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After Recession Coverage

Recession Coverage Tooth #31

A 30 year old male came into the clinic 3 years ago. Referred to me by his dentist to treat the recession in lower front tooth 31.  He complained he can not brush because of sensitivity and pain and was concerned about loosing his tooth. This case is “Miller class 3” implying the results won’t […]

Neodent webinar invite

Webinar – Protocol for a Neodent implant in the aesthetic area

רופא/ה יקר/ה, ה.א שיטות מזמינה אותך להירשם לוובינר- ניתוח Online⌛ נושא: פרוטוקול עבודה לשתל נאודנט באזור האסתטי עם העמסה מיידית משלב העקירה, השתלת עצם ורקמה לאוגמנטציה גרמית ורקמתית וחשיבות כיסוי שורשים בשיניים הסמוכות| דר’ מייזי אליעזר ✅ 10 לינואר יום ד’ 18:30-20:00 – ZOOM Register Here

Intragroup comparisons between preoperative and postoperative clinical parameters

Reconstructive Approach in Residual Periodontal Pockets with Biofunctionalized Heterografts a Retrospective Comparison of 12-Months Data from Three Centers

Abstract: Regenerative capacity of well-preserved blood clot may be enhanced by biologics like enamel matrix derivative (EMD). This retrospective analysis compares outcomes reported by three centers using different heterografts. Center 1 (C1) treated intrabony defects combining cross-linked heavy weight hyaluronic acid (xHyA) with a xenograft, Center 2 (C2) used EMD with an allograft combination to […]

Soft Tissue Management

Synergism in Oral Rehabilitation

Register for the conference and come to learn how to perform soft tissue manipulation and how to increase gum tissue around the implants and teeth.  Presented by Dr Meizi Eliezer.

Activity of Two Hayluronic Perparations on Primary Human Oral Fibroblasts

Activity of Two Hyaluronan Preparations on Primary Human Fibroblasts

Background and Objective: The potential benefit of using hyaluronan (HA) in
reconstructive periodontal surgery is still a matter of debate. The aim of the present
study was to evaluate the effects of two HA formulations on human oral fibroblasts
involved in soft tissue wound healing/regeneration.
Material and Methods: Metabolic, proliferative and migratory abilities of primary
human palatal and gingival fibroblasts were examined upon HA treatment. To uncover
the mechanisms whereby HA influences cellular behavior, wound healing-related
gene expression and activation of signaling kinases were analyzed by qRT-PCR
and immunoblotting, respectively.
Results: The investigated HA formulations maintained the viability of oral fibroblasts
and increased their proliferative and migratory abilities. They enhanced expression
of genes encoding type III collagen and transforming growth factor-β3,
characteristic
of scarless wound healing. The HAs upregulated the expression of genes encoding
pro-proliferative,
pro-migratory,
and pro-inflammatory
factors, with only a moderate
effect on the latter in gingival fibroblasts. In palatal but not gingival fibroblasts, an
indirect effect of HA on the expression of matrix metalloproteinases 2 and 3 was
detected, potentially exerted through induction of pro-inflammatory
cytokines.
Finally, our data pointed on Akt, Erk1/2 and p38 as the signaling molecules whereby
the HAs exert their effects on oral fibroblasts.
Conclusion: Both investigated HA formulations are biocompatible and enhance the
proliferative, migratory and wound healing properties of cell types involved in soft
tissue wound healing following regenerative periodontal surgery. Our data further
suggest that in gingival tissues, the HAs are not likely to impair the healing process by
prolonging inflammation or causing excessive MMP expression at the repair site.

Periodontal Healing After Application of Enamel Matrix Derivative

Periodontal Healing After Application of Enamel Matrix Derivative in Surgical Supra Infrabony Periodontal Defects in Rates with Streptozotocin-Induced Diabetes

Background and Objective: Epidemiologic and clinical studies have indicated that
diabetes is a risk factor for periodontal disease progression and healing. The
aim of the present study was to evaluate short-term healing after enamel matrix
derivative (EMD) application in combined supra/infrabony periodontal defects
in diabetic rats.
Material and Methods: Thirty male Wistar rats were initially divided into two
groups, one with streptozotocin-induced diabetes and another one with healthy
(non-diabetic) animals. Bony defects were surgically created on the mesial root
of the first maxillary molars. After root surface planing and EDTA conditioning,
EMD was applied to the roots at one side of the maxillae, while those on
the contralateral sides were left untreated. Animals were killed 3 wk after surgery,
and block sections were prepared for histologic and histomorphometric
analysis.
Results: There was statistically significant more gingival recession in diabetic
animals than in non-diabetic animals. The length of the junctional epithelium
was significantly shorter in the EMD-treated sites in both diabetic and normoglycemic
rats. Sulcus depth and length of supracrestal soft connective tissue
showed no statistically significant differences between groups. In all animals,
new bone formation was observed. Although new bone occurred more frequently
in healthy animals, the extent of new bone was not significantly different
between groups. In none of the teeth, a layer of new cementum was detectable.
EMD had no influence on bone or cementum regeneration. Adverse reactions
such as excessive inflammation due to bacterial root colonization, ankylosis and
bone fractures were exclusively observed in diabetic animals, irrespective of
EMD treatment.

Hyaluronic Acid as an Adjunctive

Hyaluronic Acid as Adjunctive to Non-Surgical and Meta-Analysis

Objectives To evaluate the potential added benefit of the topical application of hyaluronic acid (HA) on the clinical outcomes
following non-surgical or surgical periodontal therapy.
Materials and methods A systematic search was performed in Medline, Embase, Cochrane, Web of Science, Scopus and Grey
literature databases. The literature search was preformed according to PRISMA guidelines. The Cochrane risk of bias tool was
used in order to assess the methodology of the included trials.Weighted mean differences (WMDs) and 95%confidence intervals
(CIs) between the treatment and controls were estimated using the random-effect model for amount of bleeding on probing
(BOP), probing depth (PD) reduction and clinical attachment level (CAL) gain. In order to minimize the bias and to perform
meta-analysis, only randomized clinical studies (RCTs) were selected.
Results Thirteen RCTs were included: 11 on non-surgical periodontal treatment and two on surgical periodontal treatment.
Overall analysis of PD reduction, CAL gain and BOP reduction in non-surgical therapy with adjunctive HA presented WMD
of − 0.36 mm (95% CI − 0.54 to − 0.19 mm; p < 0.0001), 0.73 mm (95%CI 0.28 to 1.17 mm; p < 0.0001) and − 15% (95% CI − 22 to − 8%; p < 0.001) respectively, favouring the application of HA. The overall analysis on PD and CAL gain in surgical therapy with adjunctive HA presented WMD of − 0.89 mm (95% CI − 1.42 to − 0.36 mm; p < 0.0001) for PD reduction and 0.85 mm (95% CI 0.08 to 1.62 mm; p < 0.0001) for CAL gain after 6–24 months favouring the treatment with HA. However, comparison presented considerable heterogeneity between the non-surgical studies and a high risk of bias in general. Conclusions Within their limits, the present data indicate that the topical application ofHA may lead to additional clinical benefits when used as an adjunctive to non-surgical and surgical periodontal therapy. However, due to the high risk of bias and heterogeneity, there is a need for further well-designed RCTs to evaluate this material in various clinical scenarios. Clinical relevance The adjunctive use of HA may improve the clinical outcomes when used in conjunction with non-surgical and surgical periodontal therapy.

Accelerated Degradation of Collagen Membranes

Accelerated Degradation of Collagen Membranes in Diabetic Rats is Associated with Increased Infiltration of Macrophages and Blood Vessels

Objectives Increased collagenolytic activity in diabetes may
compromise collagen membrane (CM) survival. Tetracycline
(TTC) possesses anti-collagenolytic properties and delaysCM
degradation. This study evaluated macrophage and capillary
infiltration within CMs in diabetic rats.
Materials and methods Diabetes was induced in 20 Wistar
rats by streptozotocin and 20 served as controls. Biotinlabeled
CM discs were immersed in either TTC (50 mg/ml)
or PBS. In each animal, 2 discs (TTC and control) were implanted
under the parietal periosteum and rats were sacrificed
at 2 or 4 weeks post-implantation. The area and thickness of
the residual disc collagen were measured following staining
with streptavidin, and the number of macrophages and blood
vessels within the membranes was determined using specific
antibodies (to CD68 and transglutaminase II, respectively).
Results Diabetes significantly reduced the area and thickness
of the CMs, while TTC increased CMthickness significantly
in both groups of rats at 2 and 4 weeks. Diabetes
increased the number of macrophages (∼eightfold at
2 weeks and ∼fourfold at 4 weeks), but TTC had no significant
effect. Finally, diabetes increased the number of blood
vessels within the discs (∼threefold at 2 weeks and ∼twofold
at 4 weeks), while TTC had no effect.
Conclusions Diabetes increases degradation of native CMs
and the number of blood vessels and macrophages within
them. TTC immersion delays CM degradation without an apparent
effect on macrophage and blood vessel penetration.
Clinical relevance Enhanced CMdegradation in diabetic conditions
which impair guided regenerative procedure outcome
is apparently related to increased blood vessel formation and
macrophage infiltration.

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