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Qian Y, Zhao Y, Lu Y, Bao S, Zhu W, Chen Q, Si M. Clinical and radiographic outcomes of lateral sinus floor elevation with simultaneous hydrophilic implants placement: A retrospective study of 2-5 years. Clin Oral Implants Res 2024; 35:534-546. [PMID: 38366692 DOI: 10.1111/clr.14249] [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: 07/11/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
AIMS To investigate the clinical and radiographic outcomes of a chemically modified sandblasted large-grit acid-etched implant (hydrophilic) in lateral sinus floor elevation (LSFE), compared with a conventional one (hydrophobic). MATERIALS AND METHODS A retrospective study design was adopted. Patients who received LSFE with simultaneous implant placement were recruited. According to different types of implant surfaces, patients were divided into two groups (the hydrophilic group and the hydrophobic group). Implant survival rate (SR), endo-sinus bone stability on the radiographs, mean probing depths, percentage of bleeding on probing, marginal bone loss, and patient satisfaction were evaluated. RESULTS A total of 106 patients with 180 implants (hydrophilic:101, hydrophobic:79) in 119 maxillary sinuses were included. The follow-up period ranged from 2 to 5 years. Three hydrophobic implants and one hydrophilic implant in four different patients failed. The SR of the hydrophilic group was higher than that of the hydrophobic group but without a significant difference (p > .05). The change and change rate of endo-sinus bone height (ΔESBH and RΔESBH) and bone volume (ΔESBV and RΔESBV) in the hydrophilic group were less than those in the hydrophobic group, with a significant difference at 6 months after implantation. No other significant difference was found between the two groups. CONCLUSION Within the limitations of this study, both hydrophilic and hydrophobic implants were suitable for LSFE with predictable clinical outcomes. Meanwhile, hydrophilic implants could contribute to the grafted endo-sinus bone stability during healing time.
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Affiliation(s)
- Yinjie Qian
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yuxin Zhao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yifan Lu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Siqi Bao
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Weijun Zhu
- The First People's Hospital of Yuhang District, Hangzhou, China
| | - Qianming Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
| | - Misi Si
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China
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Gupta AK, Arora KS, Aggarwal P, Kaur K, Mohapatra S, Pareek S. Evaluation of biphasic hydroxapatite and β-tricalcium phosphate as a bone graft material in the treatment of periodontal vertical bony defects - A clinical and digital radiological measurement study. Indian J Dent Res 2022; 33:152-157. [PMID: 36254951 DOI: 10.4103/ijdr.ijdr_234_19] [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] [Indexed: 06/16/2023] Open
Abstract
AIMS AND OBJECTIVE The present study aimed to evaluate 2 bone graft materials, that is, biphasic hydroxyapatite and β-tricalcium phosphate, in the treatment of periodontal vertical bony defects. In term of attachment level, probing depth and radiographic bone level changes. Also, a new digital method of radiographic assessment was used for measurement of vertical bone defect. MATERIAL AND METHODS Ten subjects with periodontitis and having two or more vertical bony defects were enrolled in the study. Patients were classified randomly into 2 groups. Group I consisted of the experimental site where defect was filled with biphasic hydroxyapatite and β-tricalcium phosphate graft and Group II consisted of control site where only the open flap debridement (OFD) was carried out. Clinical parameters were evaluated at baseline, 3 and 6 months; Radiographs were taken at baseline and 6 months after surgery. RESULTS Overall, by the end of 6 months, biphasic hydroxyapatite and β-tricalcium phosphate and OFD treatment groups exhibited a significant reduction in probing depth almost by 75% and gain in clinical attachment level at follow-up. In the biphasic hydroxyapatite and β-tricalcium phosphate group, radiographic bone level gain appeared to be greater than in the OFD group. CONCLUSION In the present study, biphasic hydroxyapatite and β-tricalcium phosphate have shown promising results and have showed reduction in probing depth, a resolution of osseous defects and gain in clinical attachment level when compared to open flap debridement.
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Affiliation(s)
- Amit Kumar Gupta
- Department of Periodontology, Eklavya Dental College and Hospital, Kotputli, Rajasthan, India
| | - Karandeep Singh Arora
- Department of Oral Medicine and Radiology, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
| | - Priyanka Aggarwal
- Department of Periodontology, Eklavya Dental College and Hospital, Kotputli, Rajasthan, India
| | - Kirandeep Kaur
- Department of Orthodontics, Resident, Georgia School of Orthodontics, Georgia, USA
| | - Shreeyam Mohapatra
- Department of Oral Medicine and Radiology, SCB Dental College, Cuttack, Odisha, India
| | - Shubhangi Pareek
- Department of Oral Pathology and Microbiology, Institute of Dental Sciences, Bhubaneswar, Odisha, India
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Abstract
A 10-year-old German shepherd dog presented with a periodontal 10 mm interproximal defect between the left mandibular fourth premolar and first molar teeth. Bone graft removed from the caudoventral portion of the ipsilateral hemimandible was placed in the defect as a component of the periodontal treatment plan. The use of bone graft likely contributed to periodontal pocket reduction.
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Affiliation(s)
- Mark M. Smith
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061
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4
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Evaluation of Recombinant Human FGF-2 and PDGF-BB in Periodontal Regeneration: A Systematic Review and Meta-Analysis. Sci Rep 2017; 7:65. [PMID: 28246406 PMCID: PMC5427916 DOI: 10.1038/s41598-017-00113-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/07/2017] [Indexed: 02/05/2023] Open
Abstract
The prognosis for successful treatment of periodontal diseases is generally poor. Current therapeutic strategies often fail to regenerate infected periodontium. Recently an alternative strategy has been developed that combines conventional treatment with the application of recombinant human growth factors (rhGFs). But ambiguities in existed studies on the clinical efficacy of rhGFs do not permit either the identification of the specific growth factors effective for therapeutic interventions or the optimal concentration of them. Neither is it known whether the same rhGF can stimulate regeneration of both soft tissue and bone, or whether different patient populations call for differential use of the growth factors. In order to explore these issues, a meta-analysis was carried out. Particular attention was given to the therapeutic impact of fibroblast growth factor 2(FGF-2) and platelet derived growth factor BB (PDGF-BB). Our findings indicate that 0.3% rhFGF-2 and 0.3 mg/ml rhPDGF-BB show a greater capacity for periodontal regeneration than other concentrations and superiority to control groups with statistical significance. In the case of patients suffering only from gingival recession, however, the application of rhPDGF-BB produces no significant regenerative advantage. The findings of this study can potentially endow clinicians with guidelines for the appropriate application of these two rhGFs.
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5
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Behdin S, Monje A, Lin GH, Edwards B, Othman A, Wang HL. Effectiveness of Laser Application for Periodontal Surgical Therapy: Systematic Review and Meta-Analysis. J Periodontol 2015; 86:1352-63. [DOI: 10.1902/jop.2015.150212] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Roozegar MA, Mohammadi TM, Havasian MR, Panahi J, Hashemian A, Amraei M, Hoshmand B. In vitro Osteogenic impulse effect of Dexamethasone on periodontal ligament stem cells. Bioinformation 2015; 11:96-100. [PMID: 25848170 PMCID: PMC4369685 DOI: 10.6026/97320630011096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/26/2015] [Indexed: 11/23/2022] Open
Abstract
Periodontium is a complex organ composed of mineralized epithelial and connective tissue. Dexamethasone could stimulate proliferation of osteoblast and fibroblasts. This study aimed to assess the osteogenic effect of dexamethasone on periodental ligament (PDL) stem cells. PDL stem cells were collected from periodontal ligament tissue of root of extracted premolar of young and healthy people. The stem cells were cultured in α-MEM Medium in three groups, one group with basic medium contains (α- MEM and FBS 10 % and 50 mmol of β_ gelisrophosphat and L_ ascorbic acid µg/ml), the second group: basic medium with dexamethasone and the third one: basic medium without any osteogenic stimulant. Mineralization of cellular layer was analyzed with Alizarin red stain method. Osteogenic analysis was done by Alkaline phosphates and calcium test. These analysis indicated that the amount of intra-cellular calcium and alkaline phosphates in the Dexamethasone group was far more than the control and basic group (P<0.05). The results of Alizarin red stain indicated more mineralization of cultured cells in Dexamethasone group (P<0.05). The study results showed that Dexamethasone has significant osteogenic effect on PDL stem cells and further studies are recommended to evaluate its effect on treatment of bone disorders.
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Affiliation(s)
- Mohamad Ali Roozegar
- Department of Periodentistry, Faculty of Dentistry, Ilam University of Medical Sciences, Ilam/ Iran
| | - Tayebeh Malek Mohammadi
- Research Center for Social Determinant of Health, Institute of Futures Studies in Health and dental public health department, Kerman University of Medical sciences, Kerman/ Iran
| | - Mohamad Reza Havasian
- Department of Periodentistry, Faculty of Dentistry, Ilam University of Medical Sciences, Ilam/ Iran
| | - Jafar Panahi
- Department of Periodentistry, Faculty of Dentistry, Ilam University of Medical Sciences, Ilam/ Iran
| | - Amirreza Hashemian
- Department of Periodentistry, Faculty of Dentistry, Ilam University of Medical Sciences, Ilam/ Iran
| | - Mansur Amraei
- Department of Physiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam/ Iran
| | - Behzad Hoshmand
- Department of Periodontics, Faculty of Dentistry, Shahid beheshti University of Medical Sciences, Tehran/ Iran
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7
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Khoshkam V, Chan HL, Lin GH, Mailoa J, Giannobile WV, Wang HL, Oh TJ. Outcomes of regenerative treatment with rhPDGF-BB and rhFGF-2 for periodontal intra-bony defects: a systematic review and meta-analysis. J Clin Periodontol 2015; 42:272-80. [DOI: 10.1111/jcpe.12354] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Vahid Khoshkam
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
- Currently Advanced Periodontology Program; Herman Ostrow School of Dentistry; University of Southern California; Los Angeles CA USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - Guo-Hao Lin
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - James Mailoa
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - William V. Giannobile
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
| | - Tae-Ju Oh
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor MI USA
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Reynolds MA, Kao RT, Nares S, Camargo PM, Caton JG, Clem DS, Fiorellini JP, Geisinger ML, Mills MP, Nevins ML, Rosen PS. Periodontal Regeneration - Intrabony Defects: Practical Applications From the AAP Regeneration Workshop. Clin Adv Periodontics 2015; 5:21-29. [PMID: 32689725 DOI: 10.1902/cap.2015.140062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/04/2014] [Indexed: 11/13/2022]
Abstract
Focused Clinical Question: What are important considerations for selecting a predictable regenerative surgical approach for intrabony defects? Summary: The predictable regeneration of intrabony defects remains an important goal in the management of periodontitis. Clinical and histologic evidence of periodontal regeneration has been shown for multiple regenerative therapies, including bone replacement grafts, guided tissue regeneration, and biologics, when used alone or in combination. Regenerative therapies improve periodontal health, as evidenced by gains in clinical attachment level, reductions in probing depth, and gains in radiographic bone fill. Important patient-related factors (e.g., smoking) and defect/site-related factors (e.g., defect morphology and gingival biotype) can influence the potential to achieve periodontal regeneration. The regeneration of intrabony defects generally becomes more challenging with increasing loss of height, proximity, and number of bony walls. Therefore, combination therapies may be necessary to achieve predictable regeneration. Clinical improvements after regenerative therapy can be maintained over extended periods (≥10 years) with professional maintenance at appropriate intervals and adequate home care. Conclusions: Periodontal regeneration of intrabony defects is possible using a variety of regenerative strategies. Management should be coupled with an effective oral hygiene and supportive periodontal maintenance program for long-term success.
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Affiliation(s)
- Mark A Reynolds
- Department of Periodontics, School of Dentistry, University of Maryland, Baltimore, MD
| | - Richard T Kao
- Division of Periodontology, School of Dentistry, University of California at San Francisco, San Francisco, CA.,Private practice, Cupertino, CA
| | - Salvador Nares
- Department of Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL
| | - Paulo M Camargo
- Section of Periodontics, School of Dentistry, University of California at Los Angeles, Los Angeles, CA
| | - Jack G Caton
- Division of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | | | - Joseph P Fiorellini
- Department of Periodontics, College of Dentistry, University of Pennsylvania, Philadelphia, PA
| | - Maria L Geisinger
- Department of Periodontology, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Michael P Mills
- Department of Periodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | | - Paul S Rosen
- Department of Periodontics, School of Dentistry, University of Maryland, Baltimore, MD.,Private practice, Yardley, PA
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9
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Reynolds MA, Kao RT, Camargo PM, Caton JG, Clem DS, Fiorellini JP, Geisinger ML, Mills MP, Nares S, Nevins ML. Periodontal regeneration - intrabony defects: a consensus report from the AAP Regeneration Workshop. J Periodontol 2014; 86:S105-7. [PMID: 25315019 DOI: 10.1902/jop.2015.140378] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Treatment of intrabony defects is an important therapeutic goal of periodontal therapy. The goal of this consensus report was to critically appraise the evidence for the available approaches for promoting periodontal regeneration in intrabony defects. In addition to evaluating the effectiveness of new regenerative approaches for intrabony defects, recommendations for future research were defined for this area. METHODS A systematic review was conducted using computerized searches of PubMed and Cochrane databases, supplemented with screening of references in original reports, review articles, and a hand search in selected journals. All searches were focused on regenerative approaches with histologic evidence of periodontal regeneration (proof of principle), clinical trials, and case reports. For purposes of analysis, change in intrabony defect fill was considered the primary outcome variable, with change in clinical attachment as a secondary outcome. The SORT (Strength of Recommendation Taxonomy) grade was used to evaluate the quality and strength of the evidence. During the consensus meeting, the group agreed on the outcomes of the systematic review, pertinent sources of evidence, clinical recommendations, and areas requiring future research. RESULTS The systematic review, which was conducted for the consensus conference, evaluated the effectiveness of the use of biologics for the treatment of intrabony defects. Enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB) with β-tricalcium phosphate were shown to be efficacious in regenerating intrabony defects. The level of evidence is supported by multiple studies documenting effectiveness. The clinical application of biologics supports improvements in clinical parameters comparable with selected bone replacement grafts and guided tissue regeneration (GTR). Factors negatively affecting regeneration included smoking and excessive tooth mobility. CONCLUSIONS Periodontal regeneration in intrabony defects is possible on previously diseased root surfaces, as evidenced by a gain in clinical attachment, decreased pocket probing depth, gain in radiographic bone height, and overall improvement in periodontal health. These clinical findings are consistent with available histologic evidence. Clinical improvements can be maintained over long periods (>10 years). Although bone replacement grafts have been the most commonly investigated modality, GTR, biologics, and combination therapies have also been shown to be effective. Future research should emphasize patient-reported outcomes, individual response differences, and emerging technologies to enhance treatment results. CLINICAL RECOMMENDATIONS Early management of intrabony defects with regenerative therapies offers the greatest potential for successful periodontal regeneration. The clinical selection and application of a regenerative therapy or combination of therapies for periodontal regeneration should be based on the clinician's experiences and understanding of the regenerative biology and technology. This decision-making process should take into consideration the potential adverse influence of factors, such as smoking, poor oral hygiene, tooth mobility, and defect morphology, on regeneration. Management should be coupled with an effective maintenance program for long-term success.
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Affiliation(s)
- Mark A Reynolds
- Department of Periodontics, School of Dentistry, University of Maryland, Baltimore, MD
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10
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McGuire MK, Wilson TG. Commentary: From Normal Scientific Progress to Game Changers: The Impact on Periodontal Clinical Practice. J Periodontol 2014; 85:1001-5. [DOI: 10.1902/jop.2014.140220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Pelegrini CB, Maia LP, de Souza SLS, Taba M, Palioto DB. Morphological, functional and biochemical characterization of canine gingival fibroblasts. Braz Dent J 2014; 24:128-35. [PMID: 23780356 DOI: 10.1590/0103-6440201302144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 04/02/2013] [Indexed: 11/22/2022] Open
Abstract
As dogs are good models for in vivo studies, it is interesting to evaluate the behavior of canine gingival fibroblasts (CGF) in vitro, so that these cells could be seeded on a matrix and later studied in vivo. The aim of this study was to perform a morphological, functional and biochemical analysis of CGF, comparing it with human gingival fibroblasts (HGF), as well as to evaluate the change of their characteristics over several passages. Using gingival fibroblasts from 3 dogs and 3 humans in the subculture (Sub), first (P1), third (P3), fifth (P5) and seventh (P7) passages, the following parameters were assessed: cell morphology, spreading, adhesion, viability and total protein content. The results showed no major differences between the passages in terms of morphology and spreading, and a tendency of greater adhesion and viability for HGF when compared with CGF. The total protein content was significantly higher for HGF. HGF exhibited greater functional and biochemical activity in vitro compared to CGF. Higher numbers at Sub were observed for both CGF and HGF in all evaluated parameters. The differences do not prevent the use of CGF for tissue engineering, but its use seems to be more appropriate in the subculture or first passage.
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Affiliation(s)
- Camila Bonvicino Pelegrini
- Department of Traumatology and Bucomaxillofacial Surgery and Periodontology, Ribeirão Preto Dental School, USP - University of São Paulo, Ribeirão Preto, SP, Brazil
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12
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Chang PK, Hall J, Finkelman M, Park A, Levi PA. A survey: how periodontists and other dental professionals view the scope of periodontics. J Periodontol 2014; 85:925-33. [PMID: 24579761 DOI: 10.1902/jop.2014.130482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND How do periodontists think of themselves when they define their practices? How do other dental professionals view the scope of the specialty of periodontology? A strong component of periodontal residency programs is extracting teeth and preserving or building bony ridges for the eventual placement of implants. Has the discipline of periodontology moved away from retaining and treating the natural dentition? By the use of a rank-order survey, the practice of periodontology was defined by periodontists and other dental professionals. METHODS In a pilot study, respondents were asked to list the answers to the question, "What is a periodontist?" The results were consolidated into eight statements. The eight statements were placed into an anonymous rank-order survey, and more than 1,200 responses were returned. The responses primarily came from periodontists, hygienists, general practitioners, dental students, and dental hygiene students. RESULTS "Periodontists surgically treat advanced gum and bone infection problems" was considered the most important statement in all of the cohorts. The least important statement considered by all was, "Periodontists are educators promoting health." Non-periodontist dentists (NPDs) ranked the statement, "Periodontists perform dental implants and related procedures" less importantly (P <0.001) than the periodontists. The non-periodontist cohort (NPC), which includes NPDs and dental hygienists, ranked the statement, "Periodontists' treatments help general dentists and other specialists increase successful therapeutic outcomes" as second most important. CONCLUSIONS The results of this survey indicate that periodontists ranked the placement of implants and their related procedures higher than the NPC. NPDs appear to value periodontists in treating the natural dentition for their patients. The NPC appreciates that periodontal therapy done by periodontists increases their therapeutic success for their patients.
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Affiliation(s)
- Peter K Chang
- Tufts University School of Dental Medicine, Boston, MA
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13
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Hsu YT, Wang HL. How to Select Replacement Grafts for Various Periodontal and Implant Indications. Clin Adv Periodontics 2013. [DOI: 10.1902/cap.2012.120031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gupta S, Vandana KL. Evaluation of hydroxyapatite (Periobone-G) as a bone graft material and calcium sulfate barrier (Capset) in treatment of interproximal vertical defects: A clinical and radiologic study. J Indian Soc Periodontol 2013; 17:96-103. [PMID: 23633782 PMCID: PMC3636954 DOI: 10.4103/0972-124x.107483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 08/30/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This study has been undertaken to assess treatment response of interproximal vertical defects using an alloplast (Periobone-G) and calcium sulfate (Capset) as a barrier both clinically and radiographically. MATERIALS AND METHODS Eight patients were selected with 16 sites that were divided into control and experimental sites based on split mouth study design. Plaque index, gingival index, probing depth, clinical attachment level, gingival margin position were recorded at baseline and 9 months and radiographic assessment was done at baseline and 9 months after recording clinical parameters, the sites were randomly treated either with hydroxyapatite granules Periobone-G or hydroxyapatite granules (control group) was used to fill the osseous defect and calcium sulfate (Capset) (experiment group) barrier was placed. RESULT The plaque score reduction was statistically highly significant within control and experimental groups. The gingival score reduction was significant within control and experimental groups, although there were no significant difference between the 2 groups. The pocket depth reduction was significant within control and experimental group, however, the hydroxyapatite + capset group showed significant reduction as compared with hydroxyapatite alone group. The clinical attachment gain and gingival margin position was significant within control and experimental groups, although there was no significant difference between the 2 groups. The amount of defect fill was significant in both control and experimental groups but the difference between the 2 groups was not significant. The mean change in alveolar crest level between control and experimental groups was significant (P=0.02). The percentage of original defect resolved was not significant. CONCLUSION The use of calcium sulfate as a barrier proved its role in the treatment of interproximal defects. The application of calcium sulfate (Capset) barrier is easy and simple. The multifaceted properties of calcium sulfate demonstrate its usefulness in periodontal practice.
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Affiliation(s)
- Sanjay Gupta
- Department of Periodontics, Career Post Graduate Institute of Dental Sciences, Lucknow, Uttar Pradesh, India
| | - K. L. Vandana
- Department of Periodontology, College of Dental Sciences, Davangere, Karnataka, India
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15
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Kitamura M, Akamatsu M, Machigashira M, Hara Y, Sakagami R, Hirofuji T, Hamachi T, Maeda K, Yokota M, Kido J, Nagata T, Kurihara H, Takashiba S, Sibutani T, Fukuda M, Noguchi T, Yamazaki K, Yoshie H, Ioroi K, Arai T, Nakagawa T, Ito K, Oda S, Izumi Y, Ogata Y, Yamada S, Shimauchi H, Kunimatsu K, Kawanami M, Fujii T, Furuichi Y, Furuuchi T, Sasano T, Imai E, Omae M, Yamada S, Watanuki M, Murakami S. FGF-2 stimulates periodontal regeneration: results of a multi-center randomized clinical trial. J Dent Res 2010; 90:35-40. [PMID: 21059869 DOI: 10.1177/0022034510384616] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The efficacy of the local application of recombinant human fibroblast growth factor-2 (FGF-2) in periodontal regeneration has been investigated. In this study, a randomized, double-blind, placebo-controlled clinical trial was conducted in 253 adult patients with periodontitis. Modified Widman periodontal surgery was performed, during which 200 µL of the investigational formulation containing 0% (vehicle alone), 0.2%, 0.3%, or 0.4% FGF-2 was administered to 2- or 3-walled vertical bone defects. Each dose of FGF-2 showed significant superiority over vehicle alone (p < 0.01) for the percentage of bone fill at 36 wks after administration, and the percentage peaked in the 0.3% FGF-2 group. No significant differences among groups were observed in clinical attachment regained, scoring approximately 2 mm. No clinical safety problems, including an abnormal increase in alveolar bone or ankylosis, were identified. These results strongly suggest that topical application of FGF-2 can be efficacious in the regeneration of human periodontal tissue that has been destroyed by periodontitis.
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Affiliation(s)
- M Kitamura
- Department of Periodontology, Division of Oral Biology and Disease Control, Osaka University Dental Hospital, Japan
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Avila G, Wang HL, Galindo-Moreno P, Misch CE, Bagramian RA, Rudek I, Benavides E, Moreno-Riestra I, Braun T, Neiva R. The Influence of the Bucco-Palatal Distance on Sinus Augmentation Outcomes. J Periodontol 2010; 81:1041-50. [DOI: 10.1902/jop.2010.090686] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Abstract
This paper is concerned about dental-derived stem cells and their characterization in vitro and in vivo. Additionally, since conventional periodontal techniques remain insufficient to attain complete and reliable periodontal regeneration, the potential of dental-derived stem cells in promoting periodontal tissue regeneration is also reviewed.
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Kitamura M, Nakashima K, Kowashi Y, Fujii T, Shimauchi H, Sasano T, Furuuchi T, Fukuda M, Noguchi T, Shibutani T, Iwayama Y, Takashiba S, Kurihara H, Ninomiya M, Kido JI, Nagata T, Hamachi T, Maeda K, Hara Y, Izumi Y, Hirofuji T, Imai E, Omae M, Watanuki M, Murakami S. Periodontal tissue regeneration using fibroblast growth factor-2: randomized controlled phase II clinical trial. PLoS One 2008; 3:e2611. [PMID: 18596969 PMCID: PMC2432040 DOI: 10.1371/journal.pone.0002611] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 05/13/2008] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The options for medical use of signaling molecules as stimulators of tissue regeneration are currently limited. Preclinical evidence suggests that fibroblast growth factor (FGF)-2 can promote periodontal regeneration. This study aimed to clarify the activity of FGF-2 in stimulating regeneration of periodontal tissue lost by periodontitis and to evaluate the safety of such stimulation. METHODOLOGY/PRINCIPAL FINDINGS We used recombinant human FGF-2 with 3% hydroxypropylcellulose (HPC) as vehicle and conducted a randomized double-blinded controlled trial involving 13 facilities. Subjects comprised 74 patients displaying a 2- or 3-walled vertical bone defect as measured > or = 3 mm apical to the bone crest. Patients were randomly assigned to 4 groups: Group P, given HPC with no FGF-2; Group L, given HPC containing 0.03% FGF-2; Group M, given HPC containing 0.1% FGF-2; and Group H, given HPC containing 0.3% FGF-2. Each patient underwent flap operation during which we administered 200 microL of the appropriate investigational drug to the bone defect. Before and for 36 weeks following administration, patients underwent periodontal tissue inspections and standardized radiography of the region under investigation. As a result, a significant difference (p = 0.021) in rate of increase in alveolar bone height was identified between Group P (23.92%) and Group H (58.62%) at 36 weeks. The linear increase in alveolar bone height at 36 weeks in Group P and H was 0.95 mm and 1.85 mm, respectively (p = 0.132). No serious adverse events attributable to the investigational drug were identified. CONCLUSIONS Although no statistically significant differences were noted for gains in clinical attachment level and alveolar bone gain for FGF-2 groups versus Group P, the significant difference in rate of increase in alveolar bone height (p = 0.021) between Groups P and H at 36 weeks suggests that some efficacy could be expected from FGF-2 in stimulating regeneration of periodontal tissue in patients with periodontitis. TRIAL REGISTRATION ClinicalTrials.gov NCT00514657.
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Affiliation(s)
| | - Keisuke Nakashima
- Dental Hospital, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Japan
| | - Yusuke Kowashi
- Dental Hospital, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Japan
| | - Takeo Fujii
- Medical and Dental Clinic, Health Sciences University of Hokkaido, Sapporo, Japan
| | | | | | | | - Mitsuo Fukuda
- Aichigakuin University Dental Hospital, Nagoya, Japan
| | | | | | | | | | - Hidemi Kurihara
- Hiroshima University Hospital of Dentistry, Hiroshima, Japan
| | | | - Jun-ichi Kido
- Tokushima University Dental Hospital, Tokushima, Japan
| | | | | | | | - Yoshitaka Hara
- Nagasaki University Hospital, Attached School of Dentistry, Nagasaki, Japan
| | - Yuichi Izumi
- Kagoshima University Dental Hospital, Kagoshima, Japan
| | | | - Enyu Imai
- Osaka University Hospital, Suita, Japan
| | - Masatoshi Omae
- Izumisano Municipal Hospital, Rinku General Medical Center, Izumisano, Japan
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Sant'Ana AC, Marques MM, Barroso EC, Passanezi E, de Rezende MLR. Effects of TGF-β1, PDGF-BB, and IGF-1 on the Rate of Proliferation and Adhesion of a Periodontal Ligament Cell Lineage In Vitro. J Periodontol 2007; 78:2007-17. [DOI: 10.1902/jop.2007.070119] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Cetinkaya BO, Keles GC, Ayas B, Aydin O, Kirtiloglu T, Acikgoz G. Comparison of the proliferative activity in gingival epithelium after surgical treatments of intrabony defects with bioactive glass and bioabsorbable membrane. Clin Oral Investig 2006; 11:61-8. [PMID: 17111121 DOI: 10.1007/s00784-006-0087-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 10/18/2006] [Indexed: 10/23/2022]
Abstract
Guided tissue regeneration is based on preventing the more rapidly proliferating epithelium from growing into the periodontal defect after surgical procedures incorporating barrier membranes. The aim of this study was to compare the proliferative activity of gingival epithelium using proliferating cell nuclear antigen (PCNA) as a marker of cell proliferation after surgical treatments with bioactive glass graft material and bioabsorbable membrane. Using split mouth design, 20 intrabony defects were randomly assigned treatments with bioactive glass (BG group) or bioabsorbable membrane (BM group). Gingival biopsies were taken at preoperative and postoperative 12 weeks. After histological processing, the number of the inflammatory cells was measured in hematoxylin and eosin-stained sections; PCNA expression was determined in immunohistochemically-stained sections. At postoperative 12 weeks, the number of the inflammatory cells was significantly decreased (p < 0.01), PCNA expression was significantly increased (p < 0.001) in both treatment groups compared to baseline data. There was no significant difference in PCNA expression between baseline values of two groups (p > 0.05), while at postoperative 12 weeks, increase in BG group was significantly greater than that in BM group (p < 0.001). These results suggest that epithelial cell proliferation is more prominent after treatment of intrabony defects with bioactive glass compared to the treatment with bioabsorbable membrane.
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Affiliation(s)
- Burcu Ozkan Cetinkaya
- Faculty of Dentistry, Department of Periodontology, Ondokuz Mayis University, 55139, Samsun, Turkey.
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Hou LT, Tsai AYM, Liu CM, Feng F. Autologous transplantation of gingival fibroblast-like cells and a hydroxylapatite complex graft in the treatment of periodontal osseous defects: cell cultivation and long-term report of cases. Cell Transplant 2004; 12:787-97. [PMID: 14653625 DOI: 10.3727/000000003108747262] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Autogenous cell transplantation via hydroxylapatite (HA) vehicle has been reported to have beneficial effects on the treatment of human periodontal osseous defects. The aim of this study was to explore the possibility of using gingival fibroblast-like cells in the therapy of osseous defects caused by inflammatory periodontitis by reporting long-term results of gingival fibroblast-coated hydroxylapatite (GF-HA) grafting for healing these defects. Gingival fibroblasts were cultured from healthy gingivae of treated subjects. Growth of cells on HA particles was established in vitro, and then the GF-HA complex was transplanted into the periodontal osseous defects. Clinical parameters of gingival and plaque indices, probing depth, and periapical x-ray were monitored at baseline and at various periods from 50 months to 6 years after surgery. Grafting with only HA in the osseous defects of the same patient was used for comparison. The present study shows that GF-HA-treated sites could achieve marked pocket reduction and probing attachment gain at reentry and later recalls. Good clinical bone filling of osseous defects in GF-HA-treated sites was also demonstrated in periapical radiographs (increased bone height and reappearance of the crestal cortex) and in some reentry sites. One HA-treated site was filled with connective tissue only, and the absence of new bone formation was noted during a reentry operation. Another HA-treated site exhibited a comparable increase in radiographic density, while part of HA particles were gradually lost in longer recalls. These limited observations conclude that GF-HA grafting may provide a treatment modality leading to regeneration of periodontal tissues in periodontitis-affected osseous defects. Further studies including more cases and demonstration of the deposition of differentiated periodontal tissues are necessary before further application of this therapy.
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Affiliation(s)
- L-T Hou
- Department of Periodontology, Graduate Institute of Dental Sciences, College of Medicine, National Taiwan University and Hospital, Taipei 100, Taiwan.
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Reynolds MA, Aichelmann-Reidy ME, Branch-Mays GL, Gunsolley JC. The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review. ACTA ACUST UNITED AC 2004; 8:227-65. [PMID: 14971256 DOI: 10.1902/annals.2003.8.1.227] [Citation(s) in RCA: 270] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Bone replacement grafts (BRG) are widely used in the treatment of periodontal osseous defects; however, the clinical benefits of this therapeutic practice require further clarification through a systematic review of randomized controlled studies. RATIONALE The purpose of this systematic review is to access the efficacy of bone replacement grafts in proving demonstrable clinical improvements in periodontal osseous defects compared to surgical debridement alone. FOCUSED QUESTION What is the effect of bone replacement grafts compared to other interventions on clinical, radiographic, adverse, and patient-centered outcomes in patients with periodontal osseous defects? SEARCH PROTOCOL The computerized bibliographical databases MEDLINE and EMBASE were searched from 1966 and 1974, respectively, to October 2002 for randomized controlled studies in which bone replacement grafts were compared to other surgical interventions in the treatment of periodontal osseous defects. The search strategy included screening of review articles and reference lists of retrieved articles as well as hand searches of selected journals. INCLUSION CRITERIA All searches were limited to human studies in English language publications. EXCLUSION CRITERIA Non-randomized observational studies (e.g., case reports, case series), publications providing summary statistics without variance estimates or data to permit computation, and studies without BRG intervention alone were excluded. DATA COLLECTION AND ANALYSIS The therapeutic endpoints examined included changes in bone level, clinical attachment level, probing depth, gingival recession, and crestal resorption. For purposes of meta-analysis, change in bone level (bone fill) was used as the primary outcome measure, measured upon surgical re-entry or transgingival probing (sounding). MAIN RESULTS 1. Forty-nine controlled studies met eligibility criteria and provided clinical outcome data on intrabony defects following grafting procedures. 2. Seventeen studies provided clinical outcome data on BRG materials for the treatment of furcation defects. REVIEWERS' CONCLUSIONS 1. With respect to the treatment of intrabony defects, the results of meta-analysis supported the following conclusions: 1) bone grafts increase bone level, reduce crestal bone loss, increase clinical attachment level, and reduce probing depth compared to open flap debridement (OFD) procedures; 2) No differences in clinical outcome measures emerge between particulate bone allograft and calcium phosphate (hydroxyapatite) ceramic grafts; and 3) bone grafts in combination with barrier membranes increase clinical attachment level and reduce probing depth compared to graft alone. 2. With respect to the treatment of furcation defects, 15 controlled studies provided data on clinical outcomes. Insufficient studies of comparable design were available to submit data to meta-analysis. Nonetheless, outcome data from these studies generally indicated positive clinical benefits with the use of grafts in the treatment of Class II furcations. 3. With respect to histological outcome parameters, 2 randomized controlled studies provide evidence that demineralized freeze-dried bone allograft (DFDBA) supports the formation of a new attachment apparatus in intrabony defects, whereas OFD results in periodontal repair characterized primarily by the formation of a long junctional epithelial attachment. Multiple observational studies provide consistent histological evidence that autogenous and demineralized allogeneic bone grafts support the formation of new attachment. Limited data also suggest that xenogenic bone grafts can support the formation of a new attachment apparatus. In contrast, essentially all available data indicate that alloplastic grafts support periodontal repair rather than regeneration. 4. The results of this systematic review indicate that bone replacement grafts provide demonstrable clinical improvements in periodontal osseous defects compared to surgical debridement alone.
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Affiliation(s)
- Mark A Reynolds
- Department of Periodontics, Baltimore College of Dental Surgery, University of Maryland, Baltimore, Maryland, USA.
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Aichelmann-Reidy ME, Heath CD, Reynolds MA. Clinical Evaluation of Calcium Sulfate in Combination With Demineralized Freeze-Dried Bone Allograft for the Treatment of Human Intraosseous Defects. J Periodontol 2004; 75:340-7. [PMID: 15088870 DOI: 10.1902/jop.2004.75.3.340] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Medical-grade calcium sulfate (CS) is a biocompatible, bioabsorbable, and clinically versatile ceramic for use in bone repair. This study compared the clinical efficacy of a combination of calcium sulfate dihydrate, as a binder and barrier, and demineralized freeze-dried bone allograft (DFDBA) to polytetrafluoroethylene (ePTFE) and DFDBA for the treatment of human periodontal defects. METHODS Two intrabony defects were compared in each of 19 patients with chronic periodontitis. After initial preparation, full-thickness mucoperiosteal flaps were elevated, osseous defects debrided, and the roots prepared (ultrasonic, hand curets, and tetracycline conditioning). Defects were randomly treated with either a combination graft of DFDBA with CS (4:1) covered by a CS barrier or with DFDBA and fitted with an ePTFE barrier. Flaps were coronally positioned to obtain primary closure. Clinical soft tissue measurements were recorded at 6 months, and all study sites were surgically reentered for evaluation. RESULTS The mean presurgical measurements for defects randomized to the CS and ePTFE treatments, respectively, were similar for attachment level (AL; 6.2 +/- 1.8 mm and 6.1 +/- 1.7 mm), probing depth (PD; 6.3 +/- 1.1 mm and 6.2 +/- 1.1 mm), and gingival recession (0.1 +/- 1.9 mm and 0.2 +/- 1.4 mm). Defects treated with CS or ePTFE demonstrated statistically significant (P < or = 0.0001) reductions in mean PD (2.7 +/- 1.4 mm and 3.4 +/- 1.3 mm, respectively) and gains in mean AL (1.8 +/- 1.5 mm and 1.7 +/- 1.4 mm, respectively). Recession increased by 0.8 +/- 1.4 mm at CS sites and 1.6 +/- 1.7 mm at ePTFE-treated sites (P < or = 0.05). Pretreatment mean defect depths were 4.1 +/- 1.0 mm and 3.7 +/- 1.0 mm for CS and ePTFE sites, respectively. Reentry evaluations revealed a mean defect fill of 2.7 +/- 1.5 mm and 2.5 +/- 0.9 mm for the CS and ePTFE sites, respectively, with a corresponding mean defect resolution of 80.3 +/- 18.7% and 76.7 +/- 18.5%. The CS and ePTFE sites did not differ significantly in mean defect fill or defect resolution. CONCLUSIONS The results of this study indicate that calcium sulfate, when used as a binder and barrier in combination with DFDBA, supports significant clinical improvement in intrabony defects, as evidenced by reductions in probing depth, gains in clinical attachment level, and defect fill and resolution. Calcium sulfate represents an important alternative to non-resorbable ePTFE barriers in combination with DFDBA for the treatment of intrabony defects.
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Carvalho RS, Nelson D, Kelderman H, Wise R. Guided bone regeneration to repair an osseous defect. Am J Orthod Dentofacial Orthop 2003; 123:455-67. [PMID: 12695774 DOI: 10.1067/mod.2003.59] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The ultimate goal of orthodontic therapy is to establish functional and esthetic dental relationships in a balanced facial pattern. In patients with compromised periodontal support, the use of multidisciplinary treatment plans is essential in attaining these goals. This case report includes a thorough documentation of the orthodontic and periodontal treatments to demonstrate the effectiveness of guided bone regenerative procedures combined with a bone allograft to aid in correcting a dental malocclusion.
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Affiliation(s)
- Roberto S Carvalho
- Department of Orthodontics, Boston University School of Dental Medicine, MA, USA
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25
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Davenport DR, Mailhot JM, Wataha JC, Billman MA, Sharawy MM, Shrout MK. Effects of enamel matrix protein application on the viability, proliferation, and attachment of human periodontal ligament fibroblasts to diseased root surfaces in vitro. J Clin Periodontol 2003; 30:125-31. [PMID: 12622854 DOI: 10.1034/j.1600-051x.2003.00150.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this research was to examine the influence of enamel matrix proteins (EMP) on the viability, proliferation, and attachment of periodontal ligament fibroblasts (PDLF) to diseased root surfaces. MATERIALS AND METHODS Primary cell cultures of PDFL were obtained from clinically healthy third molars or premolar teeth. Viability and proliferation rates were carried out over a 10-day period. A total of 80,000 cells were plated in 24-well plates followed by EMEM with 10% FBS (positive control) and EMEM plus EMP at 25, 50, 75, and 100 micro g/ml. Cells were harvested on days 1, 3, 5, 7, and 10 and viability was performed utilizing an MTS assay. PDLF proliferation rates were assessed by a CyQUANT GR dye assay. SEM analysis was used to examine the qualitative effects of cellular attachment to diseased root surfaces following EMP compared to nontreated controls. RESULTS The results indicated that viability was negatively affected for higher doses over time while lower doses displayed viability effects similar to control. Proliferation, however, appeared to be ameliorated following exposure to EMP. The SEM analysis suggests that cellular attachment to diseased dentin was enhanced following EMP application. CONCLUSION These in vitro studies support the concept that EMP may act as a suitable matrix for PDLF.
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26
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Hou LT, Liu CM, Lei JY, Wong MY, Chen JK. Biological effects of cementum and bone extracts on human periodontal fibroblasts. J Periodontol 2000; 71:1100-9. [PMID: 10960016 DOI: 10.1902/jop.2000.71.7.1100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Non-collagenous proteins of mineralized tissues play important roles in bone induction during mineralization and in regulating the activity of many types of mesenchymal cells. This study was conducted to determine the effects of acetic acid extracts of bone and cementum on alkaline phosphatase (ALPase) activity and in vitro mineralization of cultured human periodontal fibroblasts (hPF). METHODS Alveolar bone and cementum obtained from clinically healthy subjects were extracted by a solution containing 0.5 M acetic acid and enzyme inhibitors. Osteoblastic phenotypes of hPF were assayed by ALPase activity, gene expression of bone marker proteins, and the ability to produce in vitro mineralization in culture media containing 50 microg/ml ascorbic acid, 10 mM sodium beta-glycerophosphate, and 10(-7) M dexamethasone. The effects of cementum and bone extracts on the expression of osteoblastic phenotypes in hPF were also determined. RESULTS Many protein components, varying in molecular weight from 10 to 14 to 120 kDa, were detectable in 10% SDS-PAGE of both cementum and alveolar bone extracts. The hPF cells were found to exhibit a moderate ALPase activity when compared with rat osteosarcoma (ROS) 17/2.8 cells under the same experimental conditions. Gene expression for ALPase, osteocalcin bone sialoprotein, osteopontin, and BMP-7 at mRNA message was detected by RT-PCR in hPF and ROS 17/2.8 cells. The confluent hPF and ROS 17/2.8 cells showed evidence of calcium deposition in the extracellular milieu at 30 and 15 to 30 days' cultures, respectively, under a mineralization medium. The hPF appeared to form mineralized foci with morphological characteristics different from the mineralized nodules produced by ROS 17/2.8 cells. The addition of low concentrations (5 microg/ml) of either cementum or bone extract produced an increase in the size and number of mineralization spots, as well as greater ALPase activity in both hPF and ROS 17/2.8 cultures during the observation periods. CONCLUSIONS These results suggest that hPF possess certain mineralizing phenotypes, and that acetic acid extracts of bone and cementum contain components capable of stimulating osteogenic differentiation of hPF.
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Affiliation(s)
- L T Hou
- Department of Periodontology, School of Dentistry, National Taiwan University, Taipei.
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Lackler KP, Cochran DL, Hoang AM, Takacs V, Oates TW. Development of an in vitro wound healing model for periodontal cells. J Periodontol 2000; 71:226-37. [PMID: 10711613 DOI: 10.1902/jop.2000.71.2.226] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Periodontal wound healing and regeneration are influenced by a multitude of factors. While many in vitro investigations have compared the proliferation of periodontal ligament (PDL) cells and gingival fibroblasts (GF), there are no reports directly comparing the abilities of these 2 cell types to fill a wound site. As such, the goals of this research were: 1) to develop an in vitro model of wound healing which would allow for the investigation of the biologic basis of periodontal wound healing and regeneration and 2) to compare the rates of PDL cells and GF to fill an in vitro wound site. METHODS Using both human PDL cells and GF confluent cultures, in vitro wounds were mechanically created, removing a 3 mm wide band of the cell layer. Wounded cultures were then incubated for time periods up to 12 days in media containing fetal bovine serum (FBS) concentrations (0, 0.1, 1, 5, 10, and 20%) as appropriate for each experiment. Slides were fixed, stained, and cells quantified within the wound boundaries by computer-assisted histomorphometry. The effect of wounding a cell layer was determined by comparing wounded cells as described above with a cell layer margin created without physically disrupting the cell layer. RESULTS The in vitro model for periodontal wound healing established in this study showed that GF fill in the wound site at a significantly (P <0.0025) faster rate than PDL cells over 12 days of healing. In addition, PDL cells and GF were found to have unique concentration-dependent responses to FBS (P<0.0025). It was also shown that wounding resulted in a significant delay (P <0.01) in the initial healing response of an in vitro wound. CONCLUSION This in vitro model demonstrated that the characteristics of wound healing are dependent on cell type, disruption (wounding) of the cell layer, and serum concentration. In addition, this model has incorporated both proliferation and migration to provide the first direct evidence demonstrating GF has a significantly greater ability to fill a wound site than PDL cells. This in vitro model may be utilized in future investigations of the biologic basis of periodontal wound healing.
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Affiliation(s)
- K P Lackler
- Department of Periodontics, Wilford Hall Medical Center, Lackland AFB, San Antonio, TX, USA
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Harrel SK, Nunn ME, Belling CM. Long-term results of a minimally invasive surgical approach for bone grafting. J Periodontol 1999; 70:1558-63. [PMID: 10632531 DOI: 10.1902/jop.1999.70.12.1558] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A retrospective analysis of the results obtained from regenerative surgery performed utilizing a minimally invasive surgical approach was performed. Bone grafting procedures were performed at 194 sites in 87 patients using small incisions and minimal flap reflection. There were 44 females with a mean age of 52.7 years and 43 males with a mean age of 54.9 years. The mean healing time at which data were collected was 21.7 months. Postsurgical data were collected at the time of routinely scheduled supportive periodontal therapy (SPT) appointments by 2 evaluators. Mean changes in probing depth and attachment levels were evaluated utilizing a Wilcoxon sign rank test. Mean improvement in probing depth was 4.58 mm (P <0.0001) and attachment level was 4.87 mm (P <0.0001). These improvements were seen for all levels of initial prognosis (good to poor) and appeared to be stable over time. The postsurgical gingival margin was at or within 1 mm of the cemento-enamel junction (CEJ) for 58% of the sites treated. This was interpreted to indicate good retention of soft tissue height postsurgically. It was concluded that the minimally invasive approach for bone grafting yielded results that were equivalent to more traditional surgical approaches utilizing longer incisions and greater reflection.
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Affiliation(s)
- S K Harrel
- Baylor College of Dentistry, Dallas, TX, USA.
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Murakami S, Takayama S, Ikezawa K, Shimabukuro Y, Kitamura M, Nozaki T, Terashima A, Asano T, Okada H. Regeneration of periodontal tissues by basic fibroblast growth factor. J Periodontal Res 1999; 34:425-30. [PMID: 10685372 DOI: 10.1111/j.1600-0765.1999.tb02277.x] [Citation(s) in RCA: 164] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Several growth factors (or cytokines) have recently received attention because of their ability to actively regulate various cellular functions of periodontal ligament (PDL) cells and the effects of topical application of such factor(s) on periodontal tissue regeneration has been evaluated. In this study, we examined the role of basic fibroblast growth factor (bFGF) in the wound healing and regeneration of periodontal tissues. Alveolar bone defects (such as 2-wall, 3-wall and furcation class II bone defects) were created surgically in beagle dogs and primates. Recombinant bFGF was topically applied to the artificial bony defects. Six or 8 wk after application, the periodontal regeneration was morphologically and histomorphometrically analyzed. In all sites where bFGF was applied, significant periodontal ligament formation with new cementum deposits and new bone formation was observed in amounts greater than in the control sites. We found it noteworthy that no instances of epithelial down growth, ankylosis or root resorption were observed in the bFGF sites. In vitro studies demonstrated that bFGF enhances the proliferative responses of human PDL cells, which express FGF receptor-1 and -2, but inhibits the induction of alkaline phosphatase activity and mineralized nodule formation by PDL cells. Interestingly, we observed that the mRNA level of laminin in PDL cells, which plays an important role in angiogenesis, was specifically upregulated by bFGF stimulation, but that of type I collagen was downregulated. The present study demonstrates that bFGF can be applied as one of the therapeutic modalities which actively induce periodontal tissue regeneration. The results of in vitro studies suggest that by suppressing the cytodifferentiation of PDL cells into mineralized tissue forming cells, bFGF may play important roles in wound healing by promoting angiogenesis and inducing the growth of immature PDL cells, and may in turn accelerate periodontal regeneration.
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Affiliation(s)
- S Murakami
- Department of Periodontology and Endodontology, Osaka University Faculty of Dentistry, Japan.
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Abstract
Bone replacement grafts will play a continuing role in periodontal and other regenerative therapy. Several choices are available to the clinician including autogenous, allogeneic, xenogeneic and a variety of alloplastic materials. Except for fresh autogenous bone, bone replacement graft(s) do not provide the cellular elements necessary for osteogenesis nor can they reliably be considered truly osteoinductive, but instead are mostly osteoconductive, providing a scaffold for bone deposition. Currently, significant decrease in clinical probing depth and gain of clinical attachment have been reported following use of bone replacement grafts when compared to flap debridement surgery alone for periodontal osseous defects. Reported differences among bone replacement grafts (autogenous, allogeneic, xenogeneic, and alloplastic) occur with respect to histological outcomes. Overall, probing depth reduction, attachment level gain and degree of defect fill are similar for all bone replacement grafts.
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Affiliation(s)
- H F Nasr
- Department of Periodontics, School of Dentistry, Louisiana State University Medical Center, New Orleans, USA
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Maguire H, Torabinejad M, McKendry D, McMillan P, Simon JH. Effects of resorbable membrane placement and human osteogenic protein-1 on hard tissue healing after periradicular surgery in cats. J Endod 1998; 24:720-5. [PMID: 9855821 DOI: 10.1016/s0099-2399(98)80161-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Periradicular surgeries were performed on the maxillary cuspid teeth of twelve cats. Before reapproximation of the surgical flaps, eight of the osteotomies were covered with a resorbable membrane and eight were filled with human osteogenic protein-1 (hOP-1) on a collagen carrier. The remaining eight sites received no further treatment and served as controls. The animals were euthanized after 12 wk, and the specimens were examined histomorphometrically for the presence or absence of osseous regeneration, inflammation, and cementum formation on the root ends. The results showed that the sites treated with the membrane exhibited significantly more inflammation adjacent to the resected root ends (p < 0.05), and that the use of the membrane had no statistically significant effect on osseous healing or new cementum formation. The use of hOP-1 was associated with a significant decrease in the thickness of new cementum formed on the resected root ends (p < 0.05), but had no statistically significant effect on osseous healing or degree of inflammation. Based on these results, it seems that neither the use of hOP-1 nor resorbable membranes have a positive effect on periradicular tissue healing in endodontic surgery.
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Affiliation(s)
- H Maguire
- Loma Linda University School of Dentistry, CA, USA
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Carnes DL, Maeder CL, Graves DT. Cells with osteoblastic phenotypes can be explanted from human gingiva and periodontal ligament. J Periodontol 1997; 68:701-7. [PMID: 9249643 DOI: 10.1902/jop.1997.68.7.701] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Considerable phenotypic heterogeneity has been reported in gingival fibroblasts. Similarly, cells from the periodontal ligament (PDL) can be isolated with different phenotypes. Although it has been suggested that cells from the gingiva do not contribute to the formation of hard tissue, it is theoretically possible that under appropriate stimuli, immature mesenchymal cells in gingiva could differentiate along an osteoblastic pathway. Differentiation of immature mesenchymal cells into osteoblasts following stimulation with osteoinductive factors has been demonstrated in muscle. We undertook experiments to establish whether cells with osteoblastic characteristics could be identified from human gingiva as well as from human periodontal ligament. Some cell populations from each of these tissues were found to have high basal alkaline phosphatase activity, to release osteocalcin in response to 1,25(OH)2 VitD3, and to form a mineralized matrix. Thus, cells can be isolated from the gingiva and PDL that exhibit phenotypic markers, which taken together are characteristic of osteoblastic cells. Other cell populations derived from the PDL and gingival connective tissue were isolated that had fibroblastic characteristics. These studies support the concept that gingival tissue can give rise to cells which may differentiate along either a fibroblastic or an osteoblastic pathway.
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Affiliation(s)
- D L Carnes
- Department of Endodontics, University of Texas Health Science Center, San Antonio, USA
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Abstract
Periodontal regeneration means healing after periodontal surgery that results in the restoration of the tooth-supporting tissues; namely, cementum, alveolar bone, and periodontal ligament. The response of the periodontium to conventional periodontal flap surgery is primarily repair. Regenerative flap procedures involve modifications intended to alter variables in the normal wound healing response to shift the outcome from repair to regeneration. Technical manipulations, devices, pharmacological agents, and biologicals have been used to obtain regeneration. Evaluation of periodontal therapy is done by clinical and histological assessments. Human clinical trials depend on probing, re-entry, and radiographic measurements which cannot distinguish between periodontal repair and regeneration. Histological studies are difficult in humans because they require the retrieval of tissue blocks containing the teeth and their surrounding tissues, and for this reason these studies have largely been done in animal models; however, the use of animal models creates problems of interpretation when applying the information to the human. There are other fundamental problems related to assessment of new methods of periodontal regeneration. Ideally, periodontal regeneration is attempted after resolving the periodontitis that produced the loss of periodontal support. Does the type of periodontal disease affect the outcome? If it does, then separate clinical trials would be indicated to manage defects produced by different diseases. Furthermore, certain types of periodontal defects apparently respond better than others (for example, intrabony defects versus suprabony defects). Does each type of defect require a separate trial? Do subjects respond differently and, if so, how should this be factored into selection of the study population and sample size? There appear to be more questions than answers concerning the design of clinical trials for periodontal regeneration. This is not surprising since regeneration has been possible for only a few years, is apparently unpredictable, and the origin and nature of the new tissue are poorly understood. These factors make it important that the design of clinical trials be openly and thoroughly discussed so that practical solutions are forthcoming.
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Affiliation(s)
- J G Caton
- Department of Periodontology, Eastman Dental Center, Rochester, New York, USA
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Ripamonti U, Reddi AH. Tissue engineering, morphogenesis, and regeneration of the periodontal tissues by bone morphogenetic proteins. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1997; 8:154-63. [PMID: 9167090 DOI: 10.1177/10454411970080020401] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Tissue engineering is the emerging field of science developing techniques for fabrication of new tissues for replacement based on principles of cell and developmental biology and biomaterials. Morphogenesis is the cascade of pattern formation and the attainment of form of the various organs and the organism as a whole. The periodontium consist of the periodontal ligament, cementum, and alveolar bone. Bone has considerable potential for regeneration and therefore is a prototypic model for tissue engineering. The three main ingredients for tissue engineering are regulatory signals, responding stem cells, and extracellular matrix. Recent advances in molecular biology of the bone morphogenetic proteins (BMPs) have set the stage for tissue engineering of bone and related tissues, including the periodontium. Bone-derived BMPs, with a collagenous matrix as carrier, induced cementum and alveolar bone regeneration in surgically created furcation defects in the primate. It is noteworthy that there was morphogenesis of periodontal ligament and a faithful insertion of Sharpey's fibers into cementum. In the same furcation model, recombinant human osteogenic protein-1 (rhOP-1, also known as BMP-7), in conjunction with the collagenous carrier, induced extensive cementogenesis with insertion of Sharpey's fibers into the newly formed cementum. The observation that BMPs induce cementogenesis and periodontal ligament formation indicates that these proteins may have multiple functions in vivo not limited to cartilage and bone induction. The rapid advances in the molecular biology of BMPs and their receptors bode well for novel strategies to engineer the regeneration of the periodontal tissues.
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Affiliation(s)
- U Ripamonti
- Bone Research Laboratory, MRC/University of the Witwatersrand, Medical School, Johannesburg, South Africa
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Reynolds MA, Bowers GM. Fate of demineralized freeze-dried bone allografts in human intrabony defects. J Periodontol 1996; 67:150-7. [PMID: 8667135 DOI: 10.1902/jop.1996.67.2.150] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Demineralized freeze-dried bone (DFDBA) is the most widely used allograft in periodontics. Little information exists, however, on the fate of DFDBA matrix or on the effects of residual particles within grafted defects. The purpose of this study was to histologically examine the fate of DFDBA used for regeneration in intrabony defects. A secondary objective was to compare the amount of new attachment apparatus formation, including component tissues, in relation to the presence or absence of residual graft material. Histologic data were obtained from earlier studies in which intrabony defects grafted with DFDBA were removed at 6 months en bloc and submitted for histologic examination. Histologic sections (1,120) from 12 patients with 32 grafted defects revealed that 72% of the grafted defects exhibited residual DFDBA particles. When present, DFDBA appeared amalgamated within the new viable bone. Data from 5 patients with 14 grafted sites permitted a within-subject comparison of the amount of regeneration in relation to the presence or absence of residual graft material. Defects harboring residual graft particles exhibited significantly greater amounts of new attachment apparatus formation (1.72 mm vs. 0.20 mm), including new bone (2.33 mm vs. 0.23 mm), cementum (1.74 mm vs. 0.23 mm), and associated periodontal ligament than sites without evidence of graft matrix (P < or = 0.05). No apparent differences were seen in the nature of the new attachment apparatus or component tissues, other than in amount of formation. Inflammation and graft containment appear to be important factors influencing the fate of DFDBA and the regenerative response.
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Affiliation(s)
- M A Reynolds
- Department of Periodontics, University of Maryland, Dental School, Baltimore, USA
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36
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Mailhot JM, Schuster GS, Garnick JJ, Hanes PJ, Lapp CA, Lewis JB. Human periodontal ligament and gingival fibroblast response to TGF-beta 1 stimulation. J Clin Periodontol 1995; 22:679-85. [PMID: 7593697 DOI: 10.1111/j.1600-051x.1995.tb00826.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to measure the time-sequence response of RNA and protein synthesis to transforming growth factor-beta 1 (TGF-beta 1) by human periodontal ligament (HPDLF) and gingival (HGF) fibroblasts in culture. HPDLF and HGF were cultured from explants of healthy gingival tissue and freshly extracted teeth. Cultures of 8 x 10(4) cells/ml were exposed to medium containing 3H-uridine and 35S-methionine with TGF-beta 1 at concentrations from 10(-9) M to 10(-21) M, or control medium, for up to 60 hours in order to assess RNA and protein synthesis. Protein concentrations of comparable cultures were also assayed colorimetrically. Results were reported as specific activity (CPM/microgram protein). The results indicate that 10(-9) M TGF-beta 1 treated cultures showed a significant increase in RNA synthesis by HPDLF and HGF over time, as compared to the control cultures. HPDLF showed a significant increase in protein synthesis over time while that by HGF was not significant as compared to the control cultures. Lower concentrations of TGF-beta 1 demonstrated no significant differences from control. Results suggest that the effects of TGF-beta 1 on HPDLF and HGF are both time and dose dependent, with 10(-9) M TGF-beta 1 providing the best response of those concentrations tested. These findings support the concept that TGF-beta 1 may play a role in periodontal regeneration due to its ability to promote fibroblast RNA and protein synthesis. The results also demonstrate that although these two cells types appear morphologically similar, they exhibit distinct biological responses to growth factors such as TGF-beta 1.
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Affiliation(s)
- J M Mailhot
- Department of Periodontics, Medical College of Georgia, Augusta 30912, USA
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37
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Abstract
Initiation of osteogenesis and cementogenesis is a problem central to periodontal regeneration. A major advance in the understanding of bone formation has been the identification of an entirely new family of protein initiators, the bone morphogenetic proteins, that regulate cartilage and bone differentiation in vivo. The purification, genetic cloning and expression of recombinant human bone morphogenetic proteins (BMPs) have laid the foundation for the cellular and molecular dissection of bone development and regeneration. The striking evolutionary conservation of the BMP genes indicates that they are critical in the normal development and function of animals. In addition to postfetal osteogenesis, the BMPs may play multiple roles in embryonic development and organogenesis, including skeletogenesis and the development of craniofacial and dental tissues. The availability of recombinant human BMPs provides several challenges and opportunities to gain insights into the mechanisms regulating the regeneration of bone and cementum for optimal outcome in the periodontal patient.
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Affiliation(s)
- U Ripamonti
- Medical Research Council/University of the Witwatersrand, Dental Research Institute, Johannesburg, South Africa
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38
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Wallace SC, Gellin RG, Miller MC, Mishkin DJ. Guided tissue regeneration with and without decalcified freeze-dried bone in mandibular Class II furcation invasions. J Periodontol 1994; 65:244-54. [PMID: 8164118 DOI: 10.1902/jop.1994.65.3.244] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The purpose of this study was to compare periodontal soft and hard tissue repair using expanded polytetrafluoroethylene (ePTFE) membranes with and without decalcified freeze-dried cortical bone allografts (DFDBA). Six patients with 17 mandibular Class II buccal molar furcal invasions received oral hygiene instructions followed by scaling and root planing. Baseline soft tissue measurements with periodontal probes were made to assess probing depths (PD), recession (REC), and probing attachment levels (PAL). After non-surgical therapy, 10 teeth were randomly selected as test sites (ePTFE + DFDBA) and 7 as controls (ePTFE alone). Full-thickness flaps were elevated, and open surgical measurements were made to determine alveolar crestal height (CEJ-AC) and vertical (CEJ-BDF) and horizontal (HPDF) defect depth. The ePTFE membranes were removed at 6 weeks. After 6 months, all sites were reentered and both soft tissue and open surgical measurements recorded. The following mean changes (mm) were found for ePTFE and ePTFE + DFDBA treated sites respectively: decreased PD = 1.5, 2.2; increased REC = 1.3, 1.3; loss(-)/gain PAL = -0.2, 0.8; decreased CEJ-BDF = 3.8, 5.0; increased CEJ-AC = 0.5, 0.4; and decreased HPDF = 2.3, 2.4. None of the changes were statistically significant. The addition of DFDBA to the GTR procedure did not significantly improve any of the mean soft tissue and open surgical measurements between control (ePTFE alone) and test (ePTFE+DFDBA) groups in mandibular Class II buccal furcations. Both treatment procedures resulted in significant decreases in PD, CEJ-BDF, and HPDF and a significant increase in REC. There were no differences for PAL and CEJ-AC within control and test groups seen with this sample. Larger randomized clinical trials are needed to more fully evaluate whether combined graft and GTR procedures offer an advantage over GTR alone.
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Affiliation(s)
- S C Wallace
- Department of Stomatology, College of Dental Medicine, Medical University of South Carolina
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39
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40
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Mellonig JT. Autogenous and allogeneic bone grafts in periodontal therapy. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1992; 3:333-52. [PMID: 1391415 DOI: 10.1177/10454411920030040201] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article is limited to a review of bone autografts and allografts, as used in periodontal therapy. The various graft materials are discussed with respect to case reports, controlled clinical trials, and human histology. Other reviewed areas are wound healing with periodontal bone grafts, tissue banking and freeze-dried bone allografts, and the use of bone grafts in guided tissue regeneration.
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Affiliation(s)
- J T Mellonig
- Department of Periodontics, University of Texas, San Antonio 78284
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41
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Abstract
Prosthodontics and periodontics are collaborative disciplines. A successful prosthesis depends on a healthy periodontal environment, and periodontal health depends on the continued integrity of the prosthodontic restoration. To facilitate this collaboration, prosthodontists should not only appreciate the periodontic implications of gingival displacement procedures and tooth preparation, but should be knowledgeable about the types of gingival tissues, osseous topography, occlusal effects, and their implications for abutment choice. Working as a team, the periodontist can identify for the prosthodontist a patient's periodontal strengths and limitations. In that way, the prosthodontist can then assume responsibility for a given treatment plan based on a mutual understanding of the critical factors involved.
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42
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Abstract
Bone autografts and allografts, various alloplastic materials, and guided tissue regeneration are used to reconstruct lost periodontal tissues. This paper focuses on controversies related to these therapeutic modalities as well as their role in periodontal regeneration.
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Affiliation(s)
- J T Mellonig
- Department, University of Texas, San Antonio 78284-7894
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43
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Louis JP, Dabadie M. Fibrous carbon implants for the maintenance of bone volume after tooth avulsion: first clinical results. Biomaterials 1990; 11:525-8. [PMID: 2242404 DOI: 10.1016/0142-9612(90)90071-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
When the avulsion of the last teeth of a patient is necessary, we propose to maintain the bone mass in order to improve the prosthetic conditions. For this purpose, we use fibrous carbon which is a biocompatible material well tolerated by the surrounding tissues. The results are reported of 10 yr of clinical use of fibrous carbon roots implanted in 38 alveoli of 26 patients with a mean follow-up of 34 month. There were 26 accepted artificial roots and 12 failures. The causes of failure are principally: (1) absent external bone wall near implanted alveoli (presence of the four bone walls is necessary); (2) existing local inflammation near implant site area.
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Affiliation(s)
- J P Louis
- Faculté de Chirurgie Dentaire, Nancy, France
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44
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Richardson AC, Chadroff B, Bowers GM. The apical location of calculus within the intrabony defect. J Periodontol 1990; 61:118-22. [PMID: 2313528 DOI: 10.1902/jop.1990.61.2.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although several studies have concluded that calculus removal becomes more difficult as pocket depth increases, few have examined the clinical location of calculus within the intrabony defect. This study evaluated the relationship between apical calculus position and the depth and morphology of the intrabony defect. As part of an on-going study of new attachment procedures in humans, 260 intrabony defects were surgically entered in 39 patients. Using magnifying loops and fiber optics in all defects, the most apical level of calculus was grooved to serve as both a clinical and histologic reference point. Clinical measurements made prior to root debridement included the alveolar crest to base of calculus, and the base of calculus to base of defect. The type of defect was classified by the number of remaining osseous walls. Calculus has not been found apical to the groove in any histologic section. The mean distance measured clinically between the base of the calculus and the base of the defect was found to increase with the depth of the defect. This relationship did not vary with either tooth type or number of remaining osseous walls in the defect. Data analysis of this group of patients (N = 39) showed a positive correlation (r = .83) between increasing depth of intrabony defect and the distance of the most apical calculus from the defect base.
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Affiliation(s)
- A C Richardson
- Periodontics Department, Naval Dental Clinic, Norfolk, VA
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45
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Somerman MJ, Young MF, Foster RA, Moehring JM, Imm G, Sauk JJ. Characteristics of human periodontal ligament cells in vitro. Arch Oral Biol 1990; 35:241-7. [PMID: 2161648 DOI: 10.1016/0003-9969(90)90062-f] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Periodontal ligament cells may have a role in the regulation of hard and soft periodontal tissues, but their specific function has yet to be determined. To evaluate further their role in periodontal homeostasis, they were examined for osteoblast-like behaviour; in vitro no characteristic osteoblastic responsiveness was found. Periodontal ligament cells gave a PGE2- and isoproterenol-mediated cAMP response, but did not respond in a similar fashion to calcitonin or PTH. When exposed to PGE2, isoproterenol, or 1,25(OH)2 vitamin D3, they did not exhibit an increase in protein production, as measured by [35S]-methionine incorporation. Immunofluorescent localization indicated that periodontal ligament cells produce a bone-associated protein, osteonectin. In addition, mRNA levels for osteonectin and bone proteoglycan I (biglycan) were detected in these cells, in vitro. This information should help to clarify the role such cells play in the regulation of periodontal tissues.
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Affiliation(s)
- M J Somerman
- Department of Periodontics/Pharmacology, University of Maryland Dental School, Baltimore 21201
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46
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Bowers GM, Chadroff B, Carnevale R, Mellonig J, Corio R, Emerson J, Stevens M, Romberg E. Histologic evaluation of new attachment apparatus formation in humans. Part I. J Periodontol 1989; 60:664-74. [PMID: 2614631 DOI: 10.1902/jop.1989.60.12.664] [Citation(s) in RCA: 139] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Part I of this three-part human study evaluated the formation of a new attachment apparatus (bone, cementum, and periodontal ligament) on pathologically exposed root surfaces in an open and closed environment. The most apical level of calculus on the root served as a histologic reference point to measure regeneration on root surfaces exposed to the oral environment. Attempts were made to initiate the formation of a new attachment apparatus by flap curettage, root planing, coronectomy, and submersion of vital roots beneath the mucosa. Nonsubmerged defects were treated by the same surgical technique and served as controls. Biopsies were obtained at 6 months and regeneration was evaluated histometrically by two investigators who were unaware of the treatment performed. Data from 9 patients with 25 submerged and 22 nonsubmerged defects were submitted for statistical analysis. Results indicate that a new attachment apparatus did not form in any of the 22 nonsubmerged teeth; a new attachment apparatus did form in a submerged environment (0.75 mm); significantly more new attachment apparatus (P less than 0.05), new cementum (P less than 0.01), new connective tissue (P less than 0.05), and new bone (P less than 0.02) formed in submerged defects; new cementum was cellular in nature and formed equally well on old cementum and dentin. Greater percent positive regeneration of the attachment apparatus and all component tissues occurred in submerged defects and no extensive root resorption, ankylosis, or pulp death was observed on submerged or nonsubmerged roots.
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Affiliation(s)
- G M Bowers
- Department of Periodontics, Baltimore College of Dental Surgery, University of Maryland
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47
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Bowers GM, Chadroff B, Carnevale R, Mellonig J, Corio R, Emerson J, Stevens M, Romberg E. Histologic evaluation of new attachment apparatus formation in humans. Part III. J Periodontol 1989; 60:683-93. [PMID: 2614633 DOI: 10.1902/jop.1989.60.12.683] [Citation(s) in RCA: 222] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There is still controversy as to the role of bone grafting materials in the formation of a new attachment apparatus and component tissues (bone, cementum, and periodontal ligament). The purpose of this study was to compare the healing of intrabony defects with and without the placement of decalcified freeze-dried bone allograft (DFDBA) in a nonsubmerged environment in humans. The most apical level of calculus on the root served as a histologic reference point to delineate root surfaces exposed to the oral environment and to measure new attachment apparatus and new component tissue formation. Free gingival grafts were placed over grafted and nongrafted defects to retard epithelial migration. Biopsies were obtained at 6 months and regeneration was evaluated histometrically. Data from 12 patients with 32 grafted and 25 nongrafted defects were submitted for statistical analysis. Results indicate that in nongrafted defects, a long junctional epithelium formed along the entire length of exposed root surfaces and often extended apical to the calculus reference notch. Free gingival grafts did not enhance regeneration of a new attachment apparatus, new cementum, new connective tissue, or new bone in nongrafted defects. The formation of a new attachment apparatus was observed when intrabony defects were grafted with DFDBA (x1.21 mm); significantly more new attachment apparatus (P less than .005), new cementum (P less than .005), new connective tissue (P less than .05), and new bone (P less than .0001) formed in intrabony defects grafted with DFDBA than in nongrafted defects. There was a greater chance for regeneration of a new attachment apparatus and component tissues in grafted defects than in nongrafted defects. New cellular cementum formed on old cementum and dentin but more often formed over both in the same defect). The periodontal ligament was more frequently oriented perpendicular to the root; there was greater loss in alveolar crest height in nongrafted than grafted defects (P less than .05); and extensive root resorption, ankylosis, and pulp death were not observed in grafted or nongrafted defects.
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Affiliation(s)
- G M Bowers
- Department of Periodontics, Baltimore College of Dental Surgery, University of Maryland
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48
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Rummelhart JM, Mellonig JT, Gray JL, Towle HJ. A comparison of freeze-dried bone allograft and demineralized freeze-dried bone allograft in human periodontal osseous defects. J Periodontol 1989; 60:655-63. [PMID: 2693682 DOI: 10.1902/jop.1989.60.12.655] [Citation(s) in RCA: 119] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study was conducted to clinically compare freeze-dried bone allograft (FDBA) and demineralized freeze-dried bone allograft (DFDBA). Twenty-two defects (11 intrapatient pairs) in 9 patients were grafted with either DFDBA or FDBA. Evaluations were based on standardized radiographs, presurgical and postsurgical soft tissue measurements using the cemento-enamel junction as a fixed reference point, and osseous measurements at the time of surgery. Grafted sites were re-entered at a minimum of 6 months following placement. A mean osseous repair of 1.7 mm (59%) occurred with DFDBA and 2.4 mm (66%) with FDBA. A mean clinical attachment gain of 1.7 mm was obtained with DFDBA and 2.0 mm with FDBA. Probing depths decreased a mean of 2.00 mm with both DFDBA and FDBA. These findings reveal no significant differences between the two materials in primarily intraosseous defects when evaluated at a minimum 6 months postsurgery.
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49
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Bowers GM, Chadroff B, Carnevale R, Mellonig J, Corio R, Emerson J, Stevens M, Romberg E. Histologic evaluation of new attachment apparatus formation in humans. Part II. J Periodontol 1989; 60:675-82. [PMID: 2614632 DOI: 10.1902/jop.1989.60.12.675] [Citation(s) in RCA: 185] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There is conflicting evidence regarding the value of graft materials in enhancing the formation of new bone, cementum, and periodontal ligament (new attachment apparatus). Part II of this study compared the healing of intrabony defects with and without the placement of decalcified freeze-dried bone allograft (DFDBA) in a submerged environment. The most apical level of calculus on the root served as a histologic reference point to measure regeneration on root surfaces exposed to the oral environment. Biopsies were obtained at 6-months and evaluated histometrically by two investigators unaware of the treatment performed. Data from 9 patients with 30 grafted defects and 13 nongrafted defects were submitted for statistical analysis. Results indicate that in a submerged environment significantly more new attachment apparatus (P less than .05) and new bone (P less than .05) formed in grafted than nongrafted sites. Significantly greater loss of alveolar crest height occurred in nongrafted than grafted defects (P less than .05); regeneration of new attachment apparatus, new bone, and new cementum occurred more frequently in grafted than nongrafted defects. There was a greater chance for the regeneration of a connective tissue attachment in nongrafted intrabony defects than in grafted defects; new cellular cementum formed equally well on old cementum, dentin, or both old cementum and dentin in the same defect. The periodontal ligament was oriented parallel, perpendicular, or both parallel and perpendicular in the same defect; and, no extensive root resorption, ankylosis, or pulp death was observed in grafted or nongrafted defects.
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Affiliation(s)
- G M Bowers
- Department of Periodontics, Baltimore College of Dental Surgery, University of Maryland
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50
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Barnett JD, Mellonig JT, Gray JL, Towle HJ. Comparison of freeze-dried bone allograft and porous hydroxylapatite in human periodontal defects. J Periodontol 1989; 60:231-7. [PMID: 2544717 DOI: 10.1902/jop.1989.60.5.231] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study was conducted to clinically compare the efficacy of freeze-dried bone allograft (FDBA) and porous hydroxylapatite granules. Nineteen pairs of intraosseous defects were grafted in seven patients. One defect of each pair was implanted with FDBA, the other with granular porous hydroxylapatite. Matching defects were treated similarly in all other aspects. Evaluations were based on both preoperative and postoperative measurements from a fixed reference point, standardized radiographs, surgical osseous measurements, and histology of degranulated tissues. Grafted sites were reentered 6 to 11 months postsurgery. Results showed a mean osseous fill of 2.1 mm for FDBA versus 1.3 mm for granular porous hydroxylapatite (P = .07). A mean clinical attachment gain of 2.2 mm for FDBA versus 1.3 mm for granular porous hydroxylapatite (P less than .05), and a mean decrease in probing depths of 3.0 mm for FDBA versus 1.4 mm for granular porous hydroxylapatite (P less than 0.5) was found. FDBA was clinically indistinguishable from host bone, whereas porous hydroxylapatite appeared to be separated from host bone by soft tissue. The data and clinical findings suggested that FDBA may have some enhanced reparative potential when compared to granular porous hydroxylapatite in the treatment of periodontal defects in humans.
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Affiliation(s)
- J D Barnett
- Branch Dental Clinic, Naval Station, Mayport, FL 32228
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