Long-term change of disease behavior in Papillon-Lefèvre syndrome: seven years follow-up.

Papillon-Lefèvre syndrome (PLS) is an autosomal recessive disease, characterized by severe periodontitis and palmoplantar hyperkeratosis. Mutations in the cathepsin C (CTSC) gene are the causative genetic factor. PLS starts at very early age, however, the age associated change of PLS has never been characterized. In this report, four PLS patients with CTSC mutations were followed up for seven years, periodontal condition and serum immunoglobulins (Igs) were recorded. Results showed that periodontal inflammation of PLS peaked at teenage years, but declined with time. At the same time the serum IgE change was consistent with the change, suggesting the possibility of using IgE as a monitoring index for PLS inflammation level, or to develop new target for therapy.

Use of platelet-rich fibrin membrane following treatment of gingival recession: a randomized clinical trial.

This 6-month randomized controlled clinical study primarily aimed to compare the results achieved by the use of a platelet-rich fibrin (PRF) membrane or connective tissue graft (CTG) in the treatment of gingival recession and to evaluate the clinical impact of PRF on early wound healing and subjective patient discomfort. Use of a PRF membrane in gingival recession treatment provided acceptable clinical results, followed by enhanced wound healing and decreased subjective patient discomfort compared to CTG-treated gingival recessions. No difference could be found between PRF and CTG procedures in gingival recession therapy, except for a greater gain in keratinized tissue width obtained in the CTG group and enhanced wound healing associated with the PRF group.

A surgical reentry study on the influence of platelet-rich plasma in enhancing the regenerative effects of bovine porous bone mineral and guided tissue regeneration in the treatment of intrabony defects in humans.

BACKGROUND: The purpose of this study was to evaluate the additional benefits provided by the incorporation of platelet-rich plasma (PRP) into a regenerative protocol consisting of bovine porous bone mineral (BPBM) and guided tissue regeneration (GTR) in the treatment of intrabony defects in humans. METHODS: Twenty-three paired intrabony defects were surgically treated using a split-mouth design. Defects were treated with BPBM/GTR/PRP (experimental group) or with BPBM/GTR (control group). The clinical parameters evaluated included changes in probing depth, clinical attachment level, and defect fill as revealed by reentry surgeries at 6 months. RESULTS: Preoperative probing depths, attachment levels, and transoperative bone measurements were similar for the two groups. Post-surgical measurements taken at 6 months revealed that both treatment modalities resulted in a significant decrease in probing depth, gain in clinical attachment, and bone fill of the defects compared to baseline. Postoperative differences observed between the two groups were 0.72 +/- 0.36 mm at buccal sites and 0.90 +/- 0.32 mm at lingual sites for probing depth, 0.82 +/- 0.41 mm at buccal sites and 0.78 +/- 0.38 at lingual sites for gain in clinical attachment, and 0.85 +/- 0.36 mm at buccal sites and 0.94 +/- 0.42 mm at lingual sites for defect fill, all favoring the experimental sites. However, none of the differences were statistically significant. CONCLUSION: Within the limitations related to using a small sample size, PRP did not significantly augment the effects of BPBM and GTR in promoting the clinical resolution of intrabony defects.

Correlation between atherosclerosis and periodontal putative pathogenic bacterial infections in coronary and internal mammary arteries.

BACKGROUND: Chronic infections, such as periodontitis, have been associated with an increased risk for atherosclerosis and coronary artery disease. The aim of this study was to investigate biopsy samples of coronary and internal mammary arteries for the presence of putative pathogenic bacteria (Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Tannerella forsythensis), Chlamydia pneumoniae, and human cytomegalovirus (CMV). METHODS: Patients with a diagnosis of coronary artery disease were included in the study. Fifteen coronary arteries with atherosclerosis and 15 internal mammary arteries without clinically assessable atherosclerotic degeneration were investigated. Both groups of specimens were obtained during coronary artery bypass grafting surgery. In all cases, the coronary and mammary artery specimens were taken from the same patient. The detection of periodontal pathogens, C. pneumoniae, and CMV was done by polymerase chain reaction analysis. RESULTS: Bacterial DNA was found in nine of 15 (60%) coronary artery biopsy samples: P. gingivalis in eight (53.33%), A. actinomycetemcomitans in four (26.67%), P. intermedia in five (33.33%), and T. forsythensis in two (13.33%) samples; CMV was detected in 10 (66.67%) samples, and C. pneumoniae was detected in five (33.33%) samples. Some of the samples contained more than one type of bacteria. Periodontal pathogens were not detected in internal mammary artery biopsies, whereas CMV was present in seven (46.67%) samples and C. pneumoniae was present in six (40%) samples. CONCLUSION: The absence of putative pathogenic bacteria in internal mammary arteries, which are known to be affected rarely by atherosclerotic changes, and their presence in a high percentage of atherosclerotic coronary arteries support the concept that periodontal organisms are associated with the development and progression of atherosclerosis.

Histomorphometric and fluorescence microscopic evaluation of interfacial bone healing around 3 different dental implants before and after radiation therapy.

PURPOSE: Radiation therapy influence on bone healing around 3 types of endosseous dental implants in dogs was evaluated. MATERIALS AND METHODS: Implants with 3 different surfaces (A = machined commercially pure titanium screws, B = commercially pure titanium plasma spray-coated cylinders, C = hydroxyapatite [HA] -ceramic coated cylinders) were first implanted unilaterally into the right posterior edentulous mandibles of 7 dogs as nonirradiated controls. After 12 weeks without functional loading and after sequential fluorochrome labeling these implants were retrieved by block dissection. In this same surgery, implants were placed on the contralateral side. Three weeks postimplantation the implant-containing hemimandibles were Cobalt 60 irradiated with the biologic equivalent of 5,000 cGy. Twelve weeks postimplantation and after labeling these irradiated implants were retrieved at sacrifice. On scanning electron, light, and fluorescence microscopic images of undecalcified longitudinal ground sections of the implants with surrounding tissues, percent bone-to-implant contact (% BIC), bone formation, and remodeling were histometrically and subjectively evaluated. RESULTS: Woven bone formation started 1 week after implantation at the implant interfaces on both the nonirradiated and the irradiated sides. Average BICs (total/cortical/spongious bone bed) of 26%/49%/36% for surface A, 46%/48%/64% for surface B, and 81%/83%/78% for surface C were observed. In the irradiated hemimandibles average BICs (total/cortical/spongious bone bed) were reduced to 11%/9%/4% for surface A, 43%/46%/43% for surface B, and 63%/85%/76% for surface C, with increased resorption of peri-implant bone and retarded bone formation after irradiation. DISCUSSION: Reductions of total % BIC in all irradiated implants, though not statistically significant, were significant (P < or = .05) on implant surfaces A and B in the spongious bone bed. CONCLUSION: Retarded bone formation on surfaces A and B in the spongious bone bed represented a more radiation-sensitive situation at the time of radiation onset compared to advanced bone formation and maturation at surface C.

A reentry study on the use of bovine porous bone mineral, GTR, and platelet-rich plasma in the regenerative treatment of intrabony defects in humans.

This study compared the clinical effectiveness of a combination therapy consisting of bovine porous bone mineral (BPBM), guided tissue regeneration (GTR), and platelet-rich plasma (PRP) in the regeneration of periodontal intrabony defects in humans. Twenty-eight paired intrabony defects were surgically treated using a split-mouth design. Defects were treated with BPBM, GTR, and PRP (experimental), or with open-flap debridement (control). Clinical parameters evaluated included changes in attachment level, pocket depth, and defect fill as revealed by reentry at 6 months. Preoperative pocket depths, attachment levels, and transoperative bone measurements were similar for the two groups. Postsurgical measurements taken at 6 months revealed that both treatment modalities significantly decreased pocket depth and increased clinical attachment and defect fill compared to baseline. The differences between the experimental and control groups were 2.22+/-0.39 mm on buccal and 2.12+/-0.34 mm on lingual sites for pocket depth, 3.05+/-0.51 mm on buccal and 2.88+/-0.46 mm on lingual sites for gain in clinical attachment, and 3.46+/-0.96 mm on buccal and 3.42+/-0.02 mm on lingual sites for defect fill. These differences between groups were statistically significant in favor of the experimental defects. The combined therapy was also clinically more effective than open-flap debridement. The superiority of the experimental group could not be attributed solely to the surgical intervention and was likely a result of the BPBM/GTR/ PRP application. Combining BPBM, GTR, and PRP was an effective modality of regenerative treatment for intrabony defects in patients with advanced periodontitis.

Alveolar bone preservation following tooth extraction: a perspective of clinical trials utilizing osseous grafting and guided bone regeneration.

Based on data from the authors' three clinical trials that focused on the role exerted by various regenerative materials and techniques in preserving alveolar ridge dimensions following tooth extraction, there is evidence to support the use of nonresorbable and resorbable membranes in combination with a closed-socket approach. There also is evidence to support a higher predictability of the results with resorbable membranes compared with nonresorbable membranes because the latter can become exposed to the oral environment during healing. A combination of bioactive glass and calcium sulfate using an open-socket approach is of marginal benefit in preserving alveolar ridge dimensions following tooth extraction. More research is necessary on combining osseous graft/guided bone regeneration using a closed-socket approach, on assessing the quality of bone present in the previous extraction socket following various preservation techniques, and on how effectively preserved/regenerated bone supports dental implants.

Root resorption associated with a subepithelial connective tissue graft for root coverage: clinical and histologic report of a case.

This article reports on a case of root resorption following a clinically successful root coverage procedure with a subepithelial connective tissue graft on a maxillary lateral incisor. Two years after the graft procedure was performed, the tooth was extracted in conjunction with the buccal attachment apparatus. Histologic examination of the specimen revealed signs of active resorption of the dentinal surface and bone formation in the deepest portion of the resorption cavity. Possible causative factors of the root resorption process are discussed.

Effectiveness of a combination of platelet-rich plasma, bovine porous bone mineral and guided tissue regeneration in the treatment of mandibular grade II molar furcations in humans.

OBJECTIVE: A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM) and guided tissue regeneration (GTR) has been shown to be effective as regenerative treatment for intrabony periodontal defects. The purpose of this study was to evaluate the effectiveness of PRP, BPBM and GTR used in combination as regenerative treatment for grade II molar furcation defects in humans. MATERIAL AND METHODS: Using a split-mouth design, a total of 52 grade II mandibular molar furcation defects were treated either with PRP/BPBM/GTR (experimental group, n=26) or with an open flap debridement (control group, n=26). The primary outcomes evaluated in this study included changes in pocket depth, attachment level and re-entry bone levels (horizontal and vertical) between baseline and 6 months postoperatively. RESULTS: The results showed that the experimental group presented with significantly greater pocket reduction (4.07+/-0.33 mm for experimental and 2.49+/-0.38 mm for control sites), gain in clinical attachment (3.29 +/- 0.42 mm for experimental and 1.68+/-0.31 mm for control sites), vertical defect fill (2.56+/- 0.36 mm for experimental and -0.19+/-0.02 for control sites) and horizontal defect fill (2.28+/-0.33 mm for experimental and 0.08+/-0.02 mm for control sites) than the control group. CONCLUSIONS: It was concluded that the PRP/BPBM/GTR combined technique is an effective modality of regenerative treatment for mandibular grade II furcation defects. Further studies are necessary to elucidate the role played by each component of the combined therapy in achieving these results.

Platelet-rich plasma and bovine porous bone mineral combined with guided tissue regeneration in the treatment of intrabony defects in humans.

BACKGROUND: A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM) and guided tissue regeneration (GTR) has been shown to be effective in promoting clinical signs of periodontal regeneration in intrabony defects. As an initial attempt to clarify the role played by each of the three treatment components, this study was performed to compare the clinical effectiveness of two regenerative techniques for intrabony defects in humans: a combination of PRP/BPBM/GTR vs. GTR. MATERIAL AND METHODS: Eighteen patients participated in the study. Using a split-mouth design, interproximal bony defects were surgically treated with either an absorbable membrane made of polylactic acid for GTR or a combination of PRP/BPBM/GTR. Changes in pocket depth, attachment level and defect fill as revealed by 6-month reentry surgeries were evaluated. RESULTS: Both treatment modalities resulted in significant pocket depth reduction and clinical attachment gain as compared to baseline values. Pocket depth reduction was 4.98 +/- 0.96 mm on buccal and 4.93 +/- 0.92 mm on lingual sites of the PRP/BPBM/GTR group and 3.62 +/- 0.81 mm on buccal and 3.54 +/- 0.88 mm on lingual sites of the GTR group. The gain in clinical attachment observed was 4.37 +/- 1.31 mm on buccal and 4.28 +/- 1.33 mm on lingual sites of the PRP/BPBM/GTR group and 2.62 +/- 1.23 mm on buccal and 2.44 +/- 1.21 mm on lingual sites of the GTR group. The amount of defect fill observed was 4.78 +/- 1.26 mm on buccal and 4.66 +/- 1.32 mm on lingual sites of the PRP/BPBM/GTR group and 2.31 +/- 0.76 mm on buccal and 2.26 +/- 0.81 mm on lingual sites of the GTR group. All differences between the two groups were statistically significant in favor of the PRP/BPBM/GTR group. CONCLUSIONS: The results of this study suggest that PRP and BPBM provide an added regenerative effect to GTR in promoting the clinical resolution of intrabony defects on patients with severe periodontitis.

Comparison of platelet-rich plasma, bovine porous bone mineral, and guided tissue regeneration versus platelet-rich plasma and bovine porous bone mineral in the treatment of intrabony defects: a reentry study.

BACKGROUND: A combination of platelet-rich plasma (PRP), bovine porous bone mineral (BPBM), and guided tissue regeneration (GTR) has been shown to be effective in promoting reduction in probing depth, gain in clinical attachment, and defect fill in intrabony periodontal lesions. The individual role played by PRP, BPBM, and GTR in this combined therapy is unclear and needs to be elucidated. The purpose of this study was to compare the clinical effectiveness of 2 regenerative techniques for intrabony defects in humans: a combination of PRP/BPBM/GTR versus a combination of PRP/BPBM. METHODS: Twenty-one patients participated in the study. Using a split-mouth design, interproximal bony defects were surgically treated with either a combination of PRP/BPBM/GTR or PRP/BPBM. The primary outcomes of the study included changes in probing depth, attachment level, and defect fill as revealed by reentry surgeries at 6 months post-treatment. RESULTS: At 6 months postoperatively, clinical examination of the treated defects revealed that both treatment modalities resulted in significant probing depth reduction and clinical attachment gain compared to baseline values. Probing depth improvement was 3.98 +/- 1.02 mm on buccal and 3.94 +/- 0.94 mm on lingual sites for the PRP/BPBM group and 4.19 +/- 0.88 mm on buccal and 4.21 +/- 0.92 mm on lingual sites for the PRP/BPBM/GTR group. Gain in clinical attachment was 3.78 +/- 0.72 mm on buccal and 3.84 +/- 0.76 mm on lingual sites for the PRP/BPBM group and 4.12 +/- 0.78 mm on buccal and 4.16 +/- 0.83 mm on lingual sites for the PRP/BPBM/GTR group. Reentry surgeries revealed similar defect fill for both treatment groups (PRP/BPBM group: 4.82 +/- 1.34 mm on buccal and 4.74 +/- 1.30 mm on lingual sites; PRP/BPBM/GTR group: 4.96 +/- 1.28 mm on buccal and 4.78 +/- 1.32 mm on lingual sites). None of the differences between the 2 treatment groups was statistically significant. CONCLUSIONS: The results of this study show that both combinations of PRP/BPBM/GTR and PRP/BPBM are effective in the treatment of intrabony defects present in patients with advanced chronic periodontitis. The results also suggest that GTR adds no clinical benefit to PRP/BPBM. Further studies are necessary to assess the individual role played by PRP and BPBM in the clinical outcome achieved with their combination.

Histological evaluation of 4 cases of root coverage following a connective tissue graft combined with an enamel matrix derivative preparation.

BACKGROUND: The purpose of this report was to evaluate the histological characteristics of 4 clinically successful root coverage procedures performed with a combination of a connective tissue (CT) graft and an enamel matrix derivative (EMD) preparation. METHODS: Four maxillary teeth (3 canines and 1) first premolar) that presented with mucogingival problems and Miller's Class II and III gingival recession were evaluated in the study. Surgical therapy for root coverage consisted of autogenous CT grafts combined with the topical application of EMD. Following healing, treated teeth were extracted with a portion of their buccal attachment apparatus. Two teeth were extracted at 6 months and 2 teeth at 1 year postoperatively. Specimens were prepared for histology and analyzed by light microscopy. RESULTS: All treated teeth presented with clinical signs of successful root coverage. Histological observations of the 4 specimens revealed similar findings. The junctional epithelium was < or = 2 mm long. Apical to the junctional epithelium, dense CT fibers were found in close proximity to the root surface, but in general, no insertion of these fibers into the root was observed. In one 6-month specimen, formation of new cementum and new bone was observed in the most apical end of the grafted area. CONCLUSIONS: The results of this study suggest that a combination of CT grafts and EMD results mainly in an adhesion between the CT and root surface. Some periodontal regeneration may occur in some regions. The development of a long junctional epithelium was not observed with this combined therapy for the treatment of gingival recession.

Bovine-derived bone protein extract in the treatment of mandibular Class II furcations.

This study was an initial evaluation of the use of a bovine-derived bone protein (BP) extract that contains various growth factors combined with decalcified freeze-dried bone allograft (DFDBA) as regenerative treatment for class II mandibular furcations. Twenty-five patients were divided into 5 groups according to the dosage of BP present per mg of DFDBA to be grafted: (1) 0.00 microgram/mg, (2) 3.13 micrograms/mg, (3) 6.25 micrograms/mg, (4) 12.5 micrograms/mg, and (5) 25.0 micrograms/mg. Surgical exploration of the furcation defects was performed followed by grafting with BP/DFDBA. Results at 6 months showed that attachment gain in the treated furcation areas was greatest in Groups 4 and 5, suggesting that BP has the potential to increase the effects of DFDBA in gaining clinical attachment in mandibular class II furcations.

Guided Tissue Regeneration Using Calcium Phosphate Implants Together With 4 Different Membranes. A Study on Furcations in Dogs.

Four different membranes were used in conjunction with porous calcium phosphate granules to treat grade II furcations in lower molars of 6 dogs. Six months later block sections were used to measure the amount of regeneration and inflammation. The 4 membranes (polycarbonate, silicone rubber, polytetrafluoroethylene, and polycaprolactone) all gave similar improvements in bone fill ranging from 1.74 ± 0.44 mm to 2.02 ± 0.38 mm while control areas had only 0.34 ± 0.12 mm. The amount of new attachment ranged from 2.32 ± 0.62 mm to 2.58 ± 0.62 mm for the membranes and was 0.26 ±0.11 mm for controls. There were increased numbers of chronic inflammatory cells seen with the polycarbonate and polycaprolactone group compared to controls and the other 2 membranes.J Periodontol 1993; 64:1154-1156.