Polynucleotides and Hyaluronic Acid (PN-HA) Mixture With or Without Deproteinized Bovine Bone Mineral as a Novel Approach for the Treatment of Deep Infra-Bony Defects: A Retrospective Case-Series.

Polynucleotides and Hyaluronic Acid (PN-HA) mixture showed several effects in modulation of healing process. The aim of this study was to assess the safety and clinical performance of PN-HA alone or in association with Deproteinized Bovine Bone Mineral (DBBM) with papillary preservation flaps (PPF) in the treatment of residual pockets. A total of 43 patients with 55 infra-bony defects were recruited; 30% were smokers. The mean baseline Probing Depth (PD) was 7.7 ±1.9 mm with a corresponding mean recession (Rec) of 1.9± 1.3 mm. The depth of infra-bony defect at the surgical measurement was 5.2±2.1 mm. DBBM was applied at 56% of the defects considered as not-containing based on clinical judgment. Healing was uneventful at all sites. After one year, PD reduction was 4.4±1.8 mm with a Rec increase of 1.0 ±0.8 mm. Detected bone fill at x-ray was 3.5 ± 1.9mm. The multilevel analysis showed that absence of smoking habits was associated with improved PD reduction (P =0.026) and bone gain (P= 0.039). PN-HA mixture is a safe product for periodontal surgery and seems to promote clinical benefit in the treatment of residual pockets associated to infra-bony defects.

The effect of immediate implant placement on alveolar ridge preservation compared to spontaneous healing after tooth extraction: Soft tissue findings from a randomized controlled clinical trial.

AIM: To compare soft tissue dimensional changes and relative differences in soft and hard tissue volumes 4 months after single-tooth extraction and three different treatment modalities: spontaneous healing (SH) and alveolar ridge preservation by means of a deproteinized bovine bone mineral and a collagen matrix, with (IMPL/DBBM/CM) or without (DBBM/CM) immediate implant placement. MATERIALS AND METHODS: STL files from study casts obtained at baseline and after 4 months were matched to calculate buccal soft tissue linear and volumetric changes. DICOM files from CBCTs were superimposed to STL files allowing the evaluation of soft tissue thickness at baseline and 4 months. RESULTS: Mean horizontal reduction accounted for 1.46 ± 0.20 (SH), 0.85 ± 0.38 (DBBM-CM) and 0.84 ± 0.30 IMPL/DBBM-CM, with no statistical differences. Soft tissue thickness had a significant mean increase of 0.95 for SH group, compared to a non-significant mean decrease for DBBM-CM (0.20) and IMPL/DBBM-CM groups (0.07). CONCLUSION: A preservation technique with DBBM-CM, with or without immediate implant placement, did not reduce the horizontal linear and volumetric changes at the buccal soft tissue profile significantly at 4 months after tooth extraction when compared to spontaneous healing. This is due to a significant increase in soft tissue thickness in spontaneously healing sites.

The effect of immediate implant placement on alveolar ridge preservation compared to spontaneous healing after tooth extraction: Radiographic results of a randomized controlled clinical trial.

AIM: To radiographically evaluate the effect of immediate implant placement plus alveolar ridge preservation (ARP) with a deproteneized bovine bone mineral and a collagen matrix (IMPL/DBBM/CM) as compared to ARP (DBBM/CM) or spontaneous healing (SH) on vertical and horizontal bone dimensional changes after 4 months of healing. MATERIALS AND METHODS: Thirty patients requiring extraction of one single-rooted tooth or premolar were randomly assigned to IMPL/DBBM/CM, ARP DBBM/CM or SH. Cone-beam computed tomography (CBCT) scans, performed before tooth extraction and after 4 months, were superimposed in order to assess changes in ridge height at the buccal and lingual aspect and in ridge width at 1 mm, 3 mm and 5 mm apical to the bone crest. Kruskal-Wallis test was applied for comparison of differences between groups. RESULTS: No statistically significant differences between the groups were observed for the vertical bone resorption of the buccal and the lingual side, while significant differences were found between SH group (-3.37 ± 1.55 mm; -43.2 ± 25.1%) and both DBBM/CM (-1.56 ± 0.76 mm; -19.2 ± 9.1%) and IMPL/DBBM/CM (-1.29 ± 0.38 mm; -14.9 ± 4.9%) groups in the horizontal dimension at the most coronal aspect. CONCLUSION: Ridge preservation techniques using DBBM and CM reduce the horizontal bone morphological changes that occur, mostly in the coronal portion of the buccal bone plate following tooth extraction, when compared to spontaneous healing. This is true regardless of whether immediate implant placement is performed or not.