Long-term outcome following regenerative periodontal treatment of intrabony defects

Abstract

This study aimed to evaluate the long-term outcome of the regenerative periodontal therapy of an intrabony defect in terms of tooth survival and clinical attachment level (CAL) stability. The association between failure and patient as well as tooth variables was assessed. Treatment records of the patients who received regenerative surgery and re-evaluation at 1-year post-surgery were screened. Patient and tooth variables, defect characteristics, and types of treatments were collected. Periodontal parameters were retrieved before regenerative surgery (baseline), 1-year post-surgery, and every visits of supportive periodontal treatment (SPT) until failure, including tooth loss or CAL loss ≥2 mm was found. In this study, treatment records from 89 patients were included. These patients continued SPT from 0.5-11.16 years. Of these patients, 92.1 % survived from tooth loss, while 61.8 % survived from CAL loss ≥2 mm compared to 1-year post-surgery. At the sites with residual pocket depth <5 mm, patients attending SPT >80 % had a significantly less percentage of teeth with CAL loss ≥2 mm compared to 1-year post-surgery than those attending SPT <80 %. However, at the sites with residual pocket depth ≥5 mm, no significant difference in the percentage of teeth with CAL loss ≥2 mm was found between patients attending SPT >80 % or <80 %. Smoking, patient's compliance, and residual pocket depth after regenerative surgery were significantly associated with tooth loss. However, these factors were not significantly associated with CAL loss compared to baseline or 1-year post-surgery.

Application of PRP (platelet-rich plasma) in surgical periodontal therapy: overview

“…The isolated growth factors immediately bind to the outer surface of the cell membranes of graft cells or flap cells, by means of the so-called transmembrane receptors. They, in turn, have a role to activate an endogenous intrinsic signaling protein that induces the expression of a gene stimulus on cells, which is expressed in: cell proliferation, extracellular matrix formation, osteoid production and collagen synthesis [23][24][25].…”

“…The main components of platelet-rich plasma are: growth factors, leukocytes, phagocytes, native fibrinogen, vasoactive and chemotactic agents, as well as a high concentration of platelets [6,25].…”

Composite outcome measure (COM) and pocket closure as clinical endpoints following treatment of infra bony defects with Guided tissue regeneration and Open flap debridement

“…After a periodontal regenerative therapy, outcome assessment is usually based on single probing measurements such as CAL, PPD, or probing bone level. [ 14 15 ] Among these, CAL is considered the “gold standard” as there is a link between continuous CAL loss and tooth loss in the long term. [ 16 ] Similarly, shallow probing depths without bleeding are also considered a successful clinical outcome of periodontal therapy.…”