Rosuvastatin 1.2 mg In Situ Gel Combined With 1:1 Mixture of Autologous Platelet‐Rich Fibrin and Porous Hydroxyapatite Bone Graft in Surgical Treatment of Mandibular Class II Furcation Defects: A Randomized Clinical Control Trial

Background: A wide range of regenerative materials have been tried and tested in the treatment of furcation defects. Rosuvastatin (RSV) is a new synthetic, second‐generation, sulfur‐containing, hydrophilic statin with potent anti‐inflammatory and osseodifferentiation mechanisms of action. Platelet‐rich fibrin (PRF) is a platelet concentrate having sustained release of various growth factors with regenerative potential to treat periodontal defects. Porous hydroxyapatite (HA) bone grafting material has a clinically satisfactory response when used to fill periodontal intrabony defects. This double‐masked randomized study is designed to evaluate the potency of a combination of 1.2 mg RSV in situ gel with a 1:1 mixture of autologous PRF and HA bone graft in the surgical treatment of mandibular Class II furcation defects compared with autologous PRF and HA bone graft placed after open‐flap debridement (OFD). Methods: One hundred five mandibular furcation defects were treated with OFD + placebo gel (group 1), PRF + HA with OFD (group 2), or 1.2 mg RSV gel + PRF + HA with OFD (group 3). Clinical and radiologic parameters (i.e., probing depth [PD], relative vertical and relative horizontal clinical attachment level [rvCAL and rhCAL], intrabony defect depth, and percentage of defect fill) were recorded at baseline and 9 months postoperatively. Results: Mean PD reduction was greater in group 2 (3.68 ± 1.07 mm) and group 3 (4.62 ± 1.03 mm) than group 1 (2.11 ± 1.25 mm), and mean rvCAL and rhCAL gain were greater in group 2 (3.31 ± 0.52 and 2.97 ± 0.56 mm, respectively) and group 3 (4.17 ± 0.70 and 4.05 ± 0.76 mm) compared with group 1 (1.82 ± 0.78 and 1.62 ± 0.64 mm). A significantly greater percentage of mean bone fill was found in group 2 (54.69% ± 1.93%) and group 3 (61.94% ± 3.54%) compared with group 1 (10.09% ± 4.28%). Conclusions: Treatment of furcation defects with 1.2 mg RSV in situ gel combined with autologous PRF and porous HA bone graft results in significant improvements of clinical and radiographic parameters compared with OFD alone. These results imply that the combination of RSV, PRF, and HA has synergistic effects, explaining their role as a regenerative material in the treatment of furcation defects.     

Platelet‐Rich Fibrin With 1.2% Rosuvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Regenerative periodontal therapy encompasses use of various bioactive agents that are not only inflammomodulatory but also osteoclast‐inhibitory or, rather, osteostimulative. Hypolipidemic statin drugs, particularly rosuvastatin (RSV), are known to be associated with alveolar bone formation and periodontal improvements. Platelet analogs such as platelet‐rich fibrin (PRF), being rich sources of growth factors, have also come into widespread periodontal regenerative use. The aim of this study is to evaluate and compare efficacy of open flap debridement (OFD) with or without PRF or PRF + 1.2% RSV gel in treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). Methods: Ninety individuals with a total of 90 IBDs were randomly assigned to one of three treatment groups: 1) OFD alone; 2) OFD + PRF; and 3) OFD + PRF + 1.2% RSV gel placement. Measurements recorded at baseline and 9 months after surgery were: 1) plaque index (PI); 2) modified sulcus bleeding index (mSBI); 3) probing depth (PD); 4) clinical attachment level (CAL); and 5) IBD depth. Results: Significant PI and mSBI reductions were observed in all three groups. PRF placement significantly enhanced improvements in periodontal parameters compared with OFD alone. Addition of 1.2% RSV gel to PRF resulted in significantly greater CAL gain and PD and IBD depth reductions over 9 months compared with other groups. Conclusion: OFD with RSV (1.2%) and PRF results in significantly greater periodontal benefits compared with OFD alone or with PRF.     

Autologous Platelet‐Rich Fibrin in the Treatment of 3‐Wall Intrabony Defects in Aggressive Periodontitis: A Randomized Controlled Clinical Trial

Background: Platelet‐rich fibrin (PRF) has recently been applied in osseous regeneration. The aim of the present study is to explore the efficacy of PRF in treatment of intrabony defects (IBDs) in aggressive periodontitis. Methods: Fifty‐four IBDs in 17 patients were treated either with autologous PRF with open flap debridement (OFD) or OFD alone. Clinical and radiologic parameters such as probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect change were recorded at baseline and 9 months postoperatively. Results: Mean PD reduction and mean CAL gain were significantly greater in PRF compared with the control group. Furthermore, a significantly greater percentage of mean bone defect change was found in the PRF group. Conclusion: Within the limits of the present study, there is greater bone fill at sites treated with PRF with conventional OFD than conventional OFD alone.     

Platelet‐Rich Fibrin Combined With 1.2% Atorvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Platelet‐rich fibrin (PRF), a second‐generation platelet concentrate, and atorvastatin (ATV), a potent member of the statin group, are known to promote tissue regeneration. The current study is designed to evaluate combined efficacy of PRF and 1.2% ATV gel with open flap debridement (OFD) in treatment of intrabony defects (IBDs) in individuals with chronic periodontitis (CP). Methods: Ninety‐six individuals with single defects were categorized into three groups: 1) OFD with PRF; 2) OFD with PRF + 1.2% ATV; and 3) OFD alone. Clinical parameters: 1) site‐specific plaque index; 2) modified sulcus bleeding index; 3) probing depth (PD); 4) relative clinical attachment level (rCAL); and 5) gingival marginal level were recorded at baseline before surgery and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated at baseline and 9 months. Results: PRF + 1.2% ATV and PRF alone showed significantly greater PD reduction and rCAL gain compared with OFD alone at 9 months. Furthermore, PRF + 1.2% ATV showed a similar percentage radiographic defect depth reduction (50.96% ± 4.88%) compared with PRF alone (47.91% ± 4.79%), and a greater reduction compared with OFD alone (5.54% ± 1.71%) at 9 months. Conclusions: PRF + 1.2% ATV showed similar improvements in clinical parameters with a greater percentage radiographic defect depth reduction compared with PRF alone in treatment of IBDs in individuals with CP. Thus, 1.2% ATV failed to augment the regenerative potential of PRF alone in periodontal IBDs.     

Clinical and Radiographic Evaluation of Demineralized Freeze‐Dried Bone Allograft Versus Platelet‐Rich Fibrin for the Treatment of Periodontal Intrabony Defects in Humans

Background: A wide variety of materials have been proposed for treatment of periodontal intrabony defects (IBDs); recently, platelet‐rich fibrin (PRF) has been suggested as a grafting material. The aim of this study is to report changes in clinical attachment level (CAL) and bone fill of periodontal IBDs treated with demineralized freeze‐dried bone allograft (DFDBA) compared with PRF in humans. Methods: Thirty‐six patients completed the study protocol. Each patient contributed a single IBD, which was randomized to receive either DFDBA or PRF. Clinical and standardized radiographic data were collected at baseline and 6 months after treatment. Primary outcome measures included: 1) radiographic bone fill as measured from the cemento‐enamel junction to base of bony defect and 2) change in CAL. Results: Both treatment groups had significant gains in CAL as well as bone fill, with no significant differences in outcomes between groups. DFDBA had a mean CAL gain of 1.16 ± 1.33 mm, mean clinical bone fill of 1.53 ± 1.64 mm, and mean radiographic bone fill of 1.14 ± 0.88 mm. PRF had a mean CAL gain of 1.03 ± 0.86 mm, mean clinical bone fill of 1.35 ± 1.60 mm, and mean radiographic bone fill of 1.10 ± 1.01 mm. Conclusion: Treatment of IBDs with either DFDBA or PRF resulted in a significant gain in CAL as well as bone fill after 6 months of healing, with no significant difference between materials.     

Platelet‐Rich Fibrin With 1% Metformin for the Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Platelet‐rich fibrin (PRF) is a second‐generation platelet concentrate that releases various growth factors that promote tissue regeneration. Metformin (MF), a member of the biguanide group, has been shown to facilitate osteoblast differentiation and thus may exhibit a favorable effect on alveolar bone. The current study is designed to evaluate the efficacy of open‐flap debridement (OFD) combined with PRF, 1% MF gel, and PRF + 1% MF gel in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). Methods: One hundred twenty patients with single defects were categorized into four treatment groups: OFD alone, OFD with PRF, OFD with 1% MF, and OFD with PRF plus 1% MF. Clinical parameters such as site‐specific plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), relative attachment level (RAL), and gingival marginal level (GML) were recorded at baseline (before surgery) and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated using computer‐aided software at baseline and 9 months. Results: PRF, 1% MF, and PRF + 1% MF groups showed significantly more PD reduction and RAL gain than the OFD‐only group. Mean PD reduction and mean RAL gain were found to be greater in the PRF + 1% MF group compared to just PRF or MF at 9 months. Furthermore, PRF + 1% MF group sites showed a significantly greater percentage of radiographic defect depth reduction (52.65% ± 0.031%) compared to MF (48.69% ± 0.026%), PRF (48% ± 0.029%), and OFD alone (9.14% ± 0.04%) at 9 months. Conclusion: The PRF + 1% MF group showed greater improvements in clinical parameters, with greater percentage radiographic defect depth reduction compared to MF, PRF, or OFD alone in treatment of IBDs in patients with CP.     

Platelet‐Rich Fibrin in Regeneration of Intrabony Defects: A Randomized Controlled Trial

Background: Platelet‐rich fibrin (PRF) is an autologous non‐transfusional hemo‐component with a high concentration of platelets. It incorporates leukocytes, platelets, and growth factors within the dense fibrin matrix and can be used as healing biomaterial. This study assesses the adjunctive use of PRF in regenerative management of intrabony defects in comparison with open flap debridement (OFD). Methods: Twenty‐six bilateral defects (13 per group) in 13 patients were randomized as either PRF (test group) or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and bone PD were recorded. Reduction in defect depth and percentage of bone fill was assessed radiographically. Primary outcomes assessed were changes in PD, CAL, and percentage of bone fill, and they were assessed at 6, 9, and 12 months. Secondary outcome was assessment of wound healing using a wound healing index (WHI). Results: The PRF group showed significant improvement in clinical parameters compared with the control group at 6, 9, and 12 months. The PRF group showed a bone fill of 45.18% ± 7.57%, which was statistically significant compared with 21.6% ± 9.3% seen in the control group at the end of the study period. The PRF group also showed significant soft tissue healing and reduction in PD. WHI also showed significant advantages for the PRF group. Conclusion: The adjunctive use of PRF to conventional OFD may be potentially used in the treatment of intrabony defects.     

Comparative Evaluation of Autologous Platelet‐Rich Fibrin and Platelet‐Rich Plasma in the Treatment of 3‐Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: The topical use of platelet concentrates is recent, and its efficiency remains controversial. The present study aims to explore the clinical and radiographic effectiveness of autologous platelet‐rich fibrin (PRF) and platelet‐rich plasma (PRP) in the treatment of intrabony defects in patients with chronic periodontitis. Methods: Ninety intrabony defects were treated with either autologous PRF with open‐flap debridement or autologous PRP with open‐flap debridement or open‐flap debridement alone. Clinical and radiologic parameters, such as probing depth (PD), clinical attachment level (CAL), intrabony defect depth, and percentage defect fill, were recorded at baseline and 9 months postoperatively. Results: Mean PD reduction and CAL gain were greater in PRF (3.77 ± 1.19 and 3.17 ± 1.29 mm) and PRP (3.77 ± 1.07 and 2.93 ± 1.08 mm) groups than the control group (2.97 ± 0.93 and 2.83 ± 0.91 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (55.41% ± 11.39%) and PRP (56.85% ± 14.01%) groups compared with the control (1.56% ± 15.12%) group. Conclusions: Within the limit of the present study, there was similar PD reduction, CAL gain, and bone fill at sites treated with PRF or PRP with conventional open‐flap debridement. Because PRF is less time consuming and less technique sensitive, it may seem a better treatment option than PRP. However, long‐term, multicenter randomized, controlled clinical trials will be required to know their clinical and radiographic effects on bone regeneration.     

Synergistic Approach Using Platelet‐Rich Fibrin and 1% Alendronate for Intrabony Defect Treatment in Chronic Periodontitis: A Randomized Clinical Trial

Background: Platelet‐rich fibrin (PRF) is a reservoir of concentrated platelets that provides a pool of biologic growth‐promoting factors and cytokines, which help in mediating regeneration of lost bone and soft tissue maturation. Alendronate (ALN), a member of the amino‐bisphosphonate group, is known to enhance periodontal tissue regeneration by inhibiting osteoclast‐mediated bone resorption and promoting osteoblast‐mediated osteogenesis. The current intervention aims to assess combined effectiveness of PRF and 1% ALN with access therapy in intrabony defect (IBD) treatment in patients with chronic periodontitis (CP). Methods: Single IBDs in 90 patients were categorized into three groups: 1) group 1 had access therapy alone; 2) group 2 had access therapy with PRF; and 3) group 3 had access therapy with PRF + 1% ALN. Site‐specific plaque index, modified sulcus bleeding index, probing depth (PD), clinical attachment level (CAL), and gingival marginal level, included as parameters for clinical assessment, were evaluated before surgery at baseline and 9 months postoperatively. Percentage IBD depth reduction, assessed using radiographs, was evaluated at baseline and postoperatively. Results: Compared with groups 1 and 2, group 3 exhibited significantly greater reduction in PD and gain in CAL postoperatively. Significantly greater IBD depth reduction was shown in group 3 (54.05% ± 2.88%) compared with group 2 (46% ± 1.89%) and group 1 (7.33% ± 4.86%) postoperatively. Conclusion: Combined approach therapy of PRF + 1% ALN for IBD treatment in patients with CP showed better clinical parameter outcomes with greater IBD depth reduction compared with PRF and access therapy alone.     

INTRABONY DEFECT TREATMENT WITH PLATELET-RICH FIBRIN,GUIDED TISSUE REGENERATION AND OPEN-FLAP DEBRIDEMENT: A RANDOMIZED CONTROLLED TRIAL

ObjectiveTo comparatively assess the outcomes of the treatment of periodontal intrabony defects with platelet-rich fibrin (PRF) combined with open-flap debridement (OFD), guided tissue regeneration (GTR) or OFD alone based on clinical, radiographic, and wound healing parameters for 12 months of follow-up.Materials and MethodsNinety intrabony defects were randomly divided into 3 different groups and treated as group 1 (PRF + OFD), group 2 (GTR), or group 3 (OFD alone). Clinical parameters, including the plaque index, gingival index, bleeding on probing, probing depth (PD), clinical attachment loss (CAL), and tooth mobility were assessed at 3, 6, and 12 months. Additionally, the wound healing index was assessed at 7 and 14 days postsurgery. Radiographic parameters, including bony defect fill and alveolar crestal resorption, were measured at 6 and 12 months postsurgery and calculated using image analysis software.ResultsIntragroup comparisons showed consistently significant improvements in all the clinical and radiographic parameters in the 3 groups at 12 months postsurgery. Compared to baseline, in group 1, the PD decreased to 2.37 ± 0.56; 3.30 ± 0.84; 4.80 ± 0.71 mm, and CAL decreased to 2.23 ± 0.90; 3.33 ± 0.71; 5.00 ± 0.46 mm; in group 2, the PD decreased to 2.30 ± 0.60; 3.23 ± 0.86; 4.63 ± 0.67 mm, and CAL decreased to 2.00 ± 0.98; 3.20 ± 0.71; 4.53 ± 0.57 mm); and in group 3, the PD decreased to 1.87 ± 0.68; 2.57 ± 1.36; 3.37 ± 1.00 mm, and CAL decreased to 1.60 ± 0.93; 2.23 ± 1.22; 3.37 ± 1.22 mm at 3, 6, and 12 months postsurgery, respectively. The bone fill percentages in group 1 (26.45 ± 16.47 and 45.25 ± 5.20%), group 2 (22.20 ± 15.76 and 42.15 ± 6.39%) and group 3 (10.21 ± 6.47 and 23.13 ± 6.98%) were observed at 6 and 12 months postsurgery. The alveolar crestal resorption levels were -1.07 ± 0.52 and -1.70 ± 0.60 mm in group 1, -1.03 ± 0.72 and -1.47 ± 0.73 mm in group 2 and 0.37 ± 0.62 and 0.43 ± 0.73 mm in group 3, respectively. The percentages of sites with a WHI score of 1 were 93% and 100% in group 1, 81%, and 94% in group 2 and 45% and 71% in group 3 at 7 and 14 days postsurgery, respectively.ConclusionsCompared to GTR, PRF yielded comparable treatment outcomes and periodontal tissue healing in terms of improvements in clinical and radiographic parameters. Compared to OFD alone, PRF also significantly improved these parameters in the treatment of intrabony defects.     

Advantages of Autologous Platelet‐Rich Fibrin Membrane on Gingival Crevicular Fluid Growth Factor Levels and Periodontal Healing: A Randomized Split‐Mouth Clinical Study

Background: This study evaluates contributions of platelet‐rich fibrin (PRF) combined with conventional flap surgery on growth factor levels in gingival crevicular fluid (GCF) and periodontal healing. Methods: Twenty‐six patients (52 sites) with chronic periodontitis were treated either with autologous PRF with open flap debridement (OFD+PRF) or OFD alone. Growth factor levels in GCF at baseline and 2, 4, and 6 weeks after surgery were analyzed, and clinical parameters such as probing depth (PD), relative clinical attachment level (rCAL), and gingival margin level (GML) at baseline and 9 months after surgery were measured. Results: Mean PD reduction and rCAL gain were significantly greater in OFD+PRF sites than in OFD sites. Mean GML change was ?0.38 + 0.10 mm in OFD sites and 0.11 + 0.08 mm in the test group; difference between the two groups was statistically significant (P <0.05). Both groups demonstrated increased expression levels of fibroblast growth factor‐2, transforming growth factor‐β1, and platelet‐derived growth factor‐BB at 2 weeks compared with baseline, followed by reductions at 4 and 6 weeks. The OFD+PRF group showed significantly higher growth factor levels compared with the OFD group at 2 and 4 weeks. Conclusion: PRF membrane combined with OFD provides significantly higher GCF concentrations of angiogenic biomarkers for ≈2 to 4 weeks and better periodontal healing in terms of conventional flap sites.     

Platelet-rich fibrin and bovine porous bone mineral vs. platelet-rich fibrin in the treatment of intrabony periodontal defects

Lekovic V, Milinkovic I, Aleksic Z, Jankovic S, Stankovic P, Kenney EB, Camargo PM. Platelet‐rich fibrin and bovine porous bone mineral vs. platelet‐rich fibrin in the treatment of intrabony periodontal defects. J Periodont Res 2012; 47: 409–417. © 2011 John Wiley & Sons A/S Background and Objective: Bovine porous bone mineral (BPBM) is a xenograft that has been successfully utilized in periodontal regeneration. Platelet‐rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and therefore has the potential to be used as regenerative treatment for periodontal defects. The purpose of this study was to examine the suitability of autologous PRF as regenerative treatment for periodontal intrabony defects in humans and to examine the ability of BPBM to augment the regenerative effects exerted by PRF. Material and Methods: Using a split‐mouth design, 17 paired intrabony defects were randomly treated either with PRF or with PRF–BPBM combination. Re‐entry surgeries were performed at 6 mo. Primary study outcomes were changes in pocket depth, attachment level and defect fill. Results: Preoperative pocket depths, attachment levels and transoperative bone measurements were similar for the PRF and PRF–BPBM groups. Postsurgical measurements revealed a significantly greater reduction in pocket depth in the PRF–BPBM group (4.47 ± 0.78 mm on buccal and 4.29 ± 0.82 mm on lingual sites) when compared with the PRF group (3.35 ± 0.68 mm on buccal and 3.24 ± 0.73 mm on lingual sites). The PRF–BPBM group presented with significantly greater attachment gain (3.82 ± 0.78 mm on buccal and 3.71 ± 0.75 mm on lingual sites) than the PRF group (2.24 ± 0.73 mm on buccal and 2.12 ± 0.68 mm on lingual sites). Defect fill was also greater in the PRF–BPBM group (4.06 ± 0.87 mm on buccal and 3.94 ± 0.73 mm on lingual sites) than in the PRF group (2.21 ± 0.68 mm on buccal and 2.06 ± 0.64 mm on lingual sites). Conclusion: The results of this study indicate that PRF can improve clinical parameters associated with human intrabony periodontal defects, and BPBM has the ability to augment the effects of PRF in reducing pocket depth, improving clinical attachment levels and promoting defect fill.     

Enamel Matrix Derivative,Alone or Associated With a Synthetic Bone Substitute,in the Treatment of 1‐ to 2‐Wall Periodontal Defects

Background: In this study, we compare the effects of enamel matrix derivative (EMD) associated with a hydroxyapatite and β‐tricalcium phosphate (HA/β‐TCP) implant to EMD alone and to open‐flap debridement (OFD) when surgically treating 1‐ to 2‐wall intrabony defects. Methods: Thirty‐four patients, exhibiting ≥3 intraosseous defects in different quadrants, were each treated by OFD, EMD, or EMD + HA/β‐TCP in each defect. At baseline and 12 and 24 months, a complete clinical and radiographic examination was done. Pre‐therapy and post‐therapy clinical (probing depth [PD], clinical attachment level [CAL], and gingival recession [GR]) and radiographic (defect bone level [DBL] and radiographic bone gain [RBG]) parameters for the different treatments were compared. Results: After 12 and 24 months, almost all the clinical and radiographic parameters showed significant changes from baseline within each group (P <0.001). Differences in PD, CAL, and DBL scores were also seen among the three groups at the 12‐ and 24‐month visits (P <0.001). At 12 and 24 months after treatment, the EMD + HA/β‐TCP group showed significantly greater PD reduction (4.00 ± 0.42 mm; 4.25 ± 0.63 mm), CAL gain (3.47 ± 0.65 mm; 3.63 ± 0.91 mm), and RBG (3.17 ± 0.69 mm; 3.35 ± 0.80 mm) and less GR increase (0.56 ± 0.37 mm; 0.63 ± 0.42 mm) compared with the OFD and EMD groups (P <0.05). Conclusion: Our data support the hypothesis that the adjunct of an HA/β‐TCP composite implant with EMD may improve the clinical and radiographic outcomes of the surgical treatment of unfavorable intrabony defects.     

Evaluation of Efficacy of Chlorhexidine Intracanal Medicament on the Periodontal Healing of Concomitant Endodontic‐Periodontal Lesions Without Communication: An Interventional Study

Background: Treatment of concomitant endodontic‐periodontal lesions remains a challenge in clinical practice and requires effective endodontic and regenerative periodontal therapy. Among other factors, cross seeding and recolonization of flora may affect the outcome of periodontal therapy. Intracanal medicaments have been shown to exert antimicrobial activity on the external root surface, and local delivery of antimicrobials has been suggested to be a complementary approach in the management of periodontitis. Therefore, the objective of this study is to determine the influence of chlorhexidine (CHX) intracanal medicament on the clinical outcomes of therapy. Methods: Thirty‐one patients were divided into two treatment groups: 1) open flap debridement (OFD) in endodontically treated teeth (control); and 2) OFD in endodontically treated teeth with CHX placed in the coronal space (test). The clinical variables evaluated were probing depth (PD), clinical attachment level (CAL), and percentage of sites with PD ≥5 mm. Reevaluation was performed at 3 and 6 months post‐surgery. Results: Both treatments resulted in improvement in all the clinical variables evaluated. Postoperative measurements from test and control groups showed reductions in mean PD of 2.22 ± 1.27 and 0.91 ± 0.81 mm, mean CAL gains of 2.16 ± 1.12 and 0.60 ± 0.93 mm, and 43.33% ± 31.37% and 17.71% ± 14.23% reduction in sites with PD ≥5 mm. Significantly more PD reduction, CAL gain, and percentage reduction in sites with PD ≥5 mm were observed in the test group at 6 months (P <0.05). Conclusion: CHX may be used as an effective intracanal medicament for promoting periodontal healing in concomitant endodontic‐periodontal lesions.     

Long‐Term Stability After Regenerative Treatment of Infrabony Defects: A Retrospective Case Series

Background: This study aims to evaluate long‐term stability of attachment achieved in infrabony defects (IBDs) by regenerative treatment. Methods: All patients who had received regenerative treatment for at least one IBD between 2004 and 2010 were screened for this retrospective case series. If complete examinations (plaque/gingival index, probing depth [PD], vertical clinical attachment level [CAL‐V]) were available for patients at baseline and 12 months after surgery, they were invited for reexamination 60 ± 12 months after surgery. Reexamination involved testing for interleukin (IL)‐1 polymorphism and counting number of supportive periodontal treatment (SPT) visits. Forty‐one patients (24 males and 17 females; age, median: 62.0 years, lower/upper quartile: 49.8/68.3 years; six smokers, and 9 IL‐1 positive) were included for analysis, each contributing one IBD. Results: Regenerative therapy resulted in significant attachment gain after 1 (median: ?3 mm, lower/upper quartile: ?1.5/?4 mm; P <0.001) and 5 (median: ?3 mm, lower/upper quartile: ?1.9/4.5 mm; P <0.001) years. The study failed to detect median change of CAL‐V from 1 to 5 years after surgery (median: 0 mm; lower/upper quartile: ?1/1.5 mm; P = 0.84). Multiple regression analysis identified that number of SPT visits is correlated with CAL‐V gain from 1 to 5 years after surgery. IL‐1 polymorphism and percentage of sites with PD >6 mm at 5‐year reexamination are correlated with CAL‐V loss from 1 to 5 years after surgery. Conclusions: CAL‐V achieved by regenerative therapy in IBDs may have retained stability over 5 years. Frequent SPT is associated with stability. IL‐1 polymorphism and generalized reinfection are associated with less stability.     

Intrabony Defects,Open‐Flap Debridement,and Decortication: A Randomized Clinical Trial

Background: Intramarrow penetration (IMP) is often incorporated in regenerative periodontal surgical procedures. However, the actual benefits of adding IMP to such a procedure remain undocumented. The purpose of this randomized controlled trial was to investigate the contribution of IMP to the outcomes of open‐flap debridement (OFD) treatment of intrabony defects. Methods: Forty‐two chronic periodontitis patients, each contributing a 2‐wall, 3‐wall, or combined 2‐ to 3‐wall intrabony defect, were treated. Sites were randomly assigned into one of two groups: control (OFD alone) or test (OFD + IMP). Papilla preservation flaps were raised, and defects were thoroughly debrided. In the control group, complete primary closure of flaps was ensured after debridement. In the test group, IMP was performed before flap closure, using a round bur to penetrate the cortical defect wall. Clinical and radiographic parameters were assessed at baseline and 12 months after treatment. Results: At baseline, there were no statistically significant differences between groups. At 12 months, both groups experienced significant improvements, in terms of probing depth reduction, clinical attachment level (CAL) gain, and bone level (clinical and radiographic). The test group experienced significantly greater clinical bone gain (3.07 ± 1.74 mm) and prevalence of CAL gain ≥2 mm (93% of sites) compared with the control group (1.76 ± 2.71 mm, P <0.03; 62%, P = 0.024). The test treatment benefits were particularly evident in mandibular sites, in which OFD + IMP doubled the radiographic bone gain obtained by OFD alone. Conclusion: Addition of IMP to an OFD procedure used to treat intrabony defects results in statistically and clinically significant enhancement of both clinical and radiographic outcomes.     

Efficacy of Locally Delivered 1.2% Rosuvastatin Gel To Non‐Surgical Treatment of Patients With Chronic Periodontitis: A Randomized,Placebo‐Controlled Clinical Trial

Background : Chronic periodontitis (CP) is an inflammatory condition affecting tooth‐supporting tissues and alveolar bone that surround the tooth, leading to formation of a deepened gingival sulcus that is highly prone to pathologic changes and, ultimately, bone resorption and tooth loss. In the literature, several pharmacologic agents have been administered via local delivery routes directly into diseased sites, affirming improvement in periodontal status. Therefore, this study aims to determine the clinical effectiveness of subgingivally delivered 1.2% rosuvastatin (RSV) gel incorporated into a methylcellulose vehicle for its controlled release into intrabony defect (IBD) sites as an adjunct to scaling and root planing (SRP) for treatment of patients with CP. Methods: Sixty‐five patients were categorized into two treatment groups: group 1, SRP plus 1.2 mg RSV; group 2, SRP plus placebo. Clinical parameters, including modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL), were recorded at baseline (before SRP) and at 1, 3, 4, and 6 months. Radiologic assessment of IBD fill was analyzed at baseline and after 6 months using software. Results: There was significant improvement in both study groups. At 6 months, there was a greater decrease in mSBI scores in group 1 (3.71 ± 0.24) compared to group 2 (1.48 ± 0.33). The mean decrease in PD from baseline to 6 months was 4.04 ± 0.34 and 1.31 ± 0.24 mm in groups 1 and 2, respectively. Mean CAL gain from baseline to 6 months was 4.2 ± 0.17 and 1.4 ± 0.15 mm in groups 1 and 2, respectively. In group 1, there was a greater decrease in mean IBD (2.23 ± 0.32 mm, 48.58%) compared to group 2 (0.46 ± 0.02 mm, 10.02%). All patients tolerated the drug without any adverse reaction. Conclusion: Rosuvastatin in situ gel (1.2%), when delivered locally into IBD/pocket sites, showed a greater reduction than placebo in PD and gingival index, along with increased gain in CAL.     

Titanium‐prepared platelet‐rich fibrin provides advantages on periodontal healing: A randomized split‐mouth clinical study

1 Background

The aim of this study to evaluate the contributions of titanium‐prepared platelet‐rich fibrin (T‐PRF) combined with open flap debridement (OFD) on biological markers in gingival crevicular fluid (GCF)and periodontal outcomes.

2 Methods

Twenty‐nine participants with chronic periodontitis were treated either with autologous T‐PRF+OFD or OFD alone. GCF growth factor levels and relative receptor activator nuclear factor kappa‐B/osteoprotegerin (RANKL/OPG) ratio at baseline and 2, 4, and 6 weeks postoperatively were analyzed, and clinical parameters such as probing depth (PD), relative attachment level (RAL) and gingival margin level (GML) at baseline and 9 months after surgery were compared.

3 Results

The mean PD reduction, RAL gain, and GML change were significantly greater in the OFD+T‐PRF sites than in the OFD sites (P = 0.033, P = 0.029, and P = 0.026, respectively). Both groups demonstrated increased growth factor levels at week 2 compared with baseline, followed by reductions at weeks 4 and 6. GCF growth factor levels in the test group were seen at higher concentrations with respect to control group until 6 weeks post‐surgery. During this 6‐week period, relative RANKL/OPG ratio was found significantly lower in the OFD+T‐PRF group compared to the OFD group(P < 0.05).

4 Conclusions

Using T‐PRF membrane combined with OFD provided significantly higher concentrations of growth factors and lower RANKL/OPG ratio in GCF for approximately 4 to 6 weeks, and improved periodontal healing compared to conventional flap sites.     

Platelet rich fibrin combined with decalcified freeze-dried bone allograft for the treatment of human intrabony periodontal defects: a randomized split mouth clinical trail

Objective. Polypeptide growth factors of platelet rich fibrin (PRF) have the potential to regenerate periodontal tissues. Osteoinductive property of demineralized freeze-dried bone allograft (DFDBA) has been successfully utilized in periodontal regeneration. The aim of the present randomized, split mouth, clinical trial was to determine the additive effects of PRF with a DFDBA in the treatment of human intrabony periodontal defects. Materials and methods. Sixty interproximal infrabony defects in 30 healthy, non-smoker patients diagnosed with chronic periodontitis were randomly assigned to PRF/DFDBA group or the DFDBA/saline. Clinical [pocket depth (PD), clinical attachment level (CAL) and gingival recession (REC)] and radiographic (bone fill, defect resolution and alveolar crest resorption) measurements were made at baseline and at a 12-month evaluation. Results. Compared with baseline, 12-month results indicated that both treatment modalities resulted in significant changes in all clinical and radiographic parameters. However, the PRP/DFDBA group exhibited statistically significantly greater changes compared with the DFDBA/saline group in PD (4.15 ± 0.84 vs 3.60 ± 0.51 mm), CAL (3.73 ± 0.74 vs 2.61 ± 0.68 mm), REC (0.47 ± 0.56 vs 1.00 ± 0.61 mm), bone fill (3.50 ± 0.67 vs 2.49 ± 0.64 mm) and defect resolution (3.73 ± 0.63 vs 2.75 ± 0.57 mm). Conclusion. Observations indicate that a combination of PRF and DFDBA is more effective than DFDBA with saline for the treatment of infrabony periodontal defects.     

Treatment of 3-wall intrabony defects in patients with chronic periodontitis with autologous platelet-rich fibrin: a randomized controlled clinical trial

Background: Platelet‐rich fibrin (PRF) is considered a second‐generation platelet concentrate that is widely used in osseous regeneration. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF in the treatment of intrabony defects in patients with chronic periodontitis. Methods: Fifty‐six intrabony defects were treated with either autologous PRF with open‐flap debridement or open‐flap debridement alone. Clinical parameters such as the probing depth (PD) and periodontal attachment level (PAL) were recorded at baseline and 9 months postoperatively. The defect fill at baseline and 9 months was calculated on standardized radiographs by using image‐analysis software. Results: The mean PD reduction was greater in the test group (4.55 ± 1.87 mm) than in the control group (3.21 ± 1.64 mm), whereas the mean PAL gain was also greater in the test group (3.31 ± 1.76) compared to the control group (2.77 ± 1.44 mm). Furthermore, a significantly greater percentage of mean bone fill was found in the test group (48.26% ± 5.72%) compared to the control group (1.80% ± 1.56%). Conclusions: Within the limits of the present study, there was greater PD reduction, PAL gain, and bone fill at sites treated with PRF with conventional open‐flap debridement compared to conventional open‐flap debridement alone. However, a long‐term, multicentered randomized controlled clinical trial is required to know the clinical and radiographic effects of PRF on bone regeneration.