Parodontális vertikális csontdefektusok gyógyulásának hosszú távú kiértékelése PRG- vagy EMD-vel történt kezelést követően

A retrospektív esetsorozat célja intraosszeális csontdefektusok gyógyulásának hosszú távú klinikai értékelése autológ vérlemezkében gazdag készítménnyel (Platelet-Rich Gel, PRG) vagy zománc-mátrix derivátummal (Enamel Matrix Derivatives, EMD) történt kezelést követően.A vizsgálatban 24 intraosszeális defektussal rendelkező, nem dohányzó, krónikus parodontitisben szenvedő páciens vett részt. A négy bemutatott eset ezen kontrollált klinikai vizsgálat résztvevője, akiknél 1, 3, illetve 7 évvel a műtétet követően történt kiértékelés a következő paraméterek rögzítésével: szondázási mélység (PD – probing depth), illetve klinikai tapadási szint (CAL – clinical attachment level). Teljes vastagságú lebenyek képzését követően a defektus kürettálása, illetve gyökérsimítás történt. Vérlemezkében gazdag plazma (PRP) preparálása után, Ca-glükonát és friss vénás vér hozzáadásával vérlemezkében gazdag plazma gél (PRG) készült. A parodontális vertikális defektusok ellátását PRG(n = 2) vagy EMD (n = 2) applikációját követően sebzárás követte.Egy évvel a műtét után mindkét kezelési módszer szignifikáns szondázási mélység (PD) csökkenést és klinikai tapadási nívó (CAL) növekedést eredményezett, és ezek az eredmények 3, illetve 7 év után is kedvezőek maradtak. Bemutatott eseteinknél, úgy a PRG-, mint az EMD-kezelés megbízható hosszú távú klinikai eredményeket mutatott.

A associação do enxerto de tecido conjuntivo subepitelial e a matriz derivada do esmalte no recobrimento das recessões gengivais

A recessão gengival (RG) pode ser definida como uma condição, na qual ocorre a migração em sentido apical com consequente exposição da junção amelo-cementária e superfície radicular. As técnicas cirúrgicas plásticas periodontais objetivam a melhora do fenótipo gengival e a correção da morfologia, posição e dimensões do tecido gengival. Nos últimos anos, com o intuito de melhorar os resultados destes tratamentos, novos recursos relacionados com a otimização da regeneração periodontal, vem sendo associados aos enxertos gengivais. Sendo um coadjuvante ou não às técnicas cirúrgicas de recobrimento radicular, a matriz derivada do esmalte (Emdogain â), tem sido cada vez mais incorporada nesses tratamentos, na medida em que, tanto sua aplicabilidade clínica, como seus benefícios, já se encontra embasados em evidências científicas. O objetivo deste estudo é realizar uma revisão literária integrativa sobre a utilização da matriz derivada do esmalte (EMD) nos procedimentos cirúrgicos plásticos periodontais para o tratamento da recessão gengival. Para a elaboração do estudo foi utilizada a estratégia PICO e a busca nas bases de dados PubMed, MedLine e Scielo, a partir das seguintes palavras-chave: “enamel matrix derivatives”, “gingival retraction” e “subepithelial connective tissue graft”. A partir dessa busca 181 artigos publicados entre os anos de 2016 a 2021 foram selecionados, sendo que desse número, somente 12 foram utilizados para realizar a revisão da literatura. Com esta revisão foi possível concluir que a EMD associada aos enxertos de tecido conjuntivo subepitelial pode aumentar a previsibilidade da terapia de recobrimento, podendo favorecer uma nova inserção periodontal.

Efficacy of a New-generation Platelet-rich Fibrin in the Treatment of Periodontal Intrabony Defects: a Randomized Clinical Trial

Background: The aim of the study was to clinically evaluate the healing of intrabony defects after treatment with a new generation of platelet-rich fibrin (A-PRF+) respect to enamel matrix derivatives (EMD). Methods: Thirty (30) intrabony defects of 18 patients (9 males, 9 females) were randomly treated with A-PRF+ (test, n=15) or EMD (control, n=15). The following clinical parameters were recorded at baseline and 6 months after surgery: pocket depth (PD), gingival recession (GR) and clinical attachment level (CAL). After debridement the intrabony defects were filled with A-PRF+ in the test group, respectively with EMD in the control group, and fixed with sutures to ensure wound closure and stability.Results: Both treatment methods resulted in statistically significant PD reductions, respectively CAL gains six months post-operatively. No statistically significant differences were found between the two groups as the mean CAL gain was 2.33±1.58 mm in the A-PRF+ group, respectively 2.60±1.18 mm in the EMD group (p < 0.001).Conclusion: Within the limits of this study the new-generation platelet-rich fibrin seems to be as clinically effective as EMD in the surgical treatment of intrabony defects. Treatment with A-PRF+ or EMD resulted in reliable clinical outcomes. The use of A-PRF+ as a human autologous product can give a positive impact on periodontal healing.Clinical Relevance: A-PRF+ may be suitable for the treatment of intrabony periodontal defects. Trial registration number (TRN): NCT04404374 (ClinicalTrials.gov ID)Date of registration: 19.05.2020., retrospectively registered

Metagenomic Assessment of Different Interventions for Treatment of Chronic Periodontitis: A Systematic Review and Meta-Analysis

Background: Chronic periodontitis is attributed to oral microbial imbalance and host inflammatory reaction. Objective: Our review addresses the question of: Are the available interventions able to regain oral microbial balance in patients having chronic periodontitis? Data Sources: We performed a comprehensive systematic search of MEDLine via Pubmed, Cochrane CENTRAL, Clinicalkey, Clarivate Analytics, Springer materials, Wiley, SAGE, Elsevier, Taylor & Francis group, and Wolter Kluwer, together with hand searching and searching the grey literature. Eligibility Criteria: We included interventional studies testing the microbiome analysis using metagenomic techniques as an outcome to any intervention for chronic periodontitis. Study Appraisal and Synthesis Methods: All studies were imported in Mendeley. The risk of bias was assessed using the specific tool for each study design. The results were analysed using RevMan. All the review steps were performed in duplicates. Results: The search yielded 2700 records. After exclusion steps, 10 records were found eligible. We included 5 RCTs, 1 non-RCT, 3 before-and-after studies, and 1 ongoing study. The studies tested non-surgical periodontal treatment with and without antibiotic coverage, probiotics, sodium hypochlorite rinse, and different toothpaste ingredients. One RCT tested the use of enamel matrix derivatives in cases with furcation involvement. Limitations: The eligible available studies were small in number. Also, the risk of bias and lack of a standardized protocol impaired the ability to pool all the results. Conclusions: The body of the available evidence is not sufficient, and future studies are recommended to better evaluate the effect of periodontal treatments on the periodontal microbiome.

Efficacy of Enamel Derivatives to Improve Keratinized Tissue as Adjunct to Coverage of Gingival Recessions: A Systematic Review and Meta-Analysis

Background: The systematic review was designed to answer the following focused question: Are enamel matrix derivatives able to improve the quantity of keratinized tissue (KT) around natural dentition in patients with recessions defects after their treatment with periodontal plastic procedures? Methods: Only Randomized Clinical Trials (RCT) in English language evaluating root coverage procedures in combination with enamel matrix derivatives (commercially known as Emdogain®—EMD), with at least 10 subjects and a minimum duration of six months, were included. The search was applied to PUBMED and SCOPUS and it consists of a combination of MeSH terms and free text words (from January 2000 to June 2019). Risk of bias in individual studies and across studies was also evaluated. Results: After the full text analysis and the exclusion of further 18 articles, 12 articles were finally included. In total 639 recessions were treated (334 tests and 305 control). The recessions defects were classified according to the classification of Miller (Class I, II, III, IV). Only one trial included Miller Class III recessions (7 in total). Enamel matrix derivatives were applied in conjunction with Coronally Advanced Flap (CAF), Coronally Advanced Flap + Sub Epithelial Connective Tissue Graft (CAF + CTG), Semilunar Flap (SF). For the group CAF vs CAF + EMD the mean difference between the keratinized tissue gain in the two procedures was 0.40 mm (95% Confindence Interval Lower/Upper: 0.014–0.81) (p < 0.058); for the comparison CAF + CTG + EMD vs. CAF + CTG the mean difference between the two groups resulted in −0.06 mm (95% Confindence Interval Lower Upper −0.45 to 0.33) (p = 0.7603). Discussion: Randomized clinical trials included medium-low quality evidence. The application of Enamel Matrix Derivatives to surgical procedures aimed to cover gingival recessions does not add robust clinical benefit to conventional plastic procedure alone.