[The recombinant human parathyroid hormone, teriparatide as an alternative remedy for the medication-related osteonecrosis of the jaw]. / Humán rekombináns parathormon (teriparatid) mint alternatív megoldás a gyógyszer okozta állcsontnekrózis terápiájára.

In developed countries, osteoporosis is one of the most common debilitating conditions in the population over the age of 50. Unfortunately, the pathomechanism of the disease is still not fully understood. Nowadays, the administration of antiresorptive drugs blocking osteoclastic activity is the most commonly used medication to slow down the speed of the bone loss. One of the uncommon side effects of such drugs is the medication-related osteonecrosis of the jaw (MRONJ). Recently, a number of alternative therapeutic approaches has been tested and published, amongst them the recombinant human parathyroid hormone (rhPTH, teriparatide) use, which is turning into a promising treatment modality. According to certain meta-analyses, its pharmacological effect on increasing bone mineral density and controlling pathological vertebral fractures is superior to antiresorptive drugs; however, the so-called "off-label" application of teriparatide remains controversial. As intermittent administration of teriparatide stimulates bone formation, several animal and clinical studies indicated that systemic application of teriparatide shortened fracture healing time and improved quality of the callus and the newly formed bone. Furthermore, recently several clinical studies showed the beneficial effect of the intermittent rhPTH administration in the management of MRONJ. This article reviews the history of the anabolic effect of the low-dose rhPTH discovery, provides evidence-based data from animal and human studies, summarizes its biological mechanisms and the clinical benefits of the anabolic therapy and also their possible role in the management of MRONJ. The majority of the clinical data indicates that, in the case of therapy-resistant osteonecrosis, it may be worthwhile to apply short-term intermittent teriparatide therapy. Notwithstanding, more randomized clinical trials are necessary in order to confirm the efficacy and the safety of the use of teriparatide in the treatment of MRONJ. Orv Hetil. 2023; 164(36): 1406-1415.

Utilizing a novel radiographic image segmentation method for the assessment of periodontal healing following regenerative surgical treatment.

OBJECTIVE: The aim of the current article was to present a radiographic method to determine the surface area of newly formed periodontal attachment, as well as to analyze volumetric and morphologic changes after regenerative periodontal treatment. METHOD AND MATERIALS: In this retrospective study, 11 singular intrabony periodontal defects were selected for minimally invasive surgical treatment and 3D evaluation. 3D virtual models were acquired by the segmentation of pre- and postoperative CBCT scans. This study determined the surface area of baseline periodontal attachment (RSA-A) and defect-involved root surface (RSA-D) on the preoperative 3D models, and the surface area of new periodontal attachment (RSA-NA) on the postoperative models. Finally, cumulative change of periodontal attachment (∆RSA-A) was calculated and Boolean subtraction was applied on pre- and postoperative 3D models to demonstrate postoperative 3D hard tissue alterations. RESULTS: The average RSA-A was 84.39 ± 33.27 mm2, while the average RSA-D was 24.26 ± 11.94 mm2. The average surface area of RSA-NA after regenerative periodontal surgery was 17.68 ± 10.56 mm2. Additionally, ∆RSA-A was determined to assess the overall effects of ridge alterations on periodontal attachment, averaging 15.53 ± 12.47 mm2, which was found to be statistically significant (P = .00149). Lastly, the volumetric hard tissue gain was found to be 33.56 ± 19.35 mm3, whereas hard tissue resorption of 26.31 ± 38.39 mm3 occurred. CONCLUSION: The proposed 3D radiographic method provides a detailed understanding of new periodontal attachment formation and hard tissue alterations following regenerative surgical treatment of intrabony periodontal defects.

Bioenergetic Impairment of Triethylene Glycol Dimethacrylate- (TEGDMA-) Treated Dental Pulp Stem Cells (DPSCs) and Isolated Brain Mitochondria are Amended by Redox Compound Methylene Blue †.

BACKGROUND: Triethylene glycol dimethacrylate (TEGDMA) monomers released from resin matrix are toxic to dental pulp cells, induce apoptosis, oxidative stress and decrease viability. Recently, mitochondrial complex I (CI) was identified as a potential target of TEGDMA. In isolated mitochondria supported by CI, substrates oxidation and ATP synthesis were inhibited, reactive oxygen species production was stimulated. Contrary to that, respiratory Complex II was not impaired by TEGDMA. The beneficial effects of electron carrier compound methylene blue (MB) are proven in many disease models where mitochondrial involvement has been detected. In the present study, the bioenergetic effects of MB on TEGDMA-treated isolated mitochondria and on human dental pulp stem cells (DPSC) were analyzed. METHODS: Isolated mitochondria and DPSC were acutely exposed to low millimolar concentrations of TEGDMA and 2 µM concentration of MB. Mitochondrial and cellular respiration and glycolytic flux were measured by high resolution respirometry and by Seahorse XF extracellular analyzer. Mitochondrial membrane potential was measured fluorimetrically. RESULTS: MB partially restored the mitochondrial oxidation, rescued membrane potential in isolated mitochondria and significantly increased the impaired cellular O2 consumption in the presence of TEGDMA. CONCLUSION: MB is able to protect against TEGDMA-induced CI damage, and might provide protective effects in resin monomer exposed cells.

A midline neurofibroma, clinically manifested as a mandibular gingival hyperplasia in a seven-year-old girl whose mother suffers from neurofibromatosis / Neurofibromatosisban szenvedo anya hétéves leánya alsó állcsontjának középvonalában kifejlodo, klinikailag gingivalis hyperplasia képében jelentkezo neurofibroma.

A seven-year-old girl was referred to the Department of Periodontology of the Semmelweis University with a symmetric bilateral, painless, non-inflammatory diffuse enlargement on the lingual aspects of her lower jaw. The family history revealed that her mother and elder sister had Recklinghausen's disease with typical characteristic dermatological signs and they are registered by the National NF Registry. Extraoral examination revealed an evident protrusion of the lips. Intraorally, the buccal gingiva around the upper and lower teeth appeared normal. The little patient had neither dermal nor oral mucous membrane signs characteristic of NF1. With the consent of her parents, the lingual firm mass of gingival enlargement was excised under local anesthesia and the removed tissue was histologically analyzed. The histology approved the clinical diagnosis as solitary neurofibroma. The postoperative healing was uneventful. Because of her very young age and the subtotal excision of the tumor, the patient has been regularly monitored. After one and a half years, recurrence or other sign of tumor regrowth have not been observed. The panoramic radiograph showed normal bone morphology and an age-related dental status with mixed dentition and undisturbed tooth eruption. The present case with a midline bilateral diffuse gingival overgrowth in the mouth of a 7-year-old girl without any characteristic dermatological signs in a family with genetically proven Recklinghausen's disease is very rare and unique in the literature. Orv Hetil. 2020; 161(22): 924-930.

Bacterial Contamination of ePTFE Membranes Following Regenerative Surgery of Intrabony Defects Treated with Platelet-rich Plasma and Natural Bone Mineral.

PURPOSE: The rationale of using platelet-rich plasma (PRP) in reconstructive periodontal surgery is to amplify or accelerate the wound healing through the growth factors contained in platelets. On the other hand, bacterial colonisation of membranes may negatively affect the healing process. The aim of this study was to evaluate bacterial contamination of non-bio-resorbable membranes (ePTFE) used for regenerative periodontal therapy of intrabony defects and the clinical attachment level (CAL) gain with or without PRP. MATERIALS AND METHODS: Seventeen patients were treated with a natural bone mineral (NBM) and guided tissue regeneration (GTR) with an ePTFE membrane (NBM + GTR group; ie, control group), while in another 17 patients PRP was additionally applied (NBM + PRP + GTR group; ie, test group). Furthermore, the retrieved membranes were analysed for the presence of periodontopathogens and data were related to the gain of clinical attachment. In addition, the in vitro sensitivity of selected microbes to PRP was checked by using agar diffusion test. RESULTS: Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were not detected in the PRP group whereas in the controls A. actinomycetemcomitans was detected in five patients (p = 0.022) and P. gingivalis in two cases (difference not statistically significant, p = 0.242). Detection of A. actinomycetemcomitans was not associated with less CAL gain. If the samples were positively tested for Prevotella intermedia/nigrescens and/or P. gingivalis, the CAL gains were lower compared with the negative samples (p = 0.002). PRP did not show any inhibitory effect on bacterial growth in vitro. CONCLUSION: Within their limits, the present results appear to suggest that the presence of P. intermedia/nigrescens and/or P. gingivalis at the regenerated site may negatively influence the clinical outcomes. However, the potential influence of PRP on bacterial colonisation and the impact on the clinical outcome is still unclear and remains to be elucidated.

[The association between maternal periodontal health and adverse pregnancy outcomes]. / A várandós no parodontalis egészségi állapota és a terhességi komplikációk közötti kapcsolat.

Data from epidemiological and clinical studies published in the past two decades indicate certain association between periodontal disease and increased risk for preterm birth or low birth weight. Although the strength of those observed associations is weak, periodontitis today is considered as one of the potentially modifiable risk factors for adverse pregnancy outcomes. The aims of the publication are to summarize the epidemiological and clinical evidence for the impact of periodontal disease on adverse pregnancy outcomes and to make an attempt to overview the potential biological mechanism behind this association. The majority of epidemiological and clinical studies found certain negative effect of poor maternal periodontal condition on the incidence of low birth weight, preterm birth, pre-eclampsy, restricted foetal growth or even stillbirth. Two possible biological pathways have so far been identified: 1) the direct dissemination of the periodontal pathogens or their toxic by-products which reach the foetal-placental unit, and 2) an indirect mechanism when the circulating systemic inflammatory mediators induced by the periodontal inflammation can provoke secondary inflammation and foetal damage in the amnion. The periodontal therapy applied during the second or third trimesters has not been proven to reduce the incidence of any adverse pregnancy outcomes in pregnant women. A much more prophylaxis-oriented approach in periodontal treatment is needed. The adequate periodontal therapy should be completed before the conception to provide benefit to the pregnant women and also the new born baby. Orv Hetil. 2018; 159(25): 999-1007.

Triethylene glycol dimethacrylate impairs bioenergetic functions and induces oxidative stress in mitochondria via inhibiting respiratory Complex I.

OBJECTIVES: Earlier studies demonstrated that dental resin monomers lower cellular viability and provoke oxidative stress. Reactive oxygen species (ROS) formation has a key role in triethylene glycol dimethacrylate (TEGDMA) induced adverse reactions. In the present study the effects of TEGDMA on mitochondrial functions were investigated to identify a direct molecular target for cytotoxicity. METHODS: Mitochondria were isolated from guinea pig brain. The most important bioenergetic parameters, oxygen consumption, membrane potential (ΔΨm), and ATP production were assessed. Mitochondrial H2O2 production and elimination and the NAD(P)H level reported on redox balance. RESULTS: Mitochondria were supported with respiratory substrates to be oxidized by either Complex I (CI) or Complex II (CII). ΔΨm was depolarized, respiration and ATP production was greatly diminished when applying CI substrates in the presence of TEGDMA. The same parameters remained essentially unaffected when CII substrate plus TEGDMA were applied. H2O2 production by mitochondria was significantly stimulated by TEGDMA in the presence of CI substrates. In the presence of TEGDMA mitochondrial elimination of exogenous H2O2 was impaired. When CII substrate supported the mitochondria in the absence of ADP the H2O2 generation was decreased. NADH autofluorescence results also demonstrated the inhibitory effect of TEGDMA on CI activity. SIGNIFICANCE: TEGDMA inhibits CI in the respiratory chain, which explains effects induced by TEGDMA on redox homeostasis, apoptotic and necrotic cell deaths described in previous studies. Identification of the molecular target of TEGDMA may influence the development of relevant biomaterials and may induce new therapeutic strategies to control the adverse effects of resin monomers.

[The significance of biotype in the predictability of dental-periodontal treatment]. / Biotípus jelentosége a fogászati-parodontélis kezelések kiszámíthatóságában. Irodalmi összefoglaló és keresztmetszeti vizsgálat.

BACKGROUND: The dimension of attached gingiva is a very important landmark in the periodontal health, and determine the function of the mucogingival unit, the progression of marginal inflammation and also affects aesthetic dentistry, orthodontics and implantology. The determination of gingival/periodontal biotype is important in dental/periodontal practice. Hence, the aim of this cross sectional clinical study was to assess the width and thickness of attached gingiva in young, periodontally healthy individuals and to provide anthropometric data in Hungary. MATERIALS AND METHODS: 68 periodontally healthy (between the age of 14-28) individuals participated in the study. The thickness of the gingiva was determined using transgingival transparency of periodontal probe at each tooth in the maxillary and mandibular dental arch. Based on this non-invasive technique three biotype categories were determined i.e. thin > 1 mm, medium 1-2 mm and thick < 2 mm. The width of the gingiva was assessed by William's graduated probe measuring the distance between the gingival margin and mucogingival line the midline of each tooth. The data were statistically analyzed and compared according to gender, dental arch and group of teeth. RESULTS: The gingiva was found to be thinner in females than males. The thin biotype was significantly more common among females while in males the thick biotype was the dominant. The individual variations were common within dental arch and many times the biotype switched from tooth to tooth. The average width of the attached gingiva was wider in the maxilla than in the mandible and there was no statistically significant correlation between the biotype and the width of attached gingiva. Manifest gingival recession occurred just around teeth with thin biotype. CONCLUSION: In the present study, we concluded that gingival thickness and width varies with gender and dental arch location and the biotype had no effect on the width of attached gingiva.

[Evaluation of the efficacy of powered and manual toothbrushes in preventing oral diseases (Systematic review with meta-analysis)]. / Elektromos és kézi fogkefék hatékonyságának összehasonlítása az orális prevencióban. Irodalmi áttekintés, systematic review, meta-analízis.

BACKGROUND: The removal of dental plaque plays an essential role in the maintenance of oral health. Numerous powered and manual toothbrushes were manufactured to achieve this goal, but even up to this day different opinions and research results have been revealed to assess the priority of the mentioned devices. AIM: Comparison of powered and manual toothbrushes on the basis of periodontal parameters and safety. MATERIALS AND METHODS: Electronic search of the databases of MEDLINE and EMBASE (until May 2014) was carried out with the help of keywords in order to find relevant trials. The inclusion criteria were as follows: randomised controlled clinical trials, adult population, the presence of at least 15 permanent teeth. Split-mouth trials and interventions carried out by dental professionals, were excluded. Primary outcomes were the changes of plaque and gingival indices, while secondary outcomes were probing pocket depth (PPD), safety and quality assessment. The effect-size of the interventions was expressed by the standardised mean difference (SMD) with 95% confidence interval (CI). Random-effects models were performed. RESULTS: Electronic search resulted in 173 hits. 21 trials with the total number of 1500 subjects were then eligible for the meta-analysis. Both toothbrushes were safe, without considerable side effects on soft or hard tissues. Powered toothbrushes seemed to be generally more effective in removing plaque (-9%), reducing gingivitis (-6%) and preventing calculus formation. The SMDs for plaque and gingival indices were -0,40 (95% Cl: -0,95 to -0,16) and -0,29 (95% Cl: -0,56 to -0,03) respectively, in favour of the powered devices. There was no significant difference in changes of PPD. By further dividing the powered toothbrushes according to their mode of action, the plaque removal effect of the rotation oscillation (plus three dimensional), side to side sonic and ultrasonic toothbrushes seemed to be significantly better, than their manual ones, while the counter oscillation and the ionic toothbrushes did not perform better. Quality assessment and sensitivity analysis revealed various types of bias up to a certain extent. Consequently, no trial was found to be eligible for the highest quality criteria. CONCLUSIONS: The investigated rotation oscillation and vibrating toothbrushes appeared to be statistically more effective than their manual counterparts, although there is little known about its clinical relevance. The advantage of the electric toothbrushes disappears in case of adequately instructed and motivated patients that highlights the importance of individualised oral hygiene education. The design of the trials shows high heterogeneity, therefore their clinical implications should be handled carefully.

[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.

[Clinical examination of the gingival effects of three glass ionomer restorative materials (GC Fuji IX GP, GC Fuji IX GP EXTRA és GC EQUIA)]. / GC Fuji IX GP, GC Fuji IX GP EXTRA és GC EQUIA üvegionomer tömoanyagok gingiva állapotára gyakorolt hatásának vizsgálata.

The restoration of cervical abrasions, erosions or cervical carious lesions is still challenging because of their unpredictable adhesion and possible negative effects on the marginal plaque accumulation. The impact of three different glass ionomer cements (GIC) on the marginal gingiva and root sensitivity was studied. Furthermore, it was investigated in details, whether or not a recently developed light curing varnish (GC Coat - EQUIA) had any additional effect on the gingival tissue. A total number of 30 non-smokers with healthy gingiva having at least one cervical supra/paragingival abrasion/erosion/abfraction defects were enrolled in the present study. The cervical defects were randomly restored by using one of the three GIC and the gingival parameters were recorded and evaluated at baseline, 6 weeks and 6 months. According to our results root sensitivity were substantially decreased in all the three groups. Plaque scores were also reduced in all groups with the greatest improvement at the sites where the new varnish were applied. Although this improvement was not reflected by the gingival parameters, such as bleeding on probing and crevicular fluid flow, since both were slightly increased in the varnish group. However, neither the intra-group, nor the intergroup differences reached statistical significance. Consequently, the three investigated GIC did not significantly affect the gingival health, therefore they might serve as alternative for the treatment of such cervical lesions. Nevertheless, the new light cure varnish-coated GIC did not seem to be either clinically or statistical significantly more favorable.

[Surgical correction of excessive gingival enlargements. Case studies]. / Extrém méretu iatrogén eredetu inyhiperpláziák sebészi korrekciója. Esetsorozat.

INTRODUCTION: Gingival enlargement is a common form of periodontal tissue reaction to several irritating factors. The most common form is the drug related gingival hyperplasia--nevertheless the heredity gingival fibromatosis and hematological cases can also occur and might impose a challenge to periodontists. After a short literature summary three Case reports are presented. The first case is a drug related gingival overgrowth in a young kidney transplant women who took Cyclosporin-A. The excessive mass of fibrotic tissue was removed by a series of internal beveled incision and the oral and buccal gingival flaps were united with sutures. The healing was uneventful and during the follow up patient's compliance and oral hygiene was superb. The second case is a very severe antihypertensive drug related gingival overgrowth in a 62 years old man interfering with the closure of his lip and corrected with a combination of conventional gingivectomy and internal reverse beveled incision both and Ca-channel blockers. The third case is a 42 years old woman with chronic idiopathic hemolytic anemia who presented a sudden onset acute excessive generalized gingival enlargement accompanied with severe pain and fever. At admission she was suspect for leukemia. After obtaining biopsy samples and having negative histology the soft tissue mass was removed under general anesthesia with conventional gingivectomy technique, but after a couple of days the severe pain and gingival swelling recurred. With administering systemic corticosteroid therapy (32 mg Medrol), the gingiva healed in five days and the one year follow-up showed a stable hematological and periodontal status. Today the more conservative internal beveled incision is preferred over the conventional gingivectomy in the most cases because it provides a more predictable healing and better esthetics. The recurrence of the drug related gingival hyperplasia can be anticipated by meticulous postoperative individual oral hygiene and regular supportive therapy. CONCLUSION: The combined conservative and surgical therapy leads to predictable postoperative result even in very severe systematically motivated gingival enlargements, nevertheless the successful patients management needs good cooperation with medical doctors and with the patients themselves.

[Salvage of a tooth with necrotised periodontium, caused by endodontic use of radiosurgery. Long-term results. Case report]. / Rádiósebészeti technikával gyökérkezelt fog körül kialakult parodontális nekrózis kezelése es a fog megmentése. Hosszú távú eredmények. Esetismertetés.

Electrosurgery and radiosurgery bear certain popularity in contemporary dentistry. Nevertheless, the inadequate treatment allocation may lead to tissue necrosis. A young female patient was referred to our department following root canal treatment (RCT) by radiosurgical device. Necrotised alveolar bone, lack of keratinized gingiva and increased tooth mobility were noticed. After considering all the treatment options, we attempted to keep the tooth. Therefore, the necrotised part of the alveolar process was removed and the gingival fringe was rejuvenated alongside root surface debridement. The tooth was then splinted with glass fibre reinforced composite and appropriate RCT was completed. After ten months of improvement periodontal reconstructive surgery with deproteinized bovine bone mineral and connective tissue graft was carried out. Substantial improvement was observed at the six month reassessment, including complete healing of the gingiva. The composite splint was then removed due to discontinued mobility. The tooth and the adjacent periodontium remained stable for seven years. Nevertheless, external root resorption was recently developed that was treated with glass ionomer cement filling and regenerative periodontal surgery using enamel matrix derivative (EMD). Ultimately, the tooth is still in place providing satisfactory function and aesthetics.

Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial.

BACKGROUND: A newly developed collagen matrix (CM) of porcine origin has been shown to represent a potential alternative to palatal connective tissue grafts (CTG) for the treatment of single Miller Class I and II gingival recessions when used in conjunction with a coronally advanced flap (CAF). However, at present it remains unknown to what extent CM may represent a valuable alternative to CTG in the treatment of Miller Class I and II multiple adjacent gingival recessions (MAGR). The aim of this study was to compare the clinical outcomes following treatment of Miller Class I and II MAGR using the modified coronally advanced tunnel technique (MCAT) in conjunction with either CM or CTG. METHODS: Twenty-two patients with a total of 156 Miller Class I and II gingival recessions were included in this study. Recessions were randomly treated according to a split-mouth design by means of MCAT + CM (test) or MCAT + CTG (control). The following measurements were recorded at baseline (i.e. prior to surgery) and at 12 months: Gingival Recession Depth (GRD), Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Keratinized Tissue Width (KTW), Gingival Recession Width (GRW) and Gingival Thickness (GT). GT was measured 3-mm apical to the gingival margin. Patient acceptance was recorded using a Visual Analogue Scale (VAS). The primary outcome variable was Complete Root Coverage (CRC), secondary outcomes were Mean Root Coverage (MRC), change in KTW, GT, patient acceptance and duration of surgery. RESULTS: Healing was uneventful in both groups. No adverse reactions at any of the sites were observed. At 12 months, both treatments resulted in statistically significant improvements of CRC, MRC, KTW and GT compared with baseline (p < 0.05). CRC was found at 42% of test sites and at 85% of control sites respectively (p < 0.05). MRC measured 71 ± 21% mm at test sites versus 90 ± 18% mm at control sites (p < 0.05). Mean KTW measured 2.4 ± 0.7 mm at test sites versus 2.7 ± 0.8 mm at control sites (p > 0.05). At test sites, GT values changed from 0.8 ± 0.2 to 1.0 ± 0.3 mm, and at control sites from 0.8 ± 0.3 to 1.3 ± 0.4 mm (p < 0.05). Duration of surgery and patient morbidity was statistically significantly lower in the test compared with the control group respectively (p < 0.05). CONCLUSIONS: The present findings indicate that the use of CM may represent an alternative to CTG by reducing surgical time and patient morbidity, but yielded lower CRC than CTG in the treatment of Miller Class I and II MAGR when used in conjunction with MCAT.

Treatment of multiple adjacent Miller Class I and II gingival recessions with collagen matrix and the modified coronally advanced tunnel technique.

OBJECTIVE: To clinically evaluate the treatment of Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique combined with a newly developed bioresorbable collagen matrix of porcine origin. METHOD AND MATERIALS: Eight healthy patients exhibiting at least three multiple Miller Class I and II multiple adjacent gingival recessions (a total of 42 recessions) were consecutively treated by means of the modified coronally advanced tunnel technique and collagen matrix. The following clinical parameters were assessed at baseline and 12 months postoperatively: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), probing depth (PD), recession depth (RD), recession width (RW), keratinized tissue thickness (KTT), and keratinized tissue width (KTW). The primary outcome variable was complete root coverage. RESULTS: Neither allergic reactions nor soft tissue irritations or matrix exfoliations occurred. Postoperative pain and discomfort were reported to be low, and patient acceptance was generally high. At 12 months, complete root coverage was obtained in 2 out of the 8 patients and 30 of the 42 recessions (71%). CONCLUSION: Within their limits, the present results indicate that treatment of Miller Class I and II multiple adjacent gingival recessions by means of the modified coronally advanced tunnel technique and collagen matrix may result in statistically and clinically significant complete root coverage. Further studies are warranted to evaluate the performance of collagen matrix compared with connective tissue grafts and other soft tissue grafts.

Five-year results evaluating the effects of platelet-rich plasma on the healing of intrabony defects treated with enamel matrix derivative and natural bone mineral.

BACKGROUND: Regenerative periodontal surgery using the combination of enamel matrix derivative (EMD) and natural bone mineral (NBM) with and without addition of platelet-rich plasma (PRP) has been shown to result in substantial clinical improvements, but the long-term effects of this combination are unknown. METHODS: The goal of this study was to evaluate the long-term (5-year) outcomes after regenerative surgery of deep intrabony defects with either EMD + NBM + PRP or EMD + NBM. Twenty-four patients were included. In each patient, one intrabony defect was randomly treated with either EMD + NBM + PRP or EMD + NBM. Clinical parameters were evaluated at baseline and 1 and 5 years after treatment. The primary outcome variable was clinical attachment level (CAL). RESULTS: The sites treated with EMD + NBM + PRP demonstrated a mean CAL change from 10.5 ± 1.6 to 6.0 ± 1.7 mm (P <0.001) at 1 year and 6.2 ± 1.5 mm (P <0.001) at 5 years. EMD + NBM-treated defects showed a mean CAL change from 10.6 ± 1.7 to 6.1 ± 1.5 mm (P <0.001) at 1 year and 6.3 ± 1.4 mm (P <0.001) at 5 years. At 1 year, a CAL gain of ≥4 mm was measured in 83% (10 of 12) of the defects treated with EMD + NBM + PRP and in 100% (all 12) of the defects treated with EMD + NBM. Compared to baseline, in both groups at 5 years, a CAL gain of ≥4 mm was measured in 75% (nine of 12 in each group) of the defects. Four sites in the EMD + PRP + NBM group lost 1 mm of the CAL gained at 1 year. In the EMD + NBM group, one defect lost 2 mm and four other defects lost 1 mm of the CAL gained at 1 year. No statistically significant differences in any of the investigated parameters were observed between the two groups. CONCLUSIONS: Within their limits, the present results indicate that: 1) the clinical outcomes obtained with both treatments can be maintained up to a period of 5 years; and 2) the use of PRP does not appear to improve the results obtained with EMD + NBM.

Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste.

OBJECTIVES: The aim of the study was to clinically and histologically evaluate the healing of human intrabony defects treated with open flap surgery (OFD) and application of a new, resorbable, fully synthetic, unsintered, nanocrystalline, phase-pure hydroxyapatite (nano-HA). MATERIALS AND METHODS: Six patients, each of them displaying very advanced intrabony defects around teeth scheduled for extraction due to advanced chronic periodontitis and further prosthodontic considerations, were included in the study. Following local anaesthesia, mucoperiosteal flaps were reflected; the granulation tissue was removed, and the roots were meticulously debrided by hand and ultrasonic instruments. A notch was placed at the most apical extent of the calculus present on the root surface or at the most apical part of the defect (if no calculus was present) in order to serve as a reference for the histological evaluation. Following defect fill with nano-HA, the flaps were sutured by means of mattress sutures to allow primary intention healing. At 7 months after regenerative surgery, the teeth were extracted together with some of their surrounding soft and hard tissues and processed for histological analysis. RESULTS: The postoperative healing was uneventful in all cases. At 7 months following surgery, mean PPD reduction and mean CAL gain measured 4.0 ± 0.8 and 2.5 ± 0.8 mm, respectively. The histological analysis revealed a healing predominantly characterized by epithelial downgrowth. Limited formation of new cementum with inserting connective tissue fibers and bone regeneration occurred in three out of the six biopsies (i.e. 0-0.86 and 0-1.33 mm, respectively). Complete resorption of the nano-HA was found in four out of the six biopsies. A few remnants of the graft particles (either surrounded by newly formed mineralized tissue or encapsulated in connective tissue) were found in two out of the six biopsies. CONCLUSION: Within their limits, the present results indicate that nano-HA has limited potential to promote periodontal regeneration in human intrabony defects. CLINICAL RELEVANCE: The clinical outcomes obtained following surgery with OFD + nano-HA may not reflect true periodontal regeneration.

Ten-year results following treatment of intrabony defects with an enamel matrix protein derivative combined with either a natural bone mineral or a ß-tricalcium phosphate.

BACKGROUND: The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or ß-tricalcium phosphate (ß-TCP). METHODS: Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + ß-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS: The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + ß-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + ß-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + ß-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years. CONCLUSION: Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + ß-TCP can be maintained over a period of 10 years.