Sponges with colloidal silver nanoparticles help restore bone lost in endo-periodontal injuries

Introduction: Endo-periodontal lesions can lead to the formation of severe intraosseous defects in the periodontium; which can lead to tooth loss. Objective: Demonstrate that surgical periodontal therapy with the help of gelatin sponges, with colloidal silver nanoparticles, restores bone tissue lost in endo-periodontal lesions. Case presentation: 55-year-old male patient without systemic alterations, diagnosed with grade 3 endo-periodontal lesion in patients with periodontitis. It was treated first with ducts and then with periodontal surgery combined with gelatin sponges, which contain colloidal silver nanoparticles, and were placed filling the 2-wall bone defect involving > 80 percent of the root length, with 24 months of radiographic and clinical follow-up. Conclusions: Based on the case report, surgical periodontal therapy and filling of bone defects with gelatin sponges, which contain colloidal silver nanoparticles, were sufficient to restore the lost bone at a 24-month follow-up. However, further studies are needed to assess the clinical benefit of this material for the treatment of intraosseous defects(AU)

Treatment of peri-implant soft tissue defects: a narrative review

Abstract Soft tissue defects around dental implants, such as papilla or volume loss, peri-implant recession and alterations of the ridge color and/or texture, lead to esthetic and functional complaints. Treatments of these defects in implants are more demanding than in teeth because peri-implant tissue exhibits different anatomical and histological characteristics. This narrative review discusses the proposed treatments for soft tissue defects around implants in the current literature. Several clinical and pre-clinical studies addressed methods to augment the quantity of the peri-implant keratinized mucosa. Autogenous grafts performed better than soft tissue substitutes in the treatment of soft tissue defects, but there is no clinical consensus on the more appropriate donor area for connective tissue grafts. Treatment for facial volume loss, alterations on the mucosa color or texture and shallow peri-implant recessions are more predictable than deep recessions and sites that present loss of papilla. Correction of peri-implant soft tissue defects may be challenging, especially in areas that exhibit larger defects and interproximal loss. Therefore, the regeneration of soft and hard tissues during implant treatment is important to prevent the occurrence of these alterations.

Levantamento de seio maxilar atraumático sem enxertia óssea: uma revisão integrativa / Atraumatic maxillary sinus augmentation without bone grafting: an integrative review

Objetivo: avaliar a eficácia do levantamento do seio maxilar atraumático sem enxerto ósseo e a taxa de sobrevivência da instalação de implantes imediatos. Material e métodos: realizou-se uma estratégia de busca nas bases de dados Pubmed, Web of Science e Science Direct, obtendo 103 artigos, sendo selecionados 07 estudos publicados entre 2008 até 2019. Resultados: foram registrados 576 pacientes com idades entre 19 e 85 anos de idade, de ambos os sexos e 1,113 implantes instalados. Verificou-se uma taxa de sucesso e sobrevivência dos implantes de 96,6%, após um seguimento de 1 a 3 anos e houve um ganho ósseo de aproximadamente 3mm. Considerações finais: o levantamento de seio maxilar atraumático sem enxerto ósseo é eficaz para reabilitação de áreas edêntulas e mostra um bom resultado ao longo do tempo, com uma taxa média de sobrevivência dos implantes de 96,3%. Ainda faltam estudos para determinar qual tipo de implante é melhor para este tipo de técnica. (AU)

Objective: To assess the efficacy of atraumatic maxillary sinus augmentation without bone grafting and the survival rate of the immediate implant installation. Material and methods: A search strategy was performed the in Pubmed, Web of Science, and Science Direct databases, resulting in 103 articles from which seven studies published between 2008 and 2019 were selected. Results: 576 patients of both sexes, aged between 19 and 85 years, were registered, as well as 1,113 implants installed. There was a success rate and survival of implants of 96.6% after a follow-up of 1 to 3 years and there was a bone gain of approximately 3 mm. Final considerations: The atraumatic maxillary sinus augmentation without bone graft is effective to rehabilitate edentulous areas and shows a good outcome over time, with an average rate of implant survival 96.3%. Further studies are still required to determine which type of implant is best for this type of technique.(AU)

Reabilitação oral de paciente com síndrome da combinação: relato de caso / Patient oral rehabilitation with combination syndrome: case report

Objetivo: o tratamento de pacientes desdentados com reabsorção alveolar severa é uma temática desafiadora na reabilitação protética. Identificada por Kelly em 1972, a síndrome da combinação é uma manifestação intraoral encontrada em pacientes totalmente desdentados na arcada superior, em oposição a uma prótese mandibular de extensão distal bilateral. Relato de caso: este estudo revisa e discute, por meio de um caso clínico, as características clínicas presentes em um paciente com manifestações da síndrome da combinação. Além disso, apresenta uma proposta de tratamento reabilita¬dor, restabelecendo a função fonética e a estética do paciente. Considerações finais: diagnosticar a síndrome e estabelecer um plano de tratamento adequado às necessidades do paciente, criando condições clínicas para o restabelecimento da saúde, são imprescindíveis para obter resultado e, assim, impedir o avanço do quadro clínico. (AU)

Objective: treatment of patients with reactivity with respiratory problems. Identified by Kelly in 1972, a combination syndrome and an intraoral manifestation found in fully edentulous patients in the upper arch as opposed to a mandibular prosthesis of bilateral distal extension. Case report: the present study reviews and discusses, through a clinical case, as clinical features present in a patient with manifestations of the combination syndrome, in addition, to present a proposal of rehabilitative treatment, restoring function, phonetics and esthetics to the patient. Final considerations: diagnosing a syndrome and establishing a treatment plan appropriate to the needs of the patient and creating clinical conditions for the reestablishment of health are essential to obtain the result and thus impeding the advancement of the clinical picture. (AU)

Células mononucleares autólogas en la reparación de defectos óseos provocados por la periodontitis crónica / Autologous mononuclear cells in the repair of bone defects caused by chronic periodontitis

Introducción: la periodontitis crónica es un proceso inflamatorio de origen bacteriano que afecta a los tejidos del periodonto y provoca la destrucción de los tejidos de soporte del diente. La terapia celular con células mononucleares autólogas constituye una nueva opción terapéutica para lograr la regeneración ósea. Objetivo: evaluar la efectividad del tratamiento con células mononucleares autólogas implantadas en defectos óseos provocados por la periodontitis crónica. Método: estudio cuasiexperimental que se realizó en la Clínica Provincial Docente Antonio Briones Montoto de Pinar del Río, en el periodo comprendido entre enero de 2012 hasta agosto de 2015. A los nueve pacientes del grupo de estudio, se le realizó la perfusión de células mononucleares siete días después de ser intervenidos quirúrgicamente (colgajo periodontal). La movilización a sangre periférica de células mononucleares autólogas se realizó con factor estimulante del crecimiento granulocítico Leukocim (FEC-G). Variables del estudio: dientes afectados, presencia de sangrado al sondeo, bolsas periodontales, movilidad dentaria, pérdida de inserción y evidencia radiográfica. Resultados: posterior a la terapia celular se constató que las encías presentaron características de normalidad a los 7 días de implantados, a los 12 meses se observó hueso de neoformación y aumento de la densidad ósea. Conclusiones: la terapia mostró ser un método factible, simple y seguro en la reparación de defectos óseos provocados por la enfermedad, evidenciando mejoría de los parámetros clínicos y radiográficos(AU)

Introduction: Periodontitis is an inflammatory process of bacterial origin that affects the tissues of the periodontium and causes the destruction of the tissues supporting the tooth. Cell therapy could be an effective therapeutic option to achieve bone regeneration. Objective: To evaluate the effectiveness of treatment with implanted autologous mononuclear cells in bone defects caused by periodontal disease. Methods: A quasiexperimental study was carried out in the Provincial Teaching Clinic Antonio Briones Montoto, Pinar del Río, in the period from January 2012 to August 2015. The nine patients in the study group underwent perfusion of mononuclear cells seven days after surgery (periodontal flap). The mobilization to peripheral blood of autologous mononuclear cells was made with granulocytic leukocyte growth stimulating factor (FEC-G). Study variables: affected teeth, presence of bleeding on probing, periodontal pockets, tooth mobility, loss of insertion and radiographic evidence. Results: After the cell therapy, it was found that the gums showed normality characteristics after 7 days of implantation, after 12 months neoformation bone and increase in bone density was observed. Conclusions: The therapy showed to be a feasible, simple and safe method in the repair of bone defects caused by the disease, evidencing improvement of the clinical and radiographic parameters(AU)

Treatment of endo-periodontal lesion using leukocyte-platelet-rich fibrin. A case report / Tratamiento de una lesión endoperiodontal utilizando fibrina rica en plaquetas y leucocitos. Un reporte de caso

Abstract Case Description: The main objective of this paper was to report the clinical effectiveness of leukocyte- platelet- rich fibrin (L-PRF) in the treatment of a combined endo-periodontal lesion of an upper first premolar. Clinical Findings: The tooth had a profound abfraction on the vestibular aspect and presented no mobility but revealed a deep pocket measuring of 11 mm on the mesial vestibular aspect and 14 mm on the mesial palatine aspect. The three dimensional image analysis showed total bone loss in the mesial aspect and an extensively bone loss of the vestibular aspect of the vestibular root. Treatment and Outcome: Endodontic treatment was performed and periodontal access surgery (surgical periodontal therapy) was done with the application of autologous L-PRF. Three month and 6 months after surgery, the cone beam computed tomography (CBCT) exams showed no bone regeneration in any aspect of the tooth. However, periodontal examination showed a significative improvement in the deepness of surcus. The mesial vestibular aspect had a deep pocket of 3 mm and 5 mm on the mesial palatine aspect showing a reduction in deepness of 8 mm and 9 mm, respectively. Clinical Relevance: The actual treatment for teeth with bad prognosis is the extraction and replacement with implants. Even though implants are capable of restore function and aesthetic, the abuse of this approach have led to the loss of teeth that could be successfully treated with a less invasive technique. The prognosis of teeth with endoperiodontal lesion is poor but could be enhanced with regenerative therapies. Until now there are no clinical trials and just four case report about the treatment of these teeth with platelet rich fibrin.

Resumen Descripción del caso: El objetivo de este artículo fue reportar la efectividad clínica del uso de fibrina rica en plaquetas y leucocitos (L-PRF) en el tratamiento de una lesión endoperiodontal en un primer premolar superior. Hallazgos clínicos: El diente presentaba una abfracción profunda en la superficie vestibular, sin movilidad, pero reveló una bolsa profunda de 11 mm en la superficie mesio-vestibular y de 14 mm en la superficie palato-mesial. El análisis tridimensional de la imagen mostró una pérdida ósea total en la superficie mesial y una pérdida ósea extensa de la cara vestibular de la raíz. Tratamiento y resultado: Se realizó el tratamiento endodóntico y posteriormente cirugía de acceso periodontal (terapia periodontal quirúrgica) con la aplicación de L-PRF autóloga. Tres meses y 6 meses después de la cirugía, los examenes de Tomografía Computarizada Cone Beam (CBCT) no evidenciaron regeneración ósea en ningún sector del diente. Sin embargo, el examen clínico periodontal mostró una mejora significativa en la profundidad de la bolsa. La superficie mesio-vestibular registró una profundidad de bolsa de 3 mm y 5 mm en la superficie mesio-palatino, mostrando una reducción en la profundidad de 8 mm y 9 mm, respectivamente. Relevancia clínica: El tratamiento actual para los dientes con mal pronóstico es la extracción y el reemplazo con implantes. A pesar de que los implantes son capaces de restaurar función y estética, el abuso de este enfoque ha llevado a la pérdida de dientes que podrían tratarse con éxito con una terapia más conservadora. El pronóstico de los dientes con lesión endoperiodontal es pobre, pero podría mejorarse con el uso de terapias regenerativas. Hasta ahora no hay ensayos clínicos y solo cuatro reportes de casos acerca del tratamiento de estos dientes con fibrina rica en plaquetas y leucocitos.

Implantes cortos como alternativa terapéutica actual en el tratamiento de maxilares atróficos / Short implants as current therapeutic alternatives to the treatment of athrophic jaws

La variación en el volumen óseo producida tras la pérdida dental, hace que el tratamiento de los pacientesque presentan atrofias avanzadas en los maxilares sea un desafío para todo cirujano. En la actualidad, el uso de implantes dentales para reemplazar piezas dentarias perdidas es una opción de tratamiento. El tratamiento con implantes cortos se comporta tanpredecible como el uso de implantes convencionales, pero estos resultados siguen siendo objeto de controversia. Los implantes cortos tienen tasas de éxito similares a las de los implantes de longitud estándar, pueden ser utilizados como alternativa en el tratamiento de maxilares atróficos, siempre que sean manejadosbajo una cuidadosa planificación de tratamiento. El objetivo del presente trabajo es exponer una revisiónde la literatura actual sobre el uso de implantes cortos como alternativa de tratamiento terapéutico en presencia de maxilares atróficos.

The variation in the bone volume produced afterdental loss makes the treatment of patientswith advanced atrophies in the jaws a challengefor every surgeon. At present, the use of dental implants to replace lost teeth is a treatment option.Treatment with short implants behaves aspredictably as the use of conventional implants,but these results remain controversial. Short implants have similar success rates to thoseof standard length implants and can be usedas an alternative in the treatment of atrophic jaws, provided they are handled under careful treatment planning.The aim of the present study is to presenta review of the current literature on the use of short implants as an alternative therapeutic treatment in the presence of atrophic jaws.

Clinical effect of platelet rich plasma in the treatment of periodontal intrabony defects. systematic review and meta-analysis

Introduction: One of the consequences of periodontitis is periodontal intrabony defects (PID). Various biomaterials have been used for its treatment, but there is still no biomaterial considered as the gold standard. Current research is focused on the use of platelet-rich plasma (PRP) for the treatment of PID. Objective: To determine the clinical effect of PRP in the treatment of PID through a systematic review with meta-analysis. Materials and Methods: A literature search was conducted until February 2017 in the biomedical databases: Pubmed, Embase, Scielo, Science Direct, SIGLE, LILACS, IBECS, and the Cochrane Central Register of Clinical Trials. The criteria for the selection of the studies, which were randomized clinical trials, were the following: articles or papers published in the last 5 years, reporting clinical effects, with a follow-up time equal to or greater than 6 months, and a sample size equal to or greater than 10 patients reporting the use of PRP as a treatment for PID. The methodological quality of the studies was analyzed using the Cochrane Handbook of Systematic Reviews of Interventions as a reference. Results: The search strategy yielded nine articles reporting a reduction in probing depth and gingival recession, and an increase in clinical insertion level when using PRP alone or in combination with another biomaterial. Conclusion: The reviewed literature suggests that the use of PRP in the treatment of PID has a positive clinical effect.

Effects of platelet-rich fibrin on healing of intra-bony defects treated with anorganic bovine bone mineral

Abstract Anorganic bovine bone mineral (ABBM) is extensively used in the treatment of intra-bony defects. Platelet-rich fibrin (PRF) is a new-generation platelet concentrate with a simplified technique. Although certain studies have reported the use of PRF in the treatment of intra-bony defects, to date, none of them have evaluated its additive effects with ABBM. Therefore, a randomised, split-mouth clinical trial was conducted to compare healing of intra-bony defects treated with an ABBM-PRF combination with healing of those treated with ABBM alone. By using a split-mouth design, 15 paired intra-bony defects were randomly treated with either ABBM alone (control group) or ABBM-PRF combination (test group). Following clinical parameters and radiographical measurements were recorded at baseline and 6 months after treatment: plaque index (PI), gingival index (GI), probing depth (PD), gingival recession (GR), clinical attachment level (CAL), vertical bone loss, depth of defect and defect angle. Preoperative clinical and radiographical measurements were similar for the test and control groups. Statistically significant reductions in GI, PD, CAL, vertical bone loss, depth of intra-bony defect and widening of defect angle were detected after treatment in both groups. With respect to inter-group analysis, gain in CAL was significantly greater in the test group than in the control group, whereas no inter-group differences were observed in any other parameter. The results of this study indicate that both therapies are effective in the treatment of intra-bony defects.

Encía artificial en prótesis implantoasistida: indicaciones y aplicaciones clínicas / Artificial gingiva in implant-supported prosthesis: indications and clinical applications

En la rehabilitación odontológica integral actual, hay que evaluar los parámetros clínicos para una restauración sobre implantes dentales. El tratamiento del sector anterior de ambos maxilares en situaciones clínicas complejas, hace que el éxito sea difícil de alcanzar, inclusocuando todos los objetivos establecidos de diagnóstico y de planificación del tratamiento, sean respetados y puedan realizarse. El objetivo es imitar la apariencia de los dientes contiguos para simular la dentición natural, con un enfoque en la estética de los tejidos gingivales adyacentes a las restauraciones sobre implantes. En los casos en que el tejido óseo y la pérdida mucogingivales marcada y procedimientos quirúrgicos adicionales no son viables, se requerirá de tratamientos alternativos. Uno de ellos podría ser el uso de encía artificial para reconstruir las deficiencias de tejidos duros y blandos. Este artículo describe diferentes indicaciones y aplicaciones clínicas de la encía artificial en prótesis implanto asistida.

In the current comprehensive dental rehabilitation, clinical parameters for success restoration on dental implants must be evaluated.Treatment of both anterior maxillary and mandibular jaws in complex clinical situations makes success difficult to achieve, even when allestablished goals in diagnosis and treatment planning, are respected and can be made.The goal is to mimic the appearance of the adjacent teeth to simulate natural dentition, with a focus on the aesthetics of the gingival tissuesnext to implant restorations. In cases where the bone and mucogingival tissues loss are marked and additional surgical procedures shouldnot be viable, it will require alternative treatment options. One of them could be the use of artificial gingiva to rebuild the deficiencies ofhard and soft tissues.This article describes different indications and clinical applications in artificial gum assisted implant prosthesis.

Regeneración ósea guiada en defectos de tipo II: revisión bibliográfica y presentación de un caso clínico / Guided bone regeneration in type II defects: review of the literature and report of a clinical case

La regeneración ósea guiada es una técnica capaz depromover la neoformación ósea. A través de la aplicaciónde la misma se pueden corregir los defectosóseos como dehiscencias, fenestraciones y defectoscircunferenciales similares a los causados por unaextracción dentaria. Esta técnica permite además, elaumento horizontal y vertical del reborde alveolar.La finalidad de este trabajo es la de realizar una revisiónbibliográfica para evaluar los beneficios de laregeneración ósea guiada en defectos de tipo II.

Guided bone regeneration is a techniquecapable of promoting the new bone formation.The bone defects such as dehiscences andfenestrations circumferential defects similar to thosecaused by a tooth extraction could becorrect through the application of the same.This technique also allows increased horizontaland vertical alveolar ridge. The purpose of thiswork is the carry out of a literature review toevaluate the benefits of bone regenerationguided defects in type II.

Tratamiento de las fracturas en mandíbulas atróficas: nuestra experiencia con la reducción abierta y fijación interna según el principio de carga soportada / Treatment of atrophic mandible fractures: our experience with open reduction and internal fixation according to the load-bearing principle

Objetivo: presentar los resultados terapéuticos obtenidos por medio de la reducción abierta y fijación interna, aplicando el principio de carga soportada, en el tratamiento de fracturas de mandíbulas atróficas. Casos clínicos: se llevaron a cabo tratamientos en 21 pacientes, con un total de 30 fracturas de mandíbula atrófica, sobre 410 pacientes ingresados por fracturas mandibulares, en un hospital municipal de tercer nivel y en la práctica privada, durante el período 1991-2014. Conclusión: la reducción abierta y fijación interna según el principio de carga soportada, es una terapéutica predecible y segura para el tratamiento de las fracturas en mandíbulas atróficas. La mayoría de las publicaciones recientes comparten resultados similares y lo consideran el procedimiento terapéutico de elección...

Reabsorções condilares em pacientes cirúrgicos: alternativas terapêuticas conservadoras e minimamente invasivas / Condylar reabsortion in surgical patients: conservative and minimally invasive therapeutic alternatives

Resumo / O processo degenerativo articular é caracterizado pela presença de crepitação, que pode estar acompanhada ou não de artralgia, com dor espontânea ou provocada pela palpação e/ou função. Esse diagnóstico é confirmado por meio de imagens tomográficas. A prevalência de lesões degenerativas da ATM é extremamente alta em pacientes candidatos a procedimentos de Cirurgia Ortognática, e esse pode aumentar o risco de agravamento dos quadros preexistentes, inclusive com a possibilidade de grandes recidivas pós-cirúrgicas da deformidade dentofacial. Estratégias terapêuticas envolvem protocolos capazes de produzir efeitos sobre a dor e a incapacidade funcional, mas também na interrupção da progressão e no reparo dos defeitos da cartilagem articular. A abordagem terapêutica inicial utiliza de terapias não cirúrgicas ou minimamente invasivas, baseadas na supressão da carga articular parafuncional por meio da utilização de placas estabilizadoras e na administração de suplementos ou infiltração de materiais biológicos, como as glicosaminas e ácido hialurônico. Procedimentos cirúrgicos mais invasivos, como as cirurgias abertas da ATM, são reservados para casos isolados refratários à terapia conservadora. Entre os procedimentos da medicina regenerativa, o transplante autólogo de condrócitos parece ser o mais promissor como alternativa terapêutica eficaz e segura para casos de reabsorções condilares.

Reabsorción ósea del reborde residual mandibular en desdentados totales / Bone resorption of the residual ridge in edentulous patients

Al perder los elementos dentarios, la remodelación ósea y mucosa produce una nueva estructura anatómica, el reborde residual. La reducción del reborde residual (RRR) es considerada como una enfermedad crónica, progresiva, irreversible, acumulativa en el tiempo, de etiología multifactorial. Objetivo: evaluar la pérdida del hueso alveolar en pacientes edéntulos usuarios y no de prótesis. Métodos: estudio en 115 pacientes, de 41 a 88 años, ambos sexos, edéntulos. Se realizó radiografía panorámica junto a historia clínica. Se cuantificó la altura ósea vertical, lado izquierdo y derecho, desde el borde inferior de la mandíbula al foramen mentoniano y desde el borde inferior mandibular al superior de la cresta. Se recabaron datos sobre edad, sexo, uso de prótesis dental y enfermedades sistémicas. Resultados: edad promedio 64,5 años; 71 por ciento usaba prótesis (71,91 por ciento mujeres y 28,09 por ciento varones). Hubo diferencias significativas en ambos sexos entre uso y no uso de prótesis y RRR en cada sector, derecho p=0,0173 e izquierdo p=0,0153. Los valores de RRR fueron 14,24 mm en varones y 18,03 mm en mujeres. La pérdida ósea fue mayor en mujeres posmenopáusicas y en hombres de más de 70 años. No se observaron asociaciones significativas con edad y con enfermedades sistémicas. Conclusión: la pérdida ósea aumenta en desdentados con la edad, por un factor fisiológico y pérdida de la función, el hueso no recibe fuerzas estimulantes. Las mujeres pierden más hueso que los hombres por factores hormonales propios u otros.

Colgajo mínimamente invasivo (MIST) en el tratamiento de un defecto infraóseo de 3 paredes en combinación con matriz derivada del esmalte: caso clínico / Mnimally invasive flap (MIST) in the treatment of 3-wall infrabony defect in combination with enamel matrix derivative: a case report

Objetivos: se describe el tratamiento de un defecto infraóseo de tres paredes, en una pieza anterior, la utilización de un colgajo mínimamente invasivo, en combinación con proteína derivada de esmalte, con el propósito de conseguir regeneración tisular de los tejidos perdidos por enfermedad periodontal, buscando mejorar y disminuir los tiempos de cicatrización de los tejidos involucrados y reducir la retracción de los mismso. Caso clínico: el diente a tratar era un incisivo lateral superior derecho que presentaba un defecto vertical con una profundidad de sondaje de 9 mm y una pérdida de inserción de 11mm. Los parámetros clínicos y radiográficos fueron evaluados al inicio y a los 12 meses de realizado el procedimiento regenerativo. Conclusión: los resultados clínicos y radiográficos mostraron una mejoría en los parámetros evaluados 12 meses después de la cirugía. Es importante realizar un correcto diagnóstico clínico radiográfico para poder seleccionar el tipo de colgajo y el material de regeneración a utilizar. Para la elección de este colgajo se tomó en cuenta el tipo de defecto, la morfología del mismo y su ubicación en el sector anterior.

Atrofia paraprotética de los maxilares / Paraprosthetic atrophy of the jaws

El objetivo de esta presentación es describir las alteraciones provocadas por la desadaptación o sobrecarga sectorizada de las prótesis mucosoportadas sobre el terreno de soporte óseo. Luego, relacionarlas con las alteraciones periprotéticas asociadas más comunes, y realizar la descripción de una de las alteraciones atróficas paraprotéticas de mayor casuística, con sus consecuencias en el sistema estomatognático. Finalmente, describir los tratamientos protéticos no implantológicos y la prevención de estas alteraciones con prótesis convencionales e implanto-asistidas

Assessment of combination techniques in enhancing the regenerative potential of tricalcium phosphate graft in treatment of infrabony periodontal defects.

Aims: The purpose of the present study was to evaluate and compare the clinical outcome of infrabony defects following reconstructive surgery with the use of tricalcium phosphate (TCP) alone; TCP and citric acid (CA) root conditioning; and TCP, CA, and oxidized regenerated cellulose (ORC) membrane. Materials and Methods: Thirty-nine systemically healthy subjects with vertical infrabony defect were initially selected based on intraoral periapical radiographs and clinical examination to record probing pocket depth (PPD) and clinical attachment level (CAL). Only 21 defects revealed two-walled configuration on surgical debridement. These defects were selected and randomly allotted to the study groups. Group 1 defects were treated with TCP, group 2 with TCP+CA, and group 3 with TCP+CA+ORC. PPD, CAL, defect depth (DD), and level of alveolar crest (AC) were evaluated at the time of initial surgery and after 6 months at surgical re-entry. These measurements were utilized to calculate PPD reduction, CAL gain, defect fill (DF), %defect fill (%DF), and crestal resorption (CR). Statistical Analysis: A paired t-test was used for assessing changes in each group. Unpaired t-test was used for intergroup comparisons. Results: All three groups showed statistically significant PPD reduction, CAL gain, DF, and %DF, but insignificant CR at the end of 6 months. On intergroup comparison, no statistically significant differences were noted between the groups for all the parameters. Conclusion: Efficacy of combination techniques using TCP+CA; TCP+CA+ORC in treatment of periodontal infrabony defects is at least equal to that of TCP alone.