Transplantation of mature adipocyte-derived dedifferentiated fat cells into three-wall defects in the rat periodontium induces tissue regeneration.

The transplantation of dedifferentiated fat (DFAT) cells in combination with poly(d,l-lactic-co-glycolic acid) (PLGA) scaffolds has previously been proven as an effective approach in promoting periodontal tissue regeneration in a rat fenestration defect model. The aim of this study was to assess the regenerative potential of DFAT cells in a rat model of three-wall periodontal bone defect. Three-wall bone defects were created bilaterally on the mesial side of rat maxillary first molars and were either left untreated or treated by implantation of PLGA scaffolds with DFAT cells or PLGA alone. Four weeks after surgery, the tissues were processed for micro-computed tomography (micro-CT) and histomorphometric examination. Micro-CT revealed that the PLGA/DFAT group had significantly higher rates of bone regeneration than the other groups, while histomorphometric analysis showed that the PLGA/DFAT group had significantly higher densities of collagen fiber bundles in acellular and cellular cementum than the PLGA group. Moreover, the results indicate that the placement of the PLGA scaffold prevented the downgrowth of the junctional epithelium. These findings suggest that DFAT cells contribute to tissue regeneration in three-wall periodontal defects, while PLGA provides space necessary for periodontal tissue restoration.

Eficacia del uso del plasma rico en factores de crecimiento en defectos periodontales distales de segundos molares inferiores, posterior a la extracción de un tercer molar mandibular / Efficacy of using plasma rich in growth factors in periodontal defects in lower distal second molar after extracting a mandibular third molar

Objetivo. El propósito de este estudio fue evaluar la eficacia de la aplicación de plasma rico en factores de crecimiento (PRFC), dentro de un defecto periodontal distal, a los segundos molares inferiores después de la extracción de un tercer molar mandibular. Material y métodos. Se realizó un ensayo clínico controlado, doble ciego, aleatorizado en 20 pacientes sanos, con defectos óseos bilaterales posterior a la extracción de un tercer molar retenido. Los pacientes fueron dividos en grupo experimental y control. Se realizaron mediciones de nivel clínico de inserción en el área distal del segundo molar previamente a la cirugía, usando una férula de acetato, con el fin de tener la misma referencia de medición posterior al procedimiento. Las mediciones posquirúrgicas fueron realizadas a las semanas 1, 4 y 12. Estas mediciones, así como los tiempos de evaluación, fueron analizados por medio de las pruebas de t de Student, Chi2 y Kruskal-Wallis. Resultados. Las variables demostraron similitud en cuanto a edad, sexo, dificultad y duración de los tiempos quirúrgicos. La medición del nivel clínico de inserción preoperatoria en milímetros fue de 2,68±0,56 vs. 2,63±0,50 (experimental vs. control). Durante la primera semana posterior al procedimiento los resultados fueron: 5,37±1,81 vs. 5,35±1,72; y a los 3 meses la recuperación fue similar en ambos grupos casi a sus niveles basales (2,43±0,89 vs. 2,55±0,92). Conclusiones. No se encontró diferencia significativa con el uso de PRFC en cuanto a ganancia en el nivel clínico de inserción periodontal en el área distal de segundos molares después de la extracción de terceros molares inferiores retenidos (AU)

Purpose. The aim of this study was to evaluate the effectiveness of the application of plasma rich in growth factors (CFRP) in a distal periodontal defect of the lower second molars after extraction of a third molar. Material and methods. A randomised, controlled, and double-blind clinical trial, was conducted on 20 healthy patients with bilateral defects after the extraction of an impacted third molar. The patients were divided into experimental and control groups. Measurements of clinical attachment level were performed in the distal area of the second molar prior to surgery using an acetate splint in order to have the same reference measurement after the procedure. Post-surgical measurements were performed at 1, 4, and 12 weeks. These measurements, as well as evaluation times, were analysed using the Student t-Test, χ2 and Kruskal-Wallis Test. Results. The variables showed similarity in age, gender, difficulty, and length of the surgical times. The measurements prior to clinical insertion were 2.68±0.56 vs. 2.63±0.50 (experimental vs. control). During the first week after the procedure, the results were: 5.37±1.81 vs. 5.35±1.72; and at 3 months the recovery almost to baseline was similar in both groups (2.43±0.89 vs. 2.55±0.92). Conclusions. No significant difference was found with the use of CFRP as regards achieving attachment at clinical level in the distal area of second molars after extraction of third molars (AU)

Periodontal and orthodontic approach in periodontally compromised adults / Abordagem periodontal e ortodôntica em adultos com periodonto comprometido

Saúde bucal é uma condição para prevenir muitas doenças. Cirurgia combinada com boa higiene bucal e o uso de forças ortodônticas leves para o tratamento de pacientes adultos, os quais apresentam história de doença periodontal pode prevenir perda dentária e disseminação da infecção. O objetivo foi descrever a abordagem periodontal e ortodôntica em adultos com periodonto comprometido. Cirurgia periodontal é indicada quando há extensa perda óssea devido à periodontite, com objetivo de eliminar contaminações e tecido de granulação. Quando o status periodontal for saudável e controlado, um tratamento ortodôntico, em conjunto pode ser iniciado. Boa higiene bucal, profilaxia antibiótica e terapia periodontal-ortodôntica combinadas podem produzir bons resultados para formação de um novo suporte periodontal, após movimentos de intrusão, visto não haver mais nenhuma evidência de doença periodontal e aplicação de adequado sistema de forças. Além disso, a abordagem periodontal parece produzir um estímulo positivo para a neo-formação óssea(AU)

Oral health is a condition to prevent many diseases. Surgery combined with oral hygiene and the use of light orthodontic forces for the treatment of adult patients who have a history of periodontal disease can prevent teeth loss and infection dissemination. To describe periodontal and orthodontic approach in periodontal compromised adults. Periodontal surgery is indicated when there is extensive bone loss due to periodontitis. When periodontal status is healthy and under control, an adjunctive orthodontic treatment can be initiated. Good oral hygiene, antibiotic prophylaxis and a combined periodontal-orthodontic treatment can produce good results because the new attachment conditions may be formed after orthodontic intrusion provided there is no longer any evidence of periodontal disease and a proper force system was applied. The surgical approach produces a positive stimulus for a new bone formation(AU)

Tratamento ortodôntico em paciente com periodonto reduzido ­ dez anos de acompanhamento / Orthodontic treatment in a patient with reduced periodontium ­ a ten-year follow-up

Ainda hoje, pacientes que apresentam doença periodontal com lesões localizadas ou generalizadas causam inquietude por parte dos ortodontistas que, muitas vezes, recusam o tratamento devido às dúvidas sobre como os dentes reagirão às forças ortodônticas, supondo que haverá uma acentuação dos problemas, tornando-se ainda mais grave o quadro clínico. Entretanto, quando esse tipo de tratamento é abordado abrangendo outras disciplinas, com uma inter-relação do periodontista com o ortodontista, o que se tem visto são resultados satisfatórios em ambos os aspectos, ainda sim, superando expectativas estéticas do paciente. O objetivo desse trabalho foi descrever o tratamento ortodôntico realizado em uma paciente com o periodonto reduzido, porém, sem atividade de doença, e o resultado após dez anos de acompanhamento. Em resposta a um planejamento ortodôntico bem estruturado, ao uso de mecânica adequada e ao cuidado com as restrições do paciente, obteve-se sucesso na terapia ortodôntica, sem causar efeitos adversos nas estruturas de suporte em longo prazo.

Patients that present periodontal disease with local or general lesions still pose questions for orthodontists. Often, they refused to treat due to the lack of information regarding how teeth will react to orthodontic forces, assuming there will be an accentuation of problems. That attitude could make the clinical picture even worse. However, when this type of treatment is approached covering other disciplines, in cooperation between the periodontist and the orthodontist, the results were satisfactory in both aspects and still overcoming the aesthetic expectations of patient. The goal of this task is describing the orthodontic treatment in a patient with an assymptomatic, compromised periodontium and the follow-up after ten years of completion. In response to a well-structured orthodontic planning, the use of proper mechanics and care with patient's restrictions, success was obtained in orthodontic therapy, without causing adverse effects on long-term supporting structures.

Single-flap approach in combination with enamel matrix derivative in the treatment of periodontal intraosseous defects.

Twenty-four periodontal intraosseous defects were accessed with a buccal single-flap approach (SFA) and treated with enamel matrix derivative (EMD) or EMD + deproteinized bovine bone mineral (DBBM) according to the surgeon,s discretion. EMD with or without DBBM was clinically effective in the treatment of periodontal intraosseous defects accessed with a buccal SFA. The adjunctive use of DBBM in predominantly one-wall defects seemed to compensate for, at least in part, the unfavorable osseous characteristics in terms of the outcomes of the procedure.

[Treatment of localized intrabony periodontal defects with enamel matrix derivative (Emdogain). Case series]. / Lokalizált parodontális csontdefektusok regeneratív kezelése zománc mátrix proteinnel (Emdogain). Esetsorozat.

The solitary vertical or horisonto-vertical bone lesions are mainly characteristic of aggressive periodontitis. Only a combined conservative-surgical approach can result in predictable healing. From the early 50's basically two surgical techniques were used for correcting vertical bony defects. The so called bone resective techniques combined with apically positioned flap resulted in the flattening of the bone contour by removing substantial amount of alveolar bone but compromising the periodontal support of the neighboring teeth. The other surgical approach was the facilitation of the reformation of new periodontal attachment and bone with or without bone grafting. Since the mid 80's the gold standard in the therapy of deep vertical bony defects is the guided tissue regeneration (GTR), although an alternative approach has also been developed using different growth and differentiation factors promoting periodontal wound healing. Today in the clinical practices both in periodontal osseous and mucogingival surgeries the most widely used biological factor is the amelogenin and its commercially available product the Enamel Matrix Derivative (Emdogain). With the presented five solitary horisonto-vertical bony defects of three patients the possibilities and the late results are presented that could have been achieved with the application of EMD and thorough postoperative follow-up. The clinical results were comparable to the current data presented by articles in peer reviewed periodontal journals.

Long-term clinical results on the use of platelet concentrate in the treatment of intrabony periodontal defects.

OBJECTIVE: The purpose of this clinical investigation was to evaluate long-term results obtained with the combination of platelet pellet (PP) plus bioabsorbable barrier membrane (BM) and to compare this outcome with the results obtained using bioactive glass (BG) graft material with a BM. MATERIALS AND METHODS: Using a split mouth design, 11 chronic periodontitis patients (power ≥ at least 80%) were randomly assigned to treatment with a combination of PP/GTR or BG/GTR in contra-lateral dentition areas. Clinical attachment level (CAL) as the primary outcome variable, calculated as the sum of probing pocket depth (PPD) and gingival recession, and radiological alveolar bone level were recorded at baseline, 6 months and 5 years. RESULTS: There were no statistical differences between test and control defects at baseline. PPD reductions and CAL and radiological alveolar bone height gains were statistically significant between baseline and 6 months and between baseline and 5 years in both groups (p < 0.01). Six months results of frequency distribution showed that 82% of the defects attained ≥ 4 mm CAL gain in both groups, while 5 year results showed that 73% of the defects attained 2 mm ≤ CAL gain < 4 mm in the PP/BM group and 55% of the defects attained 2 mm ≤ CAL gain < 4 mm in the BG/BM group. All parameters evaluated showed no significant differences between 6 months and 5 years in both groups (p > 0.05). No statistically significant difference in any of the clinical parameters was observed at 6 months and 5 years between the groups (p > 0.05). CONCLUSIONS: The long-term efficacy of platelet concentrate combined with a barrier membrane is similar with the combination of bioactive glass graft material and barrier membrane, suggesting that results obtained with both treatment approaches can be maintained over a period of 5 years.

Abnormalities in periodontal and salivary tissues in conditional presenilin 1 and presenilin 2 double knockout mice.

We used forebrain-specific conditional presenilin 1 (PS1) and presenilin 2 (PS2) double knockout mice (dKO mice), which exhibit neurodegenerative disease-like symptoms, including inflammation of the brain and periphery, to investigate whether periodontal and salivary tissues display alterations. Mandibles were dissected for alveolar bone height analysis. Maxillae were fixed and decalcified for histological observation and osteoclast detection. Submandibular glands were fixed for histological observation. The submandibular gland and the gingiva of the mandibular incisor teeth were used to assay inflammatory mediators. At 9 months, the number of osteoclasts had significantly increased in the periodontal ligament and the periodontal tissues exhibited obvious histomorphological abnormalities in the dKO mice compared to the control mice at the same age. Alveolar bone loss in dKO mice increased with age. The salivary tissues in dKO mice exhibited obvious age-dependent histomorphological abnormalities. The levels of the inflammatory mediators IL-1ß, TNF-α, and GM-CSF in the submandibular gland and gingiva also increased in an age-dependent manner. These findings suggest that inflammation in the dKO brain could expand to the periphery, including the oral tissue, which could ultimately induce abnormalities in the periodontal and salivary tissues.

[Effect of combined therapeutic methods on healing of periodontal vertical bone defects in regenerative surgery]. / Kombinált terápiás eljárások hatása a parodontalis vertikális csontdefektusok regeneratív sebészetében.

Several methods are available to enhance the healing and regeneration of periodontal tissues after surgical therapy of intrabony defects. The main indications for the use of combined regenerative procedures are the extent and morphology of the osseous lesions. The six studies of the present dissertation focused on the clinical effect of different barrier techniques, bone substitutes, enamel matrix derivatives and a growth factors containing adjuvant used in various combinations on the healing of severe periodontal intrabony impairments. Synthetic, xenogenetic and autologous materials were used in these randomized clinical studies. Mechanical barriers (polytetrafluoroethylene and collagen membranes) for GTR, biological barriers/enamel matrix proteins (EMD), synthetic (beta-TCP) and xenogeneic (NBM) bone grafts and autologous platelet-rich plasma (PRP) were combined in the test and control groups of the trials. The main clinical variable was the clinical attachment level (CAL) and the subsidiary one was the probing pocket depth (PPD), estimated at baseline and after one year. The summation of the results after the statistical analysis takes cognizance of the followings: a) Each of the eleven regenerative methods evaluated (ten combined procedures) leads to significant CAL gain and PPD decrease. b) Using beta-TCP or NBM with EMD or with PRP+GTR and GTR's, the difference between the parameters of the test and control groups were not statistically significant. c) It was confirmed in four studies that the addition of PRP to graft materials has not increased significantly the positive outcomes independent of the type of barrier or graft. d) Adding platelet-rich plasma to natural bone mineral, no benefit was observed from the point of view of the clinical variables. e) The polypeptide proteins of the platelet-rich plasma do not enhance the clinical regenerative effect of enamel matrix proteins. In conclusion, the option of the periodontal surgeons between these methods depends mainly on the defect morphology, the patient's attitude to the different types of materials, the medical concept of the physician, the technical possibilities and the clinical experience of the periodontist.

Mouse models of tooth abnormalities.

Tooth number is abnormal in about 20% of the human population. The most common defect is agenesis of the third molars, followed by loss of the lateral incisors and loss of the second premolars. Tooth loss appears as both a feature of multi-organ syndromes and as a non-syndromic isolated character. Apart from tooth number, abnormalities are also observed in tooth size, shape, and structure. Many of the genes that underlie dental defects have been identified, and several mouse models have been created to allow functional studies to understand, in greater detail, the role of particular genes in tooth development. The ability to manipulate the mouse embryo using explant culture and genome targeting provides a wealth of information that ultimately may pave the way for better diagnostics, treatment or even cures for human dental disorders. This review aims to summarize recent knowledge obtained in mouse models, which can be used to gain a better understanding of the molecular basis of human dental abnormalities.

Aetiological aspects of mandibular tooth agenesis--focusing on the role of nerve, oral mucosa, and supporting tissues.

The purpose of the present investigation was to consider possible aetiological aspects of mandibular tooth agenesis by comparing the pattern of mandibular molar and premolar agenesis with radiological evidence of the mandibular canal. Orthopantomograms from 33 children affected by agenesis of at least four premolar and/or molar teeth in the mandible were investigated. Three children were affected by ectodermal dysplasia. Two anthropological mandibles with absence of mandibular canals were included in the study for comparison. According to the investigation, agenesis should be divided into three groups, based on an analysis of agenesis location, the presence of nerve canals in the jaws, and finally, data on possible bone, skin and oral mucosa abnormalities. The three aetiological groups suggested are: agenesis related to nerve tissue, agenesis related to the oral epithelium, and agenesis related to the supporting tissue.

Hyperbrachycephaly, short face, midface hypoplasia, fusion of cervical vertebrae, radiolucent bone defects, and severe destruction of periodontium--a new syndrome: craniofaciocervical osteoglyphic dysplasia.

A patient with an unusual combination of findings, which do not fit in any of the known syndromes, is presented. The patient, a 24.5-year-old male of normal growth and intelligence, manifests craniofacial dysmorphism, radiolucencies in the skull and in the cervical vertebrae, progressive alveolar bone loss and fusion of cervical vertebrae. The young man does not exhibit any other systemic, hematological, biochemical, chromosomal or immunological abnormality, except for IgA deficiency.