The flapless approach with and without enamel matrix derivatives for the treatment of intrabony defects: A randomized controlled clinical trial.

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.

Epithelial Inclusions Following a Bilaminar Root Coverage Procedure with a Subepithelial Connective Tissue Graft: A Histologic and Clinical Study.

The aim of this study was to histologically examine any epithelial cell inclusions in submerged subepithelial connective tissue graft (SCTG) after clinical healing was achieved. A total of 16 patients with Miller Class I or II gingival recessions were consecutively treated with a bilaminar procedure. At 2 months after surgery, a gingival tissue specimen was harvested from all SCTG-treated sites and stained with hematoxylin-eosin. The histologic evaluation revealed connective tissue in active reorganization without epithelial inclusions in 14 of the 16 tissue specimens. In the remaining 2 specimens, epithelial islands were observed deep in the connective tissue. In one case they developed in a solid cystic space, while in the second case they were strictly integrated in the lamina propria. Complete recession coverage was obtained in 14 of the 16 treated defects, with a mean root coverage of 95.1% ± 14.2% at 12 months.

Vascularization and Innervation of Connective Tissue Grafts in the Treatment of Gingival Recessions: A Histologic and Immunohistochemical Study.

The goal of this study was to histologically evaluate the healing process of subepithelial connective tissue graft in humans. A sample of 16 patients with Miller Class I or II localized gingival recession defects were consecutively treated with a bilaminar technique. At baseline and after 2 months, tissue samples were taken from the donor and recipient sites. The revascularization and reinnervation of the graft were examined by means of hematoxylin-eosin and immunohistochemical techniques. After 2 months of healing, the integration of the grafted tissue was evident with the connective tissue expressing features belonging to both the recipient (cellular component) and the donor site (extracellular matrix) in the inner and superficial layers, respectively. This was accompanied by increased neovascularization and reduction in intraepithelial free nerve endings.

Subgingival Microbiota in White Patients With Desquamative Gingivitis: A Cross-Sectional Study.

BACKGROUND: Presence of epithelial desquamation, erythema, and erosions on gingival tissue is usually described in the literature as desquamative gingivitis (DG). A wide range of autoimmune/dermatologic disorders can manifest as DG, although the two more common are oral lichen planus and mucous membrane pemphigoid. The aim of this study is to investigate prevalence of 11 periodontopathogenic microorganisms in patients with DG and to compare it with the microbiologic status of individuals affected by plaque-induced gingivitis (pGI). METHODS: Cross-sectional clinical and microbiologic data were obtained from 66 patients (33 in each group). Subgingival plaque samples were analyzed using semiquantitative polymerase chain reaction analysis. RESULTS: Statistically significant difference, but with little clinical significance, was observed in gingival conditions between the two groups, probably due to the worse home control hygiene of patients with DG. Prevalence and levels of Aggregatibacter actinomycetemcomitans, Eikenella corrodens, and Fusobacterium nucleatum/periodonticum were statistically higher in samples from patients with DG than in those with pGI. In multivariate regression models, subgingival colonization of A. actinomycetemcomitans and F. nucleatum/periodonticum was not statistically associated with DG, whereas, high levels of E. corrodens were associated with 13-fold increased odds for DG. CONCLUSIONS: Microbiologic differences were found in subgingival plaque for patients with DG and pGI. This may suggest possible association between periodontal pathogens and DG.

A Novel Procedure for the Immediate Reconstruction of Severely Resorbed Alveolar Sockets for Advanced Periodontal Disease.

Background. Several clinical techniques and a variety of biomaterials have been introduced over the years in an effort to overcome bone remodeling and resorption after tooth extraction. However, the predictability of these procedures in sockets with severely resorbed buccal/lingual plate due to periodontal disease is still unknown. Case Description. A patient with advanced periodontitis underwent extraction of upper right lateral and central incisors. The central incisor exhibited complete buccal bone plate loss and a 9 mm vertical bone deficiency on its palatal side. The alveolar sockets were filled with collagen sponge and covered with a nonresorbable high-density PTFE membrane. Primary closure was not attained and any rigid scaffold material was not used. Histologic analysis provided evidence of new bone formation. At 12 months a cone-beam computed tomographic scan revealed enough bone volume to insert two conventional dental implants in conjunction with minor horizontal bone augmentation procedures. Clinical Implications. This case report would seem to support the potential of the proposed reconstructive approach in changing the morphology of severely resorbed alveolar sockets, minimizing the need for advanced bone regeneration procedures during implant placement.

Use of Dental Pulp Stem Cells/Collagen Sponge Biocomplex in the Treatment of Non-Contained Intrabony Defects: A Case Series.

INTRODUCTION: Because of their accessibility and biologic features, dental pulp stem cells (DPSCs) hold great promise for regeneration in clinical applications. To the best of the authors' knowledge, no data are available concerning their regenerative potential in human periodontal intrabony defects. The present case series explores the clinical and radiographic effectiveness of autologous DPSCs/collagen sponge biocomplex in the treatment of non-contained intrabony defects in patients with chronic periodontitis. CASE SERIES: Four healthy patients displaying at least one prevalently 1- or 2-wall intrabony defect and one vital third molar requiring extraction were consecutively included in the study. Before surgery, patients were enrolled in a strict periodontal program including oral hygiene instructions and scaling and root planing. The third molar was extracted and used as the autologous DPSC source. The dental pulp was mechanically dissociated and filtered through 50-µm pores to obtain a cellular suspension enriched in stem cells. The selected intrabony defects, one per patient, were filled with the cellular suspension endorsed onto a collagen sponge. The mean probing depth decreased from 8.0 ± 0.8 mm at baseline to 3.3 ± 1.0 mm at the 12-month evaluation. The mean clinical attachment level amounted to 11.0 ± 0.8 mm before the surgery and to 6.0 ± 1.4 mm at 12 months. At the end of the observational period, the mean radiographic defect fill was 4.2 ± 1.9 mm. CONCLUSION: Within the limitations of this case series, it can be concluded that autologous DPSCs may represent a very promising tool for the treatment of angular bone defects with unfavorable architecture.

Autologous dental pulp stem cells in periodontal regeneration: a case report.

Histologic findings in animal models suggest that the application of dental pulp stem cells (DPSCs) may promote periodontal regeneration in infrabony defects. This case report describes the clinical and radiographic regenerative potential of autologous DPSCs in the treatment of human noncontained intraosseous defects. A chronic periodontitis patient with one vital third molar requiring extraction was surgically treated. The third molar was extracted and used as an autologous DPSCs source to regenerate the infrabony defect on the mandibular right second premolar. At the 1-year examination, the defect was completely filled with bonelike tissue as confirmed through the reentry procedure.