Clinical healing following guided tissue regeneration (GTR) in intrabony pockets using a polyurethane membrane was compared to healing following gingival flap surgery (GFS).Ten patients with adult periodontitis and the presence of intrabony defects were selected. Oral hygienic treatments were performed during a 4- week's period prior to surgery.One intrabony defect on each patient was randomly chosen to be treated according to the guided tissue regeneration (GTR) procedure. The other side received the control treatment GFS. Test group received the GTP treatment including polyurethane membrane after reflecting the flap and curettage of defect. However, flap surgery and curettage were done in control group.The patients were evaluated for changes in probing depth (PD), clinical attachment level (CAL), recession changes in crystal resorting, and defect bone fill. Clinical examinations were performed again 6 months post operatively.The average of (PD), (CAL) and defect depth (DD) before surgery in test group was 3.23, 13.87 and 7.3 mm respectively and in control group was 3.1, 8.9, 7.4 mm. After 6 months the average of (PD), (CAL) and (DD) was 1.69, 1.68, 3.5 mm, respectively and in control group was 1.24, 1.09, and 2.90 mm. Test group and control group showed successful results in treatment of intrabony defects. Test group showed better results than control.No significant difference was observed between two treatment procedures from the point of view of pocket depth reduction, attachment gain, and recession.The bony fill and crystal resorption results suggest similar clinical potential of GTR procedures compared to GFS in treatment of intrabony pocket. However, in order to gain future insight, larger samples and longer observation periods should be evaluated.

Introduction: Most periodontal treatments aim to reduce probing depths and maintaining or improving attachment. One of these techniques for treatment of intrabony defects is guided tissue regeneration (GTR). The aim of this study was to compare one-wall intrabony defects treatment with GTR and flap debridement alone.Methods: Eight patients aged 32-43 years participated in this randomized controlled clinical trial. In the test side, a collagen membrane was used after flap/debridement but in the control side, only flap/debridement was performed. Clinical treatment outcomes were evaluated 6 months after surgery. Paired t-test was used for analyzing the data.Results: A mean reduction in pocket depth value of 5.5 mm and mean bone fill of 2.75 mm  occurred in the test group. A mean reduction in pocket depth value of 5.7 mm and mean bone fill of 1.5 mm occurred in the control group. The difference between the two treatments was statistically significant in terms of bone fill (P = 0.01) and reduction in hemiseptal defect depth (P = 0.00). Conclusion: Based on the results of this study using barrier membranes produced better clinical parameters of one-wall intrabony defects and proved to be superior to access flap alone.

Statement of problem: Digital measurement of RVG may improve diagnostic interpretation of radiographs in terms of accuracy, although it has been shown that validity of linear measurements of interproximal bone loss could not be improved by basic digital manipulations. Purpose: The aim of this study was to evaluate the accuracy of RadioVisioGraphy (RVG) in the linear measurement of interproximal bone loss in intrabony defects. Materials and Methods: Thirty two radiographs of 56 periodontally diseased teeth exhibiting interproximal intrabony defects were obtained by a standardized RVG technique and Intrabony defect depths were determined by linear measurement analysis of RVG. The following four distances were assessed intrasurgically: the cemento enamel junction (CEJ) to the alveolar crest, the CEJ to the deepest extention of the bony defect (BD), the occlusal plane to the BD and the OP to the AC. Comparison between RVG measures and intrasurgical estimates were performed using paired t-test. Results: The radiographic measurements overestimated interproximal bone loss as compared to the intrasurgical measurements: CEJ-BD measurement by RVG was 6.803±3.589 mm and intra-surgically was 6.492±3.492 (P<0.000). No statistically significant difference was seen between CEJ and occlusal references in RVG measurements (P<0.729). Conclusion: Radiographic assessment by either the CEJ or occlusal references overestimated bone loss as compared to the intrasurgical gold standard.

Introduction: Use of growth factors has been evaluated in regenerative treatments and it has been shown that they are effective in proliferation, chemotaxis, differentiation, and synthesis of extracellular matrix and cells responsible for wound healing, enhancing the repair and regeneration of the periodontium. The aim of this literature review is to evaluate the effects of platelet-rich plasma (PRP) in combination with different graft materials, with and without membranes, in regenerative therapy of intrabony defects.Review of Report: Electronic search was carried out in PUBMED and MEDLINE for randomized clinical trials which have used platelet-rich plasma in the treatment of intrabony defects with a minimum follow-up period of 6 months. Articles were collected until the end of April 2011. Inclusion criteria in the evaluated research studies consisted of defects at least 3 mm in depth and pockets at least 5 mm in depth. Twenty articles were confirmed and evaluated in this review. The parameters evaluated were probing depth changes, defect fill and an increase in clinical attachment level.Conclusion: Within the limitations of studies carried out in this respect it can be concluded that use of PRP has not exert a positive adjunctive effect on improving clinical parameters in regenerative treatments of intrabony defects when used in combination with membranes; however, when it has not been used with a membrane, use of PRP along with bone grafts has led to positive results.

Objectives: Intrabony defects are among the most important signs of progression of periodontal disease. Complete tissue regeneration is the ideal goal of periodontal treatment, and regenerative methods aim to achieve this goal. New studies have reported the positive efficacy of chitosan to enhance the recovery of bony defects. This study aimed to clinically and radiographically assess the efficacy of chitosan particles for treatment of intrabony periodontal defects. Materials and Methods: In this clinical trial, 18 intrabony three-wall periodontal defects were randomly divided into three groups (n=6). The control group only received conventional flap surgery with a sulcular incision. In the second group, low molecular weight (100, 000-300, 000g/mol) chitosan was used in the three-wall intrabony defects during surgery while high molecular weight chitosan particles (600, 000-800, 000 g/mol) were used in the third group. The probing pocket depth (PPD), clinical attachment level (CAL) and radiographic defect depth (RDD) were measured at baseline and at 6 and 12 months later. Repeated measures ANOVA, and McNemar’ s test were used for statistical analysis. Results: In both the control (P<0. 001) and coarse chitosan (P=0. 035) groups, a significant difference was noted in PPD before and after surgery. CAL was not significantly different among the three groups (P>0. 05). No significant difference was noted on radiographs between the groups regarding the regenerated bone density. Conclusion: Chitosan showed no positive efficacy for treatment of three-wall periodontal bone defects.

Background and purpose: The ultimate goal in periodontal treatment is to achieve a functional and anatomical regeneration of lost tissues. Due to the promising outcomes of biologic modifiers in regenerative therapies, this systematic review aimed at evaluating the effects of various biologic modifiers used in intra-bony osseous defects in animal models. Materials and methods: Electronic databases were searched for articles published in March 2010-March 2020 that had evaluated the effect of bio-modifiers used in periodontal intra-bony osseous defects in animal models. Screening was performed based on inclusion/exclusion criteria and SYRCLE tool was used for studies’ quality assessment. Results: After screening the titles, abstracts, and full-texts, 18 studies were included in qualitative analysis and five studies entered the meta-analysis. According to the configuration of osseous defects, the studies were categorized into three subgroups. Based on histological findings, all these biologic markers significantly enhanced new bone and cementum formation compared to control groups (P<0. 001). The meta-analysis showed that biologic modifiers could significantly increase bone regeneration (1. 58 mm, 95% CI: 1. 12-2. 03, P˂ 0. 001) and cementum regeneration (1. 27 mm, 95% CI: 0. 84-1. 70, P˂ 0. 001) in one-wall osseous defects. Conclusion: Biologic modifiers namely growth factors could positively affect periodontal regeneration, particularly the cementum and bone in animal models. Further human studies are necessary to address the clinical use of these biomaterials.

Background: Guided Tissue Regeneration (GTR) is one of the effective and predictable surgical procedures for treatment of periodontal intrabony defects. The present study aimed to clinically evaluate and compare the efficacy of Amnion Membrane (AM) +Bio-Oss and Bio-Gide+Bio-Oss in GTR treatment of intrabony periodontal defects.Methods: In this study, chronic periodontitis patients who need periodontal regenerative surgery received phase I of periodontal treatment. After 1 month follow up, 10 patients with bilateral intrabony defects and radiographic evidence of intrabony component of ³ 4 mm and probing depth ³ 6 mm were randomly assigned into two experimental and control groups. The experimental group was treated by placement of AM+Bio-Oss, while the control group was managed by placement of Bio-Gide+Bio-Oss. Clinical parameters, including Periodontal Pocket Depth (PPD), Probing Bone (PB) level, Clinical Attachment Level (CAL), and gingival recession (REC), were recorded at baseline and 6 months after the surgery. Then, the data were analyzed using T-test.Results: A significant difference was observed regarding CAL, PB, and PPD after 6 months compared to before the surgery. In addition, significant changes were observed regarding CAL, PB, PPD, and REC in the control group. However, the mean changes in CAL, PB, and PPD before and after the surgery was not significant between the two groups. Yet, a significant increase was found in REC in the control group compared to the experimental group (P=0.009).Conclusion: Both AM and Bio-Gide in conjunction with Bio-Oss resulted in improvement of the clinical periodontal parameters. According to the results, AM did not induce any significant gingival recession. Thus, AM is recommended as a new barrier membrane in GTR treatment.

Introduction: The aim of periodontal treatment is to regenerate periodontium. Regenerative treatments include the use of plasma that is rich in growth factors (PRGF).Materials & Methods: In a randomized clinical trial, 20 three-walled intrabony defects from five patients with moderate periodontitis were randomly assigned to three groups. Patients in the control group underwent debridement of lesions. In the first treatment group, the defects were debrided and cenomembrane was applied. The third group was treated with debridement, PRGF and cenomembrane. Measures of vertical probing depth (VPD), vertical clinical attachment level (VCAL), gingival index (GI; Sinless and Loe) and radiographic index (by digital subtraction) were made preoperatively and 6 months post-surgery. Wilcoxon signed-ranks and Chi-square tests were used for analyzing quantitative and qualitative variables, respectively.Results: All three groups showed improvements in all measures except GI. Intra-group comparison for clinical attachment level (CAL) indicated significant difference in all groups before and after surgery (P<0.05); there was no correlation in CAL among groups before surgery Intra-group comparison demonstrated significant differences in all three groups before and after surgery (P<0.001). A statistically significant difference was found in radiographic indices among the groups post-surgery (P=0.009).Conclusion: The use of PRGF was associated with improvements in all parameters but not for GI.