Effects of recombinant human bone morphogenetic protein-2 compared to other biomaterials in the treatment of intrabony defects in periodontitis patients: A systematic review.

BACKGROUND: Bone morphogenetic proteins have a powerful osteoinductive capacity and have been used as a new adjunct to graft materials for bone regeneration. The objectives of this systematic review are to assess the amount of radiographic bone fill, clinical attachment level (CAL) gain, and reduction in pocket depth (PD) in patients with intrabony defects in periodontitis patients following the use of recombinant human bone morphogenetic protein-2 (rhBMP-2). MATERIALS AND METHODS: Electronic bibliographic databases search of Medline, Science Direct, and Google Scholar was made from January 1980 to December 2017. Studies using rhBMP-2 to treat periodontal intrabony defects of the maxillary or mandibular region with follow-up period of at least 6 months were searched. Two reviewers performed the systematic review using the PRISMA Statement for reporting and the Cochrane risk-of-bias tool was used for quality assessment. RESULTS: It was found that rhBMP-2 showed statistically significant results with respect to radiographic defect resolution, CAL, and PD reduction at 9 months compared to open-flap debridement but showed statistically significant results only with respect to radiographic bone fill when compared with platelet-rich fibrin at 6 months. CONCLUSION: The rhBMP-2 may provide a promising alternative to traditional grafting procedures therapy that can enhance periodontal regeneration in patients having intrabony defects. Due to limited human studies, it can be concluded that no definitive evidence exists to ascertain the effectiveness of rhBMP-2 in the treatment of intrabony defects in periodontal diseases.

Effect of PRF and Allograft Use on Immediate Implants at Extraction Sockets with Periapical Infection -Clinical and Cone Beam CT Findings.

Immediate implant placement can be successful, even at infected sites. The adjunctive effects of concomitant use of platelet-rich fibrin (PRF) and decalcified freeze-dried bone allografts (DFDBA) at periapically infected sites remains to be determined, however. The purpose of this prospective study was to investigate the effect of combined use of PRF and DFDBA on immediate implant survival at tooth extraction sites exhibiting periapical lesions. Implants were immediately placed in 8 patients under a standard chemotherapeutic protocol. Adin titanium implants were used in all cases. The combination of PRF and DFDBA was used to fill the gap between the implant body and the surrounding socket wall. The final restoration was placed after 3 months. The full-mouth plaque, gingival bleeding index, and gingival esthetics scores were assessed at 3, 6, and 12 months. Cone beam computed tomography images obtained at baseline and at 12 months after implant loading were analyzed. The plaque index scores showed statistically significant differences at 3, 6, and 12 months (p<0.05). The gingival bleeding index score showed no significant difference. No difference was noted in buccal gingival level on the implant surface or adjacent teeth at 91.7% of sites. Complete closure of the interproximal space was seen in 91.7% of the implant sites. Crestal bone levels on all implant surfaces were non-significant. Implant survival was 91.67% at 12 months. The adjunctive use of PRF with DFDBA at periapically infected sites yielded a significant reduction in bone resorption and accelerated bone healing during the initial post-extraction stage. A significant improvement was achieved in the gingival esthetic score at the interproximal and midfacial surfaces. The combined use of growth factors with pre- and postoperative broadspectrum antibiotics over a short time resulted in a higher implant survival rate at the end of the 1 year post-restoration period.

Management of apicomarginal defect in esthetic region associated with a tooth with anomalies.

Tooth related factors such as palatoradicular groove can be one of the causes for localized periodontal destruction. Such pathological process may result in apicomarginal defect along with inflammation of pulp. This creates challenging situation which clinician must be capable of performing advanced periodontal regenerative procedures for the successful management. This case report discusses clinical management of apicomarginal defect associated with extensive periradicular destruction in a maxillary lateral incisor, along with histopathologic aspect of the lesion.

Effects of scaling and root planing with or without a local drug delivery system on the gingival crevicular fluid leptin level in chronic periodontitis patients: a clinico-biochemical study.

PURPOSE: The present split mouth study evaluates the effect of nonsurgical periodontal treatment on the gingival crevicular fluid (GCF) leptin level in chronic periodontitis. METHODS: Ninety sites from 30 nonobese chronic periodontitis patients were selected and divided as follows: group I, 30 healthy sites receiving no treatment; group II, 30 periodontitis sites receiving scaling and root planing (SRP); and group III, 30 periodontitis sites receiving SRP with tetracycline local drug delivery. At baseline, after GCF sampling and clinical parameter recording, the assigned treatment was performed for the study groups. During recall visits, GCF sampling followed by clinical parameter recording was done for groups II and III. RESULTS: Reductions in the probing depth and the clinical attachment level (CAL) were highly significant at different time intervals (except between day 0 and 45) in both groups II and III. Upon comparison, group III showed significant gain in CAL between day 0 and 15 and between day 0 and 45. After treatment, the reduction in the GCF leptin level was more significant in group III than in group II at day 15 but re-elevated almost to the pretreatment levels at day 45. CONCLUSIONS: Nonsurgical periodontal therapies were not effective in maintaining stable reduction in the GCF leptin level during the study period.