Guided tissue regeneration for periodontal infra-bony defects (Cochrane Review)

Eastman Dental Institute for Oral Health Care Sciences, Dept of Periodontology, University College London, University of London, 256 Gray's Inn Road, London, UK, WC1X 8LD.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 19(2):CD001724. DOI: 10.1002/14651858.CD001724.pub2
Source: PubMed


Current treatments for destructive periodontal (gum) disease are not able to restore damaged bone and connective tissue support for teeth. There are therefore limitations in treating patients with advanced disease. The surgical technique, guided tissue regeneration (GTR) may be able to achieve regeneration and therefore improve upon conventional surgical results. The results of this review have shown some advantage to using GTR in infra-bony defects but with wide variations in the benefits achievable compared with conventional surgery. We were unable to identify conclusively factors responsible for this variability. Therefore, patients and health professionals need to consider the predictability of the technique compared with other methods of treatment before making final decisions on use. Adverse effects of treatment were generally minor and similar between groups although with an increased treatment time for GTR. We recommend further research to address the issue of variability and to identify which characteristics of the disease or the patient are more clearly associated with a beneficial outcome.

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Available from: Helen V Worthington, Jan 02, 2014
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    • "Periodontal regeneration employing the tissue engineering triad of stem/progenitor cells' application with suitable scaffolds and biological agents appears to present a promising future alternative to classical GTR (Bartold et al., 2006), characterized by regenerative outcomes of small magnitude and large variability (Needleman et al., 2006, Sculean et al., 2008). Recent studies illustrated a significant capacity of stem/progenitor cells to successfully regenerate periodontal tissues in vivo (Monsarrat et al., 2014). "
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    ABSTRACT: The present study investigated the periodontal regenerative potential of gingival margin-derived stem/progenitor cells (G-MSCs) in conjunction with IL-1ra releasing hyaluronic acid synthetic extracellular matrix (HA-sECM). Periodontal defects were induced at four sites in eight miniature-pigs in the premolar/molar area (-4 weeks). Autologus G-MSCs were isolated from the free gingival margin and magnetically sorted using anti-STRO-1-antibodies. Colony-formation and multilineage differentiation potential were tested. The G-MSCs were expanded and incorporated into IL-1ra-loaded/unloaded HA-sECM. Within every miniature-pig, four periodontal defects were randomly treated with IL-1ra/G-MSCs/HA-sECM (test-group), G-MSCs/HA-sECM (positive-control), scaling and root planning (SRP; negative-control-1) or left untreated (no-treatment; negative-control-2). Differences in clinical attachment level (ΔCAL), probing depth (ΔPD), gingival recession (ΔGR), radiographic-defect-volume (ΔRDV) and changes in bleeding on probing (BOP) between baseline and 16-weeks-post-transplantation, as well as periodontal attachment level (PAL), junctional epithelium length (JE), connective tissue adhesion (CTA), cementum regeneration (CR) and bone regeneration (BR) at 16-weeks-post-transplantation were evaluated. Isolated G-MSCs showed stem/progenitor-cell characteristics. IL-1ra loaded and unloaded G-MSCs/HA-sECM showed higher ΔCAL, ΔPD, ΔGR, PAL, CR and BR as well as a lower JE compared to their negative controls and improved BOP. G-MSCs in conjunction with IL-1ra-loaded/unloaded HA-sECM show a significant periodontal regenerative potential. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Full-text · Article · Apr 2015 · Journal Of Clinical Periodontology
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    • "The flow chart of selection and reasons for exclusion are in Figure  1. We included 18 systematic reviews [18-36]; 8 were Cochrane systematic reviews [23,25-27,30,33,34,36]. The selected reviews were all published recently (range 2006 to 2013). "
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    ABSTRACT: Background Split-mouth randomized controlled trials (RCTs) are popular in oral health research. Meta-analyses frequently include trials of both split-mouth and parallel-arm designs to derive combined intervention effects. However, carry-over effects may induce bias in split- mouth RCTs. We aimed to assess whether intervention effect estimates differ between split- mouth and parallel-arm RCTs investigating the same questions. Methods We performed a meta-epidemiological study. We systematically reviewed meta- analyses including both split-mouth and parallel-arm RCTs with binary or continuous outcomes published up to February 2013. Two independent authors selected studies and extracted data. We used a two-step approach to quantify the differences between split-mouth and parallel-arm RCTs: for each meta-analysis. First, we derived ratios of odds ratios (ROR) for dichotomous data and differences in standardized mean differences (∆SMD) for continuous data; second, we pooled RORs or ∆SMDs across meta-analyses by random-effects meta-analysis models. Results We selected 18 systematic reviews, for 15 meta-analyses with binary outcomes (28 split-mouth and 28 parallel-arm RCTs) and 19 meta-analyses with continuous outcomes (28 split-mouth and 28 parallel-arm RCTs). Effect estimates did not differ between split-mouth and parallel-arm RCTs (mean ROR, 0.96, 95% confidence interval 0.52–1.80; mean ∆SMD, 0.08, -0.14–0.30). Conclusions Our study did not provide sufficient evidence for a difference in intervention effect estimates derived from split-mouth and parallel-arm RCTs. Authors should consider including split-mouth RCTs in their meta-analyses with suitable and appropriate analysis.
    Full-text · Article · May 2014 · BMC Medical Research Methodology
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    • "Congenital malformations, trauma or periodontal disease and other factors often lead to different degrees of alveolar bone defects, injuring to tooth supporting tissues, causing damages to periodontal attachment loss, eventually leading to loss of tooth [1]. Currently, several main treatment modalities such as periodontal bone grafting, guided tissue regeneration and guided bone regeneration have been developed for periodontal tissue repair [1], [2]. However, the clinical outcomes of these approaches vary tremendously among individual patients [3], [4]. "
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    ABSTRACT: Human periodontal ligament cells (hPDLCs) possess stem cell properties, which play a key role in periodontal regeneration. Physical stimulation at appropriate intensities such as low-intensity pulsed ultrasound (LIPUS) enhances cell proliferation and osteogenic differentiation of mesechymal stem cells. However, the impacts of LIPUS on osteogenic differentiation of hPDLCs in vitro and its molecular mechanism are unknown. This study was undertaken to investigate the effects of LIPUS on osteogenic differentiation of hPDLCs. HPDLCs were isolated from premolars of adolescents for orthodontic reasons, and exposed to LIPUS at different intensities to determine an optimal LIPUS treatment dosage. Dynamic changes of alkaline phosphatase (ALP) activities in the cultured cells and supernatants, and osteocalcin production in the supernatants after treatment were analyzed. Runx2 and integrin β1 mRNA levels were assessed by reverse transcription polymerase chain reaction analysis after LIPUS stimulation. Blocking antibody against integrinβ1 was used to assess the effects of integrinβ1 inhibitor on LIPUS-induced ALP activity, osteocalcin production as well as calcium deposition. Our data showed that LIPUS at the intensity of 90 mW/cm2 with 20 min/day was more effective. The ALP activities in lysates and supernatants of LIPUS-treated cells started to increase at days 3 and 7, respectively, and peaked at day 11. LIPUS treatment significantly augmented the production of osteocalcin after day 5. LIPUS caused a significant increase in the mRNA expression of Runx2 and integrin β1, while a significant decline when the integrinβ1 inhibitor was used. Moreover, ALP activity, osteocalcin production as well as calcium nodules of cells treated with both daily LIPUS stimulation and integrinβ1 antibody were less than those in the LIPUS-treated group. In conclusion, LIPUS promotes osteogenic differentiation of hPDLCs, which is associated with upregulation of Runx2 and integrin β1, which may thus provide therapeutic benefits in periodontal tissue regeneration.
    Full-text · Article · Apr 2014 · PLoS ONE
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