidants and anti-insulin resistance medications, which have been shown to counteract ROS production and inflammation. This approach may potentially enhance wound healing, especially in cases exacerbated by hyperglycemic conditions.
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Affiliation(s)
- Prima Buranasin
- Department of Conservative Dentistry and Prosthodontics, Faculty of Dentistry, Srinakharinwirot University, Bangkok 10110, Thailand
| | - Hiromi Kominato
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Risako Mikami
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Natsumi Saito
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Kohei Takeda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
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16
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Panahipour L, Botta S, Abbasabadi AO, Afradi Z, Gruber R. Enamel Matrix Derivative Suppresses Chemokine Expression in Oral Epithelial Cells. Int J Mol Sci 2023; 24:13991. [PMID: 37762294 PMCID: PMC10530986 DOI: 10.3390/ijms241813991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Epithelial cells in periodontitis patients increasingly express chemokines, suggesting their active involvement in the inflammatory process. Enamel matrix derivative (EMD) is an extract of porcine fetal tooth germs clinically applied to support the regrowth of periodontal tissues. Periodontal regeneration might benefit from the potential anti-inflammatory activity of EMD for epithelial cells. Our aim was, therefore, to set up a bioassay where chemokine expression is initiated in the HSC2 oral squamous carcinoma cell line and then test EMD for its capacity to lower the inflammatory response. To establish the bioassay, HSC2 cells being exposed to TNFα and LPS from E. coli (Escherichia coli) or P. gingivalis (Porphyromonas gingivalis) were subjected to RNAseq. Here, TNFα but not LPS caused a robust increase of chemokines, including CXCL1, CXCL2, CXCL8, CCL5, and CCL20 in HSC2 cells. Polymerase chain reaction confirmed the increased expression of the respective chemokines in cells exposed to TNFα and IL-1β. Under these conditions, EMD reduced the expression of all chemokines at the transcriptional level and CXCL8 by immunoassay. The TGF-β receptor type I kinase-inhibitor SB431542 reversed the anti-inflammatory activity. Moreover, EMD-activated TGF-β-canonical signaling was visualized by phosphorylation of smad3 and nuclear translocation of smad2/3 in HSC2 cells and blocked by SB431542. This observation was confirmed with primary oral epithelial cells where EMD significantly lowered the SB431542-dependent expression of CXCL8. In summary, our findings suggest that TGF-β signaling mediates the effects of EMD to lower the forced expression of chemokines in oral epithelial cells.
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Affiliation(s)
- Layla Panahipour
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (L.P.); (S.B.); (A.O.A.); (Z.A.)
| | - Sara Botta
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (L.P.); (S.B.); (A.O.A.); (Z.A.)
| | - Azarakhsh Oladzad Abbasabadi
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (L.P.); (S.B.); (A.O.A.); (Z.A.)
| | - Zohreh Afradi
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (L.P.); (S.B.); (A.O.A.); (Z.A.)
| | - Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090 Vienna, Austria; (L.P.); (S.B.); (A.O.A.); (Z.A.)
- Department of Periodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
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17
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Chackartchi T, Bosshardt DD, Imber JC, Stähli A, Sacks H, Nagy K, Sculean A. Histological evaluation following treatment of recession-type defects with coronally advanced flap and a novel human recombinant amelogenin. Clin Oral Investig 2023; 27:5041-5048. [PMID: 37421492 PMCID: PMC10492744 DOI: 10.1007/s00784-023-05123-x] [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: 03/05/2023] [Accepted: 06/14/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To histologically evaluate the effects of a novel human recombinant amelogenin (rAmelX) on periodontal wound healing / regeneration in recession-type defects. MATERIALS AND METHODS A total of 17 gingival recession-type defects were surgically created in the maxilla of three minipigs. The defects were randomly treated with a coronally advanced flap (CAF) and either rAmelX (test), or a CAF and placebo (control). At three months following reconstructive surgery, the animals were euthanized, and the healing outcomes histologically evaluated. RESULTS The test group yielded statistically significantly (p = 0.047) greater formation of cementum with inserting collagen fibers compared with the control group (i.e., 4.38 mm ± 0.36 mm vs. 3.48 mm ± 1.13 mm). Bone formation measured 2.15 mm ± 0.8 mm in the test group and 2.24 mm ± 1.23 mm in the control group, respectively, without a statistically significant difference (p = 0.94). CONCLUSIONS The present data have provided for the first-time evidence for the potential of rAmelX to promote regeneration of periodontal ligament and root cementum in recession-type defects, thus warranting further preclinical and clinical testing. CLINICAL RELEVANCE The present results set the basis for the potential clinical application of rAmelX in reconstructive periodontal surgery.
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Affiliation(s)
- Tali Chackartchi
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dieter D Bosshardt
- Department of Periodontology, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Robert K. Schenk Laboratory of Oral Histology, Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | | | - Katalin Nagy
- Department of Oral Surgery, Faculty of Dentistry, University of Szeged, Szeged, Hungary
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
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18
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Atieh MA, Al-Ali B, Shah M, Amir-Rad F, Baqain ZH, Al-Suwaidi S, Alsabeeha NHM. Enamel matrix derivative for alveolar ridge preservation: A randomized controlled trial. Clin Oral Implants Res 2023; 34:802-812. [PMID: 37300378 DOI: 10.1111/clr.14108] [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: 02/06/2023] [Revised: 04/19/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aims of this clinical trial were to evaluate the radiographic dimensional changes in alveolar ridge and patient-reported outcomes following tooth extraction and alveolar ridge preservation (ARP) using either deproteinized bovine bone mineral (DBBM) with EMD or DBBM alone. METHODS Participants requiring at least one posterior tooth extraction and ARP were randomly allocated into two treatment groups: ARP using either DBBM with EMD or DBBM alone. Cone-beam computed tomography (CBCT) images were recorded immediately prior to extraction and at 6 months. Changes in alveolar ridge height (ARH) and alveolar ridge width (ARW) at 1, 3, and 5 mm were recorded. RESULTS A total of 18 participants with 25 preserved sites were evaluated. ARH and ARW changed significantly from baseline to 6 months for both treatment groups but the difference between the groups was not statistically significant over the 6-month follow-up period (ARH: DBBM/EMD 1.26 ± 1.53 mm vs. DBBM 2.26 ± 1.60 mm; ARW-1 DBBM/EMD 1.98 ± 1.80 mm vs. DBBM 2.34 ± 1.89 mm). A significant difference, favoring DBBM with EMD group, was observed in percentage of sites that had less than 1 mm loss in ARH (54.5% sites in DBBM/EMD group vs. 14.3% sites in DBBM alone group). The participants' perception of bruising, bleeding, and pain in the first two postoperative days was significantly in favor of DBBM alone group. CONCLUSIONS There were no significant differences in radiographic mean measurements of ARH and ARW following ARB with DBBM and EMD or DBBM alone.
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Affiliation(s)
- Momen A Atieh
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
- Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, Dunedin, New Zealand
| | - Bashayer Al-Ali
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Maanas Shah
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Fatemeh Amir-Rad
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Zaid H Baqain
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
- School of Dentistry, The University of Jordan, Amman, Jordan
| | - Salem Al-Suwaidi
- Mohammed Bin Rashid University of Medicine and Health Sciences, Hamdan Bin Mohammed College of Dental Medicine, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Nabeel H M Alsabeeha
- Department of Dental Services, Emirates Health Services, Dubai, United Arab Emirates
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19
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Abu-Ta'a M, Marzouka D. Enamel Matrix Derivative (EMD) as an Adjunct to Non-surgical Periodontal Therapy: A Systematic Review. Cureus 2023; 15:e43530. [PMID: 37719602 PMCID: PMC10500965 DOI: 10.7759/cureus.43530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
If left untreated, periodontitis is a chronic, irreversible disease that can contribute to tooth loss. The primary objective of periodontal treatment is to arrest the progression of the disease and restore the supporting structures of the tooth. Scaling and root planing (SRP) is a common non-surgical periodontal therapy (NSPT) used to reduce inflammation, pocket depth, and clinical attachment loss. However, NSPT has limitations, notably in difficult-to-access deep pockets and molar furcations. Deep pockets (greater than 4 mm) frequently retain calculus following NSPT. To attain direct access, surgical periodontal therapy (SPT) is recommended, particularly for pockets deeper than 5 mm. Enamel matrix derivative (EMD) has emerged in recent years as a tool for periodontal regeneration when used in conjunction with NSP for infrabony defects. EMD may also have advantageous effects when combined with NSPT. The purpose of this review is to provide a thorough understanding of the effects of EMD as an adjunct to NSPT. The databases Scopus, PubMed/MEDLINE, Google Scholar, Cochrane, and Embase were systematically searched to identify relevant studies on the benefits of EMD and its use as an adjunct to NSPT. Incorporating EMD into NSPT reduces chair time, and 60% of studies demonstrated considerable benefits compared to SRP alone, according to the findings. On the basis of research, it can be concluded that EMD can be used as an adjunct to NSPT, thereby reducing the amount of time spent in the operating chair. In some cases, it can, therefore, be regarded as an alternative to surgical treatment.
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Affiliation(s)
| | - Dina Marzouka
- Dental Sciences, Arab American University, Ramallah, PSE
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20
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Damanaki A, Beisel-Memmert S, Nokhbehsaim M, Abedi A, Rath-Deschner B, Nogueira AVB, Deschner J. Influence of Occlusal Hypofunction on Alveolar Bone Healing in Rats. Int J Mol Sci 2023; 24:9744. [PMID: 37298695 PMCID: PMC10253992 DOI: 10.3390/ijms24119744] [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: 01/31/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this in vivo study was to investigate the effect of occlusal hypofunction on alveolar bone healing in the absence or presence of an enamel matrix derivative (EMD). A standardized fenestration defect over the root of the mandibular first molar in 15 Wistar rats was created. Occlusal hypofunction was induced by extraction of the antagonist. Regenerative therapy was performed by applying EMD to the fenestration defect. The following three groups were established: (a) normal occlusion without EMD treatment, (b) occlusal hypofunction without EMD treatment, and (c) occlusal hypofunction with EMD treatment. After four weeks, all animals were sacrificed, and histological (hematoxylin and eosin, tartrate-resistant acid phosphatase) as well as immunohistochemical analyses (periostin, osteopontin, osteocalcin) were performed. The occlusal hypofunction group showed delayed bone regeneration compared to the group with normal occlusion. The application of EMD could partially, but not completely, compensate for the inhibitory effects of occlusal hypofunction on bone healing, as evidenced by hematoxylin and eosin and immunohistochemistry for the aforementioned molecules. Our results suggest that normal occlusal loading, but not occlusal hypofunction, is beneficial to alveolar bone healing. Adequate occlusal loading appears to be as advantageous for alveolar bone healing as the regenerative potential of EMD.
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Affiliation(s)
- Anna Damanaki
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, 55131 Mainz, Germany
| | - Svenja Beisel-Memmert
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111 Bonn, Germany
| | - Marjan Nokhbehsaim
- Section of Experimental Dento-Maxillo-Facial Medicine, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111 Bonn, Germany
| | - Ali Abedi
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, 55131 Mainz, Germany
| | - Birgit Rath-Deschner
- Department of Orthodontics, Center of Dento-Maxillo-Facial Medicine, University of Bonn, 53111 Bonn, Germany
| | - Andressa V. B. Nogueira
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, 55131 Mainz, Germany
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University Medical Center, University of Mainz, 55131 Mainz, Germany
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Padrón-Molina OJ, Parise-Vasco JM, Zambrano-Achig PE, Montesinos-Guevara C. Effectiveness of the use of platelet-rich fibrin associated with open flap debridement compared to open flap debridement alone for the treatment of periodontal intrabony defects: Overview of systematic reviews. J Indian Soc Periodontol 2023; 27:262-272. [PMID: 37346854 PMCID: PMC10281313 DOI: 10.4103/jisp.jisp_300_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/17/2022] [Accepted: 01/15/2023] [Indexed: 06/23/2023] Open
Abstract
In the recent years, platelet-rich fibrin (PRF) has gained importance in regenerative medicine due to its attributed tissue-inducing properties. However, it is still unclear whether there are benefits from using PRF with open flap debridement (OFD) for the treatment of intrabony defects compared to OFD alone. For this reason, in this study, we performed an overview of systematic reviews with Friendly Summaries of the Body of Evidence using Epistemonikos methodology on the use of PRF with OFD compared to OFD alone for the treatment of intrabony defects. We performed a systematic search in the Epistemonikos database. We extracted data from the included systematic reviews and reanalyzed the data of primary studies and generated a summary of the findings table. We used Review Manager (RevMan) v5.3 software and GRADEpro software for data analysis and data presentation. Eighteen systematic reviews were included after full-text screening, which had 16 clinical trials. Results were reported by the mean difference (MD); the following outcomes were analyzed: change in intrabony defect depth (MD: 1.37 mm more), change in radiographic bone defect filling (MD: 37.26% more), change in probing depth (MD: 1.22 mm more), change in clinical attachment level (MD: 1.32 mm more), and change in gingival margin level (MD: 0.31 more). We concluded that applying PRF with OFD to treat an intrabony defect has some clinical advantages compared to OFD alone.
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Affiliation(s)
| | - Juan Marcos Parise-Vasco
- Maestría en Epidemiología con Mención en Investigación Clínica Aplicada, Quito, Ecuador
- Centro de Investigación en Epidemiología Clínica y Salud Pública, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Paula E. Zambrano-Achig
- Centro de Investigación en Epidemiología Clínica y Salud Pública, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Camila Montesinos-Guevara
- Centro de Investigación en Epidemiología Clínica y Salud Pública, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
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Limiroli E, Calò A, Cortellini P, Eickholz P, Katayama A, Majzoub J, Wong J, McClain P, Cortinovis I, Rasperini G. The influence of interradicular anatomy on the predictability of periodontal regenerative therapy of furcation defects: a retrospective, multicenter clinical study. Clin Oral Investig 2023:10.1007/s00784-023-04995-3. [PMID: 37052671 DOI: 10.1007/s00784-023-04995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The relationship between the anatomy of the interradicular space and success in regenerative therapy of furcation defects is discussed in this paper. The goal of this retrospective, multicenter clinical study is to clinically evaluate the relationship between the interradicular conformation and regenerative therapy success with the use of a novel measurement method. METHODS One hundred thirty-eight radiographs of mandibular molars with furcation defects that had been treated with regenerative therapy were collected from six clinical centers. Data on the type of therapy and clinical parameters before and after treatment (follow-up of at least 12 months) were collected. The radiographs (before surgery and at least 12 months postoperatively) were measured with a visual evaluation method by a blind operator using graphics software. RESULTS Success, defined as a reduction in horizontal and vertical furcation involvement, decrease in probing depths, and increase in clinical attachment level, was statistically assessed on 138 regenerated molars sites and were related to clinical variables such as age, sex, center, and treatment. No correlation was found between success in regenerative therapy and the conformation of the interradicular space, measured with a visual ratio method and a standard linear measurement. At the univariate analysis, the parameters that had a correlation with success were center, extent of furcation involvement, treatment, and sex. The use of enamel matrix derivative (EMD) seemed to be the most favorable therapy, with increase in CAL gain and reduction of vertical or horizontal furcation involvement. CONCLUSIONS The regenerative outcome was not significantly influenced by the anatomy of furcation. The center, the degree of furcation involvement, sex, and treatment (EMD) were significantly associated with higher success of periodontal regeneration.
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Affiliation(s)
- Enrico Limiroli
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
- Foundation IRCCS Ca' Granda Polyclinic, Via Della Commenda 10, 20122, Milan, Italy.
| | - Andrea Calò
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Foundation IRCCS Ca' Granda Polyclinic, Via Della Commenda 10, 20122, Milan, Italy
| | | | - Peter Eickholz
- Department of Periodontology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe-University Frankfurt Am Main, 60596, Frankfurt Am Main, Germany
| | | | - Jad Majzoub
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Wong
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology at the Harvard School of Dental Medicine, Boston, MA, USA
| | | | - Ivan Cortinovis
- Laboratory G.A. Maccacaro, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Foundation IRCCS Ca' Granda Polyclinic, Via Della Commenda 10, 20122, Milan, Italy
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23
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Fakheran O, Fischer KR, Schmidlin PR. Enamel Matrix Derivatives as an Adjunct to Alveolar Ridge Preservation-A Systematic Review. Dent J (Basel) 2023; 11:dj11040100. [PMID: 37185478 PMCID: PMC10137019 DOI: 10.3390/dj11040100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/28/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE To systematically assess the current evidence regarding the adjunctive application of enamel matrix derivatives (EMDs) during alveolar ridge preservation (ARP) following tooth extraction. METHODS A comprehensive literature search was conducted in MEDLINE, Cochrane Library, PsycINFO, Web of Science, Google Scholar, and Scopus to identify relevant randomized controlled clinical trials (RCTs). The primary outcome parameters of this systematic review were histomorphometric and radiographic data; secondary outcomes were the feasibility of implant placement after ARP as well as patient-related outcomes such as postoperative discomfort. RESULTS The search identified 436 eligible articles published from 2011 to 2022, but only five were ultimately included for data extraction (146 patients). Given the substantial heterogeneity among the included studies, no meta-analysis could be performed. The authors' qualitative analysis showed marginally improved outcomes regarding an increased percentage of new bone formation after tooth extraction and a reduction in postoperative discomfort. CONCLUSIONS Given the potential value of EMDs in other fields of regenerative dentistry, more consideration should be given to EMDs as an adjunctive treatment option in ARP. However, more well-controlled randomized clinical trials are necessary to evaluate the exact potential and impacts of EMDs.
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Affiliation(s)
- Omid Fakheran
- Department of Periodontics, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, 81658 Isfahan, Iran
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine and Oral Health, Medical University of Graz, Graz 8010, Austria
| | - Kai R Fischer
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology & Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, Plattenstrasse, 11 8032 Zurich, Switzerland
| | - Patrick R Schmidlin
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology & Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, Plattenstrasse, 11 8032 Zurich, Switzerland
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Nakasa T, Hayashi S, Nakamae A, Ishikawa M, Ochi M, Adachi N. Human Trials on the Prevention of Tunnel Widening by the Emdogain in Anterior Cruciate Ligament Reconstruction. Cureus 2023; 15:e35960. [PMID: 37050981 PMCID: PMC10085527 DOI: 10.7759/cureus.35960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Background Although anterior cruciate ligament reconstruction (ACLR) is an established procedure, some problems remain, such as bone tunnel widening after ACLR. In animal studies, Emdogain (EMD) prevented tunnel widening by promoting tendon-bone healing. This study aimed to evaluate the effects of EMD on the prevention of tunnel widening after anterior cruciate ligament (ACL) injury in humans. Methods Nineteen patients who underwent ACLR were included. Seven patients in the EMD group were administered EMDs into the femoral tunnel during ACLR, while 12 patients in the control group were not administered EMDs. After surgery, at two and four weeks and three, six, and 12 months, femoral and tibial tunnel widening were evaluated on computed tomography images. Anteroposterior laxity and clinical scores such as the Lysholm score, the International Knee Documentation Committee (IKDC) subjective form, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were assessed before surgery and 12 months postoperatively. Results Tunnel widening on the femoral side was significantly smaller in the EMD group than in the control group at two weeks. However, there was no significant difference between the two groups at 12 months. There were no significant differences in anteroposterior laxity and clinical scores between the groups before and 12 months after surgery. Conclusion EMD administration into the bone tunnel did not prevent tunnel widening at 12 months after ACLR, although tunnel widening of the femoral tunnel was reduced by EMD administration in the early phase.
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Vilarrasa J, Blasi G. Double laterally moved coronally advanced flap combined with a connective tissue graft plus enamel matrix derivatives for the management of adjacent deep gingival recessions in lower incisors: A case report. Clin Adv Periodontics 2023; 13:62-66. [PMID: 36087935 DOI: 10.1002/cap.10224] [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: 07/14/2022] [Accepted: 08/29/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Several surgical approaches have been described for the management of deep adjacent gingival recessions (GRs) in the lower anterior sextant with contrasting clinical outcomes. A modified surgical technique is presented, which consists of a double laterally moved and coronally advanced flaps in combination with a connective tissue graft (CTG) and enamel matrix derivatives (EMDs). METHODS AND RESULTS A 42-year-old systemically healthy female presented with dentin hypersensitivity and discomfort while brushing on two adjacent Cairo recession Type 2 of 7-mm depth with a narrow band of keratinized tissue in the lower incisors. The root coverage procedure was performed using a double laterally rotated and coronally advanced flap combined with a CTG harvested from the lateral palate and EMD. At 1-year follow-up, 85% of both of the roots were covered and 6 mm of keratinized tissue width was gained. CONCLUSION The presented technique is a predictable procedure for treating adjacent and deep GRs in the anterior sextant whenever keratinized tissue lateral to the gingival defects is available. KEY POINTS Why is this case new information? To the best of our knowledge, this is the first case report in the literature using a double laterally moved and coronally advanced flap combined with EMD and CTG for adjacent deep recessions. What are the keys to successful management of this case? Flap design, handling of the bilateral pedicles, and suture technique are the most important factors to obtain a predictable root coverage. What are the primary limitations to success in this case? Lack of keratinized tissue lateral to the recession defects, flap tension, and interproximal attachment loss are the main limitations to succeed with this technique.
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Affiliation(s)
- Javi Vilarrasa
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gonzalo Blasi
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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Singer L, Fouda A, Bourauel C. Biomimetic approaches and materials in restorative and regenerative dentistry: review article. BMC Oral Health 2023; 23:105. [PMID: 36797710 PMCID: PMC9936671 DOI: 10.1186/s12903-023-02808-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
Biomimetics is a branch of science that explores the technical beauty of nature. The concept of biomimetics has been brilliantly applied in famous applications such as the design of the Eiffel Tower that has been inspired from the trabecular structure of bone. In dentistry, the purpose of using biomimetic concepts and protocols is to conserve tooth structure and vitality, increase the longevity of restorative dental treatments, and eliminate future retreatment cycles. Biomimetic dental materials are inherently biocompatible with excellent physico-chemical properties. They have been successfully applied in different dental fields with the advantages of enhanced strength, sealing, regenerative and antibacterial abilities. Moreover, many biomimetic materials were proven to overcome significant limitations of earlier available generation counterpart. Therefore, this review aims to spot the light on some recent developments in the emerging field of biomimetics especially in restorative and regenerative dentistry. Different approaches of restoration, remineralisation and regeneration of teeth are also discussed in this review. In addition, various biomimetic dental restorative materials and tissue engineering materials are discussed.
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Affiliation(s)
- Lamia Singer
- Oral Technology, University Hospital Bonn, 53111, Bonn, North Rhine-Westphalia, Germany. .,Department of Orthodontics, University Hospital Bonn, 53111, Bonn, North Rhine-Westphalia, Germany.
| | - Ahmed Fouda
- grid.15090.3d0000 0000 8786 803XOral Technology, University Hospital Bonn, 53111 Bonn, North Rhine-Westphalia Germany ,grid.33003.330000 0000 9889 5690Department of Fixed Prosthodontics, Suez Canal University, Ismailia, Egypt
| | - Christoph Bourauel
- grid.15090.3d0000 0000 8786 803XOral Technology, University Hospital Bonn, 53111 Bonn, North Rhine-Westphalia Germany
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Effects of Enamel Matrix Derivative on Cell Spheroids Made of Stem Cells Obtained from the Gingiva on Osteogenic Differentiation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020377. [PMID: 36837578 PMCID: PMC9960569 DOI: 10.3390/medicina59020377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/04/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Background and Objectives: A derivative of the enamel matrix was used to speed up periodontal regeneration, including the formation of new cementum, alveolar bone, and periodontal ligament. In this study, human gingiva-derived stem cell-derived cell spheroids were used to assess the effects of an enamel matrix derivative on cell viability, osteogenic differentiation, and mineralization. Materials and Methods: Human gingiva-derived stem cells were used to create spheroids, which were then coupled with unloaded control groups and an enamel matrix derivative at a final concentration of 2.7, 27, 270, and 2700 μg/mL. The morphological examination of the created stem cell spheroids took place on days 1, 3, 5, and 7. The Live/Dead Kit assay was used to determine the qualitative viability of cells on days 3 and 7. Using the Cell Counting Kit-8, the quantitative vitality of the cell spheroids was assessed on days 1, 3, and 5. On days 7 and 14, alkaline phosphatase activity assays and Alizarin Red S staining were carried out to examine the osteogenic differentiation of the cell spheroids. RUNX2 and COL1A1 expression levels on days 7 and 14 were determined using real-time polymerase chain reaction. Results: The added enamel matrix derivative at the tested concentrations did not significantly alter the morphology of the applied stem cells' well-formed spheroids on day 1. On days 3 and 7, the majority of the spheroids' cells fluoresced green while they were being cultivated. Alkaline phosphatase activity data revealed a substantial rise in the 2700 μg/mL group on day 7 when compared to the unloaded control (p < 0.05). On days 7 and 14, calcium deposits were distinctly seen in each group. In the 27 and 2700 μg/mL groups, the treatment with the enamel matrix derivative resulted in noticeably higher values for the Alizarin Red S staining (p < 0.05). qPCR results showed that adding an enamel matrix derivative to the culture of the 27 μg/mL group raised the level of RUNX2 mRNA expression. Conclusions: These results lead us to the conclusion that a derivative of the enamel matrix may be used to promote osteogenic differentiation in stem cell spheroids.
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Simonelli A, Severi M, Trombelli L, Farina R. Minimal invasiveness in the surgical treatment of intraosseous defects: A systematic review. Periodontol 2000 2023; 91:20-44. [PMID: 36683013 DOI: 10.1111/prd.12467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/13/2022] [Accepted: 08/21/2022] [Indexed: 01/24/2023]
Abstract
The modern approach to regenerative treatment of periodontal intraosseous defects should aim at maximizing the clinical outcomes while minimizing the invasiveness (pain, complications, aesthetic impairment, chair time, and costs) of the procedure. The present systematic review evaluated the effect of flap design, regenerative technology, and perioperative and postoperative adjunctive protocols on invasiveness. Overall, the results of the 13 included trials indicate that: (a) the elevation of a single (buccal or lingual) flap positively influences the intensity of postoperative pain and improves the quality of early wound healing compared with double flaps; (b) while the adjunctive use of a membrane is associated with significantly longer surgery-related chair time and higher postoperative pain, the adjunctive use of enamel matrix derivative at sites receiving a graft significantly reduces postoperative pain; also, graft materials showed no significant impact on invasiveness; (c) open flap debridement performed through the elevation of a single flap may lead to substantial clinical improvements of the lesion with reduced surgery-related chair time and costs, thus representing a promising alternative to regenerative treatment. However, for such an approach, a histological evaluation of the nature of the reconstructed tissues is still lacking, and the presurgery conditions (eg, probing depth, defect severity, and defect morphology), which may benefit in terms of invasiveness, have not yet been defined; and (d) intraoperative and postoperative low-level laser biostimulation of the defect site may favorably modulate the postoperative course.
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Affiliation(s)
- Anna Simonelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (A.U.S.L.) of Ferrara, Ferrara, Italy
| | - Mattia Severi
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (A.U.S.L.) of Ferrara, Ferrara, Italy
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (A.U.S.L.) of Ferrara, Ferrara, Italy
| | - Roberto Farina
- Research Centre for the Study of Periodontal and Peri-Implant Diseases, University of Ferrara, Ferrara, Italy.,Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (A.U.S.L.) of Ferrara, Ferrara, Italy
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29
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Attik N, Garric X, Bethry A, Subra G, Chevalier C, Bouzouma B, Verdié P, Grosgogeat B, Gritsch K. Amelogenin-Derived Peptide (ADP-5) Hydrogel for Periodontal Regeneration: An In Vitro Study on Periodontal Cells Cytocompatibility, Remineralization and Inflammatory Profile. J Funct Biomater 2023; 14:jfb14020053. [PMID: 36826852 PMCID: PMC9966511 DOI: 10.3390/jfb14020053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
A relevant alternative to enamel matrix derivatives from animal origin could be the use of synthetic amelogenin-derived peptides. This study aimed to assess the effect of a synthetic amelogenin-derived peptide (ADP-5), alone or included in an experimental gellan-xanthan hydrogel, on periodontal cell behavior (gingival fibroblasts, periodontal ligament cells, osteoblasts and cementoblasts). The effect of ADP-5 (50, 100, and 200 µg/mL) on cell metabolic activity was examined using Alamar blue assay, and cell morphology was assessed by confocal imaging. An experimental gellan-xanthan hydrogel was then designed as carrier for ADP-5 and compared to the commercial gel Emdogain®. Alizarin Red was used to determine the periodontal ligament and cementoblasts cell mineralization. The inflammatory profile of these two cells was also quantified using ELISA (vascular endothelial growth factor A, tumor necrosis factor α, and interleukin 11) mediators. ADP-5 enhanced cell proliferation and remineralization; the 100 µg/mL concentration was more efficient than 50 and 200 µg/mL. The ADP-5 experimental hydrogel exhibited equivalent good biological behavior compared to Emdogain® in terms of cell colonization, mineralization, and inflammatory profile. These findings revealed relevant insights regarding the ADP-5 biological behavior. From a clinical perspective, these outcomes could instigate the development of novel functionalized scaffold for periodontal regeneration.
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Affiliation(s)
- Nina Attik
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Villeurbanne, France
- Faculté d’Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France
- Correspondence:
| | - Xavier Garric
- Institut des Biomolécules Max Mousseron (IBMM), University of Montpellier, CNRS, ENSCM, 34000 Montpellier, France
- Departement of Pharmacy, Nîmes University Hospital, 30900 Nîmes, France
| | - Audrey Bethry
- Institut des Biomolécules Max Mousseron (IBMM), University of Montpellier, CNRS, ENSCM, 34000 Montpellier, France
| | - Gilles Subra
- Institut des Biomolécules Max Mousseron (IBMM), University of Montpellier, CNRS, ENSCM, 34000 Montpellier, France
| | - Charlène Chevalier
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Villeurbanne, France
| | - Brahim Bouzouma
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Villeurbanne, France
| | - Pascal Verdié
- Institut des Biomolécules Max Mousseron (IBMM), University of Montpellier, CNRS, ENSCM, 34000 Montpellier, France
| | - Brigitte Grosgogeat
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Villeurbanne, France
- Faculté d’Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France
- Service d’Odontologie (UF Recherche Clinique), Hospices Civils de Lyon, 69007 Lyon, France
| | - Kerstin Gritsch
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, 69622 Villeurbanne, France
- Faculté d’Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France
- Service d’Odontologie (UF Parodontologie), Hospices Civils de Lyon, 69007 Lyon, France
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30
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Minimally Invasive Non-Surgical Technique in the Treatment of Intrabony Defects-A Narrative Review. Dent J (Basel) 2023; 11:dj11010025. [PMID: 36661562 PMCID: PMC9858434 DOI: 10.3390/dj11010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
Intrabony defects occur frequently in periodontitis and represent sites that, if left untreated, are at increased risk for disease progression. Although resective or repair procedures have been used to treat intrabony defects, aiming at their elimination, the treatment of choice is surgical periodontal regeneration. The development of periodontal regeneration in the last 30 years has followed two distinctive, though totally different, paths. The interest of researchers has so far focused on regenerative materials and products on one side, and on novel surgical approaches on the other side. In the area of materials and products, three different regenerative concepts have been explored namely, barrier membranes, bone grafts, and wound healing modifiers/biologics, plus many combinations of the aforementioned. In the area of surgical approaches, clinical innovation in flap design and handling, as well as minimally invasive approaches, has radically changed regenerative surgery. Recently, a minimally invasive non-surgical technique (MINST) for the treatment of intrabony defects was proposed. Initial clinical trials indicated comparable results to the surgical minimally invasive techniques in both clinical and radiographic outcomes. These results support the efficacy of this treatment approach. The aim of this review is to present the evidence on the application of minimally invasive non-surgical techniques and their efficacy in the treatment of intrabony defects.
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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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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: 17] [Impact Index Per Article: 8.5] [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.
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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
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Kitamura M, Yamashita M, Miki K, Ikegami K, Takedachi M, Kashiwagi Y, Nozaki T, Yamanaka K, Masuda H, Ishihara Y, Murakami S. An exploratory clinical trial to evaluate the safety and efficacy of combination therapy of REGROTH® and Cytrans® granules for severe periodontitis with intrabony defects. Regen Ther 2022; 21:104-113. [PMID: 35785043 PMCID: PMC9234541 DOI: 10.1016/j.reth.2022.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/06/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Currently, flap operation (FOP) using REGROTH® (0.3% basic fibroblast growth factor [FGF-2]) is the standard treatment for periodontal regenerative therapy in Japan. However, the periodontal tissue regenerative effect with REGROTH® monotherapy is inadequate for severe alveolar bone defects. Therefore, in this study, we evaluated the safety and effectiveness of periodontal regenerative therapy for patients with severe periodontitis using REGROTH® (test medicine) combined with Cytrans® Granules (test device: carbonated apatite granules), which is a new artificial bone. Methods The study participants included 10 patients with severe periodontitis (mean age: 47.4 years). All participants provided written informed consents. In each patient, the intrabony defect site (mean bone defect depth: 5.7 mm) was defined as the test site. FOP was performed for the test site after the baseline investigation; moreover, the test medicine and test device were administered simultaneously. Furthermore, the observation of subjects’ general condition and test sites was conducted and the blood, urine, and periodontal tissue tests were performed up to 36 weeks after FOP. The rate of bone increase (%), clinical attachment level (CAL), probing pocket depth (PPD), bleeding on probing (BOP), tooth mobility (Mo), width of keratinized gingiva (KG), gingival recession (REC), gingival index (GI), and plaque index (PlI) were evaluated during the periodontal tissue investigation. Results As the primary endpoint, no adverse events related to the test medicine and test device occurred during the entire observation period of this study. Regarding the secondary endpoints, there was a significant increase in new alveolar bone (p = 0.003) and CAL acquisition (p = 0.001) as well as decrease in PPD (p = 0.002) and BOP (p = 0.016) at 36 weeks after administration of the test medicine and test device compared with the preoperative values. Furthermore, at 36 weeks after surgery, the Mo, GI, and PlI decreased to preoperative levels at 40%, 60%, and 30% of sites, respectively. However, at 36 weeks after surgery, there was no difference in KG and REC compared with their preoperative values. Conclusions The safety of periodontal regenerative therapy using the test medicine in combination with the abovementioned test device was confirmed. In addition, it was suggested that this periodontal regenerative therapy is effective for tissue regeneration in severe alveolar bone defects. This clinical trial was conducted after registering and publicizing as a specified clinical trial in the Japan registry of clinical trials (jRCTs051190045). The safety of flap operation using 0.3% FGF-2 and carbonated apatite was confirmed. The administration of 0.3% FGF-2 and carbonated apatite improved periodontitis. Combining 0.3% FGF-2 and carbonated apatite for severe alveolar bone defects. Periodontal regenerative therapy combining both could be effective.
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Next-Generation Examination, Diagnosis, and Personalized Medicine in Periodontal Disease. J Pers Med 2022; 12:jpm12101743. [PMID: 36294882 PMCID: PMC9605396 DOI: 10.3390/jpm12101743] [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: 09/23/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 01/10/2023] Open
Abstract
Periodontal disease, a major cause of tooth loss, is an infectious disease caused by bacteria with the additional aspect of being a noncommunicable disease closely related to lifestyle. Tissue destruction based on chronic inflammation is influenced by host and environmental factors. The treatment of periodontal disease varies according to the condition of each individual patient. Although guidelines provide standardized treatment, optimization is difficult because of the wide range of treatment options and variations in the ideas and skills of the treating practitioner. The new medical concepts of “precision medicine” and “personalized medicine” can provide more predictive treatment than conventional methods by stratifying patients in detail and prescribing treatment methods accordingly. This requires a new diagnostic system that integrates information on individual patient backgrounds (biomarkers, genetics, environment, and lifestyle) with conventional medical examination information. Currently, various biomarkers and other new examination indices are being investigated, and studies on periodontal disease-related genes and the complexity of oral bacteria are underway. This review discusses the possibilities and future challenges of precision periodontics and describes the new generation of laboratory methods and advanced periodontal disease treatment approaches as the basis for this new field.
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Shirakata Y, Imafuji T, Nakamura T, Shinohara Y, Iwata M, Setoguchi F, Noguchi K, Sculean A, Dent M. Cross-linked hyaluronic acid gel with or without a collagen matrix in the treatment of class III furcation defects: A histologic and histomorphometric study in dogs. J Clin Periodontol 2022; 49:1079-1089. [PMID: 35817414 PMCID: PMC9796036 DOI: 10.1111/jcpe.13694] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/11/2022] [Accepted: 07/03/2022] [Indexed: 12/30/2022]
Abstract
AIM To histologically evaluate the effects of cross-linked hyaluronic acid (xHyA) with or without a collagen matrix (CM) on periodontal wound healing/regeneration in class III furcation defects in dogs. MATERIALS AND METHODS Class III furcation defects were surgically created in the mandibular premolars in six beagle dogs. The defects were randomly treated as follows: open flap debridement (OFD) + CM (CM), OFD + xHyA (xHyA), OFD + xHyA + CM (xHyA/CM) and OFD alone (OFD). At 10 weeks, the animals were euthanized for histological evaluation. RESULTS The newly formed bone areas in the xHyA (4.04 ± 1.51 mm2 ) and xHyA/CM (4.32 ± 1.14 mm2 ) groups were larger than those in the OFD (3.25 ± 0.81 mm2 ) and CM (3.31 ± 2.26 mm2 ) groups. The xHyA (6.25 ± 1.45 mm) and xHyA/CM (6.40 ± 1.35 mm) groups yielded statistically significantly (p < .05) greater formation of new connective tissue attachment (i.e., new cementum, with inserting connective tissue fibres) compared with the OFD (1.47 ± 0.85 mm) group. No significant differences were observed in any of the histomorphometric parameters between the xHyA and xHyA/CM groups. Complete furcation closure was not observed in any of the four treatment modalities. CONCLUSIONS Within their limits, the present results suggest that the use of xHyA with or without CM positively influences periodontal wound healing in surgically created, acute-type class III furcation defects.
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Affiliation(s)
- Yoshinori Shirakata
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Takatomo Imafuji
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Toshiaki Nakamura
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Yukiya Shinohara
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Masayuki Iwata
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Fumiaki Setoguchi
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Kazuyuki Noguchi
- Department of PeriodontologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Anton Sculean
- Department of Periodontology, School of Dental MedicineUniversity of BernBernSwitzerland
| | - Med Dent
- Department of Periodontology, School of Dental Medicine, University of Bern, Switzerland
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Induction of periodontal ligament-like cells by co-culture of dental pulp cells, dedifferentiated cells generated from Epithelial cell Rests of Malassez, and umbilical vein endothelial cells. J Endod 2022; 48:1387-1394. [PMID: 36067833 DOI: 10.1016/j.joen.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Apart from the Epithelial Cell rests of Malassez (ERM), the dental pulp (DP) contains the same types of mesenchymal cells as the periodontal ligament (PDL). The ERM may affect the characteristics of mesenchymal cells in the PDL. The aim of this study was to examine whether DP cells cultured with ERM and human umbilical vein endothelial cells (HUVECs) could transform into PDL-like cells. METHODS Progenitor-dedifferentiated into stem-like cells (Pro-DSLCs) were produced by the induction of ERM with 5-Azacytidine and valproic acid. DP cells were cultured in mesenchymal stem cell (MSC) medium for 1 week under the following conditions: DP cells alone (controls); PDL cells alone; co-culture of DP cells and ERM (DP+ERM) or Pro-DSLCs (DP+Pro-DSLC); co-culture of DP cells, HUVECs, and ERM cells (DP+ERM+HUVEC) or Pro-DSLCs (DP+Pro-DSLC+HUVEC). qRT-PCR, qMSP, and flow cytometry were performed. RESULTS The expression levels of PDL-related markers, Msx1, Msx2, Ncam1, Postn, S100a4, and MSC-positive markers, Cd29, Cd90, Cd105, were significantly higher in the PDL cells and DP+Pro-DSLC+HUVEC cultures than in the controls (p < 0.05). The DNA methylation levels of Msx1 and Cd29 in the PDL cells and DP+Pro-DSLC+HUVEC culture were significantly lower than in the controls (p < 0.01). We found a significant increase in the number of cells stained with MSX1 (p < 0.05) and CD29 (p < 0.01) in the DP+Pro-DSLC+HUVEC culture than in the controls. CONCLUSIONS Co-culture of DP cells with Pro-DSLCs and HUVECs induced their transformation into PDL-like cells. This method may prove useful for periodontal regeneration via tissue engineering.
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Swanson WB, Yao Y, Mishina Y. Novel approaches for periodontal tissue engineering. Genesis 2022; 60:e23499. [PMID: 36086991 PMCID: PMC9787372 DOI: 10.1002/dvg.23499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 12/30/2022]
Abstract
The periodontal complex involves the hard and soft tissues which support dentition, comprised of cementum, bone, and the periodontal ligament (PDL). Periodontitis, a prevalent infectious disease of the periodontium, threatens the integrity of these tissues and causes irreversible damage. Periodontal therapy aims to repair and ultimately regenerate these tissues toward preserving native dentition and improving the physiologic integration of dental implants. The PDL contains multipotent stem cells, which have a robust capacity to differentiate into various types of cells to form the PDL, cementum, and alveolar bone. Selection of appropriate growth factors and biomaterial matrices to facilitate periodontal regeneration are critical to recapitulate the physiologic organization and function of the periodontal complex. Herein, we discuss the current state of clinical periodontal regeneration including a review of FDA-approved growth factors. We will highlight advances in preclinical research toward identifying additional growth factors capable of robust repair and biomaterial matrices to augment regeneration similarly and synergistically, ultimately improving periodontal regeneration's predictability and long-term efficacy. This review should improve the readers' understanding of the molecular and cellular processes involving periodontal regeneration essential for designing comprehensive therapeutic approaches.
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Affiliation(s)
- W. Benton Swanson
- Department of Biologic and Materials Science, Division of ProsthodonticsUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Yao Yao
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Biointerfaces InstituteUniversity of MichiganAnn ArborMichiganUSA
| | - Yuji Mishina
- Department of Biologic and Materials Science, Division of ProsthodonticsUniversity of Michigan School of DentistryAnn ArborMichiganUSA
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Montero E, Roccuzzo A, Molina A, Monje A, Herrera D, Roccuzzo M. Minimal invasiveness in the reconstructive treatment of peri-implantitis defects. Periodontol 2000 2022; 91:199-216. [PMID: 35899987 DOI: 10.1111/prd.12460] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, clinically characterized by increased peri-implant probing pocket depth and progressive loss of supporting bone. Consequently, to arrest further disease progression and to increase the chance to obtain re-osseointegration, surgical reconstructive procedures have been adopted. In particular, following a paradigm gathered from periodontal therapy, recent protocols have underlined the importance of a minimally invasive approach to optimize the outcomes of therapy while minimizing the risks of postoperative complications. The present review summarizes the level of evidence on the surgical reconstructive protocols focusing on the new approaches aiming to minimize surgical trauma and patients' postoperative discomfort, underlining the pros and cons of each treatment modality.
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Affiliation(s)
- Eduardo Montero
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Ana Molina
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - David Herrera
- ETEP (Etiology and Therapy of Periodontal and Peri-Implant Diseases) Research Group, University Complutense, Madrid, Spain
| | - Mario Roccuzzo
- Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Division of Maxillofacial Surgery, University of Torino, Torino, Italy
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Meng M, Xia Q, Li Y, Chen X, Wang Q, Chen J, Xu X, Wang H, Shu J, Lu J, Cheng L, Ye Z, Song B, Dong Q. Enamel matrix derivative expedites osteogenic differentiation of BMSCs via Wnt/β-catenin pathway in high glucose microenvironment. J Bone Miner Metab 2022; 40:448-459. [PMID: 35347430 DOI: 10.1007/s00774-022-01318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/29/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The influence of enamel matrix derivative (EMD) on proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) was explored in high glucose (HG) microenvironment with interaction of Wnt/β-catenin pathway. MATERIALS AND METHODS Extraction of BMSCs from Sprague-Dawley rats, culture, and identification were manifested. The cells were treated with different concentration of EMD in HG to figure out the most available concentration for proliferation and osteogenic differentiation. Then, observation of cell growth curve and cell cycle changes, and detection of Osterix, runt-related transcription factor 2 (Runx2), COL-I, early osteogenic indexes, Calcium salt deposition, and β-catenin protein in Wnt/β-catenin pathway were assured. After adding Wnt/β-catenin pathway inhibitor (XAV-939) in the cells with osteogenesis induction, detection of binding of β-catenin to Osterix was clarified. RESULTS Via identification BMSCs cultured in vitro was qualified. Different concentrations of EMD could accelerate cell proliferation in HG and osteogenesis induction, and 75 μg/mL EMD had the best effect. The HG augmented BMSCs proliferation and the propidium iodide index of flow cytometry cycle was elevated in HG, which were strengthened via the EMD. After BMSCs' osteogenesis induction, Osterix, Runx2, CoL-1, early osteogenic indexes, and calcium salt deposition were reduced, but elevated via EMD. β-Catenin was the lowest in the HG, but elevated after EMD. After addition of XAV-939, reduction of β-catenin and the downstream (Osterix and Runx2) were manifested. Detection of binding protein bands was in β-catenin and Osterix of the HG after EMD treatment. CONCLUSION EMD may facilitate the osteogenic differentiation of BMSCs via activating the Wnt/β-catenin pathway in HG.
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Affiliation(s)
- MaoHua Meng
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
| | - Qian Xia
- Department of Preventive and Pediatric Dentistry, Stomatological Hospital of Guizhou Medical University, Guiyang City, 550004, Guizhou Province, China
| | - Ying Li
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
| | - Xin Chen
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
| | - QinYing Wang
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
| | - JingQiao Chen
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
| | - XingXing Xu
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
| | - Huan Wang
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
| | - JiaYu Shu
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
| | - Jing Lu
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China
| | - Lu Cheng
- Department of Stomatology, Guiyang Hospital of Stomatology, Guiyang City, 550005, Guizhou Province, China
| | - ZhaoYang Ye
- Clinical Research Center, The Affiliated Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China.
| | - Bin Song
- Department of Prosthodontics, Guizhou Provincial People's Hospital, 83 Zhongshan East Road, Guiyang, Guiyang City, 550003, Guizhou Province, China.
| | - Qiang Dong
- School of Stomatology, Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China.
- Department of Prosthodontics, Stomatological Hospital of Guizhou Medical University, 9 Beijing Road, Yunyan District, Guiyang City, 550004, Guizhou Province, China.
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Georgiou GO, Tarallo F, Marchetti E, Bizzarro S. Overview of the Effect of Different Regenerative Materials in Class II Furcation Defects in Periodontal Patients. MATERIALS 2022; 15:ma15093194. [PMID: 35591533 PMCID: PMC9103580 DOI: 10.3390/ma15093194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/14/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
The aim of this review was to give an overview of the outcomes of the use of different regenerative materials to treat molars with class II furcation defects in patients with periodontitis in comparison with open flap debridement (OFD). A search of five databases (PubMed-Medline, Embase, Cochrane, Scopus and Web of Science) was conducted up to and including January 2022. According to the PICOS guidelines, only randomized control trials (S) considering periodontal patients with at least one molar with a class II furcation involvement (P) treated with regenerative materials (I) in comparison to OFD as control treatment (C) and a minimum follow-up period of 6 months were included. Vertical clinical attachment level (VCAL) was considered as the primary outcome (O), while horizontal clinical attachment level (HCAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were considered as secondary outcomes. The search through the databases initially identified 1315 articles. Only 25 of them met the eligibility criteria and were included. The studies were grouped in four macro-categories according to the material used: absorbable and non-absorbable membranes, blood derivatives and a combination of different materials. The greater part of the included studies reported a statistically significant difference in using regenerative materials when compared to OFD. The blood derivatives groups reported a range of mean changes in VCAL of 0.86–4.6 mm, absorbable membrane groups reported −0.6–3.75 mm, non-absorbable membranes groups reported −2.47–4.1 mm, multiple materials groups reported −1.5–4.87 mm and enamel matrix derivatives reported a mean change in VCAL of 1.45 mm. OFD showed a range of mean VCAL changes of −1.86–2.81 mm. Although no statistical analysis was performed, the use of regenerative materials may be considered moderately beneficial in the treatment of molars with grade II furcation involvement. However, the substantial heterogeneity in the protocols’ design does not allow us to draw definitive conclusions. In addition, low levels of evidence for morbidity and patient-centered outcomes were reported.
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Affiliation(s)
- Gerasimos Odysseas Georgiou
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, 1081 LA Amsterdam, The Netherlands; (G.O.G.); (S.B.)
| | - Francesco Tarallo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Coppito, 67100 L’Aquila, Italy;
| | - Enrico Marchetti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Coppito, 67100 L’Aquila, Italy;
- Correspondence:
| | - Sergio Bizzarro
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, 1081 LA Amsterdam, The Netherlands; (G.O.G.); (S.B.)
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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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Chatzopoulos GS, Anastasopoulos M, Zarenti S, Doufexi AE, Tsalikis L. Flapless application of enamel matrix derivative in non-surgical periodontal treatment: A systematic review. Int J Dent Hyg 2022; 20:422-433. [PMID: 35143704 DOI: 10.1111/idh.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/23/2021] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the effects of the flapless application of enamel matrix derivative (EMD) in combination with non-surgical periodontal treatment (NSPT) when compared to non-surgical periodontal treatment alone in adult patients. MATERIAL AND METHODS An electronic literature search was conducted in MEDLINE, Scopus and Cochrane Library up to March 2021 complemented by a manual search. Human longitudinal studies of >5 participants and at least 3 months follow-up were eligible for inclusion in the review. Clinical outcomes were extracted and pooled. Meta-analysis of the included studies was not possible due to methodological differences. RESULTS A total of 1199 publications were identified and reviewed for eligibility. Nine of them fulfilled the inclusion criteria. Eight studies were randomized clinical trials. The clinical findings of the majority of the included studies demonstrated that the adjunctive use of EMD with NSPT could lead to significantly improved treatment outcomes including higher PPD reduction, more CAL gain, more robust BOP reduction, higher number of sites with PPD < 5 mm and more frequent pocket closure which reduces the need for further periodontal surgical treatment. Limited biological, microbiological and histological findings were reported. Minimal adverse events were observed. CONCLUSION The flapless application of EMD during NSPT leads to an improved clinical outcome in regards to CAL gain and PPD reduction when compared to conventional treatment alone. The potential effect on the biological and microbiological outcome is unclear.
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Affiliation(s)
- Georgios S Chatzopoulos
- Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Menelaos Anastasopoulos
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Sofia Zarenti
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Aikaterini-Elisavet Doufexi
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece.,Private Practice Limited to Periodontics and Implant Dentistry, Thessaloniki, Greece
| | - Lazaros Tsalikis
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece
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Lindquist S, Isehed C, Lie A, Lundberg P. Enamel matrix derivative does not affect osteoclast formation or bone resorption in cultures of mouse bone marrow macrophages or human monocytes. Acta Odontol Scand 2022; 80:487-493. [PMID: 35138975 DOI: 10.1080/00016357.2022.2036365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Enamel matrix derivative (EMD) is widely used under the brand name Emdogain® to promote periodontal regeneration in surgical treatment of periodontitis and peri-implantitis. The molecular mechanisms are unclear, but it has been proposed that EMD has stimulatory effects on the root cementum and periodontal ligament cells. Since dental implants lack these structures, we hypothesized that EMD-induced bone gain involve interactions with osteoclast precursor cells, with consequent inhibitory effect on osteoclast formation and/or activity. The aim was to evaluate this hypothesis. MATERIAL AND METHODS Primary mouse bone marrow macrophages (BMMs) and human peripheral blood monocytes were cultured in the presence of receptor activator nuclear factor-κB ligand (RANKL) to stimulate osteoclast formation. A purified Emdogain® fraction was added to the cell cultures and the effect on number and size of newly formed osteoclasts were evaluated. In cultures on natural bone slices, bioanalytical methods were used to assay osteoclast number and bone resorption. RESULTS EMD had a negative effect on osteoclastogenesis in mouse cultures on plastic surface, whereas addition of EMD to osteoclast precursor cells on bone substrate did not affect osteoclast formation or bone resorption. CONCLUSIONS The results on natural bone matrix contradict a direct effect of EMD on osteoclast precursor cells.
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Affiliation(s)
- Susanne Lindquist
- Department of Odontology, Molecular Periodontology, Umeå University, Umeå, Sweden
| | - Catrine Isehed
- Department of Periodontology, Public Dental Health County Council of Gävleborg, Gävle County Hospital, Gävle, Sweden
- Center for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | - Anita Lie
- Department of Odontology, Molecular Periodontology, Umeå University, Umeå, Sweden
| | - Pernilla Lundberg
- Department of Odontology, Molecular Periodontology, Umeå University, Umeå, Sweden
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Øvrebø Ø, Perale G, Wojciechowski JP, Echalier C, Jeffers JRT, Stevens MM, Haugen HJ, Rossi F. Design and clinical application of injectable hydrogels for musculoskeletal therapy. Bioeng Transl Med 2022; 7:e10295. [PMID: 35600661 PMCID: PMC9115710 DOI: 10.1002/btm2.10295] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Musculoskeletal defects are an enormous healthcare burden and source of pain and disability for individuals. With an aging population, the proportion of individuals living with these medical indications will increase. Simultaneously, there is pressure on healthcare providers to source efficient solutions, which are cheaper and less invasive than conventional technology. This has led to an increased research focus on hydrogels as highly biocompatible biomaterials that can be delivered through minimally invasive procedures. This review will discuss how hydrogels can be designed for clinical translation, particularly in the context of the new European Medical Device Regulation (MDR). We will then do a deep dive into the clinically used hydrogel solutions that have been commercially approved or have undergone clinical trials in Europe or the United States. We will discuss the therapeutic mechanism and limitations of these products. Due to the vast application areas of hydrogels, this work focuses only on treatments of cartilage, bone, and the nucleus pulposus. Lastly, the main steps toward clinical translation of hydrogels as medical devices are outlined. We suggest a framework for how academics can assist small and medium MedTech enterprises conducting the initial clinical investigation and post‐market clinical follow‐up required in the MDR. It is evident that the successful translation of hydrogels is governed by acquiring high‐quality pre‐clinical and clinical data confirming the device mechanism of action and safety.
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Affiliation(s)
- Øystein Øvrebø
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilanoItaly
- Department of BiomaterialsInstitute of Clinical Dentistry, University of OsloOsloNorway
- Material Biomimetic ASOslo Science ParkOsloNorway
| | - Giuseppe Perale
- Industrie Biomediche Insubri SAMezzovico‐ViraSwitzerland
- Faculty of Biomedical SciencesUniversity of Southern SwitzerlandLuganoSwitzerland
- Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyViennaAustria
| | - Jonathan P. Wojciechowski
- Department of MaterialsImperial College LondonLondonUK
- Department of BioengineeringImperial College LondonLondonUK
- Institute of Biomedical EngineeringImperial College LondonLondonUK
| | - Cécile Echalier
- Department of MaterialsImperial College LondonLondonUK
- Department of BioengineeringImperial College LondonLondonUK
- Institute of Biomedical EngineeringImperial College LondonLondonUK
- Hybrid Technology Hub, Centre of ExcellenceInstitute of Basic Medical Science, University of OsloOsloNorway
| | | | - Molly M. Stevens
- Department of MaterialsImperial College LondonLondonUK
- Department of BioengineeringImperial College LondonLondonUK
- Institute of Biomedical EngineeringImperial College LondonLondonUK
| | - Håvard J. Haugen
- Department of BiomaterialsInstitute of Clinical Dentistry, University of OsloOsloNorway
- Material Biomimetic ASOslo Science ParkOsloNorway
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilanoItaly
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Bommer C, Waller T, Hilbe M, Wiedemeier D, Meyer N, Mathes S, Jung R. Efficacy and safety of P 11-4 for the treatment of periodontal defects in dogs. Clin Oral Investig 2022; 26:3151-3166. [PMID: 35006293 PMCID: PMC8898238 DOI: 10.1007/s00784-021-04297-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
Objectives This study’s aim was to investigate the safety and performance of a self-assembling peptide matrix (SAPM) P11-4 for the treatment of periodontal disease in a controlled pre-clinical study. Materials and methods Acute buccal bony dehiscence defects (LxW: 5 × 3 mm) were surgically created on the distal root of four teeth on one mandible side of 7 beagle dogs followed by another identical surgery 8 weeks later on the contralateral side. SAPM P11-4 (with and without root conditioning with 24% EDTA (T1, T2)), Emdogain® (C) and a sham intervention (S) were randomly applied on the four defects at each time point. Four weeks after the second surgery and treatment, the animals were sacrificed, the mandibles measured by micro-computed tomography (µ-CT) and sections of the tissue were stained and evaluated histologically. Results Clinically and histologically, no safety concerns or pathological issues due to the treatments were observed in any of the study groups at any time point. All groups showed overall similar results after 4 and 12 weeks of healing regarding new cementum, functionality of newly formed periodontal ligament and recovery of height and volume of the new alveolar bone and mineral density. Conclusion A controlled clinical study in humans should be performed in a next step as no adverse effects or safety issues, which might affect clinical usage of the product, were observed. Clinical relevance The synthetic SAPM P11-4 may offer an alternative to the animal-derived product Emdogain® in the future. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04297-6.
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Affiliation(s)
| | - Tobias Waller
- Clinic for Reconstructive Dentistry, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Monika Hilbe
- Laboratory for Animal Model Pathology (LAMP), Institute of Veterinary Pathology, University of Zurich, Winterthurerstrasse 268, 8057, Zurich, Switzerland
| | - Daniel Wiedemeier
- Center of Dental Medicine, Statistical Services, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Nina Meyer
- Department for Chemistry and Biotechnology, Zurich University of Applied Sciences, 8820, Wädenswil, Switzerland
| | - Stephanie Mathes
- Department for Chemistry and Biotechnology, Zurich University of Applied Sciences, 8820, Wädenswil, Switzerland
| | - Ronald Jung
- Clinic for Reconstructive Dentistry, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
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Effect of Root Surface Biomodification on Multiple Recession Coverage with Modified Coronally Advanced Tunnel Technique and Subepithelial Connective Tissue Graft: A Retrospective Analysis. Gels 2022; 8:gels8010031. [PMID: 35049566 PMCID: PMC8775041 DOI: 10.3390/gels8010031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/23/2021] [Accepted: 01/02/2022] [Indexed: 01/22/2023] Open
Abstract
To improve treatment efficacy of gingival recessions (GR), chemical preparation of the exposed root surface was advocated. The aim of this study was to compare the additional influence of root biomodifications with 24% ethylenediaminetetraacetic acid (EDTA) alone or with enamel matrix derivative (EMD) on the 12 month outcomes of modified coronally advanced tunnel (MCAT) with subepithelial connective tissue graft in the treatment of multiple GR. Average root coverage (ARC), complete root coverage (CRC), reduction in GR, reduction in recession width (RW), gain in clinical attachment level (CAL), increase in gingival thickness (GT), increase in keratinized tissue width (KTW) and changes in root coverage esthetic score (RES) were evaluated. A total of 60 patients with 215 GR were enrolled. In 70, GR root surfaces were treated with EDTA + EMD, in other 72, with EDTA, while in the remaining 73 saline solution was applied. ARC was 94%, 89%, and 91% in the EDTA + EMD, the EDTA and the saline groups, respectively (p = 0.8871). Gains in clinical attachment level (CAL; 2.1 ± 1.1 mm) and RES values (9.6 ± 0.9) were significantly higher in the EDTA + EMD group, when compared with two other groups. The differences between other preoperative and postoperative parameters showed statistical significance only within but not between groups. MCAT outcomes may benefit from adjunctive use of EDTA + EMD regarding 12 month CAL gain and professionally assessed esthetics using RES following treatment of GR.
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Moreno Rodríguez JA, Ortiz Ruiz AJ. Periodontal granulation tissue preservation in surgical periodontal disease treatment: a pilot prospective cohort study. J Periodontal Implant Sci 2022; 52:298-311. [PMID: 36047583 PMCID: PMC9436644 DOI: 10.5051/jpis.2105780289] [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: 11/05/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose Methods Results Conclusions
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Duncan WJ, Coates DE. Meeting the challenges and clinical requirements for dental regeneration; the New Zealand experience. Bone 2022; 154:116181. [PMID: 34509689 DOI: 10.1016/j.bone.2021.116181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/02/2022]
Abstract
Disease and trauma leading to tooth loss and destruction of supporting bone is a significant oral handicap, which may be addressed through surgical therapies that aim to regenerate the lost tissue. Whilst complete regeneration of teeth is still aspirational, regeneration of supporting structures (dental pulp, cementum, periodontal ligament, bone) is becoming commonplace, both for teeth and for titanium dental implants that are used to replace teeth. Most grafting materials are essentially passive, however the next generation of oral regenerative devices will combine non-antibiotic antimicrobials and/or osteogenic or inductive factors and/or appropriate multipotential stem cells. The review gives an overview of the approaches taken, including fabrication of novel scaffolds, incorporation of growth factors and cell-based therapies, and discusses the preclinical animal models we employ in the development pathway.
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Affiliation(s)
- Warwick J Duncan
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
| | - Dawn E Coates
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
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Effects of Obesity on Bone Healing in Rats. Int J Mol Sci 2021; 22:ijms222413339. [PMID: 34948136 PMCID: PMC8704371 DOI: 10.3390/ijms222413339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
Although the association between periodontitis and obesity is well explored, it is unclear whether obesity is associated with a worse therapeutic outcome after periodontal treatment. The aim of this study was to investigate the effects of obesity on bone healing with and without the application of regeneration-promoting molecules. A standardized bone fenestration-type defect was created over the root of the mandibular first molar in 15 Wistar rats. Ten animals received a high-fat, high-sucrose diet (HFSD), while the remaining five animals were fed a standard diet. During surgery, the fenestration defects from half of the HFSD-fed, i.e., obese animals, were treated with regeneration-promoting molecules (enamel matrix derivative; EMD). After four weeks, bone healing was evaluated by histomorphometry, TRAP staining and immunohistochemistry for RUNX2 and osteopontin. The analyses revealed that the spontaneous healing of the periodontal defects was compromised by obesity. Application of EMD partially compensated for the negative effect of obesity. Nevertheless, EMD-stimulated bone healing in obese animals was not better than the spontaneous healing in the obesity-free control group, indicating that obesity may also inhibit the stimulatory effects of regeneration-promoting molecules. Our results show that obesity can negatively influence bone healing and suggest that bone healing may be compromised in humans.
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