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Sallum EA, Ribeiro FV, Ruiz KS, Sallum AW. Experimental and clinical studies on regenerative periodontal therapy. Periodontol 2000 2019; 79:22-55. [PMID: 30892759 DOI: 10.1111/prd.12246] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The recognition of a periodontal therapy as a regenerative procedure requires the demonstration of new cementum, periodontal ligament, and bone coronal to the base of the defect. A diversity of regenerative strategies has been evaluated, including root surface conditioning, bone grafts and bone substitute materials, guided tissue regeneration, enamel matrix proteins, growth/differentiation factors, combined therapies and, more recently, tissue-engineering approaches. The aim of this chapter of Periodontology 2000 is to review the research carried out in Latin America in the field of periodontal regeneration, focusing mainly on studies using preclinical models (animal models) and randomized controlled clinical trials. This review may help clinicians and researchers to evaluate the current status of the therapies available and to discuss the challenges that must be faced in order to achieve predictable periodontal regeneration in clinical practice.
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Affiliation(s)
- Enilson A Sallum
- Division of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Fernanda V Ribeiro
- Dental Research Division, School of Dentistry, Paulista University, São Paulo, São Paulo, Brazil
| | - Karina S Ruiz
- Division of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Antonio W Sallum
- Division of Periodontics, Department of Prosthodontics and Periodontics, School of Dentistry, State University of Campinas - UNICAMP, Piracicaba, São Paulo, Brazil
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Histologic evidence of periodontal regeneration in furcation defects: a systematic review. Clin Oral Investig 2019; 23:2861-2906. [PMID: 31165313 DOI: 10.1007/s00784-019-02964-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/16/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To systematically review the available histologic evidence on periodontal regeneration in class II and III furcations in animals and humans. MATERIALS AND METHODS A protocol including all aspects of a systematic review methodology was developed including definition of the focused question, defined search strategy, study inclusion criteria, determination of outcome measures, screening methods, data extraction and analysis, and data synthesis. The focused question was defined as follows: "What is the regenerative effect obtained by using or not several biomaterials as adjuncts to open flap surgery in the treatment of periodontal furcation defects as evaluated in animal and human histological studies?" SEARCH STRATEGY Using the MEDLINE database, the literature was searched for articles published up to and including September 2018: combinations of several search terms were applied to identify appropriate studies. Reference lists of review articles and of the included articles in the present review were screened. A hand search of the most important dental journals was also performed. CRITERIA FOR STUDY SELECTION AND INCLUSION Only articles published in English describing animal and human histological studies evaluating the effect of surgical treatment, with or without the adjunctive use of potentially regenerative materials (i.e., barrier membranes, grafting materials, growth factors/proteins, and combinations thereof) for the treatment of periodontal furcation defects were considered. Only studies reporting a minimum of 8 weeks healing following reconstructive surgery were included. The primary outcome variable was formation of periodontal supporting tissues [e.g., periodontal ligament, root cementum, and alveolar bone, given as linear measurements (in mm) or as a percentage of the instrumented root length (%)] following surgical treatment with or without regenerative materials, as determined histologically/histomorphometrically. Healing type and defect resolution (i.e., complete regeneration, long junctional epithelium, connective tissue attachment, connective tissue adhesion, or osseous repair) were also recorded. RESULTS In animals, periodontal regeneration was reported in class II and III defects with open flap debridement alone or combined with various types of bone grafts/bone substitues, biological factors, guided tissue regeneration, and different combinations thereof. The use of biological factors and combination approaches provided the best outcomes for class II defects whereas in class III defects, the combination approaches seem to offer the highest regenerative outcomes. In human class II furcations, the best outcomes were obtained with DFDBA combined with rhPDGF-BB and with GTR. In class III furcations, evidence from two case reports indicated very limited to no periodontal regeneration. CONCLUSIONS Within their limits, the present results suggest that (a) in animals, complete periodontal regeneration has been demonstrated in class II and class III furcation defects, and (b) in humans, the evidence for substantial periodontal regeneration is limited to class II furcations. CLINICAL RELEVANCE At present, regenerative periodontal surgery represents a valuable treatment option only for human class II furcation defects but not for class III furcations.
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Zohery AA, Meshri SM, Madi MI, Abd El Rehim SS, Nour ZM. Egyptian propolis compared to nanohydroxyapatite graft in the treatment of Class II furcation defects in dogs. J Periodontol 2018; 89:1340-1350. [PMID: 29802626 DOI: 10.1002/jper.17-0685] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Complementary and alternative medicine approaches are gaining ground in everyday practice. Propolis is a bee product that has been suggested to have bone regenerative effects. This study was conducted to compare the effectiveness of Egyptian propolis with nanohydroxyapatite graft on furcation defect regeneration in mongrel dogs. METHODS A split mouth design was utilized in six clinically healthy mongrel dogs. A total of 24 Class II furcation defects were surgically created in mandibular third and fourth premolars. The defects on the right side were filled with nanohydroxyapatite graft and covered with collagen membrane, while on the left side the defects were filled with propolis and also covered with collagen membrane. The dogs were sacrificed after 1 and 3 months. Segments containing the defects were prepared for histological evaluation. RESULTS The histological evaluation after one month revealed newly formed bone in both treatment groups. However, after 3 months, the bone trabeculae appeared thinner in the collagen/nanohydroxyapatite group than in the collagen/propolis group. The histomorphometric evaluation showed a significant increase in bone height as well as bone surface area for the collagen/propolis group compared to collagen/nanohydroxyapatite group. CONCLUSIONS Both Egyptian propolis and nanohydroxyapatite graft material showed favorable periodontal regenerative effect. Propolis showed increased cellular proliferative ability that could be beneficial in reducing the healing period needed after periodontal therapy.
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Affiliation(s)
- Amr A Zohery
- Department of Oral Medicine, Periodontology, Oral Diagnosis and Radiology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Suzanne M Meshri
- Department of Oral Medicine, Periodontology, Oral Diagnosis and Radiology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Marwa I Madi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Zubaida M Nour
- Department of Oral Medicine, Periodontology, Oral Diagnosis and Radiology Department, Faculty of Dentistry, Alexandria University
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Tambella AM, Attili AR, Dupré G, Cantalamessa A, Martin S, Cuteri V, Marcazzan S, Del Fabbro M. Platelet-rich plasma to treat experimentally-induced skin wounds in animals: A systematic review and meta-analysis. PLoS One 2018; 13:e0191093. [PMID: 29324848 PMCID: PMC5764374 DOI: 10.1371/journal.pone.0191093] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 12/28/2017] [Indexed: 12/22/2022] Open
Abstract
The objective of the study was to review current literature to determine whether the topical application of platelet-rich plasma (PRP) promotes healing in experimentally-induced full-thickness skin wounds in animals. The hypothesis was that the adjunct of PRP has a positive effect on wound healing. An electronic search was carried out on the following databases: Web of Science, Cochrane Library, PubMed, Research Gate, Cochrane Wounds Group, Veterinary Information Network. No publication date nor language restrictions were applied. Randomised and not randomised controlled clinical trials comparing PRP with placebo or with other treatments were included. The reduction of open wound area in PRP-treated (test) wounds compared to control wounds was the primary outcome. Secondary outcomes were healing time and number of healed cases in test group compared to control. The following effect sizes were calculated: the Hedges' g for continuous variables; the odds ratio for binary data. Eighteen controlled clinical trials were included in the qualitative and quantitative synthesis, with a total of 661 wounds. All studies were published in the period 2007-2016. Eight studies were carried out on rodent/lagomorph mammals and 10 on non-rodent/lagomorph mammals. In all included studies, control wounds underwent placebo or were left untreated. The PRP group showed a better healing performance than the control group in each outcome. The effect size was statistically significant considering the primary outcome and the overall aggregation of the three outcomes. The effect size, although in favour of the treatment with PRP, was not significant considering the healing time and the number of healings. The overall heterogeneity was mild or moderate. Five studies reported a high risk of selection bias. The publication bias was always mild or absent. The results support the hypothesis of the positive effects of the PRP when compared to control groups in the treatment of experimentally-induced full-thickness skin wounds in animals. PRP can therefore be considered an effective adjunctive therapy in stimulating second intention healing of acute wounds in healthy animals.
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Affiliation(s)
- Adolfo Maria Tambella
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, MC, Italy
- * E-mail:
| | - Anna Rita Attili
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, MC, Italy
| | - Gilles Dupré
- Clinic for Small Animal Surgery, Department for Clinical Sciences, Veterinary Medicine University Vienna, Vienna, Austria
| | - Andrea Cantalamessa
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, MC, Italy
| | - Stefano Martin
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, MC, Italy
| | - Vincenzo Cuteri
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, MC, Italy
| | - Sabrina Marcazzan
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
- IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical Surgical and Dental Sciences, University of Milan, Milan, Italy
- IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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Badran Z, Abdallah MN, Torres J, Tamimi F. Platelet concentrates for bone regeneration: Current evidence and future challenges. Platelets 2017. [DOI: 10.1080/09537104.2017.1327656] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Zahi Badran
- Department of Periodontology (CHU/Rmes Inserm U1229/UIC11), Faculty of Dental Surgery, University of Nantes, Nantes, France
- Division of Biomedical Sciences, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Mohamed-Nur Abdallah
- Division of Biomedical Sciences, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Jesus Torres
- Faculty of Dentistry, Universidad Complutense, Madrid, Spain
| | - Faleh Tamimi
- Division of Biomedical Sciences, Faculty of Dentistry, McGill University, Montreal, QC, Canada
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Fernandez-Moure JS, Van Eps JL, Peterson LE, Shirkey BA, Menn ZK, Cabrera FJ, Karim A, Tasciotti E, Weiner BK, Ellsworth WA. Cross-linking of porcine acellular dermal matrices negatively affects induced neovessel formation using platelet-rich plasma in a rat model of hernia repair. Wound Repair Regen 2017; 25:98-108. [DOI: 10.1111/wrr.12508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 12/15/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Joseph S. Fernandez-Moure
- Department of Surgery; Houston Methodist Hospital
- Surgical Advanced Technologies Lab; Center for Biomimetic Medicine
| | - Jeffrey L. Van Eps
- Department of Surgery; Houston Methodist Hospital
- Surgical Advanced Technologies Lab; Center for Biomimetic Medicine
| | - Leif E. Peterson
- Biostatistics Core; Institute of Academic Medicine, Houston Methodist Research Institute; Houston Texas
- Weill Cornell Medical College; New York New York
| | - Beverly A. Shirkey
- Department of Surgery; Houston Methodist Hospital
- Center for Outcomes Research, Department of Surgery
| | | | | | - Azim Karim
- Surgical Advanced Technologies Lab; Center for Biomimetic Medicine
| | - Ennio Tasciotti
- Surgical Advanced Technologies Lab; Center for Biomimetic Medicine
| | - Bradley K. Weiner
- Surgical Advanced Technologies Lab; Center for Biomimetic Medicine
- Department of Orthopedic Surgery
- Weill Cornell Medical College; New York New York
| | - Warren A. Ellsworth
- Department of Plastic & Reconstructive Surgery; Institute of Reconstructive Surgery, Houston Methodist Hospital; Houston Texas
- Weill Cornell Medical College; New York New York
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Nakajima D, Tabata Y, Sato S. Periodontal tissue regeneration with PRP incorporated gelatin hydrogel sponges. ACTA ACUST UNITED AC 2015; 10:055016. [PMID: 26481592 DOI: 10.1088/1748-6041/10/5/055016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gelatin hydrogels have been designed and prepared for the controlled release of the transforming growth factor (TGF-b1) and the platelet-derived growth factor (PDGF-BB). PRP (Platelet rich plasma) contains many growth factors including the PDGF and TGF-b1. The objective of this study was to evaluate the regeneration of periodontal tissue following the controlled release of growth factors in PRP. For the periodontal ligament cells and osteoblast, PRP of different concentrations was added. The assessment of DNA, mitochondrial activity and ALP activity were measured. To evaluate the TGF-β1 release from PRP incorporated gelatin sponge, amounts of TGF-β1 in each supernatant sample were determined by the ELISA. Transplantation experiments to prepare a bone defect in a rat alveolar bone were an implanted gelatin sponge incorporated with different concentration PRP. In DNA assay and MTT assay, after the addition of PRP to the periodontal ligament cells and osteoblast, the cell count and mitochondrial activity had increased the most in the group with the addition of 5 × PRP. In the ALP assay, after the addition of PRP to the periodontal ligament cells, the cell activity had increased the most in the group with the addition of 3 × PRP. In the transplantation, the size of the bone regenerated in the defect with 3 × PRP incorporated gelatin sponge was larger than that of the other group.
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Affiliation(s)
- Dai Nakajima
- Department of Periodontology, The Nippon Dental University, Japan
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Abstract
Periodontal regeneration-treatment that results in new alveolar bone, cementum, and a functional periodontal ligament-is successful in class II furcation defects. This article examines one aspect of periodontal regeneration-alveolar bone growth in furcation defects-in trying to answer the question, Can bone lost from furcations be regenerated? The best evidence for bone growth is histology but there is limited histologic evidence for bone growth in human furcation defects. There is more evidence from intraoperative measurements for hard tissue growth in treated furcation defects, but the nature of the hard tissue needs to be determined histologically.
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Affiliation(s)
- Joseph J Zambon
- Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, The State University of New York, 3435 Main Street, Buffalo, NY 14214, USA.
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Kuffler DP. Platelet-Rich Plasma Promotes Axon Regeneration, Wound Healing, and Pain Reduction: Fact or Fiction. Mol Neurobiol 2015; 52:990-1014. [PMID: 26048672 DOI: 10.1007/s12035-015-9251-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Indexed: 11/25/2022]
Abstract
Platelet-rich plasma (PRP) has been tested in vitro, in animal models, and clinically for its efficacy in enhancing the rate of wound healing, reducing pain associated with injuries, and promoting axon regeneration. Although extensive data indicate that PRP-released factors induce these effects, the claims are often weakened because many studies were not rigorous or controlled, the data were limited, and other studies yielded contrary results. Critical to assessing whether PRP is effective are the large number of variables in these studies, including the method of PRP preparation, which influences the composition of PRP; type of application; type of wounds; target tissues; and diverse animal models and clinical studies. All these variables raise the question of whether one can anticipate consistent influences and raise the possibility that most of the results are correct under the circumstances where PRP was tested. This review examines evidence on the potential influences of PRP and whether PRP-released factors could induce the reported influences and concludes that the preponderance of evidence suggests that PRP has the capacity to induce all the claimed influences, although this position cannot be definitively argued. Well-defined and rigorously controlled studies of the potential influences of PRP are required in which PRP is isolated and applied using consistent techniques, protocols, and models. Finally, it is concluded that, because of the purported benefits of PRP administration and the lack of adverse events, further animal and clinical studies should be performed to explore the potential influences of PRP.
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Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, University of Puerto Rico, Medical Sciences Campus, 201 Blvd. Del Valle, San Juan, 00901, Puerto Rico,
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Tambella AM, Attili AR, Dini F, Palumbo Piccionello A, Vullo C, Serri E, Scrollavezza P, Dupré G. Autologous platelet gel to treat chronic decubital ulcers: a randomized, blind controlled clinical trial in dogs. Vet Surg 2014; 43:726-33. [PMID: 24484268 DOI: 10.1111/j.1532-950x.2014.12148.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 03/01/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the efficacy of topical application of the autologous platelet gel (PG) in canine chronic protracted decubital ulcers. STUDY DESIGN Prospective, randomized, blind controlled clinical trial. ANIMALS Dogs (n = 18) with bilateral chronic wounds caused by protracted decubitus ulcers. METHODS For each dog, wound side was randomized to receive either platelet gel (group PG) every 5 days for 5 dressing changes, or paraffin gauzes dressings (group C), as negative control. Wound healing and wound surfaces were compared at admission and then evaluated every 5th day, until day 25. Outcome variables were: open wound area, reduction of open wound surface compared to admission and to each preceding dressing change, time to complete epithelialization. RESULTS Significant differences in healing process were observed at day 5 and continued throughout the entire study period (P < .00001). At 25 days, mean percent reduction in wound area was 93.5% in group PG and 13.2% in group C (P < .00001). CONCLUSIONS Appropriately prepared autologous PG, an inexpensive, readily available blood derivative, applied topically results in more rapid healing of chronic non-healing decubital ulcers in dogs than those treated by use of paraffin-impregnated gauzes.
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Affiliation(s)
- Adolfo Maria Tambella
- School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Macerata, Italy
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Coimbra LS, Steffens JP, Rossa C, Graves DT, Spolidorio LC. Clopidogrel enhances periodontal repair in rats through decreased inflammation. J Clin Periodontol 2014; 41:295-302. [PMID: 24433307 DOI: 10.1111/jcpe.12203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2013] [Indexed: 12/18/2022]
Abstract
AIM We hypothesized that platelet inactivation induced by drugs might interfere with periodontal repair in experimental periodontitis by suppressing the release of biological mediators from platelets at the site of injury. MATERIAL AND METHODS Sixty rats were randomly assigned to six groups (n = 10) and ligatures were placed around lower first molars of three groups. The other three groups were used as negative controls. Ligatures were removed after 10 days of periodontitis induction and all groups were submitted to treatment with aspirin (Asp) (30 mg/kg), clopidogrel (Clop) (75 mg/kg) or NaCl 0.9% intra-gastrically once daily for 3 days. Periodontal tissue was assessed by the measurement of CXCL12, CXCL4, CCL5 and platelet-derived growth factor (PDGF) by enzyme-linked immunosorbent assay; histomorphometrical analysis of polymorphonuclear (PMN) infiltration, attachment loss, bone loss and osteoclast numbers and quantification of blood vessels by imunnohistochemistry. RESULTS During periodontal repair and treatment with NaCl 0.9%, CCL5 was decreased and CXCL12 increased when compared with negative control groups. Asp and Clop did not affect CCL5 expression, decreased CXCL12 but only Clop decreased CXCL4 and PDGF content compared with saline-treated animals. Clop increased blood vessel number, reduced PMN count and decreased attachment and bone loss, also decreased osteoclast number in animals submitted or not to periodontal repair. CONCLUSION Systemic administration of Clop for 3 days improved the repair process associated with experimental periodontal disease, suggesting that it may have therapeutic value under situations where tissues undergo a transition from inflammation to repair.
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Affiliation(s)
- Leila S Coimbra
- Department of Physiology and Pathology, Faculdade de Odontologia de Araraquara, UNESP-Univ Estadual Paulista, Araraquara, Brazil
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