Bone replacement grafts with guided tissue regeneration in treatment of grade II furcation defects: a systematic review and meta-analysis.

AIM: The present systematic review appended with meta-analysis aimed to evaluate the efficacy of bone replacement graft (BRG) with guided tissue regeneration (GTR) over BRG or open flap debridement (OFD) alone in the treatment of grade II furcation defects. MATERIALS AND METHODS: An electronic literature search of PubMed, Cochrane Library and Google Scholar databases accompanied with manual searching was done. Randomized controlled trials (RCTs) up to October 2019, comparing BRG+GTR with BRG or OFD in grade II furcation defects, were identified. Clinical attachment level (CAL) gain, changes in gingival marginal level (GML), vertical defect fill (VDF), horizontal defect fill (HDF) and reduction in defect volume were the outcome parameters. RESULTS: Of a total of 12, 9 studies compared BRG+GTR vs BRG while 3 compared BRG+GTR vs OFD. Meta-analysis was carried out for CAL gain, VDF, HDF and GML changes. In the BRG+GTR vs BRG comparison group, out of 9 studies, 6 RCTs showed standardized mean difference (SMD) of 0.513 for VDF, 9 RCTs showed SMD of 0.83 for HDF and 2 RCTs showed SMD of 0.651 for CAL gain, whereas only 2 studies in the same group reported reduction in defect volume. Three studies of the BRG+GTR vs OFD group exhibited significant VDF and CAL gain with SMD of 2.002 and 1.161 respectively. However, no significant change was recorded for GML in both groups. CONCLUSION: The present systematic review indicates supplemental benefits of combination therapy of BRG+GTR over monotherapy in resolving grade II furcation defects. CLINICAL RELEVANCE: In our quest to achieve maximum regeneration in grade II furcation defects, combination therapies such as BRG+GTR have been accepted as treatment choices over other modalities. Clinical situations warranting near-complete regeneration of the tissues in such defects are better suited for combination therapies.

Clinical and radiographic evaluation and comparison of bioactive bone alloplast morsels when used alone and in combination with platelet-rich fibrin in the treatment of periodontal intrabony defects-A randomized controlled trial.

BACKGROUND: The present study aims to evaluate and compare the clinical and radiographic changes obtained through Bioactive Glass (BG) with and without autologous platelet-rich fibrin (PRF) in the treatment of intrabony defects in chronic periodontitis patients. METHODS: The present study was a split-mouth randomized controlled clinical trial comprising 20 chronic periodontitis patients (mean age: 35.9 years) having at least one pair of bilateral intrabony defect. Group 1 included 20 sites treated with a combination of BG and autologous PRF whereas 20 sites in Group 2 were treated with BG alone. Probing pocket depth (PPD), clinical attachment level (CAL) and gingival recession (GR) were evaluated at 3 and 6 months and bone fill at 6 months by using cone beam computed tomography (CBCT) analysis. Primary study outcomes were changes in PPD, CAL, GR, and bone fill. RESULTS: CAL gain was greater in Group 1 (5.05 ± 1.09 mm) when compared with Group 2 (4.2 ± 1.70 mm). Furthermore, a significantly greater bone fill was found in Group 1. At 6 months, statistically significant reduction in PPD in Group 1 and Group 2 was evident. CONCLUSION: BG morsel when used in combination with PRF is found to be more effective in gain in CAL, reduction in PPD and achieving greater bone fill as compared with treatment with BG alone in periodontal intrabony defects and is indicative of enhanced periodontal regeneration.

Comparative evaluation of the left ventricular mass in patients with chronic kidney disease in periodontally healthy, chronic gingivitis, and chronic periodontitis patients.

OBJECTIVES: Emerging evidence suggests that inflammation due to periodontal diseases may not be limited to adjacent oral tissues but may have influence on systemic diseases such as chronic kidney diseases (CKD) and cardiovascular diseases. Hence, this study was aimed to evaluate and compare left ventricular mass (LVM) in patients with CKD undergoing hemodialysis (CKDH) in periodontally healthy, chronic gingivitis, and chronic periodontitis. METHODOLOGY: A total of 60Â patients diagnosed with CKDH were divided equally into three groups based on periodontal status as CKDH patients with healthy periodontium (Group I), CKDH patients with chronic gingivitis (Group II), and CKDH patients with chronic periodontitis (Group III). These patients were assessed clinically, biochemically, and echocardiographically. LVM in each of these patients was calculated according to Devereux formula and was indexed to height. RESULTS: Group II and Group III patients exhibited higher mean LVM of 199.51 ± 40.17 g and 200.35 ± 65.04Â g, respectively, as compared to Group I of 161.56 ± 27.99Â g. Similarly, LVM index (LVMI) was found to be more in Group II and Group III at 59.36 ± 13.14Â g/m2.7 and 57.83 ± 19.94Â g/m2.7, respectively, while it was 45.99 ± 11.87 g/m2.7 for Group I patients. CONCLUSION: Increasing the severity of periodontal diseases in CKDH patients is associated with increase in LVM and LVMI. Periodontal screening and intervention would enable the clinician to refine cardiovascular risk assessment in such patients.