Eficacia del plasma rico en plaquetas y la fibrina rica en plaquetas en la regeneración periodontal: revisión sistemática / Efficacy of platelet rich plasma and platelet rich fibrin in periodontal regeneration: systematic review

La regeneración se define como la reproducción o reconstrucción de una parte perdida o lesionada del cuerpo de tal manera que la arquitectura y la función del tejido perdido o lesionado se restauren completamente. El objetivo de la terapia periodontal regenerativa es restaurar la estructura y la función del periodonto. Los efectos positivos del Plasma Rico en Plaquetas se atribuyen a las capacidades angiogénicas, mitogénicas y proliferativas de los factores de crecimiento, como el factor de crecimiento derivado de plaquetas, el factor de crecimiento transformante y el factor de crecimiento endotelial vascular. La fibrina rica en plaquetas, es una segunda generación de concentrado plaquetario que permite obtener membranas de fibrina enriquecidas con plaquetas y factores de crecimiento, después de comenzar con una recolección de sangre libre de anticoagulantes sin ninguna modificación artificial biomecánica. El objetivo de esta revisión es conocer la eficacia del plasma rico en plaquetas y de la fibrina rica en plaquetas en la regeneración periodontal de defectos intraóseos. Las implicaciones clínicas potenciales para este material autólogo son prometedoras. Se requieren ensayos clínicos controlados aleatorios más largos, más grandes, multicéntricos y controlados para determinar los efectos del PRP y PRF en la regeneración del hueso alveolar debido a la enfermedad periodontal

Regeneration is defined as the reproduction or reconstruction of a lost part or injury of the body in such a way that the architecture and function of the lost or injured tissue are comple-tely restored. The goal of regenerative periodontal therapy is to restore the structure and function of the periodontium. The positive effects of Platelet-rich plasma (PRP) are attributed to the angiogenic, mitogenic and proliferative capacities of growth factors such as platelet-derived growth factor, trans-forming growth factor and vascular endothelial growth factor. Platelet-rich fibrin (PRF) is a second generation platelet concentrate that allows fibrin membranes enriched with platelets and growth fac-tors to be obtained after starting an anticoagulant-free blood collection without any biomechanical artificial modification. The objective of this review is to know the efficacy of platelet-rich plasma and platelet-rich fibrin in the periodontal regeneration of intrabony defects. The clinical implications for this autologous material are promising. Further long term, larger, multicentred randomized controlled clinical trials are required to determine the effects of PRP and PRF on the regeneration of alveolar bone due to periodontal disease.

Análise e utilização de biomaterial confeccionado a partir das conchas de crassostrea gigas em defeito periodontal em ratos / Biomaterial's analysis and use, made of crassostrea gigas shells in rats' periondontal defects

As conchas de ostras podem se apresentar como fonte promissora na confecção de biomaterial para enxertia óssea, uma vez que apresentam, na sua constituição principal, o cálcio. Este trabalho teve por objetivo avaliar os efeitos de um biomaterial obtido a partir da concha da Crassostrea gigas na sua aplicação, em defeitos periodontais de ratos. Análise das partículas por MEV revelou tamanhos variados e superfície microporosa e, por EDXRF, demonstrou uma constituição básica de CaO. Dois grupos de vinte ratos receberam defeito periodontal, preenchidos com coágulo sanguíneo ou com biomaterial teste. Os tempos de monitoramento foram de 1, 3, 6 e 8 semanas. A análise histológica do biomaterial teste revelou: um processo inflamatório granulomatoso crônico; mais edema do que o controle; inicialmente, o aparecimento de um tecido osteoide mais fibroso, que resultou em um reparo ósseo em camadas finas, que, além de aspecto fibroplásico no ligamento periodontal, em estágio mais avançado, transformou-se em anquilose. Pode-se concluir que a aplicação do biomaterial no defeito periodontal deste trabalho não foi favorável.

Oyster shells may be presented as a potential source for the production of a bone graft biomaterial, once they are mainly constituted by calcium. The aim of this study was to evaluate the effects of a biomaterial based on Crassostrea gigas shell in the application of periodontal defects in rats.MEV analysis of the particles showed a variety of sizes and microporous surface, while EDXRF analysis demonstrated calcium oxide as the main component. Two groups of 20 WISTAR rats received periodontal defects filled with either blood clot or the test biomaterial. Monitoring periods were 1, 3, 6 and 8 weeks. Histological analysis revealed a chronic granulomatous process; more edema than control; an initial fibrous osteoid tissue; a thin layered bone repair; a fibroplasic aspect of the periodontal ligament; and in an advanced stage, ankylosis. It can be concluded that the application of the biomaterial in the periodontal defect of this study was unfavorable.

Wound dehiscence after anterior segmental osteotomy of maxilla: a case report

EFFECTS OF ELECTRICAL STIMULATION ON THE NORMAL PERIODONTIUM / 대한치주과학회지

The earliest reports of the use of electrical energy to directly stimulate bone healing seem to be in 1853 from England, the techniques involved the introduction of direct current into the non-united fracture site percutaneously via metallic needles, with subsequent healing of the defect. One endpoint of the periodontal therapy is to generate structure lost by periodontal diseases. Several procedural advances may support regeneration of attachment, however, regeneration of alveolar bone does not occur consistently. Therefore, factors which stimulate bone repair are areas for research in periodontal reconstructive therapy. Effects of cytokines or growth factors on bone repair are examples of such areas. Another one is electrical current which occurs in bone naturally, so that such bone may be particularly susceptible to electrical therapy. The purposes of this study were to observe the effects of electrical stimulation on the normal periodontium, to determine whether the electricity is the useful means for periodontal regeneration or not. Forty rats weighted about 100 gram were used and divided into 4 groups, the first group, there was no electrical stimulation with the connection of electrodes only. In the second group, there was stimulated by the 10 mA during 10 minutes per a day, in the third group was stimulated by the 25 mA , and the fourth by the 50 mA. At 3, 5, 10 and 15 days post-appliance , two rats in each group were serially sacrificed. and the maxillae and the mandible processed to paraffin, and the specimens were prepared with Hematoxylin-Eosin stain for the light microscopic evaluation. The results of this study were as follows : 1. There was the distinct reversal line on the lingual alveolar crest, whereas a little changes in the labial alveolar crest to the duration and amount of currents. 2. In 50 mA group, the cells were highly concentrated at the apex of anterior teeth, and was observed the necrotic tissue. In posterior root apex, the hypercementosis was appeared, and newly formed cementum layer has been increased continuously with the time. 3. The periodontal ligament fiber and Sharpey's fiber were arranged in order, and the bone trabeculae were increased as the experiment proceeded by, relatively the bone marrows were decreased. 4. In the pulp tissue, the blood vessels were increased with blood congestion in the experimetal specimens remarkably, and the dentinal tubules were obstructed . 5. The osteoblasts in alveolar bone proper had been showed highly activity, and also observed the formation of bone trabeculea. In the conclusion, it was suggested that the electrical stimulation has influence on the periodontium and the pulp tissue. However, there might be the injurious effects.

Influence of Smoking on Short-Term Clinical Results of Periodontal Bone Defects Treated with Regenerative Therapy Using Bioabsorbable Membranes / 대한치주과학회지

This study compared the short-term(4 months) clinical results of regenerative therapy with bioabsorbable membranes(BioMesh(R)) and bone allograft for the treatment of periodontal(intrabony and furcation) defects in smokers and non-smokers.(16 smokers) 32 subjects with 92 defects participated in the study(46 in smokers and 46 in non-smokers). This study also evaluated a bioresorbable barrier with and without decalcified freezedried bone allograft(DFDBA). The 92 periodontal defects were randomly treated with either the resorbable barrier alone or resorbable barrier in combination with DFDBA following thorough defect debridement and root preparation with tetracycline. Each patient received both types of treatment modalities. Clinical examinations(probing depth, gingival recession, clinical attachment level, plaque index and gingival index) were carried out immediately before and 4 months after surgery. Significant(p<0.001) gains in mean attachment level were observed for both smokers(2.93mm) and nonsmokers(3.30mm) but there were not significant difference between two groups. Similarly, significant reductions in mean probing depthshowed for smokers(4.52mm) and non-smokers(4.26mm). However, when comparing gingival recession, smokers were found to exhibit significantly poorer treatment results(1.59mm vs 0.96mm, p<0.05). Using the split-mouth-design, no statistically significant difference between the two modalities could be detected with regard to pocket depth reduction, gingival recession, or attachment gain. These results illustrate that the attachment gain is better in the non-smoker and the best in the non-smoker with the combination therapy of resorbable barrier and DFDBA than with resorbable barrier alone but smoking had no significant effect on clinical treatment outcome, even though smokers show more significant gingival recession. In addition, both treatments, either resorbable barrier plus DFDBA or resorbable barrier alone, promoted significant resolution of periodontal defects but the addition of DFDBA with a bioabsorbable membrane appears to add no extra benefit to the only membrane treatment.

The long-term study on the guided tissue regeneration with poly(alpha-hydroxy acid) membranes in beagle dogs / 대한치주과학회지

The recent trend of research and development on guided tissue regeneration focuses on the biodegradable membranes, which eliminate the need for subsequent surgical removal. They have demonstrated significant and equivalent clinical improvements to the ePTFE membranes. This study evaluate guided tissue regeneration wound healing in surgically induced intrabony periodontal defects following surgical treatment with a synthetic biodegradable membranes, made from a copolymer of glycolide and lactide, in 8 beagle dogs. After full thickeness flap reflection, exposed buccal bone of maxillary and mandibular canine and premolar was removed surgically mesiodistally and occlusoapically at 6mmx6mm in size for preparation of periodontal defects. In experimental sites a customized barrier was formed and fitted to cover the defect. Flap was replaced slightly coronal to CEJ and sutured. Plaque control program was initiated and maintained until completion of the study. In 4, 8, 16 and 24 weeks after surgery, the animals were sacrificed and then undecalcified specimens were prepared for histologic evaluation. Histologic examination indicated significant periodontal regeneration characterized by new connective tissue attachment, cementum formation and bone formation. These membranes showed good biocompatibility throughout experiodontal period. The barriers had been completely resorbed with no apparent adverse effect on periodontal wound healing at 24 weeks. These results implicated that present synthetic biodegradable membrane facilitated guided tissue regeneration in periodontal defect.