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Different Guided Tissue Regeneration (GTR) procedures, such as membranes, bone substitute materials, and Autologous Platelet Concentrates (APCs), have been applied after surgical root canal treatment (SRCT), which produce different outcomes. This study aimed to evaluate the impact of regenerative procedures on the healing process following SRCT. A comprehensive search of PubMed, Embase, Scopus, Cochrane, and the Web of Science found Randomized Controlled Trials (RCTs) published until February 25, 2024. Manual searches were also conducted. Our main outcome was SRCT success or failure after GTR procedures. The Risk Ratio (RR) and failure rate meta-analysis used a fixed effects model with a 95% confidence interval (CI). Subgroup analyses were conducted based on the use of different GTR procedures for varying lesion types in SRCT. Out of 1,605 records, 16 studies with 690 lesions were included. Overall, GTR procedures significantly improved healing after SRCT in both 2D (RR: 0.50; 95% CI, 0.34-0.73; P < 0.001) and 3D evaluation methods (RR: 0.36; 95% CI, 0.15-0.90; P < 0.001) with no significant difference between the two methods. GTR significantly improved SRCT healing regardless of the evaluation method used. Combining collagen membranes with bovine bone-derived hydroxyapatite significantly enhanced the healing process. Additionally, GTR procedures significantly improve healing in through-and-through lesions.

Aim To compare the effects of 1.8% hyaluronic acid (HA) and enamel matrix derivative (EMD) on periodontal regeneration in patients with periodontal bone defects, using clinical and radiographic parameters as outcome measures. Materials and methods We included 53 patients with 53 intrabony defects in this study who were randomly assigned to either the HA (test) or EMD (control) groups. Clinical and radiographic parameters were evaluated at 6, 12, and 18 months after the surgery. Results Clinical measurements at 6, 12, and 18 months after surgery demonstrated significant improvements in probing depth (PD), clinical attachment level (CAL), recession (REC), and bleeding on probing for both groups compared with baseline ( p  < 0.001). The EMD group exhibited the highest CAL gain of 2–3 mm at 6 months, observed in 14 of 26 (53.8%) defect sites. Conversely, the HA group demonstrated a CAL gain ≥ 4 mm at 18 months, observed in 13 of 27 (48.1%) defect sites. Radiographic assessments at 6, 12, and 18 months demonstrated significant improvements from baseline for both groups ( p  < 0.001). Conclusion We found significant clinical and radiographic benefits of HA and EMD at 18 months, with some limitations in effectiveness for specific intraosseous defects. Clinical relevance This study demonstrated that hyaluronic acid (HA), combined with minimally invasive techniques, enhances periodontal regeneration by improving PPD reduction, CAL gain, and radiographic bone filling, with cost-effectiveness, application, and bioavailability surpassing that of other biomaterials. Based on these results, HA can be considered a viable alternative to EMD in indicated cases. Clinical trial registration number clinicalTrial.gov - NCT04274244.

Objectives To explore the bone regeneration effect of different forms of concentrated growth factor (CGF) when combined with deproteinized bovine bone mineral (DBBM) for simultaneous implant-guided bone regeneration (GBR) and its impact on postoperative adverse reactions. Methods Fifty-seven patients who underwent simultaneous implant GBR were selected for the study and divided into three groups. The study involved three groups: the gel phase concentrated growth factor (GPCGF) group, which used GPCGF-DBBM mixture; the liquid phase concentrated growth factor (LPCGF) group, which used LPCGF-DBBM mixture; and the control group, which used DBBM alone. The thickness of the buccal lateral bones was measured using cone beam computed tomography (CBCT), and patients were asked to complete questionnaires to assess primary adverse reactions during the first week after surgery. The data were analyzed using one-way ANOVA, Tukey test, and Kruskal-Wallis test. Results The buccal lateral bone thickness in the GPCGF, LPCGF, and control groups decreased significantly at 6 months post-surgery compared to immediately after surgery. The change of bone thickness in the GPCGF group was lower than that in the control group ( p  < 0.01), and that in the LPCGF group did not differ from that in the control group ( p  > 0.05). During the postoperative week, statistically significant differences could be observed in bleeding, mouth opening, chewing, sleeping, speaking, daily routine, and pain ( p  < 0.05). Conclusions Compared to the DBBM applied alone, the GPCGF-DBBM mixture has more positive implications for reducing bone resorption, promoting bone reconstruction and relieving certain postoperative adverse effects in dental implants with simultaneous GBR. The GPCGF-DBBM mixture was superior to the LPCGF-DBBM mixture in alleviating adverse effects in terms of bleeding and speaking after GBR. Clinical trials registration number The Chinese Clinical Trial Registry, NO. ChiCTR2300070107 (03/04/2023).

The guided bone regeneration (GBR) technique is an effective method for treating inadequate alveolar ridge bone mass. The choice of barrier membrane materials plays a crucial role in the success of this technique. Recently, biodegradable zinc (Zn)‐based metallic barrier membranes have been extensively investigated as a novel option for alveolar bone defect repair. Although in vitro and animal studies using Zn‐based GBR membranes have shown some promising results, it remains uncertain whether these successes can be replicated in humans. In this review article, the clinical requirements for GBR membranes are discussed and the feasibility of Zn‐based alloys as a potential new option is assessed. Current advancements in the development of Zn‐based GBR membranes through alloying, surface modification, composite methods, and additive manufacturing techniques are also summarized. Importantly, several challenges persist, including stress corrosion, creep, and the need to balance osteogenesis with antimicrobial efficacy, which must be addressed in future studies. Overall, Zn‐based barrier membranes represent a biodegradable and multifunctional solution for enhancing bone regeneration in dental applications. Recent research has shown that biodegradable metals based on zinc (Zn) may be used as guided bone regeneration (GBR) membrane materials. This study examines their viability from the standpoints of material science and biology, reports on the state of research on Zn‐based GBR membranes, and suggests specific development plans based on the potential and challenges that now exist.

Background Computer-guided surgery has played a crucial role in planning alveolar ridge augmentation. In the last decade, various software programs have been used in computer-guided fabricated nonresorbable membranes, including zirconia membranes, for guided bone regeneration. However, most of these software programs are not free of charge. Objectives This study aimed to evaluate clinically and radiographically the accuracy of an open-source digital workflow for designing custom-made zirconia membranes for maxillary guided bone regeneration. Materials and methods Twelve custom-made zirconia membranes were designed for 12 patients with maxillary alveolar defects via the integration of two free open-source software programs (Blue Sky Plan ® and Autodesk Meshmixer ® ) via a preoperative cone beam computed tomography scan. All patients underwent maxillary alveolar bone augmentation via the designed membranes and particulate mixtures of 1:1 autogenous and xenogenic bone grafts. The membranes were evaluated intraoperatively and radiographically via an immediate postoperative cone beam computed tomography scan, and the collected data were statistically analysed. Results All the membranes had accurate intraoperative fits, and there were no significant differences between the virtual and milled (actual) membranes in either the volumetric analysis or the linear horizontal and vertical measurements; the P values were (0.628, 0.226 and 0.239), respectively. The designing time was significantly reduced from 4 h for the first case to 22 min for the final case, while the (mean ± standard deviation) milling time was 28 min ± 11 min, and the (mean ± standard deviation) time of the whole digital workflow including membrane sterilization was 5 h and 20 min ± 1 h and 15 min. Conclusion Zirconia membranes can be designed with free open-source software with outstanding clinical fit and promising radiographic results. Further research should be performed with larger sample sizes and other rigid Guided Bone Regeneration membrane materials. Trial registration number NCT06227455. Trial first posted date 26/1/2024 (Retrospectively registered).

Objectives This randomized controlled trial compared the outcomes of recombinant human fibroblast growth factor (rhFGF)-2 plus carbonate apatite (CO 3 Ap) granules with rhFGF-2 alone in the treatment of intrabony periodontal defects. Materials and methods Patients with Stage III Grade B/C periodontitis who had completed initial periodontal therapy and had intrabony defects with a depth of ≥ 3 mm were included. Defects were treated solely with rhFGF-2 (control) or rhFGF-2 plus CO 3 Ap (test). Periodontal parameters and a patient-reported outcome measure (PROM) were assessed at baseline, at 6, 9 and 12 months postoperatively. The primary outcome was the change in clinical attachment level (CAL) from baseline to 12 months postoperatively. Using the Friedman test with Dunn’s post-test, intragroup data were compared over time, and Mann-Whitney U test was used to assess intergroup data at each time point. Results Forty-eight sites in 38 patients were subjected to analysis. At 12 months postoperatively, CAL in both groups showed a significant improvement from baseline ( p  < 0.001). CAL gain was 3.4 ± 1.3 mm in the test group and 3.2 ± 1.2 mm in the control group, with no significant intergroup difference ( p  = 0.567). Radiographic bone fill in the test group (67.2%) was significantly greater than in the control group (32.4%) ( p  < 0.001). PROM scores showed no difference between groups. Conclusions At 12 months, the outcomes including CAL gain and PROM showed no significant differences between groups, although the combination treatment enhanced radiographic bone fill. Clinical relevance The use of rhFGF-2 (with/without CO 3 Ap) could lead to significant improvement in clinical parameters in the treatment of intrabony periodontal defects. The benefit of adding CO 3 Ap to rhFGF-2 therapy needs further evaluation. Clinical Trial Registration Number The University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) : UMIN000040783.

Background Prematurity resulted from pathological migration of periodontally involved teeth with the loss of vertical stopping points between teeth, which can lead to teeth over eruption with dimensional changes favoring occlusal discrepancies. Therefore, evaluating and comparing the effect of guided tissue regeneration followed by orthodontic intrusion as opposed to orthodontic intrusion tracked by guided tissue regeneration in the treatment of an over-erupted tooth with angular bone loss. Methods Twenty teeth in ten cases were selected with at least two teeth with vertical over-eruption and angular bone loss with the presence of their opposing. In group one, ten teeth over-erupted were treated by guided tissue regeneration followed by orthodontic intrusion, whereas, in group two, ten teeth over-erupted were treated by orthodontic intrusion followed by guided tissue regeneration. They were evaluated clinically for pocket depth, bleeding on probing, and tooth mobility. Radiographical evaluation assessed by cone beam computed tomography. Results Clinically, there existed a statistically significant difference (P value ≤ 0.05) in favor of group one at six months post and in favor of group two at one year from re-evaluation regarding pocket depth and tooth mobility. Radiographically, in group one, there was a statistically significant improvement ( P value ≤ 0.05) at six months post-guided tissue regeneration or orthodontic intrusion regarding defect depth and dimensional changes of the defect area, with a statistically significant difference ( P value ≤ 0.05) in favor of group two at one year from re-evaluation phase regarding defect depth and defect area dimensional changes. Conclusion There was a short-term improvement in group one, which deteriorated over a long period compared with group two, so it is preferable to start orthodontic intrusion before guided tissue regeneration.

Background and Objectives: This study evaluated the outcomes of single open-flap debridement, open-flap debridement (OFD) plus resorbable membrane placement, and OFD with resorbable membrane placement plus platelet-rich fibrin (PRF) in terms of periodontal clinical parameters and glycated hemoglobin (HbA1c) levels in 24 adult patients with stage 3 grade C periodontitis and type II diabetes mellitus. Materials and Methods: The primary outcome measure for this study was the clinical attachment level (CAL); secondary outcomes included additional periodontal parameters, such as the plaque index (PI), bleeding on probing (BOP), probing depth (PD), as well as glycated hemoglobin (HbA1c) levels to evaluate the systemic impact of the treatments on glycemic control. The parameters were assessed before and at three and six months post-surgery. In Group A, the flap was sutured closed; in Group B, an absorbable collagen membrane was placed over the defect; and in Group C, PRF was utilized in the defect, with two additional PRF membranes used to cover the defect. The wound healing index (WHI) was recorded at 7 and 14 days after the surgery. Results: The initial findings indicated no significant differences in the periodontal parameters among the three groups. However, improvements in the PD and CAL were most notable in Group C, followed by Group B, with Group A showing the slightest improvement. At six months, there was a highly significant difference in the CAL (p < 0.001). Group C (4.92 ± 0.35) and Group B (4.99 ± 0.31) demonstrated the most significant improvements in the CAL compared to Group A (5.89 ± 0.57). At seven days post-surgery, Group C demonstrated significant healing, with 85% of the sites showing complete healing. By the 14-day mark, all sites in Group C indicated complete healing. Although the HbA1c values did not exhibit statistically significant differences among the groups at baseline, at the 6-month evaluation, all groups showed significantly lower values than baseline. However, the comparison between groups revealed significantly improved values for Group C. Conclusions: The study’s results suggest that PRF is an exceptional material for infrabony defects treatment and notably improves HbA1c levels.

BackgroundThe current study’s aim was to evaluate and compare demineralized freeze-dried bone allograft (DFDBA) with and without concentrated growth factor (CGF) membrane in the treatment of periodontal intrabony defects on both a clinical and radiographic level.Methods30 stage III grade B periodontitis patients with bilateral intrabony defects were involved in the split mouth randomized controlled trial, and they received either DFDBA alone (control group) or DFDBA plus CGF membrane treatment (test group). At baseline and 6 and 12 months, the gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR) were assessed, whereas cone beam computed tomography was used to assess the bone defect height (BDH), vertical bone loss (VBL), bone defect depth (BDD), mesio-distal bone defect width (MDBDW), bucco-lingual bone defect width (BLBDW), and bone defect volume (CBCT) at baseline and 12 months.ResultsThe radiographic measures BDH, BDD, MDBDW, BLBDW, and BDV in the test group likewise showed a higher reduction in PPD and gain in CAL than the control group. The results of the intergroup comparison showed that the test group had statistically significant differences in BDH, BDD, and MDBDW.ConclusionThe data show that the test group achieved better results, with greater reductions in PPD, gains in CAL, and decreases in BDH, BDD, MDBDW, BLBDW, and BDV.Clinical relevanceThe use of concentrated growth factor in conjunction with demineralized freeze-dried bone allograft may be suggested for the treatment of periodontal intrabony defects.

Objectives This investigation was designed to compare the effectiveness of enamel matrix derivative (EMD) proteins in combination with flapless or flap procedure in periodontal regeneration of deep intrabony defects. Materials and methods Thirty chronic periodontitis patients who had at least one residual periodontal defect with an intrabony component of ≥3 mm were consecutively enrolled. Defects were randomly assigned to test or control treatments which both consisted of the use of EMD to reach periodontal regeneration. Test sites ( n  = 15) were treated according to a novel flapless approach, whereas control sites ( n  = 15) by means of minimally invasive surgery (MIST). Clinical and radiographic parameters were recorded at baseline, 12 and 24 months post-operatively. Results Both therapeutic modalities yielded similar probing depth (PD) reduction and clinical attachment level (CAL) gain at 24 months. In flapless-treated sites, a mean PD reduction of 3.6 ± 1.0 mm and a CAL gain of 3.2 ± 1.1 mm were observed. In the MIST group, they were 3.7 ± 0.6 and 3.6 ± 0.9 mm. The operative chair time was twice as long in the MIST compared to the flapless group, whereas comparable patient-oriented outcomes were observed. Conclusion The flapless procedure may be successfully applied in the regenerative treatment of deep intrabony defects reaching clinical outcomes comparable with those of minimally invasive surgical approaches and may present important advantages in terms of reduction of operative chair time. Clinical relevance The use of EMD as an adjunct to non-surgical periodontal treatment may be considered a suitable option to treat defects mainly in the anterior sextants.