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Introduction: Periodontal regeneration of maxillary molar proximal furcation defects are challenging due to limited access. While combination therapy of open flap debridement with barrier membrane, bone graft, and biologics are reported to be more successful than monotherapeutic approaches, combination therapy can be complicated and costly. Case Presentation: A total of four teeth in three patients are presented to demonstrate radiographic bone regeneration of deep Class 2 maxillary molar proximal furcation defects (MMPFD) treated with microscope‐assisted papilla preservation technique (PPT) and demineralized freeze‐dried bone allograft (DFDBA). Conclusion(s): Radiographic bone regeneration of deep Class 2 MMPFD is possible with microscope‐assisted PPT and DFDBA. Furthermore, treatment outcomes appear to be superior to those from previous clinical trials of Class 2 MMPFD treatment. [ABSTRACT FROM AUTHOR]

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]

Introduction: A cemental tear (CeT) is a special type of surface root fracture that may cause periodontal and even periapical tissue destruction. Unfortunately, there is limited knowledge as to how these rare cases can effectively be treated. The present case is believed to be the first reported in the literature treating a bony defect caused by a cemental tear with hyaluronic acid (HA) and a collagen membrane. The aim of this case report is to present a regenerative surgical approach with clinical and tomographic success and stability at 2‐year follow‐up. Case Presentation: A 61‐year‐old patient presented with spontaneous pain and gingival swelling over his right central maxillary incisor. Radiographically, a radiolucent area was observed in the medial third between both central incisors. The tomographic evaluation showed a buccal bone dehiscence and a bony defect. Once the differential diagnosis with an endodontic‐periodontal lesion and root fracture was performed, CeT was the presumptive diagnosis. During the exploratory flap surgery, a small root fragment (CeT) on the mesial side of the tooth was founded and removed. The bony lesion was treated with hyaluronic acid (HA) and a resorbable collagen membrane. At 2‐year follow‐up clinical, radiographic, and tomographic success was observed. Conclusion: A CeT‐associated bony defect could be successfully treated after removing cemental fragments and performing a regenerative approach using HA and a resorbable collagen membrane. [ABSTRACT FROM AUTHOR]

Abstract: 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]

Aims: This three-arm study compared the clinical and radiographic efficacy of the modified minimally invasive surgical technique (M-MIST) alone and combined with enamel matrix derivative (EMD) or EMD plus bone mineral derived xenograph (BMDX), in the treatment of isolated, inter-dental intra-bony defects. Materials and Methods: Forty-five deep isolated intra-bony defects in 45 patients were included, accessed with the M-MIST and randomly assigned to three balanced experimental groups. The M-MIST consisted of a small buccal flap without elevation of the defect-associated papilla. After removal of the granulation tissue by sharp dissection and root instrumentation the regenerative material was applied, when indicated, before obtaining primary closure with a single internal modified mattress suture. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Outcomes were evaluated as pocket depth reduction, attachment level gain, radiographic bone fill and patient-related outcomes. Results: Primary wound closure was maintained in all treated sites with the exception of one M-MIST EMD+BMDX site. No patient reported intra-operative or post-operative pain. Within group differences between baseline and 1 year were statistically significant in the three groups in terms of probing pocket depth reduction, clinical attachment level (CAL) gain and bone fill (p<0.0001). Comparisons among the the groups showed no statistically significant difference in any of the measured clinical outcomes. In particular, CAL gains of 4.1 ± 1.4mm were observed in the M-MIST control group, 4.1 ± 1.2mm in the EMD group and 3.7 ± 1.3mm in the EMD1BMDX one. The percentage radiographic bone fill of the intra-bony component was 77 ± 19% in the M-MIST control group, 71 ± 18% in the EMD group and 78 ± 27% in the EMD1BMDX group. Conclusions: M-MIST with or without regenerative materials resulted in significant clinical and radiographic improvements. While this initial study did not have sufficient power to detect inter-group CAL differences <0.96 mm, the observed outcomes were remarkably similar and warrant further investigations. [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]

Objectives: The aim of this study was to investigate the osteoconductive properties and biological performance of porous titanium granules used in osseous defects adjacent to titanium implants. Material and methods: In this animal experimental study, calibrated defects were prepared in the tibias of 24 New Zealand rabbits. The defects were randomized into two tests and one control group. The test defects were grafted with either metallic or oxidized porous titanium granules (PTG or WPTG, respectively), whereas control defects were left empty (sham). The defects were closed with a submerged coin shaped titanium implant. Defects were left for healing for 4 weeks. After healing, the implants were removed and the new bone tissue formed onto the implant surface was analyzed for run × 2, osteocalcin, collagen-I, tartrate-resistant acid phosphatase, H+-ATPase, tumor necrosis factor-α, interleukin (IL)-6 and IL-10 gene expression using reverse transcriptase polymerase chain reactuion. Wound fluid from the healed defects was analyzed for lactate dehydrogenase and alkaline phosphatase activity. Finally osteoconductivity was analyzed by micro-computed tomography and histology. Results: Significantly more new bone formed in PTG and WPTG grafted defects compared with sham. The new bone grew both through the porosities of the granules and onto the implant surfaces. The WPTG group showed significantly less expression of key inflammation markers, but with no significant difference in a marker for necrosis. The WPTG also showed a significant increase in collagen-I mRNA expression compared with PTG. Conclusion: The results suggest that PTG and WPTG are both osteoconductive materials that can be used to promote bone formation in osseous defects adjacent to titanium implants without hampering implant osseointegration. To cite this article: Wohlfahrt JC, Monjo M, Rønold HJ, Aass AM, Ellingsen JE, Lyngstadaas SP. Porous titanium granules promote bone healing and growth in rabbit tibia peri-implant osseous defects. Clin. Oral Impl. Res. 21, 2010; 165–173. doi: 10.1111/j.1600-0501.2009.01813.x [ABSTRACT FROM AUTHOR]

Aims: This paper describes a modified surgical approach of the minimally invasive surgical technique (modified minimally invasive surgical technique, M-MIST) and preliminarily evaluates its applicability and clinical performances in the treatment of isolated deep intrabony defects in combination with amelogenins. Material and Methods: Twenty deep isolated intrabony defects in 20 patients were studied. Fifteen were surgically accessed with the M-MIST, while in five sites, which presented a lingual intrabony component, the conventional MIST had to be applied. The M-MIST consisted of a buccal incision of the defect-associated papilla, according to the principles of the papilla preservation techniques. Only a buccal flap was raised while the interdental papilla was left in situ. The granulation tissue filling the defect was dissected and removed, leaving the interdental and palatal tissues untouched. Root instrumentation and application of the regenerative material were performed before suturing. Primary closure of the flaps was attained with a single internal modified mattress suture. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Results: The surgical chair-time of the M-MIST-treated sites ( N=15) was 56±8.64 min. Early wound healing was uneventful: primary wound closure was attained and maintained in all sites. No oedema or haematoma was noted. Patients did not report pain or discomfort. The 1-year clinical attachment level (CAL) gain was 4.5±1.4 mm in defects 6±1.5 mm deep. Residual probing depths (PDs) were 3.1±0.6 mm. A minimal increase of 0.1±0.3 mm in gingival recession between baseline and 1 year was observed. Conclusions: M-MIST was applicable on 15 isolated interproximal defects out of 20 selected ones. It resulted in very limited patient morbidity and excellent clinical improvements. These outcomes should be confirmed in a larger study. [ABSTRACT FROM AUTHOR]

Aims: This case cohort study was designed to evaluate the clinical performance and the intra-operative and post-operative morbidity of the “minimally invasive surgical technique” (MIST) associated with the application of an enamel matrix derivative (EMD) in the treatment of multiple deep intra-bony defects in a single surgical procedure. Material and Methods: Forty-four deep intra-bony defects in 20 patients (⩾2 defects/patient) were surgically accessed with the MIST. This technique was designed to limit the mesio-distal flap extension and the apical flap reflection in order to reduce the surgical trauma and increase flap stability. The incision of the defect-associated papilla was performed according to the principles of the papilla preservation techniques. EMD was applied on the debrided and dried root surfaces. Stable primary closure of the flaps was obtained with modified internal mattress sutures. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Clinical outcomes were collected at baseline and at 1 year. Intra-operative and post-operative morbidity was evaluated with questionnaires. Results: The 1-year clinical attachment level (CAL) gain was 4.4±1.4 mm ( p<0.0001 compared with baseline). Seventy-three per cent of defects showed CAL improvements ⩾4 mm. This corresponded to an 83±20% resolution of the defect (15 defects were completely filled). Residual probing pocket depths (PDs) were 2.5±0.6 mm. A minimal increase of 0.2±0.6 mm in gingival recession between baseline and 1 year was recorded. Twelve patients reported a mild perception of the hardship of the surgical procedure. Primary closure was obtained and maintained in all treated sites over time. Only six subjects reported moderate post-operative pain that lasted for 21±5 h. Conclusions: These data indicate that a MIST in combination with EMD can be applied successfully for the treatment of multiple deep intra-bony defects in the same surgical procedure with excellent clinical outcomes and very limited patient morbidity. [ABSTRACT FROM AUTHOR]

Objective: To study the healing at fluoride-modified implants placed in wide circumferential defects. Material and methods: Six mongrel dogs were used. The mandibular premolars and first molars were extracted. Three months later four implants were placed in one side of the mandible of each dog. The control implants (MicroThread™) had a TiOblast surface, while the test implants (OsseoSpeed™) had a fluoride-modified surface. Two implants of each type were placed. The marginal 50% of the prepared canal was widened using step drills. Following installation a 1 mm wide gap occurred between the implant surface and the bone wall in the defect. All implants were submerged. The installation procedure was repeated in the opposite side of the mandible 4 weeks after the first implant surgery. Two weeks later the animals were euthanized and block biopsies containing the implant and surrounding tissues were prepared for histological analysis. Results: The histological analysis revealed that a significantly larger area of osseointegration was established within the defect at fluoride-modified implants than at implants with a TiOblast surface after 6 weeks of healing. Further, the degree of bone-to-implant contact within the defect area was larger at fluoride-modified implants than at the TiOblast implants. Conclusion: It is suggested that the fluoride-modified implant surface promotes bone formation and osseointegration. [ABSTRACT FROM AUTHOR]

Aims: This case cohort study was designed to evaluate the clinical performance and the intra-operative and post-operative morbidity of the minimally invasive surgical technique (MIST) associated with the application of an enamel matrix derivative (EMD) in the treatment of isolated deep intra-bony defects. Material and Methods: Forty deep isolated intra-bony defects in 40 patients were surgically accessed with the MIST. This technique was designed to limit the mesio-distal flap extension and the corono-apical flap reflection in order to reduce the surgical trauma and increase flap stability. The incision of the defect-associated papilla was performed according to the principles of the papilla preservation techniques. EMD was applied on the debrided and dried root surfaces. Stable primary closure of the flaps was obtained with modified internal mattress sutures. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Clinical outcomes were collected at baseline and at 1 year. Intra-operative and post-operative morbidity was evaluated with questionnaires. Results: The 1-year clinical attachment gain was 4.9±1.7 mm ( p<0.0001 compared with baseline). This corresponded to a 77.6±21.9% resolution of the defect. Residual probing pocket depths were 3±0.6 mm. A minimal increase of 0.4±0.7 mm in gingival recession between baseline and 1 year was recorded. No patients experienced intra-operative pain, while only 14 reported a very moderate perception of the hardship of the surgical procedure [7±12 visual-analogue scale (VAS) units, on average]. Primary closure was obtained in all treated sites. At the 1-week follow-up visit, 38 sites (95%) were still closed. Only 12 subjects reported moderate post-operative pain (VAS 19±10) that lasted for 26±17 h. Conclusions: These data indicate that the minimally invasive surgical technique, in combination with EMD, can be successfully applied in the treatment of isolated deep intra-bony defects, resulting in excellent clinical outcomes with very limited intra- and post-operative morbidity. [ABSTRACT FROM AUTHOR]

Aims: This study was undertaken to describe a new surgical approach (minimally invasive surgical technique, MIST) and to evaluate preliminarily its clinical performance and patient perception associated with the application of enamel matrix derivative (EMD) in the treatment of isolated deep intra-bony defects. Methods: Thirteen deep isolated intra-bony defects in 13 patients were surgically accessed with the MIST. This technique was designed to limit the mesio-distal flap extension and the corono-apical reflection in order to reduce the surgical trauma and increase flap stability. The incision of the defect-associated papilla was performed according to the principles of the papilla preservation techniques. EMD was applied on the debrided root surfaces. Stable primary closure of the flaps was obtained with internal modified mattress sutures. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Clinical outcomes were collected at baseline and at 1 year. Intra-operative and post-operative patient perception was also recorded. Results: Early wound healing was uneventful: primary wound closure was obtained and maintained in all sites with the exception of one site with a small wound dehiscence at week 1. No oedema or haematoma were noted. Patients did not report any pain. Three patients experienced slight discomfort for 2-days post-operatively. The 1-year clinical attachment level (CAL) gain was 4.8±1.9 mm. The 1-year percent resolution of the defect was 88.7±20.7%, and reached 100% of the baseline intra-bony component in seven sites. Residual probing depths (PD) were 2.9±0.8 mm. Differences between baseline and 1-year CAL and PD were both clinically and statistically highly significant ( p<0.0001). A minimal increase of 0.1±0.9 mm in gingival recession between baseline and 1 year was recorded ( p=0.39). Conclusions: This case cohort indicates that MIST associated with EMD resulted in excellent clinical improvements while limiting patient morbidity. These preliminary findings need to be confirmed in a larger study. [ABSTRACT FROM AUTHOR]