OBJECTIVES: This case series evaluated the clinical efficacy of the novel "lateral approach" combined with an enamel matrix derivative (EMD) and bone grafting in the regenerative surgical treatment of intrabony defects associated with an edentulous ridge. MATERIAL AND METHODS: The innovative flap, called the "lateral approach," is explicitly designed for regeneration of unchallenged isolated intrabony defects associated with edentulous alveolar ridges. The flap is defined by a curved vertical incision on the buccal side opposite the treated defect and a sulcular incision on the buccal and defect-associated sides, promoting uneventful healing and regeneration while minimizing complications. Seven intrabony defects (one per patient) distal to the lower second molar were treated using the "lateral approach" combined with EMD and grafting with deproteinized bovine bone mineral. The primary outcome was clinical attachment level (CAL) change. As additional parameters, pocket probing depth (PPD) reduction and complication rate were analyzed. All the outcomes were assessed 6 months post-surgery and compared with the baseline values. RESULTS: Primary wound healing occurred in 100% of cases, and no complications were reported. At the 6-month re-evaluation, the initial median CAL of 6 mm (interquartile range 5-8 mm) was reduced to 3 mm (3-5 mm). The corresponding median PPD was reduced from 6 mm (IQR 6-8 mm) to 4 mm (IQR 3-5 mm). These differences were statistically significant (p < 0.05). CONCLUSIONS: The "lateral approach" is a technique for the surgical treatment of intrabony defects associated with the edentulous ridge. Within the limitations of the study, this method seems to be suitable for distal intrabony defects in the lower second molars, which frequently develop after third molar extraction.
- MeSH
- augmentace alveolárního výběžku * metody MeSH
- čelist bezzubá chirurgie MeSH
- chirurgické laloky transplantace MeSH
- dospělí MeSH
- hojení ran MeSH
- kostní náhrady terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- proteiny zubní skloviny terapeutické užití MeSH
- regenerace kostí MeSH
- resorpce alveolární kosti * chirurgie MeSH
- řízená tkáňová regenerace parodontu metody MeSH
- senioři MeSH
- transplantace kostí metody MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Článek se zabývá významem rutinní mikrobiologické analýzy zubního biofilmu pro léčbu parodontitidy. Autoři nabízejí různé pohledy na toto komplexní téma, ve kterém se protínají prvky mikrobiologické, patofyziologické a etiologické, s množnostmi využití analytických metod a rutinní parodontologické diagnostiky. Tradiční pohled na parodontální mikrobiom jako souhrn „bakteriálních komplexů“ vychází ze studií založených na kultivaci relativně malého množství bakterií. V současné době existují pokročilé metody mikrobiální analýzy využívající sekvenování nukleových kyselin, které významně rozšiřují a mění pohled na orální mikrobiom u parodontitidy. Spolu s aktuálním pojetím etiopatogeneze parodontitidy se proto mění náš pohled na klinický význam mikrobiologického testování a z části se odvrací od Socranského komplexů. Díky sekvenačním metodám dnes známe několik set bakterií souvisejících s parodontitidou. V klinické praxi se však využívá stále spíše levnějších metod vycházejících z kultivace malého počtu druhů, u nichž se předpokládá souvislost s onemocněním. Využití složitějších a nákladnějších metod je v běžné diagnostice zatím málo dostupné. Mezi parodontology nepanuje jednoznačný konsenzus ohledně využitelnosti poznatků mikrobiologického testování pro zlepšení klinického rozhodování, a tedy úspěšnosti lékařské péče. Cílem tohoto přehledového sdělení je přiblížit široké odborné veřejnosti z různých úhlů problematiku mikrobiálního testování v klinické parodontologické praxi.
The review deals with importance of routine microbiological analysis of dental biofilm for clinical periodontology. Authors offer different points of view of this complex topic. Advanced PCR-based methods bring new insights and change our knowledge of periodontal aetiology and pathogenesis. Recent methods are able to detect hundreds of microbes with just one test, many of them otherwise uncultivable. In clinical practice, however, cheap and simple methods are used instead to analyse only few of the relevant bacterial taxa. Research in this field helps to identify disease-related, as well as health-related bacteria. That helps with our understanding of periodontitis and defining new therapeutic options. On the other hand, advanced methods are usually expensive and often unavailable, and their use in daily practice is still controversial. There is no consensus to date on interpretation of data obtained from microbiological assays, their prognostic or therapeutic value. The aim of this article is to elaborate on current knowledge and relevance of microbiological analysis for clinical periodontology.
- MeSH
- biofilmy MeSH
- interakce mikroorganismu a hostitele fyziologie imunologie MeSH
- lidé MeSH
- mikrobiota MeSH
- parodontitida * farmakoterapie komplikace mikrobiologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
AIMS: Granulation tissue (GT) and specialized pro-resolving mediators such as lipoxins and resolvins are key elements in the successful resolution of periodontitis. Aspirin-triggered lipoxins and resolvins are even more powerful than their natural analogues. Their biosynthesis can be accelerated by omega-3 fatty acids. The aim of this study was to evaluate the use of GT enriched by aspirin and omega-3 fatty acids during the surgical treatment of periodontitis in an experimental animal model (rabbit). METHODS: In each of 24 rabbits, two experimental periodontal defects were created. In total, 47 defects were treated with open-flap debridement and one of three procedures: (1) GT extracted and soaked with aspirin and omega-3 fatty acids (ASA+OMEGA3 group); (2) GT soaked with saline (PLACEBO group); or (3) GT left untreated (CONTROL group). Then, the GT was replaced in situ. Primary evaluated criteria were the probing pocket depth (PPD) and the clinical attachment level (CAL). Necropsies were harvested 2, 6, and 12 weeks after surgery. The samples were used for histological and molecular biological assessment. RESULTS: A trend of greater PPD and CAL in the ASA+OMEGA3 group was observed at 6 weeks. However, there was no significant difference between them. During the observation period, tissue levels of FGF-7, IL-1β and TIMP-1 showed a statistically significant decrease (P<0.05). For the other variables, the ASA+OMEGA3 group was comparable with the PLACEBO and CONTROL groups. CONCLUSION: This experiment did not demonstrate the superiority of the proposed approach. However, the enriched granulation tissue did not impair healing outcomes.
- MeSH
- Aspirin farmakologie MeSH
- granulační tkáň MeSH
- králíci MeSH
- lipoxiny * MeSH
- omega-3 mastné kyseliny * farmakologie MeSH
- parodontitida * farmakoterapie MeSH
- tuberkulin MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Host genetic predispositions to dysregulated immune response can influence the development of the aggressive form of periodontitis (AgP) through susceptibility to oral dysbiosis and subsequent host-microbe interaction. This case-control study aimed to perform a multilocus analysis of functional variants in selected interleukin (IL) genes in patients with the generalized form of AgP in a homogenous population. Twelve polymorphisms in IL-1 gene cluster, IL-6 and its receptor, IL-10, IL-17A, and IL-18 were determined in 91 AgP patients and 210 controls. Analysis of seven selected periodontal bacteria in subgingival sulci/pockets was performed with a commercial DNA-microarray kit in a subgroup of 76 individuals. The pilot in vitro study included stimulation of peripheral blood monocytes (PBMC) from 20 individuals with periodontal bacteria and measurement of IL-10 levels using the Luminex method. Only the unctional polymorphism IL‐10-1087 A/G (rs1800896) and specific IL-10 haplotypes were associated with the development of the disease (P < 0.05, Pcorr > 0.05). Four bacterial species occurred more frequently in AgP than in controls (P < 0.01, Pcorr < 0.05). Elevated IL-10 levels were found in AgP patients, carriers of IL‐10-1087GG genotype, and PBMCs stimulated by periodontal bacteria (P < 0.05, Pcorr > 0.05). We therefore conclude that a combination of genetic predisposition to the altered expression of IL-10 and the presence of specific periodontal bacteria may contribute to Th1/Th2 balance disruption and AgP development.
- MeSH
- agresivní parodontitida genetika imunologie mikrobiologie MeSH
- alely MeSH
- Bacteria genetika MeSH
- dospělí MeSH
- frekvence genu genetika MeSH
- genetická predispozice k nemoci genetika MeSH
- genotyp MeSH
- haplotypy genetika MeSH
- interleukin-1 genetika MeSH
- interleukin-10 genetika MeSH
- interleukin-17 genetika MeSH
- interleukin-18 genetika MeSH
- interleukin-6 genetika MeSH
- interleukiny genetika metabolismus MeSH
- jednonukleotidový polymorfismus genetika MeSH
- lidé MeSH
- parodontitida genetika imunologie MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Different approaches to enhance healing of hard or soft tissues include the use of cytokines and growth factors to modify cellular behaviour. Numerous growth factors are found in autologous blood concentrates - platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). Enamel matrix derivative (EMD) may improve tissue healing via amelogenins. Bilayered collagen matrix (CM) is used for soft tissue augmentation. The aim of the present study was to assess potential benefits of PRP, PRF and EMD in combination with bilayered collagen matrix or CM alone in treatment of oral mucosal defects in rabbits. Twenty-seven New Zealand white rabbits were included in this randomized controlled trial. Artificial oral mucosal defects were treated with one of these five approaches: PRP+CM, PRF+CM, EMD+CM, CM alone, or left untreated as a negative control - CO. The animals were euthanized 1 day, 7 days, or 28 days after surgery and necropsies were harvested. Histological and molecular biological analyses were performed. All defects were healed by day 28. No differences between PRP+CM, PRF+CM, CM alone and CO groups were recorded at any time point. Slower angiogenesis and a higher presence of inflammatory infiltrate were observed in the EMD+CM group 28 days after surgery. Molecular biological analyses did not reveal any statistically significant changes. In conclusion, no improvement in mucosal healing of wounds covered with a collagen membrane and PRP, PRF, or EMD was observed, compared with CM alone or untreated controls.
