Uso de fibrina rica em plaquetas na periodontia: uma revisão de literatura / Use of platelet-rich fibrin in periodontia: a literature review

Fibrina rica em plaquetas (PRF) é um concentrado plaquetário de uso autólogo cuja implicação é promover uma melhor e mais rápida cicatrização além de reparo das lesões cirúrgicas, isso devido à sua disponibilidade ilimitada e ao seu potencial regenerativo com liberação de fatores de crescimento. Objetivo: fazer uma revisão de literatura sobre a utilização da PRF na periodontia. Metodologia: o estudo caracterizou-se como revisional, a partir de busca na literatura selecionando estudos transversais, longitudinais, casos clínicos e revisões sistemáticas, em português e inglês, indexados nas bases de dados portal de periódico da Capes, Medline e PubMed. Revisão: PRF tem sido utilizada na regeneração periodontal por sua capacidade de cicatrização e por conter proteínas biologicamente ativas que se ligam a uma malha de fibrina em desenvolvimento ou à matriz extracelular. Conclusão: observa-se que há uma melhora expressiva no processo de regeneração tecidual e na cicatrização quando se utiliza também a PRF no tratamento, o que a torna uma importante aliada na terapia periodontal.(AU)

Platelet Rich Fibrin is an autologous platelet concentrate whose implication is to promote better and faster healing and repair of surgical lesions. The aim of this study was to review the literature on the use of PRF in periodontics. Methodology: the study was characterized as a review, based on a search in the literature, selecting cross-sectional, longitudinal studies, clinical case and systematic reviews, in Portuguese and English, indexed in the Capes, Medline and PubMed journal databases. Review: PRF has been used in periodontal regeneration for its healing capacity and for containing biologically active proteins that bind to a developing fibrin mesh or the extracellular matrix. Conclusion: it is observed that there is an expressive improvement in the process of tissue regeneration and healing when the PRF is also used in the treatment, which makes it an important ally in periodontal therapy.(AU)

Preservación alveolar post extracción en zona estética: decisiones clinicas predecibles en sitio severamente afectado / Alveolar ridge preservation in the esthesic zone: predictable decisions in a severly affected site

INTRODUCCIÓN: La valoración particular de sitios severamente comprometidos, involucra considerar los tiempos necesarios de cicatrización, así como evidencia actual en términos de biomateriales y técnicas quirúrgicas con el fin de lograr un tratamiento exitoso. MATERIAL Y MÉTODO: Paciente sexo femenino, 28 años, asiste por dolor e infección en diente 2.1 al Postítulo de Periodoncia UDD. Se observa defecto extenso y lesión que compromete tanto las tablas óseas vestibular como palatina. El tratamiento consistió en: exodoncia y regeneración ósea, instalación del implante 6 meses después de la exodoncia y cirugía de conexión 7 meses después más injerto de tejidos blandos. RESULTADOS: El tratamiento de defectos combinados (tejidos duros y blandos), asociados a procesos infecciosos de larga data, mediante rehabilitación implanto soportada puede ser muy predecible y exitoso en la medida que se respeten los tiempos de regeneración de diferentes estructuras.

INTRODUCTION: The specific assessment of a severely compromised sites involves: the consideration of healing time according to the different kinds of tissues involved and the knowledge of the evidence available concerning biomaterials and surgical techniques. MATERIAL AND METHODS: Female patient attends the postgraduate school of periodontics, UDD University in Santiago de Chile, because of pain and chronic infection compromising tooth 2.1. At clinical evaluation, the site has an extensive defect, with active fistula that compromises the buccal and palatal bone plates. The treatment consisted of exodontia and guided bone regeneration, implantation six months after initial exodontia and abutment connection surgery seven months after implant insertion. RESULTS: the treatment of combined defects associated with a long-standing infectious process can be very predictable and successful, only if the measures of time and tissue handling are considered and applied.

New strategies and developments for peri-implant disease

Abstract The aim of this illustrated review is to present the new strategies and developments to treatment and diagnosis of periimplant diseases. Periimplant disease is a subject of great concern for modern dentistry. The numbers of implant exhibiting biological complications grows as implant dentistry expands thought-out the world. Diagnosis and treatment of those diseases are still controversial and difficult. We present novel treatment for infection control and biological rationale of additional use of guided bone regeneration, with an illustrative explanation of the treatments presented with two cases.

Cambios clínicos y radiográficos en pacientes con periodontitis tratados con plasma rico en plaquetas / Clinical and radiographical changes in patients with periodontitis treated with platelet-rich plasma

Se presentan los casos clínicos de 2 pacientes con periodontitis crónica del adulto, a quienes se les realizó la fase inicial de tratamiento y la cirugía periodontal a colgajo de Kirkland mucoperióstico, lo cual facilitó el acceso a los defectos óseos, además de raspado y alisado radicular, lavado cuidadoso del lecho receptor con suero fisiológico y luego perfusión de plasma rico en plaquetas. Se obtuvieron cambios significativos en el mejoramiento de las características clínicas de la encía durante la cicatrización y signos de integración ósea a los 3 meses del tratamiento. Este proceder constituye una manera permanente y efectiva para corregir destrucciones óseas periodontales, a través de la activación del proceso de reparación

The case reports of two patients with chronic periodontitis of the adult are presented, to whom the initial phase of the treatment and the periodontal surgery with the mucous periostical Kirkland flap technique was carried out, which facilitated the access to bone defects, as well as radicular curettage and smoothing out, careful washing of the receptor bed with physiological salt solution and then perfusion of platelet-rich plasma. Significant changes were obtained in the improvement of gum clinical features during healing and signs of bone integration after three months of treatment. This procedure constitutes a permanent and effective way to correct periodontal bone destructions by means of the activation of the repair process

Long-term effects of vertical bone augmentation: a systematic review

ABSTRACT Extraction, periodontitis, or trauma can cause a reduction on the alveolar ridge. This could result in an insufficient alveolar bone width and height. Different techniques of vertical bone augmentation are described in literature. However, nowadays there is not enough evidence against lateral augmentation procedures to verify if these techniques are stable over a long period of time. Objective This review analyses the different techniques that are used to vertically augment the bone and evaluate if these techniques are stable over a long period of time. Material and Methods The MEDLINE-PubMed database was searched from its earliest records until December 22, 2014. The following search term was used: Alveolar Ridge augmentation [MESH]. Several journals were hand searched and some authors were contacted for additional information. The primary outcome measure that was analyzed was marginal bone level change around dental implants in the augmented sites, and the secondary outcomes were survival and success rates of dental implants placed in the augmented sites. Results The search yielded 203 abstracts. Ultimately, 90 articles were selected, describing 51 studies meeting the eligibility criteria. The marginal bone level change for the inlay technique and vertical guided bone regeneration are in agreement with the success criteria. Alveolar distraction showed more marginal bone level change after the first year of loading, and for the inlay technique very few studies were available. Conclusions Based on the available data in the current existing studies with a follow-up period of at least 4 to 5 years, one can summarize that there seems to be a trend that the onlay technique, alveolar distraction, and vertical guided bone regeneration are stable for at least 4 to 5 years.

Supplement the Base to Complement the Crown: Localized Ridge Augmentation using Connective Tissue Graft.

Interdisciplinary approach should be contemplated as a long term solution for esthetic and functional dental rehabilitation of patients. To obtain longevity of treatment, the therapeutic decisions must be based on a strong periodontal foundation. To prevent unacceptable esthetic deformities due to lost oral tissues, a plethora of treatment modalities are available, to augment the alveolar ridge, and to improve the esthetic outcome of the final prosthesis. Prior to the replacement of missing teeth, esthetic, and physiologic corrections of edentulous areas are critical pre‑requisites. This article describes a surgical procedure to enhance a localized buccal ridge defect and create an emergence profile in relation to the maxillary left central incisor region, prior to the construction of a fixed partial denture using a connective tissue graft.

Novel biological activity of ameloblastin in enamel matrix derivative

Objective Enamel matrix derivative (EMD) is used clinically to promote periodontal tissue regeneration. However, the effects of EMD on gingival epithelial cells during regeneration of periodontal tissues are unclear. In this in vitro study, we purified ameloblastin from EMD and investigated its biological effects on epithelial cells. Material and Methods Bioactive fractions were purified from EMD by reversed-phase high-performance liquid chromatography using hydrophobic support with a C18 column. The mouse gingival epithelial cell line GE-1 and human oral squamous cell carcinoma line SCC-25 were treated with purified EMD fraction, and cell survival was assessed with a WST-1 assay. To identify the proteins in bioactive fractions of EMD, we used proteome analysis with two-dimensional gel electrophoresis followed by identification with liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Results Purified fractions from EMD suppressed proliferation of GE-1 and SCC-25. LC-MS/MS revealed that ameloblastin in EMD is the component responsible for inhibiting epithelial cell proliferation. The inhibitory effect of ameloblastin on the proliferation of GE-1 and SCC-25 was confirmed using recombinant protein. Conclusion The inhibitory effects of EMD on epithelial cell proliferation are caused by the biological activities of ameloblastin, which suggests that ameloblastin is involved in regulating epithelial downgrowth in periodontal tissues. .

Desarrollo de sitio periimplantario mediante regeneración ósea guiada e injerto conectivo en el sector anterior / Peri-implant Site Development using Guided Bone Regeneration and Connective Tissue Graft in the Anterior Region

Condiciones desfavorables del reborde alveolar debido a atrofia, enfermedad periodontal o traumatismos pueden generar deficiencias de volumen óseo, produciendo como consecuencia una relación corona/implante inadecuada y un aspecto estético desfavorable. La presente serie de casos propone el uso de la técnica asociada a un injerto de tejido conectivo como método de desarrollo de sitio periimplantario, con el fin de corregir deficiencias del reborde alveolar, para permitir la posterior instalación de un implante óseo integrado. Ocho pacientes con indicación de extracción de una pieza anterior, asociada a ausencia de la tabla vestibular y a una pérdida de tejidos duros y blandos, fueron sometidos a un procedimiento de regeneración ósea guiada mediante el uso de una mezcla de xenoinjerto y hueso autólogo en conjunto con una membrana reabsorbible e injerto conectivo autólogo. A los 6 meses postratamiento, fue colocado el implante, y provisionalizado inmediatamente. En todos los casos se logró una mejora y una equiparación de los contornos periimplantarios con las piezas vecinas. No existieron complicaciones posoperatorias, la regeneración de tejidos fue exitosa en todos los casos intervenidos, y todos los implantes se integraron correctamente. La regeneración ósea guiada en conjunto con un injerto de tejido conectivo fue un método efectivo para el desarrollo de sitio periimplantario previo a la colocación de implantes en el sector anterior del maxilar.

Unfavorable conditions of the alveolar ridge, due to atrophy, periodontal disease or trauma, can lead to osseous volume deficiencies, producing an inadequate crown / implant relationship and an unfavorable esthetic appearance. The present case series proposes the use of guided bone regeneration (GBR) associated with a connective tissue graft, as a method for peri-implant site development, to correct alveolar ridge deficiencies, and to allow the subsequent placement of an osseointegrated implant. Eight patients with the indication of an anterior tooth extraction, associated with a loss of the vestibular plate and a hard and soft tissue deficiency, were treated with a GBR procedure using a mixture of xenograft-autogenous bone in conjunction with a resorbable membrane and an autogenous connective tissue graft. At 6 months post-treatment, the implant was installed and immediately provisionalized. In all the cases, an improvement and matching of the tissue contours with the neighboring teeth was achieved. There were no postoperative complications. The tissue regeneration was successful in all the cases, and all the implants achieved a correct integration. GBR, in conjunction with a connective tissue graft, was an effective method to perform a peri-implant site development prior to the implant installation in the maxillary anterior region.

Adhesivo tisular tisuacryl como sustituto de suturas en autoinjertos de tejidos blandos / Tissue adhesive Tisuacryl as a suture substitute in soft tissues autografts

El autoinjerto de tejidos blandos es un procedimiento comprobado para obtener una encía adherida más ancha, aumentando al mismo tiempo la profundidad vestibular y eliminando la tensión producida por el frenillo anormal. Puede considerarse como el mejor procedimiento quirúrgico para obtener el recubrimiento radicular. En este trabajo se realiza el injerto gingival utilizando como sellante de los bordes de la herida el tisuacryl en sustitución de las suturas convencionales conocidas. El objetivo del presente artículo es describir el caso clínico de un paciente con escasa encía adherida, periodonto grado lV según clasificación de Miller y, además, con necesidad de tratamiento ortodóncico, sometido a tratamiento quirúrgico con la técnica mucogingival: autoinjerto de tejidos blandos. Los resultados demuestran la eficacia terapéutica del tisuacryl al disminuir el tiempo quirúrgico, además de lograr estética beneficiada y complacencia elevada del paciente.

Soft tissues autografting is a proven procedure to get a wider adhered gum, increasing the vestibular depth at the same time and eliminating the tension produced by the abnormal frenum. It can be considered as the best surgical procedure to complete the coverage of denuded root surface. In this work the gingival implant was carried out using “Tisuacryl” as sealant of the wound borders in substitution of the well-known conventional sutures. The objective of the current article is describing the clinical case of a patient with scarce adhered gum, periodontal tissues degree lV according to Miller´s classification and also with orthodontic treatment necessity, subjected to surgical treatment with the mucogingival technique: soft tissues autograft. The results demonstrate Tisuacryl therapeutic effectiveness providing the decrease of the surgical time, with the addition of the patient´s benefited aesthetics and high satisfaction.

Regeneração tecidual guiada no tratamento de defeito ósseo interproximal - relato de caso / Guided tissue regeneration in the treatment of interproximal bone defect - case report

As lesões ósseas têm a regeneração tecidual guiada (RTG) como uma possibilidade de tratamento, dependendo da morfologia do defeito. Esse procedimento visa selecionar células específicas usando uma membrana para a sua proliferação na área lesada. Entretanto, a regeneração completa do defeito pode não ser obtida, sendo a eliminação da doença o único resultado. O objetivo deste caso clínico foi avaliar o tratamento de um defeito interproximal, de duas paredes, pela técnica da RTG. Paciente GWS, 22 anos compareceu à clínica de Periodontia do SIOMS, queixando-se de sangramento gengival nos dentes 45 e 46. Após os exames clínico e radiográfico, verificou-se a presença de perda óssea interproximal nos referidos dentes, com profundidade de sondagem (PS) de 9mm e sangramento a sondagem (SS). Elaborou-se o plano de tratamento e seguiu-se tratamento periodontal não-cirúrgico. Sem sucesso na eliminação do problema, procedeu-se a RTG da área. A técnica realizada foi uma incisão intrassulcular, descolamento de um retalho total, debridamento, descontaminação química da raiz, inserção de um enxerto ósseo e de uma membrana absorvível xenógenos, reposicionamento do retalho e sutura. Fez-se o controle a cada 30 dias e, após 12 meses, a região demonstrou ausência de SS, redução da PS e aumento do nível clínico de inserção, porém, não viu-se a completa regeneração do osso interproximal. Concluiu-se que a eliminação da atividade da doença periodontal pode ser um benefício obtido na RTG sem a visualização da total regeneração óssea

Depending on the morphology of bone lesions guided tissue regeneration (GTR) is an option of treatment. This procedure aims at selecting specific cells, using a membrane for its proliferation in the injured area. However, complete regeneration of the defect may not be achieved, and in this case extinguish of the disease is the only result. The objective of the present study was to evaluate the clinical treatment of an interproximal two wall defect, using GTR technique. The patient GWS, 22 years old, attended to SIOMSÆ clinic of Periodontics, complaining of gingival bleeding on teeth 45 and 46. After clinical and radiographic examinations, was verified the presence of interproximal bone loss on those teeth with probing depth (PD) of 9mm and bleeding on probing (BOP). The treatment plan was prepared and a non-surgical periodontal treatment was adopted. This approach wasn´t able to eliminate the problem, GTR was performed in the area.Was performed an intrasulcular incision, followed by total detachment of a flap, debridement, chemical decontamination of the root, insertion of xenogenic bone graft and an absorbable membrane, flap repositioning, and suturing. The control was performed every 30 days, and after 12 months, the region presented absence of BOP, PD reduction and increased clinical attachment level. However it was not observed a complete regeneration of interproximal bone. It was concluded that the elimination of periodontal disease activity may be a benefit of GTR but without total bone regeneration

Clinical and radiographic evaluation of Bio-Gen with biocollagen compared with Bio-Gen with connective tissue in the treatment of class II furcation defects: a randomized clinical trial

OBJECTIVE: Treatment of furcation defects are thought to be challenging. The purpose of this study was to evaluate the clinical and radiographic parameters of Bio-Gen with Biocollagen compared with Bio-Gen with connective tissue in the treatment of Class II furcation defects. MATERIAL AND METHODS: In this clinical trial, 24 patients with Class II furcation defect on a buccal or lingual mandibular molar were recruited. After oral hygiene instruction, scaling and root planing and achievement of acceptable plaque control, the patients were randomly chosen to receive either connective tissue and Bio-Gen (case group) or Biocollagen and Bio-Gen (control group). The following parameters were recorded before the first and re-entry surgery (six months later): vertical clinical attachment level (VCAL), gingival index (GI), plaque index (PI), horizontal probing depth (HPD), vertical probing depth (VPD), gingival recession (GR), furcation vertical component (FVC), furcation to alveolar crest (FAC), fornix to base of defect (FBD), and furcation horizontal component (FHC) were calculated at the time of first surgery and during re-entry. A digital periapical radiograph was taken in parallel before first surgery and re-entry. The radiographs were then analyzed by digital subtraction. The differences with p value <0.05 were considered significant. RESULTS: Only the mean changes of FAC, FHC, mean of FHC, FBD in re-entry revealed statistically significant differences between the two groups. HPD, VPD, FBD, FAC, and FHC showed statistically significant differences after 6 months in the case group. However, in the control group, statistically significant differences were found in GR and HPD. We did not observe any significant difference in radiographic changes among the two groups. CONCLUSION: The results of this trial indicate that better clinical outcomes can be obtained with connective tissue grafts in combination with bone material compared ...

Treatment of Intrabony Defects with Anorganic Bone Matrix/P-15 or Guided Tissue Regeneration in Patients with Aggressive Periodontitis

Intrabony periodontal defects present a particular treatment problem, especially in patients with generalized aggressive periodontitis (G-AgP). Regenerative procedures have been indicated for this clinical situation. The aim of this study was to compare treatment outcomes of intrabony periodontal defects with either anorganic bone matrix/cell binding peptide (ABM/P-15) or guided tissue regeneration (GTR) in patients with G-AgP. Fifteen patients, with two intrabony defects ≥3 mm deep, were selected. Patients were randomly allocated to be treated with ABM/P-15 or GTR. At baseline and at 3 and 6 months after surgery, clinical and radiographic parameters and IL-1β and IL-6 gingival fluid concentrations were recorded. There was a significant probing pocket depth reduction (p<0.001) for both groups (2.27 ± 0.96 mm for ABM/P-15 group and 2.57 ± 1.06 mm for GTR group). Clinical attachment level gain (1.87 ± 0.94 mm for ABM/P-15 group and 2.09 ± 0.88 mm for GTR group) was also observed. There were no statistically significant differences in clinical parameters between the groups. The radiographic bone fill was more expressive in ABM/P-15 group (2.49 mm) than in GTR group (0.73 mm). In subtraction radiographs, the areas representing gain in density were 93.16% of the baseline defect for ABM/P-15 group versus 62.03% in GRT group. There were no statistically significant differences in inter-group and intra-group comparisons with regards to IL-1β and IL-6 quantification. Treatment of intrabony periodontal defects in patients with G-AgP with ABM/P-15 and GTR improved significantly the clinical outcomes. The use of ABM/P-15 promoted a better radiographic bone fill.

Defeitos periodontais infra-ósseos representam um desafio particular no tratamento, especialmente em pacientes com periodontite agressiva generalizada (PAg-G). Procedimentos regenerativos tem sido indicados para esta situação clínica. O objetivo deste estudo foi comparar os resultados do tratamento de defeitos periodontais infra-ósseos com associação de matriz óssea inorgânica bovina com o P-15 (MOI/P-15) ou regeneração tecidual guiada (RTG) em pacientes com PAg-G. 15 pacientes com PAg-G, com pelo menos dois defeitos periodontais infra-ósseos (profundidade de sondagem ≥4 mm e componente infra-ósseo ≥3 mm) foram selecionados. Os pacientes foram aleatoriamente alocados para serem tratados com MOI/P-15 ou RTG. No exame inicial, e aos 3 e 6 meses após a cirurgia, os parâmetros clínicos e radiográficos e as concentrações de IL-1β e IL-6 no fluido gengival foram registrados. Houve uma redução significativa profundidade de sondagem (p<0,001) para ambos os grupos (2,27 ± 0,96 mm para o grupo MOI/P-15 e 2,57 ± 1,06 mm para o grupo RTG). Um ganho no nível clínico de inserção (1,87 ± 0,94 mm para o grupo MOI/P-15 e 2,09 ± 0,88 mm para o grupo RTG) também foi observado. Na comparação entre grupos, não houve diferenças estatisticamente significativas nos parâmetros clínicos. O preenchimento ósseo radiográfico foi mais expressivo no grupo MOI/P-15 (2,49 mm) do que no grupo RTG (0,73 mm). Na análise radiográfica, as radiografias de subtração apresentaram ganho médio de área radiopaca em relação ao defeito inicial de 93,16% para grupo MOI/P-15, contra 62,03% para o grupo RTG. Na análise das citocinas, não foram observadas diferenças estatisticamente significantes nas comparações intra e entre os grupos. O tratamento de defeitos infra-ósseos com MOI/P-15 ou RTG em pacientes com PAg-G, em um período de 6 meses, levou a melhoras nos parâmetros clínicos. O uso de MOI/P-15 levou a um maior preenchimento radiográfico.

Regeneración ósea guiada para el aumento vertical del reborde alveolar / Guided osseous regeneration for the vertical augmentation of the alveolar ridge

Se considera como aumento óseo vertical, cualquier técnica que apunte a crear una mayor altura del reborde alveolar. A inicios de la década de los 90’s se empezó a utilizar la regeneración ósea guiada (ROG) en mandíbulas atróficas, con el fin de permitir la instalación de implantes óseointegrados. Con el fin de evaluar y exponer parte de la evidencia disponible en la actualidad, con respecto a la ROG para aumento óseo vertical, se realizó la siguiente revisión bibliográfica.

Any technique aimed to improve the alveolar ridge height is considered as a vertical bone augmentation procedure. In the early 90’s guided bone regeneration (GBR) procedures began to be used in atrophic mandibles to allow the installation of osseointegrated dental implants. The following bibliographic review was made with the purpose of evaluating and exposing part of the available evidence at present in this field.

Combined therapy with mineral trioxideaggregate, and guided tissue regeneration for a large radicular cyst: a 13-year follow-up

Biomaterials such as membrane barriers and/or bone grafts are often used to enhance periapical new bone formation. A combination of apical surgery and these biomaterials is one of the latest treatment options for avoiding tooth extraction. In case of periapical lesions, guided tissue regeneration (GTR) is attempted to improve the self-regenerative healing process by excluding undesired proliferation of the gingival connective tissue or migration of the oral epithelial cells into osseous defects. In many cases, GTR is necessary for achieving periodontal tissue healing. This report describes the healing process after surgery in a challenging case with a long-term followup. In this case report, endodontic surgery was followed by retrograde sealing with mineral trioxide aggregate (MTA) in the maxillary right central incisor and left lateral incisor. Apicectomy was performed in the maxillary left central incisor and a 1-mm filling was removed. The bone defect was filled with an anorganic bone graft and covered with a decalcified cortical osseous membrane. No intraoperative or postoperative complications were observed. After 13 years of follow-up, the patient showed no clinical signs or symptoms associated with the lesion and radiographic examination showed progressive resolution of radiolucency. In conclusion, the combination of apical surgery and regenerative techniques can successfully help the treatment of periapical lesions of endodontic origin and is suitable for the management of challenging cases.

Newly forming bone graft: a novel surgical approach to the treatment of denuded roots

Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions. OBJECTIVES: The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >4 mm at buccal sites. MATERIAL AND METHODS: Four patients presenting deep recession defects at buccal sites (>4 mm) were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI) and keratinized gingiva width (KGW) were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively. RESULTS: All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss.

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.

Cirugía guiada en implantología: reporte de un caso / Guided surgery in implantology: a case report

El avance tecnológico de la odontología ha permitido el desarrollo de nuevas técnicas en la implantología y así alcanzar una evolución en el tratamiento de los edéntulos totales. Dentro de estas técnicas se destaca la cirugía guiada, que consiste en la utilización de imágenes de tomografía computadorizada para simular la colocación de implantes en un programa virtual computadorizado, confeccion inicial de una guía quirúrgica y posterior colocación de los implantes oseointegrados sin necesidad de levantar un colgajo. Esta técnica presenta como grandes ventajas: una disminución del tiempo de tratamiento (quirúrgico y protésico), menor sangrado, ofrece una mayor previsibilidad y menor incomodidad en el post-operatorio. Este artículo tiene como objetivo describir en un relato de caso clínico la rehabilitación de un individuo edéntulo total maxilar con la técnica de cirugía guiada

The technological advancement in dentistry has enabled the development of new techniques in implantology and has allowed an evolution in the treatment of edentulous patients. Among these techniques is highlighted guided surgery, which is the use of computed tomography to provide images to a computer program to simulate implant placement and enable the production of a prototyped guide that will allow the correct installation without the need for surgical flap. Besides having as main advantages the shorter duration of surgery and treatment, the decrease in bleeding, provides greater predictability and less discomfort during and after surgery. This article aims to describe a clinical case of oral rehabilitation of an individual edentulous upper jaw with the technique of imediated loaded with guided surgery

Use of periosteal membrane as a barrier membrane for the treatment of buccal Grade II furcation defects in lower molars: A novel technique.

Objective : To use the periosteum as a barrier in treatment of buccal Grade II furcation defects of lower molars. Materials and Methods : This technique was performed on 12 patients with bilateral buccal Grade II furcation defects of lower molars. On a random basis, one furcation defect of each pair was selected for the control group and other for the experimental group. Debridement was done in the defect area in both groups. In the control group, after debridement, mucoperiosteal flap was sutured back. In the experimental group, after reflection of the mucoperiosteal flap, a portion of the periosteum along with a layer of connective tissue (periosteal membrane) was incised and mobilized in the defect area for defect coverage as a barrier, and then the periosteal membrane and mucoperiosteal flap were fixed with suture, respectively. Horizontal dimension of the furcation defect was the primary outcome measure. Gingival index, probing attachment level (PAL), and vertical dimension of furcation defect were the secondary outcome measures. Clinical parameters were registered at baseline and at 6 months. Results : Every clinical parameter was improved by surgery. Significant gain in PAL as well as horizontal and vertical dimensions of the furcation defects was found. Conclusion: This periosteum displacement technique is effective for the treatment of buccal Grade II furcation defects of lower molars.

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.

Evaluation of the relative efficacy of an alloplast used alone and in conjunction with an osteoclast inhibitor in the treatment of human periodontal infrabony defects: A clinical and radiological study.

Background: Mucoperiosteal flap surgery stimulates varying amounts of alveolar bone loss due to accelerated osteoclastic activity [Regional Accelerated Phenomenon (RAP)]. Alendronate sodium inhibits osteoclastic activity and is thought to result in a net increase in osteoblastic activity. We undertook a preliminary study evaluating the effect of adjunctive use of topically delivered bisphosphonate alendronate (ALN) along with regenerative bone graft material in the treatment of periodontal infrabony defects. Materials and Methods: Fifteen patients with two-walled or three-walled infrabony defects were selected. In each patient, the infrabony defect of one side of arch was designated as group A (control site) and received hydroxyapatite (HA) bone graft material, while the infrabony defect on the contralateral side of same arch was designated as group B (test site) and received HA + 200 μg drug solution of ALN. Results: Both the groups exhibited a highly significant reduction in probing depth and gain in clinical attachment level and linear bone fill at the end of 24 weeks. Comparative evaluation between the study groups revealed a statistically nonsignificant reduction in probing depth (P=0.128 NS ) and mean gain in attachment level (P=0.218 NS ). However, there was a statistically significant gain in linear bone fill (P=0.040*) in group B as compared to group A. Conclusions: The results suggest that use of ALN along with graft material led to enhanced linear bone fill at the surgical site. This research provides a clue that bone-targeting properties of bisphosphonates can be harnessed along with regenerative materials to potentiate osseous regeneration.