Novel Albumin Gel-platelet-rich fibrin mixture (Alb-PRF); where do we stand?

AlbPRF is a blood by-product, without additives, using only autologous blood, which after centrifugation will be produced in two stages: heating and incorporation: heating of the serum and low platelet plasma and incorporation of cells (GF and PRF cytokines liquid, removed from the junction of the leukocyte zone and the red blood cells). This new biomaterial has already been tested in vitro and translational research with this new material has already started. Excellent results can be expected from the use of AlbPRF, not only for oral/periodontal surgery applications but also for use in facial medicine and aesthetics.

Adjunctive Effect of Systemic Antibiotics in Regenerative/Reconstructive Periodontal Surgery—A Systematic Review with Meta-Analysis

Background and Objective: Systemic antibiotics (AB) are often used in conjunction with regenerative/reconstructive periodontal surgery of intrabony defects and furcations; however, their potential benefits have not been systematically assessed. Materials and Methods: Data were retrieved from two recent systematic reviews (a total of 105 randomized clinical trials (RCTs) on clinical and radiographic outcomes in intrabony defects (ID) and molars with furcation involvement (FI) treated by surgical access with regenerative techniques. Pair-wise meta-analysis of RCTs with and without AB was performed. Meta-regressions from single-arm (subgroup) RCTs including study arms with or without adjunctive AB were also conducted. Results: No statistically significant benefits of systemic AB with regard to PPD, CAL and bone gain were detected in ID by pair-wise meta-analysis. Meta-regression revealed increased PPD reduction (−0.91 mm, 95% CI = −1.30; −0.51, p < 0.001), CAL gain (−0.92 mm, 95% CI = −1.32; −0.52, p < 0.001) and bone gain (−1.08 mm, 95% CI = −1.63; −0.53, p < 0.001) in ID but not in any of the outcomes in FI for arms treated with AB vs. study arms treated with no AB. No clear differences in adverse events were detected between AB and non-AB groups. Conclusion: There is only weak indirect evidence that AB may provide additional benefits in terms of clinical improvements in the regenerative/reconstructive periodontal surgery of intrabony defects and no evidence for a benefit in furcations. Until new data are gained and in the context of antibiotic stewardship, it may be questionable to justify the adjunctive use of systemic antibiotics.

Ozônio como coadjuvante na terapia periodontal cirúrgica e não cirúrgica: revisão integrativa da literatura

Dada a complexidade da etiopatogenia das doenças que acometem o periodonto, vários mecanismos de suporte à terapia periodontal convencional, baseada em etapas não cirúrgicas e cirúrgicas têm sido estudados na literatura entre eles, o ozônio em seus diversos veículos e com diversas finalidades. O objetivo deste estudo foi descrever as aplicações da ozonioterapia em Periodontia, nos âmbitos da terapia cirúrgica e não cirúrgica sob a óptica dos efeitos moleculares, celulares e teciduais focados no processo de reparo. Foi realizada uma revisão integrativa da literatura com busca nas bases de dados Pubmed/MEDLINE e SciELO com as chaves de busca, ozone, periodontal disease e periodontal surgery associadas por meio do operador booleano and. Após a aplicação dos critérios de elegibilidade elencados pela estratégia PRISMA-ScR, 15 artigos foram selecionados para a análise qualitativa visando a resposta da seguinte pergunta do estudo elaborada pela estratégia PICO: “Quais as vantagens da ozonioterapia na periodontia do ponto de vista microbiológico, celular e do reparo tecidual?”. Percebe-se que o ozônio é um bom coadjuvante à terapia periodontal convencional, por seus efeitos hemostáticos, angiogênicos, analgésicos, anti-hipóxicos e antimicrobianos, além de impactos sobre as vias moleculares de sinalização da resposta inflamatória, embora mais estudos sejam necessários para que protocolos de sua aplicação possam ser padronizados baseado na prática clínica baseada em evidência científica, haja vista o potencial de melhora no reparo tecidual e consequentemente no tempo de recuperação cirúrgica periodontal o que se desdobra para a qualidade de vida de pacientes acometidos por periodontite.

Effect of locally delivered adjunctive antibiotics during surgical periodontal therapy: a systematic review and meta-analysis

Aim The present study aimed to systematically assess current evidence on effects of locally delivered antibiotics during periodontal surgery compared to periodontal surgery alone on clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction, recession depth (RD) changes, gingival index (GI), bleeding on probing (BOP), and plaque index (PI). Methodology MEDLINE-PubMed, Cochrane-CENTRAL and Scopus databases were searched up to April 2021 for randomized clinical trials (RCT), evaluating effects of locally delivered antibiotics during periodontal surgery. CAL gain served as primary, while PPD reduction, RD changes, GI and PI as secondary outcomes. The Cochrane Risk of Bias Tool was used to assess possible bias. Data were extracted, and meta-analysis was performed where appropriate. Result Screening of 2314 papers resulted in nine eligible studies. No adverse events were reported. Data on outcome variables were pooled and analyzed using generic inverse variance model and presented as weighted mean difference (WMD) and 95% confidence interval (95% CI). Statistically significant improvements in favor of antibiotics’ delivery were observed in studies with follow-up of ≤6 months for CAL gain (WMD = 0.61 mm (95% CI [0.07, 1.14]; p = 0.03), PPD reduction (WMD = 0.41 mm (95% CI [0.02, 0.80]; p = 0.04)) and BOP (WMD = −28.47% (95% CI [−33.00, −23.94]); p < 0.001), while for GI improvements were notable for >6 to 12 months (WMD = −0.27 (95% CI [−0.49, −0.06]; p = 0.01)). Conclusion Within the current review’s limitations, locally delivered antibiotics during surgical periodontal therapy results in post-surgical improvements for CAL, PPD, and BOP (≤6 months) with a longer-lasting GI improvement. Further randomized controlled trials are needed with true periodontal end-points to assess the ideal antibiotic agent, dosage, and delivery methods. Clinical relevance Local delivery of antibiotics during periodontal surgery improved clinical parameters for up to 6-month follow-up, with beneficial longer effects on gingival inflammation. Within the current study’s limitation, the presented evidence could support the elective usage of locally delivered antibiotics during surgical periodontal therapy.