Optimal management of intrabony defects: current insights

Abstract

Periodontitis is the most common condition, which causes bony defects. Intrabony defects thought not as common as the horizontal bone loss pose a risk of disease progression and thus should be managed optimally; however, it does not mean all the intrabony defects can be treated and all the mobile teeth saved! But, with the advent of new biomaterials prognosis of teeth can be improved. The objective of this article is to discuss old and new concepts toward the optimal management of intrabony defects.

PRP and PRF—Subgroups and Divisions When Used in Dentistry

“…The starting point in the treatment of periodontitis is the motivation for oral hygiene and non-surgical therapy [28,57]. First-line therapy is an elimination treatment, e.g., scaling and root planning (SRP) [28,58,60]. However, this has some limitation, e.g., does not remove pathogens from deep intraosseous defects, which can lead to the spread of infection; it can excessively remove tooth tissue; it can cause the formation of a smear layer that hinders periodontal regeneration; and it makes it difficult to access anatomical features, such as root concavities and furcations [58,61,62].…”

“…Regenerative therapies, such as enamel matrix derivative product application, guided tissue regeneration, bone grafting or biomolecular techniques, are also used [57,63,64]. For this purpose, many different materials are used, including demineralized freeze-dried bone allografts (DFDBA), autogenic bone, alloplastic materials or xenogenic materials, such as anorganic bovine bone mineral (ABBM), which is a material that is produced by removing organic components from cortical or spongy bovine bone [54,57,60]. Their goal is to obtain a new periodontal connection with new cement, periodontal ligament and alveolar bone.…”

“…Their goal is to obtain a new periodontal connection with new cement, periodontal ligament and alveolar bone. Regrettably, these solutions do not fully restore the complex periodontal structure, which includes alveolar bone, periodontal ligament tissue (PDL) and cementum [57,60].…”

“…The usefulness of autologous PRF in the treatment of defects inside human bones was investigated in several experiments [54,60,65,68]. In one of them, conducted by Sezgin et al [68], for the test group, PRF was mixed with ABBM granules, the mixture was added to the defect and another portion of PRF was used to cover the defect.…”

“…The results of studies on the improvement of periodontal regeneration after the addition of biomaterials are contradictory. Some of them [54,69] suggest that regeneration using autologous platelet concentrates is more effective than using graft materials alone because graft materials can act as an osteoconductive scaffold [54,60,65], while bioactive materials can induce periodontal tissue formation [62,70], whereas some of the research [68,71,72] does not show any significant improvement in the therapy of intrabony defects with the use of biomaterials compared to the therapy with scaffold materials alone.…”