Clinical and radiographic evaluation of human periodontal osseous defect (mandibular grade II furcation) treated with PepGen P-15 and a bioresorbable membrane (Atrisorb)

Comparison of the clinical efficacy of bone grafting and bone grafting combined with guided tissue regeneration in periodontal regenerative therapy: a meta-analysis

OBJECTIVE

This study aims to compare the clinical efficacy of simple bone grafting and bone grafting combined with guided tissue regeneration (GTR) in periodontal regenerative therapy.

METHODS

The authors systematically searched PubMed, the Web of Science, The National Library of Medicine, the China National Knowledge Infrastructure database and the Wanfang database and collected randomized controlled trials relating to bone graft co-guided tissue regeneration. The retrieval was conducted between January 1990 and December 2022. This study included relevant literature about the clinical efficacy of bone grafting combined with GTR according to the population, intervention, control and outcomes principle and excluded studies using other materials in addition to bone graft and membrane materials. After independently screening the literature, extracting the data and evaluating the risk of bias in the included studies, data analysis was performed using RevMan 5.3 software.  Results: Eighteen studies met the inclusion criteria, and, after further evaluation, a total of 327 teeth that were featured in 15 articles were finally included for meta-analysis. The meta-analysis showed that there was no significant statistical difference in clinical attachment level, probing depth and bone gain between the test group (bone grafting with GTR) and the control group (bone grafting only) at 6 months after the operation (p > 0.05). In terms of gingival recession (GR), the use of non-resorbable membranes produced more recession in the test group compared with the control group (p < 0.05), whereas the use of resorbable membranes produced less recession (p < 0.05).

CONCLUSION

Both simple bone grafting and bone grafting combined with membrane materials have good clinical efficacy in periodontal regenerative therapy, and no significant difference in clinical efficacy is indicated between the two, with the exception of GR.

Bone replacement grafts with guided tissue regeneration in treatment of grade II furcation defects: a systematic review and meta-analysis

AIM

The present systematic review appended with meta-analysis aimed to evaluate the efficacy of bone replacement graft (BRG) with guided tissue regeneration (GTR) over BRG or open flap debridement (OFD) alone in the treatment of grade II furcation defects.

MATERIALS AND METHODS

An electronic literature search of PubMed, Cochrane Library and Google Scholar databases accompanied with manual searching was done. Randomized controlled trials (RCTs) up to October 2019, comparing BRG+GTR with BRG or OFD in grade II furcation defects, were identified. Clinical attachment level (CAL) gain, changes in gingival marginal level (GML), vertical defect fill (VDF), horizontal defect fill (HDF) and reduction in defect volume were the outcome parameters.

RESULTS

Of a total of 12, 9 studies compared BRG+GTR vs BRG while 3 compared BRG+GTR vs OFD. Meta-analysis was carried out for CAL gain, VDF, HDF and GML changes. In the BRG+GTR vs BRG comparison group, out of 9 studies, 6 RCTs showed standardized mean difference (SMD) of 0.513 for VDF, 9 RCTs showed SMD of 0.83 for HDF and 2 RCTs showed SMD of 0.651 for CAL gain, whereas only 2 studies in the same group reported reduction in defect volume. Three studies of the BRG+GTR vs OFD group exhibited significant VDF and CAL gain with SMD of 2.002 and 1.161 respectively. However, no significant change was recorded for GML in both groups.

CONCLUSION

The present systematic review indicates supplemental benefits of combination therapy of BRG+GTR over monotherapy in resolving grade II furcation defects.

CLINICAL RELEVANCE

In our quest to achieve maximum regeneration in grade II furcation defects, combination therapies such as BRG+GTR have been accepted as treatment choices over other modalities. Clinical situations warranting near-complete regeneration of the tissues in such defects are better suited for combination therapies.

Clinical effectiveness of anorganic bovine-derived hydroxyapatite matrix/cell-binding peptide grafts for regeneration of periodontal defects: a systematic review and meta-analysis

Aim: To ascertain clinical effectiveness of anorganic bovine-derived hydroxyapatite matrix/cell-binding peptide (ABM/P-15) for regeneration of periodontal defects. Materials & methods: Electronic databases (National Library of Medicine [Medline by PubMed], Cochrane Library [Wiley], CINAHL [EBSCO] and Medline [EBSCO]) were systematically searched up to December 2019. Randomized controlled clinical trials comparing ABM/P-15 grafts to conventional surgery for intrabony and gingival recession defects were included and evaluated intrabony defects including clinical attachment level (CAL), probing depth and gingival recession. Results: A significant gain in CAL (1.37 mm), and reduction in probing depth (1.22 mm) were shown by ABM/P-15 grafts than open flap debridement (p < 0.00001). The subgroup analysis also showed better results for ABM/P-15 grafts in CAL gain for intrabony defects. For furcation and gingival recession defects, no significant difference was seen. Conclusion: The adjunct use of ABM/P-15 grafts in conventional periodontal surgery is useful for periodontal regeneration of intrabony defects.

Evaluation of Efficacy of Surgical Periodontal Therapy with the Use of Bone Graft in the Treatment of Periodontal Intrabony Defects

INTRODUCTION

One of the most important goals of periodontitis therapy is the elimination of deep periodontal pockets. In regenerative periodontal therapy, different types of bone grafts, membranes, growth factors, etc. are used to improve regeneration of lost periodontal tissue. The aim of this study was to evaluate the effect of surgical therapy supported by the use of bone replacement material in the treatment of deep intrabony pockets, compared to surgical treatment (flap surgery) without the use of bone replacement in advanced periodontitis.

METHODS AND MATERIALS

The study included 50 patients of both sexes with advanced periodontitis, divided into two groups. After initial periodontal therapy was performed, plaque index (PI), papillary bleeding index (PBI) were verified, and depth of periodontal pockets was measured in both groups. One group (group 1) of the patients underwent surgical therapy, open flap surgery, while the other group (group 2) underwent the same surgical treatment method (open flap surgery), during which bone defects were filled with bone replacement material.

RESULTS

The results showed that both group 1 and group 2 experienced improvements after periodontal surgical therapy. In group 1, there are no statistically significant changes in all three plaque index measurements (PI), while there has been a significant reduction in PI in group 2 following the surgery. For the PBI index, it was determined that there were statistically significant changes in values in group 1, both after surgical procedures and six months later, as well as in group 2. Statistical analysis of the results of the probing depth of pockets has shown that there are significant changes in the measurement of the depth of periodontal pocket one month after the surgery, as well as six months later, meaning that there has been a significant reduction in the depth of the periodontal pocket one month following the surgery as well as six months later, for both groups. However, we did not determine a statistically significant difference in the probing depth of pockets between these two groups.

CONCLUSION

Six months after a surgical therapy, clinical parameters showed a reduction of the probing depth of the periodontal pocket in both examined groups. The use of bone replacement did not yield significantly better results in reducing the depth of probing compared to the standard flap surgery. We believe that future research should focus on testing the effectiveness of new regenerative methods and materials (bone replacements with various properties, membranes, and surgical methods) that will result in better treatment results with predictable outcomes.

Evaluation of anorganic bovine-derived hydroxyapatite matrix/cell binding peptide as a bone graft material in the treatment of human periodontal infrabony defects: A clinico-radiographic study

Background:

Various bone graft materials have been used in the treatment of periodontal defects. A synthetic bone substitute material composed of P-15 with anorganic bone mineral has been scantly studied. Hence, the present study was aimed to evaluate and compare the efficacy of anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) in human periodontal infrabony defects with that of open flap debridement (OFD) alone.

Materials and Methods:

A split-mouth, randomized controlled clinical study was designed to investigate the efficacy of ABM/P-15. In this clinical trial, 10 patients having bilateral periodontal infrabony defects were treated either with ABM/P-15 or OFD and followed for a period of 9 months. At baseline and at 9 months probing pocket depth (PPD), relative attachment level (RAL), depth of a defect, and radiographic bone level were measured; and compared between test and control sites.

Results:

A statistically significant reduction (P < 0.001) in PPD was observed in test sites compared to control sites. Both sites showed a gain in RAL without any significant difference. Similarly, the radiographic evaluation revealed significantly higher radiographic defect fill in test sites as compared to control sites (P < 0.001).

Conclusion:

ABM/P-15 bone graft material appears to be useful and beneficial in the treatment of human periodontal infrabony defects.