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Tavelli L, Chen CYJ, Barootchi S, Kim DM. Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta-analysis. J Periodontol 2022; 93:1803-1826. [PMID: 36279121 DOI: 10.1002/jper.22-0120] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects. METHODS A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration. RESULTS A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p < 0.05 in all the comparisons), while rhPDGF-BB and PRF demonstrated significantly higher stability of the gingival margin (p < 0.01) and radiographic bone fill/gain (p < 0.05), together with greater, although not statistically significant, clinical attachment level gain and pocket depth reduction, than EMD and PRP. Overall, rhPDGF-BB exhibited the largest effect size for most parameters, including clinical attachment level gain, pocket depth reduction, less gingival recession and radiographic linear bone gain. Considering the relatively high number of trials presenting an unclear or high risk of bias, the strength of recommendation supporting the use of PRP was judged weak, while the recommendation for EMD, PRF and rhPDGF-BB was deemed in favor. CONCLUSIONS Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Chia-Yu Jennifer Chen
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - David M Kim
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Pal PC, Bali A, Boyapati R, Show S, Tejaswi KS, Khandelwal S. Regenerative potential of biphasic calcium phosphate and enamel matrix derivatives in the treatment of isolated interproximal intrabony defects: a randomized controlled trial. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2022; 39:322-331. [PMID: 36050839 PMCID: PMC9580055 DOI: 10.12701/jyms.2022.00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
Background The combined use of biomaterials for regeneration may have great biological relevance. This study aimed to compare the regenerative potential of biphasic calcium phosphate (BCP) alone and with growth factor enamel matrix derivatives (EMDs) for the regeneration of intrabony defects at 1 year. Methods This randomized controlled trial included 40 sites in 29 patients with stage II/III periodontitis and 2/3 wall intrabony defects that were treated with BCP alone (control group) or a combination of BCP and EMD (test group). BCP alloplastic bone grafts provide better bio-absorbability and accelerate bone formation. EMDs are commercially available amelogenins. Mean values and standard deviations were calculated for the following parameters: plaque index (PI), papillary bleeding index (PBI), vertical probing pocket depth (V-PPD), vertical clinical attachment level (V-CAL), and radiographic defect depth (RDD). Student paired and unpaired t-tests were used to compare the data from baseline to 12 months for each group and between the groups, respectively. The results were considered statistically significant at p<0.05. Results At 12 months, the PI and PBI scores of the control and test groups were not significantly different (p>0.05). The mean V-PPD difference, V-CAL gain, and RDD difference were statistically significant in both groups at 12 months (p<0.001 for all parameters). Intergroup comparisons showed that the mean V-PPD reduction (2.13±1.35 mm), V-CAL gain (2.53±1.2 mm), and RDD fill (1.33±1.0 mm) were statistically significant between the groups at 12 months (p<0.001 for all parameters). Conclusion BCP and EMDs combination is a promising modality for the regeneration of intrabony defects.
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Affiliation(s)
- Pritish Chandra Pal
- Department of Periodontology, Pacific Dental College and Hospital, PAHER University, Udaipur, India
- Corresponding author: Pritish Chandra Pal, MDS Department of Periodontology, Pacific Dental College and Hospital, staff quarter, Room 34A, College Campus, Airport Road, Debari, Udaipur 313024, Rajasthan, India Tel: +91-33-24352638 • E-mail:
| | - Ashish Bali
- Department of Periodontology, Pacific Dental College and Hospital, PAHER University, Udaipur, India
| | - Ramanarayana Boyapati
- Department of Periodontology, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, India
| | - Sangita Show
- Department of Periodontology, DR. R Ahmed Dental College and Hospital, Kolkata, India
| | - Kanikanti Siva Tejaswi
- Department of Periodontology, Sibar Institute of Dental Sciences, Takkellapadu, Guntur, India
| | - Sourabh Khandelwal
- Department of Prosthodontics and Crown & Bridge, Index Institute of Dental Sciences, Indore, India
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Nibali L, Koidou VP, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intra‐bony periodontal defects: A systematic review and meta‐analysis. J Clin Periodontol 2020; 47 Suppl 22:320-351. [DOI: 10.1111/jcpe.13237] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Luigi Nibali
- Periodontology Unit Faculty of Dentistry, Oral & Craniofacial Sciences Centre for Host‐Microbiome Interactions King's College London London UK
| | - Vasiliki P. Koidou
- Centre for Oral Immunobiology and Regenerative Medicine and Centre for Oral Clinical Research Institute of Dentistry Queen Mary University London (QMUL) London UK
| | - Michele Nieri
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Umberto Pagliaro
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine Department of Clinical and Experimental Medicine University of Florence Florence Italy
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Xu Y, Qiu J, Sun Q, Yan S, Wang W, Yang P, Song A. One-Year Results Evaluating the Effects of Concentrated Growth Factors on the Healing of Intrabony Defects Treated with or without Bone Substitute in Chronic Periodontitis. Med Sci Monit 2019; 25:4384-4389. [PMID: 31188801 PMCID: PMC6585537 DOI: 10.12659/msm.917025] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The restoration of damaged periodontium, especially one-wall intrabony defects, is a major challenge for clinicians. Concentrated growth factors (CGF) are a 100% autologous fibrin with multiple concentrated growth factors. The rigid fibrin structure of CGF makes it possible to preserve or reconstruct the initial bone volume. The aim of this study was to evaluate the clinical healing patterns after surgical application of CGF with and without a Bio-Oss graft in one-wall infrabony defects. Material/Methods We randomly divided 120 one-wall intrabony defects in 54 patients into 4 groups: flap surgery alone (Group 1), flap surgery with autologous CGF (Group 2), flap surgery with Bio-Oss (Group 3), and flap surgery with CGF+Bio-Oss (Group 4). Clinical parameters such as probing depth (PD) and clinical attachment level (CAL) change were recorded at baseline and at 6 and 12 months postoperatively. Results At 12 months postoperatively, Group 2 showed significant improvement in clinical parameters over Group 1 (P<0.05) and the results were significantly greater in Groups 3 and 4 compared to the other groups (P<0.05). Although no significant difference was noted between Groups 3 and 4 in clinical parameters (P>0.05) compared to Group 3, the mean change of CAL at 6–12 months in Group 4 was not significant (P>0.05). Conclusions CGF reduced periodontal intrabony defects depth and, when mixed with Bio-Oss, CGF showed better results in the early period and the effect was more stable.
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Affiliation(s)
- Yan Xu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, Shandong, China (mainland).,Jinan Stomatological Hospital, Jinan, Shandong, China (mainland)
| | - Jiling Qiu
- Department of Periodontology, School of Stomatology, Shandong University, Jinan, Shandong, China (mainland)
| | - Qinfeng Sun
- Department of Periodontology, School of Stomatology, Shandong University, Jinan, Shandong, China (mainland)
| | - Shiguo Yan
- Department of Periodontology, School of Stomatology, Shandong University, Jinan, Shandong, China (mainland)
| | - Wenxia Wang
- Department of Periodontology, School of Stomatology, Shandong University, Jinan, Shandong, China (mainland)
| | - Pishan Yang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, Shandong, China (mainland).,Department of Periodontology, School of Stomatology, Shandong University, Jinan, Shandong, China (mainland)
| | - Aimei Song
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, Shandong, China (mainland).,Department of Periodontology, School of Stomatology, Shandong University, Jinan, Shandong, China (mainland)
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Ku JK, Hong I, Lee BK, Yun PY, Lee JK. Dental alloplastic bone substitutes currently available in Korea. J Korean Assoc Oral Maxillofac Surg 2019; 45:51-67. [PMID: 31106133 PMCID: PMC6502751 DOI: 10.5125/jkaoms.2019.45.2.51] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 12/24/2022] Open
Abstract
As dental implant surgery and bone grafts were widely operated in Korean dentist, many bone substitutes are commercially available, currently. For commercially used in Korea, all bone substitutes are firstly evaluated by the Ministry of Health and Welfare (MOHW) for safety and efficacy of the product. After being priced, classified, and registration by the Health Insurance Review and Assessment Service (HIRA), the post-application management is obligatory for the manufacturer (or representative importer) to receive a certificate of Good Manufacturing Practice by Ministry of Food and Drug Safety. Currently, bone substitutes are broadly classified into C group (bone union and fracture fixation), T group (human tissue), L group (general and dental material) and non-insurance material group in MOHW notification No. 2018-248. Among them, bone substitutes classified as dental materials (L7) are divided as xenograft and alloplastic bone graft. The purpose of this paper is to analyze alloplastic bone substitutes of 37 products in MOHW notification No. 2018-248 and to evaluate the reference level based on the ISI Web of Knowledge, PubMed, EMBASE (1980–2019), Cochrane Database, and Google Scholar using the criteria of registered or trademarked product name.
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Affiliation(s)
- Jeong-Kui Ku
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea.,Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Hospital, Seongnam, Korea
| | - Inseok Hong
- Department of Oral and Maxillofacial Surgery, School of Dentistry and Institute of Oral Bioscience, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University, Jeonju, Korea
| | - Bu-Kyu Lee
- Department of Oral and Maxillofacial Surgery, Asan Medical Center, Seoul, Korea
| | - Pil-Young Yun
- Department of Oral and Maxillofacial Surgery, Section of Dentistry, Armed Forces Capital Hospital, Seongnam, Korea
| | - Jeong Keun Lee
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea
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Hoffmann T, Al-Machot E, Meyle J, Jervøe-Storm PM, Jepsen S. Three-year results following regenerative periodontal surgery of advanced intrabony defects with enamel matrix derivative alone or combined with a synthetic bone graft. Clin Oral Investig 2015; 20:357-64. [DOI: 10.1007/s00784-015-1522-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 06/30/2015] [Indexed: 01/08/2023]
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Artzi Z, Tal H, Platner O, Wasersprung N, Weinberg E, Slutzkey S, Gozali N, Carmeli G, Herzberg R, Kozlovsky A. Deproteinized bovine bone in association with guided tissue regeneration or enamel matrix derivatives procedures in aggressive periodontitis patients: a 1-year retrospective study. J Clin Periodontol 2015; 42:547-56. [DOI: 10.1111/jcpe.12413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Zvi Artzi
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Haim Tal
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Ori Platner
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Nadav Wasersprung
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Evgeny Weinberg
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Shimshon Slutzkey
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
| | - Nir Gozali
- Currently in Private Practice; Herzliya Israel
| | | | | | - Avital Kozlovsky
- Department of Periodontology and Oral Implants; Tel Aviv University; Tel Aviv Israel
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An S, Gao Y, Huang X, Ling J, Liu Z, Xiao Y. A comparative study of the proliferation and osteogenic differentiation of human periodontal ligament cells cultured on β-TCP ceramics and demineralized bone matrix with or without osteogenic inducers in vitro. Int J Mol Med 2015; 35:1341-6. [PMID: 25738431 DOI: 10.3892/ijmm.2015.2122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 02/27/2015] [Indexed: 11/06/2022] Open
Abstract
The repair of bone defects that result from periodontal diseases remains a clinical challenge for periodontal therapy. β-tricalcium phosphate (β-TCP) ceramics are biodegradable inorganic bone substitutes with inorganic components that are similar to those of bone. Demineralized bone matrix (DBM) is an acid-extracted organic matrix derived from bone sources that consists of the collagen and matrix proteins of bone. A few studies have documented the effects of DBM on the proliferation and osteogenic differentiation of human periodontal ligament cells (hPDLCs). The aim of the present study was to investigate the effects of inorganic and organic elements of bone on the proliferation and osteogenic differentiation of hPDLCs using three-dimensional porous β-TCP ceramics and DBM with or without osteogenic inducers. Primary hPDLCs were isolated from human periodontal ligaments. The proliferation of the hPDLCs on the scaffolds in the growth culture medium was examined using a Cell-Counting kit-8 (CCK-8) and scanning electron microscopy (SEM). Alkaline phosphatase (ALP) activity and the osteogenic differentiation of the hPDLCs cultured on the β-TCP ceramics and DBM were examined in both the growth culture medium and osteogenic culture medium. Specific osteogenic differentiation markers were examined using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). SEM images revealed that the cells on the β-TCP were spindle-shaped and much more spread out compared with the cells on the DBM surfaces. There were no significant differences observed in cell proliferation between the β-TCP ceramics and the DBM scaffolds. Compared with the cells that were cultured on β-TCP ceramics, the ALP activity, as well as the Runx2 and osteocalcin (OCN) mRNA levels in the hPDLCs cultured on DBM were significantly enhanced both in the growth culture medium and the osteogenic culture medium. The organic elements of bone may exhibit greater osteogenic differentiation effects on hPDLCs than the inorganic elements.
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Affiliation(s)
- Shaofeng An
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
| | - Yan Gao
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
| | - Xiangya Huang
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
| | - Junqi Ling
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
| | - Zhaohui Liu
- Department of Operative Dentistry and Endodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, P.R. China
| | - Yin Xiao
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD 4059, Australia
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Kaushal S, Kapoor A, Singh P, Kochhar G, Khuller N, Basavaraj P. Evaluation of OSSIFI® as Alloplastic Bone Graft Material in Treatment of Periodontal Infrabony Defects. J Clin Diagn Res 2014; 8:ZC61-5. [PMID: 25478450 DOI: 10.7860/jcdr/2014/8501.5043] [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] [Received: 01/16/2014] [Accepted: 06/20/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The shift in therapeutic concepts from resection to regeneration has significantly impacted the practice of periodontology. Human studies have revealed that hydroxyapatite bone cement holds great promise as a grafting alloplastic material. AIMS AND OBJECTIVES To evaluate the efficacy of OSSIFI(®) (combined beta tricalcium phosphate plus hydroxyapatite) in the treatment of periodontal infrabony defects. MATERIALS AND METHODS Ten study subjects were selected and divided into two groups. Group I (PD>7mm) and Group II (PD≤ 7mm). Both Groups I and II were treated by regenerative periodontal surgery using OSSIFI(®) as graft material. Plaque index, gingival index, pocket depth, clinical attachment levels were recorded clinically and bone fill, radiographically, at baseline, three months and six months. RESULTS AND CONCLUSION Statistically significant reduction in pocket depth, plaque index, gingival index was seen after six months. There was significant bone fill seen from 3-6months with significant gain in clinical attachment levels.
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Affiliation(s)
- Sumit Kaushal
- Assistant Professor, Department of Periodontology, SDD Hospital & Dental College , Barwala, India
| | - Anoop Kapoor
- Professsor, Department of Periodontology, DAV Dental College Solan, India
| | - Preetinder Singh
- Associate Professor, Department of Periodontology, SDD Hospital & Dental College , Barwala, India
| | - Gulsheen Kochhar
- Assistant Professor, Department of Periodontology, SDD Hospital & Dental College , Barwala, India
| | - Nitin Khuller
- Associate Professor, Department of Periodontology, SDD Hospital & Dental College , Barwala, India
| | - Patthi Basavaraj
- Professor and Head, Department of Public Health Dentistry, D.J College of Dental Sciences & Research , Modinagar, India
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Kao RT, Nares S, Reynolds MA. Periodontal regeneration - intrabony defects: a systematic review from the AAP Regeneration Workshop. J Periodontol 2014; 86:S77-104. [PMID: 25216204 DOI: 10.1902/jop.2015.130685] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous systematic reviews of periodontal regeneration with bone replacement grafts and guided tissue regeneration (GTR) were defined as state of the art for clinical periodontal regeneration as of 2002. METHODS The purpose of this systematic review is to update those consensus reports by reviewing periodontal regeneration approaches developed for the correction of intrabony defects with the focus on patient-, tooth-, and site-centered factors, surgical approaches, surgical determinants, and biologics. This review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews. A computerized search of the PubMed and Cochrane databases was performed to evaluate the clinically available regenerative approaches for intrabony defects. The search included screening of original reports, review articles, and reference lists of retrieved articles and hand searches of selected journals. All searches were focused on clinically available regenerative approaches with histologic evidence of periodontal regeneration in humans published in English. For topics in which the literature is lacking, non-randomized observational and experimental animal model studies were used. Therapeutic endpoints examined included changes in clinical attachment level, changes in bone level/fill, and probing depth. For purposes of analysis, change in bone fill was used as the primary outcome measure, except in cases in which this information was not available. The SORT (Strength of Recommendation Taxonomy) grading scale was used in evaluating the body of knowledge. RESULTS 1) Fifty-eight studies provided data on patient, tooth, and surgical-site considerations in the treatment of intrabony defects. 2) Forty-five controlled studies provided outcome analysis on the use of biologics for the treatment of intrabony defects. CONCLUSIONS 1) Biologics (enamel matrix derivative and recombinant human platelet-derived growth factor-BB plus β-tricalcium phosphate) are generally comparable with demineralized freeze-dried bone allograft and GTR and superior to open flap debridement procedures in improving clinical parameters in the treatment of intrabony defects. 2) Histologic evidence of regeneration has been demonstrated with laser therapy; however, data are limited on clinical predictability and effectiveness. 3) Clinical outcomes appear most appreciably influenced by patient behaviors and surgical approach rather than by tooth and defect characteristics. 4) Long-term studies indicate that improvements in clinical parameters are maintainable up to 10 years, even in severely compromised teeth, consistent with a favorable/good long-term prognosis.
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Clinical outcomes after treatment of periodontal intrabony defects with nanocrystalline hydroxyapatite (Ostim) or enamel matrix derivatives (Emdogain): a randomized controlled clinical trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:786353. [PMID: 24689056 PMCID: PMC3932837 DOI: 10.1155/2014/786353] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/05/2013] [Accepted: 12/25/2013] [Indexed: 12/04/2022]
Abstract
Introduction. Periodontitis is an inflammatory process in response to dental biofilm and leads to periodontal tissue destruction. The aim of this study was the comparison of outcomes using either an enamel matrix derivative (EMD) or a nanocrystalline hydroxyapatite (NHA) in regenerative periodontal therapy after 6 and 12 months. Methods. Using a parallel group, prospective randomized study design, we enrolled 19 patients in each group. The primary outcome was bone fill after 12 months. Attachment gain, probing pocket depth (PPD) reduction, and recession were secondary variables. Additionally, early wound healing and adverse events were assessed. Data analysis included test of noninferiority of NHA group (test) compared to EMD group (reference) in bone fill. Differences in means of secondary variables were compared by paired t-test, frequency data by exact χ2 test. Results. Both groups showed significant bone fill, reduction of PPD, increase in recession, and gain of attachment after 6 and 12 months. No significant differences between groups were found at any time point. Adverse events were comparable between both groups with a tendency of more complaints in the NHA group. Conclusion. The clinical outcomes were similar in both groups. EMD could have some advantage compared to NHA regarding patients comfort and adverse events. The trial is registered with ClinicalTrials.gov NCT00757159.
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De Leonardis D, Paolantonio M. Enamel Matrix Derivative, Alone or Associated With a Synthetic Bone Substitute, in the Treatment of 1- to 2-Wall Periodontal Defects. J Periodontol 2013; 84:444-55. [DOI: 10.1902/jop.2012.110656] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee MJ, Kim BO, Yu SJ. Clinical evaluation of a biphasic calcium phosphate grafting material in the treatment of human periodontal intrabony defects. J Periodontal Implant Sci 2012; 42:127-35. [PMID: 22977742 PMCID: PMC3439524 DOI: 10.5051/jpis.2012.42.4.127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/03/2012] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to compare the clinical outcome of open flap debridement (OFD) with a biphasic calcium phosphate (BCP) graft to that of OFD without BCP graft for the treatment of intrabony periodontal defects (IBDs). Methods The study included 25 subjects that had at least one intrabony defect of 2- or 3-wall morphology and an intrabony component≥4 mm as detected radiographically. Subjects were randomly assigned to treatment with (BCP group, n=14) or without BCP (OFD group, n=11). Clinical parameters were recorded at baseline and 6 months after surgery and included the plaque index, gingival index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). A stringent plaque control regimen was enforced for all of the patients during the 6-month observation period. Results In all of the treatment groups, significant PD reductions and CAL gains occurred during the study period (P<0.01). At 6 months, patients in the BCP group exhibited a mean PD reduction of 3.7±1.2 mm and a mean CAL gain of 3.0±1.1 mm compared to the baseline. Corresponding values for the patients treated with OFD were 2.5±0.8 mm and 1.4±1.0 mm, respectively. Compared to OFD group, the additional CAL gain was significantly greater in the patients in BCP group (P=0.028). The additional PD reduction was significant for the BCP group (P=0.048). The REC showed a significant increase in both groups, and the amount of recession was significantly smaller in the BCP group than OFD group (P=0.023). In radiographic evaluation, the height of the bone fill in the BCP group was significantly greater than OFD group. Conclusions The clinical benefits of BCP found in this study indicate that BCP may be an appropriate alternative to conventional graft materials.
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Affiliation(s)
- Min-Jae Lee
- Department of Periodontology, Chosun University School of Dentistry, Gwangju, Korea
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Döri F, Arweiler NB, Szántó E, Agics A, Gera I, Sculean A. Ten-year results following treatment of intrabony defects with an enamel matrix protein derivative combined with either a natural bone mineral or a β-tricalcium phosphate. J Periodontol 2012; 84:749-57. [PMID: 22873657 DOI: 10.1902/jop.2012.120238] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or β-tricalcium phosphate (β-TCP). METHODS Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + β-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + β-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + β-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + β-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years. CONCLUSION Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + β-TCP can be maintained over a period of 10 years.
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Affiliation(s)
- Ferenc Döri
- Department of Periodontology, Semmelweis University, Budapest, Hungary
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Singhal R, Nandlal, Kumar A, Rastogi P. Role of space provision in regeneration of localized two-wall intrabony defects using periosteal pedicle graft as an autogenous guided tissue membrane. J Periodontol 2012; 84:316-24. [PMID: 22612365 DOI: 10.1902/jop.2012.110734] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Marginal pedicle periosteum (MPP) has been used as a rigid membrane in guided tissue regeneration (GTR) for osseous defects. The present study aims to study the effect of space provision by an alloplastic graft material in bone defect area (BDA) reduction of 2-wall defects. METHODS Twenty interproximal intrabony 2-wall defects in healthy non-smoking patients with chronic periodontitis were randomly divided in control (group 1, periosteum alone) and experimental (group 2, periosteum with alloplastic graft material) groups. Measurements of probing depth (PD), clinical attachment level (CAL), and radiographic BDA were done at the baseline and 6-month postoperative evaluations. RESULTS The 6-month postoperative assessment showed clinical and radiographic improvements with PD reduction, CAL gain, and changes in BDA in both groups, which was statistically significant compared with baseline (P <0.05). However, BDA reduction was statistically greater in group 2 (48.88% ± 18.61%) compared with group 1 (14.08% ± 12.97%) at the 6-month follow-up (P = 0.009). CONCLUSION Within the limitations of this study, it can be concluded that space provision by an alloplastic graft material increases the regenerative potential of MPP as a GTR membrane and results in increased defect fill.
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Affiliation(s)
- Rameshwari Singhal
- Department of Periodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, India.
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Birang R, Abouei MS, Razavi SM, Zia P, Soolari A. The effect of an enamel matrix derivative (Emdogain) combined with bone ceramic on bone formation in mandibular defects: a histomorphometric and immunohistochemical study in the canine. ScientificWorldJournal 2012; 2012:196791. [PMID: 22619627 PMCID: PMC3349124 DOI: 10.1100/2012/196791] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/16/2011] [Indexed: 11/24/2022] Open
Abstract
Background. The purpose of this study was to evaluate the combination of an enamel matrix derivative (EMD) and an osteoconductive bone ceramic (BC) in improving bone regeneration. Materials and Methods. Four cylindrical cavities (6 × 6 mm) were prepared bilaterally in the mandible in three dogs. The defects were randomly assigned to four different treatments—filled with EMD/BC and covered with a nonresorbable membrane, filled with EMD/BC without membrane, membrane coverage only, or control (left untreated)—and healed for 2, 4, or 6 weeks. Harvested specimens were prepared for histologic, histomorphometric, and immunohistochemical analyses. Results. Sites treated with EMD/BC with or without membrane showed more total bone formation and lamellar bone formation than membrane-only and control defects. There were no statistically significant differences in total bone formation between EMD/BC with or without membrane. Conclusion. EMD with BC might improve bone formation in osseous defects more than membrane coverage alone; the use of a membrane had no significant additive effect on total bone formation.
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Affiliation(s)
- Reza Birang
- Department of Periodontics, School of Dentistry and Torabinejad Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
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Meyle J, Hoffmann T, Topoll H, Heinz B, Al-Machot E, Jervøe-Storm PM, Meiß C, Eickholz P, Jepsen S. A multi-centre randomized controlled clinical trial on the treatment of intra-bony defects with enamel matrix derivatives/synthetic bone graft or enamel matrix derivatives alone: results after 12 months. J Clin Periodontol 2011; 38:652-60. [DOI: 10.1111/j.1600-051x.2011.01726.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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18
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Comparative study of DFDBA in combination with enamel matrix derivative versus DFDBA alone for treatment of periodontal intrabony defects at 12 months post-surgery. Clin Oral Investig 2010; 15:225-32. [DOI: 10.1007/s00784-009-0369-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Accepted: 11/19/2009] [Indexed: 10/20/2022]
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Tu YK, Woolston A, Faggion CM. Do bone grafts or barrier membranes provide additional treatment effects for infrabony lesions treated with enamel matrix derivatives? A network meta-analysis of randomized-controlled trials. J Clin Periodontol 2010; 37:59-79. [DOI: 10.1111/j.1600-051x.2009.01499.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Shayegan A, Petein M, Vanden Abbeele A. The use of beta-tricalcium phosphate, white MTA, white Portland cement and calcium hydroxide for direct pulp capping of primary pig teeth. Dent Traumatol 2009; 25:413-9. [DOI: 10.1111/j.1600-9657.2009.00799.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dőri F. Effect of combined therapeutical methods on healing of intrabony defects in regenerative periodontal surgery. Orv Hetil 2009; 150:517-22. [DOI: 10.1556/oh.2009.28500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Several methods are available to enhance the healing and regeneration of periodontal tissues after surgical therapy of intrabony defects. The main indications for the use of combined regenerative procedures are the extent and morphology of the osseous lesions. The six studies of the present dissertation focused on the clinical effect of different barrier techniques, bone substitutes, enamel matrix derivatives and a growth factors containing adjuvant used in various combinations on the healing of severe periodontal intrabony impairments. Synthetic, xenogenetic and autologous materials were used in these randomized clinical studies. Mechanical barriers (polytetrafluoroethylene and collagen membranes) for GTR, biological barriers/enamel matrix proteins (EMD), synthetic (β-TCP) and xenogeneic (NBM) bone grafts and autologous platelet-rich plasma (PRP) were combined in the test and control groups of the trials. The main clinical variable was the clinical attachment level (CAL) and the subsidiary one was the probing pocket depth (PPD), estimated at baseline and after one year. The summation of the results after the statistical analysis takes cognizance of the followings: a) Each of the eleven regenerative methods evaluated (ten combined procedures) leads to significant CAL gain and PPD decrease. b) Using β-TCP or NBM with EMD or with PRP + GTR and GTR’s, the difference between the parameters of the test and control groups were not statistically significant. c) It was confirmed in four studies that the addition of PRP to graft materials has not increased significantly the positive outcomes independent of the type of barrier or graft. d) Adding platelet-rich plasma to natural bone mineral, no benefit was observed from the point of view of the clinical variables. e) The polypeptide proteins of the platelet-rich plasma do not enhance the clinical regenerative effect of enamel matrix proteins. In conclusion, the option of the periodontal surgeons between these methods depends mainly on the defect morphology, the patient’s approach to the different types of materials, the medical concept of the physician, the technical possibilities and the clinical experience of the periodontist.
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Affiliation(s)
- Ferenc Dőri
- Semmelweis Egyetem Klinikai Orvostudományok Doktori Iskola Budapest Szentkirályi utca 47. 1088
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Abstract
There are many types of diseases associated with the oral cavity. As an adjunct to professional oral dental care, various drug delivery systems have been developed to improve the treatment or prevention of these diseases. In this manuscript, the current status of drug delivery strategies for these common orofacial diseases is reviewed. Biomineral-binding drug delivery and on-demand drug release are suggested to be considered in the future design of drug delivery systems for orofacial diseases. Apparently, this research field deserves much more attention from both pharmaceutical scientists and dental health professionals.
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Affiliation(s)
- Xin-Ming Liu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198-6025, USA
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Sculean A, Windisch P, Szendröi-Kiss D, Horváth A, Rosta P, Becker J, Gera I, Schwarz F. Clinical and Histologic Evaluation of an Enamel Matrix Derivative Combined With a Biphasic Calcium Phosphate for the Treatment of Human Intrabony Periodontal Defects. J Periodontol 2008; 79:1991-9. [DOI: 10.1902/jop.2008.080009] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Trombelli L, Farina R. Clinical outcomes with bioactive agents alone or in combination with grafting or guided tissue regeneration. J Clin Periodontol 2008; 35:117-35. [DOI: 10.1111/j.1600-051x.2008.01265.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Döri F, Huszár T, Nikolidakis D, Tihanyi D, Horváth A, Arweiler NB, Gera I, Sculean A. Effect of platelet-rich plasma on the healing of intrabony defects treated with Beta tricalcium phosphate and expanded polytetrafluoroethylene membranes. J Periodontol 2008; 79:660-9. [PMID: 18380559 DOI: 10.1902/jop.2008.070473] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Regenerative periodontal therapy using platelet-rich plasma (PRP) and different types of bone substitutes with or without guided tissue regeneration (GTR) has been proposed as a modality to enhance the outcome of regenerative surgery. However, there are limited data from controlled clinical studies evaluating the effect of PRP on the healing of deep intrabony defects treated with a combination of bone substitutes and GTR. The aim of this study was to clinically evaluate the effect of PRP on the healing of deep intrabony defects treated with beta tricalcium phosphate (beta-TCP) and GTR by means of a non-bioresorbable expanded polytetrafluoroethylene membrane. METHODS Twenty-eight subjects with advanced chronic periodontal disease and displaying one intrabony defect were treated randomly with a combination of PRP + beta-TCP + GTR or beta-TCP + GTR. Plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL) were evaluated at baseline and at 1 year after treatment. CAL was the primary outcome variable. RESULTS No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all subjects. At 1 year after therapy, the sites treated with PRP + beta-TCP + GTR showed a reduction in mean PD from 9.1 +/- 0.6 mm to 3.3 +/- 0.5 mm (P <0.001) and a change in mean CAL from 10.1 +/- 1.3 mm to 5.7 +/- 1.1 mm (P <0.001). In the group treated with beta-TCP + GTR, mean PD was reduced from 9.0 +/- 0.8 mm to 3.6 +/- 0.9 mm (P <0.001), and the mean CAL changed from 9.9 +/- 1.0 mm to 5.9 +/- 1.2 mm (P <0.001). In both groups, all sites gained > or =3 mm of CAL. CAL gains > or =4 mm were noted in 86% (12 of 14 defects) of the cases treated with PRP + beta-TCP + GTR and in 79% (11 of 14 defects) of those treated with beta-TCP + GTR. No statistically significant differences in any of the investigated parameters were observed between the two groups at the 1-year reevaluation. CONCLUSION At 1 year after surgery, both therapies resulted in significant PD reductions and CAL gains.
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Affiliation(s)
- Ferenc Döri
- Department of Periodontology, Semmelweis University, Budapest, Hungary
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Jepsen S, Topoll H, Rengers H, Heinz B, Teich M, Hoffmann T, Al-Machot E, Meyle J, Jervøe-Storm PM. Clinical outcomes after treatment of intra-bony defects with an EMD/synthetic bone graft or EMD alone: a multicentre randomized-controlled clinical trial. J Clin Periodontol 2008; 35:420-8. [DOI: 10.1111/j.1600-051x.2008.01217.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Shayegan A, Petein M, Abbeele AV. Beta-tricalcium phosphate, white mineral trioxide aggregate, white Portland cement, ferric sulfate, and formocresol used as pulpotomy agents in primary pig teeth. ACTA ACUST UNITED AC 2008; 105:536-42. [DOI: 10.1016/j.tripleo.2007.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 10/09/2007] [Accepted: 10/11/2007] [Indexed: 10/22/2022]
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28
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Zafiropoulos GGK, Hoffmann O, Kasaj A, Willershausen B, Weiss O, Van Dyke TE. Treatment of Intrabony Defects Using Guided Tissue Regeneration and Autogenous Spongiosa Alone or Combined With Hydroxyapatite/β-Tricalcium Phosphate Bone Substitute or Bovine-Derived Xenograft. J Periodontol 2007; 78:2216-25. [DOI: 10.1902/jop.2007.070146] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Shirakata Y, Yoshimoto T, Goto H, Yonamine Y, Kadomatsu H, Miyamoto M, Nakamura T, Hayashi C, Izumi Y. Favorable Periodontal Healing of 1-Wall Infrabony Defects After Application of Calcium Phosphate Cement Wall Alone or in Combination With Enamel Matrix Derivative: A Pilot Study With Canine Mandibles. J Periodontol 2007; 78:889-98. [PMID: 17470023 DOI: 10.1902/jop.2007.060353] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although various periodontal regenerative therapies are used, their effects on non-contained infrabony defects are unpredictable. Our previous studies showed that injectable, moldable, fast-setting calcium phosphate cement (CPC) promoted histocompatible periodontal healing in 3-wall intrabony defects. The present study evaluated healing patterns after surgical application of CPC walls with and without an enamel matrix derivative (EMD) in 1-wall infrabony defects in dogs. METHODS One-wall infrabony defects (5 x 5 x 4 mm) were created surgically on the mesial and distal sides of bilateral mandibular fourth premolars in four beagle dogs. After elevating a full-thickness flap, exposed root surfaces were planed thoroughly. The 16 defects were assigned randomly to one of the following experimental conditions: CPC, CPC+EMD, EMD, and open flap debridement (OFD). Ten weeks post-surgery, the animals were sacrificed, and histologic specimens were prepared for histomorphometric evaluation. RESULTS Defect sites treated with EMD only exhibited varying degrees of new cementum and new bone formation, whereas the OFD group presented only limited new cementum and bone formation. Defect sites where a CPC wall was implanted (CPC and CPC+EMD groups) revealed significantly greater regeneration of new bone and new cementum than in the EMD and OFD groups. No significant differences were observed between the CPC and CPC+EMD groups. CONCLUSIONS CPC walls with and without EMD promoted regeneration of alveolar bone and cementum in 1-wall infrabony defects. Space and stable wound healing are believed to be crucial for periodontal regeneration in non-contained infrabony defects.
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Affiliation(s)
- Yoshinori Shirakata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
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Allen EP, Brodine AH, Burgess JO, Cronin RJ, Donovan TE, Summitt JB. Annual review of selected dental literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2006; 96:174-99. [PMID: 16990070 DOI: 10.1016/j.prosdent.2006.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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