Current Status of Regenerative Periodontal Treatment
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Purpose of Review
Periodontal regenerative therapy aims to completely restore the tooth’s supporting tissues (e.g., periodontal ligament, root cementum, alveolar bone, and gingiva) which have been lost following periodontal disease or trauma. The histologic outcomes should translate in substantial clinical improvements evidenced by probing depth reduction, gain in clinical attachment level, and bone fill. The present review provides a brief overview of the current status of periodontal regenerative therapy.
There is plenty of evidence to support the use of guided tissue regeneration (GTR) techniques and the application of enamel matrix proteins (EMD) onto the exposed root result in true periodontal regenerative. The use of various growth factors and autologous blood concentrates for periodontal regeneration also have produced positive results, but more studies are needed. In general, both GTR and EMD, alone or in combination with bone grafts or substitutes, result in larger clinical improvements compared to conventional periodontal treatment for deep intrabony and furcation Class II defects. Important factors that negatively impact on the clinical outcomes of periodontal regeneration procedures are smoking, large number of remaining sites with bleeding on probing, bad oral hygiene, and increased tooth mobility.
The magnitude of improvement arising from periodontal regenerative techniques and procedures depends largely on operator skills, not only in terms of dexterity but also on the ability to choose the best approach regarding the surgical technique and the regenerative technology depending on patient- and site-specific criteria. The clinical improvements after regenerative treatment can be preserved on a long-term basis on the majority of treated sites, provided that patients do not smoke, keep high oral hygiene standards, and attend regularly SPT.
KeywordsPeriodontal regeneration Intrabony Furcation GTR EMD PRP
Compliance with Ethical Standards
Conflict of Interest
Andreas Stavropoulos received nonfinancial support from Institute Straumann AG, Geistlick Pharma AG, and Scil Technology GmbH outside of the submitted work. Anton Sculean reports financial support in the form of a research grant from Institute Straumann AG outside of the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.•• Wikesjö UM, Polimeni G, Xiropaidis AV, Stavropoulos A. Periodontal wound healing/regeneration. In: Sculean A, editor. Periodontal regenerative therapy. 1st ed. London: Quintessence Publishing; 2010. p. 25–45 .This book chapter provides an extended overview of periodontal wound healing/regenerationGoogle Scholar
- 4.Tonetti MS, Claffey N, European Workshop in Periodontology group C. Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research. Group C consensus report of the 5th European Workshop in Periodontology. J Clin Periodontol. 2005;32(Suppl 6):210–3.CrossRefPubMedGoogle Scholar
- 8.•• Matuliene G, Pjetursson BE, Salvi GE, Schmidlin K, Brägger U, Zwahlen M, et al. Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol. 2008;35(8):685–95. This manuscript clearly shows the negative influence of deep pockets and furcation involvement on tooth survivalCrossRefPubMedGoogle Scholar
- 12.•• Axelsson P, Nystrom B, Lindhe J. The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. J Clin Periodontol. 2004;31(9):749–57. This manuscript shows the importance of supportive periodontal treatment for the long-term preservation of the successful outcomes of periodontal treatmentCrossRefPubMedGoogle Scholar
- 20.Needleman IG, Worthington HV, Giedrys-Leeper E, Tucker RJ. Guided tissue regeneration for periodontal infra-bony defects. Cochrane Database Syst Rev. 2006;(2):CD001724.Google Scholar
- 21.Esposito M, Grusovin MG, Papanikolaou N, Coulthard P, Worthington HV. Enamel matrix derivative (Emdogain(R)) for periodontal tissue regeneration in intrabony defects. Cochrane Database Syst Rev. 2009;(4):CD003875.Google Scholar
- 23.Tonetti MS, Cortellini P, Suvan JE, Adriaens P, Baldi C, Dubravec D, et al. Generalizability of the added benefits of guided tissue regeneration in the treatment of deep intrabony defects. Evaluation in a multi-center randomized controlled clinical trial. J Periodontol. 1998;69(11):1183–92.CrossRefPubMedGoogle Scholar
- 29.Stavropoulos A, Windisch P, Gera I, Sculean A. Guided tissue regeneration: biological concept and clinical application in intrabony defects. In: Sculean A, editor. Periodontal regenerative therapy. 1st ed. London: Quintessence Publishing; 2010. p. 47–56.Google Scholar
- 31.Stavropoulos A. Guided tissue regeneration in combination with deproteinized bovine bone and gentamicin. PhD Thesis; Dept. of Periodontology, School of Dentistry, Aarhus University; 2002.Google Scholar
- 33.Eickholz P. Prognostic and risk factors for periodontal regenerative therapy. In: Sculean A, editor. Periodontal regenerative therapy. 1st ed. London: Quintessence Publishing; 2010. p. 231–9.Google Scholar
- 34.Eickholz P, Jepsen S. Guided tissue regeneration: application in furcation defects. In: Sculean A, editor. Periodontal regenerative therapy. 1st ed. London: Quintessence Publishing; 2010. p. 57–67.Google Scholar
- 35.Huynh-Ba G, Kuonen P, Hofer D, Schmid J, Lang NP, Salvi GE. The effect of periodontal therapy on the survival rate and incidence of complications of multirooted teeth with furcation involvement after an observation period of at least 5 years: a systematic review. J Clin Periodontol. 2009;36(2):164–76.CrossRefPubMedGoogle Scholar
- 37.•• Kostopoulos L, Karring T. Susceptibility of GTR-regenerated periodontal attachment to ligature-induced periodontitis. J Clin Periodontol. 2004;31(5):336–40. This manuscript demonstrated that regenerated periodontal tissues are not more vulnerable to periodontal inflammation than the pristine periodontiumCrossRefPubMedGoogle Scholar
- 39.Hammarström L, Sculean A, Lyngstadaas SP. The biological background of Emdogain. In: Sculean A, editor. Periodontal regenerative therapy. 1st ed. London: Quintessence Publishing; 2010. p. 69–87.Google Scholar
- 47.Miron RJ, Bosshardt DD, Laugisch O, Katsaros C, Buser D, Sculean A. Enamel matrix protein adsorption to root surfaces in the presence or absence of human blood. J Periodontol. 2012;83:885–92.Google Scholar
- 49.Jepsen S, Heinz B, Jepsen K, Arjomand M, Hoffmann T, Richter S, et al. A randomized clinical trial comparing enamel matrix derivative and membrane treatment of buccal class II furcation involvement in mandibular molars. Part I: study design and results for primary outcomes. J Periodontol. 2004;75(8):1150–60.CrossRefPubMedGoogle Scholar
- 50.Casarin RCV, Del Peloso Ribeiro E, Nociti FH, Sallum AW, Sallum EA, Ambrosano GMB, et al. A double-blind randomized clinical evaluation of enamel matrix derivative proteins for the treatment of proximal class-II furcation involvements. J Clin Periodontol. 2008;35(5):429–37.CrossRefPubMedGoogle Scholar
- 52.Siciliano VI, Andreuccetti G, Siciliano AI, Blasi A, Sculean A, Salvi GE. Clinical outcomes after treatment of non-contained intrabony defects with enamel matrix derivative or guided tissue regeneration: a 12-month randomized controlled clinical trial. J Periodontol. 2011;82(1):62–71.CrossRefPubMedGoogle Scholar
- 54.• Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, et al. 20 years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43(8):668–83. This manuscript provides a comprehensive review of enamel matrix proteins in regenerative periodontal treatmentCrossRefPubMedGoogle Scholar
- 55.Miron RJ, Shuang Y, Sculean A, Buser D, Chandad F, Zhang Y. Gene array of PDL cells exposed to Osteogain in combination with a bone grafting material. Clin Oral Invest. 2016;20(8):2037–43.Google Scholar
- 62.Iorio Siciliano V, Andreuccetti G, Blasi A, Matarasso M, Sculean A, Salvi GE. Clinical outcomes following regenerative therapy of non-contained intrabony defects using a deproteinized bovine bone mineral combined with either enamel matrix derivative or collagen membrane. J Periodontol. 2014;85(10):1342–50.CrossRefPubMedGoogle Scholar
- 64.• Stavropoulos A, Wikesjö UME. Growth and differentiation factors for periodontal regeneration: a review on factors with clinical testing. J Periodontal Res. 2012;47(5):545–53. This manuscript provides an extended review on the use of growth and differentiation factors in regenerative periodontal treatmentCrossRefPubMedGoogle Scholar
- 66.Nevins M, Kao RT, McGuire MK, McClain PK, Hinrichs JE, McAllister BS, et al. Platelet-derived growth factor promotes periodontal regeneration in localized osseous defects: 36-month extension results from a randomized, controlled, double-masked clinical trial. J Periodontol. 2013;84(4):456–64.CrossRefPubMedGoogle Scholar
- 67.Ridgway HK, Mellonig JT, Cochran DL. Human histologic and clinical evaluation of recombinant human platelet-derived growth factor and beta-tricalcium phosphate for the treatment of periodontal intraosseous defects. J Periodontol. 2008;28(2):171–9.Google Scholar
- 72.Del Corso M, Vervelle A, Simonpieri A, Jimbo R, Inchingolo F, Sammartino G, et al. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 1: periodontal and dentoalveolar surgery. Curr Pharm Biotechnol. 2012;13(7):1207–30.CrossRefPubMedGoogle Scholar
- 73.Simonpieri A, Del Corso M, Vervelle A, Jimbo R, Inchingolo F, Sammartino G, et al. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 2: bone graft, implant and reconstructive surgery. Curr Pharm Biotechnol. 2012;13(7):1231–56.CrossRefPubMedGoogle Scholar
- 74.Marx RE. Platelet-rich plasma: evidence to support its use. YJOMS. 2004;62(4):489–96.Google Scholar
- 82.Dohan Ehrenfest DM, Andia I, Zumstein MA, Zhang C-Q, Pinto NR, Bielecki T. Classification of platelet concentrates (platelet-rich plasma-PRP, platelet-rich fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J. 2014;4(1):3–9.PubMedPubMedCentralGoogle Scholar