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1.
J Biomed Nanotechnol ; 17(3): 456-465, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33875080

RESUMO

Guided bone regeneration (GBR) technique is most commonly used to treat alveolar bone defect. Polylactic acid (PLA) attracts much attention to utilize as a GBR membrane because it has relatively high mechanical strength and biodegradability. However, randomized controlled trials of PLA as a GBR membrane in animals were rare. The aim of this work is to observe the efficacy of polylactic acid membrane in guiding bone regeneration in Beagle canine alveolar bone defect restoration and to compare efficacy with the collagen membrane, providing an experimental basis for further clinical use of the polylactic acid membrane. The tests of physical and chemical properties showed that the PLA membrane has well mechanical strength to maintenance the space for the new bone, and has proper aperture for the attachment of osteoblasts. Through X-ray and histopathological examination of the different time points, the bone grafting material covered with PLA membrane can form similar mature bone compared to collagen membrane ones. Meanwhile, biodegradable speed of the PLA membrane was slower. Thus, this study showed that polylactic acid membrane as synthetic biodegradable polymer was reliably effective in guiding bone regeneration of alveolar bone defects, showed the favorable osteogenic capability and forecasts well applications in bone augmentation.


Assuntos
Regeneração Óssea , Membranas Artificiais , Animais , Cães , Regeneração Tecidual Guiada Periodontal , Osteoblastos , Osteogênese , Polímeros
2.
Artigo em Inglês | MEDLINE | ID: mdl-33802261

RESUMO

We present the preliminary results of the treatment of teeth with a deep, non-contained periodontal residual defect, vestibular bone dehiscence, and soft tissue recession, by combining an apical non-incised papilla surgical approach (NIPSA) to the defect and leukocyte platelet-rich fibrin (L-PRF) in the vestibular aspect. Four patients (upper left first premolar, upper left central incisor, upper right central incisor and upper right lateral incisor) have been treated. At one year of follow up, all cases showed a considerable reduction in the periodontal pocket depth, a gain in clinical attachment and no bleeding on probing, as well as an improvement in the marginal soft tissue minimizing soft tissue contraction (recession and/or loss of papilla) and improving soft tissue architecture. NIPSA plus L-PRF seem to improve clinical outcomes in deep non-contained intrabony defects associated with soft tissue recession.


Assuntos
Perda do Osso Alveolar , Fibrina Rica em Plaquetas , Perda do Osso Alveolar/cirurgia , Regeneração Tecidual Guiada Periodontal , Humanos , Leucócitos , Perda da Inserção Periodontal/cirurgia , Resultado do Tratamento
3.
Clin Oral Investig ; 25(5): 2461-2478, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33609186

RESUMO

OBJECTIVES: This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. MATERIALS AND METHODS: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) alone versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4-6) OFD/barrier membrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8-10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means and forest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF). RESULTS: From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD and improved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG was compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differences were reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF. CONCLUSIONS: The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone with similar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future research investigating PRF at histological level is also needed. CLINICAL RELEVANCE: The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values, yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certain clinical advantages, thus warranting further investigations.


Assuntos
Perda do Osso Alveolar , Fibrina Rica em Plaquetas , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/tratamento farmacológico , Perda do Osso Alveolar/cirurgia , Transplante Ósseo , Regeneração Tecidual Guiada Periodontal , Humanos , Perda da Inserção Periodontal , Retalhos Cirúrgicos/cirurgia
4.
Quintessence Int ; 0(0): 308-316, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33533237

RESUMO

OBJECTIVES: In-vitro data have shown that cross-linked hyaluronic acid (HA) enhances the proliferative and migratory properties of cells involved in periodontal wound healing/regeneration, stabilizes the blood clot, reduces the inflammatory response, and facilitates angiogenesis. The aim of this study was to histologically evaluate the effects of cross-linked HA alone or combined with a collagen matrix (CM) on the periodontal wound healing/regeneration in intrabony defects. METHOD AND MATERIALS: Two-wall intrabony defects (5 mm wide, 5 mm deep) were surgically created at the distal and mesial aspects of mandibular premolars in six beagle dogs. The 24 defects were randomly treated as follows: open flap debridement (OFD) + HA, OFD + CM, OFD + HA + CM (HA/CM), and OFD alone (control). At 2 months, the animals were euthanized for histologic evaluation. RESULTS: The HA (2.43 ±â€¯1.25 mm) and HA/CM (2.60 ±â€¯0.99 mm) groups yielded statistically significantly (P < .05) greater formation of new attachment (ie, linear length of new cementum adjacent to newly formed bone, with inserting collagen fibers) compared with the OFD (0.55 ± 0.99 mm) group. Among the four treatment groups, the HA/CM group demonstrated the highest amount of regenerated tissues, although no statistically significant differences in any of the histometric parameters were observed between the HA and HA/CM groups. CONCLUSION: Within their limits, it can be concluded that cross-linked HA alone or combined with CM promotes periodontal wound healing/regeneration in two-wall intrabony defects in dogs.


Assuntos
Perda do Osso Alveolar , Procedimentos Cirúrgicos Reconstrutivos , Perda do Osso Alveolar/cirurgia , Animais , Regeneração Óssea , Colágeno , Cães , Regeneração Tecidual Guiada Periodontal , Ácido Hialurônico , Cicatrização
5.
J Int Acad Periodontol ; 23(1): 31-56, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512340

RESUMO

AIMS: To determine the differences in the long-term clinical outcomes between Regeneration (REG) and Conservative Surgery (CS) in infra-bony defects. MATERIALS AND METHODS: Three databases were searched [PubMed, Medline and Embase] up to April 2019. Following screening, 17 studies were included. Randomized Controlled Clinical Trials, Controlled Clinical Trials and retrospective studies with long-term clinical observations (≥ 24-months) were selected. After subgrouping the studies regarding the grafting material and the used flap, meta-analysis was performed for different outcomes [clinical attachment level gain (CALGain), probing pocket depth reduction (PPDRed), recession increase (RECInc) and bone fill (BF)] at different follow-ups (24-, 36-, 48- to 60- and 120- to 240-months). RESULTS: The time-related meta-analysis favoured REG at every interval for every outcome. In subgroup analysis, enamel matrix derivative (EMD) performed significantly better for both CALGain [24- (p less than 0.0001), 36- (p=0.02) and 60-months (p less than 0.00001)] and PPDRed [24- (p=0.0004), 36- (p=0.003) and 60-months (p less than 0.00001)]. For Ceramic Grafts (CGs), CALGain at 48-months (p less than 0.00001) and PPDRed at 24- (p=0.0006), 36- (p less than 0.00001) and 48-months (p less than 0.00001) follow-up showed better results. CONCLUSION: The better outcomes from REG using EMD or CGs can be maintained for a longer duration, suggesting a potential longevity of the occurred healing.


Assuntos
Perda do Osso Alveolar , Proteínas do Esmalte Dentário , Perda do Osso Alveolar/cirurgia , Transplante Ósseo , Proteínas do Esmalte Dentário/uso terapêutico , Seguimentos , Regeneração Tecidual Guiada Periodontal , Humanos , Perda da Inserção Periodontal/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
6.
Quintessence Int ; 0(0): 402-410, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33491386

RESUMO

Objective: The aim was to evaluate the efficacy of periodontal regenerative therapy using enamel matrix derivatives (EMDs) in aggressive periodontitis patients, and to determine the contribution of maintenance via periodic supportive periodontal treatment. Method and materials: In total, 28 patients were evaluated, comprising 74 intrabony sites. In 50 sites EMD gel was applied, and in 24 sites EMD was combined with deproteinized bovine xenograft. Patients were assigned to a supportive periodontal treatment program; 18 patients fulfilled the program, defined as the well-maintained (WM) group; 10 did not comply, defined as the nonmaintained (NM) group. Probing depth (PD), clinical attachment level (CAL), and radiographic bone level (BL) were recorded. Data were compared presurgically (T0), 6 months postsurgery (T1), and 3 to 10 years posttreatment (T2). Results: Both surgical modalities achieved similar PD reduction, CAL gain, and BL gain, maintained over time. T1 to T2 showed a mean gain/loss of 0.21 ±â€¯0.5 mm and 0.04 ±â€¯1.1 mm, and -0.65 ±â€¯3.0 mm and -0.73 ±â€¯3.0 mm for PD and CAL, respectively, at the WM/NM groups, respectively. BL gain was 21.6% and 11.5% for the WM/NM groups, respectively (P < .05). The courses of the PD, CAL, and BL differed between the WM and NM groups during the observation periods (P < .05). Conclusion: Periodontal regeneration via EMD with/without the combination of deproteinized bovine xenograft can be maintained in aggressive periodontitis cases. It appears that periodic supportive periodontal treatment is a determinant factor in achieving this task.


Assuntos
Periodontite Agressiva , Perda do Osso Alveolar , Proteínas do Esmalte Dentário , Retração Gengival , Periodontite Agressiva/cirurgia , Perda do Osso Alveolar/cirurgia , Animais , Bovinos , Seguimentos , Retração Gengival/cirurgia , Regeneração Tecidual Guiada Periodontal , Humanos , Perda da Inserção Periodontal/cirurgia , Bolsa Periodontal/cirurgia , Resultado do Tratamento
7.
Clin Oral Implants Res ; 32(3): 369-381, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33420723

RESUMO

OBJECTIVES: To evaluate new lateral bone formation and lateral volume augmentation by guided bone regeneration (GBR) in chronic non-contained bone defects with the use of a non-resorbable TiO2 -block. MATERIALS AND METHODS: Three buccal bone defects were created in each hemimandible of eight beagle dogs and allowed to heal for 8 weeks before treatment by GBR. Each hemimandible was randomly allocated to 4- or 12-week healing time after GBR, and three intervention groups were assigned by block randomization: TiO2 block: TiO2 -scaffold and a collagen membrane, DBBM particles: Deproteinized bovine bone mineral (DBBM) and a collagen membrane, Empty control: Collagen membrane only. Microcomputed tomography (microCT) was used to measure the lateral bone formation and width augmentation. Histological outcomes included descriptive analysis and histomorphometric measurements. RESULTS: MicroCT analysis demonstrated increasing new bone formation from 4 to 12 weeks of healing. The greatest width of mineralized bone was seen in the empty controls, and the largest lateral volume augmentation was observed in the TiO2 block sites. The DBBM particles demonstrated more mineralized bone in the grafted area than the TiO2 blocks, but small amounts and less than the empty control sites. CONCLUSION: The TiO2 blocks rendered the largest lateral volume augmentation but also less new bone formation compared with the DBBM particles. The most new lateral bone formation outward from the bone defect margins was observed in the empty controls, indicating that the presence of either graft material leads to slow appositional bone growth.


Assuntos
Substitutos Ósseos , Animais , Regeneração Óssea , Bovinos , Cães , Regeneração Tecidual Guiada Periodontal , Porosidade , Titânio , Microtomografia por Raio-X
8.
Clin Oral Investig ; 25(3): 807-821, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33438084

RESUMO

AIM: The present systematic review appended with meta-analysis aimed to evaluate the efficacy of bone replacement graft (BRG) with guided tissue regeneration (GTR) over BRG or open flap debridement (OFD) alone in the treatment of grade II furcation defects. MATERIALS AND METHODS: An electronic literature search of PubMed, Cochrane Library and Google Scholar databases accompanied with manual searching was done. Randomized controlled trials (RCTs) up to October 2019, comparing BRG+GTR with BRG or OFD in grade II furcation defects, were identified. Clinical attachment level (CAL) gain, changes in gingival marginal level (GML), vertical defect fill (VDF), horizontal defect fill (HDF) and reduction in defect volume were the outcome parameters. RESULTS: Of a total of 12, 9 studies compared BRG+GTR vs BRG while 3 compared BRG+GTR vs OFD. Meta-analysis was carried out for CAL gain, VDF, HDF and GML changes. In the BRG+GTR vs BRG comparison group, out of 9 studies, 6 RCTs showed standardized mean difference (SMD) of 0.513 for VDF, 9 RCTs showed SMD of 0.83 for HDF and 2 RCTs showed SMD of 0.651 for CAL gain, whereas only 2 studies in the same group reported reduction in defect volume. Three studies of the BRG+GTR vs OFD group exhibited significant VDF and CAL gain with SMD of 2.002 and 1.161 respectively. However, no significant change was recorded for GML in both groups. CONCLUSION: The present systematic review indicates supplemental benefits of combination therapy of BRG+GTR over monotherapy in resolving grade II furcation defects. CLINICAL RELEVANCE: In our quest to achieve maximum regeneration in grade II furcation defects, combination therapies such as BRG+GTR have been accepted as treatment choices over other modalities. Clinical situations warranting near-complete regeneration of the tissues in such defects are better suited for combination therapies.


Assuntos
Perda do Osso Alveolar , Defeitos da Furca , Perda do Osso Alveolar/cirurgia , Regeneração Óssea , Transplante Ósseo , Seguimentos , Defeitos da Furca/cirurgia , Regeneração Tecidual Guiada Periodontal , Humanos , Membranas Artificiais , Perda da Inserção Periodontal , Resultado do Tratamento
9.
Cient. dent. (Ed. impr.) ; 17(3): 175-181, sept.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198599

RESUMO

Se presenta el caso de un paciente varón de 43 años con lesiones periapicales radiolúcidas de origen endodóntico en dientes pilares de rehabilitación fija metalocerámica, que acude a consulta para valorar la posibilidad de mantener sus dientes. Tras la exploración clínica y radiológica mediante radiografías periapicales y tomografía computerizada de haz cónico (CBCT) se decide realizar un abordaje combinado endodóntico-quirúrgico. La evolución clínica fue favorable y los controles radiográficos y tomográficos mostraron la resolución de las lesiones radiolúcidas preexistentes. El retratamiento endodóntico combinado con la microcirugía periapical son herramientas eficaces en el tratamiento conservador de dientes con lesiones periapicales de origen endodóntico


In this case report, we present a 43-year old male patient with multiple periapical radiolucent lesions caused by endodontic failure in teeth supporting a metalloceramic prosthetic rehabilitation, who came to the office asking for any possibility to maintain his teeth. After clinical and radiological exploration with periapical x-rays and cone beam computer tomography (CBCT), we decided to use a combined endodontic-surgical approach. Clinical evolution was favourable, and radiologica - tomographic controls showed complete healing of periapical radiolucent lesions. Endodontic retreatment combined with periapical microsurgery are effective tools for conservative treatment in teeth with periapical lesions caused by endodontic failures


Assuntos
Humanos , Masculino , Adulto , Tecido Periapical/lesões , Tecido Periapical/cirurgia , Regeneração Tecidual Guiada Periodontal/métodos , Retratamento , Microcirurgia/métodos , Doenças Periapicais/patologia , Tomografia Computadorizada por Raios X , Endodontia/métodos , Radiografia Panorâmica
10.
Artigo em Inglês | MEDLINE | ID: mdl-33151186

RESUMO

This study presents the histomorphometric results of the Wafer Technique, which is based on guided bone regeneration and onlay grafts for 3D bone augmentation. This two-stage technique utilizes autogenous cortical bone plates and collagen membranes, forming a barrier containing a mixture of deproteinized bovine bone matrix, autologous blood, and bone grafted from intraoral sites. Twelve patients were treated. At 6 months postsurgery, histologic analysis of the regenerated areas revealed the presence of compact newly formed bone with no sign of inflammation. The percentages of new bone and native bone (mineralized tissue) were 16.4% (95% CI: 9.5% to 23.2%) and 42.6% (95% CI: 28.2% to 57.0%), respectively. Twenty-five implants were placed. The procedure has been proven to be safe and reliable, and only one transient complication was observed.


Assuntos
Aumento do Rebordo Alveolar , Substitutos Ósseos , Implantes Dentários , Animais , Regeneração Óssea , Transplante Ósseo , Bovinos , Implantação Dentária Endo-Óssea , Regeneração Tecidual Guiada Periodontal , Humanos , Membranas Artificiais
11.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(10): 778-782, 2020 Oct 09.
Artigo em Chinês | MEDLINE | ID: mdl-33045791

RESUMO

Minimally invasive surgery develops rapidly in the periodontal treatments, especially in the periodontal regenerative treatment, in recent years. It supplements, to a certain extent, the insufficiency of the conventional periodontal regenerative treatment. The minimally invasive surgery has many advantages such as enhancing the healing process, reducing surgical chair time and minimizing patient discomfort, etc. It has been proved to improve the clinical effect and provide additional benefits compared to conventional approaches. At present, there are many studies on minimally invasive techniques used in tooth extraction or implant placement in China, but there are few reports on the application of periodontal minimally invasive surgical techniques. Thus based on the reviews of the literatures, this article describes the applications, advantages, indications, microsurgical instruments of minimally invasive periodontal surgery on the treatment of intrabony defect, including various minimally invasive surgical procedures. The review also demonstrates the therapeutic effects and research progress of minimally invasive periodontal surgery combined with biomaterials used in the treatments of intrabony defect. The present article may also provide reference for clinicians applying minimally invasive surgeries to treat intrabony defects.


Assuntos
Regeneração Tecidual Guiada Periodontal , Procedimentos Cirúrgicos Minimamente Invasivos , China , Assistência Odontológica , Humanos , Microcirurgia
12.
Medicine (Baltimore) ; 99(40): e22507, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019451

RESUMO

RATIONALE: In this report, a combination of platelet-rich fibrin (PRF) membrane and semi-open flap technique was used to improve soft tissue regeneration in immediate implant placement in the molar region. PRF, an autologous fibrin matrix, has been widely used for soft tissue wound healing and regeneration. Semi-open flap technique is beneficial to eliminating exudates and relieving the swelling after surgery. PATIENT CONCERNS: Case 1 was a 45-year-old female with a residual crown in the posterior maxillary region that desired a dental implant operation. Case 2 was a 24-year-old male with retained deciduous tooth that requested a restoration of his congenital absent tooth. DIAGNOSES: In case 1, the tooth 16 was diagnosed with a residual crown, while in case 2, a deciduous tooth 75 was a retained deciduous tooth and 35 was congenital absent. INTERVENTIONS: In both cases, immediate implant placement was installed and PRF membranes were made to improve soft tissue augmentation with semi-open flap technique. In case 1, the mixture of an organic bovine bone and blood was filled in the gap between the implant and the socket wall. Subsequently, 2 PRF membranes covered the open wound with semi-open flap. Similarly, in case 2, another 2 PRF membranes were used to improve the soft tissue regeneration, with the same semi-open flap technique as mentioned above. OUTCOMES: In both cases, successfully soft tissue regeneration was obviously observed without postoperative infection. LESSONS: Utilizing the PRF membrane combined with semi-open flap technique can achieve excellent soft tissue augmentation around immediate implant placement in the molar regions.


Assuntos
Implantes Dentários , Regeneração Tecidual Guiada Periodontal/métodos , Dente Molar/cirurgia , Fibrina Rica em Plaquetas , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cicatrização
13.
Int J Esthet Dent ; 15(4): 454-473, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33089260

RESUMO

Ridge defects are a very common finding after tooth extraction. Recent literature has shown that the pattern of bone and soft tissue remodeling can obtain up to 50% of the original volume. Many different surgical approaches have been proposed over the years to correct ridge defects, but the results have often been inconsistent or difficult to reproduce on a daily basis. For some time, surgeons have relied on the guided bone regeneration (GBR) technique, taking advantage of a barrier membrane to protect the blood clot, combined with different combinations of autogenous bone and bone grafts from various sources. If some kind of understanding has been reached and certain guidelines adopted for the treatment of horizontal defects, those for tridimensional and vertical defects still present a challenge. About a decade ago, a new biomaterial became available on the market - a membrane made of collagenated porcine bone called cortical lamina - which proved to be reliable and easy to handle for both horizontal and vertical defects. The aim of this article is to review the current literature on the topic and to discuss the material in its three forms through the presentation of three patient cases of differing complexity, each with its unique indications and characteristics.


Assuntos
Aumento do Rebordo Alveolar , Animais , Regeneração Óssea , Transplante Ósseo , Implantação Dentária Endo-Óssea , Regeneração Tecidual Guiada Periodontal , Humanos , Suínos
14.
Artigo em Inglês | MEDLINE | ID: mdl-32925999

RESUMO

The aim of this study was to investigate which factors play a major role in the healing of Class II mandibular furcation defects treated with different surgical techniques. Twenty-five systemically healthy subjects with periodontitis stage III grade B and Class II buccal mandibular furcation involvement received one of the following open flap debridement approaches: Group 1 (n = 10), no further treatment; Group 2 (n = 10), piezoelectric contouring of the furcation roof; Group 3 (n = 9), piezoelectric contouring of the furcation roof and bone grafting; Group 4 (n = 10), piezoelectric contouring of the furcation roof and bone grafting with coronally positioned flap. Clinical and radiologic variables-bleeding on probing, probing depth (PPD), vertical and horizontal bone level (CAL and PH), gingival recession, root trunk length, radicular separation, and furcation perimeter (FP)-were evaluated at baseline and 180 days and 1 year after surgery. All clinical parameters were statistically analyzed. Surgical techniques caused clinical (CAL, PPD, PH) and radiographic (FP) improvements. Regenerative techniques and the coronally positioned flap yielded a major radiographic reduction of furcation areas. All therapies resulted in significant horizontal and vertical PPD reduction and CAL gain.


Assuntos
Defeitos da Furca/cirurgia , Regeneração Tecidual Guiada Periodontal , Humanos , Mandíbula/cirurgia , Dente Molar/cirurgia , Índice Periodontal , Resultado do Tratamento
15.
J Int Acad Periodontol ; 22(3): 117-128, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32655037

RESUMO

BACKGROUND: This systematic review evaluated the most effective therapeutic approach to treat periodontal furcation defects with a minimum follow-up of 12 months. The primary outcome was clinical attachment level (CAL). Secondary outcomes were probing pocket depth, gingival margin level, gingival index and plaque index. METHODS: A comprehensive search of studies published up to December 2019 and listed in PubMed/MEDLINE, Scopus, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) statement. Two reviewers independently searched eligible studies, made a final article selection, and extracted the data of the selected studies to evaluate qualitatively and quantitatively (meta-analysis). RESULTS: Overall, 19 studies were selected for the analysis. Six hundred and eighteen patients (mean age, 45.3) were treated. More commonly used treatment was polytetrafluoroethylene barrier (ePTFE), followed by enamel matrix derivative (EMD) and open-flap debridement (OFD). Only one study evaluated maxillary arch and remaining evaluated mandibular arch. All treatments provided CAL gain, but meta-analysis did not show significant difference among more commonly used treatments and controls (P=0.91; P=0.47; P=0.08, respectively). CONCLUSION: There is no difference on effectiveness of main therapeutic approaches evaluated for treatment of Class II periodontal furcation defects.


Assuntos
Defeitos da Furca , Índice de Placa Dentária , Seguimentos , Defeitos da Furca/cirurgia , Regeneração Tecidual Guiada Periodontal , Humanos , Pessoa de Meia-Idade , Perda da Inserção Periodontal/cirurgia , Índice Periodontal , Retalhos Cirúrgicos , Resultado do Tratamento
17.
Quintessence Int ; 51(10): 822-837, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32661522

RESUMO

OBJECTIVES: Regeneration of intrabony defects is a challenging target of periodontal therapy. The biologic rationale for regeneration not only is based on incorporating the regenerative material, but also takes into consideration the defect's inherent healing capacity. The present study was carried out to evaluate the efficacy of decortication or intramarrow penetration performed with demineralized freeze-dried bone allograft (DFDBA) in the management of intrabony defects. METHOD AND MATERIALS: Forty chronic periodontitis (stage II and III periodontitis) patients having 40 intrabony defects were randomly assigned into test group (intrabony defect filled with DFDBA after intramarrow penetration along with open flap debridement [OFD+IMP+ DFDBA]) and control group (DFDBA along with open flap debridement [OFD+DFDBA]). Primary outcome measures included probing pocket depth, clinical attachment level, and percentage bone fill (%BF). All parameters were recorded at baseline, 6 months, and 9 months postsurgical follow-up. RESULTS: Mean reduction in probing depth and gain in clinical attachment level was statistically significantly higher at the interdental defect site in the test group compared to the control group at 9 months follow-up (P = .02 and .04, respectively). In radiographic parameters, statistically significant improvements in defect depth and gain in defect area were found in the test group (P = .00 and .03, respectively). Statistically significant improvements in %BF and linear bone growth (P = .02 and .00, respectively) were also observed in the experimental group (39.47 ± 13.92% and 1.41 ± 0.54 mm) in comparison with the control group (19.29 ± 14.24%, 0.62 ± 0.49 mm). CONCLUSION: Addition of intramarrow penetration with DFDBA in surgical periodontal therapy may enhance the healing potential of periodontal intrabony defects, as observed by greater improvement in clinical and radiographic outcomes.


Assuntos
Perda do Osso Alveolar , Transplante Ósseo , Regeneração Tecidual Guiada Periodontal , Aloenxertos , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Humanos , Perda da Inserção Periodontal/cirurgia , Bolsa Periodontal/cirurgia , Resultado do Tratamento
18.
Int J Periodontics Restorative Dent ; 40(4): e137-e146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559031

RESUMO

Furcation involvement (FI) is one of the most detrimental factors affecting tooth survival rate over time. Several authors have used the severity of FI for assessing the prognosis of the tooth and the complexity of periodontal disease. While many approaches have been shown to improve the prognosis of furcation-involved teeth, clinical guidelines recommending one treatment or another (based on the horizontal and vertical component of the furcation defects) have not yet been proposed. To this aim, the present article introduces recommendations for the treatment of molars with FI and discusses different treatment options with their potential regenerative approaches. Patient-related factors, together with hard and soft-tissue conditions that may affect the outcomes of periodontal regeneration, are discussed.


Assuntos
Defeitos da Furca/cirurgia , Dente , Regeneração Tecidual Guiada Periodontal , Humanos , Dente Molar/cirurgia , Regeneração
19.
AAPS PharmSciTech ; 21(5): 173, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32548717

RESUMO

Innovative strategies for periodontal regeneration have been the focus of research clusters across the globe for decades. In order to overcome the drawbacks of currently available options, investigators have suggested a novel concept of functionally graded membrane (FGM) templates with different structural and morphological gradients. Chitosan (CH) has been used in the past for similar purpose. However, the composite formulation of composite and tetracycline when cross-linked with glutaraldehyde have received little attention. Therefore, the purpose of the study was to investigate the drug loading and release characteristics of novel freeze gelated chitosan templates at different percentages of glutaraldehyde. These were cross-linked with 0.1 and 1% glutaraldehyde and loaded with doxycycline hyclate. The electron micrographs depicted porous morphology of neat templates. After cross-linking, these templates showed compressed ultrastructures. Computerized tomography analysis showed that the templates had 88 to 92% porosity with average pore diameter decreased from 78 to 44.9 µm with increasing concentration. Fourier transform infrared spectroscopy showed alterations in the glycosidic segment of chitosan fingerprint region which after drug loading showed a dominant doxycycline spectral composite profile. Interestingly, swelling profile was not affected by cross-linking either at 0.1 and 1% glutaraldehyde and template showed a swelling ratio of 80%, which gained equilibrium after 15 min. The drug release pattern also showed a 40 µg/mL of release after 24 h. These doxycycline-loaded templates show their tendency to be used in a functionally graded membrane facing the defect site.


Assuntos
Materiais Biocompatíveis/química , Quitosana/química , Reagentes para Ligações Cruzadas/química , Congelamento , Regeneração Tecidual Guiada Periodontal/métodos , Materiais Biocompatíveis/farmacocinética , Quitosana/farmacocinética , Reagentes para Ligações Cruzadas/farmacocinética , Liberação Controlada de Fármacos , Géis , Glutaral/química , Glutaral/farmacocinética , Porosidade , Espectroscopia de Infravermelho com Transformada de Fourier/métodos
20.
J Contemp Dent Pract ; 21(1): 36-40, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32381798

RESUMO

AIM: Aim of the present study was to evaluate the loading of clindamycin with injectable-guided tissue regeneration (GTR) will prevent the colonization of Porphyromonas gingivalis and to compare and assess the quantitative changes in P. gingivalis colony forming units (CFUs) by real-time polymerase chain reaction (PCR) analysis. MATERIALS AND METHODS: Thirty microbiological samples were pooled from the deepest periodontal pockets from the thirty sites from the two groups: group I-injectable GTR placed in the defect filled with demineralized freeze-dried bone allograft (DFDBA) and group II-clindamycin loaded injectable GTR placed in the defect filled with DFDBA. The total number of P. gingivalis CFUs was estimated using real-time PCR at baseline and 4 weeks after therapy. RESULTS: A significant reduction in P. gingivalis CFUs at the end of 4 weeks was seen in both groups. Comparative evaluations between both groups at 4 weeks were with a mean of 4.44 ± 2.28 and 4.75 ± 3.32, respectively. Though there was a significant reduction in group II, the difference was statistically insignificant. CONCLUSION: The results suggest that clindamycin is beneficial in reducing microbial infection and can potentiate regeneration through host modulation. CLINICAL SIGNIFICANCE: Injectable GTR has the ability to mold according to the defect size and shape and eliminates the need to manipulate the membrane as required for the conventional membrane.


Assuntos
Clindamicina , Porphyromonas gingivalis , Transplante Ósseo , Regeneração Tecidual Guiada Periodontal , Reação em Cadeia da Polimerase em Tempo Real
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