Regeneration of a large bony lesion with advanced-platelet rich fibrin: case report / Regeneración de una lesión ósea de gran tamaño con fibrina rica en plaquetas: reporte de caso

Introduction: This case report analyzes the regeneration potential of advanced-platelet rich fibrin (A-PRF) in large bony lesions. Advanced-platelet rich fibrin provides various growth factors which aids in faster healing. Materials and Methods: Patient presented with peri-apical radiolucency. CBCT showed bony radiolucency in teeth 31, 32, 41, 42. A full mouth mucoperiosteal flap was raised and a cyst lining was enucleated. Apicoectomy was done with respect to 31, 32, 41, 42 along with and retrograde with a preparation of APRF clots were placed in the bony cavity. Results: Post-op CBCT at 6 months showed a significant difference in size and bone density of the lesion. Conclusions: Advanced-platelet rich fibrin has shown promising results in reducing the size of bony defect and periapical lesion in this case.

Introducción: Este caso clínico demuestra el potencial de regeneración de la fibrina rica en plaquetas avanzada (A-PRF) en lesiones óseas de gran tamaño. La fibrina rica en plaquetas avanzada proporciona varios factores de crecimiento que ayudan a una curación más rápida. Materiales y Métodos: El paciente se presentó con radiolucencia periapical. Tomografía computarizada de haz cónico mostró radiolucencia ósea en los dientes 31, 32, 41, 42. Se levantó un colgajo mucoperióstico de boca completa y se enucleó el revestimiento del quiste. Se realizó apicectomía con respecto a 31, 32, 41, 42, y se colocó una preparación de APRF se colocaron coágulos en la cavidad ósea. Resultados: La tomografía computarizada de haz cónico postoperatorio a los 6 meses mostró una diferencia significativa en el tamaño y la densidad ósea de la lesión. Conclusión: La fibrina rica en plaquetas avanzada ha mostrado resultados prometedores en la reducción del tamaño del defecto óseo y la lesión periapical en este caso.

Advanced Platelet-rich Fibrin-mediated Regeneration of Necrotic Immature Permanent Teeth: A Clinico-radiographic Observational Study.

Aim: The objective of the study was to assess the regenerative potential of advanced platelet-rich fibrin (APRF) in the regenerative treatment of necrotic immature permanent teeth (NIPT) in the maxillary incisor region. Study design: After institutional review board clearance, 10 children aged between 8 and 14 years with NIPT in the maxillary incisor region undergoing APRF treatment were enrolled in a prospective clinico-radiographic exploratory observational study. Baseline clinical, radiographic, and vitality testing before the start of treatment were noted. Patients were followed up at 3, 6, and 12 months posttreatment. Results: After 3, 6, and 12 months of follow-up, all patients (100%) showed complete resolution of clinical signs and symptoms. All patients (100%) showed periradicular healing, and 9 out of 10 patients (90%) showed a clear hard tissue bridge formation at various levels in the root canal on postoperative radiographs. None of the patients (0%) showed a positive response to vitality testing. Conclusion: APRF is a promising biomaterial in regenerative endodontic treatment (RET). Future randomized trials can be planned to establish superiority or equivalence to conventional PRF. How to cite this article: Wakhloo T, Shukla S, Chug A, et al. Advanced Platelet-rich Fibrin-mediated Regeneration of Necrotic Immature Permanent Teeth: A Clinico-radiographic Observational Study. Int J Clin Pediatr Dent 2022;15(4):402-406.

To evaluate the effect and longevity of Botulinum toxin type A (Botox®) in the management of gummy smile - A longitudinal study upto 4 years follow-up.

AIM: the current study was aimed (1) To study the effect of Botulinum toxin (BT) A on gummy smile (2) To determine the efficacy, predictability & longevity of the effect of Botox® in the management of gummy smile and lastly (3)To identify the treatment groups for Botox® as a single modality for the non-surgical treatment of gummy smile. MATERIAL AND METHOD: only patients who were willing to get the treatment done with Botox® injection were enrolled in the study, irrespective for the need for the surgery. Thus, total of 32 patients were divided into two groups, group 1, having a gummy smile with less than 5 â€‹mm who were treated with 3 units of Botox® and group II, having gummy smile of more than 5 â€‹mm who were treated with 5 units of Botox® and each group underwent 2 cycles of injection 7 months apart given at the Yonsei's point and were followed for a period of 14 months. RESULTS: the procedure was tolerated well by the patients; none developed any allergic reaction or antibodies related to BT. In the less that 5 â€‹mm and more than 5 â€‹mm of gingival show group the results remain excellent till 3 months after which gummy smile gradually reaches to the baseline levels. Significant changes start to reappear by the 5th month. CONCLUSION: Authors recommend use of BT for the treatment of gummy smile as the technique is safe, economical and easy to use. Though not long lasting, it may motivate patients to go for surgical procedure, mainly who have gummy smile of more than 5 â€‹mm because of maxillary vertical excess.

Outcomes of temporomandibular joint disorders treatment after a survey in the population of Uttarakhand, Part I: An epidemiological study.

AIM: To observe the prevalence of signs and symptoms of Temporomandibular joint disorders in patients visiting outpatient department, AIIMS Rishikesh. METHOD AND MATERIAL: The survey was conducted in a total of 960 patients, who visited outpatient Department (OPD), dept of Dentistry, AIIMS Rishikesh and were asked to fill a questionnaire based on Fonseca questionnaire for TMD in accordance to the inclusion and exclusion criteria. RESULTS: Out of 960 patients, 449 had no TMD, 322 patients had mild TMD, 123 moderate and severe TMD was seen in 54 patients. Also, male dominance for TMD was seen in all the groups. There was no age predilection; however most of the patients with severe TMD fell between 16 and 60 years of age. CONCLUSION: TMD is a common problem occurring in all age groups, there was a male dominance seen in the epidemiological study.

Clinical and radiographic findings without the use of bone substitute materials in extraction sockets and delayed implant placement- A case series.

AIM: To observe clinically and radiographically (CBCT), the extent of bone resorption in extraction socket without the use of bone graft substitutes and delayed implant placement. MATERIAL AND METHODS: 50 compliant patients were selected for study. All the patients who were advised extraction were followed up for entire duration of the treatment, at 5th week CBCT showed horizontal and vertical bone loss. To prevent further bone resorption, after 5 weeks implant was placed along with bone graft. RESULTS: Bone resorption after extraction is an unavoidable phenomenon. Clinical and radiographic (CBCT) analysis showed massive bone resorption by 5th week. At 5 month CBCT, all patients showed stable implant integration. There was no implant failure at the end of the study. CONCLUSION: Alveolar preservation is proven to slow down socket wall collapse with the use of a bone substitute material without which larger procedures maybe needed to restore alveolar integrity and harmony. Immediate implant placement is effective when bone graft is placed in the jumping distance.

Placement of Sticky Bone™ in Patients with Generalized Periodontitis Previously Treated with Coenzyme Q10.

AIM: The aim of this study was to observe the effects of coenzyme Q10 (CoQ10) in patients with localized periodontitis and place Sticky Bone™ in defects not resolved in the test or control group. MATERIALS AND METHODS: A total of 30 patients with periodontitis of pocket depth ≥5 mm were randomly divided into test and control groups, each comprising 25 sites, where CoQ10 was placed in the test group and methyl cellulose in the control group; all the parameters were recorded, and patients were followed up for 12 months. At the end of 12 months, patients who did not respond to subgingival placement of CoQ10 were treated surgically where Sticky Bone™ was placed and further followed up for 6 months. RESULTS: There was significant difference between plaque index (PI), gingival index (GI), and probing pocket depth (PPD) at baseline and 1 month, and there was an increase in values of PI and PPD seen at 6 months and significant increase in values of GI, PI, and PPD seen at 12 months, and no significant difference in values was seen at 12 months and baseline. CONCLUSION: Coenzyme Q10 does not aid in the treatment of periodontitis. CLINICAL SIGNIFICANCE: Clinically, it shows that CoQ10 has no role to play in the cases of periodontitis. In such cases, without delay patients should be taken up for periodontal flap surgery after complete scaling and root planning (SRP), if the pocket does not resolve.

Bacterial Adherence Around Sutures of Different Material at Grafted Site: A Microbiological Analysis.

Closure of the surgical incision has been the primary function of sutures since their introduction. However, whatever the type, they are known to carry bacteria, which can be a source of infection. Five types of surgical sutures, Gut, Silk, Vicryl, PTFE, and Polyamide, were selected and tested on their ability to carry aerobic and anaerobic bacteria and were rated on the basis of forming colony-forming units (CFUs). Aerobic bacteria grown around gut sutures showed minimum CFUs (≈30 × 104/suture). Though very less anaerobic bacteria growth was seen among all tested suture materials, it was maximum around Vicryl and polyamide sutures. Every suture material is capable, albeit not equally, of holding bacterial biofilm formation, which can be a source of surgical site infection.

Injectable-Platelet-Rich Fibrin-Smart Blood with Stem Cells for the Treatment of Alopecia: A Report of Three Patients.

Hair loss or alopecia in males is very common, and so is its treatment. Until now, platelet-rich plasma has been in use for hair regeneration, which has shown results but lacks regenerative potential as compared to platelet-rich fibrin (PRF). Injectable-PRF (i-PRF) is advanced version of PRF in liquid form which can be injected and contains stem cells with high regenerative potential. Hair regeneration in Type VI and Type VII was observed which are difficult to treat. Hair growth with i-PRF has better regenerative potential. All cases reported showed improvement in hair growth.

Optimal management of intrabony defects: current insights.

Periodontitis is the most common condition, which causes bony defects. Intrabony defects thought not as common as the horizontal bone loss pose a risk of disease progression and thus should be managed optimally; however, it does not mean all the intrabony defects can be treated and all the mobile teeth saved! But, with the advent of new biomaterials prognosis of teeth can be improved. The objective of this article is to discuss old and new concepts toward the optimal management of intrabony defects.

Root coverage with buccal fat pad placed on restored cervical abrasion: Case report with three-year follow-up.

A patient was reported with Class II gingival recession (GR) of 5 mm. After restoring abrasion with glass ionomer cement, a full-thickness flap was raised and using blunt dissection through the buccinator and loose surrounding fascia buccal fat pad (BFP) was exposed into the mouth. It was easily spread over the maxillary roots of 14, 15, and 16. It was secured and immobilized using sutures. Postoperatively, the patient did not report swelling or trismus. At 3-year postoperative, gingival margin was at cementoenamel junction, stable and healthy and did not show any recession. Thus, it can be concluded that BFP for covering GR is an excellent technique. It is simple surgical procedure with easy handling of the flap. It provides excellent color and texture match and can also be considered as an excellent procedure for increasing the width of attached gingiva.

Management of multiple recession defects in esthetic zone using platelet-rich fibrin membrane: A 36-month follow-up case report.

A patient undergoing orthodontic treatment presented with multiple recession defects in maxillary anterior region. After thorough clinical examination and assessment, measurements were recorded. Maxillary anterior teeth with recession defects of 3-4 mm were treated with coronally advanced flap and platelet-rich fibrin (PRF) membrane. Regular follow-up was maintained for the patient at 3, 6 , 12, 18, 24, 30, and 36 months. After 36 months, significant root coverage of 100 percent was observed in four defects and 50% coverage in one defect. This shows that PRF membrane along with coronally advanced provides a predictable and significant result for management of recession defects.

Role of Cone Beam Computed Tomography in Diagnosis and Treatment Planning in Dentistry: An Update.

Accurate diagnosis and treatment planning are the backbone of any medical therapy; for this reason, cone beam computed tomography (CBCT) was introduced and has been widely used. CBCT technology provides a three-dimensional image viewing, enabling exact location and extent of lesions or any anatomical region. For the very same reason, CBCT can not only be used for surgical fields but also for fields such as endodontics, prosthodontics, and orthodontics for appropriate treatment planning and effective dental care. The aim and clinical significance of this review are to update dental clinicians on the CBCT applications in each dental specialty for an appropriate diagnosis and more predictable treatment.

Is Residual Bone Height an Absolute Indicator for Simultaneous Implant Placement in Lateral Wall Sinus Grafting?

Placement of an implant in the posterior maxilla often relies heavily on a variety of procedures that increase the vertical dimensions of available bone. With numerous bone graft substitutes now available and recent advancements having been made in technique, the question arises of whether residual bone height still remains an absolute indicator for simultaneous implant placement in lateral wall sinus grafting. In addition to reviewing the literature, the authors present a case in which a direct sinus lift procedure was performed with simultaneous implant placement. The case report demonstrates how implants can be placed in a severely atrophic posterior maxilla and be successful.

Effect of Addition of Platelet-rich Plasma to Calcium Phosphosilicate Putty on Healing at 9 Months in Periodontal Intrabony Defects.

BACKGROUND AND OBJECTIVE: Combination of platelet-rich plasma (PRP) and bone substitutes for the surgical treatment of periodontal intrabony defects is based on a sound biologic rationale; however, the clinical results indicative of the synergistic effect of PRP remain ambiguous. The objective of the present study was to clinically and radiographically evaluate the use of calcium phosphosilicate (CPS) putty alone and in combination with PRP in the treatment of periodontal intrabony defects. MATERIALS AND METHODS: The study was performed at an outpatient facility at a teaching dental institute in north India. A split-mouth design was employed to assess the clinical parameters and radiographic bone fill following the use of CPS putty with and without PRP in patients scheduled for surgical periodontal treatment of intrabony osseous defects. Each defect was randomized to receive treatment with open flap debridement, with CPS putty alone (Group PUT), or open flap debridement with CPS putty and PRP (Group PRp). Probing pocket depth (PPD), plaque index (PI), gingival index (GI), and clinical attachment levels (CALs) were recorded at the investigated sites utilizing custom-made reference guides for measurement reproducibility. Standardized periapical radiographs were also obtained to evaluate defect fill at the surgical sites. RESULTS: Twenty patients each with at least two defects located in different quadrants were enrolled. The reduction in PPD from baseline to 1st, 3rd, 6th, and 9th month was found to be significant (p < 0.05). The percent reduction in PPD among PUT group was 57.18 ± 10.71% and among PRP group was 51.39 ± 12.60%. No statistically significant difference was observed in the percent reduction in PPD among two groups at 9 months (p = 0.48). Sites in both groups exhibited statistically significant reductions in PI and GI that were maintained throughout the study period. Similar results were seen while measuring CAL. CONCLUSION: Calcium phosphosilicate Putty alone provides significant improvement in outcomes for the treatment of periodontal intraosseous defects. The addition of PRP to CPS putty does not seem to provide any additive benefit to treatment and the additional surgical time and trauma can be avoided.

Residual Roots as an Anatomical Guide for Implant Placement: Case Series With Two-Year Follow-up.

As placement of implants into immediate sites involves management of the remaining root structure, these residual roots may be used as a guide for the development of osteotomy. This aids in implant positioning and prevents drill slippage into the residual root spaces during osteotomy drilling. Following completion of the osteotomy, the remaining root structure is extracted prior to implant placement into the site. The aim of this study is to assess the success rate of implants when the residual roots were used as anatomical guides for osteotomy. One hundred implants were placed in 57 patients, and 4 different types of implants were used: 47 Bioner TOP DM implants, 20 Nobel Biocare Replace implants, 25 Biohorizons Tapered Internal implants (Birmingham, Ala), and 8 Alpha-Bio Tec SPI Implants. The implants were placed into 57 patients. Osteotomies were placed through intact residual roots, which acted as anatomical guides for implant surgical placement. Patients had a follow-up period of 2 years, and in that time none reported discomfort after implant placement. There were no signs of peri-implantitis observed in any of the patients. Of all the implants placed, the Bioner TOP DM implant showed the least amount of crestal bone loss. Placing implants through residual roots as an anatomical guide is a useful technique that shows good results over a 2-year follow-up period.

Regeneration in Periodontics: Collagen-A Review of Its Properties and Applications in Dentistry.

Collagen is the most abundant protein in mammals, also making it the most important component of the body structurally and functionally. Collagen provides cell occlusiveness, biocompatibility, and resorbability. It is chemotactic for regenerative cells and may enhance the migration and attachment of fibroblasts through its space-making ability. Collagen also has the advantage of being a hemostatic agent with weak immunogenicity, easy manipulation, and the ability to augment tissue thickness. Additionally, upon breakdown through the resorption process, its byproducts are utilized by the host to form native tissue. Further, these proteins are elastic and enhance repair, properties that make the material useful for various biomedical applications. This review highlights and discusses some of the important aspects of collagen as a biomaterial in dentistry.

Alveolar ridge preservation with the socket-plug technique utilizing an alloplastic putty bone substitute or a particulate xenograft: a histological pilot study.

Following tooth extraction, ridge preservation procedures are employed to regenerate bone in the extraction socket, limit consequent ridge resorption, and provide a stable base for implant placement. The purpose of this study is to histologically evaluate and compare bone regeneration in extraction sockets grafted with either a putty alloplastic bone substitute or particulate anorganic bovine xenograft utilizing the socket-plug technique. Nineteen patients underwent 20 tooth extractions and ridge preservation following a standardized protocol. Ten sites were grafted with calcium phosphosilicate putty (CPS group) and the remaining 10 with anorganic bovine bone substitute (BO group). Patients were recalled after 4-6 months to evaluate the bone regeneration and to proceed with implant placement. A bone core was obtained during the implant procedure from each site and was used for histologic analysis. Histomorphometry revealed that residual graft values were significantly higher in the BO group (25.60% ± 5.89%) compared to the CPS group (17.40% ± 9.39%) (P < .05). The amount of new bone regenerated was also statistically significant higher in the alloplast group (47.15% ± 8.5%) as compared to the xenograft group (22.2% ± 3.5%) (P < .05). Results suggest that ridge preservation using a putty calcium phosphosilicate alloplastic bone substitute demonstrates more timely graft substitution and increased bone regeneration when compared to an anorganic bovine bone xenograft.

Periotest values of implants placed in sockets augmented with calcium phosphosilicate putty graft: a comparative analysis against implants placed in naturally healed sockets.

AIM: To measure implant stability using periotest values of implants placed in sockets augmented with calcium phospho-silicate putty (CPS Putty) as compared with implant stability in naturally healed sockets. MATERIALS AND METHODS: Twenty two sockets were implanted with CPS Putty immediately after extraction. The sockets were re-entered after a healing period at 5 to 6 months (average 5.3 months) for implant placement. Periotest values were recorded during implant insertion to assess primary stability. These were compared with the Periotest values of 26 implants placed in 22 patients, with naturally healed sockets. RESULT: Periotest values were significantly lower in the grafted group, indicating better implant stability in sites grafted with CPS putty. CONCLUSION: Implant stability seems to be significantly higher in sockets augmented using CPS putty when compared to nongrafted sites. This suggests that socket grafting with CPS putty may enhance the quality of available bone for implantation.