Effectiveness of porcine-derived xenograft with enamel matrix derivative for periodontal regenerative treatment of intrabony defects associated with a fixed dental prosthesis: a 2-year follow-up retrospective study

Does defect configuration affect the outcomes of alveolar ridge preservation? An experimental in vivo study

PURPOSE

The purpose of this study was to compare the bone healing potential of 1-, 2-, and 3-wall defects following alveolar ridge preservation (ARP) treatment, as well as to evaluate the efficacy of ARP as a treatment option for destructive sites.

METHODS

Three groups, characterized by 1-, 2-, and 3-wall defects, were randomly assigned to the maxillary second, third, and fourth premolars in each of 8 beagle dogs. Each defect was created at either the mesial or distal root site of the tooth, which was hemi-sectioned and extracted. The contralateral root was preserved to superimpose with the experimental site for histomorphometric analysis. For each site, either spontaneous healing (SH; control) or ARP (test intervention) was randomly applied. Each group was divided in half and underwent a healing period of either 4 or 12 weeks. The Mann-Whitney U test and Kruskal-Wallis test were used for histomorphometric analyses. Statistical significance was set at P<0.05.

RESULTS

Qualitative analysis revealed a higher percentage of new bone in the apical area compared to the coronal area, regardless of defect type and healing period. In quantitative analysis, the 3-wall defect exhibited a significantly higher percentage of mineralization in the ARP group after 12 weeks of healing (ARP: 61.73%±7.52%; SH: 48.84%±3.06%; P=0.029). An increased percentage of mineralization was observed with a greater number of remaining bony walls, although this finding did not reach statistical significance.

CONCLUSIONS

Within the limitations of this study, ARP treatment for compromised sockets appears to yield a higher percentage of mineralization compared to SH. Although the effectiveness of the remaining bony walls was limited, their presence appeared to improve the percentage of mineralization in ARP treatment.

Long-term results of regenerative treatment of intrabony defects: a cohort study with 5-year follow-up

BACKGROUND

The aim of this retrospective cohort study was to evaluate the long-term clinical and radiographic outcomes and survival of teeth in periodontal regenerative treatment of intrabony defects using combined enamel matrix protein derivative (EMD) and deproteinized porcine bone mineral (DPBM) compared to EMD alone.

METHODS

A total of 333 intrabony defects in 176 patients (mean age: 54.7 ± 8.9 years) were followed-up for 58.6 ± 11.2 (range, 25-78) months after periodontal regenerative treatment. Changes in clinical (pocket probing depth and clinical attachment level) and radiographic (defect depth and defect width) parameters were analyzed using serial periapical radiographs. Kaplan-Meier and multivariate Cox proportional-hazards regression analyses for tooth loss were also performed.

RESULTS

Compared to periodontal surgery with EMD alone with a mean follow-up of 5 years, combined EMD and DPBM showed significantly better gain in clinical attachment level (EMD and DPBM: 2.8 ± 2.3 mm vs. EMD alone: 2.2 ± 2.2 mm) and reduction in probing pocket depth (EMD and DPBM: 2.8 ± 1.8 mm vs. EMD alone: 2.3 ± 1.8 mm), defect depth (EMD and DPBM: 2.5 ± 2.4 mm vs. EMD alone: 2.0 ± 2.4 mm) and defect width (EMD and DPBM: 0.6 ± 1.0 mm vs. EMD alone: 0.2 ± 1.3 mm). The overall survival rates of the teeth were 91.48% and 95.20% in the patient- and tooth-based analyses, respectively, showing no statistically significant difference.

CONCLUSIONS

Within the limitations of the current study, combined EMD and DPBM offered additional clinical and radiographic benefits over a mean of 5 years compared to EMD alone. However, tooth loss did not differ significantly between the two groups.

CLINICAL RELEVANCE

Compared to EMD alone, combined EMD and DPBM for intrabony defects has additional clinical advantages; however, patient- and tooth-related risk factors must be considered when performing periodontal regenerative surgery.

Porcine-derived soft block bone substitutes for the treatment of severe class II furcation-involved mandibular molars: a prospective controlled follow-up study

PURPOSE

No evidence exists regarding the advantages of periodontal regeneration treatment for furcation defects using soft block bone substitutes. Therefore, this randomized controlled trial aimed to assess the clinical and radiographic outcomes of regenerative therapy using porcine-derived soft block bone substitutes (DPBM-C, test group) compared with porcine-derived particulate bone substitutes (DPBM, control group) for the treatment of severe class II furcation defects in the mandibular molar regions.

METHODS

Thirty-five enrolled patients (test group, n=17; control group, n=18) were available for a 12-month follow-up assessment. Clinical (probing pocket depth [PPD] and clinical attachment level [CAL]) and radiographic (vertical furcation defect; VFD) parameters were evaluated at baseline and 6 and 12 months after regenerative treatment. Early postoperative discomfort (severity and duration of pain and swelling) and wound healing outcomes (dehiscence, suppuration, abscess formation, and swelling) were also assessed 2 weeks after surgery.

RESULTS

For both treatment modalities, significant improvements in PPD, CAL, and VFD were found in the test group (PPD reduction of 4.1±3.0 mm, CAL gain of 4.4±2.9 mm, and VFD reduction of 4.1±2.5 mm) and control group (PPD reduction of 2.7±2.0 mm, CAL gain of 2.0±2.8 mm, and VFD reduction of 2.4±2.5 mm) 12 months after the regenerative treatment of furcation defects (P<0.05). However, no statistically significant differences were found in any of the measured clinical and radiographic parameters, and no significant differences were observed in any early postoperative discomfort and wound healing outcomes between the 2 groups.

CONCLUSIONS

Similar to DPBM, DPBM-C showed favorable clinical and radiographic outcomes for periodontal regeneration of severe class II furcation defects in a 12-month follow-up period.

TRIAL REGISTRATION

Clinical Research Information Service Identifier: KCT0007305.

Alveolar ridge preservation of damaged or periodontally compromised extraction sockets with bovine- and porcine-derived block bone substitutes: A retrospective case-control study

PURPOSE

Alveolar ridge preservation (ARP) was introduced to minimize postextraction alveolar bone loss and extraction socket remodeling; however, current knowledge of the ARP procedure for nonintact extraction sockets is still limited and inconclusive. This retrospective study aimed to evaluate the difference between using deproteinized bovine bone mineral with 10% collagen (DBBM-C) and deproteinized porcine bone mineral with 10% collagen (DPBM-C) when performing ARP procedures in damaged or periodontally compromised extraction sockets based on clinical, radiographic, and profilometric outcomes.

METHODS

In total, 108 extraction sockets were grafted with 67 DBBM-C and 41 DPBM-C. Changes in radiographic (horizontal width and vertical height) and profilometric outcomes were measured after the ARP procedure and before the implant surgery. Postoperative discomfort (including the severity and duration of pain and swelling), early wound healing outcomes (including spontaneous bleeding and persistent swelling), implant stability, and treatment modalities for implant placement were also assessed.

RESULTS

Radiographically, the DBBM-C group decreased by -1.70 ± 2.26 mm (-21.50%) and - 1.39 ± 1.85 mm (-30.47%) horizontally and vertically, and the corresponding DPBM-C group decreased by -1.66 ± 1.80 mm (-20.82%) and -1.44 ± 1.97 mm (-27.89%) horizontally and vertically at an average of 5.6 months. There were no serious or adverse complications in any of the cases, and none of the measured parameters differed significantly between the groups.

CONCLUSION

Within the limitations of this study, ARP with DBBM-C and DPBM-C showed similar clinical, radiographic, and profilometric outcomes in nonintact extraction sockets.

Effects of noni on cellular viability and osteogenic differentiation of gingiva-derived stem cells demonstrated by RNA sequencing and quantitative PCR

Noni fruit (Morinda citrifolia) has been widely used in traditional medicine across tropical and subtropical regions, and is now being paid more attention in Western medicine. The present study aimed to investigate the effects of noni extract on the change in the cellular morphology, maintenance of cellular viability and enhancement of osteogenic differentiation of stem cells. Stem cells obtained from gingiva were cultured where noni extracts existed at concentrations ranging from 10-200 ng/ml. Evaluations of cell morphology and cellular viability were performed. Alkaline phosphatase activity assays were performed to assess the osteogenic differentiation. Alizarin Red S staining was performed to evaluate the calcium deposits in the culture, with the addition of noni extract. Global gene expression was analyzed via next-generation mRNA sequencing. Gene ontology and pathway analyses were performed to determine the associated mechanisms. Validation procedures were performed via quantitative (q)PCR analysis. The addition of noni at concentrations ranging from 10-200 ng/ml did not produce significant morphological changes. There were significantly higher values of cellular viability, with the highest value at 100 ng/ml compared with the control (P<0.05). Furthermore, significantly higher values of alkaline phosphatase activity was noted in the 10 and 100 ng/ml groups compared with the 0 ng/ml group on day 7 (P<0.05). Alizarin Red S staining revealed calcium deposits in each group. In addition, the highest value for Alizarin Red S staining was observed at 100 ng/ml compared with the unloaded control (P<0.05). qPCR analysis demonstrated that the mRNA expression levels of RUNX2, BSP, OCN and COL1A1 increased following treatment with noni. Taken together, the results of the present study suggest that noni extract has enhancing effects on gingiva-derived mesenchymal stem cells, by enhancing cellular viability and osteogenic differentiation.