Treatment of a periodontal intrabony pocket in man by a mucoperiostal free graft combined with a calcium phosphate implant

A two-walled intrabony pocket was treated by a mucoperiostal free graft interposed between the curetted root surface and a calcium phosphate implant. The eighteen months follow up radiography showed complete healing of the bone defect, a normal periodontal ligament space, an uninterrupted lamina dura and a well-formed septum. The use of a mucoperiostal free graft may supply the wounded area with different cells such as fibroblasts, indifferenciated mesenchymal cells, periostal cells, intercelular fibers and biochemical substances such as glucoaminoglycans, proteoglycans etc...Une poche parodontale à trois murs a été traitée par l’interposition d’un greffon mucoperiosté entre la surface radiculaire surfacée et un implant de phosphate de calcium. A dix-huit mois, la radiographie de contrôle a montré un comblement total du défaut osseux, un espace ligamentaire normal, une lamina dura continue et un septum interdentaire bien formé. Il est possible que le greffon mucopériosté agisse comme un réservoir de cellules (fibroblastes, cellules mésenchymateuses indifférenciées, cellules périostées), de fibres intercellulaires et de substances biochimiques (glycoaminoglycanes, protéoglycanes etc...)

Clinical study of effectiveness of an anorganic bone matrix and cell-binding peptide (ABM/P-15), PepGen-P15®: application in advanced periodontal lesions of dogs

Os mecanismos biológicos desenvolvidos para aumentar a qualidade da regeneração óssea e da reparação tecidual de sítios periodontais específicos continuam a ser um desafio e têm sido complementado pela capacidade de adesão celular do colágeno do tipo I, promovida por um peptídeo sintético de adesão celular (P-15), associado a uma matriz inorgânica de osso (MIO) para formar MIO/P-15. O objetivo deste estudo foi avaliar a perda do nível clínico de inserção e a resposta da bolsa periodontal em dentes após 3 e 6 meses da aplicação de enxerto com MIO/P-15. Vinte e um cães do Hospital Veterinário da Universidade de São Paulo foram anestesiados para realização de tratamento periodontal e 132 faces dentais com perda de nível clínico de inserção foram tratadas, sendo que 36,4% (48 faces) receberam o peptídeo de adesão celular e 63,6% (84 faces) compuseram o grupo controle que recebeu tratamento convencional (retalho muco-gengival e aplainamento radicular). O procedimento foi documentado através de radiografia intra-oral e todas as sondagens de bolsas periodontais foram fotografadas. Depois de 3 e de 6 meses, os animais foram re-anestesiados a fim de se obter novas avaliações, radiografias, fotografias e sondagens periodontais. As 48 faces com perda de nível clínico de inserção que receberam material de enxertia apresentaram taxa de 40% de recuperação do nível clínico de inserção após 6 meses. O grupo controle de faces dentais não apresentou alteração do nível clínico de inserção. A face palatina foi a que apresentou melhor taxa de regeneração (40%) e os dentes caninos e molares mostraram as melhores respostas (57,14% e 65%, respectivamente). Não houve sinais de infecção pós-cirúrgica relacionadas à falta de higienização oral dos animais. Pode-se concluir que o MIO/P-15 auxilia na regeneração e re-aderência das estruturas periodontais, incluindo osso alveolar. Sua aplicação mostrou-se fácil e prática e a incidência de complicações pós-cirúrgicas foi baixa. Ainda assim, mais estudos e pesquisas são necessários para que se avalie a quantidade e a qualidade do osso e do ligamento periodontal formados.The development of biologic modalities designed to enhance bone regeneration and wound healing of specific periodontal sites continues to be a challenge and has been accomplished through the cell binding activity of Type-I collagen. These have been provided by a synthetic cell biding peptide (P-15), associated to a anorganic bone matrix (ABM) to form ABM/P-15. The aim of this study was to evaluate the attachment loss and periodontal pocket response in teeth after 3 and 6 months with ABM/P-15 graft application. Twenty one dogs from the Veterinary Hospital, University of São Paulo, were anesthetized in order to accomplish periodontal treatment and 132 teeth faces with attachment loss were treated. From these, 36.4% (48 faces) received cell binding peptide and 63.6% (84 faces) compounded the control group that received conventional treatment (muco-gingival flap and root planning). The procedure was documented by intra-oral radiography and all periodontal probings were photographed. After 3 and 6 months, the animals were re-anesthetized in order to accomplish new photography, radiography and periodontal probing exams. The 48 attachment loss faces that received graft material exhibited 40% of regeneration rate after 6 months. The control faces did not change their attachment level. The palatal face presented the better regeneration rates (40%) and the canines and molars teeth showed the better responses (57.14% and 65%, respectively). There was no post-surgical infection related to absence of oral home care. It can be concluded that ABM/P-15 helps a more rapidly periodontal structure re-attachment and regeneration, including alveolar bone. Its application was easy and practical, and the post-surgical complications incidence was low. Nevertheless, more work is necessary to evaluate the amount and the quality of formed bone and periodontal ligament

Behaviour of adenylic and pyridinic compounds in gingival tissue after a short-term exposure to air

Biochemical variations of adenine and pyridine compounds in human gingival grafts during the period between excision and implantation have been studied. These groups of compounds are considered as «indicators» of the metabolic and energetic status of the living cells. Adenylic compounds such as ATP, ADP and AMP are involved in numerous metabolic processes as «modulators» of allosteric enzymes.NAD+ and NADP+ are involved in the carbohydrate metabolism as co-factors of many reactions of oxydoreduction. The exposure to air of the gingival tissue induces modifications in the energy state of the cells as well as in the ox-reox system. No variation is detectable in the intermediates of the pyridine compounds cycle.Dans des gencives humaines prélevées pour des greffes, ont été étudiées, à certains intervalles de temps entre le prélèvement et la greffe, les variations biochimiques des composés adényliques et pyridiniques, qui sont les «indicateurs» des conditions énergétiques et métaboliques du tissu. Des composés comme l’ATP, l’ADP et l’AMP participent à de nombreux processus métaboliques comme «modulateurs» des enzymes allostériques. NAD+ et NADP + participent au métabolisme des carbohydrates comme co-facteurs de nombreuses réactions d’oxydoréduction. Une brève exposition de la gencive à l’air provoque des changements dans le métabolisme des cellules et du système d’oxydoréduction. Il n’y a pas de variation notable dans les composés intermédiaires du cycle pyridinique

Comparative analysis of collagen membranes for the treatment of implant dehiscence defects

Guided bone regeneration (GBR) evolved from the concept of guided tissue regeneration (GTR) and has been used for reconstructing sites with bone deficiencies associated with dental implants. For GBR, the use of absorbable collagen membranes has been increasing, but, at present, scientific information on the use of collagen membranes for GBR is limited. This study was aimed to clinically and histomorphometrically compare two collagen membranes, Bio-Gide ® and BioMend Extend TM , for the treatment of implant dehiscence defects in eight mongrel dogs. Implant dehiscence defects were surgically created in edentulous ridges, followed by the placement of three endosseous implants bilaterally in the mandible. Each implant dehiscence defect was randomly assigned to one of three treatment groups: (1) control (no membrane), (2) porcine dermis collagen barrier (Bio-Gide) or (3) bovine tendon collagen barrier (BioMend Extend). Dogs were sacrificed at 4 and 16 weeks (four dogs each) after treatment. Histomorphometric analysis included percentage linear bone fill (LF), new bone-to-implant contact (BIC) and area of new bone fill (BF). The results of the study revealed no significant differences among groups for any parameter at 4 weeks. However, at 16 weeks, more LF, BIC, and BF were noted in the membrane-treated groups than controls. BioMend Extend-treated defects demonstrated significantly greater BIC than control ( P  < 0.05) at this time point. BIC at 16 weeks was significantly greater than 4-week BIC ( P  < 0.05). Membrane exposure occurred in 9 out of 15 sites examined, resulting in significantly less LF and BIC than the sites without membrane exposure ( P  < 0.05). The results of this study indicate that: (1) GBR treatment with collagen membranes may significantly enhance bone regeneration, manifested at late stage (16 weeks) of healing; and (2) space maintenance and membrane coverage were the two most important factors affecting GBR using bioabsorbable collagen membranes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72252/1/j.1600-0501.2003.140111.x.pd

An overview of periodontal regenerative procedures for the general dental practitioner.

The complete regeneration of the periodontal tissues following periodontal disease remains an unmet challenge, and has presented clinicians with a remarkably difficult clinical challenge to solve given the extensive research in this area and our current understanding of the biology of the periodontal tissues. In particular as clinicians we look for treatments that will improve the predictability of the procedure, improve the magnitude of the effect of treatment, and perhaps most importantly in the long term would extend the indications for treatment beyond the need for single enclosed bony defects to allow for suprabony regeneration, preferably with beneficial effects on the gingival soft tissues. A rapid development in both innovative methods and products for the correction of periodontal deficiencies have been reported during the last three decades. For example, guided tissue regeneration with or without the use of bone supplements has been a well-proven treatment modality for the reconstruction of bony defects prior to the tissue engineering era. Active biomaterials have been subsequently introduced to the periodontal community with supporting dental literature suggesting that certain factors should be taken into consideration when undertaking periodontal regenerative procedures. These factors as well as a number of other translational research issues will need to be addressed, and ultimately it is vital that we do not extrapolate results from pre-clinical and animal studies without conducting extensive randomized clinical trials to substantiate outcomes from these procedures. Whatever the outcomes, the pursuit of regeneration of the periodontal tissues remains a goal worth pursuing for our patients. The aim of the review, therefore is to update clinicians on the recent advances in both materials and techniques in periodontal regenerative procedures and to highlight the importance of both patient factors and the technical aspects of regenerative procedures

Estudo de poli acidos laticos, et, complexados a hidroxiapatita ou matriz de proteina ossea : in vitro, em ratos e humanos

Orientador: Angelo Luiz CortelazzoTese (doutorado) - Universidade Estadual de Campinas, Instituto de BiologiaDoutorad

Hydroxyapatite biomaterial implanted in human periodontal defects: an histological and ultrastructural study

The purpose of the present work was to study the response of human periodontium to hydroxyapatite biomaterial particles (180-200 µm). The biomaterial was implanted in two infraosseous periodontal defects (two patients) after clearing of the granulation tissue. At two months post-surgery, biopsies were studied using light and electron microscopy. No sign of inflammation was observed, the biomaterial aggregates were surrounded either by typical fibroblasts or larger phagocytotic cells with phagocytosis vesicles containing biomaterial crystals. These intracellular crystals were noticeably smaller than the nonphagocytized ones. Some of the phagocytized crystals showed morphological signs of intracellular dissolution. The spaces between the crystals constitutive of the aggregates were filled with organic substance containing collagen fibers.Le présent travail a pour but d’étudier la réponse du parodonte humain à des particules d’hydroxyapatite de 180 à 200 µm. Le biomatériau a été implanté dans deux poches parodontales infraosseuses (deux patients) après élimination du tissu de granulation. Deux mois après l’intervention, des biopsies ont été étudiées en microscopie photonique et en microscopie électronique. Aucun signe d’inflammation n’a été décelé, les agrégats de biomatériau sont bordés soit de fibroblastes, soit de cellules phagocytaires, de taille plus importante, avec des vésicules de phagocytose renfermant des cristaux de biomatériau. Ces cristaux intracellulaires sont notablement plus petits que les cristaux non phagocytés. La morphologie de certains cristaux phagocytés traduit l’existence d’une dissolution intracellulaire. Les espaces entre les cristaux constitutifs des agrégats sont comblés par une substance organique contenant des fibres de collagène

Qualitative evaluation of the effects of professional oral hygiene instruments on prosthetic ceramic surfaces

During professional hygiene procedures, different instruments used may cause various damage to dental prostheses. Deplaquing and scaling with curettes and ultrasonic instruments may inadvertently increase the surface roughness of the material and the risk of future bacterial adhesion and/or also compromise the marginal seal of the prosthesis. Hence, the aim of this study was to assess the qualitative effects of two types of curettes and one piezoelectric instrument with a stain-less-steel tip on three types of metal-free samples. After treating the samples with different instru-mentations, they were analyzed using the scanning electron microscope and then underwent a qualitative microanalysis by using a spectroscopy machine. All the materials tested in this study have undergone significant changes of their superficial structure after instrumentation both with mechanical and manual instruments. Plastic curettes appeared to be less aggressive than the other in-struments. Disilicate samples show a significantly lower degree of surface glazing erosion com-pared to the zirconia sample with all the instruments used

Bone Modeling after Orthodontic Extrusion: A Histomorphometric Pilot Study

During osteogenesis and bone modeling, high vascularity and osteoblastic/osteoclastic cell activity have been detected. A decrease in this activity is a sign of complete bone formation and maturation. Alveolar bone maturation seems to occur within weeks and months; however, the precise timing of the alveolar bone modeling is still unknown. The aim of this clinical pilot study was to investigate the bone modeling of neo-apposed tissue during orthodontic extrusive movements, through a histomorphometric analysis of human biopsies. This study was conducted on third mandibular molars sockets, and all teeth were extracted after orthodontic extrusion between 2010 and 2014. After different stabilization timings, extractions were performed, and a specimen of neo-deposed bone was harvested from each socket for the histomorphometric analysis. Histological parameters were evaluated to identify bone quantity and quality. This study included 12 teeth extracted from 9 patients. All specimens were composed of bone tissue. Bone samples taken after 1 and 1.5 months of stabilization presented remarkable percentages of woven bone, while after 2 months, a relevant decrease was observed. Histomorphometric analysis suggested that after orthodontic extrusion, a period of stabilization of 2 months allows the neo-deposed bone to mature

Efficacy of Er:YAG laser on periodontitis as an adjunctive non‐surgical treatment: A split‐mouth randomized controlled study

Aim To evaluate the adjunctive efficacy of Er:YAG laser use with mechanical scaling and root planing (SRP ) for non‐surgical treatment of periodontitis. Materials and Methods In a randomized, single‐blinded, controlled trial, 27 patients were recruited. Using a split‐mouth design, two quadrants were randomly allocated into either a test group or a control group. The test quadrants received Er:YAG laser (ERL ; 100 mJ /pulse; 15 Hz to hard tissue and 50 mJ /pulse; 30 Hz to soft tissue) plus SRP treatment, while the control quadrants received SRP only. We evaluated periodontal indexes, including probing depth (PD ), clinical attachment level (CAL ), bleeding index (BI ), and plaque index (PLI ) at baseline, 3 months, and 6 months. Results The PD and CAL means in the ERL + SRP group were significantly lower than those in the SRP group at 3‐month follow‐up (PD : 2.98 ± 0.38 mm vs. 3.09 ± 0.35 mm; CAL : 4.51 ± 0.69 mm vs. 4.72 ± 0.67 mm) and 6‐month follow‐up (PD : 2.91 ± 0.31 mm vs. 3.02 ± 0.30 mm; CAL : 4.52 ± 0.65 mm vs. 4.72 ± 0.66 mm; p = 0.03 for both PD and CAL ). There were no significant differences in BI and PLI between two groups. Conclusions The Er:YAG laser treatment combined with conventional SRP significantly improved PD and CAL compared to SRP therapy alone; however, these differences were very small and, as a result, the adjunctive effect of Er:YAG laser is likely to be minimal clinically important