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Objectives: This randomized controlled trial compared the outcomes of recombinant human fibroblast growth factor (rhFGF)-2 plus carbonate apatite (CO3Ap) granules with rhFGF-2 alone in the treatment of intrabony periodontal defects. Materials and methods: Patients with Stage III Grade B/C periodontitis who had completed initial periodontal therapy and had intrabony defects with a depth of ≥ 3 mm were included. Defects were treated solely with rhFGF-2 (control) or rhFGF-2 plus CO3Ap (test). Periodontal parameters and a patient-reported outcome measure (PROM) were assessed at baseline, at 6, 9 and 12 months postoperatively. The primary outcome was the change in clinical attachment level (CAL) from baseline to 12 months postoperatively. Using the Friedman test with Dunn's post-test, intragroup data were compared over time, and Mann-Whitney U test was used to assess intergroup data at each time point. Results: Forty-eight sites in 38 patients were subjected to analysis. At 12 months postoperatively, CAL in both groups showed a significant improvement from baseline (p < 0.001). CAL gain was 3.4 ± 1.3 mm in the test group and 3.2 ± 1.2 mm in the control group, with no significant intergroup difference (p = 0.567). Radiographic bone fill in the test group (67.2%) was significantly greater than in the control group (32.4%) (p < 0.001). PROM scores showed no difference between groups. Conclusions: At 12 months, the outcomes including CAL gain and PROM showed no significant differences between groups, although the combination treatment enhanced radiographic bone fill. Clinical relevance: The use of rhFGF-2 (with/without CO3Ap) could lead to significant improvement in clinical parameters in the treatment of intrabony periodontal defects. The benefit of adding CO3Ap to rhFGF-2 therapy needs further evaluation. Clinical Trial Registration Number: The University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) : UMIN000040783. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Aim Methods Results Conclusions Clinical practice guidelines suggest access flap surgery for managing deep residual pockets after steps 1 and 2 of periodontal therapy. Papilla‐preservation flap surgery (PPFS) is the least invasive approach to access and instrument biofilm‐contaminated root surfaces. Endoscopic‐assisted subgingival debridement (EASD) may enhance the outcomes of repeated instrumentation and provide a minimally invasive non‐surgical alternative.This was a single‐blind, controlled, randomized, parallel‐group, non‐inferiority 12‐month trial comparing EASD with PPFS. Male and female adults with generalized stage III periodontitis and persistent periodontal pockets associated with an intrabony defect after steps 1 and 2 of periodontal therapy were recruited at Prince Philip Dental Hospital. Inter‐group differences in clinical attachment level (CAL) changes at 12 months were the primary outcome. Secondary outcomes included pocket resolution (no pocket > 5 mm and no pocket > 4 with bleeding on probing), radiographic bone changes, treatment time, early wound healing and quality‐of‐life measurements.Sixty‐two subjects (30 EASD and 32 PPFS) were included in the intention‐to‐treat analysis. CAL gains were 2.0 ± 1.0 and 1.8 ± 1.0 mm for test and controls, respectively. The 95% CI of the inter‐group difference was −0.3 to 0.8 mm and within the stipulated 1‐mm non‐inferiority margin. No inter‐group differences were observed (i) in pocket resolution, which was achieved in more than 87% of cases for all groups/time points, and (ii) in radiographic bone healing. The treatment time was significantly shorter for EASD than for PPFS. Better early wound healing index scores were observed for EASD. No inter‐group differences in pain, quality of life or safety were detected.EASD was not inferior to PPFS for managing residual pockets associated with intrabony defects. The observed outcome profile supports additional developments and studies to validate EASD as an alternative to surgery for isolated persistent pockets (ChiCTR‐INR‐16008407). [ABSTRACT FROM AUTHOR]

One of the most promising approaches to correct periodontal bone defects and achieve periodontal regeneration is platelet-rich fibrin (PRF). This systematic review and meta-analysis aimed to evaluate the regeneration of periodontal bone defects using PRF compared to other regenerative treatments. The data search and retrieval process followed the PRISMA guidelines. An electronic search of MEDLINE, Cochrane, and PubMed databases was performed, selecting exclusively randomized clinical trials where the following were measured: probing depth reduction (PD), clinical attachment level gain (CAL), and radiographic bone fill (RBF). Out of 284 selected articles, 32 were chosen based on inclusion criteria. The use of platelet-rich fibrin (PRF) + open flap debridement (OFD), PRF + metformin, PRF + platelet-rich plasma (PRP), and PRF + OFD/bone graft (BG) significantly reduced PD and improved CAL and RBF. However, the combination of PRF + BG, PRF + metformin, and PRF + STATINS reduced CAL. The intervention of PRF combined with different treatments such as metformin, OFD, PRP, BG, and STATINS has a significant impact on improving PD and CAL. The use of PRF significantly improved the regeneration of periodontal bone defects compared to other treatments. [ABSTRACT FROM AUTHOR]

Background: Peri‐implantitis poses a significant challenge in dental implantology due to its potential to result in the loss of supporting tissue around dental implants. Surgical reconstruction is often recommended for intrabony defects, accompanied by various adjunctive therapies, such as antimicrobial photodynamic therapy (aPDT), for bacterial decontamination. However, the long‐term efficacy of such treatments remains unclear. Methods: This clinical report presents a case of peri‐implantitis management in a healthy 55‐year‐old male using guided bone regeneration principles and surface decontamination via aPDT. The patient exhibited peri‐implantitis with probing pocket depths (PPD) of 7 mm at buccal sites, 5 mm at palatal sites, and significant bone loss around implant #12. The reconstructive approach involved preservation of the existing implant and following a non‐submerged healing protocol. The surgical phase included meticulous debridement, chemical detoxification with hydrogen peroxide, and aPDT using a 670 nm diode laser with methylene blue as the photosensitizer. Xenogenic bone graft and a resorbable collagen membrane were applied and the patient was followed up to through a 5‐year period. Results: Postsurgery the patient exhibited normal healing, and long‐term follow‐up at 5 years showed reduced PPD (2 mm buccally, 3 mm mid‐palatally), complete intrabony defect fill, and stable bone levels, indicating successful treatment. Conclusions: This case report demonstrates the potential long‐term success of a reconstructive approach with adjunctive aPDT in peri‐implantitis management. However, it highlights the need for standardized protocols and further clinical trials to establish the clinical benefits of aPDT in surgical reconstruction of peri‐implantitis defects, serving as valuable pilot data for future research. Key points: Why is this case new information?Provides a rare 5‐year insight into peri‐implantitis intrabony defect reconstruction, offering extended success and outcomes not frequently documented.Demonstrates the efficacy of aPDT with a 670‐nm diode laser in achieving successful long‐term outcomes, contributing valuable evidence to existing literature.Keys to successful management of this case: Success involves initial non‐surgical debridement followed by a reconstructive strategy, incorporating guided bone regeneration and surface decontamination via aPDT.Long‐term success hinges on patient compliance with routine oral hygiene, emphasizing the importance of adherence to preventive measures post‐reconstruction to minimize recurrence risk.What are the primary limitations to success in this case?Variability in photosensitizer uptake, and potential risks such as tissue damage and bacterial resistance pose challenges to the effectiveness of aPDT.The existing literature on aPDT in peri‐implantitis treatment lacks standardization in methodology, laser parameters, and follow‐up durations, making it challenging to establish a universally accepted protocol. [ABSTRACT FROM AUTHOR]

Background: This 6‐month randomized split‐mouth and placebo‐controlled clinical trial aimed to evaluate the clinical and radiographic efficacy of adjunctive use of 0.05% zoledronate (ZLN) gel as local drug delivery to scaling and root planing (SRP) in stage III, grade B periodontitis patients with and without controlled type‐2 diabetes mellitus (DM). Methods: A total of 120 infrabony sites were divided into two groups: Group‐1 (non‐diabetic periodontitis) and Group‐2 (periodontitis + DM). A total of 60 sites in each group were randomized to receive treatment with SRP + placebo gel (control) or SRP + 0.05% ZLN gel (test). Plaque index (PI), modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment levels (RAL) were assessed at baseline, 3 and 6 months, and digital intraoral periapical and cone‐beam computed tomography imaging were used to measure the linear and percentage reduction of intrabony defect depth (DD, DDR%) after 6 months. Results: Group‐1 showed significant reduction in PI (0.56 ± 0.15 and 0.52 ± 0.19 from 0.67 ± 0.17), mSBI (0.7 ± 0.60 and 0.47 ± 0.57 from 0.9 ± 0.48), PPD (4.6 ± 0.85 and 3.43 ± 0.63 from 6.5 ± 1.04) and gain in RAL (7.03 ± 0.85 and 5.93 ± 0.69 from 8.9 ± 1.09) in the ZLN‐treated sites than the placebo sites and also from Group‐2 sites after 3 and 6 months, respectively. A significant reduction in DD of 28.79% in Group‐1 and 22.20% in Group‐2 at ZLN sites was seen compared to placebo sites of both groups. Conclusion: ZLN gel applied subgingivally in infrabony pockets resulted in significant clinical improvements evident by probing depth reduction and gain in attachment levels along with radiographic evidence of more bone fill seen in non‐diabetic patients compared to diabetic periodontitis patients. [ABSTRACT FROM AUTHOR]

Background: Regenerative approaches performed in periodontics seems to be efficient in treating intrabony defects. There are, however, many factors that may affect the predictability of the regenerative procedures. The present article aimed to propose a new risk assessment tool for treating periodontal intrabony defects by regenerative therapy. Methods: Different variables that could affect the success of a regenerative procedure were considered based on their impact on (i) the wound healing potential, promoting wound stability, cells, and angiogenesis, or (ii) the ability to clean the root surface and maintain an optimal plaque control or (iii) aesthetics (risk for gingival recession). Results: The risk assessment variables were divided into a patient, tooth, defect, and operator level. Patient‐related factors included medical conditions such as diabetes, smoking habit, plaque control, compliance with supportive care, and expectations. Tooth‐related factors included prognosis, traumatic occlusal forces or mobility, endodontic status, root surface topography, soft tissue anatomy, and gingival phenotype. Defect‐associated factors included local anatomy (number of residual bone walls, width, and depth), furcation involvement, cleansability, and number of sides of the root involved. Operator‐related factors should not be neglected and included the clinician's level of experience, the presence of environmental stress factors, and the use of checklists in the daily routine. Conclusions: Using a risk assessment comprised of patient‐, tooth‐, defect‐ and operator‐level factors can aid the clinician in identifying challenging characteristics and in the treatment decision process. [ABSTRACT FROM AUTHOR]

Background: There have been limited studies with statistically sufficient sample sizes for assessment of suitable bone defect morphology for combination therapy with enamel matrix derivative (EMD) and bone grafting. The aim of this study was to investigate the appropriate feature of intrabony defects, such as bone defect angle (DA) and the containment by bony wall, for yielding the additional benefit of bone grafting in combination with periodontal regenerative therapy using EMD. Methods: Following periodontal regenerative therapy using EMD with or without autologous bone grafting, 282 intrabony defects of 177 participants were maintained for 3 years. Multilevel linear regression analysis was performed to evaluate the radiographic bony defect depth (RBD) reduction after adjusting for confounders. Results: The baseline parameters, except for the proportion of contained bony defects and tooth mobility, did not differ significantly between the groups with and without bone grafts. There was no significant difference in the improvement of clinical parameters between the groups. The 1‐ and 3‐year reduction of RBD showed significant inverse correlations with preoperative DA only in the group without bone graft. Furthermore, multivariate analysis showed a significant interaction between DA at baseline ≥40° and adjunctive bone grafting in the reduction of RBD, regardless of the number of bony walls. Conclusion: Adjunctive autologous bone grafting with enamel matrix derivative might be significantly beneficial for defect depth improvement in the case of DA at baseline ≥40°. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the effects of low‐level erbium‐doped: yttrium, aluminum, and garnet (Er:YAG) laser irradiation on periodontal tissue healing and regeneration through angiogenesis in vivo and in vitro studies. Methods: Intrabony defects were surgically created in the bilateral maxilla molar of rats. The defects were treated by open flap debridement (OFD) with Er:YAG laser, including low‐level laser irradiation (LLLI) to bone and blood clot surfaces, or conventional procedures. The mRNA expression of vascular endothelial growth factor (VEGF) in the surgical sites was quantified using real‐time polymerase chain reaction. The decalcified specimens were prepared for histometric analysis. Also, LLLI was performed on human umbilical vein endothelial cells to evaluate the effects on angiogenesis. Cell proliferation, VEGF expression, and tube formation were assessed. In addition, capsazepine (CPZ), a selective inhibitor of transient receptor potential vanilloid 1 (TRPV1), treatment was performed before LLLI for the same assays. Results: OFD using Er:YAG laser did not generate thermal damage on bone or root surfaces. LLLI accelerated hemostasis by coagulation of the superficial layers of blood clots in the laser‐treated group. Postoperative healing was sound in all animals in both groups. VEGF expression and bone formation were significantly increased in the laser‐treated group compared to those in the conventional treatment group. In vitro, cell proliferation and VEGF expression were significantly increased in the LLLI group compared to the control group. Tube‐formation assays showed that LLLI significantly promoted angiogenesis. CPZ treatment significantly suppressed VEGF expression and tube formation following LLLI. Conclusions: This study suggests that Er:YAG laser irradiation may promote periodontal tissue healing by enhancing angiogenetic effect of endothelial cells via TRPV1. [ABSTRACT FROM AUTHOR]

Soft and hard tissue deficiencies around dental implants which can potentially compromise implant survival are commonly encountered. Complicated interventions are often required to address and resolve combinations of soft and hard tissue defects. This case report describes the management of peri‐implant soft tissue fenestration accompanied by bony dehiscence associated with intrabony defect through soft tissue modification. A 51‐year‐old female was referred to the Periodontics and Oral Medicine Clinic with labial soft tissue fenestration at the maxillary left canine implant‐supported crown. The patient complained of discomfort and malodor at the implant site. The implant showed mucosal fenestration and 6 mm probing depth (PD) with profuse bleeding at the distolabial site without mobility. A cone beam computed tomography (CBCT) demonstrated labial bony dehiscence associated with a 5.56‐mm intrabony defect at mesial and distal surfaces. The implant was diagnosed as peri‐implantitis with soft tissue deficiency. The treatment comprised oral hygiene instruction, debridement of the implant and all natural teeth, and mucogingival surgery with free connective tissue graft by the envelope technique. Two weeks after debridement, the mucosal margin of the implant disappeared, presenting soft tissue dehiscence of 4 × 4 mm. Mucogingival surgery was performed 3 weeks later. A 2‐year follow‐up revealed a stable mucosal margin with PD ranged 2–4 mm. In conclusion, modification of the soft tissue thickness around the implant together with excellent plaque control by the patient successfully maintained peri‐implant health. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to retrospectively evaluate the 3-year radiographic outcomes of periodontal intrabony defects treated with non-surgical subgingival therapy (NST), assessing radiographic bone gain (RBG) through experimental digital software, named "Bone Defect Analysis (BDA)". Methods: The study included 17 intrabony defects in 14 patients. BDA software (version 1) was used on radiographs to calculate RBG (in %) and variations in defect angle (in °) between baseline (T0) and 3-year follow-up (T1). Soft tissue conditions were registered, reporting bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Defects were analyzed according to angles less (group A) or greater (group B) than 30°. Results: Nine and eight defects were, respectively, analyzed in groups A and B. Three years after treatment, an average RBG of 12.28% was found overall, with 13.25% and 10.11% for groups A and B, respectively (p = 0.28). Clinically, a mean CAL of 6.05 mm at T1 (from 10.94 mm at T0) was found, with 6.88 mm and 5.12 mm in groups A and B, respectively (p = 0.07). Conclusions: BDA software demonstrated predictability in the evaluation of bone variations after NST, revealing better clinical findings for intrabony defects with an initial smaller angle. [ABSTRACT FROM AUTHOR]

Objective: Clinical concerns exist regarding the quality of bony consolidation in the context of the induced membrane technique. This study evaluates the clinical process of bone grafting in the second stage of induced membrane bone union in patients with tibial bone defects to infer the possibility of non‐union and establish a reliable and effective evaluation method combined with computed tomography (CT) to assess fracture healing. Methods: Patients with tibial bone defects who underwent the induced membrane technique at our hospital between February 2017 and February 2020 were retrospectively analyzed. The Hounsfield unit (HU) values of the patients were evaluated at different times during the second stage of bone grafting. Bone healing at the boundary value of the 120 HU output threshold (−1024 HU–3071 HU) was directionally selected, and the changes in the growth volume of union (new bone volume [selected according to HU value]/bone defect volume) were compared with analyzing individual class bone union. Method 1 involved X‐rays revealing that at least three of the four cortices were continuous and at least 2 mm thick, with the patient being pain free. For Method 2, new bone volume (selected according to HU value/bone defect volume) at the stage was compared with analyzing individual class healing. Receiver operating characteristic curve analysis was used for Methods 1 and 2. Results: A total of 42 patients with a segmental bone defect with a mean age of 40.5 years (40.5 ± 8.3 years) were included. The relationship between bone graft volume and time variation was analyzed by single factor repeated variable analysis (F = 6.477, p = 0.016). Further, curve regression analysis showed that the change in bone graft volume over time presented a logarithmic curve pattern (Y = 0.563 + 0.086 × ln(X), Ra2 = 0.608, p = 0.041). ROC curve analysis showed that Method 2 is superior to Method 1 (AUC: 86.3% vs. 68.3%, p < 0.05). Conclusion: The induced membrane technique could be used to treat traumatic long bone defects, with fewer complications and a higher healing rate. The proposed imaging grading of HU (new bone volume/bone defect volume) can be used as a reference for the quality of bony consolidation with the induced membrane technique. [ABSTRACT FROM AUTHOR]

Cranioplasty with titanium mesh provides a stable and cosmetically sound option for the correction of extensive skull bone defects following trauma or tumour surgery with osseous involvement. Meningiomas are for the most part benign lesions that are amenable to surgical cure, however lesions with extradural extension pose additional challenges not only due to increased technical difficulty in achieving gross total resection but also because of distinct biological behaviour. We describe the case of a 43-years-old woman that had been submitted to gross total resection of a WHO grade I falcine and superior sagittal sinus secretory meningioma with extradural and bone extension and cranioplasty with a titanium mesh who had a recurrence 4 years later as two tumour masses on top of the titanium mesh with no adjacent soft tissue invasion, and without dural involvement. To our knowledge, this is the first reported case of meningioma growth on top of titanium cranioplasty material. Seeded or incompletely removed tumoral cells might have exploited the biocompatibility of titanium to promote tumour regrowth. [ABSTRACT FROM AUTHOR]

Background: The purpose of this randomized clinical study was to clinically evaluate and compare the efficiencies of platelet‐rich fibrin (PRF), concentrated growth factor (CGF) and autogenous bone graft (ABG) in the treatment of intrabony pockets and to assess the alveolar bone gain (AB gain) radiographically (panoramic and CBCT images). Methods: Eighty intrabony pockets were divided into four groups: ojnly open flap debridement (OFD), OFD+PRF, OFD+CGF and OFD+ABG; each group consisted of 20 defects. Plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and tooth mobility (TM) by using Periotest M device were evaluated. Radiographic images were also taken to evaluate the AB gain. PRF was produced using a protocol of 2,700 RPM for 12 min and the relative centrifugal force (RCF) was evaluated. CGF was prepared as follows: 2 min 2700 rpm, 4 min 2400 rpm, 4 min 2700 rpm, 3 min 3000 rpm. Results: The study results revealed a similar improvement in PI and GI values in all groups (p > 0.05). There was a statistically significant decrease in PD and CAL in favor of ABG group at day 180 in comparison with other groups (p = 0.001). There was also a statistically significant decrease in TM and alveolar bone height loss (ABHL), whereby the AB gain gradually increased among the groups with the best group being ABG, followed by CGF, PRF, and control groups, respectively (p = 0.001). Conclusions: The study results support the treatment of periodontal intrabony pockets using OFD in combination with ABG, CGF, and PRF, as ABG showed the best results followed by CGF and PRF. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate alterations in the concentrations of matrix metalloproteinase-9 (MMP-9) and interleukin-8 (IL-8) within gingival crevicular fluid (GCF) extracted from the intrabony periodontal defect site before and after minimally invasive regenerative surgery, with or without supplemental laser application. The surgical procedure was performed using the modified minimally invasive surgical technique (M-MIST). Methods: Thirty-eight patients, each presenting with a single vertical defect, were randomly assigned to either the test (M-MIST + Er:YAG + Nd:YAG) or the control group (M-MIST). IL-8 and MMP-9 levels (primary outcomes of the study) were assessed prior to therapy, after 2 and 4 weeks, and 6 months following the surgical procedure by means of dedicated ELISA kits. Results: Both procedures were clinically effective as evidenced by probing depth (PD) reduction and clinical attachment level (CAL) gain at the 6-month follow-up. No statistical differences were observed in the levels of MMP-9 and IL-8 between the groups at any time point assessed. The changes in the level of MMP-9 and IL-8 over time were not statistically significant in any group. IL-8 was positively correlated with MMP-9 in the control group throughout the study and in the test group 2 weeks and 6 months post-op. Conclusions: Within the limitations of this study, the additional application of Er:YAG + Nd:YAG lasers alongside the M-MIST procedure did not enhance the clinical and biochemical treatment outcomes compared to M-MIST alone. [ABSTRACT FROM AUTHOR]

Background: The goal of periodontal treatment is to stop this progressive destruction by controlling infection, thus preventing tooth loss. The aim of this work was to evaluate the efficacy of the combined effect of Chitosan, hyaluronan, and strontium chloride membranes in the treatment of periodontal intrabony defect. Methods: This research was randomized controlled trial. This study was carried out on 36 patients with an age range between 25 and 55 years. The patients were divided into two equal groups as follows: Group A (Control group): patients were treated with open flap debridement and group B (Test group): patients were treated surgically with hyaluronan, chitosan, and strontium chloride membrane. Results: The pain was significantly reduced in group B compared to group A at D1 and D2 (P<0.001), while the remaining durations were insignificantly different between both groups. The gingival index and probing depth was significantly reduced after 3 months and after 6 months compared to baseline in group A and in group B (P<0.001). Conclusions: The use of triphasic Hyaluronan – Chitosan – Strontium Chloride membrane in conjunction with periodontal flap surgery in treating intrabony defect did not show a statistically significant difference in comparison to OFD alone. Regarding periodontal probing depth, clinical attachment loss, gingival index, and radiographic bone fill, there was an improvement in both groups. Moreover, tissue response to the triphasic Hyaluronan -Chitosan- Strontium Chloride membrane was favorable as reflected by reduced pain and swelling. [ABSTRACT FROM AUTHOR]

Background: The purpose of this publication is to report on the 12‐month clinical and radiographic results comparing the surgical use of the Er,Cr:YSGG laser (ERL) and minimally invasive surgical technique (MIST) for the treatment of intrabony defects in subjects with generalized periodontitis stage III, grade B. Methods: Fifty‐three adult subjects (29 females and 24 males; 19–73 years) with 79 intrabony defects were randomized following scaling and root planing (SRP) to receive ERL monotherapy (n = 27) or MIST (n = 26). Fifty subjects completed the study. Recession (REC), probing depth (PD), clinical attachment level (CAL), treatment time, and standardized radiographs were assessed and compared for each treatment group. Clinical measurements were recorded at baseline, 4–6 weeks following SRP, and 6 and 12 months following surgical therapy. Radiographic results were compared to baseline at 6 and 12 months following surgical therapy. Results: The following primary and secondary outcome variables were non‐inferior with the following margins: CAL with a non‐inferiority margin of 0.7 mm (p = 0.05), PD with a non‐inferiority margin of 0.7 mm (p = 0.05), and REC with a non‐inferiority margin of 0.4 mm (p = 0.05). Standardized radiographs suggest similar bone fill of 1.14 ± 1.73 mm for MIST and 1.12 ± 1.52 mm for ERL. Conclusions: This is the first multicenter, randomized, masked, and controlled study demonstrating the ERL is not inferior to MIST at 12 months in terms of clinical outcomes and similar to MIST in terms of radiographic bone fill for the surgical treatment of intrabony defects. [ABSTRACT FROM AUTHOR]

Background and Objectives: Unfavorable intrabony defects (IBDs) are associated with the progression of periodontal disease and tooth loss. Growing scientific evidence has demonstrated the effectiveness of platelet concentrations in periodontal treatment. The aim of our study was to demonstrate the non-inferiority of an autogenous bone graft (ABG) associated with leukocyte- and platelet-rich fibrin (L-PRF) compared to ABG + Collagen Membrane in the treatment of IBDs. Material and Methods: Sixty-four patients with at least one IBD were randomly assigned to two groups: ABG+L-PRF and CM+ABG. Clinical and radiographic evaluations were performed at baseline and 12-month follow-up. Clinical attachment level (CAL), gingival recession (GR), probing pocket depth (PPD), and radiograph defect bone level (DBL) were compared between the two treatments. To evaluate the effectiveness of ABG+L-PRF, a non-inferiority margin of =1 mm (−1 mm for GR) was chosen; a second non-inferiority margin of =0.5 mm (−0.5 mm for GR) was set for clinical relevance. Results: At 12-month follow up, both treatments showed clinical and radiographic improvements. The 90% confidence intervals of the CM+ABG–L-PRF+ABG mean difference for CAL gain (−0.0564 mm [−0.316 to 0.203]), DBL gain (−0.433 mm [−0.721 to −0.145]), and PPD reduction (0.232 mm [0.015 to 0.449]) were below the 0.5 mm non-inferiority margin; the GR increase (0.255 mm [0.0645 to 0.445]) stayed above the −0.5 mm. Conclusions: the L-PRF+ABG treatment of unfavorable IBDs is non-inferior with respect to the CM+ABG therapy for CAL gain, but with a lower GR, a slightly higher PPD, and DBL gain. [ABSTRACT FROM AUTHOR]

Bone defects caused by trauma, tumor resection, and infections are significant clinical challenges. Excessive reactive oxygen species (ROS) usually accumulate in the defect area, which may impair the function of cells involved in bone formation, posing a serious challenge for bone repair. Due to the potent ROS scavenging ability, as well as potential anti-inflammatory and immunomodulatory activities, antioxidants play an indispensable role in the maintenance and protection of bone health and have gained increasing attention in recent years. This narrative review aims to give an overview of the main research directions on the application of antioxidant compounds in bone defect repair over the past decade. In addition, the positive effects of various antioxidants and their biomaterial delivery systems in bone repair are summarized to provide new insights for exploring antioxidant-based strategies for bone defect repair. [ABSTRACT FROM AUTHOR]

The aim of this study was to test the molecular expression profile (senescence-associated secretory phenotype; SASP) in gingival crevicular fluid (GCF) prior to surgery in relation to the distribution of clinical success of periodontal regeneration. Forty consecutive patients presenting sites with residual probing pocket depth (PPD) ≥ 6 mm and intrabony defects ≥ 3 mm were treated through a minimally invasive surgical technique. Pre-operatively, GCF was sampled for inflammatory biomarker analysis related to SASP [interleukin (IL)-1β, IL-6, and IL-12; matrix-metalloproteinases (MMP)-8 and -9]. Better or worse responders were classified depending on the achievement of a composite outcome measure at 1-year [COM; PPD ≤ 4 mm and clinical attachment gain (CAL) gain ≥ 3 mm]. Correlation analyses and logistic regression models were performed. Periodontal regeneration led to significant improvements in mean clinical and radiographic parameters. Teeth achieving COM presented significantly lower amounts of SASP factors compared with non-successful teeth. Higher CAL gain, PPD reduction, and radiographic bone fill were negatively correlated with IL-1β and MMP-8 and -9 (p < 0.001), while IL-12 showed a direct relationship with CAL gain (p = 0.005) and PPD reduction (p = 0.038). Sites expressing higher SASP expression in the GCF before periodontal regeneration achieved worse clinical and radiographic outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to determine the contribution of titanium prepared platelet-rich fibrin (T-PRF) with open flap debridement (OFD) on clinical, biochemical and radiographic measurements of periodontal regeneration. Twenty periodontitis patients with bilateral intrabony defects and stage III grade A periodontitis were included in the study. A total of 40 defects were randomly selected for OFD alone (control group, n = 20) or combined OFD+ T-PRF (test group, n = 20). Clinical and radiographic parameters (at baseline and nine months after surgery), and growth factor levels in gingival crevicular fluid (at baseline and at two, four, six, and twelve weeks after surgical treatment) were also evaluated. Considering the clinical parameters, alterations in probing pocket depth, gingival marginal level and clinical endpoint in the test regions treated with T-PRF significantly improved (P<0.05). Fibroblast growth factor-2 and platelet-derived growth factor-BB levels between the two groups in the second and fourth weeks were also significantly different (P<0.05). Furthermore, the receptor activator of nuclear factor κB ligand/osteoprotegerin ratio between the groups was significantly different in the second, fourth, sixth, and twelfth weeks (P<0.05). The bone-filling rate was also significantly greater in the test group than in the control group (P <0.001). Compared with OFD alone, combining T-PRF with the procedure was more successful with regards to clinical, radiographic, and biochemical measurements of periodontal regeneration. [ABSTRACT FROM AUTHOR]

Background: With the entire papilla preservation (EPP) technique, it is possible to perform regenerative therapy without incisions in the interdental papilla and to reduce the risk of papillary rupture. However, one limitation of the EPP is the sole access from the buccal side. Here, we present a case of periodontitis treated by the combination regenerative therapy employing the Double‐sided (buccal‐palatal) EPP (DEPP) technique, which adds a palatal vertical incision to the EPP. Methods: A patient with 1–2 wall intrabony defects received the regenerative therapy using recombinant human fibroblast growth factor (rhFGF)‐2 and carbonate apatite (CO3Ap). Using the DEPP technique, vertical incisions at buccal and palatal aspects were placed to gain adequate access to the 1–2 wall intrabony defects between #11 and #12 without incision in the interdental papilla. After debridement, rhFGF‐2 and CO3Ap were applied to the defect. Periodontal clinical parameters and radiographic images were evaluated at the first visit, following initial periodontal therapy (baseline), 6, 9, and 12 months postoperatively. Results: Wound healing was uneventful. Scarring of the incision lines was minimal. At 12 months postoperatively, probing depth reduction was 4 mm, clinical attachment gain was 4 mm, and gingival recession was not observed. An improvement in radiopacity in the previous bone defect was observed. Conclusion: The DEPP is an innovative technique that allows approaching from both the buccal and palatal sides while ensuring flap extensibility without compromising the interdental papilla. This report suggests that the combination of regenerative therapy with the DEPP may be promising in the treatment of intrabony defects. Key points: Why is this case new information?The DEPP allows a direct visual approach to a 1–2 wall intrabony defect extending from the buccal to palatal sides, and increases flap extensibility, without compromising the papilla. What are the keys to the successful management of this case?Assessment of three‐dimensional bone defect morphology is required. Computed tomography images are very useful. The flap elevation just under the interdental papilla should be carefully performed with a small excavator to avoid damage to the interdental papilla. What are the primary limitations to success in this case?Despite the addition of a palatal incision, it was not possible to obtain complete flexibility of the palatal gingiva. Caution must be taken in a case in which the distance between the interdental papilla is narrow. Even if the interdental papilla is ruptured during the operation, recovery is possible by continuing the operation and suturing the rupture at the end. [ABSTRACT FROM AUTHOR]

Platelet-rich fibrin has become increasingly popular in recent years due to its remarkable capacity to accelerate the post-surgery wound healing process, reduce inflammation, and promote tissue repair. This study aimed to perform a meta-analysis to evaluate the effect of platelet-rich fibrin in mixture form with bone substitute, as a membrane, or in combination. A comprehensive search using a combination of controlled vocabulary (MeSH) and free-text terms was undertaken by two reviewers to identify published randomized clinical trials. Three major electronic databases (Medline via PubMed, Cochrane database, and Embase) and the clinical trials registry (clinicaltrials.gov) were searched up to 9 July 2023. The results of the meta-analysis showed that the pooled standardized mean difference of probing depth for platelet-rich fibrin was 0.61 (95% CI, 0.33 to 0.88). The results of the meta-analysis showed that the mean difference in clinical attachment level for platelet-rich fibrin was 0.68 (95% CI, 0.35 to 1.01). The results of the meta-analysis showed that the mean difference in bone fill for platelet-rich fibrin was 0.50 (95% CI, 0.23 to 0.78). In conclusion, the study found that platelet-rich fibrin was effective as adjunct to periodontal regeneration. [ABSTRACT FROM AUTHOR]

How to deal with large tibial bone defects is still controversial. The purpose of this research was to compare the semi-focal bone transport (SFBT) technique with traditional bone transport (TBT) technique for treating such patients. Sixty-two patients were included and retrospectively analyzed. In all cases, after radical debridement large tibial bone defects remained. Patients were treated by the SFBT or TBT technique. The distraction, consolidation duration and complications were recorded by the patients' medical files. Based on the Association for the Study and Application of Methods of Ilizarov (ASAMI) standard, the bone and functional results were evaluated. The mean bone defect size was 7.7 ± 1.6 cm and 7.5 ± 2.1 cm for SFBT and TBT patients. The mean external fixation index (EFI) was 1.51 ± 0.14 months/cm and 1.89 ± 0.25 months/cm for SFBT and TBT patients (p < 0.05), respectively. With respect to bone and function results, there was no significant differences between the two groups (p > 0.05). The mean number of complications per patient was 1.1 ± 0.6 and 1.6 ± 0.7 for SFBT and TBT patients (p < 0.05). Compared to the traditional bone transport technique, patients using the semi-focal bone transport technique achieved better clinical effects, including shorter EFI and less complications. Therefore, the SFBT technique could be a new option for patients with large tibial bone defects. [ABSTRACT FROM AUTHOR]

Background.: Applying autologous growth factors and diode laser in periodontal therapy enhances fibroblast-mediated new attachment and osteoblastic differentiation. Hence, this study compared and evaluated the effectiveness of concentrated growth factor (CGF) alone and with diode laser application in managing intrabony periodontal defects. Methods.: Ten patients with stage III periodontitis were included in this study. All the patients underwent an open flap debridement (OFD) procedure followed by CGF membrane placement in the intrabony defect in site A, whereas, in site B, after OFD, all the patients underwent diode laser irradiation before CGF membrane placement. Plaque and gingival bleeding index (PI & GBI), PPD, and clinical attachment level (CAL) were evaluated at baseline and 3 and 6 months later. Bone fill (BF), BF%, bone crest changes (BCC), and BCC% were assessed radiographically at six months postoperatively. Results.: Significant reductions in PI and GBI scores, probing pocket depth (PPD), and CAL gain were observed at both sites 3 and 6 months from baseline. A significant reduction in PPD and CAL gain was noted between sites, which were higher in site B than in site A with a mean difference of 0.70±0.05 mm and 1.30±0.18 mm, 0.90±1.89 mm at 3 and 6 months, respectively. Radiographic measurement showed better BF, BF%, BCC, and BCC% at both sites at six months, which were higher at site B than at site A but statistically insignificant. Conclusion.: The combination of CGF and diode laser application has demonstrated successful and promising results in terms of regeneration, improving the clinical and radiographic parameters. [ABSTRACT FROM AUTHOR]

A thorough cleaning and shaping of root canals is one of the primary objectives of root canal treatment. For that the clinician needs to be aware of different variations in root canal configurations. The purpose of this article is to report the successful treatment of middle distal canal with type VIII vertucci's root canal configuration. Treatment plan included the non surgical root canal treatment of right mandibular first molar with five canals followed by periodontal management of mesial bony defect. Re-examination at 6 months after the periodontal surgery revealed reduction in PD (from 13 to 5 mm) and with no sign of bleeding on probing. Radiographic follow up showed bone formation in the periodontal intrabony defect. A progressive bony healing appeared radiographically and all signs and symptoms absent after 6 months of thorough root canal treatment with periodontal management of mesial bony defect of right manidibular first molar. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this retrospective case series was to report the performance up to 5 years of an innovative surgical design (the apically incised coronally advanced surgical technique [AICAST]) for the regenerative treatment of one- or two-walled intrabony periodontal lesions. Method and materials: After completion of standard step I to II periodontal therapy, nine isolated periodontal defects were treated through AICAST. The following clinical outcome measurements were collected before the surgical intervention and at the last available follow-up: probing pocket depth (PPD), recession depth (REC), and clinical attachment level (CAL). Periapical radiographs of the treated teeth were also taken at baseline and at the last available follow-up (18 months or 5 years postoperatively). Results: A mean (± standard deviation) PPD reduction of 6.05 ± 1.76mm (P < .01), REC reduction of 1.15 ± 1.97 mm (P = .119), and CAL gain of 7.20 ± 2.13 mm (P < .01) were attained when comparing preoperative results with the last follow-up visit. CAL gain of 6 mm or more was reached in eight out of nine treated cases (88.9%), with a residual PPD of 2 to 3 mm in all the cases. Complete radiographic fill of the intrabony component was present in all the defects, while detectable suprabony radiographic filling was identified in two cases. Conclusion: AICAST represents an innovative surgical design for the treatment of deep intrabony defects and the eventual reduction of the associated gingival recessions. Preliminary results show good performance in terms of clinical attachment gains and maintenance of the marginal tissues. [ABSTRACT FROM AUTHOR]

Calcium phosphate-based synthetic bone is broadly used for the clinical treatment of bone defects caused by trauma and bone tumors. Synthetic bone is easy to use; however, its effects depend on the size and location of the bone defect. Many alternative treatment options are available, such as joint arthroplasty, autologous bone grafting, and allogeneic bone grafting. Although various biodegradable polymers are also being developed as synthetic bone material in scaffolds for regenerative medicine, the clinical application of commercial synthetic bone products with comparable performance to that of calcium phosphate bioceramics have yet to be realized. This review discusses the status quo of bone-regeneration therapy using artificial bone composed of calcium phosphate bioceramics such as β-tricalcium phosphate (βTCP), carbonate apatite, and hydroxyapatite (HA), in addition to the recent use of calcium phosphate bioceramics, biodegradable polymers, and their composites. New research has introduced potential materials such as octacalcium phosphate (OCP), biologically derived polymers, and synthetic biodegradable polymers. The performance of artificial bone is intricately related to conditions such as the intrinsic material, degradability, composite materials, manufacturing method, structure, and signaling molecules such as growth factors and cells. The development of new scaffold materials may offer more efficient bone regeneration. [ABSTRACT FROM AUTHOR]

Background: The utilization of regenerative techniques in periodontology involves tailoring tissue engineering principles to suit the oral cavity's unique environment. Advancements in computer-assisted technology, specifically utilizing cone beam computed tomography (CBCT), enabled the fabrication of 3D-printed scaffolds. The current review aims to explore whether 3D-printed scaffolds are effective in promoting osteogenesis in patients with periodontal defects. Methods: A thorough exploration was undertaken across seven electronic databases (PubMed, Scopus, ScienceDirect, Google Scholar, Cochrane, Web of Science, Ovid) to detect pertinent research in accordance with specified eligibility criteria, aligning with the PRISMA guidelines. Two independent reviewers undertook the screening and selection of manuscripts, executed data extraction, and evaluated the bias risk using the Newcastle–Ottawa Scale for non-randomized clinical trials and SYRCLE's risk of bias tool for animal studies. Results: Initially, 799 articles were identified, refined by removing duplicates. After evaluating 471 articles based on title and abstract, 18 studies remained for full-text assessment. Eventually, merely two manuscripts fulfilled all the eligibility criteria concerning human trials. Both studies were prospective non-randomized clinical trials. Moreover, 11 animal studies were also included. Conclusions: The use of multidimensional, 3D-printed, customized scaffolds appears to stimulate periodontal regeneration. While the reported results are encouraging, additional studies are required to identify the ideal characteristics of the 3D scaffold to be used in the regeneration of periodontal tissue. [ABSTRACT FROM AUTHOR]

The regenerative capacity of well-preserved blood clots may be enhanced by biologics like enamel matrix derivative (EMD). This retrospective analysis compares outcomes reported by three centers using different heterografts. Center 1 (C1) treated intrabony defects combining cross-linked high-molecular-weight hyaluronic acid (xHyA) with a xenograft; center 2 (C2) used EMD with an allograft combination to graft a residual pocket. Center 3 (C3) combined xHyA with the placement of a resorbable polymer membrane for defect cover. Clinical parameters, BoP reduction, and radiographically observed defect fill at 12-month examination are reported. The 12-month evaluation yielded significant improvements in PPD and CAL at each center (p < 0.001, respectively). Analyses of Covariance revealed significant improvements in all parameters, and a significantly greater CAL gain was revealed for C2 vs. C1 (p = 0.006). Radiographic defect fill presented significantly higher scores for C2 and C3 vs. C1 (p = 0.003 and = 0.014; C2 vs. C3 p = 1.00). Gingival recession increased in C1 and C3 (p = 1.00), while C2 reported no GR after 12 months (C2:C1 p = 0.002; C2:C3 p = 0.005). BoP tendency and pocket closure rate shared similar rates. Within the limitations of the study, a data comparison indicated that xHyA showed a similar capacity to enhance the regenerative response, as known for EMD. Radiographic follow-up underlined xHyA's unique role in new attachment formation. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the effectiveness of prehydrated collagenated xenogenic bone gel and a collagenated cortico‐cancellous heterologous bone mixture in conjunction with papillae tunneling techniques (PTT) for treating isolated periodontal intraosseous defects. Materials and Methods: Twenty patients with periodontitis stage III/IV and at least one deep isolated interdental 2/3‐wall intraosseous defect were included in the study. Surgical incisions were made vertically at the adjacent tooth or horizontally at the mucogingival junction. A full‐thickness flap was then carefully lifted under the papillae using special tunneling instruments. The root surfaces were completely cleaned, and the defects were randomly filled with either prehydrated collagenated bone gel (test group; n = 10) or collagenated cortico‐cancellous heterologous bone mixture (control group; n = 10). Wounds were closed with microsurgical sutures. We predicted that the lower 95% confidence interval for the difference between the two procedures would exceed a prespecified noninferiority threshold. Results: All wounds closed sufficiently to prevent biomaterial exposure. The test and control groups showed similar mean pocket depth reduction (3.5 ± 1.0 vs. 3.9 ± 1.7 mm; p = 0.52), similar gingival recession (−0.10 ± 0.99 vs. 0.2 ± 0.8 mm; p = 0.46), and similar clinical attachment gain (3.6 ± 1.51 vs. 3.7 ± 1.8 mm; p = 0.89) at the 12‐month follow‐up. All results were below the noninferiority margin of the sample. Conclusions: At 12 months, prehydrated collagenous bone gel performed similarly to collagenous heterologous bone granules in the treatment of intraosseous lesions with PTT. In addition, both biomaterials preserved soft tissue with minimal further recession at 1 year. Clinical Relevance: When combined with PTT, collagenous xenogeneic bone granules and prehydrated collagenous bone gel achieve comparable clinical outcomes in intrabony defects. The study was registered under the NCT 04782921 on ClinicalTrails. [ABSTRACT FROM AUTHOR]

This article provides a comprehensive overview of the impact of periodontal regenerative therapies on orthodontic tooth movement (OTM) in patients with intrabony defects caused by advanced periodontitis. It discusses different regenerative technologies and their effectiveness in regenerating lost periodontal tissues. The article also explores preclinical studies on tooth movement and regenerated defects, highlighting the need for further research in this area. It emphasizes the influence of different graft materials and timing on OTM and regenerative surgery, and the importance of material selection in achieving successful outcomes in orthodontics and periodontal health. Additionally, the document is a list of references to various scientific studies related to tooth movement and bone regeneration, providing insights into the relationship between orthodontics and bone regeneration. [Extracted from the article]

Background and Objectives: The current study aimed to compare the extent of bone growth achieved after guided tissue regeneration (GTR) based on the location and nature of the initial periodontal lesion. Materials and Methods: The study sample included 80 patients who underwent GTR at Kyungpook National University Dental Hospital since 2012 and were radiologically followed up for at least 2 years after treatment. The patients were divided into four groups based on the location (maxilla and mandible) and nature (furcation involvement and intrabony defects) of the lesion. Differences in bone levels before and after treatment were analyzed. Additionally, a comparison of outcomes based on the type of bone graft material used was conducted. Statistical analysis included a comparison of groups using a t-test, assuming equal variance. Results: The proportion of bone growth observed in the maxillary furcation, mandibular furcation, maxillary intrabony, and mandibular intrabony lesions was 26%, 22%, 31%, and 34%, respectively. No statistically significant differences in the amount of bone fill were observed between the groups. However, a significant positive correlation was found between the initial depth of the bone defect and the amount of bone fill observed after treatment. Conclusions: Contrary to previous evidence, the current study observed no significant differences in the amount of bone fill after GTR based on the location and nature of the lesion. Furthermore, the amount of bone regenerated was directly proportional to the initial depth of the alveolar bone defect. [ABSTRACT FROM AUTHOR]

Bone grafts are commonly used to treat periodontal bone abnormalities. Studies indicate that using graft materials in directed tissue regeneration is effective. However, treating deep and extensive bony defects can result in a large area that lacks blood flow from the periodontal ligament or alveolar bone. This poses a risk of wound failure when an incision of the defect-associated papilla is performed. (17) Bianchi and Basetti developed a new surgical technique called the "Whale's Tail" to address this issue. This approach can effectively regenerate broad intrabony defects in the esthetic zone while preserving interdental tissues over grafting material. The proposed procedure entails the elevation of a sizeable flap from the buccal to the palatal side, thereby providing an unobstructed view and access to the intrabony defect in question. (8) [ABSTRACT FROM AUTHOR]

Aim: β-Tricalcium phosphate (β-TCP) is an alloplastic bone graft material with osteoconductive and osteoinductive properties, which acts as an alternative bone graft that has been widely used in dentistry. This study aimed to review the use of β-TCP alloplastic bone grafts in several cases in the treatment of periodontal regenerative surgery. Materials and Methods: This study was conducted in PubMed, ScienceDirect, Cochrane, and EBSCOhost databases using the PICO framework based on Preferred Reporting Items for Systematic Systems and Meta-Analyses. The type of article was research articles using β-TCP alloplast bone graft material in periodontal regenerative surgery in a human alveolar bone defect in English with randomized controlled trials and clinical trials methods in the last 10 years. Data includes number, author, defect criteria, study group, follow-up, parameters and results, and conclusions. Results: Ten articles were included based on eligibility criteria, consisting of nine articles using β-TCP in the treatment of periodontal defects, that are five articles on intrabony defects, two articles on infrabony defects, an article in localized periodontal defects, and an article on involvement furcation grade II. Then, another article used β-TCP for alveolar ridge preservation. The results showed eight articles had statistically significant results in clinical parameters (reducing clinical attachment level (CAL) and Periodontal Pocket Depth (PPD), and radiographic parameters at certain times compared with baseline, and two articles showed no significant results between the β-TCP alone and the β-TCP with additional biomaterials or other bone graft materials. Conclusions: β-TCP as an alloplastic bone graft improved clinical and radiographic parameters in regenerative periodontal surgery, especially in intrabony defects, infrabony defects, localized periodontal defects, grade II furcation, and alveolar ridge preservations. [ABSTRACT FROM AUTHOR]

Patients with periodontitis often require an inter‐disciplinary approach, including orthodontic treatment, for effective rehabilitation of masticatory function, aesthetics and quality of life. The aim of this narrative review was to comprehensively discuss literature focusing on the biology, indications and inter‐disciplinary connections related to the orthodontic approach in patients with periodontitis and to present clinical concepts in accordance with valid guidelines. The outcomes of the experimental studies indicate that orthodontic tooth movement (OTM) can be performed safely for teeth with reduced periodontium, provided infection and inflammation are controlled. Orthodontic treatment can correct pathological tooth migration, is not associated with deterioration of clinical periodontal parameters and improves aesthetics. Intrusion is safe when performed with light forces and under a strict oral hygiene regimen. Teeth can be moved either towards or away from the intrabony defect previously subjected to regenerative procedures, and research suggests that OTM has the potential to enhance bone formation after regenerative therapy. The data on orthodontic movement of teeth with furcation involvement are very scarce. The improvement in furcation involvement following either combined periodontal and orthodontic treatment was only documented in animal model studies. Due to bone and tooth loss, special consideration should be given to orthodontic treatment mechanics. © 2023 Australian Dental Association. [ABSTRACT FROM AUTHOR]

Traumatic bone defects (TBDs), although rare in children, are severe injuries that often represents a challenge for both orthopaedic and trauma surgeons. We present a case of a 6-year-old girl who sustained an open (Gustilo-Anderson type II) comminuted tibia fracture including a ± 5.0 cm distal tibial TBD following a road traffic accident. Open reduction and internal fixation with a 3.5 Locking Compression Plate (LCP) without additional bone grafting was performed, followed by cast immobilization for four months. One and a half years after reconstruction, the patient regained pain-free activity including full-range of motion of her leg and radiographs showed good tibial and fibular alignment, the presence of fracture consolidation and sufficient filling of the TBD. This case report aims to show first evidence of the safety and efficacy of single LCP plating followed by cast immobilization applied in a paediatric patient with a large tibial TBD.

Background and Objectives: Due to their specific morphology, the regeneration of intrabony defects (IBDs) represents one of the greatest challenges for clinicians. Based on the specific properties of a magnesium membrane, a new approach for the surgical treatment of IBD was developed. The surgical procedure was described using a series of three cases. Materials and Methods: The patients were healthy individuals suffering from a severe form of periodontitis associated with IBD. Based on radiographic examination, the patients had interproximal bone loss of at least 4 mm. Due to its good mechanical properties, it was easy to cut and shape the magnesium membrane into three different shapes to treat the specific morphology of each IBD. In accordance with the principles of guided bone regeneration, a bovine xenograft was used to fill the IBD in all cases. Results: After a healing period of 4 to 6 months, successful bone regeneration was confirmed using radiological analysis. The periodontal probing depth (PPD) after healing showed a reduction of 1.66 ± 0.29 mm. Conclusions: Overall, the use of the different shapes of the magnesium membrane in the treatment of IBD resulted in a satisfactory functional and esthetic outcome. [ABSTRACT FROM AUTHOR]

Large bone defects due to trauma, infections, and tumors are difficult to heal spontaneously by the body's repair mechanisms and have become a major hindrance to people's daily lives and economic development. However, autologous and allogeneic bone grafts, with their lack of donors, more invasive surgery, immune rejection, and potential viral transmission, hinder the development of bone repair. Hydrogel tissue bioengineered scaffolds have gained widespread attention in the field of bone repair due to their good biocompatibility and three-dimensional network structure that facilitates cell adhesion and proliferation. In addition, loading natural products with nanoparticles and incorporating them into hydrogel tissue bioengineered scaffolds is one of the most effective strategies to promote bone repair due to the good bioactivity and limitations of natural products. Therefore, this paper presents a brief review of the application of hydrogels with different gel-forming properties, hydrogels with different matrices, and nanoparticle-loaded natural products loaded and incorporated into hydrogels for bone defect repair in recent years. [ABSTRACT FROM AUTHOR]

Guided bone regeneration (GBR) at peri‐implantitis‐related bone defects involves the placement of bone‐filler particles in the intrabony defects and the application of a barrier membrane. The efficacy of different GBR‐supported reconstructive measures as well as their potential superiority compared to non‐GBR‐supported treatment strategies for bone defects at peri‐implantitis sites, however, remains unclear. Therefore, this analysis was designed to evaluate the long‐term (≥12 months) clinical efficacy of GBR‐supported reconstructive surgical therapy for peri‐implantitis‐related bone defects. In terms of resolving inflammation, the implementation of GBR protocols applying xenogenic bone substitutes yielded a higher reduction of bleeding on probing and probing depth value compared to the GBR protocol applying autogenous bone. Furthermore, for the changes in bleeding on probing and probing depths, GBR approaches using xenogenic bone showed superiority over the non‐GBR treatments. Xenogenic bone with or without a barrier membrane was associated with improved radiographic bone levels and less soft tissue recession compared to the use of a GBR protocol implementing autogenous bone. Nonetheless, when interpreting this findings, the limited number of available studies with low to serious risk of bias and the short follow‐up periods limited to 12 months should be considered. [ABSTRACT FROM AUTHOR]

Objectives: The current research was conducted to evaluate the use of a diode laser and a bone graft (hydroxyapatite [HA] + β‑tricalcium phosphate [β‑TCP]) in healing of intrabony defects. Materials and Methods: In this split‑mouth evaluation, 40 patients with bilateral intrabony defects were treated with, Group I (control) ‑ bone graft alone (HA + β‑TCP) and Group II, (test) ‑ bone graft with a diode laser. The clinical and radiologic parameters of all patients, such as plaque index (PI), probing depth (PD), gingival index (GI), gingival recession (GR), and relative clinical attachment level (RCAL) were recorded at baseline, after 3 months and after 6 months. Results: Reductions in PI, PD, GI, GR, and RCAL were found after 6 months. Furthermore, significant differences were displayed in the intra‑group comparison while those of the inter‑group evaluation (P > 0.05) were insignificant. Conclusion: In both groups, considerable decrease in intrabony pockets was discovered; however, the inter‑group comparison was insignificant in relation to GR and RCAL. [ABSTRACT FROM AUTHOR]

Bone defects caused by trauma, tumors, congenital malformation, or inflammation are very common in orthopedics. In recent years, mimicking the composition and structure of natural bone tissue has become a hot topic in biomaterial research, with the aim of developing an ideal biomaterial for bone defect transplantation. Here, the feasibility of a biphasic calcium phosphate (BCP)/acylated methacrylate gelatin (GelMA) composite hydrogel to repair bone defects was evaluated in vitro and in rats. The biocompatibility of a biphasic calcium phosphate (BCP)/acylated methacrylate gelatin (GelMA) composite hydrogel was evaluated by cytoskeleton staining, live/dead cell staining and cell proliferation assays. The in vitro osteogenic activities of the composite hydrogel were evaluated by alkaline phosphatase and alizarin red staining, as well as osteogenic gene expression analysis at both transcript and protein levels. The in vivo bone repair activities were evaluated using the rat skull defect model. The BCP/GelMA composite hydrogel displayed excellent biocompatibility and promoted osteogenesis of bone marrow mesenchymal stem cells in vitro. In addition, the BCP/GelMA composite hydrogel markedly promoted new bone formation in the rat skull-defect model. BCP/GelMA composite hydrogel may be an effective artificial material for bone tissue engineering. [ABSTRACT FROM AUTHOR]

Much has been published on the socket-shield technique since its introduction to implant dentistry in 2010. The literature reports the technique to be a viable treatment option. Investigations should hence focus on improving the treatment, identifying pitfalls, and better educating clinicians. The technique has been advised as contraindicated at tooth roots with periodontal defects. The present case report aims to illustrate the additional risk and why intrabony periodontal defects may be a contraindication to this already challenging treatment. (Int J Esthet Dent 2023;18:266-276) [ABSTRACT FROM AUTHOR]

Ankle arthrodesis is a commonly used salvage procedure in the management of post-traumatic ankle fractures, which often result in severe disability and may require the amputation of the distal third of the leg. Successful ankle arthrodesis relies on a thorough assessment of local and systemic risk factors to ensure optimal results. Failure to accurately assess these factors may lead to unsatisfactory results. High-energy trauma causing bone defects and soft tissue necrosis often results in osteomyelitis, a condition that poses a significant threat to the success of the arthrodesis procedure. It is important to apply a standardised surgical protocol to minimise the possibility of superficial and deep infection and limit damage to the neighbouring soft tissues. Therefore, it is critical to undertake surgical lavage and debridement and administer systemic and local antibiotic therapy, along with the use of a spacer, to eradicate infection prior to performing arthrodesis. In this study, we present our experience in the recovery of limbs with post-traumatic complications via tibio-astragalic or tibio-calcaneal arthrodesis using a retrograde intramedullary nail technique. The approach involves a multi-step procedure using a previous antibiotic spacer implant and an autologous bone graft (RIA). This study spanned a period from January 2014 to December 2021 and included 35 patients (12 women and 23 men) with a mean age of 47.8 ± 20.08 years (range: 22–85 years). Among the patients, 18 had osteomyelitis following AO 43 C3 fractures, and 9 of them had previous exposure and bone loss at the time of injury. The remaining cases included 10 patients with AO 44 C fracture outcomes and 7 patients with AO 44 B fracture outcomes. Our results emphasise the importance of the meticulous management of local and systemic risk factors in ankle arthrodesis procedures. The successful eradication of infection and subsequent arthrodesis can be achieved via the implementation of surgical lavage, debridement, and systemic and local antibiotic therapy using spacers. This surgical protocol implemented by us has yielded excellent results, saving affected limbs from post-traumatic complications and avoiding the need for amputation. Our study contributes to the existing knowledge supporting the use of retrograde arthrodesis with intramedullary nails in severe cases where limb salvage is the primary goal. However, further research and long-term follow-up studies are needed to validate these results and evaluate the effectiveness of this technique in a larger patient population. [ABSTRACT FROM AUTHOR]

Objectives: To assess the function of platelet-rich plasma (PRP) both only and in combination with bioactive glass in intrabony defects. Materials and Method: Twenty patients were split into two groups with 10 samples each: group I with PRP alone, whereas group II was done with PRP in addition to bioactive glass. Following local anesthesia, full-thickness mucoperiosteal flaps were elevated in the afflicted site, the defect was debrided, and root planning with curettes was performed. Irrigation was then used while in group II- PRP along with bone graft (BG) preservationwas done. Suturing in group I was contained. At day 0 (baseline) and 6 months after surgery, the clinical parameters for probing depth, clinical attachment stage, and radiographic assessment were noted for both groups. Result: When comparing both groups, there was no statistically considerable variation. However, the intragroup comparison for pocket depth and clinical attachment level between baseline and 6 months was significant. Radiographic bone level was not considerably dissimilar across groups; however, it was significantly different between groups. Conclusion: Reduced probing depth, higher clinical attachment level, and radiographic evidence of bone fill are clinical outcome measures that are associated with effective regenerative therapy. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate temperature changes in titanium and ceramic implants after using a 445-nm diode laser under different in vitro conditions. Titanium (Ti) and ceramic (Zr) dental implants were placed into a bone analog, and an intrabony defect was created at each implant. A 445-nm diode laser was used to irradiate the defects for 30 seconds, noncontact, at 2 W in continuous wave (c.w.) and pulsed mode. The experiment was done at room temperature (21.0 ± 1°C) and in a water bath (37.0 ± 1°C). Two thermocouple probes were used to record real-time temperature changes (°C) at the coronal part of the implant (Tc) and the apex (Ta). The temperature was recorded at time 0 (To) and after 30 seconds of irradiation (Tf). The average temperature change was calculated, and a descriptive analysis was conducted (P <.05). The Ti implant resulted in the highest ΔT values coronally (29.6°C) and apically (6.7°C) using continuous wave at 21°C. The Zr implant increased to 26.4°C coronally and 5.2°C apically. In the water bath, the coronal portion of the Ti and Zr implants rose to 14.2°C and 14.01°C, respectively, using continuous waves. The ΔT values for Ti were 11.9°C coronally and 1.7°C apically when placed in a water bath using pulsed mode. The lowest ΔT occurred on the Zr implant with ΔTc and ΔTa of 4.8°C and 0.78°C, respectively. Under in vitro conditions, the 445-nm diode laser in pulsed mode seems to be safe for use on ceramic implants and should be used with caution on titanium implants. [ABSTRACT FROM AUTHOR]

It is challenging to regenerate periodontal tissues fully. We have previously reported a heparan sulfate variant with enhanced affinity for bone morphogenetic protein-2, termed HS3, that enhanced periodontal tissue regeneration in a rodent model. Here we seek to transition this work closer to the clinic and investigate the efficacy of the combination HS3 collagen device in a non-human primate (NHP) periodontitis model. Wire-induced periodontitis was generated in ten Macaca fascicularis, and defects were treated with Emdogain or collagen (CollaPlug) loaded with (1) distilled water, (2) HS low (36 µg of HS3), or (3) HS high (180 µg of HS3) for 3 months. At the endpoint, microscopic assessment showed significantly less epithelial down-growth, greater alveolar bone filling, and enhanced cementum and periodontal ligament regeneration following treatment with the HS-collagen combination devices. When evaluated using a periodontal regeneration assessment score (PRAS) on a scale of 0–16, collagen scored 6.78 (± 2.64), Emdogain scored 10.50 (± 1.73) and HS low scored 10.40 (± 1.82). Notably, treatment with HS high scored 12.27 (± 2.20), while healthy control scored 14.80 (± 1.15). This study highlights the efficacy of an HS-collagen device for periodontal regeneration in a clinically relevant NHP periodontitis model and warrants its application in clinical trials. [ABSTRACT FROM AUTHOR]

Objectives. This umbrella review aimed to consolidate the best available evidence regarding the clinical efficacy of platelet derivatives in the treatment of periodontal defects associated with periodontitis and in the management of mucogingival deformities. Materials and Methods. The "umbrella review" strategy was used to identify systematic reviews and meta-analyses. The search was performed without language restrictions and updated at the end of February 2023. The PubMed and Scopus databases, together with gray literature, were included in the search. Results. The search yielded 412 studies. Subsequently, 12 articles were selected for further examination based on relevance. Finally, eight systematic reviews and meta-analyses were assessed. Regarding intrabony defects, in terms of clinical attachment level (CAL) gain, platelet-rich fibrin (PRF) was observed to lead to a statistically significant attachment gain compared to surgical therapy alone. PRF was also found to show greater CAL gain compared to platelet-rich plasma (PRP) and other biomaterials. The parameter probing depth decreased significantly when PRF was used compared to surgical therapy alone (P < 0.05). Similar results were seen when leukocyte- and platelet-rich fibrin (L-PRF) was applied. In terms of radiographic bone fill, both PRF and PRP showed significantly greater bone fill compared to surgical therapy. Regarding the results of periodontal plastic surgery, PRF favored a slight root coverage compared to the coronally displaced flap. This result depended on the number of PRF and L-PRF membranes used, but Emdogain or connective tissue graft produced better results regardless. However, an improvement in the healing of periodontal tissues was reported. Conclusions. Therapies with platelet derivatives applied to intrabony defects provided superior regenerative results compared to monotherapies, except in the case of root coverage. [ABSTRACT FROM AUTHOR]

Aim: The current randomized controlled clinical trial assessed the effect of injectable platelet-rich fibrin (I-PRF) combined with demineralized freeze-dried bone allograft (DFDBA) compared to DFDBA alone in the management of intrabony defects of stage-III periodontitis patients. Methodology: Following sample size calculation, twenty stage-III periodontitis patients with ≥ 5 mm clinical attachment level (CAL)-loss and ≥ 3 mm intrabony defects were randomized into test (I-PRF + DFDBA; n = 10) and control (DFDBA; n = 10) groups. CAL (primary outcome), periodontal probing depth (PPD), gingival recession depth (GRD), full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), radiographic linear defect depth (RLDD), and bone fill (secondary outcomes) were examined at baseline, 3, 6, and 9 months post-surgically. Results: I-PRF + DFDBA and DFDBA independently demonstrated significant intragroup CAL-gain, PPD-, and RLDD-reduction at 3, 6, and 9 months (p < 0.05), with no significant intergroup differences observed (p > 0.05). CAL-gain (mean ± SD) of 2.40 ± 0.70 mm and 2.50 ± 0.85 mm and PPD-reduction of 3.50 ± 1.18 mm and 2.80 ± 0.42 mm were demonstrated for I-PRF + DFDBA and DFDBA at 9 months respectively. Both groups showed significant intragroup RLDD improvement, with a RLDD of 3.58 ± 0.66 mm and 3.89 ± 1.57 mm for I-PRF + DFDBA and DFDBA at 9 months respectively. Stepwise linear regression analysis revealed that baseline RLDD and bone fill at 9 months were significant predictors of CAL (p < 0.05). Conclusion: Within the present study's limitations, DFDBA with or without I-PRF resulted in significant improvement in clinical and radiographic periodontal parameters in the surgical treatment of periodontal intrabony defects of stage-III periodontitis patients. Addition of I-PRF to DFDBA does not appear to significantly enhance the DFDBA's reparative/regenerative outcomes. Clinical relevance: Within the current study's limitations, routinely adding I-PRF to DFDBA cannot be recommended to significantly improve DFDBA's treatment outcomes in intrabony defects. [ABSTRACT FROM AUTHOR]

In stage IV periodontitis patients with pathologic tooth migration (PTM), interdisciplinary treatment includes regenerative periodontal surgery (RPS) with an application of biomaterials and orthodontic therapy (OT) to restore function, esthetics and thereby quality of life (QoL). In a 24-month randomized trial we explored the synergy between regenerative medicine and biomechanical force application. The following methods were used: Forty-three patients had been randomized to a combined treatment comprising RPS and subsequent OT starting either 4 weeks (early OT) or 6 months (late OT) post-operatively. Clinical periodontal parameters and oral health-related QoL (GOHAI) were recorded up to 24 months. We obtained the following results: Mean clinical attachment gain (∆CAL ± SD) was significantly higher with early OT (5.96 ± 2.1 mm) versus late OT (4.65 ± 1.76 mm) (p = 0.034). Pocket closure (PPD ≤ 4 mm) was obtained in 91% of defects with early OT compared to 90% with late OT. GOHAI-scores decreased significantly from 26.1 ± 7.5 to 9.6 ± 4.7 (early OT) and 25.1 ± 7.1 to 12.7 ± 5.6 (late OT). Inconclusion, teeth severely compromised by intrabony defects and PTM can be treated successfully by RPS followed by early OT with the advantage of an overall reduced treatment time. As a result of the combined periodontal-orthodontic therapy, the oral health-related QoL of patients was significantly improved. Early stimulation of wound healing with orthodontic forces had a favorable impact on the outcomes of regenerative periodontal surgery. [ABSTRACT FROM AUTHOR]