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

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

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

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

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

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

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

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

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

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

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

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