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Background: Development of autologous and recombinant growth factor/matrix combination products represent a new emerging trend in regenerative therapeutics and have gained increasing attention as a strategy to optimize tissue regeneration. The aim of the present study was to evaluate the levels of platelet derived growth factor-BB (PDGF-BB) in gingival crevicular fluid (GCF) during early healing period after the regenerative treatment of intrabony defects using beta tricalcium phosphate (β-TCP) as a bone regeneration material with either platelet rich fibrin (PRF) membrane or collagen membrane (CM) treated with recombinant human PDGF-BB (rhPDGF-BB).Methods: Twenty patients (13 males and 7 females) with chronic periodontitis participated in this prospective, randomized clinical and biochemical study. Each patient was randomly assigned to PRF membrane (group A) or CM incorporated with rhPDGF-BB (group B). GCF samples were obtained on days 3, 7, 14, and 30 for evaluation of PDGF-BB levels and alkaline phosphatase (ALP) levels.Results: On days 3 and 7 following surgery, mean levels of PDGF-BB at sites treated with PRF membrane or CM incorporated with rhPDGF-BB as a barrier membrane were not significantly different. PDGF-BB levels decreased significantly in samples collected on days 14 and 30 with significant differences between both the groups. ALP levels significantly increased from day 3 to day 30 but there was no difference between two groups.Conclusion: Within the limitations of the study, both PRF membrane and CM incorporated with rhPDGF-BB showed comparable GCF levels of PDGF-BB initially with PRF showing more sustained levels throughout the study period. [ABSTRACT FROM AUTHOR]

Copyright of Implant Dentistry is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The objective of the present paper was to review factors and conditions that are associated with hard and soft‐tissue deficiencies at implant sites. Importance: Hard‐ and soft‐tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft‐tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft‐tissue deficiencies with the aim of improving clinical outcomes of implant therapy. Findings: A large number of etiological factors have been identified that may lead to hard and soft‐tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft‐tissue defects or may appear in conjunction with other factors. Conclusions: Hard‐ and soft‐tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri‐implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft‐tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites.Importance: Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy.Findings: A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors.Conclusions: Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background The present randomized controlled clinical study was designed to investigate the effect of in situ application of 1.2 mg Simvastatin (SV) gel in the surgical management of Intrabony defects in chronic periodontitis patients. Methodology 20 patients contributing 40 sites were categorized into two treatment groups: Open flap debridement plus 1.2 mg SV gel (Group 1) and Open flap debridement plus Placebo gel (Group 2). Gingival index (GI), Plaque index (PI), Pocket depth (PD) and clinical attachment level (CAL) were recorded at baseline, 3 months, 6 months and 9 months. At baseline and at the end of 6 and 9 months Radiographic evaluation of Intrabony defect fill was done using Image j software. Results Significant reduction of GI, PD and gain in CAL was observed at the end of 9 months in both groups. Amount of bone fill and percentage of original defect fill in Group 1 was statistically highly significant than Group 2 at the end of 6 and 9 months. Conclusion Higher amount of decrease in GI and PD along with more amount of CAL gain was observed in treatment group than control group. Radiological assessment confirmed that significant intrabony defect fill and percentage fill of original defect in treatment group than controlled group. [ABSTRACT FROM AUTHOR]

Trabecular metal cones are one option for treating osseous defects during TKA. A total of 83 consecutive TKAs utilizing cones with an average of 40 months follow-up were reviewed. There were 24 males and 59 females, with an average age of 69 years old. Four were complex primary and 79 were revision procedures. Of 83 patients, 10 (12%) required repeat revision surgery (8 infections, one periprosthetic fracture, one aseptic loosening) and overall, 37 of 83 patients (45%) experienced at least one complication. Of 73 unrevised knees, 72 (99%) demonstrated radiographic evidence of osseointegration. Despite a high complication rate in this population, trabecular metal cones represent an attractive option for managing bone loss in complex primary and revision TKA with a high rate of osseointegration. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Bone grafts are frequently used for the treatment of bone defects, but can cause postoperative complications, and sometimes a sufficient quantity of bone is not available. Hence, synthetic biomaterials have been used as an alternative to autogenous bone grafts. Recent clinical reports suggest that application of autologous blood plasma enriched with platelets can enhance the formation of new bone. There are very few in vitro or in vivo studies published on the efficiency of platelet-rich plasma (PRP). The objective of this study was to evaluate the alloplastic bone substitute for its osteogenic potential with or without PRP. Materials and Methods: Twenty-three patients with periapical bony defects were selected for this study. Clinical parameters such as pain visual analog scale (VAS), swelling, infection, graft migration, rejection, radiographical interpretations at regular interval and scintigraphic evaluation were done to evaluate osteogenic potential of alloplastic bone substitute with or without PRP. Results: The highest acceleration in bone formation was observed in groups where alloplastic bone substitute was used with PRP. There were no statistically significant differences between the two groups regarding other outcome variables throughout the postoperative period. Conclusion: Addition of PRP significantly accelerates vascularization of the graft, improves soft tissue healing, reduces postoperative morbidity and enhances bone regeneration. [Copyright &y& Elsevier]

Currently, in oral and maxillofacial surgery, there is a clinical need for efficient bone grafting materials, and various efforts are being made to improve materials used as bone substitutes to facilitate faster and denser bone regeneration. The purpose of this study was to evaluate in vivo the osteogenic potential of synthetic β-tricalcium phosphate in a hydroxyl sulphate matrix (β-TCP/HS) and human demineralized bone matrix (DBM) putty. Sixteen New Zealand White rabbits were used. In each animal, two bone defects (8 mm length × 3 mm width × 3 mm depth) were created in the left and right regions of the mandible, respectively. The defect on one side, chosen randomly, was filled with β-TCP/HS (group A) or DBM putty (group B), while the defect on the opposite side was left unfilled in order to serve as a control site. Two animals in each group were sacrificed at the end of the 1st, 3rd, 5th and 6th week after surgery, respectively, and the osteotomy sites were processed for histological evaluation. Our findings confirmed that β-TCP/HS and human DBM putty possess osteogenic activity and can support new bone formation, although at a slower rate than the spontaneous healing response, in rabbit mandibular osseous defects. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive surgery (MIS) is a surgical technique using very small incisions indicated for performing regenerative therapy in periodontal defects. The 1 l-month results from a prospective study of MIS were previously published. This article presents the 6-year results of that prospective study. Methods: Patients from two private periodontal practices with advanced periodontitis who, after nonsurgical therapy, had one or more sites with probing depths ≥6 mm were included in the study. An MIS surgical approach was used for all sites ≥6 mm. After surgical debridement, enamel matrix derivative (EMD) was placed into the bony defect. The surgical sites were reevaluated after ≥6 years. Results: Six-year data were available on 142 sites in 13 patients. No significant differences were noted in the results between the two offices, and the data were combined. Probing depths (mean: 3.18 mm; SD: 0.59 mm) and attachment levels (mean: 3.93 mm; SD: 0.19) at 6 years were unchanged from the 1 l-month measurements. No recession from preoperative levels was noted. All sites continued to be considered clinically successful. Conclusions: The combination of MIS and EMD yielded significant reductions in probing depths and improvements in attachment levels while producing no detectable recession. The 1 l-month results remained stable at 6 years. [ABSTRACT FROM AUTHOR]

Bone defects of both the glenoid and humerus have long been recognized to be associated with acute and chronic recurrent instability. Clinicians have used various strategies to address bone loss in hopes of improving outcomes. As patients'' and surgeons'' functional goals have evolved, so too have the refinements of various procedures. Outcome goals such as optimization of motion and function and minimization of the rate of osteoarthritis have become almost as important as achieving a stable joint. This summary reviews the clinical evaluation, imaging techniques, and surgical decision making for various degrees of glenoid and humeral osseous deficiencies. Accurate measurement techniques are discussed to identify clinically significant bone loss causing “inverted pear” and “engaging Hill-Sachs” deformities. Surgical techniques to address these deformities are evolving, and those we address in this article are arthroscopic remplissage (insetting of the infraspinatus tendon into the Hill-Sachs defect) and open autogenous coracoid transfer (modified Latarjet). [Copyright &y& Elsevier]

Abstract: Recent studies show comparable results of arthroscopic shoulder stabilization techniques compared with the gold standard open Bankart reconstruction. Great technical advances and ever-increasing surgeon experience have rendered pathology once deemed an indication for open surgery as treatable by arthroscopic means. With this movement toward a more universal application of all-arthroscopic techniques, we might consider the following question: Is there ever a need to open? To answer this question, we must first consider normal anatomy and then appreciate the contribution of deranged pathoanatomy to recurrent instability in each individual case. The surgeon must then determine whether this is best addressed via an arthroscopic or open technique. Arthroscopy, as compared with open stabilization procedures, holds the potential benefits of decreased morbidity rates, early functional rehabilitation, and improved range of motion. Despite potential advantages, arthroscopic stabilization is clearly contraindicated when a significant pathologic lesion contributing to recurrent instability cannot be adequately addressed as a result of the limitations of current techniques or instrumentation. On the basis of this principle, we believe that sizable glenohumeral bone defects remain the only absolute contraindication to an all-arthroscopic approach. Many complicating issues, such as attenuated capsule, humeral avulsion of the glenohumeral ligament lesions, cases of revision surgery, and collision or contact athletes, exist and warrant close attention. We prefer to think of these situations as “challenges” for which both arthroscopic and open surgery should be considered, rather than as true contraindications to arthroscopic shoulder stabilization. We are, by no means, advocating arthroscopic treatment in all cases of shoulder instability, because this would represent a gross oversimplification of the issues at hand. However, we do acknowledge that the steadfast contraindications to arthroscopic shoulder stabilization are decreasing every day. [Copyright &y& Elsevier]

Copyright of DoctorConsult - The Journal. Wissen fur Klinik und Praxis is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)