RESUMEN
The masticatory organ is at the center of dental practice. Tooth loss, regarded as an organ failure, is a core dispute in our profession, as it more often than not does not happen spon-taneously but is influenced by the dentist's treatment plan. Despite the prosthetic possibili-ties of tooth replacement, efforts should be made to preserve as many teeth as possible. Decisions between tooth preservation and extraction are complex and have far-reaching consequences. This article discusses this problem using a clinical case study of a 43-year-old female patient with pronounced localized periodontitis. After a comprehensive diagnosis and treatment planning, a daring regenerative therapy was carried out to try to preserve the tooth. The case shows that even seemingly hopeless teeth can be successfully treated syn-chronously using modern therapeutic approaches. Initial literature data supports the possi-bility of preserving severely compromised teeth in the long term in compliant patients. An integrative treatment approach based on individual patient factors and modern regenerative techniques may well be a viable alternative to tooth extraction and prosthetic restoration, albeit not inexpensive and uncomplicated. This communication emphasizes the need for precise diagnostics, a comprehensive treatment plan, and honest communication with pa-tients about the prospects of success and possible risks, and highlights the strengths of con-sistent tooth preservation.
Asunto(s)
Pérdida de Diente , Humanos , Adulto , Regeneración Tisular Guiada Periodontal/métodos , Masculino , Femenino , Planificación de Atención al PacienteRESUMEN
OBJECTIVE: A combination of peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix (PRFM) could be a probable periodontal regenerative material with the synergy of the added benefits of each material. This randomized controlled clinical trial aimed to evaluate the regenerative capacity of supercell (PRFM and PBMSCs) compared with that of PRFM alone in human periodontal mandibular intraosseous defects (IOD). METHODOLOGY: This study included 17 patients of both sexes (12 men, 5 women) aged 30-55 years (mean age = 37.7±4.4 years) who fulfilled the inclusion criteria (radiographic and clinical evaluation for bilateral IOD with probing pocket depth (PPD ≥ 6 mm). A split-mouth design was used in each patient. A total of 34 sites in the mandibular arch randomly received PRFM alone + open flap debridement (OFD) [Control sites] or supercell (PRFM+PBMSCs) + OFD [Test sites]. The clinical parameters plaque index (PI), gingival index (GI), PPD, clinical attachment level (CAL), and in the radiographic parameters; defect depth (DD) and defect fill percentage (DFP) were recorded at baseline, 3 and 6 months postoperatively. Early wound healing index (EHI) was used at 1 week to assess wound healing ability. RESULTS: At 6 months, radiographic parameters revealed significant reduction in DD (P<0.001) and significant DFP values in the test group compared with the control group. The supercell showed significant improvement in PPD and CAL at the end of 6 months (P<0.001). EHI scores at 1 week showed no statistically significant difference between the test and control groups. CONCLUSION: Supercell can be considered a regenerative material in the treatment of periodontal IODs.
Asunto(s)
Trasplante de Células Madre Mesenquimatosas , Fibrina Rica en Plaquetas , Humanos , Persona de Mediana Edad , Femenino , Masculino , Adulto , Resultado del Tratamiento , Factores de Tiempo , Trasplante de Células Madre Mesenquimatosas/métodos , Reproducibilidad de los Resultados , Estadísticas no Paramétricas , Regeneración Tisular Guiada Periodontal/métodos , Pérdida de Hueso Alveolar/terapia , Pérdida de Hueso Alveolar/cirugía , Células Madre Mesenquimatosas , Regeneración Ósea/fisiología , Regeneración Ósea/efectos de los fármacos , Valores de Referencia , Índice Periodontal , Índice de Placa Dental , Cicatrización de Heridas/fisiologíaRESUMEN
The treatment of edentulism with dental implants is often combined with hard- and soft-tissue grafting procedures as a means to improve marginal bone stability and esthetic outcomes. One such method of hard-tissue grafting involves the utilization of a titanium membrane as a space maintenance device to contain the graft material and support the soft tissue. These membranes, however, are typically limited in their ability to be customized and, therefore, are often unsuitable for varying clinical situations. This case report presents a simplified prototype design of an abutment-associated titanium membrane. This design enables a greater level of customization and demonstrates stable clinical and radiographic results after 2 years of follow-up.
Asunto(s)
Regeneración Ósea , Membranas Artificiales , Titanio , Humanos , Implantación Dental Endoósea/métodos , Femenino , Implantes Dentales , Persona de Mediana Edad , Masculino , Regeneración Tisular Guiada Periodontal/métodosRESUMEN
With increased awareness, both in the dental literature and by the general public, of peri-implant disease, a growing trend in dentistry is to save teeth with a "questionable" periodontal prognosis. This prospective study involving such patients was designed to evaluate the effects of combining a bioactive barrier and graft, not on the socket but to augment adjacent periodontal conditions on teeth with severe periodontal bone loss at the time of extraction of an adjacent tooth. Fifteen patients were selected; teeth were extracted, ground, prepared with a pH 11 cleanser, partially demineralized, and made into a graft. This mixture was used to augment socket volume and perform periodontal regenerative surgery. The graft was covered with a bioactive amnion-chorion barrier membrane. Bioactive membranes can stimulate host cells in the surrounding gingival and periosteal tissues to accelerate site closure and healing, simultaneously exerting positive effects on the underlying bone and graft material not observed to the same extent with other membranes. This can improve healing and site regeneration as shown clinically and radiographically in this report. Use of these bioactive barrier membrane and dentin graft materials may have additive effects and provide stimulus for conversion to host bone after site healing. The combination of an amnion-chorion membrane with autologous dentin graft appears to maximize the benefits of the individual materials, improving guided tissue regeneration results and the prognoses of periodontally involved teeth.
Asunto(s)
Amnios , Corion , Dentina , Extracción Dental , Humanos , Amnios/trasplante , Pronóstico , Estudios Prospectivos , Corion/trasplante , Persona de Mediana Edad , Femenino , Adulto , Masculino , Pérdida de Hueso Alveolar/cirugía , Regeneración Tisular Guiada Periodontal/métodos , AncianoRESUMEN
BACKGROUND: The distal aspect of the second molar (d-M2) often exhibits infrabony defects due to the adjacent third molar. Although the defects can be treated by guided tissue regeneration (GTR) after removing the third molar, the optimal timing remains uncertain following third molar removal in clinical decision-making. This study aimed to compare delayed and immediate GTR treatments to assist in clinical decision-making. METHODS: D-M2 infrabony defects with a minimum 1-year follow-up were collected and divided into three groups: Immediate GTR group, which underwent third molar extraction and received GTR simultaneously; Delayed GTR group, which underwent delayed GTR at least 3 months after third molar extraction; and Control group, which underwent only scaling and root planing during third molar extraction. The clinical and radiographic parameters related to the infrabony defect before GTR and post-surgery were evaluated using the Kruskal-Wallis test or one-way ANOVA, followed by post-hoc Dunn's test or the Bonferroni test for pairwise comparisons. RESULTS: A total of 109 d-M2 infrabony defects were assessed. No significant differences were found between the two GTR groups, although both of them showed significant reductions in infrabony defect depth: the immediate GTR group (2.77 ± 1.97 mm vs. 0.68 ± 1.03 mm, p < 0.001) and the delayed GTR group (2.98 ± 1.08 mm vs. 0.68 ± 1.03 mm, p < 0.001) compared to the control group. CONCLUSION: GTR can effectively improve d-M2 infrabony defects when the third molar is removed, whether simultaneously or delayed. Patients may experience less discomfort with immediate GTR treatment as it requires only one surgery.
Asunto(s)
Regeneración Tisular Guiada Periodontal , Tercer Molar , Diente Molar , Extracción Dental , Humanos , Tercer Molar/cirugía , Estudios Retrospectivos , Masculino , Femenino , Adulto , Regeneración Tisular Guiada Periodontal/métodos , Diente Molar/cirugía , Pérdida de Hueso Alveolar/cirugía , Pérdida de Hueso Alveolar/diagnóstico por imagen , Factores de Tiempo , Persona de Mediana Edad , Adulto JovenRESUMEN
Commercial mammalian collagen-based membranes used for guided tissue regeneration (GTR) in periodontal defect repair still face significant challenges, including ethical concerns, cost-effectiveness, and limited capacity for periodontal bone regeneration. Herein, an enhanced biomimetic mineralized hydroxyapatite (HAp)-fish-scale collagen (FCOL)/chitosan (CS) nanofibrous membrane was developed. Specifically, eco-friendly and biocompatible collagen extracted from grass carp fish scales was co-electrospun with CS to produce a biomimetic extracellular matrix membrane. An enhanced biomimetic mineralized HAp coating provided abundant active calcium and phosphate sites, which promoted cell osteogenic differentiation, and showed greater in vivo absorption. In vitro experiments demonstrated that the HAp-FCOL/CS membranes exhibited desirable properties with no cytotoxicity, provided a mimetic microenvironment for stem cell recruitment, and induced periodontal ligament cell osteogenic differentiation. In rat periodontal defects, HAp-FCOL/CS membranes significantly promoted new periodontal bone formation and regeneration. The results of this study indicate that low-cost, eco-friendly, and biomimetic HAp-FCOL/CS membranes could be promising alternatives to GTR membranes for periodontal regeneration in the clinic.
Asunto(s)
Materiales Biomiméticos , Quitosano , Colágeno , Durapatita , Nanofibras , Osteogénesis , Animales , Quitosano/química , Quitosano/farmacología , Osteogénesis/efectos de los fármacos , Durapatita/química , Durapatita/farmacología , Nanofibras/química , Nanofibras/uso terapéutico , Materiales Biomiméticos/química , Materiales Biomiméticos/farmacología , Colágeno/química , Ratas , Diferenciación Celular/efectos de los fármacos , Membranas Artificiales , Ligamento Periodontal/efectos de los fármacos , Ligamento Periodontal/citología , Ligamento Periodontal/fisiología , Ratas Sprague-Dawley , Escamas de Animales/química , Regeneración Ósea/efectos de los fármacos , Regeneración Tisular Guiada Periodontal/métodos , Humanos , MasculinoRESUMEN
PURPOSE: To compare the regenerative clinical and radiographic effects of cross-linked hyaluronic acid (xHyA) with enamel matrix proteins (EMD) at six months after regenerative treatment of periodontal intrabony defects. MATERIALS AND METHODS: Sixty patients presenting one intrabony defect each were randomly assigned into control (EMD) and test (xHyA) groups. Clinical attachment level (CAL) gain was the primary outcome, while pocket probing depth (PPD), gingival recession (REC), bleeding on probing (BOP), full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), and radiographic parameters such as defect depth (BC-BD), and defect width (DW) were considered secondary outcome variables. Parameters were recorded at baseline and after 6 months. RESULTS: At the 6-month follow-up, 54 patients were available for statistical analysis. In the control and test groups, the mean CAL gain was statistically significant in the intragroup comparison (p < 0.001). 48.1% of test sites showed a CAL gain ≤ 2 mm compared with 33.3% of control sites. The mean PPD reduction was statistically significant in the intragroup comparison in both groups (p < 0.001). The mean REC increase was similar in the two groups: 1.04 ± 1.29 mm vs 1.11 ± 1.22 mm (test vs control). The mean BC-BD, DW, FMPS, FMBS, and BOP changed statistically significantly only in the intragroup comparison, not in the intergroup comparison. CONCLUSION: Both treatments, EMD and xHyA, produced similar statistically significant clinical and radiographical improvements after six months when compared with baseline.
Asunto(s)
Proteínas del Esmalte Dental , Ácido Hialurónico , Humanos , Ácido Hialurónico/uso terapéutico , Proteínas del Esmalte Dental/uso terapéutico , Estudios Prospectivos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Pérdida de Hueso Alveolar/diagnóstico por imagen , Índice Periodontal , Regeneración Tisular Guiada Periodontal/métodosRESUMEN
Periodontitis is a serious form of oral gum inflammation with recession of gingival soft tissue, destruction of the periodontal ligament, and absorption of alveolar bone. Management of periodontal tissue and bone destruction, along with the restoration of functionality and structural integrity, is not possible with conventional clinical therapy alone. Guided bone and tissue regeneration therapy employs an occlusive biodegradable barrier membrane and graft biomaterials to guide the formation of alveolar bone and tissues for periodontal restoration and regeneration. Amongst several grafting approaches, alloplastic grafts/biomaterials, either derived from natural sources, synthesization, or a combination of both, offer a wide variety of resources tailored to multiple needs. Examining several pertinent scientific databases (Web of Science, Scopus, PubMed, MEDLINE, and Cochrane Library) provided the foundation to cover the literature on synthetic graft materials and membranes, devoted to achieving periodontal tissue and bone regeneration. This discussion proceeds by highlighting potential grafting and barrier biomaterials, their characteristics, efficiency, regenerative ability, therapy outcomes, and advancements in periodontal guided regeneration therapy. Marketed and standardized quality products made of grafts and membrane biomaterials have been documented in this work. Conclusively, this paper illustrates the challenges, risk factors, and combination of biomaterials and drug delivery systems with which to reconstruct the hierarchical periodontium.
Asunto(s)
Materiales Biocompatibles , Regeneración Ósea , Trasplante Óseo , Regeneración Tisular Guiada Periodontal , Humanos , Regeneración Tisular Guiada Periodontal/métodos , Trasplante Óseo/métodos , Sustitutos de Huesos/uso terapéutico , Periodontitis/terapia , Membranas Artificiales , Animales , Periodoncio/fisiologíaRESUMEN
OBJECTIVES: This study aimed to assess membrane use with a bone substitute graft for guided bone regeneration (GBR) in experimental dehiscence defects. MATERIALS AND METHODS: Maxillary second incisors (I2) in 9 dogs were extracted. Six weeks later, implants were inserted and experimental dehiscence defects (5 × 3 mm) created on the buccal aspect. The defects and surrounding bone were grafted with deproteinized bovine bone mineral. One side (test) was covered with a resorbable collagen membrane whereas the contralateral side (control) was not. After 6 weeks, histomorphometrical analysis was performed to evaluate: (a) first bone-to-implant contact (fBIC), (b) buccal bone thickness at 1 mm increments from implant shoulder, (c) regenerated area (RA), (d) area and percentages of new bone (B), bone substitute (BS) and mineralized tissue (MT). RESULTS: The histological appearance was similar between test and control sites. At central and lateral sections, there were no differences between groups for fBIC, buccal bone thickness, RA, BS, B, %B, MT and %MT. At central sections, membrane use favoured more %BS and %MT (p = 0.052). There was significantly more B, %B and MT at lateral compared to central sections. CONCLUSIONS: Membrane use tended to retain more bone substitute, but had no effect on new bone ingrowth. Lateral sections showed significantly more bone ingrowth and mineralized tissue compared to central sections, confirming that new bone ingrowth takes place mainly from the lateral walls of the defect. CLINICAL RELEVANCE: Preclinical research to clarify the dynamics of bone regeneration in GBR procedures is relevant in clinical practice.
Asunto(s)
Sustitutos de Huesos , Membranas Artificiales , Animales , Bovinos , Perros , Sustitutos de Huesos/farmacología , Regeneración Ósea , Incisivo , Regeneración Tisular Guiada Periodontal/métodos , Maxilar/cirugía , Implantes Dentales , Colágeno , Dehiscencia de la Herida Operatoria , MineralesRESUMEN
AIM: To compare the clinical and radiographic outcomes of flapless procedure alone or in combination with enamel matrix derivatives (EMD) in the treatment of deep intrabony defects. MATERIALS AND METHODS: Forty-six patients re-evaluated after non-surgical therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Clinical measurements were recorded pre-surgery and at 6 and 12 months after surgery, and radiographic measurements were taken pre-surgery and after 12 months. RESULTS: Forty-six patients completed the study. Improvements were observed in both groups at 12 months for mean clinical attachment level (CAL) gain, with significant differences between test (3.9 ± 1.1 mm) and control groups (3.0 ± 1.2) (p = .017). Probing pocket depth (PPD) reduction (4.0 ± 0.7 vs. 3.3 ± 1.4 mm) was also near to statistical significance (p = .051). Also, more sites achieved successful composite outcome measure (final PPD ≤ 4 mm and CAL gain ≥3 mm) for the regenerative treatment in the flapless + EMD group (82.6% vs. 52.2%; p = .028). In terms of radiographic outcomes, EMD yielded a greater defect bone fill than flapless treatment alone (3.0 ± 1.0 mm vs. 1.8 ± 1.5 mm; p < .001). CONCLUSIONS: The additional application of EMD during the flapless procedure for intrabony defects slightly improved clinical and radiographic outcomes. CLINICALTRIALS: gov identification number: NCT05456555.
Asunto(s)
Pérdida de Hueso Alveolar , Proteínas del Esmalte Dental , Humanos , Masculino , Femenino , Pérdida de Hueso Alveolar/cirugía , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/terapia , Persona de Mediana Edad , Proteínas del Esmalte Dental/uso terapéutico , Resultado del Tratamiento , Adulto , Regeneración Tisular Guiada Periodontal/métodosRESUMEN
OBJECTIVE: Periodontitis is an inflammatory condition induced by subgingival bacterial dysbiosis, resulting in inflammatory-mediated destruction of tooth-supporting structures, potentially leading to the formation of infrabony defects. This case report describes the treatment of a patient who presented with a combination 1-2-wall defect on tooth 21. To maintain the residual periodontal attachment and minimize esthetic consequences, a regenerative approach was performed using recombinant human platelet-derived growth factor-BB (rh-PDGF-BB) and ß-tricalcium phosphate (ß-TCP). MATERIALS AND METHODS: At the time of postscaling/root planing reevaluation, a 34-year-old Asian male initially diagnosed with molar/incisor pattern stage III grade C periodontitis exhibited a 6-mm residual probing depth on the mesiopalatal aspect of tooth 21. Periodontal regenerative surgery was performed using rh-PDGF-BB with ß-TCP, without the use of a membrane. RESULTS: At the 1-year follow-up, a significant reduction in probing depth and radiographic evidence of bone fill were observed. Additionally, re-entry surgery for implant placement at site tooth 23 confirmed bone fill in the defect on tooth 21. CONCLUSION: These results demonstrate the efficacy of rh-PDGF-BB with ß-TCP in enhancing periodontal regeneration and support its use as a treatment option when treating poorly contained infrabony defects in the esthetic zone.
Asunto(s)
Becaplermina , Fosfatos de Calcio , Regeneración Tisular Guiada Periodontal , Humanos , Masculino , Fosfatos de Calcio/uso terapéutico , Adulto , Becaplermina/uso terapéutico , Regeneración Tisular Guiada Periodontal/métodos , Proteínas Recombinantes/uso terapéutico , Proteínas Recombinantes/administración & dosificación , Pérdida de Hueso Alveolar/cirugía , Pérdida de Hueso Alveolar/tratamiento farmacológico , Pérdida de Hueso Alveolar/patología , Periodontitis/cirugía , Periodontitis/tratamiento farmacológico , Proteínas Proto-Oncogénicas c-sis/uso terapéutico , Regeneración Ósea/efectos de los fármacos , Estética DentalRESUMEN
This systematic review aimed to evaluate results reported in the literature regarding the success rate of the titanium mesh technique for the placement of dental implants. The topic focused on titanium mesh used as a physical barrier for ridge reconstruction in cases of partial or total edentulism. The authors conducted an electronic search of four databases up to October 2023. Six articles fulfilled the inclusion criteria and were analysed. A total of 100 titanium meshes with a minimum of 4.6 months follow up after surgery were studied, and 241 implants were placed. The review shows that the use of titanium mesh is a predictable method for the rehabilitation of complex atrophic sites. Further investigation generating long-term data is needed to confirm these findings.
Asunto(s)
Regeneración Ósea , Mallas Quirúrgicas , Titanio , Humanos , Regeneración Ósea/fisiología , Implantación Dental Endoósea/métodos , Implantes Dentales , Aumento de la Cresta Alveolar/métodos , Regeneración Tisular Guiada Periodontal/métodosRESUMEN
Despite the various treatments proposed with barrier membranes, one of the main challenges for guided bone regeneration (GBR) is maintaining space for large defects and ensuring an adequate blood supply. The presented feasibility case series aims to introduce an original titanium frame (TF) design, customized for each defect, as a modification of well-known principles and materials for GBR to achieve an enhanced and more predictable horizontal and vertical bone augmentation. Three patients with significant horizontal defects were treated with pre-trimmed TFs to create needed space, and then a 50/50 mixture of autograft and bovine xenograft was placed and covered with a collagen membrane. After 8 months of healing, the sites were reopened, and the titanium screws were removed with the frame. An average of 8.0 ± 1.0 mm of horizontal and 3.0 ± 0.0 mm of vertical bone gain were achieved at the time of reentry and implant placement surgery. Bone core biopsy sample was obtained during the implant placement. Histomorphometric analysis revealed that 42.8% of the sample was new vital bone, 18.8% was residual bone graft particles, and 38.4% was bone marrow-like structures. After 3 to 4 months from implant placement, the implants were restored with provisional crowns and then finalized with zirconia screw-retained crowns. This case series suggests that GBR utilizing TFs with or without collagen membranes can be considered a suitable approach for horizontal and vertical bone augmentation. However, based on only three reported cases, the results should be carefully interpreted.
Asunto(s)
Aumento de la Cresta Alveolar , Estudios de Factibilidad , Titanio , Humanos , Aumento de la Cresta Alveolar/métodos , Persona de Mediana Edad , Femenino , Masculino , Regeneración Tisular Guiada Periodontal/métodos , Implantación Dental Endoósea/métodos , Trasplante Óseo/métodos , Animales , Adulto , Bovinos , Membranas ArtificialesRESUMEN
Bone graft materials are often used in implant treatment to optimize functional and esthetic outcomes. The requirements for bone grafting materials are the ability to maintain space for bone regeneration to occur and the capability of being resorbed by osteoclasts and replaced with new bone tissue occurring in passive chemolysis and bone remodeling. Carbonate apatite (CO3Ap) granules (Cytrans Granules, GC) are a chemically synthetic bone graft material similar to autogenous bone minerals and more biocompatible than allografts and xenografts. The aim of this report is to evaluate the efficacy of CO3Ap granules in implant treatments when used alone or in combination with autogenous bone. The clinical findings and the radiographic and histologic assessments in three cases of immediate implant placement and lateral and vertical guided bone regeneration are reported. Despite the short-term follow-ups, histologic findings showed that CO3Ap granules were efficiently resorbed and replaced bone in clinical use. Furthermore, the clinical findings showed that CO3Ap granules maintained their morphology around the implant. This limited short-term case report suggests that this bone substitute is effective. However, further clinical studies and long-term reports of this new biomaterial are needed.
Asunto(s)
Apatitas , Sustitutos de Huesos , Humanos , Apatitas/química , Regeneración Ósea/efectos de los fármacos , Sustitutos de Huesos/uso terapéutico , Trasplante Óseo/métodos , Regeneración Tisular Guiada Periodontal/métodos , Carga Inmediata del Implante Dental/métodosRESUMEN
Titanium has been proposed as a mesh material for guided bone regeneration (GBR) since the 1990s. To overcome difficulties in shaping and adapting meshes to the defect, digital techniques were introduced to digitally print meshes capable of fitting the bone perfectly, reproduced through the patient's CT scan. Five patients were included in this case series, and their CBCT data were acquired and sent to the producer of the titanium meshes. 3D regenerative surgery was performed with titanium meshes and a mix of demineralized bovine bone matrix (DBBM) and autogenous bone (1:1 ratio). Radiographic measures were evaluated on paraxial sections of the CBCT through a dedicated software. When possible, regenerated bone samples were obtained at implant insertion. Four out of five regenerated areas healed without local or systemic complications. One mesh was removed after 2 months and 2 weeks due to exposure. The mean vertical bone gain was 4.3 ± 1.5 mm (range: 2.5 to 7 mm). Two histologic samples were obtained. In sample 1, bone tissue area and graft material area were 44.4% and 12.5%, respectively; in sample 2, the same parameters were 15.6% and 16.9%, respectively.
Asunto(s)
Diseño Asistido por Computadora , Tomografía Computarizada de Haz Cónico , Mallas Quirúrgicas , Titanio , Humanos , Persona de Mediana Edad , Masculino , Femenino , Adulto , Regeneración Tisular Guiada Periodontal/métodos , Regeneración Ósea/fisiología , Animales , Bovinos , Implantación Dental Endoósea/métodos , Trasplante Óseo/métodos , Anciano , Matriz Ósea/trasplanteRESUMEN
The clinical impact of platelet-rich fibrin (PRF) and plasma rich in growth factors (PRGF®) respectively has been studied extensively in the field of regenerative dentistry during the last two decades. Literature supports evidence for additional benefits in regenerative periodontal therapy, alveolar ridge preservation, management of extraction sockets, implantology including guided bone regeneration as well as defect management in oral surgery. Regarding gingival wound healing and soft tissue regeneration, there is sufficient evidence for their positive effects which have been confirmed in several systematic reviews. The effects seem less clear in conjunction with osseous regenerative treatments, where the inter-study heterogenity in terms of different PRF-protocols, indications and application forms might hinder a systematic comparison. Nevertheless there is evidence that PRF might have beneficial effects on hard-tissue or its regeneration respectively.For being able to facilitate conclusions in systematic reviews, precise reporting of the used PRF-protocols is mandatory for future (clinical) research in the field of autologous platelet concentrates.
Asunto(s)
Fibrina Rica en Plaquetas , Plasma Rico en Plaquetas , Humanos , Regeneración Tisular Guiada Periodontal/métodos , Plaquetas/fisiología , Regeneración Ósea/fisiología , Regeneración Ósea/efectos de los fármacos , Cicatrización de Heridas/fisiología , Cicatrización de Heridas/efectos de los fármacos , Medicina Regenerativa/métodosRESUMEN
We evaluated the effect of periosteal-releasing incisions on flap displacement in anterior maxillary sites following implant placement and simultaneously guided bone regeneration. Thirty patients, each requiring a single dental implant and guided bone regeneration in the maxillary esthetic zone, were recruited. After full-thickness flap elevation, the displacement of the flap was measured under a standardized tension of 1 Ncm. Then, a 2-step periosteal releasing incision was placed in the internal aspect of the flap, and the displacement was remeasured using the same standardized tension. Keratinized tissue width and mucosal thickness at the surgical site were recorded. Patient-reported outcomes were assessed at the 7- and 14-day recall visits. Flap displacement (primary outcome) was calculated before and after periosteal-releasing incisions. Multivariable linear regression models were used to evaluate the influence of mucosal thickness on flap displacement and adjusted for Keratinized tissue width. Primary wound closure was achieved in all patients. The mean difference in flap coronal displacement before and after the periosteal-releasing incisions was 8.2 mm (p < .0001). Adjusted regression models showed no association between mucosal thickness and keratinized tissue width with the amount of flap displacement (p = .770). Patient-reported outcome measures for pain, swelling, and bleeding amounted to 1.28 ± 1.93, 1.36 ± 1.87, and 0.0 ± 0.0 at 7 days and 0.11 ± 0.57, 0.56 ± 1.03, and 0.0 ± 0.0 at 14 days, respectively. Periosteal-releasing incisions using the 2-step procedure described here are a predictable technique to obtain coronal flap displacements >8 mm without increased surgical complications.
Asunto(s)
Maxilar , Periostio , Humanos , Periostio/cirugía , Masculino , Femenino , Persona de Mediana Edad , Maxilar/cirugía , Regeneración Ósea , Implantación Dental Endoósea/métodos , Regeneración Tisular Guiada Periodontal/métodos , Colgajos Quirúrgicos/cirugía , Adulto , Medición de Resultados Informados por el Paciente , Anciano , Implantes Dentales de Diente ÚnicoRESUMEN
PURPOSE: The reverse guided bone regeneration protocol is a digital workflow that has been introduced to reduce the complexity of guided bone regeneration and promote prosthetically guided bone reconstruction with a view to achieving optimal implant placement and prosthetic finalisation. The aim of the present study was to investigate the accuracy of this digital protocol. MATERIALS AND METHODS: Sixteen patients with partial edentulism in the maxilla or mandible and with vertical or horizontal bone defects were treated using the reverse guided bone regeneration protocol to achieve fixed implant rehabilitations. For each patient, a digital wax-up of the future rehabilitation was created and implant planning was carried out, then the necessary bone reconstruction was simulated virtually and the CAD/CAM titanium mesh was designed and used to perform guided bone regeneration. The computed tomography datasets from before and after guided bone regeneration were converted into 3D models and aligned digitally. The actual position of the mesh was compared to the virtual position to assess the accuracy of the digital project. Surgical and healing complications were also recorded. A descriptive analysis was conducted and a one-sample t test and Wilcoxon test were utilised to assess the statistical significance of the accuracy. The level of significance was set at 0.05. RESULTS: A total of 16 patients with 16 treated sites were enrolled. Comparing the virtually planned mesh position with the actual position, an overall mean discrepancy between the two of 0.487 ± 0.218 mm was achieved. No statistically significant difference was observed when comparing this to a predefined minimum tolerance (P = 0.06). No surgical complications occurred, but two healing complications were recorded (12.5%). CONCLUSION: Within the limitations of the present study, the reverse guided bone regeneration digital protocol seems to be able to achieve good accuracy in reproducing the content of the virtual plan. Nevertheless, further clinical comparative studies are required to confirm these results.
Asunto(s)
Regeneración Ósea , Diseño Asistido por Computadora , Mallas Quirúrgicas , Titanio , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Adulto , Tomografía Computarizada por Rayos X/métodos , Arcada Parcialmente Edéntula/cirugía , Arcada Parcialmente Edéntula/rehabilitación , Implantación Dental Endoósea/métodos , Resultado del Tratamiento , Imagenología Tridimensional/métodos , Regeneración Tisular Guiada Periodontal/métodosRESUMEN
Restoring periodontally compromised teeth in esthetic zones through dental implant rehabilitation poses significant challenges due to the loss of supporting tissues. This case report describes a staged treatment strategy designed for a 48-year-old woman with advanced chronic periodontitis of the esthetic zone. This approach combined various advanced techniques, including periodontal regeneration, orthodontic implant site development with labial root torque, guided bone regeneration, and soft tissue augmentation. The innovative orthodontic implant site development with labial root torque technique was employed to harness healthy palatal periodontal ligament cells by strategically applying labial root torque in the horizontal labial-palatal direction. This technique uses healthy palatal periodontal ligament cells, which benefits overall periodontal health. The procedure involved gradually shifting hopeless teeth at a rate of 2 mm per month using nickel-titanium wires, thereby maintaining overcorrection for 2 months before extraction. Following successful orthodontic implant site development with labial root torque, the next phase involved guided bone regeneration using a honeycomb-structured titanium membrane. This set the stage for implant placement 6 months later, ensuring a stable foundation for subsequent prosthetic intervention. Soft tissue augmentation was then meticulously performed using an artificial collagen dermis infused with fibroblast growth factor-2, contributing to the overall esthetic outcome. Final prosthesis integration revealed a harmonious blend with the adjacent teeth and gums, underscoring the success of this multidisciplinary approach. This case report provides valuable insights into severe periodontitis in the esthetic field. Our findings highlight the importance of continuously researching and improving procedures for optimal patient care.