The replacement of missing teeth by osseointegrated dental implants is a commonly utilised treatment option in dentistry. However, successful treatment outcomes are dependent on sufficient bone quantity in the proposed surgical site for implant placement (Buser et al., 2004). Surgical augmentation of bone defects is commonly performed prior to or during implant placement. Bone augmentation procedures of the maxillary sinus or guided bone regeneration (GBR) procedures of alveolar ridge defects have utilised a variety of bone graft materials in block or particulate form, either alone or in combination with resorbable or non-resorbable barrier membranes. Objective: The aim of this study was to determine whether Hydroxyapatite β-Tricalcium Phosphate (HA-TCP) either alone or combined with Enamel Matrix Derivative (EMD) or recombinant human Platelet Derived Growth Factor-BB (rhPDGF-BB) is osteoinductive when implanted into a nonosseous site. Methods: Twenty CD-1 adult male mice underwent intramuscular implantation into both hindlimbs of an empty gelatine capsule or a gelatine capsule containing one of the following: 10 mg of uncoated particulate HA-TCP, (Straumann Bone Ceramic®, HA-TCP), EMD coated HA-TCP, (Emdogain®, HATCP + EMD) or rhPDGF-BB coated HA-TCP (HA-TCP + PDGF). Ten animals were sacrificed at four and eight weeks with five specimens from each group retrieved at each time point. The area of graft placement was radiographed and after graft retrieval, a semi-quantitative histological examination was performed with the aim of assessing the inflammatory changes, reparative processes and osteoinduction within the graft site. Results: At both 4 and 8 weeks, histological analysis failed to demonstrate any osteoinductive activity in any of the specimens from the three experimental groups. A minimal chronic inflammatory response and foreign body reaction was seen in the experimental groups which reduced over time. The particles were embedded within fibrous connective tissue and were encapsulated by a dense cellular layer consisting of active fibroblasts and occasional macrophages with the thickness of this layer decreasing over time. At 4 weeks, a greater density of the fibrous connective tissue was demonstrated in the HA-TCP + EMD group (P<0.001) while a greater thickness in the capsule thickness was seen in the HA-TCP group (P=0.022) although no differences were seen after 8 weeks. Greater neovascularisation was seen in the HA-TCP + PDGF group after 8 weeks (P=0.043) while greater amounts of adipose tissue surrounding the particles were detected in the HA-TCP + PDGF group at 4 weeks (P=0.002) and in the HA-TCP + EMD group at eight weeks (P=0.002). Conclusions: The results of this study suggest that the use of commercially available HA-TCP alone or in combination with EMD or rhPDGF-BB is biocompatible but not osteoinductive in the murine model. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1522641 / Thesis (D.Clin.Dent.) -- University of Adelaide, School of Dentistry, 2010

Orientador: Sergio de Toledo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-07-27T17:50:16Z (GMT). No. of bitstreams: 1 Villalpando_KarinaTeixeira_M.pdf: 2140848 bytes, checksum: 7541caa739b017ac9ad2401e4323b974 (MD5) Previous issue date: 2001 / Resumo: O objetivo do presente estudo foi comparar, clínica e radiograficamente, o tratamento cirúrgico de defeitos periodontais intra-ósseos com ou sem a utilização de um gel composto por proteínas derivadas da matriz do esmalte (EMDOGAIN@). Dezessete pacientes, apresentando um total de 21 defeitos intra-ósseos interproximais compostos por predominantemente 1 ou 2 paredes ósseas em dentes unirradiculares, foram divididos aleatoriamente nos grupos teste e controle. Os parâmetros clínicos foram avaliados através de aparelhos orientadores de sondagem - stents, antes do procedimento cirúrgico (baseline) e com 6 meses de pós-operatório, sendo eles: posição da margem gengival (PMG), nível de inserção clínica relativo (NICR) e profundidade de sondagem (PS). Paralelamente, também foram feitas nos mesmos períodos de avaliação, radiografias padronizadas e digitais que foram avaliadas por subtração radiográfica. Clinicamente, tanto para o grupo teste quanto para o grupo controle, houve uma redução significativa dos parâmetros clínicos após o tratamento (p::;; 0,001). Entretanto, essas reduções não foram estatisticamente diferentes entre o grupo teste e controle (p _ 0,001). A avaliação por subtração radiográfica identificou áreas de ganho e de perda de densidade óssea radiográfica em percentual da área total do defeito, no período de 6 meses de pós-operatório, de modo que, a comparação entre os grupos não revelou diferenças estatísticas. Entretanto, a comparação intra-grupo entre ganho e perda de densidade óssea radiográfica revelou que a utilização das proteínas derivadas da matriz do esmalte resultou em mais ganho do que perda de densidade óssea radiográfica (p ::;; 0,001). Desta forma, dentro dos limites do presente trabalho, a utilização de proteínas derivadas da matriz do esmalte pode promover benefícios no tratamento de defeitos intra-ósseos / Abstract: The aim of the present study was to compare, clinically and radiographically, the treatment of intrabony periodontal defects with or without the use of a gel composed of enamel matrix proteins derivative (EMDOGAIN@). Seventeen patients, exhibiting a total of 21 defects predominantly 1 or 2 wall intrabony defects on one-rooted teeth, were randomly divided into test and control groups. Prior to surgery (baseline) and 6 months later the following parameters were evaluated using oclusal stents: gingival recession (GR), relative clinical attachment level (CAL) and probing depth (PD). At the same time during this period, standard digital radiographies were made and evaluated through subtraction radiography. Clinically, both for the test and control groups there was a significant reduction of the clinical parameters afier the treatment (p ::; 0,001). However, these reductions were not statistically different between the test and control groups (p _ 0,001). The subtraction radiography identified gain and loss areas of bony radiographic density in percentage terms of the total area of the defect within 6 months afier the surgery, as a result the comparison between the groups has not shown any statistic differences. However, the intra-group comparison between gain and loss areas of radiographic density has revealed that the use of enamel matrix proteins derivative has led to more gain than loss of radiographic density. In conclusion, within the limits of the present study the use of enamel matrix proteins derivative can promote benefits in the treatment of intrabony defects / Mestrado / Periodontia / Mestre em Clínica Odontológica

Orientador: Sergio de Toledo / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-03T10:55:36Z (GMT). No. of bitstreams: 1 Villalpando_KarinaTeixeira_D.pdf: 2781584 bytes, checksum: 258b6c60ba7d0ffa1c34543cb90f5de2 (MD5) Previous issue date: 2003 / Resumo: O objetivo do presente estudo foi comparar através de parâmetros clínicos e radiográficos o tratamento cirúrgico de defeitos periodontais intra-ósseos com ou sem a utilização de um gel composto por proteínas derivadas da matriz do esmalte (EMDOGAIN ¿MARCA REGISTRADA¿. Quinze pacientes, apresentando um total de 19 defeitos intra-ósseos interproximais compostos por 1 ou 2 paredes ósseas em dentes unirradiculares, foram divididos aleatoriamente nos grupos teste e controle. Os parâmetros clínicos foram avaliados através de guias de sondagem - stents, antes do procedimento cirúrgico (baseline), com 6 e 18 meses de pós-operatório, sendo eles: posição da margem gengival relativa (PMGR), nível de inserção clínica relativo (NICR) e profundidade de sondagem (PS). Medidas radiográficas lineares foram obtidas nos mesmos períodos de avaliação, através de radiografias padronizadas e digitais. Os dados foram analisados estatisticamente usando ANOVA e o teste de Tukey (p< 0,05). Os resultados clínicos mostraram que aos 18 meses de avaliação houve, em média, uma redução da profundidade de sondagem de 3,2 '+ ou -' 1,44mm e um ganho no nível de inserção de 1,4 '+ ou - ' 1,26mm para o grupo teste, enquanto que no grupo controle, o valor médio de redução da profundidade de sondagem foi de 2,7 :t 0,89mm e do ganho de inserção clínica foi de 1,2 '+ ou -' 0,78mm. Radiograficamente, houve um preenchimento ósseo médio de 1,64 '+ ou -' 1,69mm no grupo teste e de 0,71 '+ ou -' 1,90mm no grupo controle. Os dois tratamentos cirúrgicos melhoraram os parâmetros clínicos e radiográficos quando comparados ao baseline, mas a diferença encontrada entre os grupos não foi estatisticamente significante. Portanto, pode-se concluir que o tratamento cirúrgico convencional e regenerativo têm efeitos favoráveis na redução da profundidade de sondagem, no ganho clínico de inserção e no preenchimento ósseo radiográfico após 18 meses de avaliação. Um estudo envolvendo uma amostra de tamanho maior é necessário para confirmar essa equivalência estatística entre as duas modalidades de tratamento / Abstract: The aim of the present study was to compare the clinical and radiographical effects of the treatment of intrabony periodontal defects with or without the use of a gel composed of enamel matrix proteins derivative (EMDOGAIN 'TRADEMARK¿). Fifteen patients, exhibiting a total of 19 defects 1 and 2 wall intrabony defects on one-rooted teeth, were randomly divided into test and control groups. Prior to surgery (baseline), 6 and 18 months after it the following parameters were evaluated using oclusal stents: relative gingival recession (RGR), relative clinical attachment levei (RCAL) and probing depth (PD). Linear radiographic measurements were obtained at the same time during this period through standard digital radiographies. Data were statistically analyzed using ANOVA and Tukey's Studentized Range Test (p< 0,05). The clinical results demonstrated that after 18 months there was a reduction in probing depth of 3.2 : '+ or -' 1.44mm and a gain in the clinical attachment levei of 1.4 '+ or -' 1.26mm on average for the test group. As for the control group the reduction in the probing depth was of 2.7 '+ or -' 0.89mm and the gain in the clinical attachment levei was of 1.2 '+ or -' 0.78mm on average. Radiographically, there was an average bone filling of 1.64'+ or -' 1.69mm in the test group and 0.7 '+ or -' 1.9mm in the control group. The two treatments improved clinical parameters as compared to baseline, but the differences found between the groups were not statistically significant. Therefore, it may be concluded that both therapies have similar effects in promoting probing depth reduction, clinical attachment gain, and defect bone till in the 18th month post treatment. A study involving a larger sample size is necessary to statistically confirm the equivalence between the two treatment modalities / Doutorado / Periodontia / Doutor em Clínica Odontológica

Zielsetzung: Verschiedene chirugische Techniken sind für die Deckung entblößter Wurzeloberflächen vorgeschlagen worden. Die vorliegende Studie sollte die Ergebnisse koronaler Verschiebelappen mit bzw. ohne Einsatz von Schmelzmatrixprotein (SMP) bei der Therapie fazialer Rezessionen vergleichen. Material und Methode: Die Studie war als intraindividueller longitudinaler Vergleich über 12 Monate in einem doppelt verblindeten plazebo-kontrollierten randomisierten Design gestaltet. 22 Patienten im Alter von 24-64 Jahren, die 2 paarige faziale Rezessionen von mindestens 3 mm aufwiesen, wurden untersucht. Beide Rezessionen wurden in derselben Sitzung nach der Technik des koronalen Verschiebelappens chirurgisch gedeckt. Eine Rezession wurde dabei zusätzlich mit einem kommerziell erhältlichen SMP (Emdogain) und die jeweils andere mit dem entsprechenden Trägergel (Vehikel: Propylen-glykol-alginat) behandelt. Die Zuweisung der Therapien erfolgte zufällig. Präoperativ sowie 1 und 3 Wochen, 3, 6 und 12 Monate postoperativ wurden durch einen verblindeten Untersucher klinische Parameter (Höhe und Breite der Rezession, Breite der keratinisierten Gingiva, Sondierungstiefe, Attachmentniveau, Knochenniveau) mittels manueller sowie elektronischer Parodontalsonde bzw. Schieblehre auf 0,5 mm genau erhoben. Ergebnisse: 12 Monate postoperativ zeigten beider Therapievarianten signifikante Rezessionsdeckungen und Attachmentgewinne. Die fazialen Rezessionen verringerten sich von 4,5 mm auf 1,5 mm in der SMP- und von 4,4 mm auf 1,5 mm in der Vehikel-Gruppe was einer Rezessionsdeckung von 71,7% bzw. 73,6% entspricht. Der Unterschied zwischen den zwei Gruppen war nicht signifikant. Alle anderen klinische Parameter zeigten keine Unterschiede zwischen den Gruppen. Schlußfolgerungen: Der Einsatz von SMP zusätzlich zum koronalen Verschiebelappen zur chirurgischen Rezessionsdeckung ergab keine wesentliche Unterschiede in den klinischen Resultaten im Vergleich zum koronalen Verschiebelappen in Kombination mit dem Trägergel. / Objectives: Various surgical techniques have been proposed for root coverage of denuded root surfaces. The aim of this study was to evaluate a comparison of coronally advanced flap procedure with or without the use of enamel matrix proteins in the treatment of recession defects. Material and methods: This study was an intra-individual longitudinal test of 12 months duration conducted as a blinded, split-mouth, placebo-controlled and randomised design. 22 patients, aged 24-64 years, with 2 paired buccal recession defects of at least 3 mm participated. Surgical recession coverage was performed as coronally advanced flap technique at both sites in the same session. One site was additionally treated with commercially available enamel matrix proteins (Emdogain) and the other site with placebo (propylene glycol alginate) in accordance with the randomisation list. A blinded examiner assessed pre- and post-surgical measurements. Clinical measurements and photographs were taken pre-surgically and after 1 week, 3 weeks, 3 months, 6 months and 12 months postoperatively. Measurements comprised height and width of the gingival recession, height of keratinized tissue, probing attachment level, probing pocket depth and alveolar bone level by periodontal probe, Florida Probe or caliper to the nearet 0.5 mm. Results: Twelve months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 4,5 mm to 1,5 mm for the Emdogain treated sites and from 4,4 mm to 1,5 mm for the control sites, corresponding to mean root coverages of 71,7% and 73,6%, respectively. This difference was not significant. All other clinical variables were not different in the between-group comparison. Conclusions: The use of Emdogain together with coronally advanced flap technique for recession coverage appeared to be equally effective in the overall clinical outcome, there is no clear benefit to combine Emdogain with this surgical technique.