Biomaterials for promoting periodontal regeneration in human intrabony defects: a systematic review

Abstract

Intrabony periodontal defects are a frequent complication of periodontitis and, if left untreated, may negatively affect long‐term tooth prognosis. The optimal outcome of treatment in intrabony defects is considered to be the absence of bleeding on probing, the presence of shallow pockets associated with periodontal regeneration (i.e. formation of new root cementum with functionally orientated inserting periodontal ligament fibers connected to new alveolar bone) and no soft‐tissue recession. A plethora of different surgical techniques, often including implantation of various types of bone graft and/or bone substitutes, root surface demineralization, guided tissue regeneration, growth and differentiation factors, enamel matrix proteins or various combinations thereof, have been employed to achieve periodontal regeneration. Despite positive observations in animal models and successful outcomes reported for many of the available regenerative techniques and materials in patients, including histologic reports, robust information on the degree to which reported clinical improvements reflect true periodontal regeneration does not exist. Thus, the aim of this review was to summarize, in a systematic manner, the available histologic evidence on the effect of reconstructive periodontal surgery using various types of biomaterials to enhance periodontal wound healing/regeneration in human intrabony defects. In addition, the inherent problems associated with performing human histologic studies and in interpreting the results, as well as certain ethical considerations, are discussed. The results of the present systematic review indicate that periodontal regeneration in human intrabony defects can be achieved to a variable extent using a range of methods and materials. Periodontal regeneration has been observed following the use of a variety of bone grafts and substitutes, guided tissue regeneration, biological factors and combinations thereof. Combination approaches appear to provide the best outcomes, whilst implantation of alloplastic material alone demonstrated limited, to no, periodontal regeneration.

Enamel matrix derivative and bone grafts for periodontal regeneration of intrabony defects. A systematic review and meta-analysis

“…Besides the anti-infectious therapy aiming to eliminate or reduce the periodontal pathogenic flora in order to arrest the destruction process, one important goal is to reconstruct the bone defects caused by the infectious process [2,3]. During the last decades, various treatment modalities such as the use different bone grafting materials, guided tissue regeneration (GTR), enamel matrix derivative (EMD) or combinations thereof have been used to predictably regenerate the lost tooth`s supporting tissues including root cementum, periodontal ligament, alveolar bone and gingiva [2,3].…”

Evaluation of Regenerative Therapy Using Cell Sheet Through Cementum Protein-1 Expression on Macaca Nemestrina

“…This technique aims to eliminate granulation and necrotic tissue at the bone defect area and thus induce healing. Bone grafts and guided tissue regeneration using membranes are common regenerative materials used in periodontal therapy [2,3].…”

“…A bone defect with crater defects or a vertical defect with a three-wall bony defect is suitable for the bone grafting procedure [2]. A one-wall bone defect or horizontal bone defect has less healthy cells and a large defect, causing difficulties in the ability of grafts to produce regenerative cells that are similar to or that resemble the lost tissue [4,5].…”

Additional use of autogenous periosteal barrier membrane combined with regenerative therapy in the interproximal intrabony defects: case series

“…5,6 Several bone graft materials, bioactive materials and growth factors can be adopted for regenerative surgery. 7 The use of an enamel matrix derivative (EMD), an extract of the enamel proteins including amelogenins of various molecular weights, would generate fewer post-operative complications. 8 Systematic reviews of several clinical trials have shown that some of these materials, when used in conjunction with surgical approaches designed to facilitate maximal preservation of soft and hard tissues, may indeed result in superior clinical outcomes.…”