Clinical and Biochemical Assessment of Lycopene Gel Combined With Nanohydroxyapatite Graft in Treatment of Grade II Furcation Defects: A Randomized Controlled Clinical Study

Background: This study aimed to evaluate the effects of lycopene gel, as a natural antioxidant, mixed with a nanohydroxyapatite graft (NHG) covered by an occlusive resorbable collagen membrane (CM) in the surgical treatment of grade II furcation defects and on the gingival crevicular fluid (GCF) levels of 8-hydroxydeoxyguanosine (8-OHdG), as a marker of oxidative injury. Methods: In this randomized controlled clinical study a total of 24 patients with grade II furcation defects were randomly assigned into three equal groups. Furcation defects in group I were managed with lycopene gel mixed with NHG and CM, group II with NHG and CM, and group III with open flap debridement only. Site-specific changes in clinical parameters including probing depth (PD), vertical clinical attachment level (VCAL), horizontal clinical attachment level (HCAL), radiographic maximum vertical depth (MAX V), and maximum horizontal depth (MAX H) were measured at baseline and six months postoperatively. Gingival crevicular fluid levels of 8-OHdG were analyzed using enzyme-linked immunosorbent assay (ELISA) at baseline, one week, and three months. Results: Surgical management of grade II furcation defects resulted in a significant reduction in PD and 8-OHdG levels and a gain in CAL, MAX V, and MAX H in all groups. The differences between lycopene treated sites compared to NHG and CM alone were not significant at six months but demonstrated significantly superior clinical parameters compared to open flap debridement alone. Conclusion: Lycopene does not confer a benefit when combined with NHG in the surgical treatment of grade II furcation defects.

Management of endo perio lesion with class iii furcation defect –A case report

The primary aim of periodontal and endodontic therapy is to restore the lost periodontium and maintain the natural dentition. An ideal endodontic treatment involves removal of any infected pulp completely, preventing or minimizing any chances of reinfection, with proper irrigation and drying of canals, care to be taken not to break any file during cleaning and shaping of canals, proper obturation and not over or under filling of canals, proper sealing, proper restoration and an ideal crown placement. An ideal periodontal treatment involves scaling and root planing, proper reflection of flap to visualize the furcation areas, removal of diseased soft tissue surrounding the lesion and furcation areas and giving adequate oral hygiene instructions. Based on grade of furcation defects, suitable treatment modalities should be chosen. This case report aims at managing an endo-perio lesion involving class III furcation defect using tunneling technique.

Management of Grade II Furcation Defect in Mandibular Molars with Allograft and Alloplastic Bone Graft: A Clinico- Radiographic Study

Aim: The present study was carried out to compare clinically and radiographically the efficacy of regenerative potential of Demineralizedfreeze-dried bone allograft (DFDBA) and Bioactive glass putty (Novabone© dental putty) in mandibular grade II furcation defects. Methods: In 34 Patients, 60 mandibular grade II furcation defects were treated using DFDBA and Bioactive glass putty. 30 furcations were treated using DFDBA, while bioactive glass putty was used to treat remaining 30 furcation defect. Clinical parameters evaluated were Plaque index (PI), Gingival index (GI), Probing pocket depth (PPD), Relative vertical attachment level (RVAL), Relative horizontal attachment level (RHAL) at baseline, 3 months and 6 months. Radiographic parameters recorded were linear measurement of defect depth and bone density in gray scale at baseline and 6 months. Results: Both the group showed significant reduction in mean (P≤0.05) GI, PI, PPD, RVAL and RHAL at 6 months. Group I showed greater reduction in PPD. Radiographic evaluation showed significant (P≤0.05) reduction in defect depth and increase in bone density in both groups. Conclusions: Bioactive glass putty showed comparable regeneration to that of DFDBA in the treatment of mandibular grade II furcation defect. Additional putty consistency of bioactive glass makes it easier and more convenient to use.

The induction of bone formation: From bone morphogenetic proteins to the transforming growth factor-β3 protein - Redundancy, pleiotropy and the induction of cementogenesis

This review proposes to translate organogenesis and the induction of bone formation by the recombinant human transforming growth factor-β3 (hTGF-β3 ) in the Chacma baboon Papio ursinus to periodontal tissue induction and regeneration. Naturally derived highly purified osteogenic proteins of the transforming growth factor-β (TGF-β) supergene family were implanted in Class II furcation defects of the first and second mandibular molars. Additional defects in P.ursinus were treated with recombinant human osteogenic protein-1 (hOP-1, also known as bone morphogeneticprotein-7, hBMP-7) and hBMP-2, singly or in binary applications. In different studies defects were also implanted with hTGF-β3singly or in binary application with hOP-1. Harvested specimens on day 60 and 180 were processed for undecalcified histology using tungsten-carbide knives mounted on Polycut sledge’ micro-tomes or the Exakt precision cutting and grinding system.Highly purified osteogenic proteins showed the induction of Sharpey’s fibres into newly formed cementoid with foci of mineralization. hOP-1 induced substantial cementogenesis whilst hBMP-2 preferentially induced alveolar bone. Intramuscular implantation of hTGF-β3 absorbed onto coral-derived macroporous bioreactors engineered large heterotopic multicellular bone organoids. Gene expression pathways by quantitative Reverse Transcription Polymerases Chain Reaction (qRT-PCR) show that the induction of bone is via several profiled BMPs and TGF-βs expressed upon implantation of hTGF-β3 recapitulating the synergistic induction of bone as shown by binary applications of low doses of hTGF-β1 and hTGF-β3with hOP-1. The rapid induction of bone by hTGF-β3 provides theframework for a paradigmatic shift from recombinanthBMPs to hTGF-β3 in clinical contexts, provocatively operational in periodontal tissue regeneration with substantial induction of cementogenesis in angiogenesis.

Guided Tissue Regeneration Treatment Yields Better Results in Class II Furcations in the Mandible Than in the Maxilla: A Retrospective Study

Absorbable porcine collagen membrane with a bovine bone graft can be considered for regenerative treatment in periodontal class II furcation defects. We evaluated the clinical efficacy of guided tissue regeneration (GTR) treatment with bovine bone xenograft and a porcine collagen membrane in molars with class II furcations. Probing depth (PD), clinical attachment level (CAL), and bone level (BL) were recorded at baseline and at 3, 6, and 9 months postoperatively. Thirty class II furcation defects from the lower and upper molars were assessed. Significant improvements in PD and CAL were observed from baseline to 9 months in all groups (p < 0.01). BL improved in all groups except group A in the upper molars in radiographic assessment (p < 0.05). The lower and upper molars showed PD reduction of 50.5% ± 7.44% and 46.2% ± 11.2%, respectively, at 9 months (p = 0.044). In furcations of 1–3 mm, the lower and upper molars showed PD reductions of 51.2% ± 4.49% and 36.5% ± 16.14%, respectively (p = 0.035). The lower and upper molars showed a CAL gain of 51.1% ± 4.64% and 33.6% ± 18.8%, respectively (p = 0.037). Thus, GTR with bovine bone graft and porcine collagen membrane yielded good results in class II furcations, with better results in the lower than in the upper molars.