Dilip .G. Nayak

Clinical and radiographic evaluation of Nano-crystalline hydroxyapatite bone graft (Sybograf) in combination with bioresorbable collagen membrane (Periocol) in periodontal intrabony defects.

Background: Nanosized ceramics may represent a promising class of bone graft substitutes due to their improved osseointegrative properties. Nanocrystalline Hydroxyapatite (NcHA) bind to bone and stimulate bone healing by stimulation of osteoblast activity. The present study aims to explore the clinical and radiographical outcome of NcHA bonegraft (Sybograf®) with collagen membrane (Periocol®), in comparison with open flap debridement (OFD), in the treatment of intrabony periodontal defects. Materials and Methods: A parallel-group, randomized, controlled clinical trial was designed to conduct the study. Eighteen intrabony defects in 14 systemically healthy patients aged between 25 to 65 years were randomly assigned to test and control group. The plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (REC) were recorded at baseline, and were reevaluated at 6 months. In addition to this, radiographic bone fill was assessed using digital software. At the test site, NcHA bone graft and collagen membrane was placed, whereas at the control site, only OFD was done. Recall appointments were made at 7 days, 30 days, and then at 3 months and 6 months. Results: The data were subjected to statistical analysis using the Mann-Whitney ‘U’ Test and Wilcoxon signed rank sum test. In the control group, the mean reduction of PPD was 3.22±1.09 mm (P=0.007) and CAL gain was 2.77±1.09 mm (P=0.007). In the test group, the mean PPD reduction of 4.33±0.5 mm (P=0.006) and mean gain in CAL was 3.77±0.66 mm (P=0.006) at 6 months. The mean increase in REC was 0.55±0.72 mm (P=0.025) in test, and 0.44±0.52 mm (P=0.046) in control group. The mean gain in radiographic defect fill was 2.07±0.67 mm (P=0.008) in test and 0.91±0.21 mm (P=0.007) in control group. Conclusion: The nanocrystalline hydroxyapatite bone graft in combination with collagen membrane demonstrated clinical advantages beyond that achieved by OFD alone.

Nano‑crystalline hydroxyapatite bone graft combined with bioresorbable collagen membrane in the treatment of periodontal intrabony defects: A randomized controlled clinical trial

Aim: To evaluate the clinical outcome of nanocrystalline hydroxyapatite (NcHA) bonegraft (Sybograf®) in combination with collagen membrane (PerioCol®) compared with open flap debridement (OFD) only in the treatment of intrabony periodontal defects. Materials and Methods: Eighteen intrabony defects in 16 systemically healthy patients aged between 25-65 years, were randomly assigned to test and control groups. The Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession were recorded at baseline, and were reevaluated at 6 months. In addition to this, radiographic bone fill was assessed using digital software. At the test site NcHA bone graft and collagen membrane was placed, whereas at the control site only, OFD was done. Recall appointments were made at 7th day, 1st month, 3rd month, and 6th month. Results: The data were subjected to statistical analysis using the Mann-Whitney ‘U’ Test and Wilcoxon signed rank sum test. In the control group, the mean reduction of PPD was 3.22±1.09 mm and CAL gain was 2.78±1.09 mm. In the test group, the mean PPD reduction of 4.33±0.5 mm and mean gain in CAL was 3.78±0.66 mm at 6 months. The mean increase in gingival recession was 0.55±0.72 mm in test and 0.44±0.52 mm in control group. Conclusion: The NcHA bone graft in combination with collagen membrane demonstrated better clinical outcomes compared with OFD alone.

Comparative Evaluation of the Efficacy of Bioactive Ceramic Composite Granules Alone and in Combination with Platelet Rich Fibrin in the Treatment of Mandibular Class II Furcation Defects: A Clinical and Radiographic Study

INTRODUCTION Predictable closure of furcation defects with bone grafts, Guided Tissue Regeneration (GTR) and a combination of the two has remained an elusive goal so far. Hence, evaluation of biomimetic agents as candidate technologies for periodontal regeneration merit due consideration. In this study, Choukrouns Platelet Rich Fibrin (PRF), a second generation platelet concentrate, is combined with bone graft to examine if the addition enhances the therapeutic potential of bone graft in the management of Class II furcation defects. AIM To evaluate and compare the clinical effectiveness of Bioactive Ceramic Composite Granules (BCCG) alone and in combination with PRF in the treatment of mandibular Class II furcation defects. MATERIALS AND METHODS Twenty mandibular Class II furcation defects in 16 systemically healthy patients were randomly allocated to test and control groups. Test sites were treated with PRF and bone graft, while control sites were treated with BCCG alone. Soft tissue parameters (probing pocket depth and clinical attachment loss), hard tissue parameters (vertical and horizontal depth of furcation defects) and radiographic parameter (radiographic alveolar bone density) were measured at baseline and six months post surgery. Statistical analysis was performed using Wilcoxon signed rank test for intragroup comparison of parameters and Mann-Whitney U test for intergroup comparison. RESULTS Statistically significant improvement was observed in the test group compared to the control group with respect to all the measured parameters. However, complete furcation closure was not observed at any of the treated sites. CONCLUSION Adjunctive use of PRF with bone graft may be a more effective treatment modality in the management of mandibular Class II furcation defects when compared to bone graft alone.

Quantification of intraosseous bone defects by conventional versus 3dimensional imaging techniques - an in vivo study.

Background:- The aim of this prospective cross sectional study was to determine the accuracy of CBCT in quantifying intra-osseous periodontal bone defects. Methods:- 5 patients with intra-bony defects were selected and 10 defects were assessed. A total of 60 measurements were performed.Periapical radiographs and Cone beam CT scan images were obtained. Height and depth of each defects was measured using appropriate software. Direct measurements were done during surgical interventions using a periodontal probe and were considered the standard reference. Measurements made by all three modalities were compared to each other. Results:- Linear measurements for all defects revealed no statistical differences between CBCT and direct intra-surgical measurements with respect to the height as well as the depth of the defect. There was a significant difference when comparing peri-apical radiographs to the other two methods. IOPA measurements were only 74.3% accurate as compared to the standard intra-surgical whereas the CBCT measurements were 86.5%. Conclusion:- All three modalities proved to be useful for identifying interproximal periodontal defect but CBCT took the lead with better accuracy in reproducing the clinical measurement of intra-bony periodontal bone defects and better visualization of the extent of the defect.

HIV and Periodontal Disease: Redemption or Resurrection

Human immunodeficiency virus (HIV) infection, a major medical crisis that has hit families, communities & nations across the world, remains a major health concern of unprecedented dimension. Mounting evidence suggests that co-infections and inflammation may result in re-activation of latent virus and blunt the success of Highly Active Anti-retroviral Therapy (HAART). Periodontal diseases are chronic multibacterial infections that can result in significant bacterial & inflammatory load in the body and HIV infection has been found to be associated with various forms of periodontal diseases. Besides Immune Reconstitution Inflammatory Syndrome (IRIS), following HAART, may also lead to increased frequency of periodontal disease among these patients. If co-infections & inflammation can increase the risk of HIV reactivation, can periodontitis in an HIV infected individual lead to HIV re-activation. This question remains unanswered, but initial evidence suggests a probable role of periodontitis in HIV re-activation. The clinical implication of such a role is that, periodontitis being most often preventable and definitely treatable, every attempt should be made to prevent and promptly treat this disease in individuals with HIV infection.