Periodontal regeneration techniques for treatment of periodontal diseases.

The ultimate goal of periodontal therapy is the regeneration of structures lost to disease. Conventional surgical approaches such as open-flap debridement offer only limited regeneration potential.Currently, surgical procedures for predictable regeneration of periodontal tissues are being developed, analyzed, and employed in clinical practice. This article addresses current trends in periodontal regeneration. Various materials/agents such as bone replacement grafts, barrier membranes, and biologic modifiers currently used for the regeneration of periodontal infrabony and furcation defects are discussed.

[1]  J. Egelberg Regeneration and repair of periodontal tissues. , 1987, Journal of periodontal research.

[2]  R. Celletti,et al.  Guided tissue regeneration with and without citric acid treatment in vertical osseous defects. , 1991, The International journal of periodontics & restorative dentistry.

[3]  J. Fiorellini,et al.  A phase I/II clinical trial to evaluate a combination of recombinant human platelet-derived growth factor-BB and recombinant human insulin-like growth factor-I in patients with periodontal disease. , 1997, Journal of periodontology.

[4]  D. Asher,et al.  WHO Consultation on Diagnostic Procedures for Transmissible Spongiform Encephalopathies: Need for Reference Reagents and Reference Panels. Geneva, Switzerland, 22-23 March 1999. , 1999, Biologicals : journal of the International Association of Biological Standardization.

[5]  K. Al-Shammari,et al.  Guided tissue regeneration-based root coverage utilizing collagen membranes: technique and case reports. , 2002, Quintessence international.

[6]  S. Nyman,et al.  Histometric evaluation of periodontal surgery. II. Connective tissue attachment levels after four regenerative procedures. , 1980, Journal of clinical periodontology.

[7]  K. Patil,et al.  Long-term evaluation of periodontal therapy: I. Response to 4 therapeutic modalities. , 1996, Journal of periodontology.

[8]  D. Carnes,et al.  Porcine fetal enamel matrix derivative enhances bone formation induced by demineralized freeze dried bone allograft in vivo. , 2000, Journal of periodontology.

[9]  C. McCulloch Basic considerations in periodontal wound healing to achieve regeneration. , 1993, Periodontology 2000.

[10]  D. Carnes,et al.  Ability of commercial demineralized freeze-dried bone allograft to induce new bone formation is dependent on donor age but not gender. , 1998, Journal of periodontology.

[11]  S. Nyman,et al.  Periodontal regeneration via selective cell repopulation. , 1987, Journal of periodontology.

[12]  J. Qian,et al.  Enhanced cell attachment to anorganic bone mineral in the presence of a synthetic peptide related to collagen. , 1996, Journal of Biomedical Materials Research.

[13]  H. L. Wang,et al.  Guided tissue regeneration. Absorbable barriers. , 1998, Dental clinics of North America.

[14]  H L Wang,et al.  Collagen membranes: a review. , 2001, Journal of periodontology.

[15]  J. Mellonig,et al.  Healing in periodontal defects treated by decalcified freeze-dried bone allografts in combination with ePTFE membranes (I). Clinical and scanning electron microscope analysis. , 1993, Journal of clinical periodontology.

[16]  D. Carnes,et al.  Ability of commercial demineralized freeze-dried bone allograft to induce new bone formation. , 1996, Journal of periodontology.

[17]  T. Karring,et al.  Clinical evaluation of an enamel matrix derivative in the treatment of mandibular degree II furcation involvement: a 36-month case series. , 2003, The International journal of periodontics & restorative dentistry.

[18]  M. Listgarten,et al.  Histological study of repair following new attachment procedures in human periodontal lesions. , 1979, Journal of periodontology.

[19]  S. Froum,et al.  Healing responses of human intraosseous lesions following the use of debridement, grafting and citric acid root treatment. I. Clinical and histologic observations six months postsurgery. , 1983, Journal of periodontology.

[20]  R. Yukna,et al.  5-year evaluation of durapatite ceramic alloplastic implants in periodontal osseous defects. , 1989, Journal of periodontology.

[21]  A. Polson,et al.  Osseous repair in infrabony periodontal defects. , 1978, Journal of clinical periodontology.

[22]  J. Gunsolley,et al.  Surgical therapies for the treatment of gingival recession. A systematic review. , 2003, Annals of periodontology.

[23]  R. Caffesse,et al.  A longitudinal study comparing scaling, osseous surgery and modified Widman procedures. Results after one year. , 1988, Journal of periodontology.

[24]  R. Corio,et al.  Histologic evaluation of new attachment apparatus formation in humans. Part II. , 1989, Journal of periodontology.

[25]  M. Crigger,et al.  Effects of citric acid on diseased root surfaces. , 1978, Journal of periodontal research.

[26]  S. von Hagen,et al.  Changes in alveolar bone height and width following post-extraction ridge augmentation using a fixed bioabsorbable membrane and demineralized freeze-dried bone osteoinductive graft. , 2003, Journal of periodontology.

[27]  S. Froum,et al.  Histological evaluation of human intraosseous healing responses to the placement of tricalcium phosphate ceramic implants. I. Three to eight months. , 1986, Journal of periodontology.

[28]  L. Sennerby,et al.  Histologic analysis of clinical biopsies taken 6 months and 3 years after maxillary sinus floor augmentation with 80% bovine hydroxyapatite and 20% autogenous bone mixed with fibrin glue. , 2001, Clinical implant dentistry and related research.

[29]  G. Pini-Prato,et al.  Effect of cigarette smoking on periodontal healing following GTR in infrabony defects. A preliminary retrospective study. , 2005, Journal of clinical periodontology.

[30]  R. McHugh,et al.  Comparison of surgical and nonsurgical treatment of periodontal disease. A review of current studies and additional results after 61/2 years. , 1983, Journal of clinical periodontology.

[31]  J. Seyer,et al.  Chemotactic attraction of human fibroblasts to type I, II, and III collagens and collagen-derived peptides. , 1978, Proceedings of the National Academy of Sciences of the United States of America.

[32]  S. D. Stein,et al.  Histological assessment of autogenous bone graft. A case report and critical evaluation. , 1979, Journal of periodontology.

[33]  A. Register,et al.  Accelerated reattachment with cementogenesis to dentin, demineralized in situ. II. Defect repair. , 1976, Journal of periodontology.

[34]  T. Mabry,et al.  Effect of various graft materials with tetracycline in localized juvenile periodontitis. , 1989, Journal of periodontology.

[35]  M. Nunn,et al.  Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 1: Comparison of clinical parameters. , 2003, Journal of periodontology.

[36]  T. O'Leary,et al.  AUTOGENOUS BONE TRANSPLANTS IN THE TREATMENT OF OSSEOUS DEFECTS. , 1965, The Journal of periodontology.

[37]  D. Cochran,et al.  Clinical evaluation of bioactive glass in the treatment of periodontal osseous defects in humans. , 1998, Journal of periodontology.

[38]  R. Yukna,et al.  Thirty-six month follow-up of 25 patients treated with combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell-binding peptide (P-15) bone replacement grafts in human infrabony defects. I. Clinical findings. , 2002, Journal of periodontology.

[39]  A. Steinberg,et al.  Extravascular clot formation and platelet activation on variously treated root surfaces. , 1986, Journal of periodontology.

[40]  M. Somerman Is there a role for DFDBA in periodontal regenerative therapy? , 1996, Journal of periodontology.

[41]  J. Mellonig Human histologic evaluation of a bovine-derived bone xenograft in the treatment of periodontal osseous defects. , 2000, The International journal of periodontics & restorative dentistry.

[42]  A. Forlino,et al.  Effect of enamel matrix derivative on human periodontal fibroblasts: proliferation, morphology and root surface colonization. An in vitro study. , 2003, Journal of periodontal research.

[43]  R. Yukna,et al.  Multi-center clinical evaluation of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) as a bone replacement graft material in human periodontal osseous defects. 6-month results. , 1998, Journal of periodontology.

[44]  K. Selvig,et al.  The effect of topical citric acid application on the healing of experimental furcation defects in dogs. , 1978, Journal of periodontal research.

[45]  D. Gardiner,et al.  Frequency of furcation closure with regenerative periodontal therapy. , 1996, The Journal of the Western Society of Periodontology/Periodontal abstracts.

[46]  J. Mellonig,et al.  Comparison of decalcified freeze-dried bone allograft and porous particulate hydroxyapatite in human periodontal osseous defects. , 1989, Journal of periodontology.

[47]  A. Reddi,et al.  Histologic comparison of regeneration in human intrabony defects when osteogenin is combined with demineralized freeze-dried bone allograft and with purified bovine collagen. , 1991, Journal of periodontology.

[48]  J. Mellonig,et al.  Comparison of freeze-dried bone allograft and porous hydroxylapatite in human periodontal defects. , 1989, Journal of periodontology.

[49]  A. Sculean,et al.  Four-year results following treatment of intrabony periodontal defects with an enamel matrix protein derivative: a report of 46 cases. , 2003, The International journal of periodontics & restorative dentistry.

[50]  J. Fiorellini,et al.  Human histologic evaluation of bioactive ceramic in the treatment of periodontal osseous defects. , 2000, The International journal of periodontics & restorative dentistry.

[51]  Y. Shyr,et al.  Evaluation of a bioactive glass alloplast in treating periodontal intrabony defects. , 1998, Journal of periodontology.

[52]  T. Karring,et al.  New attachment formation by guided tissue regeneration. , 1987, Journal of periodontal research.

[53]  J. Strub,et al.  Maxillary sinus augmentation using different grafting materials and dental implants in monkeys. Part IV. Evaluation of hydroxyapatite-coated implants. , 1997, Clinical oral implants research.

[54]  J. Mellonig,et al.  Clinical evaluation of guided tissue regeneration in the treatment of maxillary class II molar furcation invasions. , 1991, Journal of periodontology.

[55]  C R Anderegg,et al.  Gingiva thickness in guided tissue regeneration and associated recession at facial furcation defects. , 1995, Journal of periodontology.

[56]  R. Frank,et al.  Periodontal guided tissue regeneration with a new resorbable polylactic acid membrane. , 1994, Journal of periodontology.

[57]  J. Lindhe,et al.  Guided tissue regeneration in the treatment of degree II furcations in maxillary molars. , 1995, Journal of clinical periodontology.

[58]  M. Nieri,et al.  Coronally advanced flap procedure for root coverage. Is flap thickness a relevant predictor to achieve root coverage? A 19-case series. , 1999, Journal of periodontology.

[59]  E. Reich,et al.  Treatment of intrabony periodontal defects with an enamel matrix protein derivative (Emdogain): a report of 32 cases. , 1999, The International journal of periodontics & restorative dentistry.

[60]  R. Parodi,et al.  Treatment of intrabony pockets with Emdogain: results at 36 months. , 2004, The International journal of periodontics & restorative dentistry.

[61]  P. Dowell,et al.  Guided tissue regeneration , 1991, British dental journal.

[62]  W. Giannobile,et al.  Recombinant human osteogenic protein-1 (OP-1) stimulates periodontal wound healing in class III furcation defects. , 1998, Journal of periodontology.

[63]  C. Kowalski,et al.  Guided tissue regeneration-based root coverage: meta-analysis. , 2003, Journal of periodontology.

[64]  H. L. Wang,et al.  Using absorbable collagen membranes for guided tissue regeneration, guided bone regeneration, and to treat gingival recession. , 2000, Compendium of continuing education in dentistry.

[65]  W. H. Hiatt,et al.  Intraoral transplants of cancellous bone and marrow in periodontal lesions. , 1973, Journal of periodontology.

[66]  J. Steinberg,et al.  The use of collagen membrane barriers in conjunction with combined demineralized bone-collagen gel implants in human infrabony defects. , 1990, Journal of periodontology.

[67]  L L Hench,et al.  Surface-active biomaterials. , 1984, Science.

[68]  J. Gunsolley,et al.  The efficacy of bone replacement grafts in the treatment of periodontal osseous defects. A systematic review. , 2003, Annals of periodontology.

[69]  M. M. Rosenberg Free osseous tissue autografts as a predictable procedure. , 1971, Journal of periodontology.

[70]  G. Liuzzo,et al.  Use of Emdogain in the treatment of deep intrabony defects: 12-month clinical results. Histologic and radiographic evaluation. , 2000, The International journal of periodontics & restorative dentistry.

[71]  K. Selvig,et al.  Surgical treatment of intrabony periodontal defects using expanded polytetrafluoroethylene barrier membranes: influence of defect configuration on healing response. , 1993, Journal of periodontology.

[72]  William Becker,et al.  Treatment of Mandibular 3-Wall Intrabony Defects by Flap Debridement and Expanded Polytetrafluoroethylene Barrier Membranes. Long-Term Evaluation of 32 Treated Patients. , 1993, Journal of periodontology.

[73]  K. Selvig,et al.  Regenerative surgery of intrabony periodontal defects using ePTFE barrier membranes: scanning electron microscopic evaluation of retrieved membranes versus clinical healing. , 1992, Journal of periodontology.

[74]  M. Somerman,et al.  Growth and amelogenin-like factors in periodontal wound healing. A systematic review. , 2003, Annals of periodontology.

[75]  J. Brekke,et al.  The use of biodegradable polylactic acid barrier materials in the treatment of grade II periodontal furcation defects in humans--Part II: A multicenter investigative surgical study. , 1999, The International journal of periodontics & restorative dentistry.

[76]  W. R. Moore,et al.  Synthetic bone graft substitutes , 2001, ANZ journal of surgery.

[77]  H. L. Wang,et al.  Guided bone regeneration using bone grafts and collagen membranes. , 2001, Quintessence international.

[78]  R. Genco,et al.  Clinical, microbiological, and histological factors which influence the success of regenerative periodontal therapy. , 1994, Journal of periodontology.

[79]  K. G. Murphy,et al.  Guided tissue regeneration for the treatment of periodontal intrabony and furcation defects. A systematic review. , 2003, Annals of periodontology.

[80]  S. Lindskog,et al.  Effect of different concentrations of EDTA on smear removal and collagen exposure in periodontitis-affected root surfaces. , 1997, Journal of clinical periodontology.

[81]  S. Froum,et al.  Comparison of bioactive glass synthetic bone graft particles and open debridement in the treatment of human periodontal defects. A clinical study. , 1998, Journal of periodontology.

[82]  D. Cochran,et al.  Periodontal regeneration with a combination of enamel matrix proteins and autogenous bone grafting. , 2003, Journal of periodontology.

[83]  T. Karring,et al.  New attachment following surgical treatment of human periodontal disease. , 1982, Journal of clinical periodontology.

[84]  B. Gantes,et al.  Treatment of periodontal furcation defects. (II). Bone regeneration in mandibular class II defects. , 1988, Journal of clinical periodontology.

[85]  H L Wang,et al.  Evaluation of an absorbable collagen membrane in treating Class II furcation defects. , 1994, Journal of periodontology.

[86]  S. Garrett Periodontal regeneration around natural teeth. , 1996, Journal of the American Dental Association.

[87]  B. Gantes,et al.  Treatment of periodontal furcation defects. (I). Review of the literature and description of a regenerative surgical technique. , 1988, Journal of clinical periodontology.

[88]  J. Mellonig,et al.  Bone Allografts in Periodontal Therapy , 1996, Clinical orthopaedics and related research.

[89]  C. Daly Anti-bacterial effect of citric acid treatment of periodontally diseased root surfaces in vitro. , 1982, Journal of clinical periodontology.

[90]  J. Mellonig,et al.  A comparison of freeze-dried bone allograft and demineralized freeze-dried bone allograft in human periodontal osseous defects. , 1989, Journal of periodontology.

[91]  S. Lynch,et al.  Evaluation of periodontal regeneration following grafting intrabony defects with bio-oss collagen: a human histologic report. , 2003, The International journal of periodontics & restorative dentistry.

[92]  H. C. Sullivan,et al.  A Clinical and Histological Evaluation of Autogenous Iliac Bone Grafts in Humans: Part I. Wound Healing 2 to 8 Months , 1973 .

[93]  J. Mattson,et al.  The use of 2 bioabsorbable barrier membranes in the treatment of interproximal intrabony periodontal defects. , 1999, Journal of periodontology.

[94]  S. Lynch,et al.  Periodontal regeneration in humans using recombinant human platelet-derived growth factor-BB (rhPDGF-BB) and allogenic bone. , 2003, Journal of periodontology.

[95]  M. Spector,et al.  Anorganic bovine bone and ceramic analogs of bone mineral as implants to facilitate bone regeneration. , 1994, Clinics in plastic surgery.

[96]  R. Caffesse,et al.  A longitudinal study comparing scaling, osseous surgery, and modified Widman procedures: results after 5 years. , 1988, Journal of periodontology.

[97]  M. Somerman,et al.  Commercially-prepared allograft material has biological activity in vitro. , 1995, Journal of periodontology.

[98]  S. Nyman,et al.  Histometric evaluation of periodontal surgery. I. The modified Widman flap procedure. , 1980, Journal of clinical periodontology.

[99]  Y. Shyr,et al.  Evaluation of a collagen membrane with and without bone grafts in treating periodontal intrabony defects. , 1995, Journal of periodontology.

[100]  M. McGuire,et al.  Evaluation of human recession defects treated with coronally advanced flaps and either enamel matrix derivative or connective tissue. Part 2: Histological evaluation. , 2003, Journal of periodontology.

[101]  R. Harris A comparison of 2 root coverage techniques: guided tissue regeneration with a bioabsorbable matrix style membrane versus a connective tissue graft combined with a coronally positioned pedicle graft without vertical incisions. results of a series of consecutive cases. , 1998, Journal of periodontology.

[102]  S. Froum,et al.  Osseous autografts. III. Comparison of osseous coagulum-bone blend implants with open curetage. , 1976, Journal of periodontology.

[103]  G. Greenstein,et al.  Synthetic bioabsorbable barrier for regeneration in human periodontal defects. , 1994, Journal of periodontology.

[104]  J. Qian,et al.  Design of biomimetic habitats for tissue engineering with P-15, a synthetic peptide analogue of collagen. , 1999, Tissue engineering.

[105]  U. Wikesjö,et al.  Periodontal regenerative potential of space-providing expanded polytetrafluoroethylene membranes and recombinant human bone morphogenetic proteins. , 1995, Journal of periodontology.

[106]  K. Selvig,et al.  Significance of early healing events on periodontal repair: a review. , 1992, Journal of periodontology.

[107]  R. Caffesse,et al.  4 modalities of periodontal treatment compared over 5 years. , 1987, Journal of clinical periodontology.

[108]  J. Mellonig Decalcified freeze-dried bone allograft as an implant material in human periodontal defects. , 1984, The International journal of periodontics & restorative dentistry.

[109]  L. Laurell,et al.  Treatment of intrabony defects by different surgical procedures. A literature review. , 1998, Journal of periodontology.

[110]  S. Lynch,et al.  Periodontal regeneration with an autogenous bone-Bio-Oss composite graft and a Bio-Gide membrane. , 2001, The International journal of periodontics & restorative dentistry.

[111]  R. Yukna HTR polymer grafts in human periodontal osseous defects. I. 6-month clinical results. , 1990, Journal of periodontology.

[112]  S. Froum,et al.  Human clinical and histologic responses to the placement of HTR polymer particles in 11 intrabony lesions. , 1990, Journal of periodontology.

[113]  M. Tonetti,et al.  Periodontal regeneration of human infrabony defects. II. Re-entry procedures and bone measures. , 1993, Journal of periodontology.

[114]  T. Testori,et al.  Enamel matrix proteins in the treatment of intra-bony defects. A prospective 24-month clinical trial. , 2004, Journal of clinical periodontology.

[115]  K. Selvig,et al.  Healing of the intrabony periodontal lesion following root conditioning with citric acid and wound closure including an expanded PTFE membrane. , 1992, Journal of periodontology.

[116]  A. Mariotti Efficacy of chemical root surface modifiers in the treatment of periodontal disease. A systematic review. , 2003, Annals of periodontology.

[117]  J. AgustínZerón Glossary of periodontal terms , 1990 .

[118]  W. H. Hiatt,et al.  Iliac transplants in periodontal therapy. , 1970, Journal of periodontology.

[119]  M. Urist Bone: Formation by Autoinduction , 1965, Science.

[120]  A. Reddi,et al.  Tissue engineering, morphogenesis, and regeneration of the periodontal tissues by bone morphogenetic proteins. , 1997, Critical reviews in oral biology and medicine : an official publication of the American Association of Oral Biologists.

[121]  T. Karring,et al.  Guided tissue regeneration in degree II furcation-involved mandibular molars. A clinical study. , 1988, Journal of clinical periodontology.

[122]  T. Mabry,et al.  Freeze-dried bone allografts combined with tetracycline in the treatment of juvenile periodontitis. , 1985, Journal of periodontology.

[123]  A H Melcher,et al.  On the repair potential of periodontal tissues. , 1976, Journal of periodontology.

[124]  R. Yukna,et al.  Multi-center clinical comparison of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) and ABM in human periodontal osseous defects. 6-month results. , 2000, Journal of periodontology.

[125]  R. Yukna Clinical evaluation of HTR polymer bone replacement grafts in human mandibular Class II molar furcations. , 1994, Journal of periodontology.

[126]  J. Strub,et al.  Maxillary sinus augmentation using different grafting materials and osseointegrated dental implants in monkeys. Part II. Evaluation of porous hydroxyapatite as a grafting material. , 1997, Clinical oral implants research.

[127]  A. Sogal,et al.  Risk assessment of bovine spongiform encephalopathy transmission through bone graft material derived from bovine bone used for dental applications. , 1999, Journal of periodontology.

[128]  S. Salkeld,et al.  Histologic Analysis of Implant Sites After Grafting With Demineralized Bone Matrix Putty and Sheets , 2000, Implant dentistry.

[129]  A. Register,et al.  Accelerated reattachment with cementogenesis to dentin, demineralized in situ. I. Optimum range. , 1975, Journal of periodontology.

[130]  E. Rosenberg,et al.  New attachment after treatment with root isolation procedures: report for treated Class III and Class II furcations and vertical osseous defects. , 1988, The International journal of periodontics & restorative dentistry.

[131]  R. Nordquist,et al.  Evaluation of the potential of a polylactic acid barrier for correction of periodontal defects in baboons: a clinical and histologic study. , 1995, The International journal of periodontics & restorative dentistry.

[132]  K. Selvig,et al.  Early healing events at the dentin-connective tissue interface. Light and transmission electron microscopy observations. , 1991, Journal of periodontology.