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Friedmann A, Liedloff P, Eliezer M, Brincat A, Ostermann T, Diehl D. Reconstructive Approach in Residual Periodontal Pockets with Biofunctionalized Heterografts-A Retrospective Comparison of 12-Month Data from Three Centers. J Funct Biomater 2024; 15:39. [PMID: 38391892 PMCID: PMC10889411 DOI: 10.3390/jfb15020039] [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: 12/28/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
The regenerative capacity of well-preserved blood clots may be enhanced by biologics like enamel matrix derivative (EMD). This retrospective analysis compares outcomes reported by three centers using different heterografts. Center 1 (C1) treated intrabony defects combining cross-linked high-molecular-weight hyaluronic acid (xHyA) with a xenograft; center 2 (C2) used EMD with an allograft combination to graft a residual pocket. Center 3 (C3) combined xHyA with the placement of a resorbable polymer membrane for defect cover. Clinical parameters, BoP reduction, and radiographically observed defect fill at 12-month examination are reported. The 12-month evaluation yielded significant improvements in PPD and CAL at each center (p < 0.001, respectively). Analyses of Covariance revealed significant improvements in all parameters, and a significantly greater CAL gain was revealed for C2 vs. C1 (p = 0.006). Radiographic defect fill presented significantly higher scores for C2 and C3 vs. C1 (p = 0.003 and = 0.014; C2 vs. C3 p = 1.00). Gingival recession increased in C1 and C3 (p = 1.00), while C2 reported no GR after 12 months (C2:C1 p = 0.002; C2:C3 p = 0.005). BoP tendency and pocket closure rate shared similar rates. Within the limitations of the study, a data comparison indicated that xHyA showed a similar capacity to enhance the regenerative response, as known for EMD. Radiographic follow-up underlined xHyA's unique role in new attachment formation.
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Affiliation(s)
- Anton Friedmann
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany
| | - Pheline Liedloff
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany
| | | | - Arthur Brincat
- Independent Researcher, 83000 Toulon, France
- Department of Periodontology, Service of Odontology, AP-HM, UFR of Odontology, Aix-Marseille University, 13005 Marseille, France
| | - Thomas Ostermann
- Department of Psychology, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Daniel Diehl
- Department of Periodontology, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany
- Institute of Pharmacology and Toxicology, Faculty of Health, Witten/Herdecke University, 58453 Witten, Germany
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Tavelli L, Barootchi S, Rasperini G, Giannobile WV. Clinical and patient-reported outcomes of tissue engineering strategies for periodontal and peri-implant reconstruction. Periodontol 2000 2023; 91:217-269. [PMID: 36166659 PMCID: PMC10040478 DOI: 10.1111/prd.12446] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/25/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
Scientific advancements in biomaterials, cellular therapies, and growth factors have brought new therapeutic options for periodontal and peri-implant reconstructive procedures. These tissue engineering strategies involve the enrichment of scaffolds with living cells or signaling molecules and aim at mimicking the cascades of wound healing events and the clinical outcomes of conventional autogenous grafts, without the need for donor tissue. Several tissue engineering strategies have been explored over the years for a variety of clinical scenarios, including periodontal regeneration, treatment of gingival recessions/mucogingival conditions, alveolar ridge preservation, bone augmentation procedures, sinus floor elevation, and peri-implant bone regeneration therapies. The goal of this article was to review the tissue engineering strategies that have been performed for periodontal and peri-implant reconstruction and implant site development, and to evaluate their safety, invasiveness, efficacy, and patient-reported outcomes. A detailed systematic search was conducted to identify eligible randomized controlled trials reporting the outcomes of tissue engineering strategies utilized for the aforementioned indications. A total of 128 trials were ultimately included in this review for a detailed qualitative analysis. Commonly performed tissue engineering strategies involved scaffolds enriched with mesenchymal or somatic cells (cell-based tissue engineering strategies), or more often scaffolds loaded with signaling molecules/growth factors (signaling molecule-based tissue engineering strategies). These approaches were found to be safe when utilized for periodontal and peri-implant reconstruction therapies and implant site development. Tissue engineering strategies demonstrated either similar or superior clinical outcomes than conventional approaches for the treatment of infrabony and furcation defects, alveolar ridge preservation, and sinus floor augmentation. Tissue engineering strategies can promote higher root coverage, keratinized tissue width, and gingival thickness gain than scaffolds alone can, and they can often obtain similar mean root coverage compared with autogenous grafts. There is some evidence suggesting that tissue engineering strategies can have a positive effect on patient morbidity, their preference, esthetics, and quality of life when utilized for the treatment of mucogingival deformities. Similarly, tissue engineering strategies can reduce the invasiveness and complications of autogenous graft-based staged bone augmentation. More studies incorporating patient-reported outcomes are needed to understand the cost-benefits of tissue engineering strategies compared with traditional treatments.
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Affiliation(s)
- Lorenzo Tavelli
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
| | - Shayan Barootchi
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- IRCCS Foundation Polyclinic Ca’ Granda, University of Milan, Milan, Italy
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The efficiency of the regeneration of periodontal intrabony defects in East Asians: A systematic review and pooled analysis. J Dent Sci 2023; 18:1-8. [PMID: 36643225 PMCID: PMC9831819 DOI: 10.1016/j.jds.2022.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
This article aimed to assess the efficacy of periodontal regenerative therapy (PRT) for treating periodontal intrabony defects in East Asians. The systematic review was performed according to the PRISMA guidelines. Literature searches on the PubMed and national medical journal databases, and representative clinical journals of the East Asians were performed on July 31, 2018. Randomized controlled trials, prospective case-control studies, retrospective analyses, and case series receiving regenerative procedures, including barrier membrane (BM) and enamel matrix derivative (EMD) applications with or without bone replacement graft (BRG), with follow-up periods of 6 and 12 months were evaluated. The outcome variables were probing depth (PD) reduction and clinical attachment level (CAL) gain. Twenty studies were included, of which eight were assessed for bias risk. Compared to open flap debridement, PD reduction and CAL gain were superior in all PRTs at both follow-up time points. BM or EMD alone showed equivalent outcomes at 6 months, and CAL gain appeared greater with BM alone at 12 months. BM with BRG showed inferior CAL gain relative to BM alone, but EMD with BRG showed superior CAL gain relative to EMD alone at 12 months. In conclusion, PRT showed improved regenerative outcomes compared with OFD in East Asians, while BM application appeared less efficient than in non-East Asians. BRG supplementation provided additional clinical benefits in EMD application.
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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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Chen JT, Wu IT, Huang RY, Lin YC, Chou YH, Lin T, Kuo PJ, Tu CC, Hou LT, Lai YL, Lu HK, Tsai CC, Yuan K, Chen CJ, Ho CS, Yang YC, Wu AYJ, Huang KC, Chiang CY, Chang PC. Recommendations for treating stage I-III periodontitis in the Taiwanese population: A consensus report from the Taiwan Academy of Periodontology. J Formos Med Assoc 2021; 120:2072-2088. [PMID: 34294496 DOI: 10.1016/j.jfma.2021.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE Based on the fundamental of the S3-level clinical practice guideline (CPG) for treating stage I-III periodontitis developed by the European Federation of Periodontology (EFP), this consensus report aimed to develop treatment recommendations for treating periodontitis in the Taiwanese population. METHODS The report was constructed by experts from the Taiwan Academy of Periodontology. The following topics were reviewed: (a) the prevalence of periodontitis in Asia and current status of treatment in Taiwan; (b) specific anatomical considerations for treating periodontitis in Asians; (d) educational and preventive interventions and supragingival plaque control; (d) subgingival instrumentation and adjunctive treatment; (e) surgical periodontal therapy; and (f) maintenance and supportive periodontal care. Recommendations were made according to the evidences from the EFP CPG, the published literature and clinical studies in Asians, and the expert opinions. RESULTS The treatment recommendations for the Taiwanese population were generally in parallel with the EFP CPG, and extra cautions during treatment and maintenance phases were advised due to the anatomical variations, such as shorter root trunk, higher prevalence of supernumerary distolingual root and lingual bony concavity in mandibular posteriors, and thinner anterior labial plate, of the Asian population. CONCLUSION The EFP CPG could be adopted for treating periodontitis and maintaining periodontal health of the Taiwanese population, and anatomical variations should be cautious when the treatment is delivered.
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Affiliation(s)
- Jung-Tsu Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Ting Wu
- Department of Dentistry, China Medical University Hospital, Taichung, Taiwan
| | - Ren-Yeong Huang
- School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Chun Lin
- Department of Dentistry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hsiang Chou
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Taichen Lin
- School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Po-Jan Kuo
- School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Che-Chang Tu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Lein-Tuan Hou
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Lin Lai
- Department of Dentistry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsein-Kun Lu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chi-Cheng Tsai
- School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Kuo Yuan
- Institute of Oral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Jung Chen
- Department of Dentistry, Chi-Mei Medical Center, Tainan, Taiwan
| | | | - Yueh-Chao Yang
- Department of Dentistry, Cathay General Hospital, Taipei, Taiwan
| | - Aaron Yu-Jen Wu
- Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Cheng-Yang Chiang
- School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Chun Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
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Stavropoulos A, Bertl K, Spineli LM, Sculean A, Cortellini P, Tonetti M. Medium- and long-term clinical benefits of periodontal regenerative/reconstructive procedures in intrabony defects: Systematic review and network meta-analysis of randomized controlled clinical studies. J Clin Periodontol 2021; 48:410-430. [PMID: 33289191 PMCID: PMC7986220 DOI: 10.1111/jcpe.13409] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 10/26/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Systematic reviews have established the short-term improvements of periodontal regenerative/reconstructive procedures compared to conventional surgical treatment in intrabony defects. However, a hierarchy of periodontal regenerative/reconstructive procedures regarding the medium- to long-term results of treatment does not exist. AIM To systematically assess the literature to answer the focused question "In periodontitis patients with intrabony defects, what are the medium- and long-term benefits of periodontal regenerative/reconstructive procedures compared with open flap debridement (OFD), in terms of clinical and/or radiographic outcome parameters and tooth retention?". MATERIAL & METHODS Randomized controlled clinical trials (RCTs), reporting on clinical and/or radiographic outcome parameters of periodontal regenerative/reconstructive procedures ≥3 years post-operatively, were systematically assessed. Clinical [residual probing pocket depth (PD) and clinical attachment level (CAL) gain, tooth loss] and radiographic [residual defect depth (RDD), bone gain (RBL)] outcome parameters were assessed. Descriptive statistics were calculated, and Bayesian random-effects network meta-analyses (NMA) were performed where possible. RESULTS Thirty RCTs, presenting data 3 to 20 years after treatment with grafting, GTR, EMD, as monotherapies, combinations thereof, and/or adjunctive use of blood-derived growth factor constructs or with OFD only, were included. NMA based on 21 RCTs showed that OFD was clearly the least efficacious treatment; regenerative/reconstructive treatments resulted in significantly shallower residual PD in 4 out 8 comparisons [range of mean differences (MD): -2.37 to -0.60 mm] and larger CAL gain in 6 out 8 comparisons (range of MD: 1.26 to 2.66 mm), and combination approaches appeared as the most efficacious. Tooth loss after regenerative/reconstructive treatment was less frequent (0.4%) compared to OFD (2.8%), but the evidence was sparse. There were only sparse radiographic data not allowing any relevant comparisons. CONCLUSION Periodontal regenerative/reconstructive therapy in intrabony defects results, in general, in shallower residual PD and larger CAL gain compared with OFD, translating in high rates of tooth survival, on a medium (3-5 years) to long-term basis (5-20 years). Combination approaches appear, in general, more efficacious compared to monotherapy in terms of shallower residual PD and larger CAL gain. A clear hierarchy could, however, not be established due to limited evidence.
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Affiliation(s)
- Andreas Stavropoulos
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland.,Department of Periodontology, Faculty of Odontology, University of Malmö, Sweden.,Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Austria
| | - Loukia M Spineli
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Switzerland
| | | | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPERIO), Genova, Italy.,Department of Oral and Maxillofacial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Centre of Stomatology, Shanghai 9th People Hospital, School of Medicine Shanghai, Jiao Tong University, Shanghai, China
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Tsai S, Ding Y, Shih M, Tu Y. Systematic review and sequential network meta‐analysis on the efficacy of periodontal regenerative therapies. J Clin Periodontol 2020; 47:1108-1120. [DOI: 10.1111/jcpe.13338] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/21/2020] [Accepted: 06/20/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Shang‐Jie Tsai
- Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan
- Department of Medical Research National Taiwan University Hospital National Taiwan University Taipei Taiwan
| | - Yu‐Wei Ding
- Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan
| | - Ming‐Chieh Shih
- Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan
| | - Yu‐Kang Tu
- Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan
- Department of Medical Research National Taiwan University Hospital National Taiwan University Taipei Taiwan
- Department of Dentistry National Taiwan University Hospital National Taiwan University Taipei Taiwan
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Iwata M, Saito A, Kuroda Y, Shinohara T, Tanaka E. Interdisciplinary therapy for severe periodontitis with Angle Class II Division 1 malocclusion: A case report with 7-year follow-up. J Am Dent Assoc 2019; 150:960-971. [PMID: 31668173 DOI: 10.1016/j.adaj.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/26/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OVERVIEW Previous studies have suggested that occlusal discrepancy is a risk factor contributing to periodontal disease. Occlusal discrepancy could increase the risk of developing infrabony defects. The authors present a case of a patient with severe periodontitis who exhibited many infrabony defects in the molar region due to malocclusion-induced trauma. They report the 7-year treatment outcomes of the patient after periodontal regenerative and comprehensive orthodontic therapies for functional recovery with implant prosthodontics. CASE DESCRIPTION A 56-year-old woman sought treatment with the chief symptom of masticatory disturbance. In the molar region, excessive tooth mobility, deep periodontal pockets, and infrabony defects were observed. She had excessive overjet, resulting in collapse of anterior guidance. Malocclusion was considered to be an exacerbating factor of the infrabony defects. After initial periodontal therapy, the authors performed periodontal regenerative therapy in the mandibular molar regions. The authors carefully placed implants in a position in the maxillary molar region that would ensure an appropriate anterior dental relationship after orthodontic treatment. Comprehensive orthodontic treatment was subsequently performed, using implants as anchoring units. Definitive surgery was then performed on the mandibular molars before placing the final prosthesis. Favorable periodontal condition and stable occlusion have been maintained for the 7-year posttreatment period. CONCLUSIONS AND PRACTICAL IMPLICATIONS Comprehensive and interdisciplinary treatment enables stable occlusion and establishment of periodontal and peri-implant tissues with high cleansability, even in patients with severe periodontitis and malocclusion. In this case, a favorable long-term treatment outcome can be expected.
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Li M, Liu J, Cui X, Sun G, Hu J, Xu S, Yang F, Zhang L, Wang X, Tang P. Osteogenesis effects of magnetic nanoparticles modified-porous scaffolds for the reconstruction of bone defect after bone tumor resection. Regen Biomater 2019; 6:373-381. [PMID: 31827889 PMCID: PMC6897341 DOI: 10.1093/rb/rbz019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/12/2019] [Accepted: 05/23/2019] [Indexed: 12/29/2022] Open
Abstract
The treatment of bone defect after bone tumor resection is a great challenge for orthopedic surgeons. It should consider that not only to inhibit tumor growth and recurrence, but also to repair the defect and preserve the limb function. Hence, it is necessary to find an ideal functional biomaterial that can repair bone defects and inactivate tumor. Magnetic nanoparticles (MNPs) have its unique advantages to achieve targeted hyperthermia to avoid damage to surrounding normal tissues and promote osteoblastic activity and bone formation. Based on the previous stage, we successfully prepared hydroxyapatite (HAP) composite poly(lactic-co-glycolic acid) (PLGA) scaffolds and verified its good osteogenic properties, in this study, we produced an HAP composite PLGA scaffolds modified with MNPs. The composite scaffold showed appropriate porosity and mechanical characteristics, while MNPs possessed excellent magnetic and thermal properties. The cytological assay indicated that the MNPs have antitumor ability and the composite scaffold possessed good biocompatibility. In vivo bone defect repair experiment revealed that the composite scaffold had good osteogenic capacity. Hence, we could demonstrate that the composite scaffolds have a good effect in bone repair, which could provide a potential approach for repairing bone defect after bone tumor excision.
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Affiliation(s)
- Ming Li
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianheng Liu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiang Cui
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China
| | - Guofei Sun
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianwei Hu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China
| | - Sijia Xu
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Fei Yang
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Licheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiumei Wang
- State Key Laboratory of New Ceramics and Fine Processing, School of Materials Science and Engineering, Tsinghua University, Beijing 100084, China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China
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SEZGIN Y, URAZ A, TANER IL, ÇULHAOĞLU R. Effects of platelet-rich fibrin on healing of intra-bony defects treated with anorganic bovine bone mineral. Braz Oral Res 2017; 31:e15. [DOI: 10.1590/1807-3107bor-2017.vol31.0015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/08/2016] [Indexed: 11/22/2022] Open
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11
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Ge J, Yang C, Zheng J, Hu Y. Autogenous bone grafting for treatment of osseous defect after impacted mandibular third molar extraction: A randomized controlled trial. Clin Implant Dent Relat Res 2016; 19:572-580. [PMID: 27933720 DOI: 10.1111/cid.12466] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 09/17/2016] [Accepted: 10/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Extraction of impacted mandibular third molar (M3) has been cited as causing osseous defect at the distal aspect of the adjacent second molar (M2). PURPOSE This randomized controlled trial was aimed to evaluate the effect of autogenous bone grafting in situ for regeneration of periodontal osseous defect distal to the M2 compared with non-grafting after impacted M3 removal. MATERIALS AND METHODS A total of 60 sites in 51 adult patients were enrolled and randomly assigned to the control group or the test group. In both groups, the M3 was extracted using a piezosurgical device, and the distal root surface of M2 was scaled and root planned. In addition, the removed alveolar bone was grinded to particles and grafted to the distal osseous defect of M2 in the test group. The primary outcome variable was the osseous defect depth (ODD), the secondary outcome variables were probing pocket depth (PD) and clinical attachment level (CAL) on the disto-buccal aspect of the M2 during a 12-month follow-up period. Postoperative symptom at 7-day postoperatively and adverse events were also recorded and analyzed. RESULTS The patient characteristics were homogeneous between the 2 groups. Six and 12 months after surgery, there were statistically significant bone fill in both groups (P < .01). Moreover, the ODD and CAL in the test group were significantly lower than the control group at every postoperative re-entry (P < .01). The postoperative symptom was more severe in the test group than the control group, but the difference was not significant (P > .05). CONCLUSIONS The result of this study demonstrated that scaling and root planning was beneficial to periodontal healing of M2 after impacted M3 extraction. Addition of autogenous bone grafting for the treatment of osseous defects distal to M2 was safe and more effective than periodontal treatment alone. (Registry Number: ChiCTR-IOC-15006561).
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Affiliation(s)
- Jing Ge
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC
| | - Chi Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC
| | - Jiawei Zheng
- Department of Oral-maxillofacial Head and Neck Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC
| | - Yingkai Hu
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medical; Shanghai Key Laboratory of Stomatology, Shanghai, PRC
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Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, Donos N, Lyngstadaas SP, Deschner J, Dard M, Stavropoulos A, Zhang Y, Trombelli L, Kasaj A, Shirakata Y, Cortellini P, Tonetti M, Rasperini G, Jepsen S, Bosshardt DD. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol 2016; 43:668-83. [PMID: 26987551 DOI: 10.1111/jcpe.12546] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 12/27/2022]
Abstract
BACGROUND On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20 years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarström demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibres, and new alveolar bone formation. This pioneering work and vision by Lars Hammarström has paved the way to an enormous amount of publications related to its biological basis and clinical use. Twenty years later, it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium. AIMS This review article aims to: (1) provide the biological background necessary to understand the rational for the use of EMD for periodontal regeneration, (2) present animal and human histological evidence of periodontal regeneration following EMD application, (3) provide clinically relevant indications for the use of EMD and (4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, Nova Southeastern University, Fort Lauderdale, Florida, USA.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - David L Cochran
- Department of Periodontics, Dental School, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stuart Froum
- Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlos Nemcovsky
- Department of Periodontology and Dental Implantology, Dental School, Tel-Aviv University, Tel-Aviv, Israel
| | - Nikos Donos
- Department of Periodontology, Queen Marry University of London, London, UK
| | | | - James Deschner
- Section of Experimental Dento-Maxillo-Facial Medicine, University of Bonn, Bonn, Germany
| | - Michel Dard
- New York University, College of Dentistry, New York, NY, USA
| | | | - Yufeng Zhang
- Department of Oral Implantology, Wuhan University, Wuhan, China
| | - Leonardo Trombelli
- Department of Periodotology, Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Adrian Kasaj
- Department of Operative Dentistry and Periodontology, University Medical Center, Mainz, Germany
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPerio), Genova, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Foundation IRCCS Ca' Granda Polyclinic, Milan, Italy
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, 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 2015; 114:756-809. [PMID: 26611624 DOI: 10.1016/j.prosdent.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Terence E Donovan
- Chair, Committee on Scientific Investigation, American Academy of Restorative Dentistry (AARD); and Professor and Chair for Biomaterials, Department of Operative Dentistry, University of North Carolina School of Dentistry at Chapel Hill, NC.
| | - Riccardo Marzola
- Adjunct Professor, Fixed Implant Prosthodontics, University of Bologna; and Private practice, Ferrara, Italy
| | - William Becker
- Clinical Professor, Advanced Education in Prosthodontics, Herman Ostrow School of Dentistry, Los Angeles, Calif
| | - David R Cagna
- Associate Dean, Professor and Director, Advanced Prosthodontics, University of Tennessee Health Sciences Center, Memphis, Tenn
| | - Frederick Eichmiller
- Vice President and Dental Director, Delta Dental of Wisconsin, Stevens Point, Wisc
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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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