A Novel Approach of Periodontal Osseous Wall Piezosplitting and Sequential Bone Expansion in Management of Localized Intra-Bony Defects with Wide Angulation-A Randomized Controlled Trial.

Piezoelectric surgical instruments with various mini-sized tips and cutting technology offer a precise and thin cutting line that could allow the wider use of periodontal osseous wall swaging. This randomized controlled trial was designed to investigate the use of a minimally invasive piezo knife to harvest vascularized interseptal bone pedicles in treating intra-bony defects. Sixteen non-smoking patients (mean age 39.6 ± 3.9) with severe chronic periodontitis were randomly assigned into one of two groups (N = 8). The Group 1 (control) patients were treated by bone substitute grafting of the intra-bony defect, whereas the Group 2 patients were treated by intra-bony defect osseous wall swaging (OWS) combined with xenograft filling of the space created by bone tilting. In both groups, the root surfaces were treated with a neutral 24% EDTA gel followed by saline irrigation. Clinical and radiographic measurements were obtained at baseline and 6 months after surgery. The sites treated with osseous wall swaging showed a statistically significant probing-depth reduction and increase in clinical attachment compared with those of the Group 1 patients. The defect base level was significantly reduced for the OWS group compared to that of the Group 1 control. By contrast, the crestal bone level was significantly higher in the OWS group compared to Group 1. The crestal interseptal bone width was significantly higher in Group 2 at 6 months compared to the baseline value and to that of Group 1 (<0.001). The osseous wall swaging effectively improved the clinical hard- and soft-tissue parameters. The use of mini inserts piezo-cutting, sequential bone expanders for osseous wall redirection, and root surface EDTA etching appears to be a reliable approach that could allow the use of OWS at any interproximal dimension.

Enhanced ß-tricalcium phosphate blended clot adhesion to EDTA biomodulated periodontally affected root surfaces: in vivo scanning electron microscopy evaluation.

BACKGROUND: The objective of this study is to evaluate ß-tricalcium phosphate (ß-TCP) blended clot adhesion to EDTA-conditioned root surfaces. METHODS: Sixty patients with chronic periodontitis and two teeth designated for extraction were enrolled in this study. Patients were divided into six groups (G1 to G6; 10 patients in each). In G1, intrabony defects were grafted with ß-TCP with a particle size ranging from 150 to 500 µm. In G2, intrabony defects were grafted with ß-TCP with a particle size ranging from 63 to 150 µm. Roots in G3 were etched for 2 minutes with a neutral EDTA, followed by defect overfill of the ß-TCP used for G1. Defects of G4 were treated by the same method as in G3, except the EDTA gel application was 4 minutes. Roots in G5 and G6 were etched for 2 and 4 minutes, respectively, followed by the defect fill with ß-TCP used for G2. For each patient, one tooth was extracted immediately after surgery and the other tooth was extracted at 14 days for scanning electron microscopy evaluation. RESULTS: Fourteen days after surgery, the G1 and G2 samples revealed undetected graft particles. The G3 samples showed areas of adherent ß-TCP particles covering about 42.5%. The G4 samples showed 53.7% graft material coverage. The G5 and G6 samples had adherent grafted particles that covered 77.9% and 82.7%, respectively. CONCLUSION: Root conditioning with EDTA gel improves ß-TCP blended clot adhesion to periodontally involved root surfaces.

Platelet-derived growth factor-BB release profile in gingival crevicular fluid after use of marginal periosteal pedicle graft as an autogenous guided tissue membrane to treat localized intrabony defects.

BACKGROUND: The aim of this study is to evaluate levels of platelet-derived growth factor-BB (PDGF-BB) in gingival crevicular fluid (GCF) during the early stages of healing for sites treated by marginal periosteal pedicle (MPP) graft as an autogenous guided tissue membrane compared to that of the control open flap debridement (OFD). METHODS: Fifteen non-smoking patients (13 males and 2 females) with severe chronic periodontitis participated in this prospective, controlled, masked trial. Each subject contributed matched pairs of 2- or 3-walled intrabony interproximal defects in premolar or molar teeth. Interproximal contralateral defects were randomly assigned to either the MPP group 1 or control OFD group 2. GCF samples were collected at 1, 3, 7, 14, and 30 days after surgery. PDGF-BB in the GCF samples was measured using a human PDGF-BB enzyme-linked immunosorbent assay kit. RESULTS: In both MPP and OFD, PDGF-BB concentrations peaked in the samples obtained during the early postoperative days (days 2 and 3) and decreased sharply in the samples obtained 7, 14, and 30 days post-surgery. CONCLUSION: Periosteal coverage of periodontal defects is not associated with a significant increase in PDGF-BB levels.