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Belleggia F. Effects of intentional early dense-polytetrafluoroethylene membrane removal on vertical ridge augmentation. Clin Adv Periodontics 2024. [PMID: 38853695 DOI: 10.1002/cap.10298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/03/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Vertical ridge augmentation (VRA) requires long healing times for bone maturation. This case study deals with the intentional early removal of a titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membrane that allowed for treatment times reduction and improvement of bone quality. METHODS A TR-dPTFE membrane was used for VRA in the premolar region of the upper right maxilla. The defect was filled with a mix of particulate autogenous bone and porcine xenograft in a 1:1 ratio. After a 4-month uneventful healing period, the membrane was removed, and the thick keratinized palatal tissue was moved toward the buccal side via a pedicle flap. Implants insertion and healing abutments application were carried out 3 months later, when bone graft could have been revascularized and nourished by the periosteum. RESULTS The histologic evaluation of a bone sample harvested during implant bed preparation revealed a huge amount of mature newly formed bone even in the most coronal part. Two screw-retained crowns were delivered 2 months after implant insertion and the 3.5-year follow-up showed perfectly maintained hard and soft tissues. CONCLUSIONS Intentional early removal of TR-dPTFE membrane after a 4-month healing time, with simultaneous soft tissue augmentation via a buccally reposioned pedicle flap, allowed graft revascularization from the periosteum, and resulted in optimal quantity and quality of the regenerated bone. This process shortened the overall treatment times, taking only 9 months from VRA to prosthetic loading. Both augmented hard and soft tissues allowed for crestal bone maintenance around implants. KEY POINTS Titanium-reinforced dense polytetrafluoroethylene (TR-dPTFE) membranes, due to their closed structure, do not allow the passage of cells and vessels from the periosteum, and revascularization from the residual bone alone is not enough for proper graft maturation and long-term crestal bone maintenance. Early removal of TR-dPTFE membrane allows graft revascularization from the periosteum, and results in optimal quantity and quality of the regenerated bone. Increasing the thickness of the soft tissues, increasing the width of the keratinized mucosa, and repositioning the mucogingival line, via a free gingival graft or a pedicle flap, should be performed simultaneously in the membrane removal phase to reduce the number of surgical interventions, decrease patient morbidity, and shorten the total treatment time.
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Mahmoud AH, Han Y, Dal-Fabbro R, Daghrery A, Xu J, Kaigler D, Bhaduri SB, Malda J, Bottino MC. Nanoscale β-TCP-Laden GelMA/PCL Composite Membrane for Guided Bone Regeneration. ACS APPLIED MATERIALS & INTERFACES 2023; 15:32121-32135. [PMID: 37364054 PMCID: PMC10982892 DOI: 10.1021/acsami.3c03059] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Major advances in the field of periodontal tissue engineering have favored the fabrication of biodegradable membranes with tunable physical and biological properties for guided bone regeneration (GBR). Herein, we engineered innovative nanoscale beta-tricalcium phosphate (β-TCP)-laden gelatin methacryloyl/polycaprolactone (GelMA/PCL-TCP) photocrosslinkable composite fibrous membranes via electrospinning. Chemo-morphological findings showed that the composite microfibers had a uniform porous network and β-TCP particles successfully integrated within the fibers. Compared with pure PCL and GelMA/PCL, GelMA/PCL-TCP membranes led to increased cell attachment, proliferation, mineralization, and osteogenic gene expression in alveolar bone-derived mesenchymal stem cells (aBMSCs). Moreover, our GelMA/PCL-TCP membrane was able to promote robust bone regeneration in rat calvarial critical-size defects, showing remarkable osteogenesis compared to PCL and GelMA/PCL groups. Altogether, the GelMA/PCL-TCP composite fibrous membrane promoted osteogenic differentiation of aBMSCs in vitro and pronounced bone formation in vivo. Our data confirmed that the electrospun GelMA/PCL-TCP composite has a strong potential as a promising membrane for guided bone regeneration.
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Affiliation(s)
- Abdel H Mahmoud
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Yuanyuan Han
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109, United States
- Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, 999077 Hong Kong, China
| | - Renan Dal-Fabbro
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Arwa Daghrery
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Restorative Dental Sciences, School of Dentistry, Jazan University, Jazan 45142, Kingdom of Saudi Arabia
| | - Jinping Xu
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Darnell Kaigler
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Sarit B Bhaduri
- Department of Mechanical, Industrial and Manufacturing Engineering, University of Toledo, Toledo, Ohio 43606-3390, United States
- EEC Division, Directorate of Engineering, The National Science Foundation, Alexandria, Virginia 22314, United States
| | - Jos Malda
- Regenerative Medicine Center Utrecht, 3584 CT Utrecht, The Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3508 TC Utrecht, the Netherlands
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Ut Utrecht, The Netherlands
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
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Eldabe AK, Abdel-Ghaffar KA, Amr AE, Abu-Seida AM, Abdelhamid ES, Gamal AY. The impact of membrane perforation and L-PRF for vertical ridge augmentation with a xenogeneic block graft: an experimental study in a canine model. Clin Oral Investig 2023; 27:3949-3960. [PMID: 37083985 PMCID: PMC10329594 DOI: 10.1007/s00784-023-05018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/02/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES This study evaluated clinically and histologically the efficacy of modified perforated collagen membrane (PCM) and/or leukocyte- and platelet-rich fibrin (L-PRF) in combination with xenogeneic block bone graft in the vertical alveolar ridge augmentation. MATERIALS AND METHODS Six adult mongrel dogs were enrolled in this randomized blinded study. After defect preparation, xenogeneic screw-fixed block graft was covered by an occlusive collagen membrane in group 1 that represented the control group (Block + CM). In group 2, L-PRF membrane was added first before top coverage by occlusive collagen membrane (Block + L-PRF + CM). Groups 3 (Block + PCM) and 4 (Block + L-PRF + PCM) were identical to the first two groups except that the occlusive collagen membrane was replaced by a perforated one. Following a healing period of 2 months, the dogs were submitted to the surgical reentry phase for clinical and histological evaluation. RESULTS Clinically, no significant differences were found among all groups regarding vertical and horizontal ridge dimensions (p = 0.155, 0.492, respectively). Histomorphometric analysis revealed that the percentage of the total bone area and mature bone was significantly higher in group 4 (69.36 ± 2.72, 33.11 ± 5.18) compared to the control group (59.17 ± 4.27, 21.94 ± 2.86) (p = 0. 027, p = 0.029). CONCLUSION The use of xenogenic block grafts in combination with a double-layered perforated collagen L-PRF membrane in vertical ridge augmentation appeared to improve the inductive power of this challenging defect type. CLINICAL RELEVANCE Size and number of perforations may affect the mechanical and handling properties of the membrane.
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Affiliation(s)
- Abdelrahman K Eldabe
- Dept. of Oral Medicine and Periodontology, Faculty of Dentistry, Assiut University, Assiut, Egypt
| | - Khaled A Abdel-Ghaffar
- Dept. of Oral Medicine and Periodontology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ahmed E Amr
- Dept. of Oral Medicine and Periodontology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ashraf M Abu-Seida
- Dept. of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Cairo University, Giza, PO: 12211, Egypt
| | - Ehab S Abdelhamid
- Dept. of Oral Pathology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ahmed Y Gamal
- Ain Shams University, Faculty of Dentistry, Cairo, Egypt.
- Misr University for Science and Technology, Faculty of Dentistry, October 5 City, Egypt.
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Predictability and Clinical Stability of Barrier Membranes in Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12104835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The adjunctive use of GTR membranes helps us to achieve predictable periodontal regeneration. The aim of this systematic review was to evaluate and compare the treatment efficacy of resorbable versus non-resorbable barrier membranes used in guided tissue regeneration in the treatment of intrabony defects in chronic periodontitis patients. The following databases were searched: Medline, the Cochrane Central Register of Controlled Trails (CENTRAL), SCOPUS, EMBASE. Randomized clinical trials (RCTs) published in English languages over the past 25 years were included. The primary outcomes assessed were: change of probing pocket depth (PD), change in clinical attachment level (CAL) and gingival recession coverage (GRC), and intrabony defect fill (IBDF). A total of eight RCTs were included for systematic review. The outcome of GR at a six-month interval revealed a significant difference in treatment effect with a mean difference of 0.42, 95% CI [0.02, 0.81]; Z = 2.09, (p = 0.04) favouring the resorbable membrane group. The intrabony defect depth fill at a 12-month interval revealed a significant difference in treatment effect with MD of 0.79, p = 0.00001; favoring the resorbable membrane group. The resorbable membrane showed a significant improvement in gingival recession coverage and intrabony defect fill, owing to its advantage of avoiding the second surgical intervention.
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Belleggia F. Hard and soft tissue augmentation of vertical ridge defects with the “hard top double membrane technique”: introduction of a new technique and a case report. AIMS BIOENGINEERING 2022. [DOI: 10.3934/bioeng.2022003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
<abstract>
<p>Vertical ridge defects (VRD) of the jaws often require both bone and keratinized mucosa (KM) reconstruction. A new staged procedure is proposed to restore both hard and soft tissues in the VRD through a case report. A patient required the lower right second premolar and first molar rehabilitation. The first surgery aimed to restore the bone architecture through the use of a titanium reinforced dense-PTFE (TR-dPTFE) membrane, positioned and stabilized on top of tenting screws. This membrane didn't cover the whole defect, it just created an hard top that avoided the collapse of a collagen membrane that was placed over it. This resorbable membrane was stabilized with tacks and covered the whole defect, protecting a mixture of autogenous bone and porcine xenograft both lingually and buccally. The second surgery was performed after a 5 month healing time either to remove the tenting screws and the TR-dPTFE membrane, and to augment KM with a gingival graft harvested from the palate. Both regenerated hard and soft tissues were left to mature for 7 months before the third surgery. In this last stage implants insertion and healing abutments application were carried out in a straightforward way, since bone and KM had been previously restored. Two bone samples, harvested for histologic evaluation, stated a great amount of new bone formation. This new approach allowed inserting implants in matured and stable regenerated bone and augmented KM, avoiding the hard and soft tissue loss around implant neck that can affect the VRD treatments during healing.</p>
</abstract>
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Feher B, Apaza Alccayhuaman KA, Strauss FJ, Lee JS, Tangl S, Kuchler U, Gruber R. Osteoconductive properties of upside-down bilayer collagen membranes in rat calvarial defects. Int J Implant Dent 2021; 7:50. [PMID: 34095987 PMCID: PMC8180471 DOI: 10.1186/s40729-021-00333-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
Background Bilayer collagen membranes are routinely used in guided bone/tissue regeneration to serve as osteoconductive scaffolds and prevent the invasion of soft tissues. It is recommended to place the membranes with their dense layer towards the soft tissue and their porous layer towards the bony defect area. However, evidence supporting this recommendation is lacking. This study aimed to determine whether the alignment of bilayer collagen membranes has an effect on bone regeneration. Methods In two groups of ten male Sprague-Dawley rats each, a 5-mm calvarial defect was created. Thereafter, the defect was randomly covered with a bilayer, resorbable, pure type I and III collagen membrane placed either regularly or upside-down (i.e., dense layer towards bone defect). After 4 weeks of healing, micro-computed tomography (μCT), histology, and histomorphometry of the inner cylindrical region of interest (4.5 mm in diameter) were performed to assess new bone formation and the consolidation of the collagen membrane in the defect area. Results Quantitative μCT showed similar bone volume (median 8.0 mm3, interquartile range 7.0–10.0 vs. 6.2 mm3, 4.3–9.4, p = 0.06) and trabecular thickness (0.21 mm, 0.19–0.23 vs. 0.18 mm, 0.17–0.20, p = 0.03) between upside-down and regular placement, both leading to an almost complete bony coverage. Histomorphometry showed comparable new bone areas between the upside-down and regularly placed membranes, 3.9 mm2 (2.7–5.4) vs. 3.8 mm2 (2.2–4.0, p = 0.31), respectively. Both treatment groups revealed the same regeneration patterns and spatial distribution of bone with and without collagen fibers, as well as residual collagen fibers. Conclusions Our data support the osteoconductive properties of collagen membranes and suggest that bone regeneration is facilitated regardless of membrane layer alignment. Supplementary Information The online version contains supplementary material available at 10.1186/s40729-021-00333-y.
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Affiliation(s)
- Balazs Feher
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Karol Ali Apaza Alccayhuaman
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria
| | - Franz Josef Strauss
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria.,Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.,Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Jung-Seok Lee
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
| | - Stefan Tangl
- Core Facility Hard Tissue and Biomaterial Research, Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Ulrike Kuchler
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria. .,Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
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Comparison of the Migration Potential through Microperforated Membranes of CD146+ GMSC Population versus Heterogeneous GMSC Population. Stem Cells Int 2021; 2021:5583421. [PMID: 33777147 PMCID: PMC7979285 DOI: 10.1155/2021/5583421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/31/2020] [Indexed: 12/30/2022] Open
Abstract
Background Guided tissue regeneration (GTR) is a powerful modality for periodontal regeneration, but it blocks the periosteum and gingival stem cells (GMSCs), from supporting periodontal wound by the nutrients, growth factors, and regenerative cells. The microperforated membrane considered a rewarding solution for this major drawback; GMSCs can migrate through a GTR microperforated membrane toward a chemoattractant, with the blocking of other unfavorable epithelial cells and fibroblasts. In the absence of a sole marker for MSC, a homogeneous population of GMSC is difficult to isolate; using CD146 as confirmatory markers for MSC identification, testing the behaviour of such homogeneous population in migration dynamics was the question to answer in this study. Materials and Methods GMSCs from healthy crown lengthening tissue was isolated (n = 3), its stem cell nature was confirmed, CD146 and CD271 markers were confirmatory markers to confirm homogenous stem cell population, and magnetic sorting was used to isolate GMSC with CD146 markers. A homogenous CD146 population was compared to heterogeneous GMSCs of origin; the population doubling time and MTT test of the two populations were compared. Migration dynamics were examined in a transwell migration chamber through 8 μm perforated polycarbonic acid membrane, and 0.4 μm and 3 μm perforated collagen-coated polytetrafluoroethylene membrane (PTFE) and 10% fetal bovine serum (FBS) were the chemoattractants used in the lower compartment to induce cell migration, were incubated in a humidified environment for 24 hours, then migrated the cell in the lower compartment examined by a light and electron microscope. Results GMSCs fulfilled all the minimal criteria of stem cells and showed low signal 10% for CD146 on average and extremely low signal 2% for CD271 on average. Magnetic sorting optimized the signal of CD146 marker to 55%. GMSC CD146 population showed nonstatistically significant shorter population doubling time. CD146 homogeneous population migrated cell numbers were statistically significant compared to the heterogeneous population, through 0.4 μm and 3 μm perforated collagen membrane and 8 μm perforated polycarbonate membrane. Scanning electron microscopy proved the migration of the cells. Conclusions A subset of the isolated GMSC showed a CD146 marker, which is considered a dependable confirmatory marker for the stem cells. In terms of GMSC migration through the microperforated membrane, a homogeneous CD146 population migrates more statistically significant than a heterogeneous GMSC population.
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Abdal-Wahab M, Abdel Ghaffar KA, Ezzatt OM, Hassan AAA, El Ansary MMS, Gamal AY. Regenerative potential of cultured gingival fibroblasts in treatment of periodontal intrabony defects (randomized clinical and biochemical trial). J Periodontal Res 2020; 55:441-452. [PMID: 32080858 DOI: 10.1111/jre.12728] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 11/22/2019] [Accepted: 12/11/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Defective cellular elements constitute an important challenge to achieve predictable periodontal regeneration. In an attempt to improve the cellularity of periodontal defects, gingival fibroblasts were implanted without their associated extracellular elements in periodontal defects to expose them to periodontal tissue mediators. In order to investigate the regenerative potential of gingival fibroblasts translocated into periodontal defects, the present study was designed to clinically and biochemically investigate the use of gingival fibroblasts (GF) and their associated mesenchymal stem cells (GMSC) in the treatment of intrabony periodontal defects. METHODS A total of 20 subjects were randomly divided into two groups (n = 20). Group I: ten patients were included with ten intrabony periodontal defects that received β-calcium triphosphate (β-TCP) followed by collagen membrane defect coverage, while group II: (10 patients) ten periodontal defects received cultured gingival fibroblasts (GF) on the β-TCP scaffold and covered by a collagen membrane. The clinical evaluation was carried out at the beginning and at 6 months. Gingival crevicular fluid (GCF) samples were collected directly from the test sites for the quantitative measurement of PDGF-BB and BMP-2 using the ELISA kit at 1, 7, 14, and 21 days after surgery. RESULTS Group II reported a significantly greater reduction in vertical pocket depth (VPD) and CAL gain compared with group I after 6 months. Radiographic bone gain was statistically higher in group II compared with group I. A significantly higher concentration of PDGF-BB was observed in group II on days 1, 3, and 7 compared with group I. CONCLUSIONS Translocation of gingival fibroblasts from gingival tissue to periodontal defects could be a promising option that increases cellular elements with regeneration potential. The concept of total isolation of gingival fibroblasts using occlusive membranes must be re-evaluated.
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Affiliation(s)
- Mahetab Abdal-Wahab
- Department of Periodontology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | | | - Ola M Ezzatt
- Department of Periodontology, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | | | | | - Ahmed Y Gamal
- Department of Periodontology, Faculty of Dentistry, Nahda University, Cairo, Egypt
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Effect of Inflammation on Gingival Mesenchymal Stem/Progenitor Cells' Proliferation and Migration through Microperforated Membranes: An In Vitro Study. Stem Cells Int 2020; 2020:5373418. [PMID: 32148522 PMCID: PMC7054781 DOI: 10.1155/2020/5373418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/18/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background In the field of periodontal guided tissue regeneration, microperforated membranes have recently proved to be very promising periodontal regenerative tissue engineering tools. Regenerative periodontal approaches, employing gingival mesenchymal stem/progenitor cells in combination with these novel membranes, would occur mostly in inflamed microenvironmental conditions intraorally. This in turn entails the investigation into how inflammation would affect the proliferation as well as the migration dynamics of gingival mesenchymal stem/progenitor cells. Materials and Methods. Clones of human gingival mesenchymal stem/progenitor cells (GMSCs) from inflamed gingival tissues were characterized for stem/progenitor cells' characteristics and compared to clones of healthy human GMSCs (n = 3), to be subsequently seeded on perforated collagen-coated poly-tetra-floro-ethylene (PTFE) membranes with a pore size 0.4 and 3 microns and polycarbonic acid membranes of 8 microns pore size in Transwell systems. The population doubling time and the MTT test of both populations were determined. Fetal bovine serum (FBS) was used as a chemoattractant in the culturing systems, and both groups were compared to their negative controls without FBS. Following 24 hours of incubation period, migrating cells were determined on the undersurface of microperforated membranes and the membrane-seeded cells were examined by scanning electron microscopy. Results GMSCs demonstrated all predefined stem/progenitor cell characteristics. GMSCs from inflamed gingival tissues showed significantly shorter population doubling times. GMSCs of inflamed and healthy tissues did not show significant differences in their migration abilities towards the chemoattractant, with no cellular migration observed in the absence of FBS. GMSCs from healthy gingival tissue migrated significantly better through larger micropores (8 microns). Scanning electron microscopic images proved the migratory activity of the cells through the membrane pores. Conclusions Inflammation appears to boost the proliferative abilities of GMSCs. In terms of migration through membrane pores, GMSCs from healthy as well as inflamed gingival tissues do not demonstrate a difference in their migration abilities through smaller pore sizes, whereas GMSCs from healthy gingival tissues appear to migrate significantly better through larger micropores.
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Issa DR, Abdel-Ghaffar KA, Al-Shahat MA, Hassan AAA, Iacono VJ, Gamal AY. Guided tissue regeneration of intrabony defects with perforated barrier membranes, simvastatin, and EDTA root surface modification: A clinical and biochemical study. J Periodontal Res 2019; 55:85-95. [PMID: 31448832 DOI: 10.1111/jre.12692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 07/08/2019] [Accepted: 07/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Perforated barrier membranes (PBM) were suggested to enhance periodontal regeneration by allowing positive charity of wanted elements from the gingival tissue side. The present study was designed to evaluate clinically and biochemically the use of PBM combined with simvastatin (SMV) gel with and without an associated EDTA gel root surface etching as a suggested option that could improve SMV availability and clinical outcomes of PBM. METHODS Forty patients having moderate-to-severe chronic periodontitis with 40 intrabony defects were randomly divided into four treatment groups (10 sites each). Patients in group 1 received 1.2% SMV gel and covering the defect with occlusive membrane (OM). Patients in group 2 received 1.2% SMV gel and covering the defect with PBM. Group 3 received 24% EDTA root surface etching, 1.2% SMV gel, and defect coverage with OM (eOM). Patients in group 4 were treated as in group 3 but the defect was covered with PBM (ePBM). Clinical parameters were recorded at baseline before surgical procedures and were reassessed at 6 and 9 months after therapy. The mean concentration of SMV in gingival crevicular fluid (GCF) was estimated by reverse-phase high-performance liquid chromatography at days 1, 7, 14, 21, and 30. RESULTS At 6- and 9-month observation periods, groups 3 and 4 showed a statistically significant improvement in PD reduction and CAL gain compared with groups 1 and 2. Group 4 showed a statistically significant more defect fill compared with groups 1, 2, and 3 (P ≤ .05). Group 2 showed statistically significant higher defect fill compared with group 1 and group 3 (P < .05). Bone density was significantly increased with no significant difference between the four groups at 6- and 9-month observation periods. SMV-GCF concentration in group 4 showed the highest mean concentration with no significant difference than that of group 3. CONCLUSION The use of perforated barrier membranes in association with SMV enhances the clinical hard tissue parameters compared with occlusive ones in treating intrabony periodontal defects. Moreover, EDTA root surface treatment could enhance SMV availability in the defect area.
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Affiliation(s)
- Dalia Rasheed Issa
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Kafrelsheikh University, Kafr El Sheikh, Egypt
| | - Khaled A Abdel-Ghaffar
- Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed A Al-Shahat
- Department of Periodontology, Faculty of Dental Medicine, Delta University for science and technology, Cairo, Egypt
| | - Ahmed Abdel Aziz Hassan
- Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt
| | - Vincent J Iacono
- School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Ahmed Y Gamal
- Department of Periodontology, Faculty of Oral and Dental Medicine, Nahda University, Benisweif, Egypt
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Khorsand B, Elangovan S, Hong L, Kormann MSD, Salem AK. A bioactive collagen membrane that enhances bone regeneration. J Biomed Mater Res B Appl Biomater 2019; 107:1824-1832. [PMID: 30466196 PMCID: PMC6531367 DOI: 10.1002/jbm.b.34275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
Abstract
Membranes are an integral component of guided bone regeneration protocols. This pre-clinical study was aimed at enhancing the bioactivity of collagen membranes by incorporating plasmid DNA (pDNA) or chemically modified RNA (cmRNA) encoding bone morphogenetic protein-9 (BMP-9). In addition, we also endeavored to harness the regenerative potential of the periosteum by creating perforations in the membrane. Nanoplexes of polyethylenimine (PEI)-nucleic acids (PEI-pDNA or PEI-cmRNA encoding BMP-9) were incorporated into commercially obtained and perforated collagen membranes (PCM) to produce PCM-pDNA(BMP-9) or PCM-cmRNA(BMP-9). After structural characterization, the biodegradation kinetics of PCM, PCM-pDNA(BMP-9) and PCM-cmRNA(BMP-9) were assessed in simulated body fluid in vitro. Using a 24-well transwell plate system with bone marrow stromal cells (BMSCs) in the lower chamber and the PCM to be tested in the upper chamber, the in vitro bioactivity of different PCMs was evaluated by measuring various markers for osteogenesis in BMSCs. Alkaline phosphatase activity was assessed in BMSCs, after 7 and 11 days of exposure to PCM, PCM-pDNA(BMP-9), or PCM-cmRNA(BMP-9). Similarly, calcium deposition and Alizarin red staining in BMSCs were assessed after 14 days of exposure to the three different types of PCM. PCMs were then tested in vivo using the calvarial defect model in rats. After 4 weeks, animals were euthanized and bone specimens were harvested for micro-computed tomography and histological assessments. Incorporation of pDNA or cmRNA did not alter the biodegradation profile of PCMs. Alkaline phosphatase activity trended toward being higher in BMSCs exposed to PCM-cmRNA(BMP-9) or PCM-pDNA(BMP-9), when compared to BMSCs alone. Similar trends were observed when calcium deposition and alizarin red staining was evaluated. Calvarial bone defects treated with PCM-cmRNA(BMP-9) resulted in significantly higher bone volume/total volume % (BV/TV%), when compared to empty defects and trended toward being higher than defects treated with PCM-pDNA(BMP-9) and PCM alone. We demonstrate for the first time that resorbable PCM can be utilized to efficiently deliver pDNA and cmRNA of interest. The released pDNA and cmRNA encoding BMP-9 in this assessment was shown to be functional in vitro as well as in vivo. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1824-1832, 2019.
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Affiliation(s)
- Behnoush Khorsand
- Division of Pharmaceutics and Translational Therapeutics, University of Iowa College of Pharmacy, Iowa City, Iowa
| | - Satheesh Elangovan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa
| | - Liu Hong
- Department of Prosthodontics University of Iowa College of Dentistry, Iowa City, Iowa
| | - Michael S D Kormann
- Department of Translational Genomics and Gene Therapy, University of Tübingen, Wilhelmstr. 56, Tübingen, Germany
| | - Aliasger K Salem
- Division of Pharmaceutics and Translational Therapeutics, University of Iowa College of Pharmacy, Iowa City, Iowa
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa
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12
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Górski B, Jalowski S, Górska R, Zaremba M. Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: a 4-year follow-up of a randomized controlled trial. Clin Oral Investig 2019; 24:1183-1196. [PMID: 31324986 DOI: 10.1007/s00784-019-02982-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/20/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE (1) To assess long-term outcomes 4 years following guided tissue regeneration (GTR) of intrabony defects in patients diagnosed with aggressive periodontitis (AgP) and (2) to identify predictors of clinical attachment level (CAL) gain and bone/graft density gain. MATERIALS AND METHODS In 15 patients, two deep intrabony defects were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). After 4 years, clinical and radiographic outcomes were evaluated and compared with outcomes at baseline and after 1 year. RESULTS After 4 years, 14 test sites and 13 control sites were available for analysis. One tooth was lost as a result of root fracture. There were significant improvements in all evaluated parameters after 1 and 4 years in relation to baseline, but no differences were observed between tests and controls. However, some non-significant changes were found between 1 and 4 years. Regression analyses showed that recurrence of periodontitis was a significant predictor for CAL gain (p = 0.001) and bone/graft density gain (p = 0.024) from 1 to 4 years. CONCLUSIONS GTR of intrabony defects in AgP with either standard or modified CM yielded similarly successful and maintainable clinical benefits for compromised teeth 4 years following the surgery. The use of MPM showed no additional benefit. CLINICAL RELEVANCE This study demonstrates that most of the positive outcomes of GTR in AgP may be preserved over 4 years. Periodontitis recurrence might influence long-term outcomes.
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Affiliation(s)
- Bartłomiej Górski
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Miodowa St 18, 00-246, Warsaw, Poland.
| | - Stanisław Jalowski
- Department of Dental and Maxillofacial Radiology, Medical University of Warsaw, Nowogrodzka St 59, 02-006, Warsaw, Poland
| | - Renata Górska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Miodowa St 18, 00-246, Warsaw, Poland
| | - Maciej Zaremba
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Warsaw, Miodowa St 18, 00-246, Warsaw, Poland
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Geão C, Costa-Pinto AR, Cunha-Reis C, Ribeiro VP, Vieira S, Oliveira JM, Reis RL, Oliveira AL. Thermal annealed silk fibroin membranes for periodontal guided tissue regeneration. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:27. [PMID: 30747338 DOI: 10.1007/s10856-019-6225-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
Guided tissue regeneration (GTR) is a surgical procedure applied in the reconstruction of periodontal defects, where an occlusive membrane is used to prevent the fast-growing connective tissue from migrating into the defect. In this work, silk fibroin (SF) membranes were developed for periodontal guided tissue regeneration. Solutions of SF with glycerol (GLY) or polyvinyl alcohol (PVA) where prepared at several weight ratios up to 30%, followed by solvent casting and thermal annealing at 85 °C for periods of 6 and 12 h to produce high flexible and stable membranes. These were characterized in terms of their morphology, physical integrity, chemical structure, mechanical and thermal properties, swelling capability and in vitro degradation behavior. The developed blended membranes exhibited high ductility, which is particular relevant considering the need for physical handling and adaptability to the defect. Moreover, the membranes were cultured with human periodontal ligament fibroblast cells (hPDLs) up to 7 days. Also, the higher hydrophilicity and consequent in vitro proteolytic degradability of these blends was superior to pure silk fibroin membranes. In particular SF/GLY blends demonstrated to support high cell adhesion and viability with an adequate hPDLs' morphology, make them excellent candidates for applications in periodontal regeneration.
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Affiliation(s)
- Catarina Geão
- CBQF-Centro de Biotecnologia e Química Fina, Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Arquiteto Lobão Vital, 4200-072, Porto, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradable and Biomimetics, Headquarters of the European Institute of Excellence on tissue Engineering and Regenerative Medicine, AvePark, 4805-17, Barco, Guimarães, Portugal
| | - Ana R Costa-Pinto
- CBQF-Centro de Biotecnologia e Química Fina, Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Arquiteto Lobão Vital, 4200-072, Porto, Portugal
| | - Cassilda Cunha-Reis
- CBQF-Centro de Biotecnologia e Química Fina, Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Arquiteto Lobão Vital, 4200-072, Porto, Portugal
| | - Viviana P Ribeiro
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradable and Biomimetics, Headquarters of the European Institute of Excellence on tissue Engineering and Regenerative Medicine, AvePark, 4805-17, Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associated Laboratory, Braga/Guimarães, Portugal
| | - Sílvia Vieira
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradable and Biomimetics, Headquarters of the European Institute of Excellence on tissue Engineering and Regenerative Medicine, AvePark, 4805-17, Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associated Laboratory, Braga/Guimarães, Portugal
| | - Joaquim M Oliveira
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradable and Biomimetics, Headquarters of the European Institute of Excellence on tissue Engineering and Regenerative Medicine, AvePark, 4805-17, Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associated Laboratory, Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, AvePark, 4805-017, Barco, Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradable and Biomimetics, Headquarters of the European Institute of Excellence on tissue Engineering and Regenerative Medicine, AvePark, 4805-17, Barco, Guimarães, Portugal
- ICVS/3B's-PT Government Associated Laboratory, Braga/Guimarães, Portugal
- The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, AvePark, 4805-017, Barco, Guimarães, Portugal
| | - Ana L Oliveira
- CBQF-Centro de Biotecnologia e Química Fina, Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Rua Arquiteto Lobão Vital, 4200-072, Porto, Portugal.
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14
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Temraz A, Ghallab NA, Hamdy R, El-Dahab OA. Clinical and radiographic evaluation of amnion chorion membrane and demineralized bone matrix putty allograft for management of periodontal intrabony defects: a randomized clinical trial. Cell Tissue Bank 2019; 20:117-128. [DOI: 10.1007/s10561-018-09743-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 12/21/2018] [Indexed: 01/03/2023]
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15
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Fahmy RA, Kotry GS, Ramadan OR. Periodontal regeneration of dehisence defects using a modified perforated collagen membrane. A comparative experimental study. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.fdj.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: subtraction radiography outcomes, prognostic variables, and patient morbidity. Clin Oral Investig 2018; 23:3005-3020. [PMID: 30374832 PMCID: PMC7398389 DOI: 10.1007/s00784-018-2712-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
Abstract
Objectives The main objectives of this study were (1) to evaluate bone/graft density alterations by digital subtraction radiography; (2) to determine factors associated with favorable clinical and radiographic outcomes, and (3) to report on patient morbidity after guided tissue regeneration (GTR) in aggressive periodontitis (AgP) patients. Materials and methods Adapting a split-mouth design, 30 comparative intrabony defects in 15 patients were randomly treated with xenogenic graft plus modified perforated membranes (MPM, tests) or xenogenic graft plus standard collagen membranes (CM, controls). The time period of observation was 12 months. Results There were significant improvements in clinical and radiographic parameters within each group, without intergroup differences. However, higher PPD reduction for three-wall defects was noted in MPM sites (5.22 versus 3.62 mm; p = 0.033). Moreover, a significant gain in bone/graft density of 4.9% from 6 to 12 months post-operatively was observed in test sites. Multivariate analysis demonstrated that morphology of intrabony defects was a predictor of CAL gain (p = 0.06), while independent prognostic variables effecting changes in bone/graft density were radiographic defect depth (p = 0.025) and radiographic angle (p = 0.033). The majority of patients reported some discomfort, pain, and edema with mild intensity without any significant differences between treatment modalities. Conclusions This study demonstrated enhanced bone/graft density gain after GTR with MPM, which may indicate greater area of new bone formation. Independent variables effecting treatment outcomes were intrabony defect morphology, radiographic defect depth, and radiographic angle. Clinical relevance This study supports the regenerative treatment of intrabony defects in AgP patients and identifies some variables with prognostic value.
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17
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Sadeghi R, Mahdavi P, Lee WS, Quan B, Sone E, Ganss B, McCulloch CA. A novel, cell-permeable, collagen-based membrane promotes fibroblast migration. J Periodontal Res 2018; 53:727-735. [DOI: 10.1111/jre.12557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 01/06/2023]
Affiliation(s)
- R. Sadeghi
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
- Department of Periodontics; Faculty of Dentistry; Shahed University; Tehran Iran
| | - P. Mahdavi
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - W. S. Lee
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - B. Quan
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto ON Canada
| | - E. Sone
- Institute of Biomaterials and Biomedical Engineering; University of Toronto; Toronto ON Canada
| | - B. Ganss
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
| | - C. A. McCulloch
- Matrix Dynamics Group; Faculty of Dentistry; University of Toronto; Toronto ON Canada
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18
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Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: a 12-month randomized controlled trial. Clin Oral Investig 2018; 22:2819-2828. [PMID: 29411112 DOI: 10.1007/s00784-018-2368-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 01/25/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to compare the clinical and radiographic efficacy of guided tissue regeneration with a modified perforated collagen membrane (MPM) or standard collagen membrane (CM) in the treatment of intrabony defects in patients with aggressive periodontitis (AgP). MATERIALS AND METHODS Fifteen AgP patients were included in the study. Two single intrabony defects of at least 3 mm depth with ≥ 6 mm probing pocket depth (PPD) from each patient were randomly assigned to either xenogenic graft plus MPM (test group) or xenogenic graft plus CM (control group). PPD, clinical attachment level (CAL), and gingival recession (GR) were recorded at baseline and at 12 months. The radiographic assessments included the measurements of defect depth (DD), change in alveolar crest position (ACP), linear defect fill (LDF), and percentage defect fill (%DF). RESULTS After treatment, PPD, CAL, DD, and ACP values improved significantly in both groups, without statistical differences between them. However, with respect to LDF and %DF, the 12-month radiographic analysis at MPM-treated sites showed a significant improvement compared to the 6-month outcomes, that was not observed at control sites (additional LDF of 0.4 ± 0.5 mm, p = 0.010 and %DF of 6.4 ± 7.6%, p = 0.025). CONCLUSIONS Both strategies proved effective in the treatment of intrabony defects in patients with AgP. Nonetheless, enhanced LDF and %DF 12 months postoperatively at MPM-treated sites may stem from cellular and molecular migration from the periosteum and overlying gingival connective tissue through barrier's pores. CLINICAL RELEVANCE Modification of CM may have positive ramifications on periodontal regeneration.
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19
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Carrion JA, Wang HH, Masselli J, Iacono VJ. Enhanced Lateral Bone Augmentation With a Perforated Resorbable Barrier Membrane. Clin Adv Periodontics 2017; 7:152-158. [DOI: 10.1902/cap.2017.160080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/14/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Julio A. Carrion
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY
| | - Howard H. Wang
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY
| | - Joseph Masselli
- Department of Biochemistry and Cell Biology, Stony Brook University
| | - Vincent J. Iacono
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY
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20
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Gamal AY, Al-Berry NN, Hassan AA, Rashed LA, Iacono VJ. In vitro
evaluation of the human gingival fibroblast/gingival mesenchymal stem cell dynamics through perforated guided tissue membranes: cell migration, proliferation and membrane stiffness assay. J Periodontal Res 2017; 52:628-635. [DOI: 10.1111/jre.12431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A. Y. Gamal
- Department of Periodontology; Faculty of Dentistry; Ain Shams University; Cairo Egypt
| | - N. N. Al-Berry
- Department of Periodontology; Faculty of Dentistry; Ain Shams University; Cairo Egypt
| | - A. A. Hassan
- Department of Periodontology; Faculty of Dentistry; Ain Shams University; Cairo Egypt
| | - L. A. Rashed
- Faculty of Medicine; Cairo University; Cairo Egypt
| | - V. J. Iacono
- School of Dental Medicine; Stony Brook University; Stony Brook NY USA
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21
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Larsson L, Decker AM, Nibali L, Pilipchuk SP, Berglundh T, Giannobile WV. Regenerative Medicine for Periodontal and Peri-implant Diseases. J Dent Res 2015; 95:255-66. [PMID: 26608580 DOI: 10.1177/0022034515618887] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The balance between bone resorption and bone formation is vital for maintenance and regeneration of alveolar bone and supporting structures around teeth and dental implants. Tissue regeneration in the oral cavity is regulated by multiple cell types, signaling mechanisms, and matrix interactions. A goal for periodontal tissue engineering/regenerative medicine is to restore oral soft and hard tissues through cell, scaffold, and/or signaling approaches to functional and aesthetic oral tissues. Bony defects in the oral cavity can vary significantly, ranging from smaller intrabony lesions resulting from periodontal or peri-implant diseases to large osseous defects that extend through the jaws as a result of trauma, tumor resection, or congenital defects. The disparity in size and location of these alveolar defects is compounded further by patient-specific and environmental factors that contribute to the challenges in periodontal regeneration, peri-implant tissue regeneration, and alveolar ridge reconstruction. Efforts have been made over the last few decades to produce reliable and predictable methods to stimulate bone regeneration in alveolar bone defects. Tissue engineering/regenerative medicine provide new avenues to enhance tissue regeneration by introducing bioactive models or constructing patient-specific substitutes. This review presents an overview of therapies (e.g., protein, gene, and cell based) and biomaterials (e.g., resorbable, nonresorbable, and 3-dimensionally printed) used for alveolar bone engineering around teeth and implants and for implant site development, with emphasis on most recent findings and future directions.
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Affiliation(s)
- L Larsson
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA Department of Periodontology, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden
| | - A M Decker
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - L Nibali
- Periodontology Unit and Department of Clinical Research, UCL Eastman Dental Institute, London, UK
| | - S P Pilipchuk
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - T Berglundh
- Department of Periodontology, Institute of Odontology, University of Gothenburg, Gothenburg, Sweden
| | - W V Giannobile
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA
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22
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Gamal AY, Abdel-Ghaffar KA, Iacono VJ. Gingival crevicular fluid vascular endothelial cell growth factor and platelet-derived growth factor-BB release profile following the use of perforated barrier membranes during treatment of intrabony defects: a randomized clinical trial. J Periodontal Res 2015; 51:407-16. [PMID: 26549803 DOI: 10.1111/jre.12321] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Perforated barrier membranes open channels between the suprabony and intrabony compartments of the defect, which could allow for more physiologic cellular interactions between different components of the periodontium during guided tissue regeneration surgery. To test this assumption, this study was designed to evaluate levels of vascular endothelial cell growth factor (VEGF) and platelet-derived growth factor (PDGF)-BB in gingival crevicular fluid during the early stages of healing of localized intrabony defects treated with perforated membranes (PMs) or non-PMs, as compared with open flap debridement. MATERIAL AND METHODS Thirty non-smoking patients with severe chronic periodontitis participated in this prospective, randomized and single blinded trial. Each patient contributed one interproximal defect that was randomly assigned to the PM group (n = 10), occlusive membrane (OM) group (n = 10) or open flap debridement (OFD) group (n = 10). Plaque index, gingival index, probing depth, clinical attachment level and the intrabony depth of the defect were measured at baseline and reassessed at 6 and 9 mo after therapy. Gingival crevicular fluid samples were collected on days 1, 3, 7, 14, 21 and 30 d after therapy for the changes in VEGF and PDGF-BB levels. RESULTS During the early stages of healing (1, 3 and 7 d), the mean VEGF and PDGF-BB concentrations at sites treated with PMs and OFD peaked with a statistically significant difference as compared with the OM-treated group. VEGF and PDGF-BB levels at sites treated with PMs and OFD were not statistically different. Growth factor levels decreased sharply in the samples obtained at days 21 and 30 with non-significant differences between the three groups. Nine months after therapy, the PM-treated group showed a statistically significant improvement in probing depth, clinical attachment level and intrabony defect compared to the OM and OFD groups. CONCLUSIONS Within the limits of the present study, one can conclude that PM coverage of periodontal defects is associated with initial gingival crevicular fluid growth factor upregulation that could improve the clinical outcomes of guided tissue regeneration surgery.
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Affiliation(s)
- A Y Gamal
- Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt
| | - K A Abdel-Ghaffar
- Department of Periodontology, Faculty of Dental Medicine, Ain Shams University, Cairo, Egypt
| | - V J Iacono
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
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23
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Barbeck M, Lorenz J, Kubesch A, Böhm N, Booms P, Choukroun J, Sader R, Kirkpatrick CJ, Ghanaati S. Porcine Dermis-Derived Collagen Membranes Induce Implantation Bed Vascularization Via Multinucleated Giant Cells: A Physiological Reaction? J ORAL IMPLANTOL 2014; 41:e238-51. [PMID: 25546240 DOI: 10.1563/aaid-joi-d-14-00274] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this study, the tissue reactions to 2 new porcine dermis-derived collagen membranes of different thickness were analyzed. The thicker material (Mucoderm) contained sporadically preexisting vessel skeletons and fatty islands. The thinner membrane (Collprotect) had a bilayered structure (porous and occlusive side) without any preexisting structures. These materials were implanted subcutaneously in mice to analyze the tissue reactions and potential transmembranous vascularization. Histological and histomorphometrical methodologies were performed at 4 time points (3, 10, 15, and 30 days). Both materials permitted stepwise connective tissue ingrowth into their central regions. In the Mucoderm matrix, newly built microvessels were found within the preexisting vessel and fatty island skeletons after 30 days. This vascularization was independent of the inflammation-related vascularization on both material surfaces. The Collprotect membrane underwent material disintegration by connective tissue strands in combination with vessels and multinucleated giant cells. The histomorphometric analyses revealed that the thickness of Mucoderm did not decrease significantly, while an initial significant decrease of membrane thickness in the case of Collprotect was found at day 15. The present results demonstrate that the 2 analyzed collagen membranes underwent a multinucleated giant cell-associated vascularization. Neither of the materials underwent transmembraneous vascularization. The microvessels were found within the preexisting vessel and fatty island skeletons. Additional long-term studies and clinical studies are necessary to determine how the observed foreign body giant cells affect tissue regeneration.
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Affiliation(s)
- Mike Barbeck
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jonas Lorenz
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Alica Kubesch
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nicole Böhm
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Patrick Booms
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Robert Sader
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Shahram Ghanaati
- 1 Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University Frankfurt, Frankfurt am Main, Germany
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Donovan TE, Marzola R, Becker W, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP. Annual review of selected scientific literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2014; 112:1038-87. [PMID: 25443419 DOI: 10.1016/j.prosdent.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Terence E Donovan
- Chair, Committee on Scientific Investigation, American Academy of Restorative Dentistry (AARD); Professor and Section Head for Biomaterials, Department of Operative Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - William Becker
- Clinical Professor, Advanced Education in Prosthodontics, Herman Ostrow School of Dentistry, University of Southern California; private practice, Tucson, Ariz
| | - David R Cagna
- Associate Dean, Professor and Director, Advanced Prosthodontics, University of Tennessee, Health Science Center, College of Dentistry, Memphis, Tenn
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Moore SR, Milz S, Knothe Tate ML. Periosteal thickness and cellularity in mid-diaphyseal cross-sections from human femora and tibiae of aged donors. J Anat 2013; 224:142-9. [PMID: 24175932 DOI: 10.1111/joa.12133] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 11/30/2022] Open
Abstract
Due to lack of access in healthy patients, the structural properties underlying the inherent regenerative power and advanced material properties of the human periosteum are not well understood. Periosteum comprises a cellular cambium layer directly apposing the outer surface of bone and an outer fibrous layer encompassed by the surrounding soft tissues. As a first step to elucidating the structural and cellular characteristics of periosteum in human bone, the current study aims to measure cambium and fibrous layer thickness as well as cambium cellularity in human femora and tibiae of aged donors. The major and minor centroidal axes (CA) serve as automated reference points in cross-sections of cadaveric mid-diaphyseal femora and tibiae. Based on the results of this study, within a given individual, the cambium layer of the major CA of the tibia is significantly thicker and more cellular than the respective layer of the femur. These significant intraindividual differences do not translate to significant interindividual differences. Further, mid-diaphyseal periosteal measures including cambium and fibrous layer thickness and cellularity do not correlate significantly with age or body mass. Finally, qualitative observations of periosteum in amputated and contralateral or proximal long bones of the lower extremity show stark changes in layer organization, thickness, and cellularity. In a translational context, these novel data, though inherently limited by availability and accessibility of human mid-diaphyseal periosteum tissue, provide important reference values for the use of periosteum in the context of facilitated healing and regeneration of tissue.
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Affiliation(s)
- Shannon R Moore
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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Surgical Approaches Based on Biological Objectives: GTR versus GBR Techniques. Int J Dent 2013; 2013:521547. [PMID: 23843792 PMCID: PMC3697289 DOI: 10.1155/2013/521547] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/30/2013] [Accepted: 05/19/2013] [Indexed: 01/07/2023] Open
Abstract
Guided tissue regenerative (GTR) therapies are performed to regenerate the previously lost tooth supporting structure, thus maintaining the aesthetics and masticatory function of the available dentition. Alveolar ridge augmentation procedures (GBR) intend to regain the alveolar bone lost following tooth extraction and/or periodontal disease. Several biomaterials and surgical approaches have been proposed. In this paper we report biomaterials and surgical techniques used for periodontal and bone regenerative procedures. Particular attention will be adopted to highlight the biological basis for the different therapeutic approaches.
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