Tissue-mimicking composite barrier membranes to prevent abdominal adhesion formation after surgery

Postoperative abdominal adhesions often occur after abdominal surgery; barrier membranes which mimic peritoneal tissue can be constructed to prevent abdominal adhesions. To this end, silk fibroin (SF) sheets were coated with polyvinyl alcohol (PVA) and agarose (AGA) at PVA:AGA ratios of 100:0, 70:30, 50:50, 30:70, and 0:100 to create a composite anti-adhesive barrier and allow us to identify a suitable coating ratio. The membranes were characterized in terms of their molecular organization, structure, and morphology using Fourier transform Infrared spectrometer (FT-IR), differential scanning calorimeter (DSC), and scanning electron microscope (SEM), respectively. The physical and mechanical properties of the membranes and their biological performance (i.e., fibroblast proliferation and invasion) were tested in vitro. Each membrane showed both smooth and rough surface characteristics. Membranes coated with PVA:AGA at ratios of 100:0, 70:30, 50:50, and 30:70 exhibited more -OH and amide III moieties than those coated with 0:100 PVA:AGA, which consequently affected structural organization, degradation, and fibroblast viability. The 0:100 PVA:AGA-coated degraded the fastest. Barrier membranes coated with 100:0 and 70:30 PVA: AGA demonstrated reduced fibroblast proliferation and attachment. The membrane coated with 70:30 PVA:AGA exhibited a stable appearance, and did not curl under wet conditions. Therefore, SF sheets coated with 70:30 PVA:AGA show promise as anti-adhesive barrier membranes for further development.

Evaluation of a hydroxyapatite-crosslinked fish gelatin membranes

Background/purpose

Porcine collagen is widely used in regenerative therapies to generate membranes for bone augmentation. However, porcine or bovine gelatin or collagen is often not appropriate for patients with creed and religious beliefs or for allergic reasons. In this study, we evaluated the potential of fish gelatin to generate membranes.

Materials and methods

Fish gelatin and hydroxyapatite (HAp) were used at three different ratios (2:0, 2:1, 2:1.5, and 2:2) to prepare gelatin-hydroxyapatite (G-HAp) membranes via freeze-drying and heat-crosslinking. The surface morphology and cell attachment of G-HAp membranes were observed using scanning electron microscopy and confocal laser microscopy. G-HAp membrane was placed at the bottom of a well plate, and MC3T3-E1 cells were seeded on it. Cell viability and cytotoxicity were tested after 1 and 3 days of culture. Alkaline phosphatase (ALP) and alizarin red staining was performed at 10 and 21 days, respectively.

Results

Viability of cells on G-HAp membrane with the gelatin:HAp ratio of 2:1.5 was significantly higher than that on membranes with other gelatin:HAp ratios. ALP and alizarin red staining showed that ALP-positive areas and calcium deposition were the highest on G-HAp membrane with the gelatin:HAp ratio of 2:1. These membranes showed negligible cytotoxicity.

Conclusion

Fish-derived G-HAp membranes have the potential to promote osteogenic differentiation of MC3T3-E1 cells with negligible cytotoxicity.

Semi-customized three-dimensional ultra-fine titanium meshes in guided bone regeneration for implant therapy in severe alveolar bone defect: a case report

This case report provides a detailed description of a simple and fast bone regeneration procedure using a semi-customized three-dimensional ultra-fine titanium mesh. A 50-year-old male with a severe vertical and horizontal bone defect in the anterior mandible underwent implant treatment in a staged approach. The autologous bone was combined with a xenograft, and the mixture was grafted to augment the bone defect and covered with semi-customized ultra-fine titanium meshes, which were selected among its various types according to size and configuration of the bone defect, directly connected and immobilized on the tenting screws with minimal shaping. In a postoperative 6 months re-entry surgery, the performed titanium meshes were removed, implants were placed, and a bone core biopsy was obtained that demonstrated satisfactory new bone formation. Finally, two months later, the definitive prosthesis was installed. This semi-customized ultra-fine titanium mesh could help an implant clinician obtain more predictable results in the guided bone regeneration (GBR).

A bi-layered asymmetric membrane loaded with demineralized dentin matrix for guided bone regeneration

OBJECTIVES

Guided bone regeneration (GBR) is a well-established method for repairing hard tissue deficiency in reconstructive dentistry. The aim of this study was to investigate the barrier function, osteogenic activity and immunomodulatory ability of a novel bi-layered asymmetric membrane loaded with demineralized dentin matrix (DDM).

METHODS

DDM particles were harvested from healthy, caries-free permanent teeth. Electrospinning technique was utilized to prepare bi-layered DDM-loaded poly(lactic-co-glycolic acid) (PLGA)/poly(lactic acid) (PLA) membranes (abbreviated as DPP bilayer membranes). We analyzed the membranes' surface properties, cytocompatibility and barrier function, and evaluated their osteogenic activity in vitro. In addition, its effects on the osteogenic immune microenvironment were also investigated.

RESULTS

Synthetic DPP bilayer membranes presented suitable surface characteristics and satisfactory cytocompatibility. Transwell assays showed significant fewer migrated cells by the DPP bilayer membranes compared with blank control, with or without in vitro degradation (all P < 0.001). In vitro experiments indicated that our product elevated messenger ribonucleic acid (mRNA) expression levels of osteogenic genes alkaline phosphatase (ALP), osteopontin (OPN), osteocalcin (OCN) and runt-related transcription factor 2 (Runx2). Among all groups, 20% DPP bilayer membrane displayed highest ALP activity (P < 0.001). Furthermore, DPP bilayer membranes enhanced the mRNA expression of M2 macrophage markers and increased the proportion of CD206+ M2 macrophages by 100% (20% DPP: P < 0.001; 30% DPP: P < 0.001; 40% DPP: P < 0.05), thus exerting an inflammation suppressive effect.

CONCLUSIONS

DPP bilayer membranes exhibited notable biological safety and osteogenic activity in vitro, and have potential as a prospective candidate for GBR approach in the future.

Physical, mechanical, and biological properties of collagen membranes for guided bone regeneration: a comparative in vitro study

BACKGROUND

To provide a reference for clinical selection of collagen membranes by analyzing the properties of three kinds of collagen membranes widely used in clinics: Bio-Gide membrane from porcine dermis (PD), Heal-All membrane from bovine dermis (BD), and Lyoplant membrane from bovine pericardium (BP).

METHODS

The barrier function of three kinds of collagen membranes were evaluated by testing the surface morphology, mechanical properties, hydrophilicity, and degradation rate of collagen membranes in collagenase and artificial saliva. In addition, the bioactivity of each collagen membrane as well as the proliferation and osteogenesis of MC3T3-E1 cells were evaluated. Mass spectrometry was also used to analyze the degradation products.

RESULTS

The BP membrane had the highest tensile strength and Young's modulus as well as the largest water contact angle. The PD membrane exhibited the highest elongation at break, the smallest water contact angle, and the lowest degradation weight loss. The BD membrane had the highest degradation weight loss, the highest number of proteins in its degradation product, the strongest effect on the proliferation of MC3T3-E1 cells, and the highest expression level of osteogenic genes.

CONCLUSIONS

The PD membrane is the best choice for shaping and maintenance time, while the BD membrane is good for osteogenesis, and the BP membrane is suitable for spatial maintenance. To meet the clinical requirements of guided bone regeneration, using two different kinds of collagen membranes concurrently to exert their respective advantages is an option worth considering.

Platelet rich fibrin is not a barrier membrane! Or is it?

Platelet-rich fibrin (PRF) is widely used in dentistry and other fields of medicine, and its use has become popular in dental implantology. In several published studies, PRF has been used as a barrier membrane. A barrier membrane is a sheet of a certain material that acts as a biological and mechanical barrier against the invasion of cells that are not involved in bone formation, such as epithelial cells. Among the basic requirements of a 'barrier membrane, occlusivity, stiffness, and space maintenance are the criteria that PRF primarily lacks; therefore, it does not fall under the category of barrier membranes. However, there is evidence that PRF membranes are useful in significantly improving wound healing. Does the PRF membrane act as a barrier? Should we think of adding or subtracting some points from the ideal requirements of a barrier membrane, or should we coin a new term or concept for PRF that will incorporate some features of a barrier membrane and be a combination of tissue engineering and biotechnology? This review is aimed at answering the basic question of whether the PRF membrane should be considered a barrier membrane or whether it is something more beyond the boundaries of a barrier membrane.

Poly (l-lactic acid)-based modified nanofibrous membrane with dual drug release capability for GBR application

Electrospun multilayer nanofibers guided bone regeneration (GBR) with a new design were developed in this study. The synthesized multilayer GBR was composed of two distinct layers. Poly l-lactic acid (PLA) incorporated with simvastatin (SIM) was designed as PLA/SIM layer to contact with a bone defect. In addition, the hydrophilic gelatin (GT) containing thymol (THY) was fabricated as GT/THY layer to contact connective tissue, potentially for bacterial gathering. Due to the different chemical nature and weak cohesion of the hydrophilic and hydrophobic layers, hybrid fibers made of PLA/SIM and GT/THY were electrospun as cohesion promoters between these layers. The microstructure and characteristics of the synthesized multilayer substrate, named GT/PLA, were evaluated, and different fibrous monolayers were fabricated to determine the optimal concentrations of drugs. Scanning electron microscopy (SEM) images showed continuous, smooth, randomly aligned, and bead-free fibers. In addition, there were no drug particles on the fiber surfaces which displayed the good placement of those inside the fibers. The mats exhibited satisfactory tensile strength (4.60 ± 0.14 MPa) and favorable physicochemical properties, including proper porosity percentage (<50 %) and appropriate pore size. Suitable swelling behavior (293 ± 0.05 %) and adequate degradation rates were also approved by characterizing swelling and degradability in vitro. The GT/PLA membrane exhibited a prolonged and sustained SIM release and controlled THY release with high antibacterial efficiency. Cell viability, cell attachment assay, and nuclear staining using 4',6-diamidino-2-phenylindole (DAPI) showed that the designed GT/PLA substrate had good biocompatibility and cell attachment. Cell infiltration testing also showed that the cells were finely prevented by the outer layer (GT/THY). Overall, the obtained results in this study indicated the great potential of the prepared GT/PLA for use as a GBR which can develop osteogenic and antibacterial biomimetic periosteum optimizing the clinical application of GBR strategies.

Self-healing hybrid hydrogels with sustained bioactive components release for guided bone regeneration

Guided bone regeneration (GBR) is widely used in treating oral bone defects to exclude the influence of non-osteogenic tissue on the bone healing process. The traditional method of GBR with a titanium mesh to treat large-area bone defects is limited by the deficiency of increased trauma and costs to patients. Herein, a bi-layered scaffold for GBR composed of a fiber barrier layer and a self-healing hydrogel repair layer is successfully fabricated. The barrier layer is a fibrous membrane material with specific porosity constructed by electrospinning, while the functional layer is a self-healing hydrogel material formed by multiple dynamic covalent bonds. The system can provide an osteogenic microenvironment by preventing the infiltration of connective tissue to bone defects, maintain the stability of the osteogenic space through the self-healing property, and regulate the release of bioactive substances in the dynamic physical condition, which is beneficial to osteoblast proliferation, differentiation, and bone regeneration. This study focused on exploring the effects of different crosslinkers and bonding methods on the comprehensive properties of hydrogels. and proved that the hybrid scaffold system has good biocompatibility, cell barrier function and can enhance bone regeneration activity. Thereby it could be a promising clinical strategy for bone regeneration.

A long-lasting guided bone regeneration membrane from sequentially functionalised photoactive atelocollagen

The fast degradation of collagen-based membranes in the biological environment remains a critical challenge, resulting in underperforming Guided Bone Regeneration (GBR) therapy leading to compromised clinical results. Photoactive atelocollagen (AC) systems functionalised with ethylenically unsaturated monomers, such as 4-vinylbenzyl chloride (4VBC), have been shown to generate mechanically competent materials for wound healing, inflammation control and drug delivery, whereby control of the molecular architecture of the AC network is key. Building on this platform, the sequential functionalisation with 4VBC and methacrylic anhydride (MA) was hypothesised to generate UV-cured AC hydrogels with reduced swelling ratio, increased proteolytic stability and barrier functionality for GBR therapy. The sequentially functionalised atelocollagen precursor (SAP) was characterised via TNBS and ninhydrin colourimetric assays, circular dichroism and UV-curing rheometry, which confirmed nearly complete consumption of collagen's primary amino groups, preserved triple helices and fast (< 180 s) gelation kinetics, respectively. Hydrogel's swelling ratio and compression modulus were adjusted depending on the aqueous environment used for UV-curing, whilst the sequential functionalisation of AC successfully generated hydrogels with superior proteolytic stability in vitro compared to both 4VBC-functionalised control and the commercial dental membrane Bio-Gide®. These in vitro results were confirmed in vivo via both subcutaneous implantation and a proof-of-concept study in a GBR calvarial model, indicating integrity of the hydrogel and barrier defect, as well as tissue formation following 1-month implantation in rats. STATEMENT OF SIGNIFICANCE: Collagen-based membranes remain a key component in Guided Bone Regeneration (GBR) therapy, but their properties, e.g. proteolytic stability and soft tissue barrier functionality, are still far from optimal. This is largely attributed to the complex molecular configuration of collagen, which makes chemical accessibility and structure-function relations challenging. Here, we fabricated a UV-cured hydrogel network of atelocollagen, whereby triple helices were sequentially functionalised with two distinct ethylenically unsaturated monomers. The effects of the sequential functionalisation and UV-curing on the macroscopic properties, degradation behaviour and GBR capability were investigated in vitro and in vivo. The results highlight the key role of the sequential functionalisation and provide important insights for the design of future, longer-lasting resorbable membranes for GBR therapy.

Fabrication and characterization of a semi-rigid shell barrier system made of polycaprolactone and biphasic calcium phosphate: A novel barrier system for bone regeneration

INTRODUCTION

Nowadays, no barrier membrane serves all purposes of bone augmentation. This study aimed to fabricate a semi-rigid shell barrier system composed of a semi-rigid shell and a covering membrane or a semi-resorbable barrier membrane, based on polycaprolactone (PCL) and biphasic calcium phosphate (BCP) for guided bone regeneration (GBR).

MATERIALS AND METHODS

A shell and a covering membrane were fabricated by a solvent casting technique based on PCL (70) and BCP (30). The experimental groups were a semi-rigid shell, an airdried membrane, a buffered membrane, and a commercial d-PTFE as a control. Physico-chemical, mechanical properties, and in vitro biocompatibility with osteoblasts and fibroblasts cells were evaluated in all groups.

RESULTS

The fabricated materials had rough surfaces with a homogeneous distribution of BCP particles on one side and a smooth surface on the opposite side. The airdried membrane presented a rougher surface on both top and bottom sides (Sq = 605.45 nm, 556.82 nm) than the semi-rigid shell (310.74 nm, 424.56 nm) and the buffered membrane (277.9 nm, 306.98 nm), respectively. The pore sizes of the airdried membrane (25-40 μm) were larger than the semi-rigid shell (5-40 μm) and the buffered membrane (5-25 μm). The porosities of the airdried and buffered membranes (∼40%) were higher than the semi-rigid shell (∼20%) significantly (p < 0.05). All fabricated materials were hydrophilic, with the lowest water contact angle in the semi-rigid shell (54.7° ± 3.06°), then the airdried (61.15° ± 4.76°), and the buffered (75.74° ± 2.8°) respectively. The semi-rigid shell resisted a higher load on compressive force (18.82 ± 2.72 N) than the d-PTFE membrane (4.23 ± 0.5 N). The tensile stress of the buffered membrane (2.544 ± 0.19 MPa) was not different from the d-PTFE (2.908 ± 0.12 MPa) but was higher than the airdried membrane (1.302 ± 0.13 MPa) significantly (P < 0.05). The airdried membrane had reached 100% swelling ability within 1 h, which was significantly faster than the buffered membrane (12 h) and the semi-rigid shell (7 days), and they were slowly degraded by lysozyme at 6 months (airdried: 24.88% ± 0.96%, buffered: 13.67% ± 0.55%, and semi-rigid: 8.62% ± 0.88%). All fabricated membranes showed no toxicity to osteoblast and fibroblast cells.

CONCLUSION

The semi-rigid shell and the covering membranes demonstrated suitable physical and mechanical properties, and biocompatibility, and can be assembled as the novel semi-rigid shell barrier system for bone regeneration.

A bi-layered membrane with micro-nano bioactive glass for guided bone regeneration

Guided bone regeneration (GBR) is widely used to treat oral bone defects. However, the osteogenic effects are limited by the deficiency of the available barrier membranes. In this study, a novel bi-layer membrane was prepared by solvent casting and electrospinning. The barrier layer made of poly (lactic-co-glycolic acid) (PLGA) was smooth and compact, whereas the osteogenic layer consisting of micro-nano bioactive glass (MNBG) and PLGA was rough and porous. The mineralization evaluation confirmed that apatite formed on the membranes in simulated body fluid. Immersion in phosphate-buffered saline led to the degradation of the membranes with proper pH changes. Mechanical tests showed that the bi-layered membranes have stable mechanical properties under dry and wet conditions. The bi-layered membranes have good histocompatibility, and the MNBG/PLGA layer can enhance bone regeneration activity. This was confirmed by cell culture results, expression of osteogenic genes, and immunofluorescence staining of RUNX-related transcription factor 2 and osteopontin. Therefore, the bi-layered membranes could be a promising clinical strategy for GBR surgery.

Barrier membranes for tissue regeneration in dentistry

Background: In dentistry, barrier membranes are used for guided tissue regeneration (GTR) and guided bone regeneration (GBR). Various membranes are commercially available and extensive research and development of novel membranes have been conducted. In general, membranes are required to provide barrier function, biosafety, biocompatibility and appropriate mechanical properties. In addition, membranes are expected to be bioactive to promote tissue regeneration.

Objectives: This review aims to organize the fundamental characteristics of the barrier membranes that are available and studied for dentistry, based on their components.

Results: The principal components of barrier membranes are divided into nonbiodegradable and biodegradable materials.

Nonbiodegradable membranes are manufactured from synthetic polymers, metals or composites of these materials. The first reported barrier membrane was made from expanded polytetrafluoroethylene (e-PTFE). Titanium has also been applied for dental regenerative therapy and shows favorable barrier function. Biodegradable membranes are mainly made from natural and synthetic polymers. Collagens are popular materials that are processed for clinical use by cross-linking. Aliphatic polyesters and their copolymers have been relatively recently introduced into GTR and GBR treatments. In addition, to improve the tissue regenerative function and mechanical strength of biodegradable membranes, inorganic materials such as calcium phosphate and bioactive glass have been incorporated at the research stage.

Conclusions: Currently, there are still insufficient guidelines for barrier membrane choice in GTR and GBR, therefore dentists are required to understand the characteristics of barrier membranes.

A novel γ-PGA composite gellan membrane containing glycerol for guided bone regeneration

An ideal barrier membrane design should incorporate the function of a delivery vehicle for transporting drugs and osteoinductive factors to where the body is under inflammation. In the present study, a functional hydrogel-based barrier membrane is fabricated using calcium-form poly-γ-glutamic acid (γ-PGA) and glycerol blending into gellan gum. The concentration of the calcium-form poly-γ-glutamic acid (γ-PGA) and the glycerol ratio are studied for improving practicability in easy-handling and expanding the coverage area. Gellan gum-based membranes with uniformly distributed calcium aggregates are not only successfully manufactured but also providing excellent characteristics for protein adsorption, bioactivity, and bone cell maturation. Our composite gellan gum-based membranes were tested including to their morphology, mechanical properties, swelling behavior, protein adsorption, drug diffusion, and lysozyme degradation. The biocompatibility, proliferation, and osteoblastic response of membranes were examined by osteoblast-like (MG63) cells. Our results indicate that adequate physical cross-linking with γ-PGA improves the original mechanical properties and delays degradation. Growing glycerol ratio not only enhances the elongation at break and diffusion rate, but it also changes the tensile strength and the remaining weight. In vitro biocompatibility tests, an adequate ratio of γ-PGA modification significantly enhances the proliferation, the secretion of alkaline phosphatase (ALP) and mineralization. However, worth noting is the glycerol-modified membrane cannot bear a close resemblance with the non-glycerol group in the high level of osteoblastic response. In general, these tunable materials with biocompatibility, biodegradability, and positive osteoblastic responses were poised to be possible candidates for bone defect repair.

Tuning the immune reaction to manipulate the cell-mediated degradation of a collagen barrier membrane

In order to elicit a desired barrier function in guided bone regeneration (GBR) or guided tissue regeneration (GTR), a barrier membrane has to maintain its integrity for a certain period of time to guarantee the regeneration of target tissue. Due to the complexity and variety of clinical conditions, the healing time required for tissue regeneration varies from one case to another, which implies the need for tailoring the barrier membranes to diverse conditions via manipulating their degradation property. As a "non-self" biomaterial, a barrier membrane will inevitably trigger host-membrane immune response after implantation, which entails the activation of phagocytic cells. In the degradation process of a barrier membrane, the cell-mediated degradation may play a more vital role than enzymatic and physicochemical dissolution; however, limited studies have been carried out on this topic. In this context, we investigated the cell-mediated degradation and illustrated the possible key cells and mediators for immunomodulation via in vivo and in vitro studies. We discovered that IL-13, a key cytokine mainly released by T helper 2 cells (Th2), induced the formation of foreign body giant cells (FBGCs), thus resulting in membrane degradation. Neutralizing IL-13 could suppress membrane degradation and formation of FBGC. The contributions of this study are (1) unveiling the immune mechanisms underlying the cell-mediated collagen membrane degradation; (2) allowing the formation of an "immunodegradation" strategy to develop an "immune-smart" barrier membrane to manipulate its degradation; (3) providing the key regulatory immune cells and cytokines for the immunomodulation target in collagen membrane degradation. STATEMENT OF SIGNIFICANCE: The significance of this research includes.

Physicochemical characterization of barrier membranes for bone regeneration

Barrier membranes are essential biomaterials for guided bone regeneration. Due to different origin and structure of barrier membranes, singular mechanical properties and clinical behaviors can be expected. It is important to understand the physic and chemical properties of barrier membranes to select the needed biomaterial for each clinical situation. To date, no study has evaluated and compared the physicochemical properties of various families of barrier membranes. The aim of this study is to evaluate the physicochemical properties of various barrier membranes. Fifteen membranes of different origin were tested in this study. Membranes were divided into biological or synthetic origin and grouped in natural allogenic collagen, natural xenogenic collagen, cross-linked collagen and synthetic membranes. Physicochemical properties were evaluated in terms of tension, stiffness, absorption ability, pH and wettability. For the tension tests, all membranes showed similar low tension and low stiffness, especially after a 4-min hydration, except for bone laminas that showed a greater stiffness particularly in a dry status. Regarding wettability and hydration of the barrier membranes, porcine origin membranes had greater hydration; wettability was also superior in porcine derived barrier membranes and showed a faster absorption of the drop on the rough surfaces. All membranes had a stable pH, having the synthetic membranes the most stable pH when compared to physiologic. The wide variety of barrier membranes opens a debate in which the practitioner should select the adequate barrier membrane for each clinical situation. Different materials show singular potentials depending on their tissue origin making them suitable for specific clinical indications. More studies regarding adsorption, integration and degradation of barrier membranes are needed to understand their behavior.

Resorbable Versus Nonresorbable Membranes: When and Why?

Guided bone-regeneration techniques use either resorbable or nonresorbable membrane. Ideal membrane material should be biocompatible with tissue integration, be able to create and maintain space, be occlusive with selective permeability, and have good handling properties. Commercially available nonresorbable membranes are Gor-tex (e-PTFE), Cytoplast (d-PTFE), and titanium mesh. Resorbable membranes are available as natural and synthetic. Clinical trials, a systematic review and meta-analysis have shown no statistically significant difference in most clinical indications between both types of membrane. The choice of membrane varies according to the choice of grafting materials and nature of defect.

Regenerative potential of subepithelial connective tissue graft in the treatment of periodontal infrabony defects

BACKGROUND

Due to high prevalence and progression of infrabony defects lead to increase in the possibility of tooth loss. Various regenerative techniques such as guided tissue regeneration, bone grafts, and biomimetic agents have been proposed. Subepithelial connective tissue graft (SCTG) is an autogenous membrane, which contains mesenchymal cells and has osteogenic, chondrogenic, and osteoblastic activities. The present study investigates the effective application of SCTG as an autogenous barrier membrane in the treatment of periodontal infrabony defect.

MATERIALS AND METHODS

Ten patients in the age group of 30-45 years suffering from chronic periodontitis with clinical and radiographic evidence of vertical defects were selected for the study. Clinical parameters evaluated were gingival index, plaque index, probing pocket depth, clinical attachment level, and gingival recession. These parameters were assessed at baseline, 6 and 9 months. Radiographic parameter (defect fill) was evaluated at baseline, 6, and 9 months postoperatively. Sites were treated with PERIOGLAS® and connective tissue graft. Statistical analysis was done using paired t-test.

RESULTS

All the patients finished the study. A significant improvement was observed regarding clinical parameters from baseline to 9 months. The radiographic defect fill was seen in all the cases at the end of 9 months, which was statistically significant in comparison with baseline scores.

CONCLUSION

SCTG could be effectively used as a barrier membrane for the treatment of periodontal infrabony defects.

In situ photochemical crosslinking of hydrogel membrane for Guided Tissue Regeneration

OBJECTIVE

Periodontitis is an inflammatory disease that destroys the tooth-supporting attachment apparatus. Guided tissue regeneration (GTR) is a technique based on a barrier membrane designed to prevent wound space colonization by gingival cells. This study examined a new formulation composed of two polymers that could be photochemically cross-linked in situ into an interpenetrated polymer network (IPN) forming a hydrogel membrane.

METHODS

We synthetized and characterized silanized hydroxypropyl methylcellulose (Si-HPMC) for its cell barrier properties and methacrylated carboxymethyl chitosan (MA-CMCS) for its degradable backbone to use in IPN. Hydrogel membranes were cross-linked using riboflavin photoinitiator and a dentistry visible light lamp. The biomaterial's physicochemical and mechanical properties were determined. Hydrogel membrane degradation was evaluated in lysozyme. Cytocompatibility was estimated by neutral red uptake. The cell barrier property was studied culturing human primary gingival fibroblasts or human gingival explants on membrane and analyzed with confocal microscopy and histological staining.

RESULTS

The IPN hydrogel membrane was obtained after 120s of irradiation. The IPN showed a synergistic increase in Young moduli compared with the single networks. The CMCS addition in IPN allows a progressive weight loss compared to each polymer network. Cytocompatibility was confirmed by neutral red assay. Human cell invasion was prevented by hydrogel membranes and histological sections revealed that the biomaterial exhibited a barrier effect in contact with soft gingival tissue.

SIGNIFICANCE

We demonstrated the ability of an innovative polymer formulation to form in situ, using a dentist's lamp, an IPN hydrogel membrane, which could be an easy-to-use biomaterial for GTR therapy.

Sugar-based collagen membrane cross-linking increases barrier capacity of membranes

OBJECTIVES

This study examines the permeability and barrier capacity of a sugar cross-linked resorbable collagen membrane ex vivo and in vivo.

MATERIALS AND METHODS

In an ex vivo study, injectable platelet-rich fibrin (i-PRF), a peripheral blood-derived human leukocyte-and-platelet-rich plasma was used to analyze membrane permeability. in vivo subcutaneous implantation in Wistar rats (n = 4 per time point and group) was used to investigate the barrier capacity of the membrane. The induced in vivo cellular reaction was evaluated at 3, 15, and 30 days and compared to sham OP (control) without biomaterial using histological, immunohistochemical, and histomorphometric methods.

RESULTS

Ex vivo, the membrane was impenetrable to leukocytes, platelets, and fibrin from peripheral human blood concentrate (PRF). In vivo, the membrane maintained its structure and remained impervious to cells, connective tissue, and vessels over 30 days. CD-68-positive cell (macrophage) numbers significantly decreased from 3 to 15 days, while from day 15 onwards, the number of multinucleated giant cells (MNGCs) increased significantly. Correspondingly, a rise in implantation bed vascularization from 15 to 30 days was observed. However, no signs of degradation or material breakdown were observed at any time point.

CONCLUSION

Ex vivo and in vivo results showed material impermeability to cellular infiltration of human and murine cells, which highlights the membrane capacity to serve as a barrier over 30 days. However, whether the induced MNGCs will lead to material degradation or encapsulation over the long term requires further investigation.

CLINICAL RELEVANCE

The data presented are of great clinical interest, as they contribute to the ongoing discussion concerning to what extent an implanted material should be integrated versus serving only as a barrier membrane.

Immediate implant placement into posterior sockets with or without buccal bone dehiscence defects: A retrospective cohort study

OBJECTIVES

To evaluate bone reconstruction and soft tissue reactions at immediate implants placed into intact sockets and those with buccal bone dehiscence defects.

METHODS

Fifty-nine internal connection implants from four different manufacturers were immediately placed in intact sockets(non-dehiscence group, n=40), and in alveoli with buccal bone dehiscence defects: 1) Group 1(n= N10), the defect depth measured 3-5 mm from the gingival margin. 2) Group 2(n=9), the depth ranged from 5mm to 7mm. The surrounding bony voids were grafted with deproteinized bovine bone mineral (DBBM) particles. Cone beam computed tomography(CBCT) was performed immediately after surgery (T1), and at 6 months later(T2). Radiographs were taken at prosthesis placement and one year postloading(T3). Soft tissue parameters were measured at baseline (T0), prosthesis placement and T3.

RESULTS

No implants were lost during the observation period. For the dehiscence groups, the buccal bone plates were radiographically reconstructed to comparable horizontal and vertical bone volumes compared with the non-dehiscence group. Marginal bone loss occurred between the time of final restoration and 1-year postloading was not statistically different(P=0.732) between groups. Soft tissue parameters did not reveal inferior results for the dehiscence groups.

CONCLUSIONS

Within the limitations of this study, flapless implant placement into compromised sockets in combination with DBBM grafting may be a viable technique to reconstitute the defected buccal bone plates due to space maintenance and primary socket closure provided by healing abutments and bone grafts.

CLINICAL SIGNIFICANCE

Immediate implants and DBBM grafting without using membranes may be indicated for sockets with buccal bone defects.

Evaluation of efficacy of a novel resorbable collagen membrane for root coverage of Miller's Class I and Class II recession in the maxillary anteriors and premolars

Background:

There are several surgical techniques in literature that have been used to perform root coverage (RC). Currently, the use of a resorbable collagen membrane (RCM) as a guided tissue regenerative material is one of the highly sought treatment modalities. The present study aimed at evaluating the clinical outcome of RC in the treatment of Miller's Class I and II recession defects in maxillary anteriors and premolars by coronally advanced flap (CAF) with and without RCM.

Materials and Methods:

This split-mouth study (bilateral buccal recession defects) was randomized to include 15 test (CAF + membrane) and 15 control (CAF alone) sites. Clinical parameters included gingival recession depth (RD), probing pocket depth (PPD), clinical attachment level (CAL), and keratinized tissue height (KTH) measured at baseline and 9 months postoperatively.

Results:

Both test and control groups showed statistically significant (P < 0.05) reductions in RD (1.54 ± 0.46 mm and 1.60 ± 0.07 mm), PPD (0.53 ± 0.15 mm and 0.94 ± 0.10 mm), increase in KTH (0.67 ± 0.90 mm and 0.73 ± 0.14 mm) and CAL (1.94 ± 0.27 mm and 2.60 ± 0.19 mm) when comparing the 9-month data from baseline. The present study showed that mean improvement in RD was 1.60 ± 0.507 and 1.53 ± 0.64 mm in both test and control groups, respectively. Mean percent RC was 58.33% ±12.19% and 56.22% ±10.22% for test and control groups, respectively. However, there were no statistically significant differences between groups for RD, PPD, KTH, and CAL.

Conclusion:

The results of this study suggest that both the groups CAF (control) and CAF and RCM (test) could be successfully used to treat Miller's Class I and II gingival recession defects and also demonstrated an overall significant improvement in all the assessed clinical parameters. However, there was a greater reduction of gingival RD with the use of RCM when compared with the group of CAF alone.

Comparative study of nonabsorbable and absorbable barrier membranes in periodontal osseous defects by guided tissue regeneration

BACKGROUND

Periodontal invasion of furcation area in multirooted teeth represents one of the most demanding therapeutic challenges in periodontics. Furcation therapy includes various treatment modalities like either maintenance or elimination of furcation or increased access to furcation area. Recent treatment modalities include regenerative procedures like placement of different type of bone grafts with nonabsorbable or absorbable barrier membranes, through guided tissue regeneration. This study compared the clinical efficacy of nonabsorbable barrier membrane with absorbable membrane when used with hydroxyapatite bone graft (G-Graft) in grade II buccal furcation defects in mandibular 1st molars.

MATERIALS AND METHODS

Fourteen subjects with bilateral grade II buccal furcation defects in lower 1st molars were selected and treated in a split-mouth design. After phase I therapy, molars were divided randomly into two groups for the treatment with either resorbable or nonresorbable membrane in conjunction with G-Graft in both groups.

RESULTS

All the clinical parameters recorded showed statistically significant improvement in both the groups but no significant difference between two groups was observed.

CONCLUSION

Both nonabsorbable and absorbable barrier membranes were equally effective in treating grade II buccal furcation defects in lower molars when used in conjunction with G-Graft except with respect to horizontal bone fill in which absorbable barrier membrane showed better results.

In vitro evaluation of mechanical properties of platelet-rich fibrin membrane and scanning electron microscopic examination of its surface characteristics

Background:

The aim of this study was to evaluate the mechanical properties of the platelet-rich fibrin (PRF) membrane and to compare these properties with that of commercially available collagen membranes used for guided tissue regeneration (GTR) procedures. Scanning electron microscopic (SEM) examination of PRF membrane was also performed to determine the cell distribution pattern within the different regions of the membrane.

Materials and Methods:

Modulus of elasticity and hardness of (i) PRF membrane (ii) bovine collagen membrane and (iii) fish collagen membrane were assessed by performing surface indentation test using T1 950 Triboindenter. The in vitro degradation tests were conducted by placing the (i) PRF membrane (ii) bovine collagen membrane and (iii) fish collagen membrane of equal sizes (10 mm × 5 mm) in 5 ml of pH 7.4 phosphate buffer solution on a shaker set at 40 rpm for 1-week. The degradation profiles were expressed as the accumulated weight losses of the membrane. SEM evaluation of the PRF membrane was done under both low and high magnification.

Results:

Young's Modulus of elasticity was found to be 0.35 GPa for PRF membrane, 2.74 GPa for bovine collagen membrane and 1.92 GPa for fish collagen. The hardness was 10.67 MPa for PRF membrane, 110.7 MPa for bovine collagen membrane and 90.5 MPa for fish collagen membrane. PRF membrane degraded by about 36% of initial weight after a 1-week in vitro shaking test. Fish collagen membrane degraded by about 8% of initial weight, bovine collagen membrane degraded by about 3% of initial weight. Dense clusters of platelets formed due to extensive aggregation, and few leukocytes were observed in buffy coat area.

Conclusions:

The preliminary findings from the assessment of the mechanical properties of PRF membrane showed that it was lacking in several desired properties when compared to commercially available collagen membranes. Lack of rigidity and faster degradation may limit its application in GTR procedures.

Palatogingival groove - a silent killer: Treatment of an osseous defect due to it

A male patient of 21 years of age reported to the Department of Periodontology and Implantology with a chief complain of pus discharge in both right and left upper lateral incisors. On clinical examination a deep pocket of about 10–14 mm was noticed in both lateral incisors. Radiographic interpretation shows a teardrop-shaped radiolucency in both the laterals giving suspicion of palatogingival groove, which was later discovered and treated surgically.