EVALUATION OF EFFICACY OF DEMINERALIZED FREEZE DRIED BONE ALLOGRAFT WITH AND WITHOUT PLATELET-RICH FIBRIN IN THE TREATMENT OF INTRABONY DEFECTS BY CONE BEAM COMPUTED TOMOGRAPHY: A CLINICAL AND RADIOGRAPHIC STUDY

Background: Eventhough the combination of DFDBA (demineralized freeze dried bone allograft) with PRF (platelet-rich fibrin) has been attempted in periodontal practice with significant results, assessment of the intrabony defect and defect bone fill largely done with two-dimensional imaging modalities. Three dimentional analysis of the intrabony defect and defect bone fill has not been attempted with cone beam computer tomography (CBCT). The present study evaluated the efficacy of DFDBA with and without PRF in the treatment ofintrabony defects by CBCT. Methods: 60 defects in systemically healthy patients ranging from 18 to 50 years of age will be included in the study.30 defects were treated with PRF+DFDBA and 30 defects were treated with DFDBA alone. The study will include the assessment of clinical parameters involving probing depth (PD), relative attachment level(RAL), full mouth bleeding scores(FMBS),plaque index and gingival index from baseline to 3 , 6, 9 months. Hard tissue changes will be assessed radiographically by evaluating defect fill and defect resolution by CBCT at baseline& 9 months. Results: The results of the present study are statistically significant in both groups in terms of clinical and radiographical parameters (P < 0.001). In inter-group comparison, there was a statistically significant greater PD reduction and attachment gain while there was not significant reduction in terms of PI, GI, FMBS, defect fill and defect resolution in DFDBA+ PRF group. Conclusion: DFDBA along with PRF failed to provide additional value in terms of defect fill and defect resolution over DFDBA alone.

FROM TRIVIAL TO CONSEQUENTIAL-A UNIQUE APPROACH OF BUTTRESS BONE AS AN AUTO-GRAFT FOR EFFECTIVE RESTORATION

An unusual bony growth evokes suspicion, buttressing bone formation is one such exemplar. Periodontal disease leads to the destruction of soft and hard supporting tissue. The immunoinflammatory process in bone triggers the formation and resorption of bone simultaneously. In an attempt to buttress bony trabecular weakened by resorption, peripheral buttressing bone is formed which sometimes is accompanied by the formation of intrabony defect. In the present case report, A 27-year-old female patient presented with the chief complaint of painless hard swelling on the upper right and left-back tooth region since 5-6 years. The patient was diagnosed with generalized chronic Periodontitis with Bilateral Maxillary buttressing of bone. Conventional Respective osseous surgery was done in one quadrant and respective osseous surgery with the regenerative technique by using the bone obtained during surgery as an autograft to fill the intraosseous defect in the same periodontitis patient. The patient was followed up after 3 weeks, 3 months, and then 6 months. There was no increase in bone growth at the end of the 6th month obtaining the bone as a graft from donor site during the respective osseous procedure serves dual advantage of Recon touring and obtaining desirable bony contours and eliminating any other donor site or another kind of graft material for restoring the intraosseous defect. As in the case presented, the problem was used as a solution. The buttress bone obtained from the respective procedure serves as the gold standard autogenous graft for restoring the intraosseous defect.

A Systematic Review and Meta-Analysis of Local Administration of 1 Percent Metformin as an Adjunct to Scaling and Root Planning on Periodontal Intrabony Defects

The Purpose: This systematic review conducted to assess the effectiveness of local administration of 1 % Metformin as an adjunct to scaling and root planing on periodontal intrabony defects. Methods: Two independents reviewers searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and ClinicalTrials.gov.We included randomized controlled trials (RCTs) of local administration of 1% metformin interventions in patients with periodontal intrabony defect undergoing scaling and root planing as compared to local administration of placebo gel where periodontal parameters were evaluated. The Cochrane RoB tool was used to evaluate the risk of bias. Meta-analyses for the quantitative data were performed. We assessed the level of certainty for our outcomes using (GRADE) tool. Results: Among the 1666 studies screened, two RCTs were included in the meta-analyses. The meta-analysis showed a statistically significant difference for all outcomes except the plaque index.Quantitative analyses showed a weighted mean difference (WMD) of1.17 mm (95% CI=1.01 to 1.34 mm, P<0.00001) for depth of periodontal intrabony defect; a WMD of 2.54 mm (95% CI=2.20 to 2.88 mm, P<0.00001) for clinical attachment level;a WMD of 2.01 mm (95%CI=1.68 to 2.33 mm, P<0.00001) for probing depth (PD);a WMD of 0.38 (95% CI=0.14 to 0.62, P = 0.002) for bleeding on probing (BOP); and a WMD of 0.00 mm (95% CI=−0.04 to 0.04 mm, P=0.95) for plaque index. There is moderate certainty of the evidence for all outcomes. Conclusions: Local application of 1% metformin in patients with periodontal intrabony defect may improve the clinical and radiographic periodontal parameters. Future clinical trials are required to confirm the clinical benefits of a 1% metformin application as adjunctive to scaling and root planing in patients with periodontal intrabony defect. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD167223.