Emerging Regenerative Approaches for Periodontal Reconstruction: Practical Applications From the AAP Regeneration Workshop.

Focused Clinical Question: Can emerging technologies for periodontal regeneration become clinical reality? Summary: Emerging technologies are presenting options to hopefully improve the outcomes of regeneration in challenging clinical scenarios. Cellular allografts represent a current technology in which cells and scaffolds are being delivered directly to the periodontal lesion. Recombinant human fibroblast growth factor 2 and teriparatide (parathyroid 1-34) have each been tested in controlled prospective human randomized clinical trials, and both have been shown to have potential for periodontal regeneration.

Emerging regenerative approaches for periodontal reconstruction: a consensus report from the AAP Regeneration Workshop.

Background: Historically, periodontal regeneration has focused predominantly on bone substitutes and/or barrier membrane application to provide for defect fill and/or selected cell repopulation of the lesion. More recently, a number of technologies have evolved that can be viewed as emerging therapeutic approaches for periodontal regeneration, and these technologies were considered in the review paper and by the consensus group. The goal of this consensus report on emerging regenerative approaches for periodontal hard and soft tissue reconstruction was to develop a consensus document based on the accompanying review paper and on additional materials submitted before and at the consensus group session.

Accessory mandibular foramen during dental implant placement: case report and review of literature.

Accurate knowledge of vital anatomical structures, such as the inferior alveolar nerve, mental nerve, and mental foramen, is critical to achieve favorable results during oral surgical procedures and dental implant placement. Although uncommon, variations in mandibular foramina have been reported and if unnoticed and, as a result, injured, may lead to patient morbidity, neurosensory disturbances, and other undesired complications. We present a case report of identification of an accessory mandibular foramen (AMF) encountered during placement of 2 dental implants for a mandibular implant-retained overdenture and demonstrate appropriate management.

The role of factors associated with apoptosis in assessing periodontal disease status.

Background: Little is known about the release of apoptotic proteins during periodontal breakdown. This pilot study investigates the presence of factors associated with apoptosis in serum, saliva, and gingival crevicular fluid (GCF) and their association with periodontal disease severity and activity.

Methods: GCF, whole saliva, and serum were obtained from 47 adult patients with chronic periodontitis (CP) and 10 healthy controls.

The effect of flapless surgery on implant survival and marginal bone level: a systematic review and meta-analysis.

Background: The clinical outcomes of implants placed using the flapless approach have not yet been systematically investigated. Hence, the present systematic review and meta-analysis aims to study the effect of the flapless technique on implant survival rates (SRs) and marginal bone levels (MBLs) compared with the conventional flap approach.

Methods: An electronic search of five databases (from 1990 to March 2013), including PubMed, Ovid (MEDLINE), EMBASE, Web of Science, and Cochrane Central, and a hand search of peer-reviewed journals for relevant articles were performed.

Application of modified bony lid technique to remove or replace compromised implants: case series.

Purpose: The original bony lid technique involves removing window of cortical bone using a microsaw, removing a failing implant through the window, and then replacing the bone into its original position. The purpose of this case series was to present modifications to the bony lid technique to improve outcomes.

Materials And Methods: Ten patients (9 men and 1 woman) aged between 47 and 89 years were treated during a 5-year period with modifications to the bony lid technique.

Effect of flapless surgery on single-tooth implants in the esthetic zone: a randomized clinical trial.

Background: Implant therapy is a highly predictable treatment option; however, insufficient data exist to show whether flapless implant surgery provides better esthetic outcomes and less bone loss than implant surgery with a flap approach.

Methods: In this randomized, controlled study comparing the flapless and traditional flap protocol for implant placement, 24 patients received a single implant in the anterior maxillary region. A cone beam computed tomography-aided surgical guide was used for implant placement surgery for both groups.

Statins, glucocorticoids, and nonsteroidal anti-inflammatory drugs: their influence on implant healing.

This article aimed at exploring the effects of common systemic medications used in the United States and their effects on periimplant bone healing. An electronic search for articles evaluating the influence of systemic medications on periimplant bone healing was conducted using the PubMed (MEDLINE) database. Statins, when administered locally or systemically, were found to increase bone formation and density.

Systemic Teriparatide Administration Promotes Osseous Regeneration of an Intrabony Defect: A Case Report.

Introduction: Teriparatide comprises the first 34 amino acids of parathyroid hormone and is a systemic anabolic agent that is Food and Drug Administration approved for the treatment of osteoporosis but not for periodontitis. To our knowledge, this is the first clinical case report to document the treatment of a patient with severe periodontitis using an open-flap debridement procedure in conjunction with teriparatide.

Case Presentation: A 45-year-old female patient was diagnosed with severe chronic periodontitis, including the presence of an intrabony defect on tooth #6.

Histological analysis of soft and hard tissues in a periimplantitis lesion: a human case report.

Background: Little is known regarding the histologic hard and soft tissue changes that occur in chronic periimplantitis situations in humans. It is critical to gain an understanding of all aspects of periimplantitis to develop appropriate therapeutic approaches.

Methods: An 83-year-old African American man presented with a fractured implant affected by severe, chronic periimplantitis and surrounded by keratinized gingiva.

Biologic Agents to Promote Periodontal Regeneration and Bone Augmentation.

Periodontal regeneration is preferred over tissue repair and is accomplished through the exclusion of epithelial tissues, which allows cementum, bone, and connective tissue to repopulate the wound. Recently, biologic materials have emerged as adjuncts to aid in regeneration by augmenting the events of wound healing in the area. A review of biologic agents was conducted using the following MeSH terms: guided tissue regeneration, intercellular signaling peptides and proteins, and biologic factors.

Retrograde peri-implantitis: a case report introducing an approach to its management.

Background: Although several potential etiologic factors associated with retrograde peri-implantitis (RPI) and potential treatment options have been discussed in the literature, the etiology has not been fully investigated and the definitive management methods remain undefined. We propose a decision-making protocol for the treatment of RPI and provide new insight into the etiology of this process based on the findings from two clinical cases.

Methods: The medical and dental histories of two patients who developed RPI were thoroughly reviewed.

Teriparatide and osseous regeneration in the oral cavity.

Background: Intermittent administration of teriparatide, a drug composed of the first 34 amino acids of parathyroid hormone, has anabolic effects on bone. Although teriparatide has been evaluated for the treatment of osteoporosis and for the healing of fractures, clinical trials evaluating it for the treatment of osseous conditions of the oral cavity in humans are lacking.

Methods: A total of 40 patients with severe, chronic periodontitis underwent periodontal surgery and received daily injections of teriparatide (20 μg) or placebo, along with oral calcium (1000 mg) and vitamin D (800 IU) supplementation, for 6 weeks.

Implant compression necrosis: current understanding and case report.

Background: Implants fail for a variety of reasons; it can be difficult to determine the exact cause of failure, especially if there are multiple contributing factors. Overcompression of the adjacent bone during implant placement is a potential contributing factor to implant failure that is not well documented in the literature.

Methods: This case report reviews the concept of bone loss induced by overcompression and presents a case of implant failure with overcompression as a potential etiology.

Periodontal and endodontic regeneration.

Guided tissue regeneration (GTR) is effective in halting tissue and bone destruction and promoting new tissue and bone formation. Although the goal of complete and predictable regeneration still remains elusive, many techniques and materials have been developed that show good clinical and histologic outcomes. The most commonly used materials in GTR include bone replacement grafts from numerous sources, nonresorbable and bioabsorbable membranes, and recently growth hormones/cytokines and other host modulating factors.

Role of platelet-rich plasma in soft tissue root-coverage procedures: a review.

The aim of this article was to review the current evidence on the role of platelet-rich plasma (PRP) in enhancing root-coverage techniques and discuss the rationale for its use in these applications. Sound biologic rationale and a multitude of basic science research support the use of PRP to promote soft tissue healing, although evidence of its role in enhancing periodontal applications, especially root coverage, is limited. Current scientific research has yet to elucidate all of the mechanisms by which PRP can affect soft tissue healing and assess its capacity to stimulate regeneration.

Common implant esthetic complications.

Today, osseointegration of implants is readily attainable with high long-term survival rates. Consequently, clinicians are now focusing on improving implant esthetics and are starting to incorporate this parameter into their definition of implant success. However, studies measuring factors that affect implant esthetics and implant esthetic outcomes are lacking in the literature.

Effects of Vitaxin, a novel therapeutic in trial for metastatic bone tumors, on osteoclast functions in vitro.

The integrin alphavbeta3 mediates cell-matrix interactions. Vitaxin(R), a humanized monoclonal antibody that blocks human and rabbit alphavbeta3 integrins, is in clinical trials for metastatic melanoma and prostate cancer. alphavbeta3 is the predominant integrin on osteoclasts, the cells responsible for bone resorption in health and disease.