E7-Conjugated Bio-Inspired Microspheres as a Biological Barrier for Guided Tissue Regeneration.

Guided tissue regeneration (GTR), which is based on creating a physical barrier to prevent the downgrowth of epithelial and connective tissues into the defect site, has been widely used in clinical practice for periodontal regeneration for many years. However, its outcomes remain variable due to highly specific indications, the demand for proficient surgical skills, and frequent occurrence of complications. In this study, we developed a new GTR biomaterial that acts as a biological barrier for epithelial cells and fibroblasts while also serving as a scaffold for bone marrow-derived mesenchymal stem cells (BMSCs) and periodontal ligament stem cells (PDLSCs). This innovative GTR biomaterial is bioinspired injectable microspheres that are self-assembled from nanofibers, and their surfaces are conjugated with E7, a short peptide that selectively promotes BMSC and PDLSC adhesion but inhibits the attachment and spreading of epithelial cells and gingival fibroblasts. The selective affinity afforded by E7 on the surfaces of the nanofibrous microspheres facilitated the colonization of BMSCs in the periodontal defect, thereby substantially improving functional periodontal regeneration, as evidenced by enhanced new bone formation, reduced root exposure, and diminished attachment loss. The remarkable superiority of the bioinspired microspheres over conventional GTR materials in promoting periodontal regeneration underscores the potential of this innovative approach to enhance the efficacy of functional periodontal tissue regeneration.

A retrospective risk factor analysis of infection and wound dehiscence following guided bone regeneration in cystectomy defects of the jaws.

This study's objective is to determine if the combined use of bone substitutes and collagen membranes is related to worse postoperative outcomes after intra-osseous oral cystectomies. Additional risk factors mentioned in the existing literature were retrospectively analysed by reviewing the medical records and imaging tests of adult patients. Age, gender, smoking habit, cyst location, size, shape, histopathology, perilesional osteosclerosis and associated intracystic third molars were registered. The type of biomaterials applied and the number of bony walls remaining after surgery were also identified. All factors were analysed in relation to wound dehiscence and postoperative infection. Simple and multiple logistic regression analyses were performed to exclude possible confounding effects between the risk factors identified. In a sample of 211 cystectomies, guided bone regeneration was not significantly associated with infection, only the presence of impacted third molars was (p = 0.0219). This finding remained true, even in cysts larger than 25 mm. However, the risk of wound dehiscence was 4.9 times higher when biomaterials were applied (CI 95%, 1.6818-12.8274, p = 0.0014). In accordance with recent studies, these findings suggest that whenever guided bone regeneration might prove useful after cyst enucleation, avoiding chemically cross-linked membranes should be considered.

Releasing incisions of the buccal periosteum adjacent to the lower molar teeth can injure the facial artery: an anatomical study.

PURPOSE: Periosteal releasing incision (PRI) techniques are often used with guided bone regeneration procedures. As complications such as intra- and postoperative bleeding have been noticed, we aimed to study and clarify these as related to the PRI, especially on the mandibular buccal periosteum. METHODS: Fourteen sides from seven fresh-frozen Caucasian cadaveric heads were used in this study. The seven cadavers were derived from two females and five males. The mean age at the time of death was 75.9 ± 10.8 years. The PRI was made using a no. 15c blade using a surgical microscope. Subsequently, the fat tissue lateral to the periosteum was slightly dissected. The diameter of the facial artery (or its branch) and closest relationship between the tooth and position of the artery was recorded. Finally, the artery was traced back proximally to clarify its origin. RESULTS: On all sides, the inferior labial artery (ILA) was identified in the fat tissue lateral to and close to the periosteum. The ILA was closest to the periosteum at the midpoint of the PRI (approximately between the first and second molar teeth area or 10 mm mesial to the apex of the retromolar pad). The mean diameter of the ILA was 2.72 ± 0.26 mm. CONCLUSION: This anatomical finding should encourage dentists to make the PRI incision without invading the tissue underneath the periosteum.

Minimally invasive non-surgical vs. surgical approach for periodontal intrabony defects: a randomised controlled trial.

BACKGROUND: Periodontal intrabony defects are usually treated surgically with the aim of increasing attachment and bone levels and reducing risk of progression. However, recent studies have suggested that a minimally invasive non-surgical therapy (MINST) leads to considerable clinical and radiographic defect depth reductions in intrabony defects. The aim of this study is to compare the efficacy of a modified MINST approach with a surgical approach (modified minimally invasive surgical therapy, M-MIST) for the treatment of intrabony defects. METHODS: This is a parallel-group, single-centre, examiner-blind non-inferiority randomised controlled trial with a sample size of 66 patients. Inclusion criteria are age 25-70, diagnosis of periodontitis stage III or IV (grades A to C), presence of ≥ 1 'intrabony defect' with probing pocket depth (PPD) > 5 mm and intrabony defect depth ≥ 3 mm. Smokers and patients who received previous periodontal treatment to the study site within the last 12 months will be excluded. Patients will be randomly assigned to either the modified MINST or the M-MIST protocol and will be assessed up to 15 months following initial therapy. The primary outcome of the study is radiographic intrabony defect depth change at 15 months follow-up. Secondary outcomes are PPD and clinical attachment level change, inflammatory markers and growth factors in gingival crevicular fluid, bacterial detection, gingival inflammation and healing (as measured by geometric thermal camera imaging in a subset of 10 test and 10 control patients) and patient-reported outcomes. DISCUSSION: This study will produce evidence about the clinical efficacy and potential applicability of a modified MINST protocol for the treatment of periodontal intrabony defects, as a less invasive alternative to the use of surgical procedures. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03797807. Registered on 9 January 2019.

Case Report: Managing the postoperative exposure of a non-resorbable membrane surgically.

Alveolar ridge deformities can be caused by several factors. Managing alveolar deformities prior to implant placement is essential to increase bone width, height or both. Several techniques and materials are now available to perform ridge augmentation procedures. The postoperative exposure of the membrane is the most frequent postoperative complications of ridge augmentation procedures. The present case describes the horizontal ridge augmentation procedure and the outcome of surgical attempt to manage post-operative membrane exposure, and shows the unpredictability of managing postoperative membrane exposure surgically.

Wound Healing Complications Following Guided Bone Regeneration for Ridge Augmentation: A Systematic Review and Meta-Analysis.

PURPOSE: The rate of developing soft tissue complications that accompany guided bone regeneration (GBR) procedures varies widely, from 0% to 45%. The present review was conducted to investigate the rate for resorbable versus nonresorbable membranes and the timing of soft tissue complications. MATERIALS AND METHODS: Electronic and manual literature searches were conducted by two independent reviewers using several databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, for articles published through July 2015, with no language restriction. Articles were included if they were clinical trials aimed at demonstrating the incidence of soft tissue complications following GBR procedures. RESULTS: Overall, 21 and 15 articles were included in the qualitative and quantitative synthesis, respectively. The weighted complication rate of the overall soft tissue complications, including membrane exposure, soft tissue dehiscence, and acute infection/abscess, into the calculation was 16.8% (95% CI = 10.6% to 25.4%). When considering the complication rate based on membrane type used, resorbable membrane was associated with a weighted complication rate of 18.3% (95% CI: 10.4% to 30.4%) and nonresorbable membrane with a rate of 17.6% (95% CI: 10.0% to 29.3%). Moreover, soft tissue lesions were reported as early as 1 week and as late as 6 months based on the included studies. CONCLUSION: Soft tissue complications after GBR are common (16.8%). Membrane type did not appear to significantly affect the complication rate, based on the limited number of data retrieved in this study. Technique sensitivity (ie, soft tissue management) may still be regarded as the main component to avoid soft tissue complications and, hence, to influence the success of bone regenerative therapy.

Effectiveness of Laser Application for Periodontal Surgical Therapy: Systematic Review and Meta-Analysis.

BACKGROUND: Evidence has shown some improved clinical outcomes and morbidity reduction with the use of lasers for non-surgical periodontal therapy due to ablation, vaporization, hemostasis, and field sterilization. The purpose of this systematic review is to evaluate and compare studies involving lasers as monotherapy or adjunctive to surgical periodontal treatment. METHODS: Electronic and manual searches were conducted by two independent reviewers in several databases for articles written in English up to December 2014. Articles were included in this review if they reported outcomes of surgical periodontal therapy with and without the use of lasers. The primary outcome was probing depth (PD), and secondary outcomes were measured changes in clinical factors such as clinical attachment level (CAL) and gingival recession (GR). For the comparative studies included, the pooled weighted mean difference (WMD) and 95% confidence interval (CI) of each variable were calculated using random-effects meta-analysis. RESULTS: Eight and nine articles were included in the quantitative and qualitative analyses, respectively. Although low-to-moderate risk of bias was detected, high heterogeneity among studies was found. In flap surgery with or without laser treatment, there was no statistically significant difference in primary outcome. Similarly, in guided tissue regeneration (GTR)/enamel matrix derivative (EMD) with and without laser treatment, the WMD of PD was negligible; however, the GTR/EMD group showed better outcomes (P = 0.005) than the laser group. Regarding the secondary outcomes, in the flap surgery group, the WMD of CAL gain was 1.34 mm, and the WMD of GR was -0.24 mm; no significant difference was detected between groups. In GTR/EMD with and without laser treatment, the WMD of CAL gain was 0.10 mm and the WMD of recession was -0.18 mm; again, no significant difference was detected between groups. CONCLUSIONS: The available evidence is insufficient to support the effectiveness of dental lasers as an adjunct to resective or regenerative surgical periodontal therapy. However, precautions must be exercised when interpreting the results of this study because of the small sample size and high heterogeneity among studies.

Restoring lost gingival pigmentation in the esthetic zone: A case report.

BACKGROUND AND OVERVIEW: There is insufficient literature on the lack of oral pigmentation in the esthetic zone. The aim of this case report was to illustrate the potential impact of loss of gingival pigmentation in the esthetic zone, describe its surgical treatment, and discuss the limited literature on this topic. CASE DESCRIPTION: An African American woman with high smile line had localized loss of gingival melanin pigmentation as a complication after implant failure and attempted guided bone regeneration in site 8. A highly pigmented free gingival graft was collected from the facial-attached gingiva of the maxillary posterior teeth and placed onto the previously de-epithelialized recipient bed in the maxillary front. Some pigmentation of the graft was preserved and was visible a few weeks after surgery; some pigmentation recovered over time. At 6 months after surgery, the patient was satisfied with the esthetics. Complete recovery of pigmentation took 12 months, at which time the patient was ready to proceed with the final prosthetic work. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Gingival pigmentation can be restored using a free gingival graft from a highly pigmented area. When surgical procedures are performed in such cases, loss of gingival pigmentation should be part of the informed consent. However, further research, including histology, is needed.

Regeneración ósea guiada: nuevos avances en la terapéutica de los defectos óseos / Guided bone regeneration: new advances in the treatment of bone defects

Introducción: el procedimiento de regeneración ósea guiada ha demostrado ser una técnica exitosa para promover el llenado de defectos óseos presentes, así como para aumentar las dimensiones de rebordes alveolares atróficos previo a rehabilitación protésica convencional o implanto soportada. Objetivo: describir la utilización clínica de injerto aloplástico de b-fosfato tricálcico como material de relleno en la regeneración de defectos óseos alveolares. Presentación del caso: se presentó el caso de una paciente femenina de 57 años de edad quien acudió a la consulta odontológica por presencia de supuración en un diente anterosuperior, como consecuencia de un proceso infeccioso apical. Al examen clínico se observó resto radicular de incisivo central superior izquierdo e incisivo lateral superior izquierdo; radiográficamente se observó fractura radicular de incisivo central superior derecho. Posterior a la extracción de los restos radiculares, se empleó la técnica de regeneración ósea guiada, utilizando injerto aloplástico de b-fosfato tricálcico con una membrana de colágeno reabsorbible. Tres meses posteriores al tratamiento, se observó aumento en altura y anchura del reborde alveolar, con lo que se logró la conformidad estética y funcional deseada. Conclusión: el caso presentado revela resultados clínicos satisfactorios gracias a la neoformación de hueso observada y a la planificación adecuada del tratamiento con regeneración ósea guiada, por lo que el uso de injerto óseo, específicamente el injerto aloplástico b-fosfato tricálcico, en combinación con las membranas de barrera, se sugiere para el manejo de los defectos óseos alveolares(AU)

Introduction: the procedure of guided bone regeneration has proven to be a successful technique to promote the filling of bone defects and enlarge the dimensions of atrophic alveolar ridges prior to conventional or implant-supported prosthetic rehabilitation. Objective: describe the clinical use of b-tricalcium phosphate alloplastic graft as a filler material in the regeneration of alveolar bone defects. Case report: a female 57-year-old patient presented at dentistry consultation with exudate from an upper anterior tooth due to apical infection. Clinical examination revealed root rests of the upper left central incisor and upper left lateral incisor. Radiography showed root fracture of the upper right central incisor. Upon extraction of the root rests, guided bone regeneration technique was performed, using b-tricalcium phosphate alloplastic grafting with a resorbable collagen membrane. Three months after treatment, an increase in height and width of the alveolar ridge was observed, achieving the desired aesthetic and functional status. Conclusions: satisfactory clinical results in terms of bone neoformation are due to adequate therapeutic planning and the employment of guided bone regeneration. Use of bone grafting, specifically alloplastic graft of b-tricalcium phosphate in combination with barrier membrane, is thus suggested for the management of alveolar bone defects(AU)

Minimally invasive surgical techniques in periodontal regeneration.

A review of the current scientific literature was undertaken to evaluate the efficacy of minimally invasive periodontal regenerative surgery in the treatment of periodontal defects. The impact on clinical outcomes, surgical chair-time, side effects and patient morbidity were evaluated. An electronic search of PUBMED database from January 1987 to December 2011 was undertaken on dental journals using the key-word "minimally invasive surgery". Cohort studies, retrospective studies and randomized controlled clinical trials referring to treatment of periodontal defects with at least 6 months of follow-up were selected. Quality assessment of the selected studies was done through the Strength of Recommendation Taxonomy Grading (SORT) System. Ten studies (1 retrospective, 5 cohorts and 4 RCTs) were included. All the studies consistently support the efficacy of minimally invasive surgery in the treatment of periodontal defects in terms of clinical attachment level gain, probing pocket depth reduction and minimal gingival recession. Six studies reporting on side effects and patient morbidity consistently indicate very low levels of pain and discomfort during and after surgery resulting in a reduced intake of pain-killers and very limited interference with daily activities in the post-operative period. Minimally invasive surgery might be considered a true reality in the field of periodontal regeneration. The observed clinical improvements are consistently associated with very limited morbidity to the patient during the surgical procedure as well as in the post-operative period. Minimally invasive surgery, however, cannot be applied at all cases. A stepwise decisional algorithm should support clinicians in choosing the treatment approach.

A retrospective study of the risk factors for ridge expansion with self-tapping osteotomes in dental implant surgery.

PURPOSE: To analyze the risk factors associated with the survival of self-threading implants placed with the ridge expansion technique using self-tapping osteotomes after at least 24 months. MATERIALS AND METHODS: This retrospective study followed patients for at least 2 years in whom implants had been inserted by means of the ridge expansion technique. The patient was taken as the unit of analysis, and the loss of any implant as a result of mobility at any time during the follow-up period was considered as a failure. A number of patient variables were recorded: sociodemographic (age/sex), anatomical (bone quantity/quality, expansion zone), infection history (prior antibiotic therapy for active infection), prosthodontic (type of provisional prosthesis and type of definitive rehabilitation), and surgical (number of surgical stages, the use of biomaterials or atraumatic maxillary sinus elevation). Risk factors were expressed as values of relative risk (RR) and the odds ratio. RESULTS: Seventy-four patients (157 implants) were followed over a mean period of 38.8 ± 7.7 months. Most patients (91.9%) did not lose any implants, and failures occurred mainly after implant loading (5.4%). Sociodemographic factors (sex and age) were not associated with a significant risk of implant failure. However, the existence of previous local infection (RR = 34.0), the use of an immediate fixed provisional prosthesis (RR = 15.0), and type D3 bone (RR = 5.1) were seen to be the main risk factors involved in this technique for the period assessed. CONCLUSIONS: The risk of failure when implants are placed using self-tapping osteotomes was highest in patients who had active local infection; immediate provisionalization and less dense bone were also associated with additional risk of failure.

Intraoperative bleeding during open flap debridement and regenerative periodontal surgery.

BACKGROUND: The objective of this study was to measure the intraoperative bleeding during periodontal flap surgery. METHODS: Patients scheduled for periodontal surgery were recruited for this study. Data regarding smoking habits, general health, and medications were collected. The amount of the local anesthetic that was injected was then recorded, as well as the number of teeth in the operative field and the duration of the procedure. During surgery, the liquids from the oral cavity were suctioned and collected into a sterile empty vial. To calculate the net amount of blood volume in the liquids, colorimetric assay using capillary blood fructosamine as a reference molecule was used. RESULTS: Twenty-six patients were included in this study. The amount of blood lost during the procedure ranged from 6.0 to 145.1 mL, with an overall mean of 59.47 ± 38.2 mL. Patients taking aspirin (acetylsalicylic acid) showed mean blood loss of 43.26 ± 31.5 mL, whereas the mean blood loss among patients that did not use this medication was higher (65.4 ± 39.4 mL) but not statistically significant. Local anesthetic amount, surgical field size, and the operation duration did not relate to blood-loss volume. The mean blood loss among current smokers was significantly higher (96.47 ± 44.2 mL) compared to former (12 ± 8.4 mL) or never (54.74 ± 30.5 mL, P = 0.011) smokers. CONCLUSION: The results of the current study support previous papers and confirm that blood loss during periodontal surgery is minimal.

Surgical endodontic management of an invasive cervical resorption class 4 with mineral trioxide aggregate: a 6-year follow-up.

Invasive cervical resorption is a type of external resorption rarely seen as an adverse effect after a guided tissue regeneration procedure for a periodontal condition. This case report summarizes the surgical endodontic management of an invasive cervical resorption class 4 (Heithersay) with mineral trioxide aggregate, in a mandibular incisor of a 67-year-old man. A 6-year clinical follow-up with radiovisiography and cone-beam computerized tomography revealed complete healing. A surgical endodontic management could promote healing and survival of a tooth with advanced root resorption due to a periodontal condition.

Use of mineral trioxide aggregate in the treatment of invasive cervical resorption: a case report.

INTRODUCTION: Guided tissue regeneration (GTR) is a successful treatment procedure of periodontal reconstructive surgery. Adverse effects can be observed after GTR procedure, but external root resorption is rarely reported at clinical studies. Invasive cervical resorption is a clinical term used to describe a relatively uncommon, insidious, and often aggressive form of external root resorption. METHODS: The present case demonstrates an invasive cervical resorption that is a potential late complication of GTR in a maxillary canine of a 59-year-old male patient. After the surgical intervention and root canal treatment, the resorption was subsequently sealed with mineral trioxide aggregate. RESULTS: The 1-year follow-up demonstrates no pathologic changes on clinical and radiographic examination. CONCLUSIONS: This case report presents a treatment strategy that might improve the healing outcomes for patients with invasive cervical resorption.

The effect of periodontal therapy on the survival rate and incidence of complications of multirooted teeth with furcation involvement after an observation period of at least 5 years: a systematic review.

OBJECTIVE: To systematically review the survival rate and incidence of complications of furcation-involved multirooted teeth following periodontal therapy after at least 5 years. MATERIAL AND METHODS: Electronic and manual searches were performed up to and including January 2008. Publication selection, data extraction and validity assessment were performed independently by three reviewers. RESULTS: Twenty-two publications met the inclusion criteria. Because of the heterogeneity of the data, a meta-analysis could not be performed. The survival rate of molars treated non-surgically was >90% after 5-9 years. The corresponding values for the different surgical procedures were: Surgical therapy: 43.1% to 96%, observation period: 5-53 years. Tunnelling procedures: 42.9% to 92.9%, observation period: 5-8 years. Surgical resective procedures including amputation(s) and hemisections: 62% to 100%, observation period: 5-13 years. Guided tissue regeneration (GTR): 83.3% to 100%, observation period: 5-12 years. The most frequent complications included caries in the furcation area after tunnelling procedures and root fractures after root-resective procedures. CONCLUSIONS: Good long-term survival rates (up to 100%) of multirooted teeth with furcation involvement were obtained following various therapeutic approaches. Initial furcation involvement (Degree I) could be successfully managed by non-surgical mechanical debridement. Vertical root fractures and endodontic failures were the most frequent complications observed following resective procedures.

A comparison of two techniques to augment maxillary sinuses using the lateral window approach: rigid synthetic resorbable barriers versus anorganic bovine bone. Five-month post-loading clinical and histological results of a pilot randomised controlled clinical trial.

PURPOSE: To compare the efficacy of two different techniques to augment maxillary sinuses using a lateral window approach: rigid synthetic resorbable barriers (Inion) versus granular anorganic bovine bone (Bio-Oss). MATERIALS AND METHODS: Ten partially edentulous patients having bilaterally 1 to 5 mm of residual bone height and at least 5 mm bone width below the maxillary sinuses, as measured on computed tomography (CT) scans, were randomised to receive two different 2-stage sinus lift procedures using the lateral window approach. In one side, the sinus lining was raised by placing a resorbable rigid Inion barrier without any bone substitute whereas the contralateral side was loosely packed with 100% granular Bio-Oss. After 6 months, 2 to 3 implants were inserted at each side and submerged for 4 months. Implants were loaded with provisional acrylic prostheses and replaced after 4 months, by definitive screwretained metal-ceramic prostheses. Outcome measures were: time necessary to complete the augmentation procedure, bone gain on CT scans, histomorphometry, any complication, implant and prosthetic failures, and clinician and patient preference assessed by a blinded outcome assessor. All patients were followed up to 5 months after loading. RESULTS: No patient dropped out. There was no significant difference in time to complete the augmentation procedure (19.8 minutes for Inion versus 20.5 for Bio-Oss). After 6 months, both interventions gained bone in a highly statistically significant way (14.4 mm for Inion versus 14.1 mm for Bio- Oss) with no significant differences between the procedures. Histologically, more new bone formed at Bio-Oss treated sites (36.1% versus 24.2%), the difference being highly statistically significant (P = 0.002). There were no differences in complications between groups (2 perforations of the maxillary lining at Inion treated sites versus 1 at a Bio-Oss site), however, in one of the patients where a perforation occurred at the Inion site, at implant placement, the sinus was two-thirds filled with soft tissue and the site was successfully retreated with Bio-Oss. No implant failed. The clinician preferred Bio-Oss because it was simpler to handle. There were no statistically significant differences in patient preference 1 month after surgery and 1 month after delivery of definitive prostheses: 8 patients had no preference while 2 preferred the Bio-Oss treated side. CONCLUSIONS: Although bone grafting is not needed to augment atrophic maxillary sinuses since it is sufficient to keep space with a rigid barrier, bone was histologically more mature and appeared to be clinically harder when using Bio-Oss. Moreover, it was judged simpler to fill sinuses with a bone substitute than to position a rigid barrier for maintaining space.

Foreign body reaction to anorganic bovine bone and autogenous bone with platelet-rich plasma in guided bone regeneration.

BACKGROUND: Guided bone regeneration is frequently performed to augment deficient alveolar ridges. Although many materials may be used for these procedures, the outcome is usually predictable. In this report, we present an unusual reaction to a frequently used commercially available xenograft material. METHODS: A 36-year-old African American male was referred for restoration of edentulous space #8. Examination confirmed a ridge inadequate for implant placement without augmentation. A staged approach was chosen, with augmentation by a mixture of autogenous bone and anorganic bovine bone with platelet-rich plasma and a bioabsorbable collagen membrane. Healing was uneventful, although after 4 months, upon flap reflection, no regenerated hard tissue was found. The tissue at the site was submitted for histology, and the site was regrafted with an allograft/xenograft mixture and covered by a bioabsorbable collagen membrane. Wound healing was uneventful, and a histologic core was obtained at implant placement 5 months later. RESULTS: The initial histologic specimen consisted of a fibrous connective tissue matrix supporting islands of the anorganic bovine bone. The majority of the graft material demonstrated an intimate association with multinucleated foreign body-type giant cells. The histologic core obtained at the second procedure consisted of trabeculae of viable lamellar bone and associated fibrous connective tissue without a significant inflammatory cell infiltrate. Scattered particles of anorganic bovine bone were present, but no foreign body-type giant cells were identified. CONCLUSION: Failure of commonly used materials for guided bone regeneration is rare; however, different batches of materials may elicit varying immune responses in the recipient.

Levels of platelet activating factor in gingival crevice fluid following periodontal surgical therapy.

BACKGROUND AND OBJECTIVE: Elevated levels of platelet activating factor (PAF), a potent inflammatory phospholipid mediator, have been previously detected in gingival tissues and gingival crevice fluid (GCF) in periodontal disease. However, the role of this mediator during wound healing after periodontal surgery remains unclear. The hypothesis, a relationship between PAF levels and periodontal healing, was tested by measuring PAF levels in GCF samples collected from sites that had undergone guided tissue regeneration (GTR) or flap surgery. MATERIAL AND METHODS: Using a split-mouth design, 30 intrabony defects were randomly assigned to treatment with GTR (group 1) or to flap surgery (group 2). GCF was sampled pre-operatively and at 6-, 12- and 24-wk follow-up evaluation visits. PAF levels in GCF were analyzed by high-performance liquid chromatography (HPLC). RESULTS: Both treatment modalities significantly reduced the probing pocket depth and improved the clinical attachment level (p < 0.01). Compared with pre-operative values, the GCF volume and PAF levels were significantly decreased at postoperative weeks 6, 12 and 24 in both groups (p < 0.01). There were also significant differences in GCF volume and PAF levels at all time points up to 24 wks in both groups (p < 0.01). No statistically significant differences were observed in any of the parameters investigated between the two groups (p > 0.05). CONCLUSION: PAF is detectable in GCF by HPLC and showed a continuous decrease at all the time points monitored following periodontal surgical therapy. This suggests that changes in the levels of this mediator in GCF might be useful for monitoring the progress of periodontal repair and regeneration.

Postoperative complications following gingival augmentation procedures.

BACKGROUND: Postoperative pain, swelling, and bleeding are the most common complications following soft tissue grafting procedures; however, detailed documentation is sparse in the literature. The aims of this prospective study were as follows: 1) to compare the frequency of complication occurrence after free soft tissue grafting (FSTG) or subepithelial connective tissue grafting (SCTG) procedures; 2) to evaluate the use of an acellular dermal matrix (ADM) as the donor tissue alternative to an FSTG or SCTG; and 3) to identify possible predictors for these complications. METHODS: Seventy-five FSTG and 256 SCTG procedures were performed in 228 patients by a single operator. In five free soft tissue and 84 bilaminar graft procedures, an ADM was used instead of autogenous tissue. Variables such as the duration and location of procedures, smoking history, gender, and age were recorded. Patients were asked to fill out a questionnaire 1 week after the surgeries regarding postoperative pain, swelling, and bleeding. Data were analyzed using the chi2 test and logistic regression analysis. Odds ratios were calculated for moderate and severe adverse outcomes grouped together. RESULTS: The duration of surgical procedures was highly correlated with pain or swelling post-surgically (P = 0.001). Current smokers were three times more likely to experience post-surgical swelling (P = 0.01). Patients who underwent FSTG procedures were three times more likely to develop post-surgical pain (P = 0.002) or bleeding (P = 0.03) compared to those who received SCTG procedures. When an ADM was applied instead of autogenous tissue, the probability of swelling or bleeding was significantly reduced (odds ratio [OR] = 0.46, P = 0.02 and OR = 0.3, P = 0.001, respectively). CONCLUSIONS: Long surgical procedures and smoking may increase the severity and frequency of certain post-surgical complications after gingival augmentation procedures. FSTG procedures incur a higher likelihood for postoperative pain or bleeding than SCTG procedures, whereas the application of an ADM may significantly reduce the probability of swelling and bleeding.