Two-year follow-up of the outcomes of endoscope-assisted minimally invasive nonsurgical periodontal therapy for deep intrabony defects / 口腔疾病防治

Objective@#To explore the clinical efficacy and imaging changes of minimally invasive nonsurgical periodontal therapy (MINST) assisted by endoscopy for deep intrabony defects and to compare its effectiveness with that of traditional scaling and root planning (SRP) to therefore provide a reference for clinical periodontal treatment.@*Methods@#Patients with deep intrabony defects ≥ 4 mm in size were selected and divided into two groups: the MINST (MINST, 20 cases, 81 sites) group and the classic scaling and root planing (SRP, 20 cases, 80 sites) group. Before treatment and 12 and 24 months after treatment, probing depth (PD) and clinical attachment loss (CAL) were examined. Moreover, changes in the depth and angle of the intrabony defects were analyzed. Follow-up examination and maintenance treatment should be conducted every 3 months for 12 months after the initial treatment and every 6 months thereafter until 24 months.@*Results@#The PD and CAL of patients in both groups continued to decrease (P<0.001), and imaging examinations revealed a decrease in defect depth and an increase in intrabony defect angle (P<0.001). The changes in the first 12 months were significantly greater than those in the last 12 months in both groups (P<0.001). The decreases in PD, CAL, and depth of intrabony defects and increase in angle in the MINST group were significantly greater than those in the SRP group (P<0.001). At 12 and 24 months after treatment, the PD and CAL in the MINST group were lower than those in the SRP group (P<0.001). The defect height of the MINST group decreased more than that of the SRP group (P<0.001), and the defect angle of the MINST group increased more than that of the SRP group (P<0.001).@*Conclusion@#Minimally invasive nonsurgical periodontal therapy can significantly promote the healing of deep intrabony defects and the regeneration of alveolar bone. Imaging reflects that alveolar bone healing is rapid at first and then slows. Compared with traditional SRP, endoscopically assisted MINST can yield better clinical indicators and imaging changes in intrabony defects.

Clinical and radiographic evaluation of Bio-Oss granules and Bio-Oss Collagen in the treatment of periodontal intrabony defects: a retrospective cohort study

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.

Clinical Evaluation of Regenerative Potential of Xenogenic Bone Grafts in The Treatment of Periodontal Intrabony Defects

The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to evaluate the efficacy of xenogenic bone graft with open flap debridement (OFD) in treatment of periodontal intrabony defects. Methods: Twenty intrabony defects were surgically treated. The defects were randomly assigned to treatment with OFD + bone graft (Group B) or OFD alone (Group A). The clinical efficacy of two treatment modalities was evaluated at 9months postoperatively clinically and radiographically. Results: Statistically significant intra group improvements were seen with all the hard tissue and soft tissue parameters in both test and control groups. Statistically significant improvements were seen in group B with clinical parameters and the mean defect fill (AC-BOD) when intergroup comparisons were made. Conclusion: Treatment with bone graft + OFD led to a significantly more favorable clinical outcome in intrabony defects as compared to OFD alone.

Decalcified freeze-dried bone allograft combined with rich platelet derivatives for the treatment of human periodontal intrabony defects: a Meta-analysis / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This review aims to systematically evaluate the effect of decalcified freeze-dried bone allograft (DFDBA) combined with rich platelet derivatives on the treatment of human periodontal intrabony defects.</p><p><b>METHODS</b>A search in PubMed, Web of Science, Embase, Cochrane Library, CNKI, and other electronic databases was conducted to identify randomized controlled trials (RCT) of the use of DFDBA combined with rich platelet derivatives in the treatment of human periodontal intrabony defects, performed before May 2016. The quality of the RCTs was assessed. RevMan 5.3 software was applied for Meta-analysis.</p><p><b>RESULTS</b>A total of nine RCTs were included. A total of 194 patients and 303 defects were involved. Short-term (6 months) and long-term (12 to 18 months) groups were included. Meta-analysis results revealed that DFDBA combined with rich platelet derivatives was superior to DFDBA or rich platelet derivatives alone for probing depth reduction in the short-term [MD=0.75 mm, 95% confidence intervals (CI) (0.31 mm, 1.20 mm), P=0.001 0] and longterm groups [MD=0.87 mm, 95%CI (0.02 mm, 1.72 mm), P=0.04], clinical attachment level gain in the short-term [MD=
0.65 mm, 95%CI (0.08 mm, 1.22 mm), P=0.03] and long-term groups [MD=1.31 mm, 95%CI (0.60 mm, 2.01 mm), P<0.000 3], gingival recession reduction in the long-term group [MD=-0.58 mm, 95%CI (-0.78 mm, -0.38mm), P<0.000 01], bone fill gain in the short-term [MD=0.52 mm, 95%CI (0.03 mm, 1.00 mm), P=0.04] and long-term groups [MD=1.26 mm, 95%CI (0.65 mm, 1.86 mm), P<0.000 1].</p><p><b>CONCLUSIONS</b>DFDBA combined with platelet rich derivatives is probably effective in the treatment of human periodontal intrabony defects. It is probably superior to DFDBA or platelet rich derivatives alone. Considering the limitation of the included studies, high-quality and large-sample RCTs are required to evaluate the effect.</p>

Regenerative Potential of Platelet Rich Fibrin (PRF) for Curing Intrabony Periodontal Defects: A Systematic Review of Clinical Studies

Platelet-rich fibrin (PRF) has been used in regenerative medicine and dentistry. Recently, its use has been advocated for regenerative periodontics and wound healing. The randomized control trials have assessed the regenerative efficacy of the PRF for restoring intrabony periodontal defects.The objectives are to critically analyze and appraise the currently available literature, focusing on the use of PRF in regenerating periodontal bone defects. An electronic search was conducted (PubMed/MEDLINE, Google Scholar, ISI-WOS). Various combinations of following keywords were used: ‘ platelet-rich fibrin’, ‘ intrabony’, ‘ periodontal’, ‘ bone defect’ and ‘ guided tissue regeneration’.Asecondary search was conducted by analyzing the reference lists of the articles obtained in initial search. The final search resulted in 13 randomized controlled trials being included. Inmajority of studies, PRF resulted in better clinical/radiographic outcomes than open flap debridement and augmented therapeutic effects of bone grafts. The combination of bovine bone substitutes and PRF resulted in better performance compared to alone. Similarly better outcomes were observed while using PRF in combination with nanohydroxyapatite, metformin and demineralized freeze-dried bone allograft. It can be concluded that PRF produces better outcomes than open flap debridement alone and augments the regenerative effects of bone substitutes.

Porous Titanium Granules in Treatment of Intra-bony Defects: A Literature Review.

Background: This study aimed to do a review on the applications of porous titanium granules (PTG) in periodontal and non-periodontal treatments. Methods: An electronic search was carried out in Google Scholar and PubMed databases using the key words “guided tissue regeneration”, “intrabony defects”, “porous titanium granules” and “moderate to advanced chronic periodontitis”. English articles published from 2006 to 2014 were searched. Results: Porous titanium granules showed positive results in enhancing the outcome of treatment in medicine. Most of the relevant studies have been conducted using culture media or animal models. Conclusion: It can be stated that PTGs have many applications in periodontal procedures due to their space maintaining capability, long-term substantivity, not requiring a membrane and biocompatibility.

Evaluation of the polyactide-polyglycolide copolymer Fisiograft® in the treatment of intrabony defects: clinical and radiographic results of a pilot study

To evaluate the efficacy of the polylactide-polyglycolide copolymer Fisiograft® as a bone graft material in the treatment of interproximal intrabony defects clinically and radiographically. Methods: A total of 22 intrabony defects in 8 patients with chronic periodontitis (4 males and 4 females) aged 20 to 55 years were recruited and divided equally into two groups: control (open flap debridementalone) and experimental (open flap debridement with Fisiograft®). Recordings of probing pocket depth (PPD), clinical attachment level (CAL), gingival margin position (GMP) and radiovisiographic assessment was done at baseline and 6 months. Results: Statistical analysis was done by Wilcoxon Signed Rank test for intra-group comparisons and Mann-Whitney U-test for inter-group comparisons. The clinical parameters PPD, CAL and GMP were found to be statistically significant(p<0.05) within each group. Inter-group comparison showed only the CAL gain to be statistically significant (p<0.01). In relation to hard tissue changes, statistically significant (p=0.05) result was seen for the percent filling of the original defect, comparing the experimental and control groups 6 months postoperatively. Conclusions: Placement of Fisiograft® resulted in better healing of intrabony defects as assessed clinically and radiographically when compared to open flap debridement alone.

Histologic evaluation of various membranes on periodontal tissue regeneration of 1-wall intrabony defects in dogs / 대한치주과학회지

PURPOSE: In dental clinical fields, various periodontal membranes are currently used for periodontal regeneration. The periodontal membranes are categorized into two basic types: resorbable and non-resorbable. According to the case, clinician select which membrane is used. Comparing different membranes that are generally used in clinic is meaningful. For this purpose, this study evaluates histological effects of various membranes in canine one wall intrabony defect models and it suggest a valuation basis about study model. MATERIAL AND METHOD: The membranes were non-resorbable TefGen Plus(R), resorbable Gore Resolut XT(R) and resorbable Osteoguide(R). One wall intrabony defects were surgically created at the second and the mesial aspect of the fourth mandibular premolars in either right or left jaw quadrants in two dogs. The animals were euthanized 8 weeks post-surgery when block sections of the defect sites were collected and prepared for histological evaluation. RESULTS: 1. While infiltration of inflammatory cells were observed in control, TefGen Plus(R) and Gore Resolut XT(R), it was not observed in Osteoguide(R). 2. TefGen Plus(R) had higher integrity than others and Osteoguide(R) was absorbed with folding shape. Gore Resolut XT(R) was divided everal parts during resorbtion and it was also absorbed from inside. 3. Quantity of new bone and new cementum was not abundant in all membranes. 4. For histologic evaluation of membranes we should consider infiltration of inflammatory, migration of junctional epithelium, integrity of membrane, quantity of new bone and new cementum, connective tissue formation and aspect of resorption. CONCLUSION: This histologic evaluation suggests that Osteoguide(R) provides periodontal regenerative environment with less inflammatory state. It is meangful that this study model suggests a valuation basis about other study model.

Movimento ortodôntico em dentes com defeitos periodontais intra-ósseos: análise clínica e histológica em cães / Orthodontic movement of teeth with intrabony peridontal defects: clinical and histologic analysis in dogs

Este estudo teve como objetivo analisar, em cães, as alterações periodontais que ocorrem, clínica e histologicamente, quando a raiz de um dente que apresenta um defeito periodontal intra-ósseo de uma parede em uma de suas faces proximais é movimentada para dentro deste defeito. Foram utilizados 4 cães adultos, nos quais os defeitos foram criados nas faces mesiais dos segundos premolares superiores e quartos premolares inferiores e distal dos segundos premolares inferiores. Os dentes foram divididos em dois grupos: teste e controle, sendo que neste último, os mesmos não foram movimentados. Sete dias após, instalou-se o aparelho ortodôntico que consistiu na colocação de uma mola de fio retangular de TMA com um sistema de força que permitiu obter um movimento de inclinação radicular. A fase ativa do movimento ortodôntico durou 2 meses e após um período igual de estabilização, os animais foram sacrificados.Durante todo o estudo, os animais receberam um controle de placa bacteriana com aplicação diária de gel digluconato de clorexidina a 2,0%. As análises clínica e histológica demonstraram que ambos os grupos apresentaram resultados semelhantes, com regularização do defeito e regeneração periodontal parcial, limitada à sua porção apical. A análise histométrica do cemento novo, inserção conjuntiva e migração epitelial não demonstrou diferenças significantes entre os grupos. Houve diferença estatística apenas para a altura óssea, que foi 0,53 mm, em média, menor do Grupo Experimental. Os resultados nos permitiram concluir que o movimento ortodôntico realizado não interferiu na reparação dos defeitos intra-ósseos de uma parede, exceto na extensão linear coronária de osso novo formado

The aim of this study was to clinically and histologically evaluate, in dogs, the periodontal alterations that occur when a dental root with a periodontal intrabony defect in one of its proximal faces is moved into this defect. Four adult dogs with surgically created defects in the mesial faces of second upper premolars and forth lower premolars, and distal face of second lower premolars were used. Seven days later an orthodontic appliance was adapted with a TMA spring for root movement. The active phase of orthodontic movement was present for two months and after an equivalent period for stabilization the animals were sacrifield. During this study the animals received plaque control with daily use of 2,0% chlorexedine digluconate gel. Clinical and histological analysis showed similar results for both groups, with defect regularization and partial periodontal regeneration in its apical portion. The histometric evaluation of the new cement, connective insertion and epitelial migration did not show significant differences between the groups. There was statistic significant difference in osseous height, that was 0.53 mm lower in the experimental group. The results let us conclude that the orthodontic movement did not interfere in the reparation of intrabony defects, with the exception of the linear coronary extension of the new bone formed