Efficacy of inorganic bovine bone combined with leukocyte and platelet‐rich fibrin or collagen membranes for treating unfavorable periodontal infrabony defects: Randomized non‐inferiority trial

Abstract

Background: Growing evidence shows the efficacy of platelet concentrates in periodontal therapy. This study aimed to demonstrate that an inorganic bovine bone graft (IBB) in combination with a leukocyte and platelet rich fibrin (L-PRF) is non-inferior to a combination with a collagen membrane (CM) when managing unfavorable infrabony defects (IBDs). Methods: All patients exhibited at least one unfavorable IBD; they were randomly assigned to two groups, 31 treated with L-PRF+IBB and 31 with CM+IBB.A clinical and radiographic examination was performed at baseline and 12 months later. Clinical attachment level (CAL), gingival recession (GR), probing depth (PD), and radiographic defect bone level (DBL) post-therapy changes were compared between the two treatments. A non-inferiority margin = 1 mm was set to determine the efficacy of the test treatment (-1 mm for GR); a second noninferiority margin = 0.5 mm (-0.5 mm for GR) was chosen for clinical relevance.Results: Twelve months after surgery a significant improvement of clinical and radiographic parameters was observed at both experimental sites. The 90% confidence intervals of the CM+IBB-L-PRF+IBB mean difference for CAL gain (-0.810 mm [-1.300 to -0.319]) and DBL gain (-0.648 mm [-1.244 to -0.052]) were below the 0.5 mm non-inferiority margin; GR increase (1.284 mm [0.764 to 1.804]) remained above the -0.5 mm, while PD reduction (0.499 mm [0.145 to 0.853]) crossed its 0.5-mm margin. Conclusions:The L-PRF+IBB treatment of unfavorable IBDs offers noninferior efficacy for CAL gain, showing less GR and more DBL gain too, while for PD reduction it is inferior to the CM+IBB treatment.

The Outcomes of Enamel Matrix Derivative on Periodontal Regeneration under Diabetic Conditions

“…Enhanced osteoclastogenesis is present because of the chronic inflammation throughout the body, as well as at the periodontium level, increasing the risk of developing periodontal disease for diabetic patients [21]. Therefore, alternatives such as platelet-rich fibrin with/without inorganic bovine bone or autologous bone alone or combined with xenogenic bone should be taken into account [32,33].…”

Peri-Implant Mucosa Augmentation with an Acellular Collagen Matrix

“…Given the limited information available, we recommend that clinicians ensure close contact between the aCM and underlying periosteum, combined with secure fixation to prevent micro-movements that could destroy newly formed blood vessel networks. It would be interesting to check if the use of additional biomaterials in combination with aCM will provide enhanced regenerative effect [ 31 ].…”

Impact of Magnetic Stimulation on Periodontal Ligament Stem Cells

“…Seo et al in 2004 isolated, for the first time, PDLSCs from impacted human third molars and discovered their ability to differentiate into periodontal bones, cementum, alveolar ligaments, peripheral nerves and blood vessels [ 6 , 7 , 8 ]. The advantage is that these cells can differentiate into various cell lines as a consequence of the stimulatory agents used in their management [ 9 ].…”

“…It is well known that PDLSCs have an important role in maintaining periodontal homeostasis and are responsible for the regeneration and remodelling of periodontal tissues [ 8 , 10 ]. As reported in the literature, several biological mediators can influence cell phenotype and functions in the PDL and represent critical factors to understanding the homeostatic mechanisms regulating the regeneration of the PDL [ 11 ].…”