Application of digital technology and platelet-rich fibrin technology in a novel regenerative treatment for posterior lingual furcation defect: a 6-year follow-up case report.

Conventional periodontal regenerative surgery has limited effect on tooth with severe periodontitis-related alveolar bone defects. This article reported a case of regenerative treatment in severe distal-bone defect of mandibular first molar. The treatment involved applying 3D printing, advanced/injectable platelet-rich fibrin, and guided tissue-regeneration technology. After the operation, the periodontal clinical index significantly improved and the alveolar bone was well reconstructed.

Histologic and histomorphometric evaluation of Aloe vera adjunctive to ß-tricalcium phosphate in class II furcation defects in dogs.

Aloe vera has antimicrobial activity and enhances the osseointegration process, thus it may have the potential in treating periodontal defects. This study aimed to evaluate the effect of Aloe vera as an adjunction to Beta-tricalcium phosphate (ß-TCP) bone graft in Grade II furcation defects. A randomized study was conducted on six healthy mongrel dogs' premolars. A total of twenty-four Grade II furcation critical-sized defects were surgically created after reflecting a full-thickness flap, twelve defects were filled with ß-TCP while the other twelve defects were filled with Aloe vera mixed with ß-TCP and both covered by collagen membrane. Animals were euthanized at the end of the fourth and eighth week and defects were analyzed histologically and histomorphometrically. Histologically, Aloe vera mixed with ß-TCP resulted in more bone formation and new PDL fibers compared to ß-TCP alone. After 2 and 4 weeks, the experimental group had significantly higher newly formed interradicular bone height (p < 0.0001, and p < 0.0001, respectively), bone thickness (p < 0.0001, and p < 0.0001, respectively), and percentage of the surface area (p = 0.009, and p = 0.023, respectively). Aloe vera gel adjunctive to ß-TCP is an effective bioactive agent that enhances periodontal tissue regeneration and bone formation in critically sized defects.

Local drug delivery in the treatment of furcation defects in periodontitis: a systematic review.

OBJECTIVES: To evaluate the effect of subgingival administration of various antimicrobials and host-modulating agents in furcation defects as an adjunct to scaling and root planing (SRP) compared to SRP alone or combined with placebo. METHODS: A systematic review was carried out using MEDLINE-PubMed, Embase, and Scopus for articles up to October 2022 in addition to hand searches. All longitudinal studies that evaluated the effect of subgingival application of antimicrobial and host-modulating agents in furcation defects as adjuncts to SRP compared to SRP alone or SRP + placebo with at least 3 months of follow-up were eligible for inclusion. RESULTS: A total of eight studies were included. Superior clinical treatment outcomes were shown when alendronate, rosuvastatin, boric acid, simvastatin, and tetracycline (only at 3 months) were utilized in furcation defects in conjunction with SRP alone or SRP + placebo. Significant improvement was reported in radiographic bone defect depth and defect depth reduction when SRP was supplemented with alendronate, rosuvastatin, boric acid, and simvastatin. CONCLUSIONS: Within the limitations of this review, the adjunctive subgingival administration of medications and host-modulating agents in furcation defects may confer additional clinical and radiographic benefits than non-surgical periodontal treatment alone. Future investigations are needed to confirm their long-term effectiveness. CLINICAL RELEVANCE: Local host modulators and antimicrobials may be used supplementary to enhance the clinical and radiographic treatment outcomes of conventional periodontal therapy in furcation defects.

The effect of systemic antibiotics on periodontal regeneration: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of the use of systemic antibiotics in regenerative periodontal surgery for treating teeth affected by periodontitis. DATA SOURCES: Electronic (MEDLINE, EMBASE, LILACS, Scopus, and Cochrane) and manual literature searches for human randomized controlled trial studies published up to November 2022 were conducted by two reviewers. Meta-analysis was performed to assess probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain in groups receiving systemic antibiotics compared to those not receiving systemic antibiotics. A total of eight studies were included. While treated sites were intrabony defects in six papers, two studies focused on furcation defects. For intrabony defects, the weighted mean difference (WMD) of 0.30 mm (95% CI -0.18 to 0.78) and 0.27 mm (95% CI -0.13 to 0.66) was calculated for PPD reduction and CAL gain, respectively. The differences between antibiotics and non-antibiotics groups for PPD and CAL were not statistically significant. Quantitative analysis could not be performed for furcation defects due to the limited number of studies. However, regardless of the membrane type selection, the existing evidence indicated that antibiotics did not lead to superior clinical outcomes for furcation defects at 9 to 12 months after the regenerative procedures. CONCLUSION: Based on this meta-analysis study's findings, the use of adjunct systemic antibiotics in regenerative periodontal surgery did not appear to achieve more favorable clinical outcomes. Thus, the use of adjunct systemic antibiotics as part of the regenerative periodontal therapy might not be justifiable and should be reconsidered. (Quintessence Int 2023;54:210-219; doi: 10.3290/j.qi.b3648957).

Regeneration of critical-sized grade II furcation using a novel injectable melatonin-loaded scaffold.

BACKGROUND: Periodontal regenerative therapy using bone-substituting materials has gained favorable clinical significance in enhancing osseous regeneration. These materials should be biocompatible, osteogenic, malleable, and biodegradable. This study assessed the periodontal regenerative capacity of a novel biodegradable bioactive hydrogel template of organic-inorganic composite loaded with melatonin. MATERIALS AND METHODS: A melatonin-loaded alginate-chitosan/beta-tricalcium phosphate composite hydrogel was successfully prepared and characterized. Thirty-six critical-sized bilateral class II furcation defects were created in six Mongrel dogs, and were randomly divided and allocated to three cohorts; sham, unloaded composite, and melatonin-loaded. Periodontal regenerative capacity was evaluated via histologic and histomorphometric analysis. RESULTS: Melatonin-treated group showed accelerated bone formation and advanced maturity, with a significant twofold increase in newly formed inter-radicular bone compared with the unloaded composite. The short-term regenerative efficacy was evident 4 weeks postoperatively as a significant increase in cementum length concurrent with reduction of entrapped epithelium. After 8 weeks, the scaffold produced a quality of newly synthesized bone similar to normal compact bone, with potent periodontal ligament attachment. CONCLUSIONS: Melatonin-loaded hydrogel template accelerated formation and enhanced quality of newly formed bone, allowing complete periodontal regeneration. Furthermore, the scaffold prevented overgrowth and entrapment of epithelial cells in furcation defects.

Comparative Evaluation of Hydroxyapatite Bone Alloplast with Combination Bone Alloplast (Hydroxyapatitie and ?-Tricalcium Phosphate) in Grade II Mandibular Furcation Involvements.

BACKGROUND: The management of furcation involvements by regenerative surgery with bone alloplast have been used with varying degrees of success in periodontal therapy. The aim of the study was to clinically and radiographically compare the effectiveness of Hydroxyapatite bone alloplast with combination bone alloplast (Hydroxyapatite and ?-Tricalcium phosphate) for the treatment of Grade II mandibular furcation involvements. METHODS: Thirty patients with bilateral Grade II mandibular furcation involvements were distributed in Group A (Hydroxyapatite) and Group B (Hydroxyapatite and ?-Tricalcium phosphate). Clinical parameters such as Plaque Index, Gingival Index, Probing Pocket Depth, Clinical Attachment Level and Horizontal Probing Depth were recorded at baseline and at one, three and six mths postoperatively. Radiographic bone fill measurements were recorded at baseline and six months post-operatively. RESULTS: Both the groups showed statistically significant (p <0.01) improvement in clinical and radiographic parameters at each recall visits. Inter-group comparison of clinical parameters showed no significant difference in both the groups whereas radiographic measurements following six months post-surgery showed significantly (p <0.05) greater amount of bone fill in Group B compared to Group A. CONCLUSIONS: It can be concluded that at six months post-operative, both the alloplastic materials resulted in significant improvement in clinical parameters and no significant difference was found between both groups. There was a statistically significant radiographic bone fill when a combination of Hydroxyapatite and ?-Tricalcium phosphate was used demontrating its effectiveness in the treatment of Grade II Furcation involvement.

Added benefit of L-PRF to autogenous bone grafts in the treatment of degree II furcation involvement in mandibular molars.

BACKGROUND: Tissue regeneration within the periodontally involved furcation area is one of the most challenging aspects of periodontal surgery. The aim of this study was to evaluate the additional benefit of leukocyte and platelet-rich fibrin (L-PRF) to autogenous bone grafts (ABGs) in the treatment of mandibular molar degree II furcation involvement, comparing the clinical outcomes with those from open flap debridement (OFD)+ABG and OFD alone treatments. METHODS: Fifty-four patients, exhibiting one buccal or lingual mandibular molar furcation defect, were randomly assigned to three treatment groups: OFD+ABG+L-PRF (n = 18); OFD+ABG (n = 18); and OFD (n = 18). Clinical (probing depth [PD], horizontal clinical attachment level [HCAL], vertical clinical attachment level [VCAL], gingival recession [GR]) and radiographic (vertical bone level [VBL]) parameters were evaluated at baseline and 6 months after treatment. HCAL change was the primary outcome. RESULTS: No significant differences within each group were reported for GR changes, but statistically significant improvements in HCAL, VCAL, PD, and VBL were observed in all groups, except for VBL in the OFD group. At 6 months, the mean HCAL gain was 2.29 ± 0.18 mm in the OFD+ABG+L-PRF group, which was significantly greater than that in the OFD+ABG (1.61 ± 0.18 mm) and OFD (0.86 ± 0.18 mm) groups. Both OFD+ABG+L-PRF and OFD+ABG therapies produced a significantly greater clinical and radiographic improvement than OFD. CONCLUSION: The addition of L-PRF to ABG produces a significantly greater HCAL gain and PD reduction as compared with OFD+ABG treatment in mandibular degree II furcation involvements.

Clinico-radiographic comparative evaluation of 1% metformin gel plus platelet-rich fibrin over platelet-rich fibrin alone in the treatment of Grade II furcation defects: A randomized controlled double-blind clinical trial.

BACKGROUND: The present study was aimed to evaluate and compare the effects of 1% MF plus PRF over PRF alone in treatment of Grade II furcation defects, clinically and radiographically by using cone-beam computed tomography. METHODS: This split-mouth clinical trial randomly allotted 21 patients with 42 bilateral Grade II furcation defects into two groups. Group I was treated with PRF alone while Group II with 1% MF gel and PRF. The primary outcome parameters were clinical attachment level (CAL) and horizontal probing depth (HPD) while the secondary outcome parameters were probing depth (PD) and defect volume (DV). The clinical parameters were evaluated at 3, 6, and 12 months and the radiographic parameters at 12 months. RESULTS: Both the study groups yielded improvements in assessed parameters; however, significantly greater mean reduction of PD, HPD, and CAL gain was observed in Group II (3.90 ± 0.78 mm, 2.94 ± 0.80 mm, and 3.42 ± 0.93 mm) in comparison with Group I (3.23 ± 0.90 mm, 1.96 ± 0.80 mm, and 2.67 ± 0.88 mm) at 12 months, respectively. A significant reduction of DV was exhibited radiographically in Group II (12.61 ± 4.01 mm3 ) as compared with Group I (9.14 ± 4.31 mm3 ) at the end of 12 months. CONCLUSIONS: Better clinical and radiographic findings in terms of reduction in PD, HPD, CAL gain, and significant reduction in DV in Group II patients indicated that the combination therapy of 1% MF + PRF promotes regenerative ability within the periodontal tissues in Grade II furcation defects to a greater extent.

Efficacy of FGF-2 in Periodontal Regeneration in a Case of Severe Intrabony Defect and Furcation Involvement With 15-Month Follow-Up.

INTRODUCTION: Several studies have demonstrated that basic fibroblast growth factor (FGF-2) is one of the most effective growth factors for periodontal regeneration. The Ministry of Health, Labor and Welfare in Japan have approved 0.3% human recombinant FGF-2 for periodontal regeneration, and it has been commercially available since 2016. In this case report, a patient was treated with this periodontal regenerative medicine and demonstrated success at 15-month follow-up, as confirmed by dental X-ray and on cone-beam computed tomography (CBCT). CASE PRESENTATION: A 42-year-old woman with a one by two walled intrabony defect and Class III furcation involvement in tooth #19, and Class II furcation involvement in tooth #18 (lingual) underwent periodontal regenerative surgery with FGF-2 without any bone graft materials. Favorable clinical and radiographic outcomes were noted 15 months after the procedure. The vertical bone defect in tooth #19 showed a clinical attachment level gain of 8 mm. Moreover, CBCT analysis revealed considerable new bone formation in the Class II furcation involvement in tooth #18 and limited bone formation in the Class III furcation involvement in tooth #19. CONCLUSIONS: This case report indicates that FGF-2 showed a positive outcome in terms of periodontal regeneration in a case of one by two wall intrabony defects with Class III furcation involvement. A complete recovery of Class II furcation involvement was observed without artificial bone graft materials.

The use of enamel matrix derivative in the treatment of class II furcation defects: systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of enamel matrix derivative (EMD) in the regeneration of class II furcation defects, used alone or in conjunction with biomaterials. METHODS: Electronic database searches and hand searches were carried out and double-blind randomized controlled trials evaluating the use of EMD in class II furcation therapy were included, and a meta-analysis comparing the effect of open flap debridement (OFD) + ßTCP/HA with and without EMD was carried out. RESULTS: The initial search resulted in a total of 298 articles, after removing the duplicates and exclusions after analysing the titles, abstracts and full text, five studies were included for the qualitative synthesis and two for the quantitative analysis. The meta-analysis showed no statistical difference when comparing OFD + ßTCP/ HA with or without EMD in the treatment of furcation defects in any of the evaluated parameters. According to GRADE, the certainty of the evidence for the variables evaluated was moderate. CONCLUSION: The therapeutic modalities studied improved the periodontal clinical parameters of class II furcations, but the use of EMD in the treatment of these defects did not contribute to a clinical improvement that justified its use associated with the therapies/biomaterials. It is important to emphasize the need for more studies with larger samples to increase the certainty of the evidence reported in this review.

Injectable chitosan/ß-glycerophosphate hydrogels with sustained release of BMP-7 and ornidazole in periodontal wound healing of class III furcation defects.

The aim of this study was to determine the effect of bone morphogenetic protein-7 (BMP-7) and ornidazole (ORN) loaded Chitosan/ß-glycerophosphate (CS/ß-GP) thermosensitive hydrogels on periodontal regeneration. CS/ß-GP hydrogels with and without BMP-7 and ORN were compared with respect to physicochemical properties, release kinetics, and antimicrobial activity in vitro, and periodontal regeneration properties in class III furcation defects in beagles via radiography, histology including immunohistochemical staining of osteoblasts and osteoclasts, and histometric analysis. CS/ß-GP hydrogels with and without BMP-7 and ORN had comparable physicochemical properties and gelation kinetics. Release kinetics showed that the hydrogels were capable of stable and sustained release of BMP-7 and ORN. The hydrogels loaded with ORN exhibited obvious antimicrobial activity against P. gingivalis. Histometric analysis quantitatively showed significantly more new bone and cementum, and less connective tissue in defects implanted with BMP-7 loaded hydrogels compared with hydrogels without BMP-7. The number of osteoclasts reduced significantly in the CS/BMP-7/ORN and CS/BMP-7 groups, while the number of osteoblasts increased significantly in these groups. Our findings showed that BMP-7 and ORN conferred additional advantages to the CS/ß-GP hydrogel in periodontal regeneration and suggest potential consideration of this approach for periodontal therapy.

Experimental furcal perforation treated with mineral trioxide aggregate plus selenium: immune response.

The aim of this study is to evaluate the expression of cytokines in response to mineral trioxide aggregate (MTA) plus selenium in germ-free mice with experimental furcal perforation. The first left maxillary molar was opened, and the furcal area was perforated and treated with post-MTA-Se (experimental group). The same surgical intervention was performed for the maxillary right first molar, which was treated with MTA (control group). Fifteen mice were sacrificed 7, 14, and 21 days after furcal perforation, and periapical tissue samples were collected. The mRNA expression levels of the cytokines TGF-ß, TNF-α, IFN-γ, HPRT, IL-10, IL-4, RANK, RANKL, IL-1, and IL-17 were assessed by using real-time polymerase chain reaction. In the experimental group, at 21-days post-MTA-Se sealing, the mRNA levels of TNF-α and IL-10 were upregulated compared with those in the control group (p < 0.05). Futher assessment revealed basal mRNA expression levels of IL-1α, IFN-γ, RANK, RANKL, IL-17A, IL-4, and TGF-ß, over long experimental times, in both the experimental and control groups (p > 0.05). In conclusion, MTA+Se sealing favoured increased expression of IL-10 and TNF-α at later time points (day 21).

Evaluation of a hydrogel membrane on bone regeneration in furcation periodontal defects in dogs.

The aim of the study was to evaluate bone regeneration using a canine model with surgically created periodontal defects filled for 12 weeks using a stratified biomaterial consisting in a biphasic calcium phosphate (BCP) covered with a crosslinking hydrogel acting as polymer membrane of silated hydroxypropyl methylcellulose (Si-HPMC) as the tested new concept. Bilateral, critical-sized, defects were surgically created at the mandibular premolar teeth of six adult beagle dogs. The defects were randomly allocated and: (i) left empty for spontaneous healing or filled with: (ii) BCP and a collagen membrane; (iii) BCP and hydrogel Si-HPMC membrane. At 12 weeks, the experimental conditions resulted in significantly enhanced bone regeneration in the test BCP/Si-HPMC group. Within the limits of this study, we suggest that the hydrogel Si-HPMC may act as an occlusive barrier to protect bone area from soft connective tissue invasion and then effectively contribute to enhance bone regeneration.

Boric acid gel as local drug delivery in the treatment of class II furcation defects in chronic periodontitis: a randomized, controlled clinical trial.

AIM: Boric acid (BA) exhibits antibacterial, anti-inflammatory, as well as osteoblastic, activity. The aim of the present study was to explore the efficacy of 0.75% BA gel as a local drug-delivery system in adjunct to scaling and root planing (SRP) for the treatment of class II furcation defects in comparison with placebo gel. METHODS: A total of 48 mandibular class II furcation defects were randomized and treated with either 0.75% BA gel or placebo gel. Clinical parameters were recorded at baseline, 3 months, and 6 months, while radiographic parameters were recorded at baseline and 6 months. RESULTS: Greater mean probing depth reduction and mean relative vertical and horizontal clinical attachment level gain were shown to be greater in group 1 than in group 2 at 3 and 6 months. Furthermore, a significantly greater mean percentage of bone fill was found in group 1 (16.98%±1.03%) than in the placebo (2.86%±0.92%) at 6 months. CONCLUSION: The .75% BA group showed significant improvement in clinical parameters compared to placebo gel as an adjunct to SRP. This implies an alternative for treatment of class II furcation.

Experimental furcal perforation treated with mineral trioxide aggregate plus selenium: immune response

Abstract The aim of this study is to evaluate the expression of cytokines in response to mineral trioxide aggregate (MTA) plus selenium in germ-free mice with experimental furcal perforation. The first left maxillary molar was opened, and the furcal area was perforated and treated with post-MTA-Se (experimental group). The same surgical intervention was performed for the maxillary right first molar, which was treated with MTA (control group). Fifteen mice were sacrificed 7, 14, and 21 days after furcal perforation, and periapical tissue samples were collected. The mRNA expression levels of the cytokines TGF-β, TNF-α, IFN-γ, HPRT, IL-10, IL-4, RANK, RANKL, IL-1, and IL-17 were assessed by using real-time polymerase chain reaction. In the experimental group, at 21-days post-MTA-Se sealing, the mRNA levels of TNF-α and IL-10 were upregulated compared with those in the control group (p < 0.05). Futher assessment revealed basal mRNA expression levels of IL-1α, IFN-γ, RANK, RANKL, IL-17A, IL-4, and TGF-β, over long experimental times, in both the experimental and control groups (p > 0.05). In conclusion, MTA+Se sealing favoured increased expression of IL-10 and TNF-α at later time points (day 21).

[Effect of concentrated growth factors on the treatment of degree II furcation involvements of mandibular molars].

OBJECTIVE: Concentrated growth factors (CGF), a new generation of platelet concentrate products, appears to have more abundant growth factors because of its special centrifugation process. However, there are few studies supporting this. This study was designed to evaluate the effect of CGFs in the treatment of II° furcations of mandibular molars. METHODS: In the present study, thirty-one II° furcation involvements in twenty mandiblular molars were included and randomly divided into two groups. The furcation involvements in the experimental group were treated with bone graft therapy combined with CGFs, and the furcation involvements in the control group were treated with bone graft therapy alone. The clinical examination and cone beam computed tomography (CBCT) were performed at baseline and 1 year post-surgery for the two groups. The changes of clinical and CBCT data at baseline and 1 year post-surgery were compared between the experimental group and the control group. RESULTS: At baseline, there were no significant differences between the two groups in the probing depth (PD), vertical clinical attachment loss (CAL-V) and horizontal clinical attachment loss (CAL-H): PD (7.36±2.32) mm (the experimental group) vs. (7.53±2.06) mm (the control group); CAL-V (8.69±1.65) mm (the experimental group) vs. (8.81±1.53) mm (the control group); CAL-H (5.24±2.01) mm (the experimental group) vs. (5.35±2.14) mm (the control group). At the end of 1 year post-surgery, the clinical parameters of both groups were significantly improved (P<0.001). For the experimental group, the average vertical attachment gain was (2.78±1.66) mm, and the vertical attachment loss was improved significantly compared with the baseline (P<0.001); the average horizontal attachment gain was (2.10±1.89) mm, and the horizontal attachment loss were improved significantly compared with the baseline (P<0.001). Furthermore, the improvement degree of the experimental group was significantly higher than that of the control group (P<0.001). At baseline, there were no statistical differences in the vertical bone loss (BL-V) or horizontal bone loss (BL-H) between the two groups (P>0.05): BL-V (5.08±2.17) mm (the experimental group) vs. (5.84±2.65) mm (the control group); BL-H (5.85±2.13) mm (the experimental group) vs. (6.01±2.27) mm (the control group). At 1 year post-surgery, both groups showed significant radiographic bone gain at vertical and horizontal directions compared with baseline (P<0.001). For the experimental group, the average vertical radiographic bone gain was (2.20±1.98) mm, the horizontal radiographic bone gain was (2.51±2.18) mm, the vertical and horizontal radiographic bone loss were both significantly reduced compared with the baseline (P<0.001). For the control group, the average vertical radiographic bone gain was (1.89±2.15) mm, the horizontal radiographic bone gain was (1.30±2.47) mm, the vertical and horizontal radiographic bone losses were both significantly reduced compared with the baseline (P<0.001). And the experimental group showed significantly higher bone gain at vertical and horizontal directions compared with the control group (P<0.001). CONCLUSION: Within the limitation of the present study, CGFs showed positive role in the treatment of II° furcation involvements of mandibular molars.

Effects of EMD liquid (Osteogain) on periodontal healing in class III furcation defects in monkeys.

AIM: To evaluate the effect of a novel liquid carrier system of enamel matrix derivative (Osteogain) soaked on an absorbable collagen sponge (ACS) upon periodontal wound healing/regeneration in furcation defects in monkeys. MATERIALS AND METHODS: The stability of the conventional enamel matrix derivative (Emdogain) and Osteogain adsorbed onto ACS was evaluated by ELISA. Chronic class III furcation defects were created at teeth 36, 37, 46, 47 in three monkeys (Macaca fascicularis). The 12 defects were assigned to one of the following treatments: (1) open flap debridement (OFD) + ACS, (2) OFD+Emdogain/ACS, (3) OFD+Osteogain/ACS, and (4) OFD alone. At 16 weeks following reconstructive surgery, the animals were killed for histological evaluation. RESULTS: A 20-60% significantly higher amount of total adsorbed amelogenin was found for ACS-loaded Osteogain when compared to Emdogain. The histomorphometric analysis revealed that both approaches (OFD + Emdogain/ACS and OFD + Osteogain/ACS) resulted in higher amounts of connective tissue attachment and bone formation compared to treatment with OFD + ACS and OFD alone. Furthermore, OFD + Osteogain/ACS group showed higher new attachment formation, cementum, and new bone area. CONCLUSIONS: Within their limits, the present data indicate that Osteogain possesses favourable physicochemical properties facilitating adsorption of amelogenin on ACS and may additionally enhance periodontal wound healing/regeneration when compared to Emdogain.

Histologic tissue response to furcation perforation repair using mineral trioxide aggregate or dental pulp stem cells loaded onto treated dentin matrix or tricalcium phosphate.

OBJECTIVES: The aim of this study is to compare the effect of treated dentine matrix (TDM) and tricalcium phosphate (TCP) scaffolds on odontogenic differentiation and mineralization of dental pulp stem cells (DPSCs) in furcation perforations created in the pulp chamber floor of premolar teeth in dogs. MATERIAL AND METHODS: DPSCs were isolated and cultured from the dental pulp of the maxillary left second and third premolars of dogs. The DPSCs were loaded on TCP (SC+TCP) and TDM (SC+TDM) scaffolds and inserted into intentionally perforated pulp chamber floors of premolars in dogs; six teeth were used for each group. Three more groups of six specimens were created, and mineral trioxide aggregate (MTA), TDM, and TCP were inserted into the perforations to act as controls. An intact premolar and no treatment in the perforation site were used as positive and negative controls respectively. After 3 months, the animals were sacrificed and the type of inflammation, presence of dentine, continuation and type of cementum, type of connective tissue, and presence of foreign body reaction were evaluated, and significant differences were between groups determined using the Fisher's exact test. The evaluation of the amount of inflammation and the percentage of new bone formation was evaluated using the Mann-Whitney U test. RESULTS: The negative control group was associated with severe inflammation and granulation tissue formation. In the positive control group, intact periodontal tissues and no inflammation were observed. Dentine bridge formation was not seen in specimens of any group. The specimens in the SC+TDM group were associated with significantly more bone formation than other groups (P < 0.001). The amount of inflammation was less than 10 % in specimens of all groups with the exception of three specimens in the TCP group that were categorized as 10-30 %. Chronic inflammation without foreign body reactions was the major pattern of inflammation in groups. Formation of cementum with a cellular and continuous appearance was seen in all specimens. CONCLUSIONS: SC+TDM was associated with significantly more bone formation when used to repair uninfected furcation perforations in the premolar teeth of dogs. CLINICAL RELEVANCE: Application of TDM as a biological scaffold in combination with DPSCs may offer an advantage during the repair of root perforation defects.

1.2% Rosuvastatin and 1.2% Atorvastatin Gel Local Drug Delivery and Redelivery in the Treatment of Class II Furcation Defects: A Randomized Controlled Clinical Trial.

BACKGROUND: Statins are one of the lipid-lowering drugs that help in reducing cholesterol levels in the body by specifically inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase, which is a rate-limiting enzyme for cholesterol synthesis. Rosuvastatin (RSV) and atorvastatin (ATV) have shown bone stimulatory and anti-inflammatory effects. The present study aims to explore efficacy of 1.2% RSV and 1.2% ATV gels as a local drug delivery and redelivery system adjunct to scaling and root planing (SRP) for treatment of Class II furcation defects. METHODS: Ninety patients with mandibular buccal Class II furcation defects were randomly allocated to three treatment groups: 1) SRP with placebo gel (group 1); 2) SRP with 1.2% RSV gel (group 2); and 3) SRP with 1.2% ATV gel (group 3). Clinical and radiographic parameters were recorded at baseline and after 6 months. Gels were redelivered at the respective sites at a 6-month recall appointment. All clinical and radiographic parameters were recorded again after 3 months (i.e., 9 months from baseline). RESULTS: Greater mean probing depth (PD) reduction and greater mean gain in relative vertical clinical attachment level (CAL) and relative horizontal CAL were seen in the RSV group than in the ATV group at 6 and 9 months. Significantly greater mean percentage of defect depth reduction (DDR) was found in the RSV group (30.80% ± 8.35%, 41.86% ± 6.76%) than in the ATV group (25.54% ± 8.89%, 34.31% ± 8.04%) at 6 and 9 months, respectively. CONCLUSION: The RSV group shows significant improvement in all clinical parameters and significantly greater DDR compared with the ATV group in treatment of mandibular Class II furcation defects as an adjunct to SRP.

Mandibular Degree II Furcation Defects Treatment With Platelet-Rich Fibrin and 1% Alendronate Gel Combination: A Randomized Controlled Clinical Trial.

BACKGROUND: Different materials have been investigated for renewal of lost supporting periodontal structures and tested for furcation defect treatment. Platelet-rich fibrin (PRF) is a pool of growth-promoting factors and cytokines that promote bone regeneration and maturation of soft tissue. Alendronate (ALN), an influential member of the bisphosphonate group, is known to enhance osteoblastogenesis and inhibit osteoclastic bone resorption, thus promoting tissue regeneration. This randomized trial was done to assess effectiveness of PRF and 1% ALN gel combination in mandibular degree II furcation defect treatment in comparison with PRF and access therapy alone. METHODS: Seventy-two mandibular molar furcation defects were treated with either access therapy alone (group 1), access therapy with PRF (group 2), or access therapy with PRF and 1% ALN (group 3). Plaque index, modified sulcus bleeding index, probing depth (PD), relative vertical attachment level (RVAL) and relative horizontal attachment level (RHAL), and intrabony defect depth were recorded at baseline and 9 months postoperatively. Radiographically, defect fill, assessed in percentage, was evaluated at baseline, before surgery, and 9 months post-therapy. RESULTS: Group 3 showed greater PD reduction and RVAL and RHAL gain when compared with groups 1 and 2 postoperatively. Moreover, group 3 sites showed a significantly greater percentage of radiographic defect fill (56.01% ± 2.64%) when compared with group 2 (49.43% ± 3.70%) and group 1 (10.25% ± 3.66%) at 9 months. CONCLUSIONS: Furcation defect treatment with autologous PRF combined with 1% ALN gel results in significant therapeutic outcomes when compared with PRF and access therapy alone. Combining ALN with PRF has potential for regeneration of furcation defects without any adverse effect on healing process.