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

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

[The incidence of local plaque retentive factors in chronic periodontitis]. / Lokális plakkretenciós tényezok elofordulási gyakorisága krónikus parodontitisben.

One of the leading local risk factors for chronic periodontitis is the presence of plaque retentive factors in the oral cavity. The main objective of the study was to assess how the local irritation and plaque retention caused by untreated carious lesions, subgingival and approximal overhanging crown margins can affect the attachment loss at patients with chronic periodontitis. The incidence of plaque retentive factors were evaluated on 200 panoramic radiographs randomly selected from the archive of the Department of Periodontology. On the radiographs each fully erupted tooth were studied under magnifying glasses (1:2 magnification), and the distance between CEJ and the most coronal bone level was measured with a ruler with mm scales. The quality of restorations were evaluated based on the approximal adaptation of their margins. During the clinical examination the presence of local plaque retentive factors were registered by tooth, and the radiological alveolar bone level were recorded around both the healthy and restored or filled teeth. Statistical analyzes were made with linear regression analysis and ANOVA. Only 177 out of the randomly selected 200 radiographs met the incursion criteria and could be evaluated. The average age of patients was 49.98 years and the average approximal bone loss was 5.439 mm, showing increasing tendency with age. The 177 patients had a total of 3618 teeth and 1407 teeth presented plaque retentive factors including 164 untreated approximal carious lesions, and 1243 faulty restorations with approximal overhangs or open margins. Radiographically 82.5% of the restorations had incorrect approximal marginal adaptation. The majority of the untreated carious lesions occurred in the molar as well as in the front regions. The average bone loss at the teeth with faulty restorations were higher than at the sound teeth. 113 patients had an average bone loss higher than >4 mm. In those patients the differences between sound and restored teeth were smaller than those in the groups of patients with mild bone loss. Nevertheless neither group showed statistically significant differences between restored and sound teeth. In mild to moderate periodontitis local plaque retentive factors, overhanging crown margins or carious lesions are decisive aggregating factors both in gingivitis and periodontitis, especially in the susceptible population. In severe periodontitis according to our data there were only minimal differences between the attachment level around sound teeth and teeth with faulty restorations and local plaque retentive factors.

[Necrotizing sialometaplasia]. / Nekrotizáló sialometaplasia: Esetismertetés.

Necrotizing sialometaplasia is a non-neoplastic self-limiting inflammatory-ulcerous condition of the minor salivary glands. It is reported to appear in the oral cavity at every area where minor salivary glands exist, particularly those of the palate. Necrotizing sialometaplasia is a very rare disease that spontaneously develops with fearsome features. It is thought to be due to infarction of minor salivary glands, and heals in a few weeks, without any treatment. The clinical and histopathological features of necrotizing sialometaplasia often simulate those of such malignancies as squamosus cell carcinoma or mucoepidermoid carcinoma. Familiarity with necrotizing sialometaplasia and correct differential diagnosis are paramount in avoiding misdiagnosis and inappropriate treatment.