RESUMO
Introduction: Bone loss progression due to periodontitis can lead to pathologic tooth migration, ultimately compromising the overall structure and function of the oral cavity. In pathologic tooth migration, a periodontal-orthodontic interdisciplinary approach is necessary. The combination of a bone graft and orthodontic treatment has shown promising results for periodontal regeneration. The treatment sequence and selection of a bone graft define the success of the therapy. Objective: This study aims to discuss the protocol of the interdisciplinary approach to regenerative periodontal surgery in cases of intrabony defects requiring orthodontic treatment. Material & methods: Literature searches were conducted on four online databases (PubMed, Wiley, ScienceDirect, and Google Scholar). The keywords used were (intrabony defect OR vertical bone defect) AND (bone graft OR periodontal regeneration) AND (orthodontic). Out of 1656 studies that were retrieved initially, 14 full-text articles were checked for eligibility assessment. Finally, a total of seven studies met all of the requirements for inclusion in this study. This study includes two randomized controlled trials (RCTs), which are considered the highest level of evidence, however it is important to note that the overall evidence base is heterogeneous, inclusive of various study designs. Discussion: Periodontal tissue damage must be addressed before considering orthodontic therapy, including cases with intrabony defects. On the basis of the seven studies, orthodontic therapy can be initiated as early as four weeks after surgery or as late as one year after periodontal surgery. Different types of bone graft materials, such as autografts, allografts, xenografts, and alloplasts, are used in the included studies. Three out of seven studies used autogenous graft combined with xenograft or enamel matrix derivative as the graft material as it is osteoconductive, osteogenic, and osteoinductive. Regular periodontal tissue maintenance therapy should be performed every 2-6 months, before, during, and after orthodontic treatment. Conclusion: Making a proper diagnosis and treatment sequence is key to the success of a periodontal-orthodontic treatment. In addition, identifying the appropriate timing between periodontal surgery and orthodontic movement, selecting the most suitable bone graft material, and ensuring regular maintenance of periodontal tissue are important considerations.
RESUMO
Background and Objectives: Periodontitis is an inflammatory disease in the supporting tissues of the teeth caused by specific microorganisms or groups of microorganisms. P. gingivalis bacterium is the keystone pathogen in periodontitis, so even at low concentrations, it has a considerable influence on the oral community. Antimicrobials and antiplaque agents can be used as adjunctive therapy for periodontitis treatment. Konjac glucomannan (KGM), as a natural polysaccharide, has flavonoid (3,5-diacetyltambulin) and triterpenoids (ambylon) compounds that show antibacterial activity. This research aims to analyze the antibacterial activity of KGM on animal and in vitro periodontitis models. Materials and Methods: The animal study divided 48 mice into four groups (control, KGM, periodontitis, KGM + periodontitis). Mice were given an intervention substance by oral gavage from day 1 to day 14, periodontitis was induced on day 7, and decapitation was performed on day 14. Samples from the right maxillary jaw of mice were used for histological preparations and morphometrics analysis. In vitro studies were carried out by adding several concentrations of KGM (25, 50, and 100 µg/mL) into a planktonic P. gingivalis and P. gingivalis biofilm. Results: In the animal model, KGM could prevent alveolar bone loss in the periodontitis mice model, both in histologic and morphometrics assessments. In vitro, KGM had antibacterial activity against P. gingivalis with better bacteriostatic (15-23%) than bactericidal (11-20%) ability, proven by its ability to inhibit P. gingivalis proliferation. Conclusions: KGM can be considered to have the potential as an antibacterial agent to prevent periodontitis. The prevention of periodontitis may improve patient well-being and human quality of life.
