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Mizraji G, Davidzohn A, Gursoy M, Gursoy U, Shapira L, Wilensky A. Membrane barriers for guided bone regeneration: An overview of available biomaterials. Periodontol 2000 2023; 93:56-76. [PMID: 37855164 DOI: 10.1111/prd.12502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 10/20/2023]
Abstract
Dental implants revolutionized the treatment options for restoring form, function, and esthetics when one or more teeth are missing. At sites of insufficient bone, guided bone regeneration (GBR) is performed either prior to or in conjunction with implant placement to achieve a three-dimensional prosthetic-driven implant position. To date, GBR is well documented, widely used, and constitutes a predictable and successful approach for lateral and vertical bone augmentation of atrophic ridges. Evidence suggests that the use of barrier membranes maintains the major biological principles of GBR. Since the material used to construct barrier membranes ultimately dictates its characteristics and its ability to maintain the biological principles of GBR, several materials have been used over time. This review, summarizes the evolution of barrier membranes, focusing on the characteristics, advantages, and disadvantages of available occlusive barrier membranes and presents results of updated meta-analyses focusing on the effects of these membranes on the overall outcome.
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Affiliation(s)
- Gabriel Mizraji
- Department of Periodontology, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Mervi Gursoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
- Oral Health Care, Welfare Division, City of Turku, Turku, Finland
| | - Ulvi Gursoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Lior Shapira
- Department of Periodontology, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asaf Wilensky
- Department of Periodontology, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Zelikman H, Slutzkey G, Rosner O, Levartovsky S, Matalon S, Beitlitum I. Bacterial Growth on Three Non-Resorbable Polytetrafluoroethylene (PTFE) Membranes-An In Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5705. [PMID: 36013840 PMCID: PMC9414989 DOI: 10.3390/ma15165705] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
GBR (Guided Bone Regeneration) procedure is challenged by the risk of membrane exposure to the oral cavity and contamination. The barrier quality of these membranes serve as a mechanical block from bacterial penetration into the GBR site. The purpose of this in vitro study was to evaluate the antibacterial effect of three commercial non-resorbable polytetrafluoroethylene membranes. (Two d-PTFE membranes and one double layer e-PTFE +d-PTFE membrane). A validated in vitro model with two bacterial species (Streptococcus sanguinis and Fusobacterium nucleatum) was used. Eight samples from membrane each were placed in a 96-well microtiter plate. The experimental and positive control groups were exposed to a bacterial suspension which involved one bacterial species in each plate. Bacterial growth was monitored spectrophotometrically at 650 nm for 24 h in temperature controlled microplate spectrophotometer under anaerobic conditions. One- Sample Kolmogorov−Smirnov Normal test and the Kruskal−Wallis test was used for the statistical analysis. As shown by the bacterial growth curves obtained from the spectrophotometer readings, all three membranes resulted in bacterial growth. We have not found a statistical difference in F. nucleatum growth between different membrane samples and the positive control group. However, S. sanguinis growth was reduced significantly in the presence of two membranes (CYTOPLAST TXT-200 and NeoGenTM) when compared to the control (p < 0.01). The presence of Permamem® had no significant influence on S. sanguinis growth. Some types of commercial non-resorbable PTFE membranes may have an impact on the growth dynamics of specific bacterial species.
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Affiliation(s)
- Helena Zelikman
- Department of Oral Rehabilitation, Goldschleger School of Dental Medicine, Sackler Medical Faculty, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gil Slutzkey
- Department of Periodontology and Dental Implantology, Goldschleger School of Dental Medicine, Sackler Medical Faculty, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ofir Rosner
- Department of Oral Rehabilitation, Goldschleger School of Dental Medicine, Sackler Medical Faculty, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shifra Levartovsky
- Department of Oral Rehabilitation, Goldschleger School of Dental Medicine, Sackler Medical Faculty, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shlomo Matalon
- Department of Oral Rehabilitation, Goldschleger School of Dental Medicine, Sackler Medical Faculty, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ilan Beitlitum
- Department of Periodontology and Dental Implantology, Goldschleger School of Dental Medicine, Sackler Medical Faculty, Tel Aviv University, Tel Aviv 6997801, Israel
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3
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Liu TJ, Zhou JN, Guo LH. Impact of different regenerative techniques and materials on the healing outcome of endodontic surgery: a systematic review and meta-analysis. Int Endod J 2020; 54:536-555. [PMID: 33159322 DOI: 10.1111/iej.13440] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Regenerative techniques are increasingly applied in endodontic surgery, but different materials used in regenerative techniques may have varying impacts on wound healing. OBJECTIVES This study evaluated the effects of different regenerative techniques and materials on the outcome of endodontic surgery. PARTICIPANTS patients with persistent periapical lesions, treated with root-end surgery. CONTROL endodontic surgery without the use of regenerative techniques/materials. INTERVENTION endodontic surgery with the use of regenerative techniques/materials. OUTCOME combined clinical and radiographic results. METHODS PubMed, Web of Science, Embase, SinoMed and the CENTRAL Cochrane were searched up to 10th July 2020, followed by a manual search. Detailed eligibility criteria were applied. Cochrane's risk-of-bias tool 2.0 was used to assess the risk of bias of the eligible studies. Meta-analysis was conducted using RevMan software. Subgroup analyses were performed based on the regenerative materials used in endodontic surgery. RESULTS Eleven eligible randomized controlled trials (RCTs) were included in the meta-analysis: two had a low risk of overall bias, and nine had some concerns of overall bias. Generally, the use of regenerative techniques significantly improved the outcome of endodontic surgery (risk ratio [RR]: 0.42; 95% confidence interval [CI], 0.26-0.68; P < 0.001). On subgroup analysis, the use of expanded polytetrafluoroethylene (e-PTFE) membranes alone had no added benefits (RR: 2.00; 95% CI, 0.22-18.33; P = 0.54). The application of collagen membranes or autologous platelet concentrates (APCs) alone was associated with a trend for better outcomes (RR: 0.51; 95% CI, 0.20-1.25; P = 0.14) (RR: 0.55; 95% CI, 0.18-1.71; P = 0.30). The combined use of collagen membranes and bovine-derived hydroxyapatite significantly improved the outcome (RR: 0.35; 95% CI, 0.17-0.75; P = 0.007). DISCUSSION This systematic review evaluated the effects of collagen membranes, e-PTFE membranes, APCs and bone grafting materials, providing detailed information about the risks and benefits of using each regenerative technique/material or its combination in endodontic surgery. CONCLUSIONS Regenerative techniques improve periapical lesion healing after endodontic surgery. The combined use of collagen membranes and bovine-derived hydroxyapatite may be beneficial as an adjunct to endodontic surgery. In contrast, the positive efficacy of e-PTFE membranes or APCs alone remains doubtful.
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Affiliation(s)
- T J Liu
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - J N Zhou
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - L H Guo
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, China
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Cappellin M. Simplified protocol for horizontal and vertical post-extractive GBR with intentionally exposed PTFE membrane - Case series. JOURNAL OF SURGERY PERIDONTOLOGY AND IMPLANT RESEARCH 2020; 2:38-43. [DOI: 10.35252/jspir.2020.1.002.1.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Purpose: Post-extractive sites often need soft and hard tissue regeneration in order to
place implants with optimal functional and aesthetic conditions. The author proposed
several techniques for bone preservation and regeneration: most of them requires
release incisions and coronally advanced flap to obtain primary closure, so regain a
correct alignment of keratinized gingiva makes mandatory a further surgery with a
connective tissue graft from secondary surgical site.
Case report: Since May 2018 we applied with some adjustments Open Barrier Technique
(proposed by E. Funakoshi, 2005) in 152 post-extractive alveolar preservation and GBR;
after 3-6 months we placed 194 implants, with 100% success and survival rate.
Conclusions: Our simplified protocol allows performing vertical and horizontal GBR
in post-extractive sites without release incisions: non resorbable PTFE membrane
protects wound and bone graft for 6-8 week; secondary healing ensures thick
keratinized tissue and bone maturation, suitable to place implants after 3-6 months.
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Majzoub J, Barootchi S, Tavelli L, Wang C, Travan S, Wang H. Treatment effect of guided tissue regeneration on the horizontal and vertical components of furcation defects: A retrospective study. J Periodontol 2020; 91:1148-1158. [DOI: 10.1002/jper.19-0529] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Jad Majzoub
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Lorenzo Tavelli
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Chin‐Wei Wang
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Sunčica Travan
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
| | - Hom‐Lay Wang
- Department of Periodontics & Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
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Agarwal A, Manjunath RGS, Sethi P, Shankar GS. Platelet-rich fibrin in combination with decalcified freeze-dried bone allograft for the management of mandibular degree II furcation defect: A randomised controlled clinical trial. SINGAPORE DENTAL JOURNAL 2020; 39:33-40. [PMID: 32054425 DOI: 10.1142/s2214607519500032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Treatment of furcation involvement of molars with periodontal disease remains challenging and unpredictable. Platelet-rich fibrin (PRF) has received the attention of researchers due to its pleiotropic properties essential for periodontal wound healing. The osteoinductive property of demineralized freeze-dried bone allograft (DFDBA) has been successfully used in periodontal regeneration. Aim: The present study aimed to explore the effectiveness of PRF alone and with DFDBA in the treatment of mandibular degree II furcation defects in subjects with chronic periodontitis. Material and Methods: Patients treated were from the Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly. A total of 60 mandibular molars were treated with either open flap debridement (OFD) alone, [Formula: see text] combination or [Formula: see text] combination. The soft and hard tissue parameters such as vertical probing depth (VPD), vertical clinical attachment level (VCAL), gingival marginal level (GML), horizontal probing depth (HPD), vertical bone fill (VBF), horizontal bone fill (HBF) and furcation width (FW) were determined at baseline and 9 months postoperatively. A paired [Formula: see text]-test was conducted to assess the statistical significance between time period within each group for clinical and radiographic parameters. ANOVA and post-hoc Tukey's tests were also conducted for intergroup comparison of soft and hard tissue parameters. Statistical significance was set at [Formula: see text]. Results and Discussion: After 9 months, all treatment groups showed significant ([Formula: see text]) improvement in soft and hard tissue parameters, except GML in all the three groups and HBF and FW in the OFD group as compared to baseline. The mean VBF change was highest in the [Formula: see text] group ([Formula: see text]) mm, followed by that in the [Formula: see text] and OFD groups ([Formula: see text] and [Formula: see text][Formula: see text]mm, respectively). Conclusions: It was shown that both [Formula: see text] and [Formula: see text] combinations were significantly advantageous for the management of mandibular degree II furcation defects. However, the [Formula: see text] combination has significantly greater benefits than [Formula: see text] combination in terms of VBF.
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Affiliation(s)
- Ashish Agarwal
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - R G Shiva Manjunath
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Priyamwada Sethi
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - G Shiva Shankar
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
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Capetillo JF, Coleman BG, Johnson TM. Combination Bone Replacement Graft with Dense Polytetrafluoroethylene Barrier Membrane for Treatment of an Infrabony Periodontal Defect. Clin Adv Periodontics 2018. [DOI: 10.1002/cap.10026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Joseph F. Capetillo
- Department of Periodontics; Korea Dental Health Activity; United States Army; Seoul Republic of Korea
| | - Brandon G. Coleman
- United States Army Advanced Education Program in Periodontics; Fort Gordon GA
- Department of Periodontics; Army Postgraduate Dental School; Uniformed Services University of the Health Sciences; Fort Gordon GA
| | - Thomas M. Johnson
- United States Army Advanced Education Program in Periodontics; Fort Gordon GA
- Department of Periodontics; Army Postgraduate Dental School; Uniformed Services University of the Health Sciences; Fort Gordon GA
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Singhal S, Pradeep AR, Kanoriya D, Garg S, Garg V. Boric acid gel as local drug delivery in the treatment of class
II
furcation defects in chronic periodontitis: a randomized, controlled clinical trial. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/jicd.12279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sandeep Singhal
- Department of PeriodontologyGovernment Dental College and Research Institute Bangalore India
| | - Avani Raju Pradeep
- Department of PeriodontologyGovernment Dental College and Research Institute Bangalore India
| | - Dharmendra Kanoriya
- Department of PeriodontologyGovernment Dental College and Research Institute Bangalore India
| | - Shruti Garg
- Department of PeriodontologyGovernment Dental College and Research Institute Bangalore India
| | - Vibhuti Garg
- Department of PeriodontologyGovernment Dental College and Research Institute Bangalore India
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Borges FA, de Barros NR, Garms BC, Miranda MCR, Gemeinder JLP, Ribeiro-Paes JT, Silva RF, de Toledo KA, Herculano RD. Application of natural rubber latex as scaffold for osteoblast to guided bone regeneration. J Appl Polym Sci 2017. [DOI: 10.1002/app.45321] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Felipe Azevedo Borges
- Instituto de Química, Faculdade de Ciências e Letras, UNESP Univ Estadual Paulista, Campus Araraquara; Rua Prof. Francisco Degni no. 55 Araraquara SP 14800-060 Brazil
| | - Natan Roberto de Barros
- Instituto de Química, Faculdade de Ciências e Letras, UNESP Univ Estadual Paulista, Campus Araraquara; Rua Prof. Francisco Degni no. 55 Araraquara SP 14800-060 Brazil
| | - Bruna Cambraia Garms
- Instituto de Química, Faculdade de Ciências e Letras, UNESP Univ Estadual Paulista, Campus Araraquara; Rua Prof. Francisco Degni no. 55 Araraquara SP 14800-060 Brazil
| | - Matheus Carlos Romeiro Miranda
- Instituto de Química, Faculdade de Ciências e Letras, UNESP Univ Estadual Paulista, Campus Araraquara; Rua Prof. Francisco Degni no. 55 Araraquara SP 14800-060 Brazil
| | - Jose Lucio Padua Gemeinder
- Departamento de Ciências Biológicas, Faculdade de Ciências e Letras de Assis; UNESP Univ Estadual Paulista; Campus Assis. Av. Dom Antonio no. 2100 Assis SP 19806-900 Brazil
| | - João Tadeu Ribeiro-Paes
- Departamento de Ciências Biológicas, Faculdade de Ciências e Letras de Assis; UNESP Univ Estadual Paulista; Campus Assis. Av. Dom Antonio no. 2100 Assis SP 19806-900 Brazil
| | - Rodrigo Ferreira Silva
- Departamento de Química, Faculdade de Filosofia Ciêcias e Letras de Ribeirão Preto; USP Univ de São Paulo; Av. Bandeirantes no. 3900 Ribeirão Preto SP 14040-901 Brazil
| | - Karina Alves de Toledo
- Departamento de Ciências Biológicas, Faculdade de Ciências e Letras de Assis; UNESP Univ Estadual Paulista; Campus Assis. Av. Dom Antonio no. 2100 Assis SP 19806-900 Brazil
| | - Rondinelli Donizetti Herculano
- Departamento de Bioprocessos e Biotecnologia, Faculdade de Ciências Farmacêuticas de Araraquara; UNESP Univ Estadual Paulista, Campus Araraquara; Rodovia Araraquara Jaú, Km 01-s/n Araraquara SP 14800-903 Brazil
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Kanoriya D, Pradeep AR, Garg V, Singhal S. Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin and 1% Alendronate Gel Combination: A Randomized Controlled Clinical Trial. J Periodontol 2016; 88:250-258. [PMID: 27712462 DOI: 10.1902/jop.2016.160269] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Different materials have been investigated for renewal of lost supporting periodontal structures and tested for furcation defect treatment. Platelet-rich fibrin (PRF) is a pool of growth-promoting factors and cytokines that promote bone regeneration and maturation of soft tissue. Alendronate (ALN), an influential member of the bisphosphonate group, is known to enhance osteoblastogenesis and inhibit osteoclastic bone resorption, thus promoting tissue regeneration. This randomized trial was done to assess effectiveness of PRF and 1% ALN gel combination in mandibular degree II furcation defect treatment in comparison with PRF and access therapy alone. METHODS Seventy-two mandibular molar furcation defects were treated with either access therapy alone (group 1), access therapy with PRF (group 2), or access therapy with PRF and 1% ALN (group 3). Plaque index, modified sulcus bleeding index, probing depth (PD), relative vertical attachment level (RVAL) and relative horizontal attachment level (RHAL), and intrabony defect depth were recorded at baseline and 9 months postoperatively. Radiographically, defect fill, assessed in percentage, was evaluated at baseline, before surgery, and 9 months post-therapy. RESULTS Group 3 showed greater PD reduction and RVAL and RHAL gain when compared with groups 1 and 2 postoperatively. Moreover, group 3 sites showed a significantly greater percentage of radiographic defect fill (56.01% ± 2.64%) when compared with group 2 (49.43% ± 3.70%) and group 1 (10.25% ± 3.66%) at 9 months. CONCLUSIONS Furcation defect treatment with autologous PRF combined with 1% ALN gel results in significant therapeutic outcomes when compared with PRF and access therapy alone. Combining ALN with PRF has potential for regeneration of furcation defects without any adverse effect on healing process.
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Affiliation(s)
- Dharmendra Kanoriya
- Department of Periodontology, Government Dental College and Research Institute (GDCRI), Bangalore, Karnataka, India
| | - A R Pradeep
- Department of Periodontology, Government Dental College and Research Institute (GDCRI), Bangalore, Karnataka, India
| | - Vibhuti Garg
- Department of Periodontology, Government Dental College and Research Institute (GDCRI), Bangalore, Karnataka, India
| | - Sandeep Singhal
- Department of Periodontology, Government Dental College and Research Institute (GDCRI), Bangalore, Karnataka, India
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11
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Avila-Ortiz G, De Buitrago JG, Reddy MS. Periodontal regeneration - furcation defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2016; 86:S108-30. [PMID: 25644295 DOI: 10.1902/jop.2015.130677] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this review is to present the available evidence regarding the effectiveness of different regenerative approaches for the treatment of furcation defects in specific clinical scenarios compared with conventional surgical therapy to provide clinical guidelines for the therapeutic management of furcation defects and to identify priorities for future research that may advance the understanding of periodontal regenerative medicine. METHODS A comprehensive search based on predetermined eligibility criteria was conducted to identify human original studies and systematic reviews on the topic of periodontal regeneration of furcation defects. Two reviewers independently screened the title and abstract of the entries yielded from the initial search. Subsequently, both reviewers read the full-text version of potentially eligible studies, made a final article selection, and extracted the data of the selected studies considering specific clinical scenarios. The clinical scenarios contemplated in this review included the following: 1) facial and interproximal Class I defects in maxillary molars; 2) facial and lingual Class I defects in mandibular molars; 3) facial and interproximal Class II furcation defects in maxillary molars; 4) facial and lingual Class II furcation defects in mandibular molars; 5) Class III furcation defects in maxillary molars; 6) Class III furcation defects in mandibular molars; and 7) Class I, II, or III furcation defects in maxillary premolars. Endpoints of interest included different clinical, radiographic, microbiologic, histologic, and patient-reported outcomes. RESULTS The initial search yielded a total of 1,500 entries. The final selection consisted of 150 articles, of which six were systematic reviews, 109 were clinical trials, 27 were case series, and eight were case reports. A summary of the main findings of previously published systematic reviews and the available evidence relative to the indication of regenerative approaches for the treatment of furcation defects compared with conventional surgical therapy are presented. Given the marked methodologic heterogeneity and the wide variety of materials and techniques applied in the selected clinical trials, the conduction of a meta-analysis was not viable. CONCLUSIONS On the basis of the reviewed evidence, the following conclusions can be drawn. 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial or interproximal and mandibular facial or lingual Class II furcation defects. 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the evidence is limited to one case report. 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in maxillary molars is limited to clinical case reports. 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy. 5) Future research efforts should be primarily directed toward the conduction of clinical trials to test novel regenerative approaches that place emphasis primarily on patient-reported outcomes and also on histologic demonstration of periodontal regeneration. Investigators should also focus on understanding the influence that local, systemic, and technical factors may have on the outcomes of regenerative therapy in furcation defects.
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Abstract
Periodontal regeneration-treatment that results in new alveolar bone, cementum, and a functional periodontal ligament-is successful in class II furcation defects. This article examines one aspect of periodontal regeneration-alveolar bone growth in furcation defects-in trying to answer the question, Can bone lost from furcations be regenerated? The best evidence for bone growth is histology but there is limited histologic evidence for bone growth in human furcation defects. There is more evidence from intraoperative measurements for hard tissue growth in treated furcation defects, but the nature of the hard tissue needs to be determined histologically.
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Affiliation(s)
- Joseph J Zambon
- Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, The State University of New York, 3435 Main Street, Buffalo, NY 14214, USA.
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13
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Liu J, Kerns DG. Mechanisms of guided bone regeneration: a review. Open Dent J 2014; 8:56-65. [PMID: 24894890 PMCID: PMC4040931 DOI: 10.2174/1874210601408010056] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 01/05/2014] [Accepted: 02/12/2014] [Indexed: 01/25/2023] Open
Abstract
Post-extraction crestal bone resorption is common and unavoidable which can lead to significant ridge dimensional changes. To regenerate enough bone for successful implant placement, Guided Bone Regeneration (GBR) is often required. GBR is a surgical procedure that uses barrier membranes with or without particulate bone grafts or/and bone substitutes. There are two approaches of GBR in implant therapy: GBR at implant placement (simultaneous approach) and GBR before implant placement to increase the alveolar ridge or improve ridge morphology (staged approach). Angiogenesis and ample blood supply play a critical role in promoting bone regeneration.
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Affiliation(s)
- Jie Liu
- Department of Periodontics, Baylor College of Dentistry, Texas A&M University, Dallas, TX
| | - David G Kerns
- Department of Periodontics, Baylor College of Dentistry, Texas A&M University, Dallas, TX
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14
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Chen TH, Tu YK, Yen CC, Lu HK. A systematic review and meta-analysis of guided tissue regeneration/osseous grafting for the treatment of Class II furcation defects. J Dent Sci 2013. [DOI: 10.1016/j.jds.2013.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Carbonell JM, Martín IS, Santos A, Pujol A, Sanz-Moliner JD, Nart J. High-density polytetrafluoroethylene membranes in guided bone and tissue regeneration procedures: a literature review. Int J Oral Maxillofac Surg 2013; 43:75-84. [PMID: 23810680 DOI: 10.1016/j.ijom.2013.05.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 05/19/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
Abstract
Expanded polytetrafluoroethylene (e-PTFE) has been used successfully as a membrane barrier for regeneration procedures. However, when exposed to the oral cavity, its high porosity increases the risk of early infection, which can affect surgical outcomes. An alternative to e-PTFE is non-expanded and dense polytetrafluoroethylene (n-PFTE), which results in lower levels of early infection following surgical procedures. The aim of this literature review was to analyze and describe the available literature on n-PFTE, report the indications for use, advantages, disadvantages, surgical protocols, and complications. The medical databases Medline-PubMed and Cochrane Library were searched and supplemented with a hand search for reports published between 1980 and May 2012 on n-PTFE membranes. The search strategy was limited to animal, human, and in vitro studies in dental journals published in English. Twenty-four articles that analyzed the use of n-PTFE as a barrier membrane for guided tissue regeneration and guided bone regeneration around teeth and implants were identified: two in vitro studies, seven experimental studies, and 15 clinical studies. There is limited clinical and histological evidence for the use of n-PTFE membranes at present, with some indications in guided tissue regeneration and guided bone regeneration in immediate implants and fresh extraction sockets.
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Affiliation(s)
- J M Carbonell
- Department of Periodontology, Universitat Internacional de Catalunya, Spain
| | - I Sanz Martín
- Department of Periodontology, Universitat Internacional de Catalunya, Spain
| | - A Santos
- Department of Periodontology, Universitat Internacional de Catalunya, Spain
| | - A Pujol
- Department of Periodontology, Universitat Internacional de Catalunya, Spain
| | - J D Sanz-Moliner
- Department of Periodontology, Universitat Internacional de Catalunya, Spain
| | - J Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Spain.
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16
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Ronda M, Rebaudi A, Torelli L, Stacchi C. Expanded vs. dense polytetrafluoroethylene membranes in vertical ridge augmentation around dental implants: a prospective randomized controlled clinical trial. Clin Oral Implants Res 2013; 25:859-66. [DOI: 10.1111/clr.12157] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Lucio Torelli
- Department of Mathematics and Informatics; University of Trieste; Trieste Italy
| | - Claudio Stacchi
- Department of Medical, Surgical and Health Sciences; University of Trieste; Trieste Italy
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17
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Prathap S, Hegde S, Kashyap R, Prathap MS, Arunkumar MS. Clinical evaluation of porous hydroxyapatite bone graft (Periobone G) with and without collagen membrane (Periocol) in the treatment of bilateral grade II furcation defects in mandibular first permanent molars. J Indian Soc Periodontol 2013; 17:228-34. [PMID: 23869132 PMCID: PMC3713757 DOI: 10.4103/0972-124x.113083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 01/24/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Furcation invasions represent one of the most demanding therapeutic challenges in periodontics. This investigation assessed and compared the clinical efficacy of hydroxyapatite bone graft material when used alone and with collagen membrane in the treatment of grade II furcation defects. MATERIALS AND METHODS Ten patients with comparable bilateral furcation defects in relation to mandibular first molars were selected and treated in a split-mouth design. After the hygiene phase of therapy was completed, the groups were selected randomly either for treatment with hydroxyapatite bone graft (Periobone G) alone or with a combination of bone graft and guided tissue regeneration (GTR) membrane (Periocol). Clinical parameters like plaque index, gingival index, vertical probing depth, horizontal probing depth, clinical attachment level, position of marginal gingiva, and the amount of bone fill were used at baseline and at 3 and 6 months postoperatively. RESULTS At 6 months, both surgical procedures resulted in statistically significant reduction in vertical and horizontal probing depths and gain in the clinical attachment level. CONCLUSION The use of combination technique yielded superior results compared to sites treated with bone graft alone. However, the difference was not statistically significant.
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Affiliation(s)
- Sruthy Prathap
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
| | - Shashikanth Hegde
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
| | - Rajesh Kashyap
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
| | - M. S. Prathap
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
| | - M. S. Arunkumar
- Department of Periodontics, Yenepoya Dental College, Mangalore, Karnataka, India
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18
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Bajaj P, Pradeep AR, Agarwal E, Rao NS, Naik SB, Priyanka N, Kalra N. Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of mandibular degree II furcation defects: a randomized controlled clinical trial. J Periodontal Res 2013; 48:573-81. [PMID: 23317096 DOI: 10.1111/jre.12040] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND The treatment of molar furcation defects remains a considerable challenge in clinical practice. The identification of clinical measurements influential to treatment outcomes is critical to optimize the results of surgical periodontal therapy. The present study aimed to explore the clinical and radiographical effectiveness of autologous platelet-rich fibrin (PRF) and autologous platelet-rich plasma (PRP) in the treatment of mandibular degree II furcation defects in subjects with chronic periodontitis. MATERIAL AND METHODS Seventy-two mandibular degree II furcation defects were treated with either autologous PRF with open flap debridement (OFD; 24 defects) or autologous PRP with OFD (25), or OFD alone (23). Clinical and radiological parameters such as probing depth, relative vertical clinical attachment level and horizontal clinical attachment level along with gingival marginal level were recorded at baseline and 9 mo postoperatively. RESULTS All clinical and radiographic parameters showed statistically significant improvement at both the test sites (PRF with OFD and PRP with OFD) compared to those with OFD alone. Relative vertical clinical attachment level gain was also greater in PRF (2.87 ± 0.85 mm) and PRP (2.71 ± 1.04 mm) sites as compared to control site (1.37 ± 0.58 mm), and relative horizontal clinical attachment level gain was statistically significantly greater in both PRF and PRP than in the control group. CONCLUSIONS The use of autologous PRF or PRP were both effective in the treatment of furcation defects with uneventful healing of sites.
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Affiliation(s)
- Pavan Bajaj
- Department of Periodontics, Government Dental College & Research Institute, Bangalore, India
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19
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Kinaia BM, Steiger J, Neely AL, Shah M, Bhola M. Treatment of Class II Molar Furcation Involvement: Meta-Analyses of Reentry Results. J Periodontol 2011; 82:413-28. [DOI: 10.1902/jop.2010.100306] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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20
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Sharma A, Pradeep AR. Autologous platelet-rich fibrin in the treatment of mandibular degree II furcation defects: a randomized clinical trial. J Periodontol 2011; 82:1396-403. [PMID: 21284545 DOI: 10.1902/jop.2011.100731] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Platelet-rich fibrin (PRF), an intimate assembly of cytokines, glycan chains, and structural glycoproteins enmeshed within a slowly polymerized fibrin network, has the potential to accelerate soft and hard tissue healing. This double-masked randomized study is designed to evaluate the effectiveness of autologous PRF in the treatment of mandibular degree II furcation defects compared with open flap debridement (OFD). METHODS Using a split-mouth design, 18 patients with 36 mandibular degree II furcation defects were randomly allotted and treated either with autologous PRF and OFD or OFD. Plaque index, sulcus bleeding index, probing depth, relative vertical and horizontal clinical attachment level, gingival marginal level, and radiographic bone defect were recorded at baseline and 9 months postoperatively. Comparison between indices between the test and control groups was performed using the paired t test except for plaque index and sulcus bleeding index data, which used the χ(2) test. RESULTS All clinical and radiographic parameters showed statistically significant improvement at the sites treated with PRF and OFD compared to those with OFD alone. CONCLUSION Within the limitation of this study, significant improvement with autologous PRF implies its role as a regenerative material in the treatment of furcation defects.
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Affiliation(s)
- Anuj Sharma
- Department of Periodontics, Government Dental College and Research Institute, Bangalore, Karnataka, India
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21
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Hanes PJ. Bone replacement grafts for the treatment of periodontal intrabony defects. Oral Maxillofac Surg Clin North Am 2008; 19:499-512, vi. [PMID: 18088901 DOI: 10.1016/j.coms.2007.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bone replacement grafts, including autogenous grafts from intraoral donor sites, allografts, xenografts, and alloplastic bone substitutes, are the most widely used treatment modalities for the regeneration of periodontal osseous defects. Studies suggest a favorable clinical outcome with the use of these materials in terms of improvements in periodontal probing depths, probing attachment gains, and bone fill. In terms of bone fill, most studies report more than 50% resolution of intrabony defects when treated with bone replacement grafts. However, histologic evidence of periodontal regeneration, including new bone, periodontal ligament, and cementum, has been reported only for autogenous bone grafts and demineralized freeze-dried bone allografts.
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Affiliation(s)
- Philip J Hanes
- Department of Periodontics, Medical College of Georgia, School of Dentistry, 1459 Laney Walker Boulevard, Augusta, GA 30912-1220, USA.
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22
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Norian craniofacial repair system: compatibility with resorbable and nonresorbable plating materials. Plast Reconstr Surg 2007; 120:1487-1495. [PMID: 18040178 DOI: 10.1097/01.prs.0000282034.07517.cc] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Choice of bone replacement materials is important when reconstructing large craniofacial defects. Hydroxyapatite cements are often used for such reconstructions. Recent advances in the development of these cements have produced locally applied, in situ hardening materials excellent for use in craniofacial defects. To date, there has been a paucity of data comparing the use of calcium phosphate cements in combination with titanium or resorbable plating systems and their combined biocompatibility. An experimental dog model was used to compare these systems. METHODS Two 4 x 4-cm calvarial defects were created in each of 18 mongrel dogs, and defects were reconstructed with calcium phosphate cement with either titanium or resorbable mesh sheets to evaluate their interaction. Specimens were harvested and evaluated histologically for the development of new bone formation at 3, 6, and 12 months. RESULTS At 3 months, no differences were noted in the amount of bone formed between titanium and resorbable plating. By 6 months, the resorbable mesh sheet showed delayed bone formation compared with the titanium mesh. At 12 months, bone formation over the resorbable mesh accelerated to be no different from the titanium mesh. Importantly, new bone formation was seen within the monocalcium phosphate cement Norian Craniofacial Repair System on a reliable basis, regardless of mesh plate used. CONCLUSIONS There are no long-term adverse effects with the use of Norian cement with either titanium or resorbable mesh. However, further studies need to be conducted to determine why there is an arrested healing phase between 3 and 6 months with the Norian cement and resorbable plating materials.
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