Effectiveness of Platelet-Rich Fibrin with Decalcified Freeze-Dried Bone Allograft Compared to Decalcified Freeze-Dried Bone Allograft Alone in Mandibular Grade-II Furcation Defects: A Quasi-Experimental Study

ABSTRACT Objective: To assess the effectiveness of platelet-rich fibrin (PRF) with decalcified freeze-dried bone allograft (DFDBA) compared to DFDBA alone in mandibular grade-II furcation defects. Material and Methods: A quasi-experimental study was conducted on nine patients with chronic periodontitis, each having two almost identical mandibular grade II furcation defects. Test sites (left mandibular first molars) were treated with open flap debridement (OFD), DFDBA, and PRF, whereas control sites (right mandibular first molars) received OFD and DFDBA alone. Clinical parameters (plaque index (PI), gingival index (GI), vertical clinical attachment level (VCAL) and horizontal clinical attachment level (HCAL) into the furcation defect) and radiographic measurements (mean alveolar bone defect) were done at baseline and after six months postoperatively. Results: The gain in relative horizontal clinical attachment level (RHCAL) in the test sites was 2.94±0.52 mm compared to 1.33±0.35 mm in control sites (p=0.01). Improvement in mean alveolar bone defect (MABD) (was 1.21±0.5 mm2 at test sites compared to 1.15±0.7 mm2 at control sites) probing pocket depth (PPD), recession, relative vertical attachment level (RVCAL), and percentage of bone fill was found in the test sites compared to control, which statistically insignificant. Conclusion: The test sites had better outcomes than control sites, which was significant for the parameter RHCAL. Therefore, combining the biological benefits of autologous PRF with DFDBA is an efficient and economical treatment modality for the management of mandibular grade II furcation defects.

Platelet-rich plasma in the treatment of Class II furcation defects: a histometrical study in dogs

OBJECTIVE: This study was designed to evaluate the potential adjunctive benefits of platelet-rich plasma (PRP) when used with guided-tissue regeneration (GTR) and bioactive glass (BG) in the treatment of Class II furcation lesions. MATERIAL AND METHODS: Bilateral Class II furcation lesions were surgically created and allowed to become chronic in the mandibular third premolars of 9 dogs. The defects were randomly assigned to: A) GTR+BG and B) GTR+BG+PRP. Similar defects were created in the maxillary third premolars and received the same treatments after 45 days. Dogs were sacrificed 90 days after the first treatment. The histometric parameters evaluated were: connective tissue adaptation, new cementum, new bone, mineralized bone area, non-mineralized bone area, and residual BG particle area. RESULTS: Data analysis showed a superior length of new cementum and a greater mineralized bone area for group B in both periods (p<0.05). The non-mineralized bone area was greater in the control group (p<0.05) in both periods. CONCLUSION: Within the limits of this study, it can be concluded that the use of PRP in the treatment of Class II furcation defects may enhance the amount of new cementum and provide a more mineralized bone in a shorter period of time.

Morphometric study of the root anatomy in furcation area of mandibular first molars

Furcation involvement in periodontal disease has been a challenge for the dentist. OBJECTIVE: The aim of this study was to investigate root dimensions in the furcation area of 233 mandibular first molars. MATERIAL AND METHODS: Digital photomicrographs were used to obtain the following measurements on the buccal and lingual surfaces of each tooth: root trunk height (RT), horizontal interadicular distance obtained 1 mm (D1) and 2 mm (D2) below the fornix and interadicular angle (IA). RESULTS: Mean± standard deviation of buccal and lingual furcation measurements were, respectively, 1.37±0.78 mm and 2.04±0.89 mm for RT; 0.86±0.39 mm and 0.71±0.42 mm for D1; 1.50±0.48 mm and 1.38±0.48 mm for D2; 41.68±13.20° and 37.78±13.18° for IA. Statistically significant differences were found between all measured parameters for buccal and lingual sides (p<0.05, paired t test). CONCLUSIONS: In conclusion, the lingual furcation of mandibular first molars presented narrower entrance and longer root trunk than the buccal furcation, suggesting more limitation for instrumentation and worse prognosis to lingual furcation involvements in comparison to buccal lesions.

Capacidade seladora do agregado de trióxido mineral em perfurações de furca após irrigação final com diferentes soluções / Mineral trioxide aggregate sealing ability in furcal perforations after final irrigation with different solutions

Introdução - O presente estudo avaliou a influência de diferentes soluções irrigadoras na capacidade seladora do MTA quando utilizado em perfurações na região de furca de molares inferiores extraídos. Material e Métodos - Trinta molares inferiores humanos foram submetidos à abertura endodôntica convencional e tiveram o centro do assoalho perfurado propositalmente com broca esférica diamantada. Os espécimes foram divididos em 3 grupos (n = 10) de acordo com as soluções utilizadas: G1-soro fisiológico; G2-NaOCl a 1% e G3-EDTA 17%. Foi realizado o preenchimento da perfuração com MTA Angelus cinza e o selamento coronário provisório. Em seguida,realizou-se a impermeabilização da superfície externa, exceto na região de furca, e imersão em corante nanquim por 72 horas. A mensuração, em milímetros, da infiltração linear foi realizada por meio do software Image Tool. Resultados - Os resultados demonstraram que a solução de EDTA 17% permitiu menor infiltração, sendo estatisticamente diferente do NaOCl a 1% e do soro fisiológico(p < 0,05). Conclusão - De acordo com os resultados, pode-se concluir que a solução de EDTA parece ser a melhor escolha para irrigação final em casos de perfuração de furca.

Introduction - This study assessed the influence of different final irrigation on the sealing ability of MTA-Angelus in furcal perforations of extracted human molar teeth. Material and Methods - Thirty human mandibular molars were conventionally accessed and perforations were purposely created in the center of the pulp chamber floor by using a round diamond bur. The specimens were divided into 3 groups (n = 10) according to the irrigation: G1-saline solution; G2-1% sodium hypochlorite; G3-17% EDTA. Teeth were repaired with Angelus'gray MTA and the crowns were sealed.Then the impermeabilization of the external surface was made except in the furcal region, and they were immersed into Indian Ink for 72 hours. The leakage was measured, in millimeters, by Image Tool software. Results - The results showed lower leakage index for EDTA group that was statistically different from 1% NaOCl and saline solution groups (p < 0.05). Conclusion - According to results it can be concluded that in cases of furcal perforation EDTA solution seems to be the best choice of final irrigation.

Enamel matrix proteins associated with GTR and bioactive glass in the treatment of class III furcation in dogs / Proteína da matriz do esmalte associada a R.T.G. e vidro bioativo no tratamento de furca grau III em cães

Este estudo investigou, histológica e histometricamente, a eficácia da proteína derivada da matriz de esmalte (EMD) associada com vidro bioativo (BG) e membrana absorvível, no tratamento de defeitos de furcas classe III em cães. Após criação cirúrgica e cronificação dos defeitos, as lesões foram divididas aleatoriamente em três grupos de acordo com o tratamento proposto: Grupo Teste 1 - EMD + BG + membrana, Grupo Teste 2 - EMD + membrana e Grupo Controle - BG + membrana. Após 90 dias do período de cicatrização, os cães foram sacrificados. A análise descritiva e os dados histométricos mostraram resultados similares para os grupos experimentais em todos os parâmetros estudados (MANOVA, p > 0,05). As associações de Emdogain com vidro bioativo e RTG, ou somente com RTG, mostraram resultados similares quando comparadas ao vidro bioativo associado à membrana no tratamento de defeito de furca classe III, em cães. As três modalidades de tratamento mostraram preenchimento parcial das furcas com regeneração óssea e cementária limitada à porção apical das mesmas.

Regeneration of class II furcation defects: determinants of increased success

As lesões de bifurcação classe II constituem uma das principais indicações para a técnica de regeneração tecidual guiada. Entretanto, a regeneração periodontal deste tipo de defeito ósseo, embora possível, não é considerada um resultado totalmente previsível, principalmente em termos de completo preenchimento ósseo. Muitos fatores podem explicar a variabilidade nos resultados do tratamento regenerativo nas lesões de bifurcação classe II. O objetivo desta revisão de literatura foi avaliar o significado de fatores relacionados ao paciente (fumo, estresse, diabetes mellitus, AIDS e outras doenças agudas e debilitantes, e presença de bolsas periodontais em outros sítios da boca), às condições locais (anatomia da furca, morfologia do defeito, espessura gengival e mobilidade dentária), ao tratamento cirúrgico (controle de infecção, utilização de materiais para preenchimento ósseo, tipo de membrana e técnica cirúrgica) e ao período pós-operatório (controle de placa, exposição e remoção das membranas e terapia periodontal de suporte) para o sucesso da RTG no tratamento das lesões de bifurcação classe II.