Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting

Palatal-tissue harvesting is a routinely performed procedure in periodontal and peri-implant plastic surgery. Over the years, several surgical approaches have been attempted with the aim of obtaining autogenous soft-tissue grafts while minimizing patient morbidity, which is considered the most common drawback of palatal harvesting. At the same time, treatment errors during the procedure may increase not only postoperative discomfort or pain but also the risk of developing other complications, such as injury to the greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, and inadequate graft size or quality. This chapter described treatment errors and complications of palatal harvesting techniques, together with approaches for reducing patient morbidity and accelerating donor site wound healing. The role of biologic agents, photobiomodulation therapy, local and systemic factors, and genes implicated in palatal wound healing are also discussed

Recombinant human bone morphogenetic protein 2 outcomes for maxillary sinus floor augmentation: a systematic review and metaâ analysis

AimsTo study the effect of the recombinant human bone morphogenetic protein 2 (rhBMPâ 2) on sinus volumetric and histometric changes after sinus floor augmentation compared to a conventional approach of nonâ biologic bone grafting materials.Materials and methodsAn electronic search of 4 databases (January 1990â February 2015), including PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Central, and a hand search of peerâ reviewed journals for relevant articles were performed. Human clinical trials with data on comparison of sinus volumetric and/or histometric outcomes with and without the use of rhBMPâ 2 in sinus grafting procedures, with â ¥10 augmentation sites in each study group, and with a followâ up period of at least 6 months, were included. Randomâ effects metaâ analyses were performed to analyze weighted mean difference (WMD) and confidence interval (CI) for the recorded variables according to PRISMA guidelines.ResultsSix randomized controlled trials (RCTs) were included. The results of the metaâ analyses showed that the WMD of vertical bone height gain was â 0.14 mm (95% CI = â 1.91 to 1.62 mm, P = 0.87), the WMD of bone density was â 142.42 mg/cm3 (95% CI = â 310.62â 25.78 mg/cm3, P = 0.10), the WMD of the percentage of vital bone was â 4.59% (95% CI = â 11.73â 2.56%, P = 0.21), and the WMD of the percentage of residual bone grafting materials was â 9.90% (95% CI = â 26.38â 6.58%, P = 0.21). The comparison of implant survival rate presented an overall risk ratio of 1.00 (95% CI = 0.94â 1.07). The two approaches (conventional bone grafting compared to BMPs) demonstrated comparable effectiveness for both clinical and histomorphometric measures.ConclusionsThis systematic review revealed that the use of rhBMPâ 2 in maxillary sinus floor augmentation achieved similar clinical and histometric outcomes when compared to conventional sinus grafting procedures after a healing period of 6â 9 months. However, previous studies showed the morbidity and other patientâ reported outcomes were improved in rhBMPâ 2 approaches as compared to bone autograft procedures (both intraoral and extraoral bone harvesting because no donor site is required). Longâ term studies are required to determine the costâ benefit of sinus floor augmentation procedures for patients requiring implant reconstruction.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134457/1/clr12737.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134457/2/clr12737_am.pd

Surgical periodontal therapy with and without initial scaling and root planing in the management of chronic periodontitis: a randomized clinical trial

Aim To compare the outcomes of surgical periodontal therapy with and without initial scaling and root planing. Methods Twenty‐four patients with severe chronic periodontitis were enrolled in this pilot, randomized controlled clinical trial. Patients were equally allocated into two treatment groups: Control group was treated with scaling and root planing, re‐evaluation, followed by Modified Widman Flap surgery and test group received similar surgery without scaling and root planing. Clinical attachment level, probing depth and bleeding on probing were recorded. Standardized radiographs were analysed for linear bone change from baseline to 6 months. Wound fluid inflammatory biomarkers were also assessed. Results Both groups exhibited statistically significant improvement in clinical attachment level and probing depth at 3 and 6 months compared to baseline. A statistically significant difference in probing depth reduction was found between the two groups at 3 and 6 months in favour of the control group. No statistically significant differences in biomarkers were detected between the groups. Conclusions Combined scaling and root planing and surgery yielded greater probing depth reduction as compared to periodontal surgery without initial scaling and root planing.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107504/1/jcpe12259.pd

Comparative Histologic Analysis of Coronally Advanced Flap With and Without Collagen Membrane for Root Coverage

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142033/1/jper0779.pd

The Effect of Plateletâ Rich Plasma on the Coronally Advanced Flap Root Coverage Procedure: A Pilot Human Trial

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141653/1/jper1768.pd

Outcomes of regenerative treatment with rhPDGF‐BB and rhFGF‐2 for periodontal intra‐bony defects: a systematic review and meta‐analysis

BackgroundThe aim was to evaluate the effects of recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB) and recombinant human fibroblast growth factor‐2 (rhFGF‐2) on treating periodontal intra‐bony defects, compared to the control (carrier alone).MethodsElectronic and hand searches were performed to identify eligible studies. The weighed mean differences of linear defect fill (LDF), probing depth (PD) reduction, clinical attachment level (CAL) gain and gingival recession (GR) were calculated using random effect meta‐analysis.ResultsThe searches yielded 1018 articles, of which seven studies were included. Only one included study was considered at low risk of bias. The outcomes that reached statistical significance in comparison to carriers alone included: LDF (0.95 mm, 95% CI: 0.62–1.28 mm or 20.17%, 95% CI: 11.81–28.54%) and CAL gain (0.34 mm, 95% CI: 0.03–0.65 mm) for PDGF, and LDF (21.22%, 95% CI: 5.82–36.61%) for FGF‐2.ConclusionsWithin the limits of this review, rhPDGF‐BB demonstrated significantly more LDF and CAL gain; rhFGF‐2 resulted in significantly higher percentage of LDF.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110825/1/jcpe12354.pd

Biologicsâ based regenerative technologies for periodontal soft tissue engineering

This manuscript provides a stateâ ofâ theâ art review on the efficacy of biologics in root coverage procedures, including enamel matrix derivative, plateletâ derived growth factor, platelet concentrates, and fibroblastâ growth factorâ 2. The mechanism of action and the rationale for using biologics in periodontal plastic surgery, as well as their anticipated benefits when compared with conventional approaches are discussed. Although the clinical significance is still under investigation, preclinical data and histologic evidence demonstrate that biologicâ based techniques are able to promote periodontal regeneration coupled with the provision of tooth root coverage.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154295/1/jper10426_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154295/2/jper10426.pd

Extracellular matrixâ based scaffolding technologies for periodontal and periâ implant soft tissue regeneration

The present article focuses on the properties and indications of scaffoldâ based extracellular matrix (ECM) technologies as alternatives to autogenous soft tissue grafts for periodontal and periâ implant plastic surgical reconstruction. The different processing methods for the creation of cellâ free constructs resulting in preservation of the extracellular matrices influence the characteristics and behavior of scaffolding biomaterials. The aim of this review is to discuss the properties, clinical application, and limitations of ECMâ based scaffold technologies in periodontal and periâ implant soft tissue augmentation when used as alternatives to autogenous soft tissue grafts.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153617/1/jper10427.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153617/2/jper10427_am.pd