Ozonoterapia como adyuvante en el tratamiento periodontal no quirúrgico y quirúrgico / Ozonoterapia as adjuvant in the non-surgical and surgical periodontal treatment

Introducción: El ozono (O3) presenta múltiples acciones biológicas, entre ellas su efecto antimicrobiano, lo que ha sido beneficioso en odontología, siendo la presentación acuosa la más utilizada (20 µg/ mL), la cual presenta efectos similares a la clorhexidina. Reporte de caso: Paciente masculino de 76 años de edad, diagnosticado con periodontitis crónica moderada localizada, el cual fue tratado mediante ozonoterapia acuosa durante la fase inicial periodontal y la fase quirúrgica en colgajo por debridación. 12 semanas posteriores al acto quirúrgico se obtuvo la eliminación de las bolsas periodontales, encontrándose un surco de 3 y 2 mm y un buen control de placa dentobacteriana. Conclusión: No existen reportes acerca del uso de ozonoterapia acuosa durante un colgajo por debridación. El éxito del tratamiento periodontal consiste en la eliminación del factor causal así como en establecer y mantener un control de placa dentobacteriana adecuado (AU)

Introduction: Ozone (O3) has multiple biological actions, including its antimicrobial effect, which has been beneficial in dentistry, the aqueous presentation being the most used (20 µg/mL), which has similar effects to chlorhexidine. Case report: Male patient of 76 years of age, diagnosed with localized moderate chronic periodontitis, which was treated by aqueous ozone therapy during the initial periodontal phase and surgical phase in debridement flap. Twelve weeks after surgery, the periodontal pockets were eliminated, finding a 3 and 2 mm groove and good control of dentobacterial plaque. Conclusion: There are no reports about the use of aqueous ozone therapy during a debridement flap. The success of the periodontal treatment consists in the elimination of the causal factor, as well as establishing and maintaining an adequate control of plaque (AU)

Exostosis: A donor site for autograft.

This article reports the utilization of exostosis as a source of autogenous bone for the treatment of osseous defects. A patient presented with an exostosis on the mandibular lingual region on the right side of the jaw. Exostosis was surgically removed using a chisel and mallet. The autograft thus obtained was used to treat a shallow osseous crater between 46 and 47. New bone formation was noticed at the grafted site 6 months after grafting. Bone formed in the grafted areas showed comparable clinical features to those of native bone.

Treatment of human periodontal infrabony defects with hydroxyapatite+ β tricalcium phosphate bone graft alone and in combination with platelet rich plasma: A randomized clinical trial.

Background: The present study was aimed at comparing the clinical effectiveness of two regenerative techniques - platelet rich plasma (PRP) + bone graft (HA + β TCP) versus bone graft (HA + β TCP) + normal saline in the treatment of periodontal intrabony defects. Materials and Methods: Ten patients diagnosed with chronic periodontitis were enrolled in a randomized split mouth clinical trial. Following phase I therapy the sites were randomly assigned to the test group - PRP + bone graft (HA + β TCP) and control group - saline + bone graft (HA + β TCP). Clinical parameters recorded at baseline and 6 months included plaque index, probing pocket depth, relative attachment levels, and relative gingival margin levels. Hard tissue evaluation was done using digital radiography to evaluate the image intensity and therefore the radioopacity of a desired region of interest in the intrabony defect. Pre- and postoperative comparisons were made between the treatment groups at 6 months. Results: Test group sites showed a significantly higher reduction in pocket depth compared to control group sites. Test group sites showed a significantly higher amount of radioopacity in the regions of interest, indicative of better graft remodeling, compared to control group sites. Conclusion: (HA + β TCP) bone graft appears to be a beneficial material in the treatment of human periodontal intrabony defects. When combined with platelet-rich plasma there is a significantly higher reduction in probing pocket depth, higher gain in attachment levels and higher amount of radio-density seen in the intrabony defects.

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.

Comparison of the regenerative potential of an allograft used alone and that in conjunction with an immunosuppressive drug in the treatment of human periodontal infrabony defects: A clinical and radiological study.

Background: Experimentation confirmed the conclusion that bone allografts, like other tissue and organ allografts, are immunogenic. These immune responses cause resorption of allograft, thus lowering the bone formation capacity of the graft. An attempt has been made in this study to prevent immune reactions and achieve enhanced regeneration of allograft-demineralized freeze-dried bone matrix by incorporating it with an immunosuppressive drug Cyclosporine-A (CsA) in the treatment of human periodontal infrabony defects. Materials and Methods: Fifteen patients showing clinical evidence of almost bilateral infrabony defects requiring bone grafting procedures were selected. In each patient, the infrabony defect of one side of the arch was designated as Group A (control site) and the infrabony defect of the contralateral side of the same arch was designated as Group B (test site). Results: On comparative evaluation of the two groups (by Student t-test), the mean values of reduction in probing depth (P=0.81 NS ) and gain in clinical attachment level (P=1.00 NS ) of Group B were found to be greater than that of Group-A, but the differences were statistically non-significant. The mean linear bone fill (P=0.010 ** ) of Group B was also detected to be higher than that of Group A, and the difference was found to be statistically significant. Conclusion: Increase in linear bone fill in Group B signifies the role of CsA in augmenting the regenerative potential of allograft by eliminating immune reactions.

Efficacy and acceptability of 0.074% diclofenac-containing mouthwash after periodontal surgery: A clinical study.

Background: The systemic use of non-steroidal anti-inflammatory drugs are associated with various side-effects like hepatotoxicity, blood dyscrasias, nephrotoxicity and gastric irritability. Among these, gastric irritability is the most common and the most important one, which should be taken care of. Therefore, it may be preferable to use a local formulation such as a mouthwash to treat the inflammatory conditions of the oral cavity. Aim: To determine the efficacy and acceptability of 0.074% diclofenac mouthwash in relieving pain and inflammation of post-periodontal surgery patients. Materials and Methods: The study was designed as a double-blind, placebo-controlled clinical trial. Twenty chronic periodontitis patients who were scheduled for full-mouth periodontal flap surgery were randomized to receive either diclofenac mouthwash or placebo to rinse with 15 ml of solution daily for a period of 7 days. Modified gingival index (Lobene 1986) was used to verify gingival inflammation and visual analog scale was used to assess pain. After the baseline measurements for all the parameters were recorded, spontaneous pain and burning were evaluated daily while redness and edema were recorded on the 3 rd and 7 th day from the day of treatment. Results: Data obtained were analyzed statistically using paired " t" test for intragroup comparison and unpaired " t"-test for intergroup comparison. Spontaneous pain was significantly reduced by diclofenac mouthwash. Other parameters, i.e. gingival inflammation and swelling, had not shown significant reduction in scores in either group, although the reduction was higher in the test group. Conclusion: The new 0.074% diclofenac mouthwash is an effective and tolerable medicinal product for post-surgical symptomatic relief.

Evaluation of HTR polymer (Bioplant® HTR® ) as a bone graft material in the treatment of interproximal vertical bony defects: A clinical and radiological study.

Background and Objectives : Bone grafting is the most common form of regenerative therapy. Several bone substitutes have been used in clinical periodontal therapy to encourage bone formation. The present study has been undertaken to evaluate the efficacy of hard tissue replacement polymer (Bioplant® HTR® ) as a bone graft material in the treatment of interproximal vertical bony defects in human beings, both clinically and radiologically. Materials and Methods : Five chronic periodontitis patients were selected with 16 sites assigned randomly into control (open debridement alone) and experimental (open flap debridement plus Bioplant® HTR® ) groups. Clinical measurements like plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), gingival margin position (GMP) assessment was done at 0, 3 and 6 months and radiographic assessment at 0 and 6 month. Statistical analysis was performed using Wilcoxon's signed Rank test and Mann-whitney U-test. Results : There were statistically no significant (P=1.00) changes in Plaque index and Gingival Index scores in both the groups from baseline to six months post surgery. Statistically significant (P<0.05) reduction in Probing Pocket Depth was seen on comparison between the groups. In relation to the hard tissue changes, significant results were seen with respect to change in alveolar crest and percentage of original defect resolved. Comparison of results from six to 12 months following similar treatments showed no significant differences or advantages to having a clinical evaluation period longer than 6 months post surgically (Yukna 1999). Interpretation and Conclusion : Bioplant® HTR® material is a biocompatible, easy to handle and a beneficial grafting material for the treatment of periodontal osseous defects.

Use of enamel matrix protein derivative with minimally invasive surgical approach in intra-bony periodontal defects: clinical and patient-centered outcomes

This case series evaluated the clinical performance and patient-centered outcomes after a minimally invasive surgical technique (MIST) associated with enamel matrix protein derivative (EMD), for the treatment of intra-bony defects. Twelve patients presenting teeth with probing depth >5 mm and bleeding on probing associated with radiographic evidence of intra-bony defect were treated by MIST associated with EMD. Clinical parameters were measured at baseline, 3 and 6 months. Patient perception during the intraoperative period and during the first postoperative week was evaluated. The use of MIST with EDM promoted significant improvements in clinical parameters, minimal pain/discomfort and maximum esthetics satisfaction. Within of limits of the present study, it could be shown that MIST combined with EMD for the treatment of intra-bony defects promotes satisfactory clinical and patient-centered outcomes.

O objetivo deste estudo foi avaliar os resultados clínicos e centrados no paciente após abordagem cirúrgica minimamente invasiva (CMI) associada à aplicação das proteínas derivadas da matriz do esmalte (PDE) no tratamento de defeitos infra-ósseos. Doze pacientes apresentando um sítio com profundidade de sondagem >5 mm e sangramento à sondagem , associado à evidência radiográfica de defeito infra-ósseo, foram tratados com CMI e aplicação das PDE. Os parâmetros clínicos foram avaliados imediatamente antes do procedimento e após 3 e 6 meses. A percepção de dor e desconforto do paciente durante o período trans-cirúrgico e ao longo da primeira semana de pós-operatório, bem como a satisfação estética 6 meses após o tratamento, foram avaliadas por meio de questionários. Os resultados mostraram que o uso da CMI associada à aplicação de PDE promoveu melhoras estatisticamente significantes nos parâmetros clínicos, mínima dor e desconforto e máxima satisfação estética aos pacientes. Dentro dos limites do estudo, foi demonstrado que a associação de CMI e PDE, no tratamento de defeitos infra-ósseos, é capaz de promover satisfatórios resultados clínicos e centrados no paciente.