Search Results (17)

Background: Two-dimensional periapical radiographs (PAs) only offer limited information regarding three-dimensional periodontal infrabony defects. In contrast, cone beam computed tomography (CBCT) enables visualization of the entire defect morphology. This study aimed to evaluate the agreement between CBCT and direct intrasurgical measurements (ISs) regarding the characteristics of infrabony defects, including measurements of defect depth, width, the type of defect (one-wall, two-wall, three-wall), and defect extension. Methods: Intrasurgical and radiographic assessments were performed by two calibrated examiners on 26 infrabony defects in 17 patients who underwent periodontal surgery. The defect depth, width, type, and extension were compared between intrasurgical observations and PA or CBCT findings. The CBCT assessment was performed mainly using axial reconstructions. Angle measurements were compared between CBCT and PAs. Results: The mean differences between CBCT and intrasurgical measurements were −0.11 ± 0.49 mm for depth and −0.07 ± 0.41 mm for width, with no significant differences. The ICC values were 0.938 and 0.923 for depth and width, respectively. The mean difference in width between PAs and ISs was significantly different (−0.36 ± 0.73 mm; p = 0.002). CBCT demonstrated high agreement with intrasurgical observations for defect type (κ = 0.819) and defect extension (κ = 0.855), while lower agreements were found for PAs. Conclusions: CBCT is a valid assessment modality for infrabony defects. It demonstrated strong agreement with ISs—as the gold standard—for depth and width measurements, and its agreement with ISs regarding defect type and extension appeared to surpass that of PAs. Full article

Mature adipocyte-derived dedifferentiated fat (DFAT) cells show proliferative capabilities and multipotency. Given that the buccal fat pad (BFP) serves as a readily available resource for DFAT cell isolation, BFP-derived DFAT (BFP-DFAT) cells are a promising candidate in orofacial tissue engineering. In this research, we assessed the regenerative capacity of the periodontium through autologous BFP-DFAT cell transplantation in adult swine (micro-minipigs; MMPs). The BFP-DFAT cells were transplanted into inflammation-inducing two-walled infrabony periodontal defects located on the mesial of the second mandibular premolar (n = 6). Twelve weeks post-transplantation, a remarkable attachment gain was noted in the DFAT group, based on probing depths and clinical attachment levels. Histological and immunohistochemical analyses indicated new continuous cellular cementum and alveolar bone formation within the created infrabony defect. Well-organized periodontal ligament-like fibers were embedded between newly formed cementum and the alveolar bone. Histometric analysis demonstrated that the DFAT group had a 2.2-fold increase in new alveolar bone length and a 2.2-fold enhancement in vascularization than those in the control group. Except for minor inflammation in the lungs, no teratomas were detected in the recipient MMPs. BFP-DFAT cells significantly enhanced periodontal tissue regeneration, thus representing an optimal source for tissue engineering applications in dentistry. Full article

The aim of this study was to compare the efficacy of the guided tissue regeneration (GTR) of periodontal infrabony defects using the frozen radiation-sterilized allogenic bone graft (FRSABG) versus deproteinized bovine bone mineral (DBBM) 5 years after treatment. The association between patients’ compliance and periodontitis recurrence with 5-year outcomes was also evaluated. Thirty infrabony defects in 15 stage III/IV periodontitis patients were randomly allocated to the FRSBAG group (tests) or the DBBM group (controls). Between 1 and 5 years, one patient was lost to follow-up and one tooth was extracted due to root fracture. No tooth was extracted for periodontal reasons. Consequently, 13 teeth in test sites and 14 teeth in control sites were available for the 5-year analysis. The clinical attachment level gain (CAL-G, primary outcome), probing pocket depth (PPD), radiographic defect depth (DD), and linear defect fill (LDF) were examined at baseline and 5 years post-surgically. Both groups showed statistically significant improvements in all evaluated clinical and radiographic parameters at 5 years, with insignificant intergroup differences. CAL-Gs were 4.46 ± 2.07 mm in the FRSBAG group, and 3.86 ± 1.88 mm in the DBBM group (p = 0.5442). In six (43%) patients, we observed periodontitis recurrence, among whom two (33.33%) participated regularly in supportive periodontal care (SPC) and the other four (66.7%) did not take part in SPC. A regression analysis revealed that periodontitis recurrence was a significant predictor of CAL loss and DD increase. FRSBAG and DBBM were both equally effective 5 years after the GTR of infrabony defects. Within the limitations of the present study, its outcomes advocate that both grafts may be considered as a viable option based on patient preferences and clinical considerations. Full article

Hyaluronic acid was proposed to support soft tissue recession surgery and guided tissue regeneration. The molecular mechanisms through which hyaluronic acid modulates the response of connective tissue cells remain elusive. To elucidate the impact of hyaluronic acid on the connective tissue cells, we used bulk RNA sequencing to determine the changes in the genetic signature of gingival fibroblasts exposed to 1.6% cross-linked hyaluronic acid and 0.2% natural hyaluronic acid. Transcriptome-wide changes were modest. Even when implementing a minimum of 1.5 log2 fold-change and a significance threshold of 1.0 −log10, only a dozenth of genes were differentially expressed. Upregulated genes were PLK3, SLC16A6, IL6, HBEGF, DGKE, DUSP4, PTGS2, FOXC2, ATAD2B, NFATC2, and downregulated genes were MMP24 and PLXNA2. RT-PCR analysis supported the impact of hyaluronic acid on increasing the expression of a selected gene panel. The findings from bulk RNA sequencing suggest that gingival fibroblasts experience weak changes in their transcriptome when exposed to hyaluronic acid. Full article

(1) Background: Impacted third molar extraction with a scalpel and rotary instruments is one of the most traumatic surgeries in dentistry. Therefore, it is necessary to discover less traumatic methods and instruments to reduce the risk of postoperative complications. (2) Methods: This study is reported in accordance with the CONSORT guidelines. The study aim is to assess the effectiveness of an Er:YAG laser with a wavelength of 2.94 μm, cutting and rotating instruments in the extraction of lower third molars in comparison with the traditional instruments using clinical and radiology parameters. In the control group, the impacted third molars were extracted with the traditional instruments, like scalpel and rotary instruments; in the test group, the impacted third molars were extracted with an Er:YAG laser. As per the inclusion and exclusion criteria, we enrolled 60 patients who were randomly assigned into two groups (Er:YAG laser group and control group). The efficacy of the Er:YAG laser was assessed by postoperative pain, collateral swelling, mouth opening, and radiology parameters such as radiographic infrabony defects and radiographic bone height after tooth extraction. (3) Results: The results showed that the clinical postoperative parameters like pain, collateral swelling, and mouth opening were less pronounced in the Er:YAG laser group than those in the control group (p < 0.001). According to the data of the radiology parameters (RBH and RID), the regeneration of the socket after extraction was better in the laser group than in the control group (p < 0.001). (4) Conclusions: Based on the obtained results of clinical and radiology parameters assessment, it was shown that third molar extraction using an Er:YAG laser is a less traumatic method than extraction using a scalpel and rotary instruments. Full article

Intrabony defects can be the result of parodontitis. In this study we aimed to examine how clot stability is affected by different infrabony defect angles and superficial treatments in regenerative surgery. Methods: Thirty single-root extracted teeth were cut to obtain a section from each tooth. This section was placed in an artificial model containing an infrabony defect with three walls in order to achieve 10 models at angles of 25°, 37°, and 50°. Five root samples for every angle were not subjected any treatment (NT) and five were subjected to root conditioning with a neutral pH solution of ethylenediaminetetraacetic acid (EDTA) at 24%, applied for 2 min. Venous blood was put into the artificial models containing the root sections, and these were placed in an incubator at a constant temperature of 37 °C for 2 h. Samples were analyzed by laser confocal microscopy. Results: All samples exhibited signs of retraction. The EDTA group exhibited a plateau trend for infrabony defects, while in the NT group, there was a statistically significant difference between clot retraction and the increase in defect amplitude. Conclusion: The greater the angle of the infraosseous defect, the higher the rate of clot retraction. This showed that EDTA could reduce the influence of the angle of the infraosseous defect. Full article

Background and Objectives: This study evaluated the outcomes of single open-flap debridement, open-flap debridement (OFD) plus resorbable membrane placement, and OFD with resorbable membrane placement plus platelet-rich fibrin (PRF) in terms of periodontal clinical parameters and glycated hemoglobin (HbA1c) levels in 24 adult patients with stage 3 grade C periodontitis and type II diabetes mellitus. Materials and Methods: The primary outcome measure for this study was the clinical attachment level (CAL); secondary outcomes included additional periodontal parameters, such as the plaque index (PI), bleeding on probing (BOP), probing depth (PD), as well as glycated hemoglobin (HbA1c) levels to evaluate the systemic impact of the treatments on glycemic control. The parameters were assessed before and at three and six months post-surgery. In Group A, the flap was sutured closed; in Group B, an absorbable collagen membrane was placed over the defect; and in Group C, PRF was utilized in the defect, with two additional PRF membranes used to cover the defect. The wound healing index (WHI) was recorded at 7 and 14 days after the surgery. Results: The initial findings indicated no significant differences in the periodontal parameters among the three groups. However, improvements in the PD and CAL were most notable in Group C, followed by Group B, with Group A showing the slightest improvement. At six months, there was a highly significant difference in the CAL (p < 0.001). Group C (4.92 ± 0.35) and Group B (4.99 ± 0.31) demonstrated the most significant improvements in the CAL compared to Group A (5.89 ± 0.57). At seven days post-surgery, Group C demonstrated significant healing, with 85% of the sites showing complete healing. By the 14-day mark, all sites in Group C indicated complete healing. Although the HbA1c values did not exhibit statistically significant differences among the groups at baseline, at the 6-month evaluation, all groups showed significantly lower values than baseline. However, the comparison between groups revealed significantly improved values for Group C. Conclusions: The study’s results suggest that PRF is an exceptional material for infrabony defects treatment and notably improves HbA1c levels. Full article

Periodontal diseases significantly impact about half of the global population, and their treatment often encompasses relieving symptoms as well as regenerating the destroyed tissues. Revolutionary research in the management of periodontal disease includes biomaterials, a boon to re-generative dentistry owing to their excellent biological properties: non-toxicity, anti-inflammatory, biocompatibility, biodegradability, and adhesion. This study aimed to fabricate an injectable fucoidan containing chitosan hydrogel and prove its effectiveness in periodontal bone regeneration. The injectable hydrogel was prepared using the sol-gel method and was subjected to various physical, chemical, and biological characterizations to understand its efficacy in formation of new bone. The effectiveness of the developed hydrogel was assessed in periodontal bony defects to study the soft and hard tissue changes. A total of 40 periodontitis patients with bony defects were recruited and randomized into two groups to receive fucoidan-chitosan hydrogel and concentrated growth factor, respectively. Customized acrylic stents were used to guide the hydrogel placement into the defect site. Post-surgical changes in clinical parameters were assessed at 3, 6, and 9 months to appreciate the soft and hard tissue changes using repeated measures analysis of variance and Bonferroni’s post hoc test. Significance was kept at 5%. The porosity, water uptake of the prepared hydrogel showed good efficacy, with particle size of the fucoidan containing chitosan hydrogel of 6.000 nm. The MG-63 osteoblasts cell line revealed biocompatibility, biodegradability and showed slow and sustained drug release, increased cell proliferation, and enhanced alkaline phosphatase secretion. Mineralization assay was greatest in the fucoidan containing chitosan hydrogel. Clinically, it exhibited significantly lower probing depth values and a higher mean improvement in clinical attachment level as compared to the concentrated growth factor (CGF) group at the end of 3 and 6 months (p < 0.05). The mean of the defect fills in the fucoidan containing chitosan group was 1.20 at the end of 9 months (p < 0.001) as compared with defect fills observed in the CGF group. The presence of fucoidan in the hydrogel significantly contributed to bone regeneration in humans, thus strengthening its potential in tissue engineering. Fucoidan-chitosan will be a promising biomaterial for bone tissue regeneration. Full article

Background: smoking is considered the most modifiable risk factor for periodontal disease. Objective: the aim of this narrative review is to emphasize the effect of smoking on periodontal and implant therapy. Methods: The authors reviewed the literature reporting the clinical outcomes of smoking on periodontal surgical and nonsurgical treatment. The impact of smoking on implant therapy and sinus lifting procedures were also reviewed. Results: Periodontal and implant therapy outcomes are adversely affected by smoking. Smokers respond less favorably to periodontal therapy and periodontal flap procedures as compared to nonsmokers. Clinical outcomes for smokers are 50–75% worse than for nonsmokers. Studies reveal that smokers experience a significantly lower reduction in pocket depth compared to nonsmokers as well as less bone growth after treating infra-bony defects with guided tissue regeneration. The relative risk of implant failure is significantly higher in patients who smoke 20 cigarettes or more per day compared to nonsmokers. Additionally, smoking has also been shown to increase postoperative wound dehiscence and infection rates following sinus floor elevation. Longitudinal studies on smoke cessation have shown a reduction in bone loss and probing depths for periodontitis patients after cessation compared to those who smoke. Conclusion: Smoking cessation can reduce probing depths and improve clinical attachment after nonsurgical periodontal therapy. There is insufficient evidence regarding the effect of smoking on peri-implantitis, as well as the loss of implants in the long-term. Full article

Tissue engineering in the orofacial region with bioactive components by the activation of immune complexes or other proteins is the current focus of biomaterials research. Consequently, natural ground materials and tissue components are being created. Bioactive glass is one of the most promising biomaterials and has bioactive properties making it suited for a range of different clinical dental applications, including the regeneration of hard tissues in the craniofacial region. This narrative review provides a summary of the favorable properties and recent applications of bioactive glass materials for the management of periodontal lesions. Bioactive glass mimics natural calcified tissues in terms of composition and has a bioactive role in bone regeneration. The present review concluded that bioactive glass materials have a promising potential for various periodontal applications including the repair of infrabony defects, gingival recession, furcation defects, and guided tissue regeneration. However, further in vivo studies and clinical trials are warranted to advance and validate the potential of bioactive glass for periodontal applications and translate its usage in dental clinics for periodontology. Full article

Background and objectives: The aim of this systematic review was to assess the electronic literature about the benefits of using hyaluronic acid (HA) in the surgical periodontal treatment of infrabony defects. Materials and methods: This review was conducted under the PRISMA guidelines. The electronic search was conducted on PubMed, Scopus, Web of Science, and Cochrane databases until February 2022. The inclusion criteria consisted of human clinical trials that reported the use of HA in open-flap debridement (OFD) for infrabony defects. The assessment of risk of bias was performed using the Cochrane risk of bias tool. Statistical analysis was performed using Review Manager. Results: Overall, three RCTs were found eligible for the statistical analysis. Probing depth (PD) reduction and clinical attachment level (CAL) gain in the HA test group presented WMs of −1.11 mm (95% CI −2.38 to 0.16 mm; p = 0.09) and −1.38 mm (95% CI −2.26 to −0.49 mm; p = 0.002), respectively. However, the heterogeneity of the RCTs was high, and the risk of bias, in general, was low. Conclusions: The use of hyaluronic acid seems to have beneficial effects in periodontal surgery using OFD, in terms of PD and CAL. To draw a clear conclusion, more adapted and well-designed clinical trials are needed to assess the advantage of this product in comparison with other products. Full article

Background: A similar long-term stable clinical attachment level (CAL) of infrabony defects (IBDs) after regenerative treatment compared to control teeth would indicate a high level of stability resulting from the regenerative approach. Methods: Patients with a regeneratively treated IBD were screened 120 ± 12 months postoperatively for eligibility for study participation, and were included if complete baseline and 12-month examinations (plaque (PlI), periodontal probing depth (PPD), CAL) were available and a respective control tooth could be identified. Re-examination included clinical examination (PPD, CAL, PlI/GI, bleeding on probing, plaque control record, gingival bleeding index). Results: A total of 27 patients (16 females; age (median; lower/upper quartile): 57.0; 44.0/60.0 years; 6 smokers) contributed 27 IBDs (test), for each of which a control tooth was identified. Five test teeth (18.5%) were lost between 12 and 120 months. The remaining 22 test teeth revealed a significant CAL gain after 1 (2.5 mm; 1.0/4.0 mm, p < 0.0001) and 10 (2.5 mm; 0.5/3.5 mm, p < 0.0001) years, whereas control teeth were stable (1 year: 0.0 mm; 0.0/1.0 mm, p = 0.396; 10 years: 0.0 mm; −1.0/1.5 mm, p = 0.215). The study did not detect any significant CAL change between 1 and 10 years for test (−0.5 mm; −1.0/0.5 mm, p = 0.414) and control teeth (0.0 mm; −1.0/1.0 mm, p = 0.739). In 15 patients, test and control teeth revealed stable CAL values between 12 and 120 months. Conclusion: Regenerative treatment of IBDs exhibited stability comparable to non-surgically treated, periodontally reduced sites over a 10-year period. Full article

Background and Objectives: The aim was to systematically review the available literature regarding the use of polymers as a bone substitute for the treatment of periodontal infrabony defect. Materials and methods: Three databases (PubMed, Scopus and Web of Science) were searched to find all relevant studies published in English from inception until September 2021 using a combination of keywords. The inclusion criteria consisted of human clinical studies which reported the use of a polymer-based bone substitute in the treatment of infrabony defects. Results: 164 studies were provided from the databases. Of these, five articles were eligible and reported favorable outcome in terms of probing depth, clinical attachment gain and defect fill at the follow-up (3 months and 6 months). Conclusions: Polymer based-bone substitutes may represent a useful alternative in treating infrabony defects. Due to the limited number of studies, more research is needed to sustain the advantages of these products. Full article

Objective: To compare the results of periodontal infrabony lesions treated using nanohydroxyapatite (NcHA) graft with other bone grafts (BGs). Methods: Four electronic databases were searched including PubMed (NLM), Embase (Ovid), Medline, and Dentistry and Oral Sciences (EBSCO). The inclusion criteria included randomised controlled clinical trials (RCTs) and controlled clinical trials (CCTs). The clinical results of NcHA were compared with other BGs. For clinical attachment level (CAL) gain, probing pocket depth (PPD) decrease, and gingival recession (REC) change, weighted averages and forest plots were computed. Results: Seven RCTs fulfilled the selection criteria that were included. When NcHA was compared to other BGs, no clinically significant differences were found in terms of each outcome assessed, except the REC change for synthetic BGs as compared to NcHA. Conclusions: The use of an NcHA graft showed equivalent results compared to other types of BGs. To further validate these findings, future studies are required to compare the NcHA and various BGs over longer time periods and in furcation deficiencies. Full article

Background and Objectives: Enamel matrix derivative (EMD) is a biomaterial used for periodontal regenerative therapy due to its properties of stimulating cementum development and bone synthesis. Diabetes is a chronic condition that affects healing and predisposes to infection. The aim of this review was to evaluate the current studies available on the application and results of EMD for periodontal regenerative therapy under diabetic conditions. Materials and Methods: Five databases (PubMed, ResearchGate, Scopus, Web of Science and Google Scholar) were searched for relevant articles, using specific keywords in different combinations. The inclusion criteria were clinical trials, case reports, case studies, and animal studies published in English, where periodontal treatment for bone defects includes EMD, and it is performed under diabetic conditions. Results: Of the 310 articles resulted in search, five studies published between 2012 and 2020 met the inclusion criteria and were selected for the current review. In human studies, the use of EMD in infrabony defects showed favorable results at follow-up. In animal studies, periodontal regeneration was reduced in diabetic rats. Conclusions: EMD might promote bone healing when used under diabetic conditions for the regenerative periodontal therapy. Due to limited number of studies, more data are required to sustain the effects of EMD therapy in diabetic settings. Full article