Periodontal granulation tissue - To remove or not to remove, that is the question.

Formation of granulation tissue is a fundamental phase in periodontal wound healing with subsequent maturation leading to regeneration or repair. However, persistently inflamed granulation tissue presents in osseous defects as a result of periodontitis and is routinely disrupted and discarded with non-surgical and surgical therapy to facilitate wound healing or improve chances of regeneration. Histological assessment suggests that granulation tissue from periodontitis-affected sites is effectively a chronic inflammatory tissue resulting from impaired wound healing due to persistence of bacterial dysbiotic bioflim. Nevertheless, the immunomodulatory potential and stem cell characteristics in granulation tissue have also raised speculation about the tissue's regenerative potential. This has led to the conception and recent implementation of surgical techniques which preserve granulation tissue with the intention of enhancing innate regenerative potential and improve clinical outcomes. As knowledge of fundamental cellular and molecular functions regulating periodontitis-affected granulation tissue is still scarce, this review aimed to provide a summary of current understanding of granulation tissue in the context of periodontal wound healing. This may provide new insights into clinical practice related to the management of granulation tissue and stimulate further investigation.

Effect of antioxidant lycopene on human osteoblasts.

OBJECTIVE: The aim of this in vitro study is to evaluate the effect of antioxidant lycopene on human osteoblasts. MATERIAL AND METHOD: The human osteoblast cell line (CRL-11372) was obtained from the American Type Culture Collection (ATCC Manassas, Va) and grown in Dulbecco's Modified Eagle's medium (DMEM) supplemented with 10% fetal calf serum (FCS), penicillin (100 U/ml), and streptomycin (100 mg/ ml) at 37 °C in a humidified atmosphere of 5% CO2 and 95% air. The effective dose of lycopene was determined by MTT assay and a real-time cell analysis (RTCA) system. Proliferative effects were analyzed by in vitro wound healing model. Gene expressions of type 1 collagen (COL1A1), osteocalcin (OCN), and growth differentiation factor-5 (GDF-5) were measured by quantitative real-time polymerase chain reaction (qRT-PCR) at 72 h. Statistical differences between test groups were analyzed with a one-way ANOVA test. RESULTS: MTT assay showed that the doses between 10-5 and 1 µmol of lycopene had dose-dependent proliferative effects. The doses between 10-5 and 10-1 µmol were most effective at 72 h. Lycopene accelerates the healing rate by increasing osteoblast proliferation. CONCLUSION: Results suggested that lycopene had proliferative effects on human osteoblasts, which may help to increase bone regeneration, and thus, it can be useful in tissue engineering procedures. CLINICAL RELEVANCE: By the help of antioxidants like lycopene capacity, velocity and quality of new bone forming may be increased in periodontal and dental implant treatments.

Factors affecting periodontal healing of the adjacent second molar after lower third molar surgery: a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aim to evaluate the effect modifiers which may influence the periodontal healing of the adjacent second molar after lower third molar surgery. MATERIALS AND METHODS: Prospective studies including patients with third molars requiring removal, with at least 6 months follow-up were considered. Outcomes were periodontal probing depth (PPD) reduction, final PPD, clinical attachment level (CAL) change, final CAL, alveolar bone defect (ABD) reduction, and final ABD depth. Meta-regression was performed to identify factors. RESULTS: Fourteen studies were included in the quantitative synthesis. At 6 months, the PPD reduction was 1.06 mm (95% CI, 0.72 to 1.39 mm) and the remaining PPD was 3.81 mm (95% CI, 3.00 to 4.62 mm). Baseline PPD was strongly correlated with the remaining PPD at 6 months (p < 0.001, adjusted R2 = 70.05%). CONCLUSIONS: Lower third molar surgery results in a modest reduction in PPD, CAL, and ABD; however, periodontal defects still remain at 6 months and beyond. Baseline PPD is strongly correlated with final PPD. While age is not shown to have effect on most of the periodontal parameters, a larger baseline PPD is more likely to manifest with increasing age and third molar surgery should be done before severe periodontitis occurs to avoid persistent periodontal defects. CLINICAL RELEVANCE: This study shows that lower third molar surgery results in modest improvement in periodontal parameters on adjacent second molars and identified factors such as baseline PPD which may affect the healing, which may guide the pre-, peri-, and post-operative management of lower third molar surgery.

The outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries.

BACKGROUND/AIMS: Tooth auto-transplantation is a treatment option, which is often not considered to replace anterior maxillary incisors in children and adolescents. There are multiple prognostic factors that may influence the outcomes of premolar auto-transplantation, but there is limited evidence from human studies. The aim of this study was to report the outcomes of auto-transplanted premolars in the anterior maxilla following traumatic dental injuries (TDIs) and to identify their prognostic factors. MATERIALS AND METHODS: The clinical records of patients who had premolars transplanted in the anterior maxilla following TDI, with appropriate radiographs and a minimal of 1-year follow-up, were reviewed retrospectively. A specific data extraction form was developed, tested and used to collect information for the prognostic factors and outcomes. RESULTS: The cohort included 120 patients with 144 auto-transplanted premolars. The mean age was 12.2 years (±2.0), and the mean observation period was 3.7 years (±1.8). The success rate was 80%, and the survival rate was 93%. Unfavourable outcomes included external replacement resorption in 12.5%, uncontrolled external inflammatory resorption in 2.7%, and both resorption types in 4.9% of teeth. Periodontal healing was significantly associated with donor tooth root maturity, graft handling at the time of surgery including ease of donor tooth extraction and placement at the recipient sites, recipient site alveolar bone status, and post-operative transplant mobility. Seventy-four teeth (53.4%) were immature at the time of transplantation where pulp revascularisation was anticipated, and 52 (70%) of those had radiographic and clinical signs of pulp healing. Pulp healing was significantly related to donor tooth eruption stage, ease of extraction of donor tooth, and ease of placement in the recipient site. CONCLUSIONS: Good outcomes were observed for premolar teeth auto-transplanted in the anterior maxilla. The main prognostic factors were ease of extraction of donor tooth and ease of placement in the recipient sites and donor tooth root maturity.

Impact of health and lifestyle food supplements on periodontal tissues and health.

According to the new classification, periodontitis is defined as a chronic multifactorial inflammatory disease associated with dysbiotic biofilms and characterized by progressive destruction of the tooth-supporting apparatus. This definition, based on the current scientific evidence, clearly indicates and emphasizes, beside the microbial component dental biofilm, the importance of the inflammatory reaction in the progressive destruction of periodontal tissues. The idea to modulate this inflammatory reaction in order to decrease or even cease the progressive destruction was, therefore, a logical consequence. Attempts to achieve this goal involve various kinds of anti-inflammatory drugs or medications. However, there is also an increasing effort in using food supplements or so-called natural food ingredients to modulate patients' immune responses and maybe even improve the healing of periodontal tissues. The aim of this chapter of Periodontology 2000 is to review the evidence of various food supplements and ingredients regarding their possible effects on periodontal inflammation and wound healing. This review may help researchers and clinicians to evaluate the current evidence and to stimulate further research in this area.

Periodontal tissue engineering using an apatite/collagen scaffold obtained by a plasma- and precursor-assisted biomimetic process.

BACKGROUND AND OBJECTIVES: In the treatment of severe periodontal destruction, there is a strong demand for advanced scaffolds that can regenerate periodontal tissues with adequate quality and quantity. Recently, we developed a plasma- and precursor-assisted biomimetic process by which a porous collagen scaffold (CS) could be coated with low-crystalline apatite. The apatite-coated collagen scaffold (Ap-CS) promotes cellular ingrowth within the scaffold compared to CS in rat subcutaneous tissue. In the present study, the osteogenic activity of Ap-CS was characterized by cell culture and rat skull augmentation tests. In addition, the periodontal tissue reconstruction with Ap-CS in a beagle dog was compared to that with CS. METHODS: The plasma- and precursor-assisted biomimetic process was applied to CS to obtain Ap-CS with a low-crystalline apatite coating. The effects of apatite coating on the scaffold characteristics (i.e., surface morphology, water absorption, Ca release, protein adsorption, and enzymatic degradation resistance) were assessed. Cyto-compatibility and the osteogenic properties of Ap-CS and CS were assessed in vitro using preosteoblastic MC3T3-E1 cells. In addition, we performed in vivo studies to evaluate bone augmentation and periodontal tissue reconstruction with Ap-CS and CS in a rat skull and canine furcation lesion, respectively. RESULTS: As previously reported, the plasma- and precursor-assisted biomimetic process generated a low-crystalline apatite layer with a nanoporous structure that uniformly covered the Ap-CS surface. Ap-CS showed significantly higher water absorption, Ca release, lysozyme adsorption, and collagenase resistance than CS. Cell culture experiments revealed that Ap-CS was superior to CS in promoting the osteoblastic differentiation of MC3T3-E1 cells while suppressing their proliferation. Additionally, Ap-CS significantly promoted (compared to CS) the augmentation of the rat skull bone and showed the potential to regenerate alveolar bone in a dog furcation defect. CONCLUSION: Ap-CS fabricated by the plasma- and precursor-assisted biomimetic process provided superior promotion of osteogenic differentiation and bone neoformation compared to CS.

Repair of teeth with cracks in crowns and roots: An observational clinical study.

AIM: This retrospective observational study investigated the survival rate of teeth with radicular cracks that were restored using composite materials. METHODOLOGY: The study was approved by the Ethical Committee of Sistema Sanitario Nazionale (prot. N°2370CELazio1), Clinicaltrials.gov identifier: NCT04430205. Between 1991 and 2019, 87 teeth with radicular cracks (87 patients [46 men, 41 women, mean age 50.2 years]) were treated with adhesive composite restorations. Forty-five cracks were observed in the maxillary posterior teeth (molars and premolars), 40 in the mandibular posterior teeth and only two cracks in the anterior teeth, both in maxilla. Based on the depth of the crack, teeth were categorized as proximal radicular cracked teeth (PRCT), in which the fracture line was restricted within the pulpal floor or the coronal one-third of the root and deep radicular cracked teeth (DRCT), in which the fracture line extended to the middle and apical thirds of the root canal up to the apex. Bone loss/recovery was evaluated radiographically at 1-year follow-up. All patients were treated using surgical microscopy by the same operator. Logistic regression analysis was performed to determine independent predictors of extraction. Kaplan-Meier survival curves were used to analyse PRCT and DRCT. RESULTS: Among 87 cracked teeth, 66 were molars, 19 premolars and 2 incisors. Fifty-two were DRCT, 35 were PRCT, 46 had a periodontal probing defect. Patients were followed up for a mean of 66.9 months (standard deviation 44.6, min 1 to max 172). Lack of probing depth was a significant protective factor against extraction (odds ratio [OR] 0.027, 95% confidence interval [CI] 0.003-0.27, p < .05), whereas further bone loss (OR 10.63, 95% CI 2.08-54.36, p < .05) was a risk factor for extraction. More than 50% of teeth treated with the adhesive protocol were functional (46 of 87 teeth [χ2 test], p < .05) at 5-year follow-up. Among the PRCT group, a 78% survival rate at 5 years was found, while among the DRCT group, a 58% survival rate was found. CONCLUSION: Composite resin restorations resulted in tooth survival in >50% of patients; 85.4% of PRCT and 61.5% of DRCT were functional after 5 years of follow-up.

Influence of incision on periodontal parameters after apical surgery: a meta-analysis.

INTRODUCTION: The aim of the present meta-analysis was to determine the effect of the different incision designs used in apical surgery on periodontal parameters. METHODS: An electronic search in Cochrane Library, Pubmed (MEDLINE), and Scopus was conducted on April 2020. Two independent investigators included clinical trials and prospective cohort studies comparing the influence of different incision designs used in apical surgery on gingival recession, periodontal probing depth, and clinical attachment level. A pairwise and network meta-analysis was performed in order to meta-analyze the direct and the indirect comparisons among the incision designs. RESULTS: Six articles were included for the qualitative and the quantitative syntheses, involving a total of 401 teeth (372 patients). The pairwise meta-analysis did not reveal statistically significant differences between the incision designs in any of the outcomes evaluated. However, to reduce the amount of buccal gingival recession, the papilla base incision presented the highest probabilities of being ranked the most effective incision (85.7%), followed by submarginal incision (50.0%) and intrasulcular incision (14.3%). CONCLUSION: Regardless of the incision design used, the periodontal parameters did not statistically differ after apical surgery. CLINICAL RELEVANCE: Periodontal parameters did not significantly change despite the incision used in apical surgery. However, based on the results of the present review, the papilla base incision seems to be the best option to reduce the amount of buccal gingival recession.

Effect of splinting times on the healing of intra-alveolar root fractures in 512 permanent teeth in humans: A Scandinavian multicenter study.

BACKGROUND/AIM: Long-term splinting of teeth with intra-alveolar root fractures has been considered important for the deposition of hard tissue between the root fragments. The aim of this study was to compare the healing outcomes in teeth with intra-alveolar root fractures relative to splinting times in three dental centers in Scandinavia, using historical data. MATERIALS AND METHODS: A total of 512 maxillary and mandibular incisors from three dental trauma centers were included in the study. Two of the centers used long-term splinting protocols of two to three months while the other center used a short-term splinting protocol of one month or less. Three outcomes were evaluated: (1) Healing with hard tissue (dentin and/or cementum). (2) Healing with connective tissue (periodontal ligament) interposition with or without bone between the fragments. (3) Non-healing due to the coronal pulp being necrotic and infected with granulation tissue interposed between the fragments. RESULTS: The mean splinting times were 18, 81, and 110 days in the three centers. Long-term splinting resulted in hard tissue healing more frequently than short-term splinting. Short-term splinting resulted in more connective tissue/bony healing than long-term splinting, while there was no difference in the frequency of non-healing between long-term and short-term splinting protocols. CONCLUSIONS: While the results suggest that long-term splinting favors hard tissue deposition, one cannot, however, conclude that long-term splinting definitely favors hard tissue healing since the treatment protocols were not randomized among the three centers. More clinical studies on the role of splinting time need to be done.

Effect of tetracyclines on pulpal and periodontal healing after tooth replantation: a systematic review of human and animal studies.

BACKGROUND: Pulpal and periodontal healing are two main concerns of delayed replantation of avulsed teeth. The objective of this review was to evaluate the effectiveness of topical and systemic application of tetracyclines on pulpal and periodontal healing after tooth replantation. METHODS: A comprehensive electronic search was conducted in six databases. This systematic review was carried out according to Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: After exclusion of 246 irrelevant papers, 14 animal studies and one human study were included in this review. The human study showed that avulsed permanent teeth treated with doxycycline did not show a better clinical outcome for pulp and periodontal healing compared with treatment with normal saline. As for animal studies, significant more pulpal healing was observed in immature teeth treated with topical doxycycline in two researches, while another one study showed that there is no difference between teeth treated with normal saline and teeth treated with doxycycline. Systemic doxycycline exerted no significant effect on pulpal revascularization illustrated by one research. Only one out of four articles illustrated the positive effect of systemic tetracyclines on periodontal healing. One paper reported that intracanal application of demeclocycline promoted favorable periodontal healing. Two articles showed topical doxycycline contributed to favorable periodontal healing, while five studies showed no significant effect of topical tetracyclines on periodontal healing. CONCLUSIONS: As a result of data heterogeneity and limitations of the studies, the effect of topical or systemic application of tetracyclines on pulpal and periodontal healing is inconclusive. More studies are required to get more clinically significant conclusions.

Efficacy of a new-generation platelet-rich fibrin in the treatment of periodontal intrabony defects: a randomized clinical trial.

BACKGROUND: The aim of the study was to clinically evaluate the healing of intrabony defects after treatment with a new generation of platelet-rich fibrin (A-PRF+) respect to enamel matrix derivative (EMD). METHODS: Thirty (30) intrabony defects of 18 patients (9 males, 9 females) were randomly treated with A-PRF+ (test, n = 15) or EMD (control, n = 15). The following clinical parameters were recorded at baseline and 6 months after surgery: pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL). After debridement the intrabony defects were filled with A-PRF+ in the test group, respectively with EMD in the control group, and fixed with sutures to ensure wound closure and stability. RESULTS: Both treatment methods resulted in statistically significant PD reductions, respectively CAL gains six months post-operatively. No statistically significant differences were found between the two groups as the mean CAL gain was 2.33 ± 1.58 mm in the A-PRF+ group, respectively 2.60 ± 1.18 mm in the EMD group (p < 0.001). CONCLUSION: Within the limits of this study the new-generation platelet-rich fibrin seems to be as clinically effective as EMD during surgical treatment of intrabony defects. Treatment with A-PRF+ or EMD resulted in reliable clinical outcomes. The use of A-PRF+ as a human autologous product can give a positive impact on periodontal healing. Clinical Relevance A-PRF+ may be suitable for the treatment of intrabony periodontal defects. Trial registration number (TRN) NCT04404374 (ClinicalTrials.gov ID).

Expression of inflammatory biomarkers and growth factors in gingival crevicular fluid at different healing intervals following non-surgical periodontal treatment: A systematic review.

BACKGROUND: Non-surgical periodontal treatment (NSPT) is widely employed for the treatment of periodontal disease and yields significant clinical improvements. Gingival crevicular fluid (GCF) can be used to profile health and disease, and recent technological advances, such as multiplex bead immunoassays, are promising in identifying a wider array of GCF factors with the ultimate aim to predict the treatment response. OBJECTIVE: The aim of this systematic review was to compare the expression of GCF markers using multiplex bead immunoassays before treatment and during early, average, or late healing period, following non-surgical periodontal treatment (NSPT). METHODS: An electronic literature search was conducted by two independent examiners (VK and NC) in MEDLINE, EMBASE, OpenGrey, LILACS, and Cochrane Library up to January 2020. The PICO question formulated was as follows: "In patients with periodontal disease, does the expression of gingival crevicular fluid (GCF) markers detected using multiplex bead immunoassay differ at baseline compared with early (≤30 days), average (6-8 weeks), or late (≥3 months) healing after intervention?" RESULTS: A total of 366 publications were obtained and reviewed for eligibility for inclusion. Of these, 12 publications fulfilled the inclusion criteria and were included in the present review. Data for a total of 31 different GCF markers were extracted and summarized for early, average, or late healing after NSPT. Early healing following NSPT (≤ 30 days) indicated an increase in IL-1ß, TNFα, and IL-10. At the average healing period (6-8 weeks), IL-1ß, IL-1α, IL-6, TNF-α, IFN-γ, GM-CSF, MCP-1, and MIP-1α were all reduced, compared to their respective baseline values. Three months after NSPT, IL-1ß, IL-4, IL-6, IL-10, TNF-α, and IFN-γ were detected at reduced levels, compared to pre-treatment levels. Overall, the changes following treatment indicated a reduction of inflammation present at baseline. CONCLUSION: Following non-surgical periodontal treatment, an upregulation of inflammation markers is noted early post-operatively and a subsequent reduction of their levels three months following treatment. The investigation of levels of GCF markers associated with inflammation and regeneration, especially using multiplex bead immunoassay technologies, is a valuable tool to better understand the processes associated with healing following periodontal treatment.

Diabetes alters the involvement of myofibroblasts during periodontal wound healing.

OBJECTIVES: Myofibroblasts constitute a specific cell phenotype involved in connective tissue healing. Diabetes alters the wound healing response. However, it is not clear whether diabetes modifies the involvement of myofibroblasts in periodontal wounds. MATERIALS AND METHODS: Type I diabetes was induced in rats through streptozotocin injection, and periodontal wounds were performed. Wound healing was evaluated histologically at 2, 5, 7, and 15 days by measuring epithelial migration, neutrophil infiltration, and collagen and biofilm formation. Distribution of myofibroblasts was evaluated through immunofluorescence for α-smooth muscle actin. Data analyses were performed using the Shapiro-Wilk, ANOVA, or Kruskal-Wallis tests. RESULTS: Diabetic wounds were characterized by delayed epithelial closure, increased neutrophil infiltration, biofilm formation, and reduced collagen formation. Quantification of the myofibroblasts showed a significant reduction at 5 and 7 days in wounds of diabetic rats and an increase at 15 days when compared to wounds of non-diabetic rats. CONCLUSIONS: Diabetic wound healing was associated with decreased epithelial and connective tissue healing, increased levels of inflammation, and biofilm formation. Myofibroblast differentiation was delayed in diabetic periodontal wounds at early time points. However, myofibroblasts persisted at later time points of healing. The present study suggests that diabetes alters the involvement of myofibroblasts during periodontal wound healing.

Gingival recession after scaling and root planing with or without systemic metronidazole and amoxicillin: a re-review.

BACKGROUND: Gingival recessions inevitably occur during healing after scaling and root planing, but synoptic data on this topic is still lacking. This review compared the recession formation with and without the administration of systemic antibiotics. OBJECTIVES: To evaluate the formation of recession with and without the administration of antibiotics during the healing after scaling and root planing. MATERIALS AND METHODS: This study re-analyzed publications that reported clinical attachment levels (CAL) and probing pocket depths (PD) up to January 2019, including the pivotal review by Zandbergen and co-workers (2013). Whereas these studies traditionally focused on PD and CAL, the present analysis compared recession formation (ΔREC) after adjunctive systemic administration of amoxicillin (amx) and metronidazole (met) during scaling and root planing (SRP) and SRP alone. The mean increase in ΔREC, if not reported, was calculated from CAL and PD values and statistically analyzed. Recession formation was compared after 3 and 6 months after therapy. Results were separately reported for chronic periodontitis (CP) as well as aggressive periodontitis (AP) cases. RESULTS: Recessions increased consistently between baseline and follow-up. In the AP group, median ΔREC was 0.20 mm after 3 months, irrespective of whether antibiotics were administered or not. After 6 months, median ΔREC increased to 0.35 mm after AB and remained stable at 0.20 mm with SRP alone. In the CP group, after 3 months with and without antibiotics, median ΔREC accounted for 0.30 mm and 0.14 mm, respectively. After 6 months, median ΔREC accounted for 0.28 mm (with AB) and 0.20 mm (without AB). The quantitative assessment by meta-analyses also yielded small values (≤ 0.25 mm) for the estimated differences in recession formation between AB and noAB; however, none of them reached statistical significance. CONCLUSIONS: Although a slight tendency towards higher recession formation after SRP in combination with AB could be observed in many studies, quantitative meta-analyses showed no clinically relevant difference in recession formation due to the administration of AB. In general, the description and discussion of recessions in the literature seems not to be a major focus so far. CLINICAL RELEVANCE: Since the preservation of gingival tissues is important by preventive and therapeutic means, e.g., when avoiding postoperative root sensitivity or performing regenerative surgery, these aspects should not be neglected. We thus suggest to report REC measurements along with PD and CAL values for more direct recession formation (ΔREC) assessments in the future.

Computer-aided three-dimensional assessment of periodontal healing distal to the mandibular second molar after coronectomy of the mandibular third molar: a prospective study.

BACKGROUND: The periodontal healing distal to the mandibular second molar (M2M) after coronectomy of the M3M has shown controversial results. We aimed to combine a digital method with cone-beam computed tomography (CBCT) and estimate periodontal healing of M2M after M3M coronectomy. An accurate and stable indicator in three dimensions was also explored tentatively. METHODS: Patients with a M3M in contact with the inferior alveolar canal were included. CBCT was applied immediately after coronectomy (baseline) and 6-months later. Data were investigated with digital software for registration. Previously reported and coronectomy-related factors were included for univariate and multivariate analyses. RESULTS: A total of 181 patients (213 M3Ms) completed 6-month follow-up. Significant reduction in the distal intra-bony defect (DBD) depth of the M2M was shown (1.28 ± 1.24 mm, P < 0.001). DBD depth of the M2M at baseline was the most influential factor (r = 0.59), followed by preoperative M3M condition, age, rotation and migration of the root complex. Remaining enamel (OR = 6.93) and small retromolar space (0.67) contributed to re-contact of the root complex and M2M. Bone volume regenerated in the distal 2 mm was associated significantly with DBD-depth reduction (r = 0.74, P < 0.001). CONCLUSIONS: Bone volume regenerated in the distal 2 mm of the M2M denoted stability of distal periodontal healing of the M2M. DBD depth at baseline was the most influential factor for healing of a DBD of the M2M after M3M coronectomy. The remaining enamel and a small retromolar space could contribute to re-contact of the root complex and the M2M. TRIAL REGISTRATION: China Clinical Trial Center, ChiCTR1800014862 . Registered 10 February 2018.

Effect of implant macrogeometry on peri-implant healing outcomes: a randomized clinical trial.

OBJECTIVES: This randomized split-mouth clinical trial investigated the influence of implant macrogeometry on bone properties and peri-implant health parameters during the healing process. MATERIAL AND METHODS: Ninety-nine implants were placed bilaterally in posterior mandibles of 23 patients that received at least four dental implant macrogeometries: standard geometry, Integra (IN) and three geometries inducing "healing chamber": Duo (D), Compact (C), and Infra (IF). Insertion torque (IT) and implant stability quotient (ISQ) were measured. Peri-implant health were monitored by visible plaque index (VPI), peri-implant inflammation (PI), and presence of calculus (CC). Data were collected during 90 days. Data were assessed for normality using the asymmetry and kurtosis coefficients followed by the Shapiro-Wilk test. A one-way ANOVA was used to investigate differences in IT and linear bone dimensions between the macrogeometry groups. The repeated measurements ANOVA test or ANOVA-R was used for analysis of ISQ, VPI, and PI. Tukey-Kramer test or Student's t test was used for comparisons between the groups or within each macrogeometry. RESULTS: Macrogeometry did not significantly influence IT and ISQ values. The minimum ISQ was recorded after 7 days (71.95 ± 12.04, p = 0.0001). Intermediate ISQ was found after 14 days, when the ISQ reached values that are statistically identical to primary stability. The VPI showed significantly higher scores for the D (0.88 ± 1.03) and IN (0.72 ± 0.94) implants after 7 days. The PI was only influenced by the healing time significantly decreasing from 7 (1.07 ± 0.89) to 21 days (0.18 ± 0.18). CONCLUSION: Implant macrogeometry did not influence IT nor ISQ values. The relationship between IT and SS was more evident for the Duo implant, but only in the final stage of healing process. CLINICAL RELEVANCE: Show to the clinician that the macrogeometry and drilling protocols did not interfere in the clinical behavior of the implants during the healing process. However, the IT, primary and secondary stability, is quite dependent of the surgeon experience.

A retrospective study of survival of 196 replanted permanent teeth in children.

BACKGROUND/AIM: The extra-alveolar period and storage medium are important for the survival of replanted teeth. The aim of this study was to evaluate factors affecting the survival of replanted teeth in children. MATERIAL AND METHODS: Complete dental records of avulsed teeth including age, gender, extra-alveolar time, storage type and period, stage of root development, crown fracture, gingival laceration, alveolar fracture, antibiotics, and splint type and period were obtained. Kaplan-Meier, Cox regression and chi-square tests were used to analyse the risk factors affecting survival (P < 0.05). RESULTS: The study included 196 replanted teeth with a mean follow-up period of 4.0 years. Forty-two (21.4%), 45 (23.0%), and 109 teeth (55.6%) showed functional healing, inflammatory resorption and replacement resorption. The root resorption incidence of teeth with extra-alveolar time longer than 30 minutes was higher vs teeth with a time of less than 30 minutes (P = 0.010). Physiologically stored replanted teeth showed lower incidence of root resorption (19/31, 61.3%) than those stored in non-physiologic media (94/114, 82.5%) (P = 0.025). Root resorption incidence of teeth stored non-physiologically within 30 minutes and then transferred to physiologic media (25/33, 75.8%) was similar to that of teeth stored physiologically (P = 0.127). Teeth stored non-physiologically for longer than 30 minutes had a significantly higher root resorption incidence (99/113, 87.6%) than teeth stored non-physiologically within 30 minutes (55/83, 66.3%) (odds ratio = 1.726, P = 0.001). Pulp canal obliteration occurred in five of the 56 immature teeth (8.9%) but two of them were later extracted because of replacement resorption. The survival of mature teeth (111/140, 79.3%) was significantly higher than that of immature teeth (39/56, 69.6%) (P = 0.007). CONCLUSIONS: This study suggested that non-physiologic storage within 30 minutes was critical for the periodontal healing of replanted teeth. Replanted immature teeth had lower survival rates than mature teeth.

Early wound healing outcomes after regenerative periodontal surgery with enamel matrix derivatives or guided tissue regeneration: a systematic review.

BACKGROUND: Proper wound healing after regenerative surgical procedures is an essential issue for clinical success. Guided tissue regeneration (GTR) and application of enamel matrix derivatives (EMD) are common means to regenerate periodontal tissues. Both methods bear considerable advantages due to their special characteristics, but also go along with certain disadvantages. Today, there is no consensus in the literature whether GTR or EMD show better results regarding early wound healing, which is considered a crucial stage in periodontal regeneration. Therefore, the aim of the present systematic review was to compare the early wound healing after regenerative periodontal surgery with either EMD or GTR treatment. METHODS: An electronic literature search in PubMed was performed to identify randomized clinical trials (RCTs) or clinical trials (CTs) comparing regenerative surgery employing EMD and/or GTR in patients with chronic periodontitis. Among the finally included studies, a qualitative and quantitative data extraction regarding early wound healing parameters was performed. Primary outcome parameters were early wound healing index (EWH), flap dehiscence, membrane exposure, suppuration and abscess formation during the first 6 weeks. As secondary parameters, swelling and allergic reactions were assessed. RESULTS: Seven studies reporting 220 intrabony periodontal defects in 199 patients were analysed. Flap dehiscence was observed in two studies in 12% of the GTR treated sites and in 10.3% of those treated with EMD. Membrane exposure was evaluated in five studies and was registered in the 28.8% of the defects, while no dehiscence was reported on the EMD group. Swelling was reported only in one study in 8/16 GTR sites and 7/16 EMD sites. Due to considerable heterogeneity of parameters no meta-analysis was possible. CONCLUSIONS: Due to considerable heterogeneity of the published studies a clear beneficial effect of the EMD on the early wound healing outcomes after surgical treatment of periodontal intrabony defects cannot be confirmed. Standardized RCT studies are needed in order to allow for proper comparison of early wound healing after both types of surgical approaches.

Outcomes and prognostic factors that influence the success of tooth autotransplantation in children and adolescents.

BACKGROUND/AIM: Tooth autotransplantation has been advocated for replacement of missing teeth or teeth that are unsuitable for restoration. The aim of this study was to investigate the outcomes and prognostic factors that influenced the success of tooth transplantation in a paediatric population. MATERIALS AND METHODS: Data were extracted from the records of 75 patients (89 teeth). Demographic and prognostic factors were recorded and analysed for the clinical and radiographic outcomes for periodontal ligament (PDL) and pulp healing of transplanted teeth. RESULTS: The mean age at transplant was 13.2 years, and the mean follow-up observation period was 2.6±1.8 years with a range of 12.0 months to 9.9 years. The main reason for transplantation was to replace upper central incisors lost or missing due to dental trauma, hypodontia and dilaceration. Of the 45 teeth that were monitored for pulp revascularization, 75.6% showed clinical and radiographic signs of pulp healing and 24.4% showed signs of pulp necrosis and infection. Pulp healing was significantly related to the stage of root development of the transplant. Favourable PDL healing was observed in 87.6% of the transplants, while 13.5% showed signs of replacement resorption. PDL healing was significantly related to the stage of root formation of the transplanted tooth at the time of the surgery, the ease of handling and placement of the tooth, and the status of the alveolar bone at the recipient site at the time of the surgery. Overall success of tooth transplantation was 87.6%, and the survival rate was 94.4%. CONCLUSIONS: Tooth transplantation carried out in children and adolescents demonstrated high success and survival, with the stage of root development influencing both the pulp and PDL healing of the transplanted teeth.

Effects of diode laser irradiation and fibroblast growth factor on periodontal healing of replanted teeth after extended extra-oral dry time.

AIM: The search for effective protocols to reduce the incidence of root resorption and allow periodontal ligament repair is still challenging, given the unpredictable outcome of late tooth replantation. The aim of this study was to assess the effects of both high-power diode laser irradiation (DL) and basic fibroblast growth factor (FGF) on the periodontal healing of replanted teeth after extended extra-oral dry time. METHODS: Maxillary incisors of 50 male rats were extracted and assigned to three experimental and two control groups (n = 10). DL: root surfaces treated with DL (810 nm, continuous mode, 1.0 W, 30 s), FGF: topical application of FGF gel to the root surface and in the alveolar wound, DL + FGF: DL and topical application of FGF gel, C+: no treatment after extraction and immediate replantation and C-: no treatment after extraction and replantation after 60 min. In the experimental groups, the specimens were kept dry for 60 min, the pulps were removed and the canals were filled with calcium hydroxide paste prior to tooth replantation. The animals were euthanized after 60 days. The specimens were processed for radiographic, histological and immunohistochemical analyses. RESULTS: The radiographic analysis showed fewer resorptive areas in DL + FGF (P < 0.05). The histological and immunohistochemical analyses showed that the DL group had lower mean values of ankylosis, replacement and inflammatory resorption when compared to C-, not differing statistically from C+. DL + FGF produced significantly more collagen fibers (type I and type III) than C-, not differing from C+ in the case of type I fibers (P < 0.05). CONCLUSIONS: DL, with or without FGF, reduced the occurrence of external root resorption and ankylosis. Periodontal healing was favored and some fiber reinsertion occurred only when FGF was used.