Periosteum as a barrier membrane in the treatment of intrabony defect: A new technique

Clinical efficacy of periosteal pedicle graft as a barrier membrane in guided tissue regeneration: A systematic review and meta-analysis

Background

The study aims to assess the clinical efficacy of periosteal pedicle graft (PPG) as a barrier membrane in guided tissue regeneration (GTR) for gingival recession, intrabony, and furcation defects.

Materials and Methods

Electronic and hand searches were performed to identify randomized controlled/clinical trials investigating GTR using PPG, with 6-month follow-up. Primary outcomes recorded: probing depth (PD), clinical attachment level (CAL), bone fill, recession depth (RD) reduction, percentage of mean root coverage, keratinized tissue width (KTW), and bone defect area (BDA).

Results

Thirteen articles were selected; 6 for recession, 2 for furcation, and 5 for intrabony. Meta-analysis was performed whenever possible, results expressed as pooled standardized mean differences (SMDs). In recession defects, the RD pooled SMD is 0.47 (95% confidence interval (CI) = [-0.50-1.44]), KTW pooled SMD is 1.30 (95% CI = [-0.30-2.91]), favoring PPG over the comparator. In furcation defects, PD pooled SMD is 1.12 (95% CI = [-2.77-0.52]), CAL pooled SMD is 0.71 (95% CI = [-1.09-2.50]), and bone fill pooled SMD is 0.67 (95% CI = [-3.34-4.69]) favoring PPG. In intrabony defects, PD pooled SMD is 0.54 (95% CI = [-2.12-1.04]), CAL pooled SMD is 0.23 (95% CI = [-1.13-0.68]), and BDA pooled SMD is 0.37 (95% CI = [-1.58-2.31]) favoring PPG. The results were not statistically significant.

Conclusion

The current evidence indicates that PPG constitutes a valid and reliable alternative to collagen barrier membranes for successful GTR.

Stem Cells in the Periodontium-Anatomically Related Yet Physiologically Diverse

Periodontitis is a complex chronic disease discernible by the deterioration of periodontal tissue. The goal of periodontal therapy is to achieve complete tissue regeneration, and one of the most promising treatment options is to harness the regenerative potential of stem cells available within the periodontal complex. Periodontal ligament stem cells, gingival mesenchymal stem cells, oral periosteal stem cells, and dental follicle stem cells have structural similarities, but their immunological responses and features differ. The qualities of diverse periodontal stem cells, their immune-modulatory effects, and variances in their phenotypes and characteristics will be discussed in this review. Although there is evidence on each stem cell population in the periodontium, understanding the differences in markers expressed, the various research conducted so far on their regenerative potential, will help in understanding which stem cell population will be a better candidate for tissue engineering. The possibility of selecting the most amenable stem cell population for optimal periodontal regeneration and the development and current application of superior tissue engineering treatment options such as autologous transplantation, three-dimensional bioengineered scaffolds, dental stem cell-derived extracellular vesicles will be explored.

Appraising and comparing the role of autogenous periosteal graft as a barrier membrane in the treatment of intrabony defects in chronic periodontitis cases: A systematic review and meta-analysis

Periodontal regeneration refers to procedures aimed at restitution of lost supporting tissue around the periodontally compromised tooth. Regenerative procedures very often include the use of barrier materials to encourage the growth of key surrounding tissues. The current study aimed to evaluate the effectiveness of autogenous periosteal graft as a barrier membrane for the treatment of intrabony defects in chronic periodontitis patients. A total of four data bases MEDLINE (by PubMed), Cochrane database, EBSCO, and Google Scholar were explored to identify the studies in English up to December 2022. An additional hand search of relevant journals was also done. A team of three independent reviewers screened the retrieved articles using the inclusion criteria. Randomized control trials (RCTs) evaluating the effectiveness of autogenous periosteal grafts in the treatment of intrabony defects in chronic periodontitis cases were included in the study. A total of six relevant articles were recognized for data procurement. A total of 117 patients with 68 sites with an age range between 18 years and 55 years were selected. Outcome variables examined were pocket depth (PD), clinical attachment level (CAL), radiographic bone defect fill (BDF), gingival recession (GR), plaque index (PI), gingival index (GI) and bleeding on probing (BOP). Data were analyzed using Revman 5.3 software. The mean differences and 95% confidence interval were used to illustrate the estimate of effect size. There is an equal effect in both groups for the PI, GI, and BOP reduction. For PD reduction, the result was in the favor of periosteal graft with open flap debridement (OFD) group. For CAL gain, radiographic BDF and GR, results also favored the periosteal graft, but no statistically significant difference was found amongst the groups. Within the limitation of the study, it seems that the autogenous periosteal graft can be used successfully along with OFD to treat intrabony defects in chronic periodontitis patients.

Functionally graded membrane: A novel approach in the treatment of gingival recession defects

Background:

Guided tissue regeneration has recently been advocated in re-constructing soft-tissue dimensions in recession defects. Advancement in nanotechnology has led to increased zest for approaches such as electrospinning of biologically active; nanofibrous functionally graded regenerative membranes for periodontal tissue engineering. A functionally graded membrane (FGM) had been tailored by incorporating chitosan and nano-hydroxyapatite over Amnion membrane and used in gingival recession defects.

Study Design:

It was single-blind, randomized controlled study. Split-mouth study was conducted in nine patients and 22 sites with recession defects were selected. Sites were divided into Group A (Amnion membrane with coronal advanced flap) and Group B (FGM with coronal advanced flap).

Materials and Methods:

Sites were assessed clinically by recording plaque index (PI), gingival index (GI), vertical recession defect depth (VRDD), relative clinical attachment level (CAL), and width of keratinized tissue at baseline, 3–6 months; and radiographically by recording linear bone growth by dentascan at baseline and 6 months.

Result:

Both groups showed statistically significant reduction in PI, GI and VRDD, and CAL and nonsignificant reduction in width of keratinized tissue at 3 and 6 months postoperatively. Group A showed statistically significant linear bone growth at 6 months. Group B also showed gain in linear bone growth at 6 months; however, result was statistically nonsignificant.

Conclusion:

FGM had shown favorable results by enhancing bone growth while preventing the gingival tissue downgrowth.

Osteogenic Potential of Human Oral-Periosteal Cells (PCs) Isolated From Different Oral Origin: An In Vitro Study

The periosteum is a specialized connective tissue containing multipotent stem cells capable of bone formation. In this study, we aimed at demonstrating that human oral periosteal cells derived from three different oral sites (upper vestibule, lower vestibule, and hard palate) represent an innovative cell source for maxillo-facial tissue engineering applications in terms of accessibility and self-commitment towards osteogenic lineage. Periosteal cells (PCs) were isolated from patients with different ages (20-30 yy, 40-50 yy, 50-60 yy); we then analyzed the in vitro proliferation capacity and the bone self-commitment of cell clones culturing them without any osteogenic supplement to support their differentiation. We found that oral PCs, independently of their origin and age of patients, are mesenchymal stem cells with stem cell characteristics (clonogenical and proliferative activity) and that, even in absence of any osteogenic induction, they undertake the osteoblast lineage after 45 days of culture. These results suggest that oral periosteal cells could replace mesenchymal cells from bone marrow in oral tissue-engineering applications.