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Abstract Objective This retrospective study aimed to analyze the clinical efficacy of two regenerative surgical methods — Bio-Oss granules combined with barrier membranes and Bio-Oss Collagen alone — and to help clinicians achieve better periodontal regeneration outcomes in the specific periodontal condition. Methodology Patients who underwent periodontal regeneration surgery from January 2018 to April 2022 were retrospectively screened, and their clinical and radiographic outcomes at 6 months postoperatively were analyzed. The probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), gingival recession (GR), distance from the cemento-enamel junction to the bottom of the bone defect (CEJ-BD), and depth of intrabony defects (INFRA) were recorded before the operation (T0) and 6 months after it (T1), and subsequently compared. Results In total, 143 patients were included — 77 were placed in the Bio-Oss group and 66 were placed in the Bio-Oss Collagen group. All indicators, including PD and CAL at T1, showed significant differences compared to baseline, for both groups (P<0.001). PD reduction was greater in the group receiving the Bio-Oss Collagen treatment (P=0.042). Furthermore, in cases when the baseline PD range was 7-11 mm and the age range was 35-50 years, PD reduction was more significant for patients receiving the Bio-Oss Collagen treatment (P=0.031, 0.023). A linear regression analysis indicated that postoperative PD and CAL were positively correlated with baseline values, and that the efficacy tended to decrease with increasing age. Conclusion Both the use of Bio-Oss Collagen alone and the use of Bio-Oss granules combined with barrier membranes resulted in significant effects in the treatment of periodontal intrabony defects. The Bio-Oss Collagen treatment generated more improvements in PD than the Bio-Oss granules combined with barrier membranes, particularly within the baseline PD range of 7-11 mm and the 35-50 years age group. Additionally, age was the main factor influencing the effectiveness of regenerative surgery for intrabony defects: older individuals exhibited fewer improvements.
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Objective@# To analyze the current status, hotspots, and trends in the field of stem cell therapies for periodontal tissue engineering based on bibliometric analysis.@*Methods @# The literature on stem cell therapies for periodontal tissue engineering in animal experiments and clinical studies was searched in the Web of Science core database up to December 31, 2021. The bibliometric analysis of the relevant literature data was carried out by using the "Bibliometrix" package of R language.@*Results @#A total of 304 articles were included, and the number of publications and the citation frequency are increasing. The number of related studies from China ranks first in the world with 166 publications; the institution with the largest number of publications is the Fourth Military Medical University; the author with the largest number of publications is Jin Y; and Tissue Engineering Part A had the most related publications. The hotspots of stem cell therapies for periodontal tissue engineering are mainly focused on tissue engineering and periodontal ligament regeneration, while the frontiers are mainly focused on exosomes, gold nanoparticles, and angiogenesis. @*Conclusion@#Research on stem cell therapies for periodontal tissue engineering continues to expand, and the academic influence is gradually increasing. Future research directions should focus on periodontal ligament regeneration, exosomes, gold nanoparticles and angiogenesis.
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Periodontitis is an inflammatory disease caused by bacterial infection directly, and the dysregulation of host immune-inflammatory response finally destroys periodontal tissues. Current treatment strategies for periodontitis mainly involve mechanical scaling/root planing (SRP), surgical procedures, and systemic or localized delivery of antimicrobial agents. However, SRP or surgical treatment alone has unsatisfactory long-term effects and is easy to relapse. In addition, the existing drugs for local periodontal therapy do not stay in the periodontal pocket long enough and have difficulties in maintaining a steady, effective concentration to obtain a therapeutic effect, and continuous administration always causes drug resistance. Many recent studies have shown that adding bio-functional materials and drug delivery systems upregulates the therapeutic effectiveness of periodontitis. This review focuses on the role of biomaterials in periodontitis treatment and presents an overview of antibacterial therapy, host modulatory therapy, periodontal regeneration, and multifunctional regulation of periodontitis therapy. Biomaterials provide advanced approaches for periodontal therapy, and it is foreseeable that further understanding and applications of biomaterials will promote the development of periodontal therapy.
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Abstract Periodontal regeneration faces multiple challenges, the most important being cellular insufficiency. In an attempt to improve defect cellularity, we aimed to demonstrate enhancing cellular attraction using arginine-glycine-aspartic acid (RGD) adhesion molecule legend blended hydrogel within the intrabony defects. Methodology Forty-five intrabony defects were selected from patients with stage III or IV - grade A or B periodontitis and divided randomly into three equal groups of 15 each: group1 (G1): received minimally invasive surgical technique (MIST) alone, group2 (G2): received MIST and placebo hydrogel injection, and group3 (G3): were treated with MIST and RGD hydrogel injection. Primary outcomes 6 months following therapy were; defect base fill (DBF) and defect width measurement (DW); secondary outcomes were clinical attachment level (CAL), pocket depth (PD), plaque index (PI), gingival index (GI), and biochemical analysis of bone morphogenetic protein (BMP-2) evaluated at 1,7,14 and 21 days following therapy. Results Significant improvements in DBF, CAL, and PD were observed in the three studied groups 6 months following therapy compared to baseline (p<0.05). A significant improvement in DBF was reported in G3 compared to G1 and 2 (p=0.005). Additionally, a significantly higher CAL gain was reported in G3 compared to that of G1 (p=0.02). Group 3 was associated with a significantly higher level of BMP-2 compared to G1 and G2 in all reported periods. Conclusion RGD peptide carried on a hydrogel delivery agent and contained with a minimally invasive flap could be a reliable option in improving the outcomes of periodontal therapy.
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Objectives: This study aimed to evaluate and compare the mechanical properties of platelet?rich fibrin (PRF) membrane with that of commercially available collagen membranes and chorionic membranes. Materials and Methods: The modulus of elasticity and hardness of PRF membrane, bovine collagen membrane, fish collagen membrane, and chorionic membrane were assessed using a universal testing machine. The in vitro degradation rate was assessed by placing these membranes on a temperature?controlled shaker set for one week. The degradation profiles were expressed as the accumulated weight loss of the membrane. A scanning electron microscope (SEM) evaluation of these membranes was done under both low and high magnification. One?way analysis of variance (ANOVA) and Tukey’s post hoc tests were performed for statistical analysis. Results: A statistically significant difference in the tensile strength and hardness of membranes was observed. Bovine collagen membrane had the highest strength (84.11 MPa and 16.46 MPa) followed by fish collagen membrane, chorionic membrane, and least for PRF membranes observed. The degradation rate at one week was highest for the PRF membrane (55.6%), followed by the fish collagen membrane (32.5%). SEM evaluation showed that the bovine collagen membrane had significantly higher numbers of collagen fibres compared to the fish collagen membrane and chorionic membrane. Conclusion: Bovine collagen membrane had the highest mechanical properties with the maximum amount of collagen fibre meshwork. Only the PRF membrane had cellular distribution in its composition, while the commercially available membrane had significantly higher numbers of collagen fibres with the total absence of cellular components
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Abstract Regenerative approaches using mesenchymal stem cells (MSCs) have been evaluated to promote the complete formation of all missing periodontal tissues, e.g., new cementum, bone, and functional periodontal ligaments. MSCs derived from bone marrow have been applied to bone and periodontal defects in several forms, including bone marrow aspirate concentrate (BMAC) and cultured and isolated bone marrow mesenchymal stem cells (BM-MSCs). This study aimed to evaluate the periodontal regeneration capacity of BMAC and cultured BM-MSCs in the wound healing of fenestration defects in rats. Methodology: BM-MSCs were obtained after bone marrow aspiration of the isogenic iliac crests of rats, followed by cultivation and isolation. Autogenous BMAC was collected and centrifuged immediately before surgery. In 36 rats, fenestration defects were created and treated with suspended BM-MSCs, BMAC or left to spontaneously heal (control) (N=6). Their regenerative potential was assessed by microcomputed tomography (µCT) and histomorphometry, as well as their cell phenotype and functionality by the Luminex assay at 15 and 30 postoperative days. Results: BMAC achieved higher bone volume in 30 days than spontaneous healing (p<0.0001) by enhancing osteoblastic lineage commitment maturation, with higher levels of osteopontin (p=0.0013). Defects filled with cultured BM-MSCs achieved higher mature bone formation in early stages than spontaneous healing and BMAC (p=0.0241 and p=0.0143, respectively). Moreover, significantly more cementum-like tissue formation (p<0.0001) was observed with new insertion of fibers in specimens treated with BM-MSCs within 30 days. Conclusion: Both forms of cell transport, BMAC and BM-MSCs, promoted bone formation. However, early bone formation and maturation were achieved when cultured BM-MSCs were used. Likewise, only cultured BM-MSCs were capable of achieving complete periodontal regeneration with inserted fibers in the new cementum-like tissue.
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Objective@#The purpose of this study was to investigate the effect of different concentrations of exosomes (Exos) secreted from dental folic cells (DFCs) preconditioned with lipopolysaccharide (LPS) on the osteogenic differentiation ability of periodontal cells in periodontitis (p-PDLCs) in patients to provide a basis for the prevention and treatment of periodontal disease.@*Method @#Tissue block and enzyme digestion methods were used to culture DFCs and p-PDLCs. Exosomes were isolated from 250 ng/mL LPS-preconditioned DFCs 24 h later. The characteristics of exosomes were detected by transmission electron microscopy, particle size analysis and Western blotting. The effects of 10 μg/mL and 100 μg/mL exosomes on the osteogenic differentiation of p-PDLCs were detected by RT-PCR and Alizarin red staining.@*Results @# LPS-pretreated DFC-derived exosomes (L-Exos) are vesicle-like structures with a size between 30-100 nm that positively express CD63 and Alix. Compared with the control group, exosomes significantly upregulated Periostin, Col Ⅰ, and Col Ⅲ expression at 100 μg/mL (P < 0.05), while TGF- β1 was significantly upregulated at 10 μg/mL (P < 0.01). At 7 days after osteogenic induction, mineralized nodules were significantly more abundant in the exosome group than in the control group (P < 0.01), and the results were better at a concentration of 100 μg/mL (P < 0.01). @*Conclusion@# 100 μg/mL L-Exos are better than 10 μg/mL L-Exos in enhancing the osteogenic differentiation ability of p-PDLCs.
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OBJECTIVES@#To investigate the clinical effect of Er:YAG laser combined with ethylenediamine tetra acetic acid (EDTA) on three-walled periodontal intrabony defects adjacent to implant sites.@*METHODS@#A total of 30 patients with three-walled periodontal intrabony defects adjacent to implant sites were treated with the combination therapy. Patients with three-walled intrabony defects were divided into two groups according to the depth of the intrabony pocket between the implant and natural teeth. Evaluation of wound healing was performed 10 days after the operation, and bone augmentation was evaluated 6 months after the operation.@*RESULTS@#Primary healing in group 1 was 92.31%, primary healing in group 2 was 82.35%. No significant difference was observed between the two groups (@*CONCLUSIONS@#The effect of bone augmentation with combination therapy was more ideal in group 2 than in group 1. Implant placement with combination therapy may be a viable technique to reconstruct three-walled intrabony defects due to the space maintenance provided by implants and bone grafts and the good root surface biocompatibility provided by the Er:YAG laser and EDTA.
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Humans , Acetic Acid , Alveolar Bone Loss , Dental Implants , Ethylenediamines , Follow-Up Studies , Guided Tissue Regeneration, Periodontal , Lasers, Solid-State , Periodontal Attachment Loss , Treatment OutcomeABSTRACT
BACKGROUND: When the teeth are separated from the alveolar fossa, the periodontal membrane breaks, and the residual periodontal membrane on the avulsed tooth root surface changes from three-dimensional to two-dimensional, thus losing the role of scaffold, and leading to root bone adhesion after replantation of avulsed tooth. How to develop a three-dimensional sustained-release scaffold material that can adhere to the root surface with a certain thickness and strength is one of the key factors for successful regeneration of avulsed tooth periodontal membrane. OBJECTIVE: To construct a three-dimensional periodontal biomimetic membrane that can adhere to the avulsed tooth root surface and allow sustained-release of growth factors. METHODS: Poly(lactic-co-glycolic acid) (PLGA) membrane was prepared using electrospinning technique. The effects of dichloromethane and dimethylformamide mixture, hexafluoroisopropanol, and trichloromethane on electrospun membrane were investigated to obtain the optimal electrospinning solvent. Chitosan microspheres were prepared by electrospray and ion cross-linking techniques. The effects of molecular weight (50, 000, 100, 000) and mass concentration (10, 20 g/L) of chitosan, sodium tripolyphosphate concentration (2%, 5%, 10%) and voltage (14, 28 kV) on chitosan microspheres were studied to screen the optimum parameters. Chitosan microspheres containing stromal cell-derived factor-1 (optimal parameter design) were constructed. The release rate of stromal cell-derived factor-1 alpha in vitro was determined. First, the root surface of teeth was wrapped with electrospun PLGA membrane, then chitosan microspheres were dripped on the surface, and finally the surface was wrapped with a thin layer of electrospun PLGA. Thus, PLGA-chitosan-PLGA biomimetic membrane was constructed. RESULTS AND CONCLUSION: Electrospun PLGA membrane prepared with hexafluoroisopropanol as electrospinning solvent had the smallest average diameter and the largest porosity. When the relative molecular weight of chitosan was 50, 000 and the mass concentration was 20 g/L, the size of chitosan microspheres was basically the same, and the average diameter was 366. 6 μm. In addition, chitosan microsphere had good monodispersity, fullness, and stability. Chitosan microspheres formed under 28 kV voltage and were more in line with the requirements of biomimetic membrane for avulsed tooth. The surface of microspheres prepared by 5% sodium tripolyphosphate had medium-sized pores, which are most conducive to clinical periodontal membrane regeneration. Chitosan microspheres can sustainably release stromal cell derived factor 1alpha for about 1 month. In this study, we constructed a three-dimensional PLGA-chitosan-PLGA periodontal biomimetic membrane that can adhere to the avulsed tooth root surface and allow sustained-release of growth factors and obtained the optimal parameters of constructing the periodontal biomimetic membrane. Based on the PLGA-chitosan-PLGA periodontal biomimetic membrane, the effect and mechanism of tissue engineering on replantation of avulsed tooth can be further studied.
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Objective: To observe the orthodontic tooth movement after regeneration of Beagl dog' s periodontal tissue defect with biphasic calcium phosphate (BCP), and to elucidate the mechanism of BCP as a scaffold material for periodontal regeneration. Methods: Six adult male Beagle dogs were selected; the right upper quardrant (B) and the left lower quardrant (D) regions of each dog were used as blank control group, and the left upper quardrant (A) and the right lower quardrant (D) regions were used to establish the dog models of periodontal tissue defect of bilateral incisors. BCP was implanted into the defect to regenerate the defect. After 12 weeks of BCP implantation into the defect for defect tissue regeneration, the orthodontic tooth movement models were established (experimental group). Stress stimulation was applied in experimental group and control group, respectively. Two Beagle dogs were randomly executed at 1, 2 and 4 weeks after loading. The specimens were stained, the histological changes of regenerated periodontal tissue and the expression of core binding factor al (Cbfal) regulating osteogenesis under stress were observed; the changes in normal periodontal tissue under the same stress were observed. Results: The Masson staining results showed that the periodontal ligament of the dogs in experimental group and control group became narrower and denser at 1 week after stress stimulation; the alveolar bone of the dogs in dogs in experimental group was mainly blue; the alveolar bone of the dogs in control group was generally red except for the compression area of the periodontal ligament. At 4 weeks after stress stimulation, the alveolar bone of the dogs in experimental group was red-blue, while the alveolar bone of the dogs in control group was red; the blood vessels in periodontal ligament of the dogs in two groups were rounded. One week after stress stimulation, the alveolar bone surface of the dogs in experimental group and control group was covered with bone resorption lacunae containing the multinucleated osteoclasts, the cytoplasmic Cbfal staining was positive, and the compressed and deformed periodontal ligament cells were arranged disorderly. Four weeks after stress stimulation, the osteoclasts disappeared in experimental group, and the bone resorption lacunae was filled by osteoblasts, and the osteoblasts on the other side of the trabecula were also active; the expression of Cbfal was still found in the bone marrow mesenchymal cells and the marginal osteoblasts of alveolar bone. The expression of Cbfal was weak in control group. Conclusion: The periodontal tissue regenerated by BCP has reached the normal periodontal tissue. Under the action of orthodontic force, it has normal osteogenesis function and can complete the bone remodeling process of orthodontic tooth movement.
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The teeth are highly differentiated chewing organs formed by the development of tooth germ tissue located in the jaw and consist of the enamel, dentin, cementum, pulp, and periodontal tissue. Moreover, the teeth have a complicated regulatory mechanism, special histologic origin, diverse structure, and important function in mastication, articulation, and aesthetics. These characteristics, to a certain extent, greatly complicate the research in tooth regeneration. Recently, new ideas for tooth and tissue regeneration have begun to appear with rapid developments in the theories and technologies in tissue engineering. Numerous types of stem cells have been isolated from dental tissue, such as dental pulp stem cells (DPSCs), stem cells isolated from human pulp of exfoliated deciduous teeth (SHED), periodontal ligament stem cells (PDLSCs), stem cells from apical papilla (SCAPs), and dental follicle cells (DFCs). All these cells can regenerate the tissue of tooth. This review outlines the cell types and strategies of stem cell therapy applied in tooth regeneration, in order to provide theoretical basis for clinical treatments.
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Animals , Humans , Adult Stem Cells , Physiology , Cell Differentiation , Stem Cell Transplantation , Tissue Engineering , Tooth , Cell Biology , Physiology , Wound HealingABSTRACT
@#Periodontitis is the most common oral disease and has a high incidence in humans. Periodontitis seriously affects the function of the oral and maxillofacial systems and is the most important cause of tooth loss in adults. In addition, as a long-term and persistent source of infection, periodontitis can not only trigger chronic inflammation and immune responses but also has an important impact on systemic health. Traditional periodontitis treatment focuses on inflammation control, and although this can prevent or delay the progression of the disease, satisfactory periodontal lesion tissue regeneration is difficult to obtain. With the introduction of new technologies and new materials such as guided tissue regeneration, bone grafting, growth factors and biological materials for the treatment of periodontitis, the method of periodontal tissue regeneration is more abundant, and the clinical effect has been greatly improved. In the future, stem cell transplantation and endogenous regeneration strategies are expected to become important methods for physiological and functional regeneration of periodontal lesions. This article briefly reviews the basic research and clinical application of periodontal tissue regeneration and forecasts the future development prospects and opportunities in this field.
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Objective@# To analyze the different fabrication methods and surface structure of treated dentin matrix (TDM) and demineralized dentin matrix (DDM) and their diverse function on promoting the proliferation and osteogenic differential capability of human periodontal ligament cells (hPDLCs). This study provides a preliminary basis for the treatment of periodontal bone defects with bone substitutes from teeth.@*Methods@#TDM was made from human dentin matrices and demineralized incompletely by soaking in different concentrations of ethylene diamine tetra-acetic while DDM was made of human dentin matrices and demineralized completely by soaking in a hydrochloric acid solution followed by observation via SEM. The liquid extracts of TDM and DDM were collected according to the protocol of the International Standardization Organization (ISO 10993). Then, hPDLCs were divided into the following three groups: the TDM group (liquid extracts of TDM), the DDM group (liquid extracts of DDM), the control group (a-modified eagle medium with 10% fetal bovine serum), hPDLCs were cultured with liquid extracts of TDM or DDM, or a-modified eagle medium with 10% FBS). hPDLC proliferation was detected by a Cell Counting Kit-8 (CCK-8). The alkaline phosphatase (ALP) expression and calcified nodules of hPDLCs were tested.@*Results @#TDM obtained a preferable surface structure compared to DDM due to more sufficiently exposed dentinal tubules and looser fiber bundles of the intertubular and peritubular dentin. Both TDM and DDM promoted the proliferation of hPDLCs compared with the control group, and the proliferation of hPDLCs was significantly greater in the TDM group compared to the DDM group (F = 36.480, P < 0.05). The ALP activity of hPDLCs in the TDM group was higher than the DDM group. After a 14-day osteogenic induction, Alizarin red staining mineral nodes were observed in both groups; however, the TDM group displayed more calcified nodules than the DDM group.@*Conclusion@#The advantages of TDM including the surface structure, proliferation and osteogenic differentiation of hPDLCs, are more prominent than those of DDM, suggesting that TDM is a potential promising bone graft substitute in periodontal regeneration.
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PURPOSE: To histologically characterize periodontal healing at 8 weeks in surgically created dehiscence defects in beagle dogs that received a collagen matrix with periodontal ligament (PDL) progenitor cells. METHODS: The bilateral maxillary premolars and first molars in 6 animals were used. Standardized experimental dehiscence defects were made on the buccal side of 3 premolars, and primary culturing of PDL progenitor cells was performed on the molars. Collagen matrix was used as a scaffold and a delivery system for PDL progenitor cells. The experimental sites were grafted with collagen matrix (COL), PDL progenitor cells with collagen matrix (COL/CELL), or left without any material (CTL). Histologic and histomorphometric analyses were performed after 8 weeks. RESULTS: The defect height from the cementoenamel junction to the most apical point of cementum removal did not significantly differ across the CTL, COL, and COL/CELL groups, at 4.57±0.28, 4.56±0.41, and 4.64±0.27 mm (mean ± standard deviation), respectively; the corresponding values for epithelial adhesion were 1.41±0.51, 0.85±0.29, and 0.30±0.41 mm (P<0.05), the heights of new bone regeneration were 1.32±0.44, 1.65±0.52, and 1.93±0.61 mm (P<0.05), and the cementum regeneration values were 1.15±0.42, 1.81±0.46, and 2.57±0.56 mm (P<0.05). There was significantly more new bone formation in the COL/CELL group than in the CTL group, and new cementum length was also significantly higher in the COL/CELL group. However, there were no significant differences in the width of new cementum among the groups. CONCLUSIONS: PDL progenitor cells carried by a synthetic collagen matrix may enhance periodontal regeneration, including cementum and new bone formation.
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Animals , Dogs , Bicuspid , Bone Regeneration , Collagen , Dental Cementum , Molar , Osteogenesis , Periodontal Ligament , Regeneration , Stem Cells , Tooth Cervix , TransplantsABSTRACT
RESUMEN: Diferentes técnicas quirúrgicas periodontales han surgido a lo largo del tiempo con el objetivo de lograr una regeneración periodontal y mejorar su predictibilidad. La Fibrina Rica en Plaquetas y Leucocitos (L-PRF) se ha posicionado como una alternativa para cumplir este objetivo, debido a que no requiere anticoagulantes en su preparación y muestra liberación sostenida de factores de crecimiento durante por lo menos 7 días. El objetivo de esta revisión narrativa es describir la evidencia disponible sobre el uso de L-PRF en defectos intra-óseos. Se realizó una búsqueda en las bases de datos MEDLINE y Cochrane Library, exploración manual y páginas web. De un total de 494 artículos recuperados, fueron seleccionados 12 publicaciones para esta revisión. Los resultados sugieren que L-PRF muestra beneficios al ser utilizada en el tratamiento periodontal regenerativo de defectos intra-óseos. Sin embargo, son necesarios ensayos clínicos con diseño metodológico estandarizado que permitan comparar L-PRF con biomateriales habitualmente empleados en el tratamiento de estos defectos.
ABSTRACT: Periodontal surgical techniques have emerged over time with the aim of achieving periodontal regeneration and improving its predictability. Leukocyte and Platelet-Rich Fibrin (L-PRF) has been proposed as an alternative, for not requiring anticoagulants in its preparation and for performing sustained release of growth factors for at least 7 days. The aim of this narrative review is to describe the available evidence on the use of L-PRF in periodontal intra-bony defects. An electronic and hand search was conducted in MEDLINE and Cochrane Library databases. Of 494 papers retrieved, 12 were selected for this review. The results suggest that even if L-PRF shows benefits when used in regenerative periodontal treatment of intra-bony defects, clinical trials with standardized methodological design are necessary to compare L-PRF with biomaterials usually used in these defects.
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Humans , Periodontics , Regeneration , Platelet-Rich Fibrin , LeukocytesABSTRACT
@#Periodontal disease is one of the most common oral diseases and a prime reason for adult tooth loss. One of the goals of periodontal therapy is to regenerate and restore the periodontal tissues affected by periodontitis to their original architectural form and function. Cementum is an important component of periodontal tissue that plays a significant role in periodontal tissue regeneration. Explorations of the characteristics and components of cementum and the potential of growth factors related to cementum formation, especially the roles played by cementum-specific proteins and their potential in promoting periodontal regeneration, have become popular in current research. Here, we review the characteristics and components of cementum and the potential roles played by cementum-specific proteins during cementum formation and periodontal regeneration.
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@#BACKGROUND. Periodontal regeneration is the reconstruction of periodontal tissues and restoration of functions, which is achieved through techniques, such as soft tissue grafts, guided tissue regeneration, bone replacement grafts, root bio-modification, and a combination of these techniques. Chitosan is a natural biopolymer with several beneficial properties, including excellent biocompatibility, low toxicity and corresponding degradation rates and hemostatic activities. This systematic review assessed the efficacy of biopolymer membrane (chitosan) for guided tissue regeneration (GTR) in animal and human studies. MATERIAL AND METHODS. The Cochrane Oral Health Group specialist trials, PubMed, MEDLINE, and EMBASE databases were searched for articles published before January 2017. Animal and human studies that used chitosan for GTR, which had a follow-up period of ≥6 weeks and 6 months, respectively, were retrieved. The following outcomes were analyzed: new bone (NB) and new cementum (NC) formation for animal studies and probing pocket depth and clinical attachment level changes for human studies. RESULTS. After a full-text review,six animal studies and three human studies were found to be eligible for this study. All included animal and human studies demonstrated that the use of chitosan for GTR exerts a positive effect on periodontal defects. Subgrouping meta-analysis outcomes of three dog studies revealed that GTR with pure chitosan membranes has a positive effect on NB (14.36%) and NC (10.21%) formation. CONCLUSION. Within the limitations of the present study, there is little evidence to demonstrate the efficacy of chitosan for GTR either in animal or human studies. Chitosan should rather be used as an adjunct component for membrane production.
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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.
Subject(s)
Humans , Bone Regeneration , Platelet-Rich Plasma , Platelet-Rich Fibrin , Periodontal DiseasesABSTRACT
A regeneração periodontal tem como objetivo recuperar as estruturas perdidas (osso alveolar, cemento e ligamento periodontal) como sequelas da doença periodontal. O conhecimento da Matriz Derivada do Esmalte (MDE) tem na literatura uma ampla aplicação, porém sua relação direta associada aos vidros bioativos é pouco caracterizada em todas suas vias, nesse contexto este estudo teve como proposta baseada numa revisão literária por meio de bases de dados (Pubmed, Scielo, lilacs), discutir aspectos importantes sobre a avaliação da efetividade clínica do vidro bioativo em combinação com a MDE (Emdogain) principalmente em defeitos infra-ósseos. O Emdogain (EMD) sozinho ou em associação a outros biomaterais de enxertia parece promover ganhos na regeneração tecidual de tecidos perdidos pela periodontite, porém sua associação tem-se poucos resultados significativos que justifiquem sua ampla utilização, sua indicação deve estar baseada em um bom diagnóstico periodontal e da morfologia do defeito infraósseo. Assim, tornam-se necessários mais estudos para elucidar interações e mecanismos celulares envolvidos no complexo de ação para justificar o seu uso.(AU)
Periodontal regeneration aims to recover the lost structures (alveolar bone, cementum and periodontal ligament) as sequelae of periodontal disease. The knowledge derived from the enamel matrix (EMD) is in the literature a wide application, but its direct relationship associated with bioactive glass is poorly characterized in all its way in this context this study was proposed based on a literature review through databases (Pubmed, Scielo, lilacs), discuss important aspects of the evaluation of the clinical effectiveness of bioactive glass in combination with EMD (Emdogain) mainly intraosseous defects.Emdogain (EMD) alone or in association with other biomaterials of grafting appears to promote gains in the tissue regeneration of lost tissues by periodontitis, but its association has few significant results that justify its wide use, its indication must be based on a good periodontal diagnosis and infraosseous defect morphology. Thus, further studies are needed to elucidate interactions and cellular mechanisms involved in the action complex to justify its use.(AU)
Subject(s)
Periodontal Diseases , Guided Tissue Regeneration, PeriodontalABSTRACT
Background: A critical step in periodontal regenerative therapy is to alter the periodontitis affected root surface to make it a hospitable substrate, to support and encourage migration, attachment, proliferation and proper phenotypic expression of periodontal connective tissue progenitor cells. So the Concept of Biochemical modification or alteration of the root surface has emerged as a potential therapeutic approach to the reconstruction of the periodontal unit. Aim: To review various agents used for root biomodification and update on the current status of root biomodification in periodontal regenerative therapy. Materials and Methods: Google Scholar database is searched using keyword “Root Biomodfication”and the studies with experimental design either In Vivo or In vitro were included in the search whereas Narrative reviews or Non – Systematic reviews were excluded. These studies were reviewed together to update the various agents used for root biomodification and their current status in Periodontal regenerative therapy. Result: Only the representative studies of the agents used were included in this studies including 2 systematic review, 1 literature review and 1 world workshop report. Conclusion: The present status suggests that root biomodification does not have any added advantage in periodontal regeneration. Large Size randomized clinical trials are necessary to give an definite conclusion.