Surgical treatment of peri-implantitis: 3-year results from a randomized controlled clinical trial.

OBJECTIVES: This study reports on the 3-year follow-up of patients enrolled in a randomized controlled clinical trial on surgical treatment of advanced peri-implantitis. MATERIAL AND METHODS: A total of 100 patients with advanced peri-implantitis were randomly assigned to one of four treatment groups. Surgical therapy aiming at pocket elimination was performed and, in three test groups, supplemented by either systemic antibiotics, use of an antiseptic agent for implant surface decontamination or both. Outcomes were evaluated after 1 and 3 years by means of clinical and radiological examinations. Differences between groups were explored by regression analysis. RESULTS: Clinical examinations at 3 years after treatment revealed (i) improved peri-implant soft tissue health with a mean reduction in probing depth of 2.7 mm and a reduction in bleeding/suppuration on probing of 40% and (ii) stable peri-implant marginal bone levels (mean bone loss during follow-up: 0.04 mm). Implant surface characteristics had a significant impact on 3-year outcomes, in favour of implants with non-modified surfaces. Benefits of systemic antibiotics were limited to implants with modified surfaces and to the first year of follow-up. CONCLUSION: It is suggested that surgical treatment of peri-implantitis is effective and that outcomes of therapy are affected by implant surface characteristics. Potential benefits of systemic antibiotics are not sustained over 3 years.

Hyaluronan in non-surgical and surgical periodontal therapy: a systematic review.

AIM: To evaluate the effect of hyaluronan (HY) application as monotherapy or as adjunct to non-surgical and/or surgical periodontal therapy. METHODS: Literature search was performed according to PRISMA guidelines with the following main eligibility criteria: (a) English or German language; (b) pre-clinical in vivo or human controlled trials; (c) effect size of HY evaluated histologically or clinically. RESULTS: Two pre-clinical in vivo studies on surgical treatment and 12 clinical trials on non-surgical and/or surgical treatment were included. Most of the studies were highly heterogeneous, regarding with HY product used and application mode, and of high risk of bias, thus not allowing meta-analysis. The majority of clinical studies described a beneficial, occasionally statistically significant, effect of HY on bleeding on probing (BoP) and pocket depth (PD) reduction (2.28-19.5% and 0.2-0.9 mm, respectively), comparing to controls; no adverse effects were reported. CONCLUSIONS: Hyaluronan application as adjunct to non-surgical and surgical periodontal treatment seems to have a beneficial, generally moderate, effect on surrogate outcome variables of periodontal inflammation, i.e., BoP and residual PD, and appears to be safe. The large heterogeneity of included studies, does not allow recommendations on the mode of application or effect size of HY as adjunct to non-surgical and surgical periodontal treatment.

A two-stage surgical approach to the treatment of severe peri-implant defect: a 30-month clinical follow-up report.

With the advance of dental implant technology and the consequential increase in its success rate, the implant has become a highly predictable treatment method. Despite this, related complications are on the rise, with peri-implant mucositis and peri-implantitis being the most commonly observed. As in the case of conventional periodontitis, many patients experience peri-implant mucositis and peri-implantitis. In this case presentation, extensive bone loss occurred around the implant due to peri-implantitis, and the infection was first treated by applying chlorhexidine-soaked gauze and topical antibiotics. Then the guided bone regeneration procedure was performed using a bovine bone material and a collagen membrane, which resulted in the recovery of the lesion. With follow-ups of the healing process for 30 months, a successful outcome was observed that is reported herein.

A single-centre randomized controlled clinical trial on the adjunct treatment of intra-bony defects with autogenous bone or a xenograft: results after 12 months.

BACKGROUND: Limited evidence exists on the efficacy of regenerative treatment of peri-implantitis. MATERIAL AND METHODS: Subjects receiving antibiotics and surgical debridement were randomly assigned to placement of autogenous bone (AB) or bovine-derived xenograft (BDX) and with placement of a collagen membrane. The primary outcome was evidence of radiographic bone fill and the secondary outcomes included reductions of probing depth (PD) bleeding on probing (BOP) and suppuration. RESULTS: Twenty-two subjects were included in the AB and 23 subjects in the BDX group. Statistical analysis failed to demonstrate differences for 38/39 variables assessed at baseline. At 12 months, significant better results were obtained in the BDX group for bone levels (p < 0.001), BOP (p = 0.004), PI (p = 0.003) and suppuration (p < 0.01). When adjusting for number of implants treated per subject, a successful treatment outcome PD ≤ 5.0 mm, no pus, no bone loss and BOP at 1/4 or less sites the likelihood of defect fill was higher in the BDX group (LR: 3.2, 95% CI: 1.0-10.6, p < 0.05). CONCLUSIONS: Bovine xenograft provided more radiographic bone fill than AB. The success for both surgical regenerative procedures was limited. Decreases in PD, BOP, and suppuration were observed.

The clinical effect of locally delivered minocycline in association with flap surgery for the treatment of chronic severe periodontitis: a split-mouth design.

OBJECTIVE: The purpose of this study was to determine the effectiveness of adjunctive application of locally delivered minocycline ointment associated with flap surgery for the treatment of patients with chronic severe periodontitis. MATERIAL AND METHODS: Twenty patients with chronic severe periodontitis were treated in a split-mouth study to either adjunctive application of locally delivered minocycline ointment in association with flap surgery (FM) or flap surgery only (FO); additional minocycline application was performed at 3 months post operation. Clinical evaluation of the plaque index, probing depth (PD), bleeding on probing (BOP), gingival recession, and clinical attachment level (CAL) was conducted at baseline and at 3 and 6 months after treatment. RESULTS: Clinical evaluations revealed that although both sites exhibited clinical improvement, there was a statistically significant reduction in PD (3.34 ± 0.03 mm) and BOP (78.01 ± 11.42%), and a significant gain of CAL (1.88 ± 0.21 mm) at the FM site compared with the FO site (reduction of PD and BOP: 2.62 ± 0.06 mm, 50.33 ± 15.01%, and gain of CAL: 1.55 ± 0.13 mm) at 6 months post operation (p < 0.05). CONCLUSION: Adjunctive application of locally delivered minocycline may be beneficial to the surgical treatment protocol of chronic severe periodontitis.

Er:YAG laser in the treatment of periodontal sites with recurring chronic inflammation: a 12-month randomized, controlled clinical trial.

AIM: The objective of this randomized, controlled clinical trial was to compare the clinical and microbiological effects of pocket debridement using erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser with conventional debridement in maintenance patients. MATERIAL & METHODS: Fifteen patients, all smokers, having at least four teeth with residual probing depth (PD) ≥ 5 mm were recruited. Two pockets in two jaw quadrants were randomly assigned to subgingival debridement using an Er:YAG laser (test) or ultrasonic scaler/curette (control) at 3-month intervals. Relative attachment level (RAL), PD, bleeding on probing and dental plaque were recorded at baseline and at 6 and 12 months. Microbiological subgingival samples were taken at the same time points and analysed using a checkerboard DNA-DNA hybridization technique. RESULTS: A significant decrease in PD took place in both treatments from baseline to 12 months (p < 0.01). In the control, the mean initial PD decreased from 5.4 to 4.0 mm at 12 months. For the test, a similar decrease occurred. No significant between-treatment differences were shown at any time point. The mean RAL showed no overall significant inter- or intra-treatment differences (p > 0.05). No significant between-treatment differences were observed in subgingival microbiological composition or total pathogens. CONCLUSION: The results failed to support that an Er:YAG laser may be superior to conventional debridement in the treatment of smokers with recurring chronic inflammation. This appears to be the first time that repeated Er-YAG laser instrumentation has been compared with mechanical instrumentation of periodontal sites with recurring chronic inflammation over a clinically relevant time period.

Combined surgical therapy of peri-implantitis evaluating two methods of surface debridement and decontamination. A two-year clinical follow up report.

OBJECTIVES: The study aimed at evaluating the 2-year results obtained following combined surgical resective and regenerative treatment of advanced peri-implantitis defects comparing two methods of surface debridement/decontamination (DD). MATERIAL & METHODS: Twenty-four patients (n = 26 combined supra- and intrabony defects) completed the 24 months follow-up observation following access flap surgery, granulation tissue removal and implantoplasty at bucally and supracrestally exposed implant parts. The remaining aspects were randomly allocated to surface DD using either (i) an Er:YAG laser (ERL) device, or (ii) plastic curets + cotton pellets + sterile saline (CPS) were augmented with a natural bone mineral and covered with a collagen membrane. RESULTS: At 24 months, ERL treated sites failed to reveal significantly higher reductions in mean BOP (ERL: 75.0 ± 32.6% versus CPS: 54.9 ± 30.3%) and CAL values (ERL: 1.0 ± 2.2 mm versus CPS: 1.2 ± 2.2 mm) when compared with the CPS group. In both groups, mean CAL values were not significantly different when compared with baseline. CONCLUSION: The long-term stability of clinical outcomes obtained following combined surgical therapy of advanced peri-implantitis may be influenced by factors other than the method of surface debridement/decontamination.

Effectiveness of root planing with diode laser curettage for the treatment of periodontitis.

This study investigated the effectiveness of scaling/root planing using closed approach, closed approach with laser-curettage, closed approach with laser-curettage/laser-sealing, and an open approach (papilla reflection/flap closure) in treating moderate-advanced chronic periodontitis. All treatments resulted in a reduction in probing depth and bleeding upon probing. The closed approach therapies: SRP, laser-curettage/SRP, and laser-curettage/SRP/laser-sealing resulted in less gingival recession than the open approach (papilla reflection/flap closure). If esthetics are a concern, laser-curettage is a viable option.

The efficacy of host response modulation therapy (omega-3 plus low-dose aspirin) as an adjunctive treatment of chronic periodontitis (clinical and biochemical study).

BACKGROUND AND OBJECTIVE: Regeneration of lost periodontal tissues is considered to be one of the most challenging aspects of periodontal therapy. Our current understanding of the role of the host immuno-inflammatory response in periodontal diseases forms the basis of new therapeutic approaches. The aim of this study was to evaluate the efficacy of systemic administration of omega-3 polyunsaturated fatty acids plus low-dose aspirin as an adjunctive treatment to regenerative therapy of furcation defects. MATERIAL AND METHODS: Forty patients displaying at least a single grade II furcation defect were enrolled in the study. They were randomly allocated into two groups: an experimental group receiving decalcified freeze-dried bone allograft (DFDBA) + omega-3 polyunsaturated fatty acids combined with low-dose aspirin; and a control group receiving DFDBA + placebo. Clinical parameters were monitored at baseline, and at 3 and 6 mo following therapy, and included plaque index, gingival index, gingival bleeding index, probing pocket depth and clinical attachment level. The biochemical markers assessed in gingival crevicular fluid samples were interleukin-1ß and interleukin-10. RESULTS: The experimental intervention resulted in a greater mean probing pocket depth reduction (P < 0.001) and gain in clinical attachment (P < 0.05) compared with the control at 6 mo. Furthermore, the experimental protocol was able to achieve a significant modulatory effect on the levels of interleukin-1ß and interleukin-10 compared with control therapy. CONCLUSION: The findings suggest that the combination therapy demonstrated successful reduction of gingival inflammation, reduction of pocket depth and attachment level gain, accompanied by a trend for modulation of the cytokines profile in gingival crevicular fluid.

Impact of the method of surface debridement and decontamination on the clinical outcome following combined surgical therapy of peri-implantitis: a randomized controlled clinical study.

OBJECTIVES: The study aimed at investigating the impact of two surface debridement/decontamination (DD) methods on the clinical outcomes of combined surgical treatment of peri-implantitis. MATERIAL AND METHODS: Thirty-two patients suffering from advanced peri-implantitis (n=38 combined supra- and intra-bony defects) were treated with flap surgery, granulation tissue removal, and implantoplasty at buccally and supracrestally exposed implant parts. The intra-bony aspects were randomly allocated to surface DD using either (i) an Er:YAG laser (ERL) device, or (ii) plastic curets+cotton pellets+sterile saline (CPS). In both groups, the intra-bony component was augmented with a natural bone mineral and covered with a collagen membrane. Clinical and radiographic parameters were recorded at baseline and after 6 months of non-submerged healing. RESULTS: Two patients were lost during follow-up. At 6 months, ERL-treated sites failed to reveal higher reductions in mean bleeding on probing (ERL: 47.8 ± 35.5 versus CPS: 55.0 ± 31.1%) and CAL values (ERL: 1.5 ± 1.4 versus CPS: 2.2 ± 1.4 mm) when compared with the CPS group. Both groups exhibited a comparable radiographic bone fill at the intra-bony defect component. CONCLUSION: The study failed to demonstrate a significant impact of the method of surface DD on the clinical outcome following combined surgical therapy of advanced peri-implantitis lesions.

A multi-centre randomized controlled clinical trial on the treatment of intra-bony defects with enamel matrix derivatives/synthetic bone graft or enamel matrix derivatives alone: results after 12 months.

OBJECTIVES: Comparison of the clinical and radiographic outcomes of a combination of enamel matrix derivatives (EMD) and a synthetic bone graft (EMD/SBG) with EMD alone in wide (≥2 mm) and deep (≥4 mm) one- and two- wall intra-bony defects 12 months after treatment. MATERIALS AND METHODS: Seventy-three patients with chronic periodontitis and one wide (≥2 mm) and deep (≥4 mm) intra-bony defect were recruited in five centres in Germany. During surgery, defects were randomly assigned to EMD/SBG (test) or EMD (control). Assessments at baseline, after 6 and 12 months included bone sounding, attachment levels, probing pocket depths, bleeding on probing, and recessions. Changes in defect fill were recorded radiographically. RESULTS: Both treatment modalities led to significant clinical improvements. In the EMD/SBG group a mean defect fill of 2.7 ± 1.9 mm was calculated, in the EMD group the defect fill was 2.8 ± 1.6 mm. A mean gain in clinical attachment of 1.7 ± 2.1 mm in the test group and 1.9 ± 1.7 mm in the control group after 1 year was observed. Radiographic analysis confirmed for both groups that deeper defects were associated with greater defect fill. CONCLUSION: The results show comparable clinical and radiographic outcomes following both treatment modalities 12 months after treatment.

Surgical therapy of peri-implantitis lesions by means of a bovine-derived xenograft: comparative results of a prospective study on two different implant surfaces.

OBJECTIVES: The aim of this prospective study was to evaluate a regenerative surgical treatment modality for peri-implantitis lesions on two different implant surfaces. MATERIALS AND METHODS: Twenty-six patients with one crater-like defect, around either TPS (Control) or SLA (Test) dental implants, with a probing depth (PD) ≥6 mm and no implant mobility, were included. The implant surface was mechanically debrided and treated using a 24% EDTA gel and a 1% chlorhexidine gel. The bone defect was filled with a bovine-derived xenograft (BDX) and the flap was sutured around the non-submerged implant. RESULTS: One-year follow-up demonstrated clinical and radiographic improvements. PDs were significantly reduced by 2.1±1.2 mm in the Control implants and by 3.4±1.7 mm in the Test implants. Complete defect fill was never found around Controls, while it occurred in three out of 12 Test implants. Bleeding on probing decreased from 91.1±12.4% (Control) and 75.0±30.2% (Test) to 57.1±38.5% (p=0.004) and 14.6±16.7% (p=0.003), respectively. Several deep pockets (≥6 mm) were still present after surgical therapy around Controls. CONCLUSIONS: Surface characteristics may have an impact on the clinical outcome following surgical debridement, disinfection of the contaminated surfaces and grafting with BDX. Complete fill of the bony defect seems not to be a predictable result.

Outcome of surgical treatment of peri-implantitis: results from a 2-year prospective clinical study in humans.

AIM: The aim of the present study was to evaluate the outcome of a surgical procedure based on pocket elimination and bone re-contouring for the treatment of peri-implantitis. MATERIAL AND METHODS: The 31 subjects involved in this study presented clinical signs of peri-implantitis at one or more dental implants (i.e. ≥6 mm pockets, bleeding on probing and/or suppuration and radiographic evidence of ≥2 mm bone loss). The patients were treated with a surgical procedure based on pocket elimination and bone re-contouring and plaque control before and following the surgery. At the time of surgery, the amount of bone loss at implants was recorded. RESULTS: Two years following treatment, 15 (48%) subjects had no signs of peri-implant disease; 24 patients (77%) had no implants with a probing pocket depth of ≥6 mm associated with bleeding and/or suppuration following probing. A total of 36 implants (42%) out of the 86 with initial diagnosis of peri-implantitis presented peri-implant disease despite treatment. The proportion of implants that became healthy following treatment was higher for those with minor initial bone loss (2-4 mm bone loss as assessed during surgery) compared with the implants with a bone loss of ≥5 mm (74% vs. 40%). Among the 18 implants with bone loss of ≥7 mm, seven were extracted. Between the 6-month and the 2-year examination, healthy implants following treatment tended to remain stable, while deepening of pockets was observed for those implants with residual pockets. CONCLUSION: The results of this study indicated that a surgical procedure based on pocket elimination and bone re-contouring and plaque control before and following surgery was an effective therapy for treatment of peri-implantitis for the majority of subjects and implants. However, complete disease resolution at the site level seems to depend on the initial bone loss at implants. Implants with no signs of peri-implantitis following treatment tended to remain healthy during the 2-year period, while a tendency for disease progression was observed for the implants that still showed signs of peri-implant disease following treatment.

Treatment of lymphangioma with CO2 laser in the mandibular alveolar mucosa.

OBJECTIVE: In this case report, treatment of lymphangioma (a red-purple vesicular apperance, nonulcerated lesion, located on the gingiva of the mandibular alveolar bone) with CO2 laser on a 63-year-old female patient and 2 years clinical outcome is presented. BACKGROUND: Lymphangiomas are hemorrhagic, rare, benign hamartomatous tumors of lymphatic system have a marked predilection for the head, neck and oral cavity. Lymphangiomas are congenital lesions and an often present at or around the time of birth (60%). Among the dental laser systems, CO2 laser is the most suitable instrument for the treatment of soft tissue pathologies because of its affinity for water-based tissues. The absorbed energy causes vaporization of the intra- and extracellular fluid and destruction of the cell membranes. A major advantage of the 10.600 nm wavelength CO2 laser is its ability to seal blood vessels during surgery and to make the excision of vascular lesions with its hemostatic effect. METHODS: CO2 laser application (focused CO2 laser beam, 10.600 nm) was performed in a separate operation room at 3 watt (W), continous wave (CW) with 90 degree angle tip under local anesthesia. The mouth was protected from reflection of the laser by wet gauzes. The wound formed by laser was left open to secondary epithelization. Excessive bleeding was not observed during the procedure. The wound formed by laser was left open to secondary epithelization. Neither sutures nor dressings were used after surgery. Only paracetamol and chlorhexidine digluconate mouthwash were prescribed during the postoperative period. There was no postsurgical complaints from the patient. RESULTS: CO2 laser worked well while making the excision with its hemostatic effect. No recurrence was seen in the two years follow-up period. CONCLUSION: CO2 laser therapy can be used as a primary alternative method in the treatment of lymphangiomas. It can be safely used and recurrence may be less than conventional excision with scalpel. However, long-term clinical follow-up is neccessary for the recurrence of the lesion. CLINICAL SIGNIFICANCE: CO2 laser treatment can be used safely in the treatment of lymphangiomas.

Regenerative treatment with platelet-rich plasma combined with a bovine-derived xenograft in smokers and non-smokers: 12-month clinical and radiographic results.

AIM: The purpose of this study was to assess the healing response of intrabony defects following regenerative treatment with platelet-rich plasma (PRP) combined with a bovine-derived xenograft (BDX) in smokers and non-smokers. MATERIALS AND METHODS: A total of 24 advanced chronic periodontitis patients, 12 smokers and 12 non-smokers, with 113 intrabony defects with an intrabony component of or /=3 mm were included in this study. Defects were surgically treated with PRP/BDX. At baseline and 12 months after surgery, the following parameters were recorded: plaque and sulcus bleeding indices, probing depth (PD), relative attachment level, marginal recession, probing and radiographic bone levels. RESULTS: Considering the soft tissue measurements, smokers and non-smokers presented a mean PD reduction of 3.97 +/- 0.76 and 4.63 +/- 0.52 mm, recession of 0.76 +/- 0.44 and 0.50 +/- 0.12 mm and attachment gain of 3.26 +/- 0.42 and 4.06 +/- 0.40 mm, respectively. Evaluation of the hard tissue findings revealed that the mean clinical and radiographic bone gains in smokers and non-smokers were 2.83 +/- 0.47 and 3.63 +/- 0.38 mm, 2.98 +/- 0.38 and 3.67 +/- 0.48 mm, respectively. Inter-group differences for PD reduction (p<0.05), attachment (p<0.001), clinical (p<0.001) and radiographic bone gains (p<0.001) were found to be significant between smokers and non-smokers. CONCLUSIONS: Within the limits of this study, the results indicate that treatment outcome following PRP/BDX application in intrabony defects is impaired with smoking.

Systemic inflammation following non-surgical and surgical periodontal therapy.

AIM: To describe the kinetics of serum inflammatory markers after a course of treatment comprising surgical and non-surgical treatment of chronic periodontitis (CP). MATERIAL AND METHODS: Fourteen CP cases received full-mouth non-surgical treatment and, after 6 months, at least two surgical sessions. Blood samples were collected at various time-points after treatment. Blood markers of systemic inflammation/coagulation including leucocyte counts, C-reactive protein (CRP), serum amyloid-A (SAA) and D-dimers and renal function (cystatin C) were determined using high-sensitivity assays. RESULTS: Periodontal treatment resulted in substantial reductions of the number of pockets, gingival bleeding and plaque at 3 and 6 months after non-surgical therapy (p<0.001). Surgical therapy led to an additional reduction of periodontal pockets (p<0.01). Marked increases in the serum levels of CRP and SAA were noted 24 h after non-surgical therapy (p<0.01) and periodontal surgeries (p<0.05). D-dimer levels increased drastically 24 h after non-surgical therapy (p<0.05). The drastic increase of CRP after non-surgical therapy was greater than both the surgical therapy sessions (p<0.05). CONCLUSIONS: Patients undergoing periodontal treatment experience perturbations of systemic inflammation of a greater magnitude after non-surgical than surgical periodontal therapy.

Cervical restoration and the amount of soft tissue coverage achieved by coronally advanced flap: a 2-year follow-up randomized-controlled clinical trial.

BACKGROUND: The aim of this study was to evaluate the 2-year follow-up success of the treatment of gingival recession associated with non-carious cervical lesions by a coronally advanced flap (CAF) alone or in combination with a resin-modified glass ionomer restoration (CAF+R). MATERIAL AND METHODS: Sixteen patients with bilateral Miller Class I buccal gingival recessions, associated with non-carious cervical lesions, were selected. The defects received either CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL) and cervical lesion height (CLH) coverage were measured at the baseline and 6, 12 and 24 months after the treatment. RESULTS: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant in BOP, PD, RGR and CAL, after 2 years. The percentages of CLH covered were 51.57 +/- 17.2% for CAF+R and 53.87 +/- 12.6% for CAF (p>0.05). The estimated root coverage was 80.37 +/- 25.44% for CAF+R and 83.46 +/- 20.79% for CAF (p>0.05). CONCLUSION: Within the limits of the present study, it can be concluded that both procedures provide acceptable soft tissue coverage after 2 years, with no significant differences between the two approaches.

Open flap debridement and guided tissue regeneration after 10 years in infrabony defects.

OBJECTIVE: Evaluation of the 10-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) therapy of infrabony defects in a randomized controlled clinical trial. MATERIALS AND METHODS: In 16 periodontitis patients OFD or polylactide acetyltributyl citrate barriers (GTR; n=23) were assigned randomly to 44 infrabony defects. In a subgroup of 10 patients exhibiting 2 contra-lateral defects each OFD and GTR was assigned to either side (split-mouth). At baseline, 12, and 120 +/- 12 months after surgery clinical parameters were obtained. RESULTS: Fifteen patients (41 defects) were available at 120 months. Twelve and 120 +/- 12 months after therapy both groups showed statistically significant (p<0.01) attachment gain (split-mouth: OFD: 12 months: 3.60 +/- 2.67 mm; 120 months: 3.65 +/- 3.36 mm; GTR: 12 months: 3.50 +/- 1.90 mm; 120 months: 2.85 +/- 2.24 mm; parallel: OFD: 12 months: 3.47 +/- 2.80 mm; 120 months: 3.41 +/- 2.75 mm; GTR: 12 months: 3.67 +/- 2.11 mm; 120 months: 2.89 +/- 2.12 mm). From 12 to 120 months both groups experienced insignificant attachment changes, however, six teeth (two OFD, four GTR) were lost (all for prosthodontic reasons). The study failed to show statistically significant attachment gain differences between both groups after 120 months. CONCLUSIONS: Ten years after OFD and GTR in infrabony defects 35 of 41 teeth were still in place.

Clinical effectiveness of autologous platelet-rich plasma and Peptide-enhanced bone graft in the treatment of intrabony defects.

BACKGROUND: The goal of periodontal therapy has always been the regeneration of lost attachment apparatus. The use of platelet-rich plasma (PRP) plus anorganic bovine-derived matrix and peptide 15 (ABM/P-15) for periodontal regenerative therapy offers a potentially useful modality for treating periodontal osseous defects. However, it is unknown whether a combination of these materials enhances the outcome of periodontal regenerative therapy. Therefore, this study was carried out to compare the effectiveness of the two regenerative techniques (autologous PRP plus ABM/P-15 versus autologous PRP) in treating intrabony defects in humans by analyzing the clinical and radiologic parameters. METHODS: Using a split-mouth design, 28 intrabony defects were treated with autologous PRP (control) or a combination of autologous PRP and ABM/P-15 (test). Clinical parameters such as plaque index, sulcus bleeding index, probing depth, attachment level, and gingival marginal level were recorded at baseline and 9 months postoperatively. Hard tissue measurements such as defect fill, defect resolution, and change in alveolar crest height were also recorded using spiral computed tomography (CT). RESULTS: A statistically significant difference was observed in all clinical parameters in the test group compared to the control group. Furthermore, spiral CT images revealed significantly greater bone fill in the test group. CONCLUSIONS: A combination of PRP plus ABM/P-15 was more effective than PRP alone in the treatment of intrabony defects. Further studies using a larger sample size are necessary to confirm the results of the present study.

Minimally invasive surgical technique and enamel matrix derivative in intrabony defects: 2. Factors associated with healing outcomes.

This case cohort study was designed to evaluate the healing response of a minimally invasive surgical technique (MIST) in combination with enamel matrix derivative (EMD) in isolated deep intrabony defects. Forty deep intrabony defects were surgically accessed with the MIST This technique was designed to limit the flap extent and reflection to reduce surgical trauma and increase flap stability. EMD was applied on the dried root surfaces. Surgery was performed with the aid of an operating microscope and microsurgical instruments. The 1-year clinical attachment level gain was 4.9 +/- 1.7 mm. Seventy percent of defects gained > or = 4 mm. Clinical attachment level gain was significantly associated with the depth of the three-wall component of the defect, with the intraoperative bleeding tendency of the defect, and with its interaction with the baseline amount of bone loss. Defect morphology and bleeding tendency seem to influence clinical outcomes from the use of MIST in combination with EMD.