Adjunctive Nd:YAG laser irradiation in the treatment of stage III/IV periodontitis: a 12-month, randomized, controlled trial.

OBJECTIVES: The aim of this study was to evaluate the clinical efficacy of the adjunctive use of Nd:YAG laser (1064 nm) to full-mouth scaling and root planning (FMS), in stage III/IV periodontitis patients. MATERIALS AND METHODS: Sixty stage III/IV periodontitis patients were randomly assigned to three groups. The control group received FMS, laser 1 group received combined FMS/single Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 µs), and laser 2 group received combined FMS/double Nd:YAG laser irradiation with 1-week interval (2.0 W, 200 mJ, 10 Hz, 100 µs). PD, CAL, FMPS, GI, FMBS, and GR were evaluated at baseline, 6 weeks, 3, 6, and 12 months after treatment. Patient-reported outcomes were evaluated 1 week after treatment. RESULTS: A significant improvement (p < 0.001) for all clinical parameters was observed during the entire study period, with the exception of mean CAL gain for the laser 2 group at 12 months. The percentage of pockets ≤ 4 mm was significantly higher compared to baseline for all groups throughout the study, with no inter-group differences at any time point. Patient-reported analgesic consumption was higher for laser 1 group. CONCLUSIONS: The adjunctive use of Nd:YAG laser irradiation was similarly effective to FMS alone, during the entire study period. A slightly higher, though not statistically significant improvement was reported for PD at 6 and 12 months after a single post-FMS application of Nd:YAG laser for pocket epithelium removal and coagulation. CLINICAL RELEVANCE: Additional Nd:YAG laser application for sulcular epithelium removal and coagulation may provide minor long-term improvements compared to FMS or laser irradiation for pocket disinfection and detoxification. TRIAL REGISTRATION: ISRCTN26692900. Registration date: 09/06/2022.

Histologic evidence of periodontal regeneration in furcation defects: a systematic review.

OBJECTIVE: To systematically review the available histologic evidence on periodontal regeneration in class II and III furcations in animals and humans. MATERIALS AND METHODS: A protocol including all aspects of a systematic review methodology was developed including definition of the focused question, defined search strategy, study inclusion criteria, determination of outcome measures, screening methods, data extraction and analysis, and data synthesis. The focused question was defined as follows: "What is the regenerative effect obtained by using or not several biomaterials as adjuncts to open flap surgery in the treatment of periodontal furcation defects as evaluated in animal and human histological studies?" SEARCH STRATEGY: Using the MEDLINE database, the literature was searched for articles published up to and including September 2018: combinations of several search terms were applied to identify appropriate studies. Reference lists of review articles and of the included articles in the present review were screened. A hand search of the most important dental journals was also performed. CRITERIA FOR STUDY SELECTION AND INCLUSION: Only articles published in English describing animal and human histological studies evaluating the effect of surgical treatment, with or without the adjunctive use of potentially regenerative materials (i.e., barrier membranes, grafting materials, growth factors/proteins, and combinations thereof) for the treatment of periodontal furcation defects were considered. Only studies reporting a minimum of 8 weeks healing following reconstructive surgery were included. The primary outcome variable was formation of periodontal supporting tissues [e.g., periodontal ligament, root cementum, and alveolar bone, given as linear measurements (in mm) or as a percentage of the instrumented root length (%)] following surgical treatment with or without regenerative materials, as determined histologically/histomorphometrically. Healing type and defect resolution (i.e., complete regeneration, long junctional epithelium, connective tissue attachment, connective tissue adhesion, or osseous repair) were also recorded. RESULTS: In animals, periodontal regeneration was reported in class II and III defects with open flap debridement alone or combined with various types of bone grafts/bone substitues, biological factors, guided tissue regeneration, and different combinations thereof. The use of biological factors and combination approaches provided the best outcomes for class II defects whereas in class III defects, the combination approaches seem to offer the highest regenerative outcomes. In human class II furcations, the best outcomes were obtained with DFDBA combined with rhPDGF-BB and with GTR. In class III furcations, evidence from two case reports indicated very limited to no periodontal regeneration. CONCLUSIONS: Within their limits, the present results suggest that (a) in animals, complete periodontal regeneration has been demonstrated in class II and class III furcation defects, and (b) in humans, the evidence for substantial periodontal regeneration is limited to class II furcations. CLINICAL RELEVANCE: At present, regenerative periodontal surgery represents a valuable treatment option only for human class II furcation defects but not for class III furcations.

Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review.

Intrabony periodontal defects are a frequent complication of periodontitis and, if left untreated, may negatively affect long-term tooth prognosis. The optimal outcome of treatment in intrabony defects is considered to be the absence of bleeding on probing, the presence of shallow pockets associated with periodontal regeneration (i.e. formation of new root cementum with functionally orientated inserting periodontal ligament fibers connected to new alveolar bone) and no soft-tissue recession. A plethora of different surgical techniques, often including implantation of various types of bone graft and/or bone substitutes, root surface demineralization, guided tissue regeneration, growth and differentiation factors, enamel matrix proteins or various combinations thereof, have been employed to achieve periodontal regeneration. Despite positive observations in animal models and successful outcomes reported for many of the available regenerative techniques and materials in patients, including histologic reports, robust information on the degree to which reported clinical improvements reflect true periodontal regeneration does not exist. Thus, the aim of this review was to summarize, in a systematic manner, the available histologic evidence on the effect of reconstructive periodontal surgery using various types of biomaterials to enhance periodontal wound healing/regeneration in human intrabony defects. In addition, the inherent problems associated with performing human histologic studies and in interpreting the results, as well as certain ethical considerations, are discussed. The results of the present systematic review indicate that periodontal regeneration in human intrabony defects can be achieved to a variable extent using a range of methods and materials. Periodontal regeneration has been observed following the use of a variety of bone grafts and substitutes, guided tissue regeneration, biological factors and combinations thereof. Combination approaches appear to provide the best outcomes, whilst implantation of alloplastic material alone demonstrated limited, to no, periodontal regeneration.

Which biomaterials may promote periodontal regeneration in intrabony periodontal defects? A systematic review of preclinical studies.

OBJECTIVE: To systematically analyze the regenerative effect of the available biomaterials either alone or in various combinations for the treatment of periodontal intrabony defects as evaluated in preclinical histologic studies. DATA SOURCES: A protocol covered all aspects of the systematic review methodology. A literature search was performed in Medline, including hand searching. Combinations of searching terms and several criteria were applied for study identification, selection, and inclusion. The preliminary outcome variable was periodontal regeneration after reconstructive surgery obtained with the various regenerative materials, as demonstrated through histologic/ histomorphometric analysis. New periodontal ligament, new cementum, and new bone formation as a linear measurement in mm or as a percentage of the instrumented root length were recorded. Data were extracted based on the general characteristics, study characteristics, methodologic characteristics, and conclusions. Study selection was limited to preclinical studies involving histologic analysis, evaluating the use of potential regenerative materials (ie, barrier membranes, grafting materials, or growth factors/proteins) for the treatment of periodontal intrabony defects. Any type of biomaterial alone or in various combinations was considered. All studies reporting histologic outcome measures with a healing period of at least 6 weeks were included. A meta-analysis was not possible due to the heterogeneity of the data. CONCLUSION: Flap surgery in conjunction with most of the evaluated biomaterials used either alone or in various combinations has been shown to promote periodontal regeneration to a greater extent than control therapy (flap surgery without biomaterials). Among the used biomaterials, autografts revealed the most favorable outcomes, whereas the use of most biologic factors showed inferior results compared to flap surgery.

Treatment of multiple adjacent Miller class I and II gingival recessions with a Modified Coronally Advanced Tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial.

BACKGROUND: A newly developed collagen matrix (CM) of porcine origin has been shown to represent a potential alternative to palatal connective tissue grafts (CTG) for the treatment of single Miller Class I and II gingival recessions when used in conjunction with a coronally advanced flap (CAF). However, at present it remains unknown to what extent CM may represent a valuable alternative to CTG in the treatment of Miller Class I and II multiple adjacent gingival recessions (MAGR). The aim of this study was to compare the clinical outcomes following treatment of Miller Class I and II MAGR using the modified coronally advanced tunnel technique (MCAT) in conjunction with either CM or CTG. METHODS: Twenty-two patients with a total of 156 Miller Class I and II gingival recessions were included in this study. Recessions were randomly treated according to a split-mouth design by means of MCAT + CM (test) or MCAT + CTG (control). The following measurements were recorded at baseline (i.e. prior to surgery) and at 12 months: Gingival Recession Depth (GRD), Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Keratinized Tissue Width (KTW), Gingival Recession Width (GRW) and Gingival Thickness (GT). GT was measured 3-mm apical to the gingival margin. Patient acceptance was recorded using a Visual Analogue Scale (VAS). The primary outcome variable was Complete Root Coverage (CRC), secondary outcomes were Mean Root Coverage (MRC), change in KTW, GT, patient acceptance and duration of surgery. RESULTS: Healing was uneventful in both groups. No adverse reactions at any of the sites were observed. At 12 months, both treatments resulted in statistically significant improvements of CRC, MRC, KTW and GT compared with baseline (p < 0.05). CRC was found at 42% of test sites and at 85% of control sites respectively (p < 0.05). MRC measured 71 ± 21% mm at test sites versus 90 ± 18% mm at control sites (p < 0.05). Mean KTW measured 2.4 ± 0.7 mm at test sites versus 2.7 ± 0.8 mm at control sites (p > 0.05). At test sites, GT values changed from 0.8 ± 0.2 to 1.0 ± 0.3 mm, and at control sites from 0.8 ± 0.3 to 1.3 ± 0.4 mm (p < 0.05). Duration of surgery and patient morbidity was statistically significantly lower in the test compared with the control group respectively (p < 0.05). CONCLUSIONS: The present findings indicate that the use of CM may represent an alternative to CTG by reducing surgical time and patient morbidity, but yielded lower CRC than CTG in the treatment of Miller Class I and II MAGR when used in conjunction with MCAT.

Treatment of class III multiple gingival recessions: a randomized-clinical trial.

BACKGROUND: The aim of this controlled randomized split-mouth study was to evaluate whether a modified tunnel/connective tissue graft (CTG) technique - enamel matrix derivative (EMD) combination will improve the treatment of multiple class III recession when compared with the same technique alone. MATERIALS AND METHODS: Twenty healthy subjects with a mean age of 31.7 years, were enrolled for the trial in a university periodontal clinic. Patients with at least three adjacent gingival recessions on both sides of the mouth were treated with a modified tunnel/CTG technique. On the test side, an EMD was used in addition. Clinical parameters were measured at baseline, 28 days, 3, 6 and 12 months after the surgery. Results are presented at the subject level. RESULTS: The mean root coverage from baseline to 1 year post-surgery was 82% for the test group and 83% for the control group. Complete root coverage was achieved at 1 year in eight (38%) of the 20 surgeries (experimental and control group). CONCLUSIONS: One-year results indicate that the modified tunnel/CTG technique is predictable for the treatment of multiple class III recession-type defects. The addition of EMD does not enhance the mean clinical outcomes.

Effect of platelet-rich plasma on the healing of intrabony defects treated with an anorganic bovine bone mineral: a pilot study.

BACKGROUND: Periodontal therapy using the combination of platelet-rich plasma (PRP) and different grafting materials has been suggested as a modality to enhance the outcome of regenerative surgery. In most clinical studies, a barrier membrane was used to cover the defects, and thus, the effects of PRP may have been masked by the effects of the barrier. The data from controlled clinical studies evaluating the effect of regenerative therapy using various grafting materials with or without PRP are still limited. The purpose of this study was to clinically compare the healing of intrabony defects treated with either a combination of an anorganic bovine bone mineral (ABBM) and PRP to those obtained with ABBM alone. METHODS: Thirty patients with advanced chronic periodontal disease and displaying one intrabony defect were randomly treated with PRP + ABBM or ABBM alone. The following clinical parameters were evaluated at baseline and 1 year after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS: No statistical significant differences in any of the investigated parameters between the two groups were observed at baseline. Healing was uneventful in all patients. In the PRP + ABBM group, mean PD decreased from 8.6 +/- 1.8 mm to 3.4 +/- 1.4 mm (P <0.001) and mean CAL changed from 9.9 +/- 1.7 mm to 5.3 +/- 1.8 mm (P <0.001). In the ABBM group, mean PD decreased from 8.5 +/- 2.0 mm to 3.2 +/- 1.3 mm (P <0.001) and mean CAL changed from 9.6 +/- 1.9 mm to 4.9 +/- 1.5 mm (P <0.001). CAL gains >or=3 mm were measured in 80% (12 of 15 defects) of cases treated with PRP + ABBM and in 87% (13 of 15 defects) of cases treated with ABBM alone. No statistically significant differences in any of the investigated parameters were observed between the two groups at the 1-year reevaluation. CONCLUSIONS: Within the limits of the present study, it can be concluded that 1) at 1 year after regenerative surgery with PRP + ABBM and ABBM alone, significant PD reductions and CAL gains were found, and 2) the use of PRP failed to improve the results obtained with ABBM alone.

The effect of a low dose of transforming growth factor beta1 (TGF-beta1) on the early bone-healing around oral implants inserted in trabecular bone.

Transforming growth factor beta1 (TGF-beta1) has been shown to stimulate bone healing in several animal models and may influence bone response directly after implant installation. Aim of the present study is to investigate the effect of a low dose of TGF-beta1, on the early bone-healing around oral implants placed in trabecular bone (femoral condyle of goats). Twenty-four cylindrical screw type implants were used and TGF-beta1 in two different concentrations were applied on sixteen of them. Each animal received three implants: one Ti (control), one Ti loaded with 0.5 microg TGF-beta1 (Ti-TGF(0.5)), and one Ti loaded with 1.0 microg TGF-beta1 (Ti-TGF(1.0)). The eight animals were euthanized at 6 weeks after implantation and implants with surrounding tissue were retrieved for histological preparation and histomorphometrical evaluation. Light microscopical analysis showed the occurrence of an intervening fibrous tissue layer around about half of the TGF-beta1 loaded implants. Further, the histomorphometrical measurements revealed that the Ti implants demonstrated the highest percentage of bone-implant contact (65+/-4%), while Ti-TGF(1.0) implants showed the lowest amount (45+/-12%). The difference between these two groups was statistically significant. On basis of the results, it is concluded that a low dose of TGF-beta1 has a negative effect on the integration of oral implants in trabecular bone during the early post-implantation healing phase.

Photodynamic therapy as adjunct to non-surgical periodontal treatment in patients on periodontal maintenance: a randomized controlled clinical trial.

Recent preclinical and clinical data have suggested the potential benefit of photodynamic therapy (PDT) in the treatment of periodontitis. However, currently, there are very limited data from controlled clinical trials evaluating the effect of PDT in the treatment of periodontitis. The aim of the present study was to evaluate the clinical and microbiological effects of the adjunctive use of PDT in non-surgical periodontal treatment in patients receiving supportive periodontal therapy. Twenty-four patients receiving regularly supportive periodontal therapy were randomly treated with either subgingival scaling and root planing followed by a single episode of PDT (test) or subgingival scaling and root planing alone (control). The following parameters were evaluated at baseline and at 3 months and 6 months after therapy: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), bleeding on probing (BOP) at experimental sites, probing pocket depth (PPD), gingival recession (REC), and clinical attachment level (CAL). Primary outcome variables were changes in PPD and CAL. Microbiological evaluation of Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythensis (T.f.), Treponema denticola (T.d.), Peptostreptococcus micros (P.m.), Fusobacterium nucleatum (F.n.), Campylobacter rectus (C.r.), Eubacterium nodatum (E.n.), Eikenella corrodens (E.c.), and Capnocytophaga species (C.s.) was also performed at baseline and at 3 months and 6 months after therapy, using a commercially available polymerase chain reaction test. No differences in any of the investigated parameters were observed at baseline between the two groups. At 3 months and 6 months after treatment, there were no statistically significant differences between the groups in terms of PPD, CAL and FMPS. At 3 months and 6 months, a statistically significantly higher improvement of BOP was found in the test group. At 3 months after therapy, the microbiological analysis showed a statistically significant reduction of F.n. and E.n. in the test group. At 6 months, statistically significantly higher numbers of E.c. and C.s. were detected in the test group. The additional application of a single episode of PDT to scaling and root planing failed to result in an additional improvement in terms of PPD reduction and CAL gain, but it resulted in significantly higher reduction of bleeding scores than following scaling and root planing alone.

Cervical external root resorption: 3-year follow-up of a case.

Cervical external root resorption can be present in natural teeth, involving one or more teeth in the same patient. The incidence of these lesions appears random and the etiology remains unclear. Cervical external root resorption has been considered a difficult clinical situation, and its diagnosis and treatment of the defect challenging. The present report describes a case of multiple external cervical resorption lesions involving four teeth, including the history, and the clinical and radiographic findings. The treatment included surgical intervention and restoration of the defect without sacrificing the pulp. A 3-year re-evaluation of the case confirmed a stable, uneventful clinical recovery.

Photodynamic therapy as an adjunct to non-surgical periodontal treatment: a randomized, controlled clinical trial.

BACKGROUND: Recent preclinical and clinical data have suggested a potential benefit of photodynamic therapy (PDT) in the treatment of periodontitis. However, there are very limited data from controlled clinical trials evaluating the effect of PDT in the treatment of periodontitis. The aim of this study was to evaluate the clinical and microbiologic effects of the adjunctive use of PDT to non-surgical periodontal treatment. METHODS: Twenty-four subjects with chronic periodontitis were randomly treated with scaling and root planing followed by a single episode of PDT (test) or scaling and root planing alone (control). Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), gingival recession, and clinical attachment level (CAL) were measured at baseline and 3 and 6 months after therapy. Primary outcome variables were changes in PD and CAL. Microbiologic evaluation of Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans), Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia (previously T. forsythensis), Treponema denticola, Parvimonas micra (previously Peptostreptococcus micros or Micromonas micros), Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenella corrodens, and Capnocytophaga spp. was performed at baseline and 3 and 6 months following therapy by using a commercially available polymerase chain reaction test. RESULTS: At 3 and 6 months after treatment, there were no statistically significant differences between the groups with regard to CAL, PD, FMPS, or microbiologic changes. At 3 and 6 months, a statistically significantly greater improvement in FMBS was found in the test group. CONCLUSION: The additional application of a single episode of PDT to scaling and root planing failed to result in an additional improvement in terms of PD reduction and CAL gain, but it resulted in a significantly higher reduction in bleeding scores compared to scaling and root planing alone.

Regeneration of periodontal tissues: combinations of barrier membranes and grafting materials - biological foundation and preclinical evidence: a systematic review.

BACKGROUND: Regenerative periodontal therapy aims to predictably restore the tooth's supporting periodontal tissues and should result in formation of a new connective tissue attachment (i.e. new cementum with inserting periodontal ligament fibres) and new alveolar bone. Histologic evidence from preclinical models has demonstrated periodontal regeneration following treatment with barrier membranes, various types of grafting materials or a combination thereof. However, it is still not clear to what extent a combination of barrier membranes and grafting materials may additionally enhance the regeneration process compared with barrier membranes alone, grafting materials alone or open flap debridement. OBJECTIVES: To review with a systematic approach all preclinical (i.e. animal) studies presenting histologic support for periodontal regeneration using the combination of barrier membranes and grafting materials. MATERIAL AND METHODS: Based on a focused question, an electronic and manual search was conducted for animal studies presenting histological data for the effect of the combined use of barrier membranes and grafting materials on the treatment of periodontal defects. A systematic approach was followed by two independent reviewers including eligibility criotateria for study inclusion, outcome measures determination, screening method, data extraction, data synthesis and drawing of conclusions. RESULTS: Ten papers completely fulfilling the inclusion criteria were selected. All relevant data from the selected papers were extracted and recorded in separate tables according to the types of periodontal defects treated (i.e. supra-alveolar defects, intrabony defects, furcation defects and fenestration defects) with the combination of barrier membranes and grafting materials. Most studies have demonstrated periodontal regeneration following the combination approach. Most studies demonstrated superior histologic healing following the combination of barrier membranes and grafting materials than following open flap debridement. Histologically superior healing following the combination of barrier membranes and grafting materials when compared with barrier membranes alone or grafting materials alone were only obtained in non-contained two wall intrabony and supraalveolar defects. CONCLUSION: Within its limits the present analysis indicates that: (a) The combination of barrier membranes and grafting materials may result in histological evidence of periodontal regeneration, predominantly bone repair. (b) No additional benefits of combination treatments were detected in models of three wall intrabony, Class II furcation or fenestration defects. (c) In supra-alveolar and two wall intrabony (missing buccal wall) defect models of periodontal regeneration, the additional use of a grafting material gave superior histological results of bone repair to barrier membranes alone. (d) In one study using a supra-alveolar model, combined graft and barrier membrane gave a superior result to graft alone.

The biology of platelet-rich plasma and its application in oral surgery: literature review.

Platelet-rich plasma (PRP) is a new approach in tissue regeneration and a developing area for clinicians and researchers. It is used in various surgical fields, including oral and maxillofacial surgery. PRP is prepared from the patient's own blood and contains growth factors that influence wound healing. Of these growth factors, platelet-derived growth factor, transforming growth factor, insulin-like growth factor, and epidermal growth factor play a pivotal role in tissue repair mechanisms. Although the growth factors and mechanisms involved are still poorly understood, the easy application of PRP in the clinic and its possible beneficial outcome, including reduction of bleeding, rapid soft tissue healing, and bone regeneration, hold promise for new treatment approaches. However, animal studies and human trials demonstrate conflicting results regarding the application of PRP. Therefore the aim of this literature review is to evaluate the scientific evidence regarding the use of PRP in dentistry, to describe the different bioactive substances included in PRP and their participation in the healing process, to elucidate the different techniques and available technology for PRP preparation, to review animal and human studies, to clarify risks, and to provide guidance for future research.

Effect of platelet-rich plasma on the healing of intrabony defects treated with Beta tricalcium phosphate and expanded polytetrafluoroethylene membranes.

BACKGROUND: Regenerative periodontal therapy using platelet-rich plasma (PRP) and different types of bone substitutes with or without guided tissue regeneration (GTR) has been proposed as a modality to enhance the outcome of regenerative surgery. However, there are limited data from controlled clinical studies evaluating the effect of PRP on the healing of deep intrabony defects treated with a combination of bone substitutes and GTR. The aim of this study was to clinically evaluate the effect of PRP on the healing of deep intrabony defects treated with beta tricalcium phosphate (beta-TCP) and GTR by means of a non-bioresorbable expanded polytetrafluoroethylene membrane. METHODS: Twenty-eight subjects with advanced chronic periodontal disease and displaying one intrabony defect were treated randomly with a combination of PRP + beta-TCP + GTR or beta-TCP + GTR. Plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession, and clinical attachment level (CAL) were evaluated at baseline and at 1 year after treatment. CAL was the primary outcome variable. RESULTS: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all subjects. At 1 year after therapy, the sites treated with PRP + beta-TCP + GTR showed a reduction in mean PD from 9.1 +/- 0.6 mm to 3.3 +/- 0.5 mm (P <0.001) and a change in mean CAL from 10.1 +/- 1.3 mm to 5.7 +/- 1.1 mm (P <0.001). In the group treated with beta-TCP + GTR, mean PD was reduced from 9.0 +/- 0.8 mm to 3.6 +/- 0.9 mm (P <0.001), and the mean CAL changed from 9.9 +/- 1.0 mm to 5.9 +/- 1.2 mm (P <0.001). In both groups, all sites gained > or =3 mm of CAL. CAL gains > or =4 mm were noted in 86% (12 of 14 defects) of the cases treated with PRP + beta-TCP + GTR and in 79% (11 of 14 defects) of those treated with beta-TCP + GTR. No statistically significant differences in any of the investigated parameters were observed between the two groups at the 1-year reevaluation. CONCLUSION: At 1 year after surgery, both therapies resulted in significant PD reductions and CAL gains.

Effect of platelet-rich plasma on bone regeneration in dentistry: a systematic review.

OBJECTIVE: To review systematically the reported effects of platelet-rich plasma (PRP) on bone regeneration. MATERIAL AND METHODS: Up to June 2006, MEDLINE and Cochrane databases were explored with different combinations of three search terms: 'PRP', 'bone regeneration', 'dentistry' and their synonyms. INCLUSION CRITERIA: human controlled clinical trials designed to treat maxillofacial bony defects with application of PRP (test) or without PRP (control), including at least five patients with a follow-up period of more than 3 months and using clinical assessment, radiography, histology and/or histomorphometry for evaluation. Literature search, selection of eligible articles and data extraction were carried out independently by two readers. RESULTS: The literature search revealed 108 references, of which 17 were selected for further analysis. Finally, nine articles fulfilling the inclusion criteria were selected for systematically review. Owing the substantial heterogeneity of the studies it was not possible to analyze the data statistically. An attempt was made to compare results from studies that used similar outcome measures by calculating and adding confidence intervals to the data presented in the original papers. Differences in treatment effects for periodontal defects in terms of clinical attachment level (CAL) were significant (ranging from 0.8 to 3.2 mm). The reported effects of PRP in sinus elevation (compared with their controls) were <10%. CONCLUSION: We found evidence for beneficial effects of PRP in the treatment of periodontal defects. Evidence for beneficial effects of PRP in sinus elevation appeared to be weak. No conclusions can be drawn about other applications of PRP in dentistry.

Effect of platelet-rich plasma on the healing of intrabony defects treated with an enamel matrix protein derivative and a natural bone mineral.

BACKGROUND: Regenerative periodontal surgery utilizing a combination of an enamel matrix protein derivative (EMD) and a natural bone mineral (NBM) and platelet-rich plasma (PRP) has been shown to enhance the outcomes of regenerative surgery significantly. At present, it is unknown whether root conditioning with EMD, followed by defect fill with a combination of NBM+PRP may additionally enhance the clinical results obtained with EMD+NBM. AIM: To compare clinically the treatment of deep intrabony defects with either EMD+NBM+PRP or EMD+NBM. MATERIAL AND METHODS: Twenty-six patients suffering from advanced chronic periodontitis, and each of whom displayed one advanced intrabony defect were randomly treated with either EMD+NBM+PRP (test) or EMD+NBM (control). The following clinical parameters were evaluated at baseline and at 1 year after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR) and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS: Healing was uneventful in all patients. At 1 year after therapy, the test sites showed a reduction in mean PD from 8.8+/-1.9 mm to 3.1+/-0.9 mm ( p<0.001) and a change in mean CAL from 10.8+/-2.0 mm to 6.0+/-1.5 mm ( p<0.001). In the control group the mean PD was reduced from 8.8+/-2.0 mm to 2.8+/-1.6 mm ( p<0.001) and the mean CAL changed from 10.5+/-1.6 mm to 5.5+/-1.4 mm ( p<0.001). CAL gains of > or =4 mm were measured in 77% (i.e. in 10 out of 13 defects) of the cases treated with EMD+NBM+PRP and in 100% (i.e. in all 13 defects) treated with EMD+NBM. No statistically significant differences in any of the investigated parameters were observed between the two groups. CONCLUSIONS: Within its limits, the present study has shown that (i) 1 year after regenerative surgery, both treatments resulted in statistically significant PD reductions and CAL gains and (ii) the use of PRP failed to enhance the results obtained with EMD+NBM.

Effect of platelet-rich plasma on the early bone formation around Ca-P-coated and non-coated oral implants in cortical bone.

OBJECTIVES: The purpose of the present study was to investigate the effect of local application of platelet-rich plasma (PRP) on the early healing of cortical bone around Ti implants with two different surface configurations. MATERIAL AND METHODS: Six goats were used in this study. PRP fractions were obtained from a venous blood sample of the goats and administered immediately before implant insertion. PRP was applied via gel preparation and installation of the gel into the implant site, or via dipping of the implants in PRP fraction before insertion. A total of 36 implants (18 non-coated and 18 Ca-P-coated) were placed into the tibial cortical bone. The animals were sacrificed at 6 weeks after implantation and implants with surrounding tissue were prepared for histological examination. Histomorphometrical variables like the percentage of implant surface with direct bone-implant contact and the percentage of new and old bone adjacent to the implant were evaluated. RESULTS: More interfacial bone-to-implant contact was observed for all the three groups of Ca-P-coated implants and the Ti/PRP liquid group. All groups revealed similar percentages of old and new bone adjacent to the implant. CONCLUSIONS: It was concluded that the additional use of PRP did not have any effect on the early cortical bone response to the Ca-P-coated implants, while PRP in a liquid form showed a tendency to increase bone apposition to roughened titanium implants.

Effect of platelet-rich plasma on the healing of intrabony defects treated with an anorganic bovine bone mineral and expanded polytetrafluoroethylene membranes.

BACKGROUND: Regenerative periodontal therapy with a combination of platelet-rich plasma (PRP) + an anorganic bovine bone mineral (ABBM) + guided tissue regeneration (GTR) has been shown to result in significantly higher probing depth reductions and clinical attachment level gains compared to treatment with open flap debridement (OFD) alone, ABBM alone, or GTR alone. However, there are no data evaluating to what extent the use of PRP may additionally enhance the clinical outcome of the therapy compared to treatment with ABBM + GTR. This study aimed to clinically evaluate the effect of PRP on the healing of deep intrabony defects treated with ABBM and GTR by means of a non-resorbable expanded polytetrafluoroethylene (ePTFE) membrane. METHODS: Twenty-four patients with advanced chronic periodontal disease and displaying one intrabony defect were randomly treated with a combination of either PRP + ABBM + GTR or ABBM + GTR. The following clinical parameters were evaluated at baseline and at 1 year after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS: No differences in any of the studied parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with PRP + ABBM + GTR showed a reduction in mean PD from 8.6 +/- 1.7 mm to 3.1 +/- 1.3 mm (P <0.001) and a change in mean CAL from 10.3 +/- 1.4 mm to 5.7 +/- 1.6 mm (P <0.001). In the group treated with ABBM + GTR, mean PD was reduced from 8.8 +/- 1.7 mm to 3.1 +/- 1.0 mm (P <0.001), and the mean CAL changed from 10.4 +/- 2.6 mm to 5.9 +/- 1.8 mm (P <0.001). In both groups, all sites gained > or =3 mm of CAL. CAL gains > or =4 mm were measured in 83% (i.e., in 10 of 12 defects) of the cases treated with PRP + ABBM + GTR and in 92% (i.e., in 11 of 12 defects) treated with ABBM + GTR. No statistically significant differences in any of the studied parameters were observed between the two groups at 1-year reevaluation. CONCLUSION: Within its limits, the present study has shown that, at 1 year after regenerative therapy in periodontal intrabony defects, optimal clinical results were obtained with ABBM + GTR with a non-resorbable barrier, with or without the addition of PRP.

Effect of platelet-rich plasma on the healing of intra-bony defects treated with a natural bone mineral and a collagen membrane.

BACKGROUND: Regenerative periodontal therapy with a combination of platelet-rich plasma (PRP)+a natural bone mineral (NBM)+guided tissue regeneration (GTR) has been shown to result in significantly higher probing depth reductions and clinical attachment-level gains compared with treatment with open flap debridement alone. However, at present, it is unknown to what extent the use of PRP may additionally enhance the clinical outcome of the therapy compared with treatment with NBM+GTR. AIM: To clinically compare treatment of deep intra-bony defects with NBM+PRP+GTR with NBM+GTR. MATERIAL AND METHODS: Thirty patients suffering from advanced periodontal disease, and each of whom displayed one advanced intra-bony defect were randomly treated with a combination of either NBM+PRP+collagen membrane (GTR) or NBM+GTR. The following clinical parameters were evaluated at baseline and at 1 year after treatment: plaque index, gingival index, bleeding on probing, probing depth (PD), gingival recession and clinical attachment level (CAL). CAL changes were used as the primary outcome variable. RESULTS: No differences in any of the investigated parameters were observed at baseline between the two groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with NBM+PRP+GTR showed a reduction in mean PD from 8.9+/-2.3 mm to 3.4+/-2.0 mm (p<0.001) and a change in mean CAL from 10.9+/-2.2 mm to 6.4+/-1.8 mm (p<0.001). In the group treated with NBM+GTR, the mean PD was reduced from 8.9+/-2.5 mm to 3.4+/-2.3 mm (p<0.001), and the mean CAL changed from 11.1+/-2.5 mm to 6.5+/-2.3 mm (p<0.001). In both groups, all sites gained at least 3 mm of CAL. CAL gains of > or = 4 mm were measured in 80% (i.e. in 12 out of 15 defects) of the cases treated with NBM+PRP+GTR and in 87% (i.e. in 13 out of 15 defects) treated with NBM+GTR. No statistically significant differences in any of the investigated parameters were observed between the two groups. CONCLUSIONS: Within its limits, the present study has shown that (i) at 1 year after regenerative surgery with both NBM+PRP+GTR and NBM+GTR, significant PD reductions and CAL gains were found, and (ii) the use of PRP has failed to improve the results obtained with NBM+GTR.