Enamel Renal Gingival Syndrome in an Adolescent.

Enamel renal gingival syndrome is a rare clinical condition characterized by the presence of amelogenesis imperfecta hypoplastic type, gingival fibromatosis and delayed tooth eruption, in addition to nephrocalcinosis with normal blood calcium levels. It is inherited as an autosomal recessive trait caused by mutations in the FAM20A gene located on chromosome 17q24.2. The purpose of this report is to describe a case of enamel renal gingival syndrome and discuss its distinct features and management.

Minimally invasive periodontal regeneration with the buccal approach: a systematic review and meta-analysis of clinical studies.

OBJECTIVE: The aim of this study was to investigate clinical periodontal parameters after treatment using the Minimally Invasive Surgical Technique (MIST), Modified Minimally Invasive Surgical Technique (M-MIST), and/or any technique for papilla preservation, such as Entire Papilla Preservation (EPP), modified-papilla preservation technique (M-PPT), or simplified-papilla preservation technique (SPPT). METHODS: The focus question was "For patients with periodontal intrabony defects (P), what is the best minimally invasive regenerative approach (I), comparing MIST, M-MIST, and papilla preservation techniques' outcomes (C) to improve PD, CAL, GR, and periodontal stability (O)?" An online search was conducted on PubMed, Cochrane Library, and Embase. Only randomized clinical trials and case series with a minimum of 10 enrolled patients were included. The risk of bias was evaluated using the Critical Appraisal tools in JBI Systematic Reviews. The meta-analysis compared the data obtained for the periodontal parameters analyzed, and the heterogeneity was verified. RESULTS: After the screening, nine articles were included. Seven studies applied MIST and its modifications; two used M-PPT, one SPPT, and one approached EPP. A general statistically significant PD reduction and CAL gain were noted between the groups, comparing baseline and follow-up for all articles, independently of the technique or materials used. Also, all studies showed a non-significant increase in the gingival recession. Four studies had a low risk of bias, four had a moderate risk, and only 1 had a high risk. Moderate heterogeneity was found in one analysis for CAL (65.73%); moderate and substantial heterogeneity was found in the PD results (71.91% and 89.19%); and no heterogeneity was found within all analyses for gingival recession (0%). CONCLUSION: MIST, M-MIST, and papilla preservation techniques demonstrated their potential and efficacy to improve periodontal conditions of sites with intrabony defects with minimal morbidity.

Effects of enamel matrix derivative in nonsurgical periodontal therapy on pro-inflammatory profiles, microbial environment and clinical outcome: a randomized clinical trial.

OBJECTIVES: This study aimed to evaluate the impact of enamel matrix derivative (EMD) application following subgingival instrumentation of residual pockets in periodontitis patients on inflammatory host response, microbiological composition, and clinical outcome. METHODS: In this double-blinded randomized controlled trial, a total of 22 patients with generalized periodontitis stage III or IV presenting with ≥ 6 mm probing pocket depth (PPD) at re-evaluation after initial periodontal therapy were included. Participants were randomly allocated at a 1:1 ratio to subgingival instrumentation with (EMD +) or without (EMD-) non-surgical EMD application into the pocket. PPD, clinical attachment level (CAL), bleeding on probing (BoP), plaque index (PI), as well as a panel of pro-inflammatory cytokines and periodontal pathogen count in the gingival crevicular fluid (GCF) of the respective sites were evaluated at baseline (T0) and six months afterwards (T1). RESULTS: Both treatment groups showed a significant PPD reduction (EMD + 1.33 ± 1.15 mm, p < 0.001; EMD- 1.32 ± 1.01 mm, p < 0.001) as well as CAL gain (EMD + 1.13 ± 1.58 mm, p < 0.001; EMD- 0.47 ± 1.06 mm, p = 0.005) from T0 to T1. While no intergroup differences for PPD reduction were observed, CAL gain was higher in EMD + sites compared to EMD- (p = 0.009). No essential effects on cytokine expression as well as bacterial count were detected. CONCLUSIONS: Application of EMD as an adjunct to subgingival instrumentation of residual pockets yielded benefits regarding CAL gain; however, effects on PPD reduction, inflammatory cytokines, and bacterial count were negligible. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04449393), registration date 26/06/2020. CLINICAL RELEVANCE: Based on the obtained results, additional non-surgical EMD application compared to subgingival instrumentation alone showed no clinically relevant effects on treatment outcome and underlying biological mechanisms.

VISTA Approach in Conjunction with Enamel Matrix Derivative, Corticocancellous Bone, and Connective Tissue Graft for Periodontal Defect Surgery: A Case Series.

The biggest challenge during periodontal regeneration in the anterior region is the prevention of soft tissue recession. Minimally invasive surgeries, particularly papilla preservation techniques and soft tissue augmentation, may significantly reduce such postoperative soft tissue recession. This article presents the vestibular incision subperiosteal tunnel access (VISTA) approach for periodontal regeneration in the anterior region. A subperiosteal tunnel prepared from a single vertical vestibular incision adjacent to the defect is used for debridement, application of enamel matrix derivative, defect grafting with corticocancellous tuberosity bone, and insertion of the connective tissue graft. Evaluation of six cases with up to 6 years of follow-up showed improvements in all clinical parameters. The probing pocket depth improved from 8.2 ± 0.75 mm initially to 2.7 ± 0.52 mm at follow-up, clinical attachment level improved from 8.5 ± 0.83 mm initially to 2.7 ± 0.52 mm at follow-up, and midfacial gingival recession of 1 mm at two sites was corrected. The papillae were stable at all sites, with an average distance of 4.8 mm from the incisal edge to the papilla tip. This technique seems to be a promising approach for achieving both esthetic and functional goals of periodontal regenerative surgery. However, experience in performing microsurgeries and harvesting tuberosity tissues may be a limitation.

Association between defect morphology and healing of intrabony defects treated with minimally invasive non-surgical therapy: A pilot exploratory analysis of two cohorts.

OBJECTIVE: The aim of this study was to explore the associations between defect morphology (defined by clinical and radiographic parameters) and the healing of periodontal intrabony defects treated with minimally invasive non-surgical therapy (MINST). BACKGROUND DATA: MINST has shown to result in favorable clinical and radiographic improvements in intrabony defects. However, it is not clear which types of intrabony defects are most suitable for this treatment. METHODS: Clinical and radiographic analyses were carried out in a total of 71 intrabony defects treated with MINST belonging to two previously published studies. Baseline defect characteristics were analyzed and related to clinical and radiographic outcomes at 12 months post-MINST with or without adjunctive enamel matrix derivative. RESULTS: No associations were detected between defect depth, angle and predicted number of walls and clinical and radiographic healing 12 months post-MINST. CONCLUSIONS: No evidence emerged for associations between defect characteristics and healing following MINST. These data seem to suggest that factors other than defect morphology may influence treatment response to MINST.

Entire Papilla Preservation Technique with Enamel Matrix Proteins and Allogenic Bone Substitute for the Treatment of Isolated Intrabony Defects: A Prospective Case Series.

The aim of this study was to evaluate the outcomes of a modified entire papilla preservation technique (EPPT) in the treatment of isolated intrabony defects in patients diagnosed with stage III periodontitis. A total of 18 intrabony defects were treated: 4 one-wall, 7 two-wall, and 7 three-wall. Mean probing pocket depth reductions of 4.33 mm (P < .0001), clinical attachment level gains of 4.87 mm (P < .0001), and radiographic defect depth reductions of 4.27 mm (P < .0001) were observed at 6 months. Changes in gingival recession and keratinized tissue were not statistically significant. It can be concluded that the proposed modification of the EPPT is useful in the treatment of isolated intrabony defects.

Long-term stability of infrabony defects treated with enamel matrix derivative alone: A retrospective two-centre cohort study.

AIM: To assess the long-term stability of attachment gain in infrabony defects (IBDs) 10 years after regenerative treatment with an enamel matrix derivative (EMD) alone. MATERIALS AND METHODS: Two centres (Frankfurt [F] and Heidelberg [HD]) invited patients for re-examination 120 ± 12 months after regenerative therapy. Re-examination included clinical examination (periodontal probing depths (PPD), vertical clinical attachment level (CAL), plaque index (PlI), gingival index (GI), plaque control record, gingival bleeding index and periodontal risk assessment) and review of patient charts (number of supportive periodontal care [SPC] visits). RESULTS: Both centres included 52 patients (29 female; median baseline age: 52.0 years; lower/upper quartile: 45.0/58.8 years; eight smokers), each contributing one IBD. Nine teeth were lost. For the remaining 43 teeth, regenerative therapy showed significant CAL gain after 1 year (3.0; 2.0/4.4 mm; p < .001) and 10 years (3.0; 1.5/4.1 mm; p < .001) during which CAL remained stable (-0.5; -1.0/1.0 mm; p = 1.000) after an average SPC of 9 years. Mixed-model regression analyses revealed a positive association of CAL gain from 1 to 10 years with CAL 12 months post operation (logistic: p = .01) as well as a higher probability for CAL loss with an increasing vertical extent of a three-walled defect component (linear: p = .008). Cox proportional hazard analysis showed a positive association between PlI after 12 months and tooth loss (p = .046). CONCLUSION: Regenerative therapy of IBDs showed stable results over 9 years. CAL gain is associated with CAL after 12 months and decreasing initial defect depth in a three-walled defect morphology. Tooth loss is associated with PlI 12 months post operation. CLINICAL TRIAL NUMBER: DRKS00021148 (URL: https://drks.de).

Use of enamel matrix- derived proteins combined with bone graft for the treatment of intrabony defects: overview of reviews (FRISBEE review) / Uso de proteínas derivadas de la matriz del esmalte combinado con injerto óseo para el tratamiento de defectos intraóseos: resumen estructurado de revisiones sistemáticas (revisión FRISBEE)

Introduction: The use of enamel matrix-derived proteins (EMD) has increased in recent years due to their tissue-inducing properties that support periodontal regeneration. This study is an overview of systematic reviews with FRISBEE methodology on the use of EMD alone or combined with autologous bone graft materials (BGM) in the treatment of intrabony defects. Materials and Methods: A systematic search in the Epistemonikos database was performed. RevMan 5.3 and GRADEpro were used for data analysis and presentation Results: Four systematic reviews and two clinical trials were identified. All studies analysed change in probing depth, clinical attachment level, gingival margin level and bone defect depth (all changes in favour of EMD+BGM groups: mean difference (MD): 0.37 mm more, MD: 0.7 mm more, MD: 0.3 mm less, MD: 0.75 more, respectively). Conclusions: Adding autologous bone graft to EMD to treat intrabony defects showed better results, but not a relevant clinical difference compared to the use of EMD alone.

Introducción: El uso de proteínas derivadas de la matriz del esmalte (EMD) ha aumentado en los últimos años debido a sus propiedades inductoras de tejidos que apoyan la regeneración periodontal. Este estudio es una revisión sistemática de revisiones sistemáticas utilizando metodología FRISBEE sobre el uso de EMD solo o combinado con materiales injerto óseo autólogo (BGM) en el tratamiento de defectos intraóseos. Materiales y Métodos: Se realizó una búsqueda sistemática en la base de datos Epistemonikos. Se utilizaron RevMan 5.3 y GRADEpro para el análisis y la presentación de los datos. Resultados: Se identificaron cuatro revisiones sistemáticas y dos ensayos clínicos. Todos los estudios analizaron el cambio en la profundidad de sondaje, el nivel de inserción clínica, el nivel del margen gingival y la profundidad del defecto óseo (todos los cambios a favor de los grupos EMD+BGM: MD: 0,37 mm más, media de diferencia (MD): 0,7 mm más, MD: 0,3 mm menos, MD: 0,75 más, respectivamente). Conclusión: La adición de injerto óseo autólogo a la EMD para tratar defectos intraóseos mostró mejores resultados, pero no una diferencia clínica relevante en comparación con el uso de la EMD sola.

Radiographic angle width as predictor of clinical outcomes following regenerative periodontal therapy with enamel matrix derivative: a retrospective cohort study with a mean follow-up of at least 10 years.

OBJECTIVES: To assess the association between the baseline radiographic defect angle and the long-term clinical outcomes following periodontal regenerative therapy with enamel matrix derivative (EMD). METHOD AND MATERIALS: Baseline periapical radiographs obtained from a cohort of patients treated with periodontal regenerative therapy were digitized and the radiographic angle width between the root surface and the bony wall of the adjacent intraosseous defect was calculated and reported (in degrees). Changes in pocket probing depth (PD) and clinical attachment level (CAL) were assessed and reported (in mm). Clinical outcomes were evaluated at baseline (T0), 6 months following therapy (T1), and at the latest follow-up (T2). RESULTS: Thirty-eight defects in 26 patients enrolled in supportive periodontal care for a mean period of 10.4 years (range 8.0 to 15.5 years) were available for analysis. The mean PD change between T0 and T2 was 2.33 ± 1.66 mm at teeth with a defect angle width < 20 degrees and 0.86 ± 1.66 mm at teeth with a defect angle width > 30 degrees (P = .021). When the baseline radiographic angle width was < 20 degrees the probability of obtaining a CAL gain > 3 mm was 1.5-times higher (95% CI 0.19 to 13.8) at T1 and 2.5-times higher (95% CI 0.40 to 15.6) at T2 compared with defects with a radiographic angle width > 30 degrees. CONCLUSION: Within their limitations, these results indicate that pretherapeutic measurement of the radiographic defect angle width might provide relevant information on the short-/long-term clinical outcomes following regenerative periodontal therapy with EMD.

Regenerative Surgery of Mandibular Class II Furcation Defects: A Comparison of Two Techniques in a Randomized Clinical Trial with 3D CBCT Measurements at 24 Months.

The aim of the present study was to evaluate, clinically and via CBCT, the long-term efficacy of a bioresorbable polylactic acid membrane combined with deproteinized bovine bone graft (DBBM) and compare it to enamel matrix derivative (EMD) combined with DBBM graft in the treatment of class II furcation defects. Sites were randomly assigned to the test group (Guidor Matrix Barrier + Bio-Oss) or the control group (Emdogain + Bio-Oss). Probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (REC), and keratinized tissue (KT) width were assessed at 12 and 24 months, and radiographic bone gain was investigated at 24 months via CBCT. Both groups showed a significant radiographic bone fill and clinical gain. The combination of Emdogain + Bio-Oss showed better clinical outcomes and less complications, though this difference was not statistically significant.

The Tunnel Wall Approach and Enamel Matrix Derivative to Cover Exposed Roots and Improve Clinical Attachment Levels in Cairo Class III Defects Associated with an Intrabony Lesion in the Anterior Area: Three Cases.

These case reports present a surgical technique to improve the clinical attachment level and cover the exposed root surface in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area. The tunnel wall approach combined previously described concepts and placed a CTG into a modified tunnel-type flap through a vertical releasing incision. The CTG acted both as a buccal soft tissue wall to stabilize the blood clot and as a space maintainer to coronally move the tissue. The decontaminated root surfaces were treated with enamel matrix derivative, and a bone filler material was placed from the bottom of the intrabony defect up to the cementoenamel junction to support the proximal soft tissue architecture. Healing of the four presented sites was uneventful. Clinical measurements up to 12 months showed significant probing depth reduction, clinical attachment gain, and coverage of the buccal recession in each case. Papilla improvement was reported in three cases. Radiographic examinations confirmed intrabony defect healing and the presence of embedded bone filler material in the soft tissue above the bone crest. The tunnel wall approach seems to be a valuable option to safely enhance the clinical attachment level and cover the exposed root in Cairo Class III situations associated with a one- to two-wall combined intrabony defect in the anterior area.

Recession coverage using the modified coronally advanced tunnel and connective tissue graft with or without enamel matrix derivative: 5-year results of a randomised clinical trial.

OBJECTIVES: To evaluate the 5-year results of single and multiple recession type (RT) 1 and 2 (Miller I to III) recessions treated with the modified coronally advanced tunnel (MCAT) and connective tissue graft (CTG) with or without an enamel matrix derivative (EMD). The main outcome variable was the stability of obtained root coverage from 6 months to 5 years. MATERIALS AND METHODS: In 24 patients, both complete and mean root coverage (CRC and MRC) and gain of keratinised tissue (KT) were assessed at 6 months and 5 years after recession coverage by means of MCAT and CTG with or without EMD. Aesthetic outcomes after 5 years were evaluated using the root coverage aesthetic score (RES). RESULTS: At 5 years, 24 patients with a total of 43 recessions were evaluated. Eight patients (57.14%) of the test and 6 (60.0%) of the control group showed complete root coverage. MRC revealed no statistically significant differences between the two groups, with 73.87 ± 26.83% (test) and 75.04 ± 22.06% (control), respectively. KT increased from 1.14 ± 0.57 mm to 3.07 ± 2.27 mm in the test group and from 1.24 ± 0.92 mm to 3.02 ± 1.55 mm in the control group, respectively. CONCLUSION: Treatment of single and multiple RT 1 and 2 recessions by means of MCAT and CTG with or without EMD yielded comparable clinical improvements which could be maintained over a period of 5 years. The additional use of EMD did not influence the clinical outcomes. CLINICAL RELEVANCE: The use of MCAT + CTG yielded successful coverage of single and multiple RT 1 and 2 gingival recessions, while the additional application of EMD did not seem to influence the results.

Five-year results following regenerative periodontal surgery with an enamel matrix derivative in patients with different smoking status.

OBJECTIVE: To evaluate the five-year results following regenerative periodontal surgery of intrabony defects using an enamel matrix derivative (EMD) in patients with different smoking status. METHOD AND MATERIALS: The dental records of patients treated with regenerative periodontal surgery with EMD between 2001 and 2011 were screened. The clinical parameters at baseline (T0) and 6 months (T1) and 5 years (T2) after surgery were collected and analyzed in relation to patient's smoking status (smokers, former smokers, and nonsmokers). RESULTS: A total of 71 sites were initially assessed in 38 patients. In total, 56 sites could be evaluated at T1, and 34 after 5 years (T2). At 6 months after surgery, a statistically significant mean probing pocket depth (PPD) reduction of 2.91 ± 1.60 mm and a mean clinical attachment level (CAL) gain of 1.89 ± 1.90 mm were measured. Nonsmokers revealed a greater, statistically not significant CAL gain compared to smokers (2.38 ± 2.12 mm vs 1.50 ± 1.71 mm). Although at 5 years the site-specific PPD values remained stable in nonsmokers, smokers showed an increase of 1.60 ± 2.41 mm. CONCLUSIONS: The present study provides evidence that regenerative periodontal surgery with EMD may lead to clinically relevant improvements even in smoking patients. However, the positive effect of EMD seems to be limited in time and can only partially compensate for the negative influence of smoking.

Comparison of Coronally Advanced Flap and Connective Tissue Graft With or Without Enamel Matrix Derivative for Gingival Recession Treatment: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

The aim of this systematic review and meta-analysis was to assess whether the addition of enamel matrix derivative (EMD) to a coronally advanced flap (CAF) combined with a connective tissue graft (CTG) resulted in a greater amount of root coverage in patients treated for gingival recessions, as compared to CAF+CTG alone. The search for clinical trials on root coverage procedures comparing CAF+CTG+EDM vs CAF+CTG was completed on online databases and gray literature, and it included studies published up to January 2022. The risk of bias was assessed using the Cochrane bias assessment tool, and the quantitative analysis was performed using a random effects model. A total of 1,917 articles were identified, and 12 underwent full-text review. Three studies were excluded, and 9 were selected for full analysis. The meta-analysis showed that there is a statistically significant difference (P = .04) in favor of CAF+CTG+EMD compared to CAF+CTG alone for the amount of root coverage (mean difference: 0.30 mm; 95% CI: 0.01, 0.58 mm). According to the results of this systematic review and meta-analysis, the addition of EMD to CAF+CTG results in a greater amount of root coverage in teeth treated for gingival recessions.

Surgical Periodontal Therapy Using Recombinant Human Fibroblast Growth Factor-2 in Combination with Carbonate Apatite Granules for Stage III Grade B Periodontitis: A Case Report with 1-year Follow-up.

This report describes a case of generalized chronic periodontitis requiring periodontal treatment including regenerative therapy. The patient was a 60-year-old woman who visited the Tokyo Dental College Suidobashi Hospital with the chief complaint of tooth mobility and pain in tooth #26. Periodontal examination at the first visit revealed that 32.0% of sites had a probing depth of ≥4 mm and 43.8% bleeding on probing. Radiographic examination revealed vertical bone resorption in #17. Horizontal resorption was noted in other areas. Initial periodontal therapy consisting of plaque control, scaling and root planing, and caries treatment was performed based on a clinical diagnosis of Stage III Grade B periodontitis. Tooth #26 was extracted due to bone resorption extending as far as the root apex. After reevaluation, periodontal regenerative therapy using recombinant human fibroblast growth factor-2 (rhFGF-2) in combination with carbonate apatite (CO3Ap) granules was performed for #17. Following reevaluation, a zirconia crown (#16) and zirconia bridge (#24-27) were placed. Following further reevaluation, the patient was placed on supportive periodontal therapy (SPT). The periodontal regenerative therapy using rhFGF-2 with CO3Ap granules yielded an improvement in the vertical bone resorption observed in #17. This improvement has been adequately maintained over a 1-year period postoperatively. Continued SPT is needed to maintain stable periodontal conditions.

Use of Enamel Matrix Derivative in Minimally Invasive/Flapless Approaches: A Systematic Review with Meta-Analysis.

PURPOSE: The aim of the present systematic review with meta-analysis was to investigate the clinical effectiveness of EMD (enamel matrix derivative) using a minimally invasive surgical technique (MIST) or flapless approach for the treatment of severe periodontal probing depths. MATERIALS AND METHODS: A systematic review of the literature including searches in PubMed/Medline, Cochrane Library, Google Scholar, and Grey Literature databases as well as manual searches was performed on September 1st, 2021. Studies utilising EMD in a non-surgical or minimally invasive approach were included. The eligibility criteria comprised randomised controlled trials (RCTs) comparing minimally-invasive/flapless approaches with/without EMD for the treatment of probing depths >5 mm. RESULTS: From 1525 initial articles, 7 RCTs were included and 12 case series discussed. Three studies investigated a MIST approach, whereas 3 studies utilised a flapless approach. One study compared EMD with either a MIST or a flapless approach. The RCTs included ranged from 19-49 patients with at least 6 months of follow-up. While 5 of the studies included smokers, patients smoking >20 cigarettes/day were excluded from the study. The meta-analysis revealed that EMD with MIST improved recession coverage (REC) and bone fill (BF) when compared to MIST without EMD. However, no difference in CAL or PD was observed between MIST + EMD vs MIST without EMD. No statistically significant advantage was found for employing the EMD via the flapless approach. CONCLUSIONS: Implementing EMD in MIST procedures displayed statistically significant improvement in REC and BF when compared to MIST alone. These findings suggest that MIST in combination with EMD led to improved clinical outcomes while EMD employed in nonsurgical flapless therapy yielded no clinical benefits when compared to nonsurgical therapy alone without EMD. More research is needed to substantiate these findings.

Treatment of Chronic Periodontitis with Periodontal Surgery Including Regenerative Therapy Using Recombinant Human Fibroblast Growth Factor-2 and Papilla Preservation Technique: A Case Report with a Two-year Follow-up.

This report describes a case of generalized chronic periodontitis requiring periodontal therapy including periodontal regeneration. The patient was a 59-year-old man who visited the Tokyo Dental College Suidobashi Hospital with the chief complaint of mobility in tooth #47. Periodontal examination at the first visit revealed that 32.1% of sites had a probing depth of ≥4 mm and 32.7% of sites bleeding on probing. Radiographic examination revealed vertical bone resorption in #26 and horizontal resorption in #12, 13, 42, and 43. Based on a clinical diagnosis of severe chronic periodontitis, initial periodontal therapy consisting of plaque control, scaling and root planing, occlusal adjustment, caries treatment, and placement of an occlusal splint was performed. Tooth #47 was extracted due to bone resorption extending as far as the root apex. After reevaluation, surgical periodontal treatment was performed at the selected site. Periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF)-2 and papilla preservation technique was performed for #26. To reduce periodontal pockets, open flap debridement was implemented for #12, 13, 42, and 43. After reevaluation, the patient was placed on supportive periodontal therapy (SPT). Periodontal regenerative therapy with rhFGF-2 and modified papilla preservation technique yielded an improvement in angular bone resorption which has been properly maintained for two years. Periodontal therapy with open flap debridement resulted in an improvement in horizontal bone resorption. Continued SPT is needed to maintain a stable periodontal condition.

Enamel Matrix Derivative Decreases Pyroptosis-Related Genes in Macrophages.

Background: Pyroptosis is a caspase-dependent catabolic process relevant to periodontal disorders for which inflammation is central to the pathophysiology of the disease. Although enamel matrix derivative (EMD) has been applied to support periodontal regeneration, its capacity to modulate the expression of pyroptosis-related genes remains unknown. Considering EMD has anti-inflammatory properties and pyroptosis is linked to the activation of the inflammasome in chronic periodontitis, the question arises whether EMD could reduce pyroptosis signalling. Methods: To answer this question, primary macrophages obtained from murine bone marrow and RAW 264.7 macrophages were primed with EMD before being challenged by lipopolysaccharide (LPS). Cells were then analysed for pyroptosis-signalling components by gene expression analyses, interleukin-1ß (IL-1ß) immunoassay, and the detection of caspase-1 (CAS1). The release of mitochondrial reactive oxygen species (ROS) was also detected. Results: We report here that EMD, like the inflammasome (NLRP3) and CAS1 specific inhibitors-MCC950 and Ac-YVAD-cmk, respectively-lowered the LPS-induced expression of NLRP3 in primary macrophages (EMD: p = 0.0232; MCC950: p = 0.0426; Ac-YVAD-cmk: p = 0.0317). EMD further reduced the LPS-induced expression of NLRP3 in RAW 264.7 cells (p = 0.0043). There was also a reduction in CAS1 and IL-1ß in RAW 264.7 macrophages on the transcriptional level (p = 0.0598; p = 0.0283; respectively), in IL-1ß protein release (p = 0.0313), and CAS1 activity. Consistently, EMD, like MCC950 and Ac-YVAD-cmk, diminished the ROS release in activated RAW 264.7 cells. In ST2 murine mesenchymal cells, EMD could not be tested because LPS, saliva, and IL-1ß + TNF-α failed to provoke pyroptosis signalling. Conclusion: These findings suggest that EMD is capable of dampening the expression of pyroptosis-related genes in macrophages.

Combination Therapy with Connective Tissue Graft, Amelogenins, and Bone Substitutes for Treatment of Deep Intrabony Defects Associated with Gingival Recession: 1-Year Follow-up of 12 Cases.

Combined surgical procedures have been introduced that combine periodontal regenerative/reconstructive procedures in intrabony defects with a connective tissue graft to compensate for a deficient bone wall and limit soft tissue shrinkage, but little is known about the reproducibility of these advanced surgical techniques. This 12-case series applies a combined surgical procedure, combining amelogenins, bone substitutes, and connective tissue graft to treat deep intrabony defects associated with gingival recession. Twelve deep intrabony defects with a mean clinical attachment loss of 9.9 ± 2.1 mm, mean probing depth (PPD) of 7.8 ± 1.5 mm, mean recession of the tip of the interdental papilla (TP) of 2.1 ± 1.5 mm, and mean buccal recession (REC) of 2.3 ± 1.8 mm were treated. At 1 year, the average attachment gain was 5.1 ± 1.8 mm (P < .001), the residual PPD was 2.9 ± 0.7 mm (P < .001), no change was observed in the TP (-0.4 ± 0.8 mm, P = .078), and the REC slightly decreased to 1.7 ± 1.5 mm (P = .047). These results suggest that the proposed technique led to predictable clinical outcomes that support regeneration while maintaining or improving the position of the soft tissue margin for the interdental and buccal aspects in deep intrabony defects associated with gingival recession.

Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs.

AIM: The modified minimally invasive surgical technique (M-MIST) optimizes wound stability in the treatment of intrabony defects. Short-term observations show similar results as with flap alone or adjunctive regenerative materials. This study aims to compare the stability of the long-term outcomes, complication-free survival, and costs of the three treatment options. MATERIALS AND METHODS: Forty-five intrabony defects in 45 patients were randomized to M-MIST alone (N = 15), combined with enamel matrix derivative (M-MIST + EMD, N = 15), or EMD plus bone-mineral-derived xenograph (M-MIST + EMD + BMDX, N = 15). Supportive periodontal care (SPC) and necessary re-treatment were provided for 10 years. RESULTS: Three subjects were lost to follow-up. Clinical attachment level differences between 1 and 10 years were -0.1 ± 0.7 mm for M-MIST, -0.1 ± 0.8 mm for M-MIST + EMD, and -0.3 ± 0.6 mm for M-MIST + EMD + BMDX (p > .05 for within- and between-group differences). Four episodes of recurrence occurred in the M-MIST group, four in the M-MIST + EMD group, and five in the M-MIST + EMD + BMDX group. No significant differences in complication-free survival were observed between the three groups (p = .47). Complication-free survival was 7.46 years (95% confidence interval: 7.05-7.87) for the whole population. The M-MIST + EMD + BMDX group lost one treated tooth. Data indicated no significant inter-group difference of the total cost of recurrence over 10 years. When the baseline cost of treatment was considered, the total cost was lower for M-MIST alone. CONCLUSIONS: Teeth with deep pockets associated with intrabony defects can be successfully maintained over the long term with either M-MIST alone or by adding a regenerative material in the context of a careful SPC programme. M-MIST alone provided similar short- and long-term benefits as regeneration, at a lower cost. These findings need to be confirmed in larger, independent studies.