Evaluation of the efficiency of hyaluronic acid, PRP and I-PRF intra-articular injections in the treatment of internal derangement of the temporomandibular joint: A prospective study.

This study aimed to evaluate the clinical effects of hyaluronic acid (HA), platelet-rich plasma (PRP), and platelet-rich fibrin (I-PRF) injections in the internal derangement of the temporomandibular joint. Adult patients who had failed to respond to nonsurgical treatment were were included in the study. The patients were divided into three treatment groups according to the given substance: 1) HA administration three times in a row on a weekly basis, 2) a single dose of PRP, or 3) a single dose of I-PRF. Clinical assessment was performed preoperatively and 6 and 12 months after the treatment, including maximal mouth opening (MMO) and pain level (Visual Analog Scale). Low and high molecular weight (HAL, HAH) hyaluronic acid forms were also compared. 68 adult patients, with a total of 109 joints were included in the study. The mean age was 53 ± 16 years. The statistical analysis showed a significant improvement in MMO in the HA group (p < 0.01). The pain level significantly decreased in all treatment groups (pHA,PRP,I-PRF<0.01). Comparing HAL and HAH forms, no significant difference was found in the evaluation of MMO and VAS values. Within the limitations of the study it seems that due to the similar effects of HA and the autologous blood substances, the platelet concentrates should be preferred in the intra-articular treatment in order to reduce the risk of possible adverse effects.

Healing of periodontal intrabony defects following treatment with a new-generation platelet-rich fibrin. / Vérlemezkében gazdag fibrinnel kezelt parodontalis csontdefektusok gyógyulásának értékelése.

Összefoglaló. Az autológ vérlemezke-koncentrátumok az orvoslás egyre több területén kerülnek alkalmazásra. A vérlemezkében gazdag fibrin, ebben a kategóriában, az adott terápiás lehetoségek közül a legaktuálisabb. Elonyei, hogy alvadásgátló hozzáadása nélkül preparálható, egy centrifugálást igényel, és több formában alkalmazható. A vérlemezkében gazdag fibrin újabb generációja további lehetoségeket teremthet, így a parodontalis sebgyógyulás terén is. Az esetek bemutatásának célja parodontalis intraossealis csontdefektusok gyógyulásának rövid távú klinikai értékelése autológ vérlemezkében gazdag készítménnyel (advanced platelet-rich fibrin) történt kezelést követoen. A bemutatott eseteknél preoperatíven, majd 6 hónappal a mutétet követoen történt kiértékelés a következo parodontológiai paraméterek rögzítésével: tasakszondázási mélység (probing depth), illetve klinikai tapadási szint (clinical attachment level). Teljes vastagságú lebenyek képzését követoen a csontdefektus kürettálása, illetve gyökérsimítás történt, majd a preoperatíven preparált, vérlemezkében gazdag fibrin applikálására került sor, melyet sebzárás követett. Fél évvel a sebészi beavatkozás után a szondázási mélység csökkenése és a klinikai tapadási nívó növekedése volt tapasztalható. Bemutatott eseteinknél a vérlemezkében gazdag fibrin applikációja pozitív klinikai eredményeket mutatott a parodontalis sebgyógyulás tekintetében. A vérlemezkében gazdag fibrinnek mint humán autológ preparátumnak a használata elosegítheti a parodontalis defektusok sikeres kezelését. Orv Hetil. 2022; 163(12): 484-490. Summary. Autologous platelet concentrates are being used in more and more areas of medicine. Application of platelet-rich fibrin is the most topical among these therapeutic options. As main advantages, it can be prepared without the addition of anticoagulants, requires only one centrifugation and can be used in various forms. A new generation of platelet-rich fibrin may open up further opportunities, including those in periodontal wound healing. The aim of this case series is to provide a short-term clinical evaluation of the healing of periodontal intrabony defects after treatment with an autologous platelet-rich fibrin product (advanced platelet-rich fibrin). The presented cases were evaluated preoperatively and 6 months after surgery by recording the following periodontal parameters: probing depth and clinical attachment level. After full-thickness flap preparation, intrabony defect curettage, scaling and root planing were performed, followed by the application of preoperatively prepared platelet-rich fibrin and wound closure. Six months after surgery, pocket depth reductions and clinical attachment level gains were observed. In our presented cases, the platelet-rich fibrin application showed positive clinical results regarding periodontal wound healing and may facilitate the successful treatment of periodontal defects. Orv Hetil. 2022; 163(12): 484-490.

Histological Examination of Retrieved ePTFE Membranes Following Regenerative Surgery of Intrabony Defects Treated with Platelet-rich Plasma and Bone Substitutes.

PURPOSE: Regenerative periodontal therapy using platelet-rich plasma (PRP) and bone substitutes with guided tissue regeneration (GTR) have been proposed as a therapeutic method to enhance the outcome of regenerative surgery. This includes light microscopic evaluation of retrieved ePTFE membranes to assess formation of new connective tissue attachment, and following the regeneration process. The objectives of this study were to evaluate the histological findings of retrieved ePTFE membranes using PRP and bone substitutes, the effect of PRP on graft materials, and the correlation of the findings with the clinical outcomes. MATERIALS AND METHODS: Seventy-two (72) patients with chronic periodontitis, each of whom had one deep intrabony defect, were randomly included in two studies and treated using the same type of membrane and different bone substitutes. In the first study, 17 cases were treated with a natural bone mineral and a non-resorbable membrane (NBM + GTR), and 17 cases were treated with PRP + NBM + GTR. In the second study, 19 patients were treated with ß-tricalcium phosphate and a non-resorbable membrane (ß-TCP + GTR), and 19 patients were treated with PRP + ß-TCP + GTR. In both studies, tissue integration of the retrieved ePTFE membranes and attached remnants were evaluated histologically. RESULTS: Histological scores showed that membranes combined with NBM are better integrated than membranes combined with ß-TCP; the difference between the two decreased with the addition of PRP. The application of PRP had no significant effect on the quality of membrane integration combined with NBM, whilst significantly improving the integration quality when combined with ß-TCP. No correlations were detected between the histological scores and the clinical attachment level (CAL) gain in any of the groups. CONCLUSIONS: The present results indicate that: a) application of ß-TCP and PRP may enhance membrane integration and periodontal healing, and b) histological examination of retrieved membranes may provide valuable additional information with regard to the clinical findings.

Efficacy of a new-generation platelet-rich fibrin in the treatment of periodontal intrabony defects: a randomized clinical trial.

BACKGROUND: The aim of the study was to clinically evaluate the healing of intrabony defects after treatment with a new generation of platelet-rich fibrin (A-PRF+) respect to enamel matrix derivative (EMD). METHODS: Thirty (30) intrabony defects of 18 patients (9 males, 9 females) were randomly treated with A-PRF+ (test, n = 15) or EMD (control, n = 15). The following clinical parameters were recorded at baseline and 6 months after surgery: pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL). After debridement the intrabony defects were filled with A-PRF+ in the test group, respectively with EMD in the control group, and fixed with sutures to ensure wound closure and stability. RESULTS: Both treatment methods resulted in statistically significant PD reductions, respectively CAL gains six months post-operatively. No statistically significant differences were found between the two groups as the mean CAL gain was 2.33 ± 1.58 mm in the A-PRF+ group, respectively 2.60 ± 1.18 mm in the EMD group (p < 0.001). CONCLUSION: Within the limits of this study the new-generation platelet-rich fibrin seems to be as clinically effective as EMD during surgical treatment of intrabony defects. Treatment with A-PRF+ or EMD resulted in reliable clinical outcomes. The use of A-PRF+ as a human autologous product can give a positive impact on periodontal healing. Clinical Relevance A-PRF+ may be suitable for the treatment of intrabony periodontal defects. Trial registration number (TRN) NCT04404374 (ClinicalTrials.gov ID).

Bacterial Contamination of ePTFE Membranes Following Regenerative Surgery of Intrabony Defects Treated with Platelet-rich Plasma and Natural Bone Mineral.

PURPOSE: The rationale of using platelet-rich plasma (PRP) in reconstructive periodontal surgery is to amplify or accelerate the wound healing through the growth factors contained in platelets. On the other hand, bacterial colonisation of membranes may negatively affect the healing process. The aim of this study was to evaluate bacterial contamination of non-bio-resorbable membranes (ePTFE) used for regenerative periodontal therapy of intrabony defects and the clinical attachment level (CAL) gain with or without PRP. MATERIALS AND METHODS: Seventeen patients were treated with a natural bone mineral (NBM) and guided tissue regeneration (GTR) with an ePTFE membrane (NBM + GTR group; ie, control group), while in another 17 patients PRP was additionally applied (NBM + PRP + GTR group; ie, test group). Furthermore, the retrieved membranes were analysed for the presence of periodontopathogens and data were related to the gain of clinical attachment. In addition, the in vitro sensitivity of selected microbes to PRP was checked by using agar diffusion test. RESULTS: Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were not detected in the PRP group whereas in the controls A. actinomycetemcomitans was detected in five patients (p = 0.022) and P. gingivalis in two cases (difference not statistically significant, p = 0.242). Detection of A. actinomycetemcomitans was not associated with less CAL gain. If the samples were positively tested for Prevotella intermedia/nigrescens and/or P. gingivalis, the CAL gains were lower compared with the negative samples (p = 0.002). PRP did not show any inhibitory effect on bacterial growth in vitro. CONCLUSION: Within their limits, the present results appear to suggest that the presence of P. intermedia/nigrescens and/or P. gingivalis at the regenerated site may negatively influence the clinical outcomes. However, the potential influence of PRP on bacterial colonisation and the impact on the clinical outcome is still unclear and remains to be elucidated.

Effects of platelet rich plasma (PRP) on human gingival fibroblast, osteoblast and periodontal ligament cell behaviour.

BACKGROUND: The use of platelet rich plasma (PRP, GLO) has been used as an adjunct to various regenerative dental procedures. The aim of the present study was to characterize the influence of PRP on human gingival fibroblasts, periodontal ligament (PDL) cells and osteoblast cell behavior in vitro. METHODS: Human gingival fibroblasts, PDL cells and osteoblasts were cultured with conditioned media from PRP and investigated for cell migration, proliferation and collagen1 (COL1) immunostaining. Furthermore, gingival fibroblasts were tested for genes encoding TGF-ß, PDGF and COL1a whereas PDL cells and osteoblasts were additionally tested for alkaline phosphatase (ALP) activity, alizarin red staining and mRNA levels of osteoblast differentiation markers including Runx2, COL1a2, ALP and osteocalcin (OCN). RESULTS: It was first found that PRP significantly increased cell migration of all cells up to 4 fold. Furthermore, PRP increased cell proliferation at 3 and 5 days of gingival fibroblasts, and at 3 days for PDL cells, whereas no effect was observed on osteoblasts. Gingival fibroblasts cultured with PRP increased TGF-ß, PDGF-B and COL1 mRNA levels at 7 days and further increased over 3-fold COL1 staining at 14 days. PDL cells cultured with PRP increased Runx2 mRNA levels but significantly down-regulated OCN mRNA levels at 3 days. No differences in COL1 staining or ALP staining were observed in PDL cells. Furthermore, PRP decreased mineralization of PDL cells at 14 days post seeding as assessed by alizarin red staining. In osteoblasts, PRP increased COL1 staining at 14 days, increased COL1 and ALP at 3 days, as well as increased ALP staining at 14 days. No significant differences were observed for alizarin red staining of osteoblasts following culture with PRP. CONCLUSIONS: The results demonstrate that PRP promoted gingival fibroblast migration, proliferation and mRNA expression of pro-wound healing molecules. While PRP induced PDL cells and osteoblast migration and proliferation, it tended to have little to no effect on osteoblast differentiation. Therefore, while the effects seem to favor soft tissue regeneration, the additional effects of PRP on hard tissue formation of PDL cells and osteoblasts could not be fully confirmed in the present in vitro culture system.

Five-year results evaluating the effects of platelet-rich plasma on the healing of intrabony defects treated with enamel matrix derivative and natural bone mineral.

BACKGROUND: Regenerative periodontal surgery using the combination of enamel matrix derivative (EMD) and natural bone mineral (NBM) with and without addition of platelet-rich plasma (PRP) has been shown to result in substantial clinical improvements, but the long-term effects of this combination are unknown. METHODS: The goal of this study was to evaluate the long-term (5-year) outcomes after regenerative surgery of deep intrabony defects with either EMD + NBM + PRP or EMD + NBM. Twenty-four patients were included. In each patient, one intrabony defect was randomly treated with either EMD + NBM + PRP or EMD + NBM. Clinical parameters were evaluated at baseline and 1 and 5 years after treatment. The primary outcome variable was clinical attachment level (CAL). RESULTS: The sites treated with EMD + NBM + PRP demonstrated a mean CAL change from 10.5 ± 1.6 to 6.0 ± 1.7 mm (P <0.001) at 1 year and 6.2 ± 1.5 mm (P <0.001) at 5 years. EMD + NBM-treated defects showed a mean CAL change from 10.6 ± 1.7 to 6.1 ± 1.5 mm (P <0.001) at 1 year and 6.3 ± 1.4 mm (P <0.001) at 5 years. At 1 year, a CAL gain of ≥4 mm was measured in 83% (10 of 12) of the defects treated with EMD + NBM + PRP and in 100% (all 12) of the defects treated with EMD + NBM. Compared to baseline, in both groups at 5 years, a CAL gain of ≥4 mm was measured in 75% (nine of 12 in each group) of the defects. Four sites in the EMD + PRP + NBM group lost 1 mm of the CAL gained at 1 year. In the EMD + NBM group, one defect lost 2 mm and four other defects lost 1 mm of the CAL gained at 1 year. No statistically significant differences in any of the investigated parameters were observed between the two groups. CONCLUSIONS: Within their limits, the present results indicate that: 1) the clinical outcomes obtained with both treatments can be maintained up to a period of 5 years; and 2) the use of PRP does not appear to improve the results obtained with EMD + NBM.

Ten-year results following treatment of intrabony defects with an enamel matrix protein derivative combined with either a natural bone mineral or a ß-tricalcium phosphate.

BACKGROUND: The purpose of the present study is to evaluate the 10-year results following treatment of intrabony defects treated with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or ß-tricalcium phosphate (ß-TCP). METHODS: Twenty-two patients with advanced chronic periodontitis and displaying one deep intrabony defect were randomly treated with a combination of either EMD + NBM or EMD + ß-TCP. Clinical evaluations were performed at baseline and at 1 and 10 years. The following parameters were evaluated: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level (CAL). The primary outcome variable was CAL. RESULTS: The defects treated with EMD + NBM demonstrated a mean CAL change from 8.9 ± 1.5 mm to 5.3 ± 0.9 mm (P <0.001) and to 5.8 ± 1.1 mm (P <0.001) at 1 and 10 years, respectively. The sites treated with EMD + ß-TCP showed a mean CAL change from 9.1 ± 1.6 mm to 5.4 ± 1.1 mm (P <0.001) at 1 year and 6.1 ± 1.4 mm (P <0.001) at 10 years. At 10 years two defects in the EMD + NBM group had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. In the EMD + ß-TCP group three defects had lost 2 mm, whereas two other defects had lost 1 mm of the CAL gained at 1 year. Compared with baseline, at 10 years, a CAL gain of ≥3 mm was measured in 64% (i.e., seven of 11) of the defects in the EMD + NBM group and in 82% (i.e., nine of 11) of the defects in the EMD + ß-TCP group. No statistically significant differences were found between the 1- and 10-year values in either of the two groups. Between the treatment groups, no statistically significant differences in any of the investigated parameters were observed at 1 and 10 years. CONCLUSION: Within their limitations, the present findings indicate that the clinical improvements obtained with regenerative surgery using EMD + NBM or EMD + ß-TCP can be maintained over a period of 10 years.

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.

[Effect of combined therapeutic methods on healing of periodontal vertical bone defects in regenerative surgery]. / Kombinált terápiás eljárások hatása a parodontalis vertikális csontdefektusok regeneratív sebészetében.

Several methods are available to enhance the healing and regeneration of periodontal tissues after surgical therapy of intrabony defects. The main indications for the use of combined regenerative procedures are the extent and morphology of the osseous lesions. The six studies of the present dissertation focused on the clinical effect of different barrier techniques, bone substitutes, enamel matrix derivatives and a growth factors containing adjuvant used in various combinations on the healing of severe periodontal intrabony impairments. Synthetic, xenogenetic and autologous materials were used in these randomized clinical studies. Mechanical barriers (polytetrafluoroethylene and collagen membranes) for GTR, biological barriers/enamel matrix proteins (EMD), synthetic (beta-TCP) and xenogeneic (NBM) bone grafts and autologous platelet-rich plasma (PRP) were combined in the test and control groups of the trials. The main clinical variable was the clinical attachment level (CAL) and the subsidiary one was the probing pocket depth (PPD), estimated at baseline and after one year. The summation of the results after the statistical analysis takes cognizance of the followings: a) Each of the eleven regenerative methods evaluated (ten combined procedures) leads to significant CAL gain and PPD decrease. b) Using beta-TCP or NBM with EMD or with PRP+GTR and GTR's, the difference between the parameters of the test and control groups were not statistically significant. c) It was confirmed in four studies that the addition of PRP to graft materials has not increased significantly the positive outcomes independent of the type of barrier or graft. d) Adding platelet-rich plasma to natural bone mineral, no benefit was observed from the point of view of the clinical variables. e) The polypeptide proteins of the platelet-rich plasma do not enhance the clinical regenerative effect of enamel matrix proteins. In conclusion, the option of the periodontal surgeons between these methods depends mainly on the defect morphology, the patient's attitude to the different types of materials, the medical concept of the physician, the technical possibilities and the clinical experience of the periodontist.

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 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.

Emdogain in regenerative periodontal therapy. A review of the literature.

The goal of regenerative periodontal therapy is the reconstitution of the lost periodontal structures (i.e. the new formation of root cementum, periodontal ligament and alveolar bone). Results from basic research have pointed to the important role of the enamel matrix protein derivative (EMD) in the periodontal wound healing. Histological results from animal and human studies have shown that treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. The goal of the current overview is to present, based on the existing evidence, the clinical indications for regenerative therapy with EMD. Surgical periodontal treatment of deep intrabony defects with EMD promotes periodontal regeneration. The application of EMD in the context of non-surgical periodontal therapy has failed to result in periodontal regeneration. Surgical periodontal therapy of deep intrabony defects with EMD may lead to significantly higher improvements of the clinical parameters than open flap debridement alone. The results obtained following treatment with EMD are comparable to those following treatment with GTR and can be maintained over a longer period. Treatment of intrabony defects with a combination of EMD + GTR does not seem to additionally improve the results compared to treatment with EMD alone or GTR alone. The combination of EMD and some types of bone grafts/bone substitutes may result in certain improvements in the soft and hard tissue parameters compared to treatment with EMD alone. Treatment of recession-type defects with coronally repositioned flaps and EMD may promote formation of cementum, periodontal ligament and bone, and may significantly increase the width of the keratinized tissue. Application of EMD seems to provide better long-term results than coronally repositioned flaps alone. Application of EMD may enhance periodontal regeneration in mandibular Class II furcations. The clinical results are comparable to those obtained following GTR.

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.

Clinical evaluation of an enamel matrix protein derivative combined with either a natural bone mineral or beta-tricalcium phosphate.

BACKGROUND: The purpose of the present study was to compare the healing of deep intrabony defects following treatment with an enamel matrix protein derivative (EMD) combined with either a natural bone mineral (NBM) or beta-tricalcium phosphate (beta-TCP). METHODS: Twenty-four patients with advanced periodontal disease, each of whom displayed one intrabony defect, were randomly treated with a combination of either EMD + NBM or EMD + beta-TCP. Clinical evaluation was performed at baseline and 1 year following therapy. 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 EMD + NBM showed a reduction in mean probing depth (PD) from 7.9 +/- 1.0 mm to 3.2 +/- 0.6 mm and a change in mean clinical attachment level (CAL) from 8.8 +/- 1.1 mm to 4.5 +/- 0.6 mm (P < 0.001). In the group treated with EMD + beta-TCP, the mean PD was reduced from 7.8 +/- 1.2 mm to 3.2 +/- 0.9 mm, and the mean CAL changed from 8.8 +/- 1.2 mm to 4.7 +/- 1.2 mm (P < 0.001). In both groups, all sites gained at least 3 mm of CAL. CAL gains of 4 or 5 mm were measured in the majority of the cases (75%), irrespective of treatment modality. No statistically significant differences in terms of PD reductions and CAL gains were observed between the two groups. CONCLUSION: Within the limits of the present study, both therapies resulted in significant PD reductions and CAL gains 1 year after surgery.

[Experience with the clinical use of beta-tri-calcium phosphate (Cerasorb) as a bone replacement graft material in human periodontal osseous defects]. / A beta tri-calcium phosphate (Cerasorb) klinikai alkalmazásával nyert tapasztalatok humán parodontális csonthiányok pótlásában.

Various bone replacement graft materials have been used in attempting to restore periodontal bone structure lost as a result of periodontal inflammation. The pure beta-tricalcium phosphate has been successfully used in oral surgery for replacing lost bone but the periodontal data available are very limited. The major objective of the present clinical trial is to evaluate the regenerative-reparative potential of beta-tricalcium phosphate (CERASORB) in the treatment of two-three-wall vertical periodontal bony defect. 21 patients with advanced intrabony defects were selected for this study. Parameters used for assessment: Bleeding on probing, Clinical Probing Depths (CPD), Clinical Attachment Loss (CAL), Clinical Gingival Recession (CGR) and Radiological evaluation on standardized periapical radiographs. Following local anesthesia, intracervicular incisions is placed and a full thickness mucoperiosteal flap is raised vestibularly and lingually. The granulation tissue was completely removed from the defects and the roots were thoroughly scaled and planed using hand and ultrasonic instruments. Osseous recontouring was not performed. Following defect debridement, the CERASORB bone-grafting material was carefully applied and gently condensed in the bone crater then the flaps were repositioned in a coronal position and closed with vertical or horizontal mattress sutures. Six months after surgery CPD, CAL and CGR parameters were also measured and compared to baseline data. Bone defects treated with beta-TCP bone grafting materials showed a great variation in healing tendency. The best radiological results (bone fill) were obtained in three wall defects. Even using the most thorough suturing technique substantial part of the bone grafting material was lost during the first post-surgical week. If no sequestration occurred substantial bone fill and clinical attachment gain occurred especially in the three wall defects one year after grafting. The use of biological barrier membranes are recommended.