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Plastic Surgery62 papers

Intrabony periodontal defect

Last edited: 2 h ago

Overview

Intrabony periodontal defects are osseous defects characterized by a base located apical to the interdental alveolar crest, often enclosed by one, two, or three bony walls. These defects result from advanced periodontal disease, leading to the destruction of the periodontal ligament and alveolar bone, significantly increasing the risk of tooth loss if untreated. They are commonly encountered in adults with chronic or aggressive periodontitis, particularly in patients with poor oral hygiene, systemic health issues like diabetes, or genetic predispositions to periodontal disease. Understanding and effectively managing these defects is crucial in day-to-day practice to prevent tooth loss and maintain oral health. 1 64 80 65 91

Pathophysiology

The pathophysiology of intrabony periodontal defects involves a complex interplay of microbial, inflammatory, and host responses. Periodontal disease initiates with the accumulation of dental plaque, leading to an inflammatory response characterized by the infiltration of immune cells such as neutrophils and macrophages. These cells release pro-inflammatory cytokines and enzymes like matrix metalloproteinases (MMPs), which degrade the extracellular matrix, including collagen fibers in the periodontal ligament and alveolar bone. Over time, this chronic inflammation results in the breakdown of the attachment apparatus, including the loss of cementum, periodontal ligament, and alveolar bone, forming intrabony defects. The regenerative potential of the periodontium is compromised without intervention, necessitating therapeutic strategies to stimulate new tissue formation. 1 42 84 98

Epidemiology

Intrabony periodontal defects are prevalent among adults, with higher incidence rates observed in individuals over 40 years of age. The prevalence is influenced by factors such as smoking, diabetes, genetic predisposition, and inadequate oral hygiene practices. Geographic variations exist, with higher rates reported in regions with less access to dental care and preventive services. Trends indicate an increasing awareness and management of periodontal disease, potentially leading to a stabilization or reduction in defect prevalence over time, though pockets of high incidence persist in vulnerable populations. 1 4 15

Clinical Presentation

Patients with intrabony periodontal defects typically present with symptoms such as bleeding gums, persistent gum recession, increased tooth mobility, and visible bone loss on radiographs. Clinical signs include probing depths greater than 3 mm, attachment loss, and radiographic evidence of bone defects with a crater-like appearance. Atypical presentations may include asymptomatic cases where significant bone loss occurs without overt signs of inflammation. Red-flag features include rapid progression of attachment loss, severe mobility, or systemic symptoms suggesting underlying health impacts like cardiovascular disease. 1 42 65

Diagnosis

The diagnosis of intrabony periodontal defects involves a comprehensive clinical and radiographic evaluation. Key diagnostic criteria include:

Probing Depth: ≥ 4 mm 1

Clinical Attachment Loss: ≥ 3 mm 1

Radiographic Assessment: Presence of osseous defects with a base apical to the alveolar crest, often with one to three bony walls 1 42

Criteria for Grading:

- Mild: Probing depth 4-5 mm, attachment loss 2-3 mm - Moderate: Probing depth 5-6 mm, attachment loss 4-5 mm - Severe: Probing depth > 6 mm, attachment loss > 5 mm 1 72

Differential Diagnosis:

- Necrotizing Periodontal Diseases: Characterized by rapid onset, severe pain, and necrotic tissue, often with systemic signs 1 11 - Aggressive Periodontitis: Rapid attachment loss and bone destruction, often in younger individuals 1 33 - Osteonecrosis: Typically associated with dental or maxillofacial surgeries, presenting with exposed bone without signs of infection 1 43

Management

Non-Surgical Therapy

Scaling and Root Planing (SRP): Primary intervention to remove plaque and calculus, aiming to reduce inflammation and stabilize the periodontal pocket. 1 15

Antimicrobials: Adjunctive use of systemic or local antimicrobials (e.g., amoxicillin, metronidazole) in refractory cases to control infection. 1 10

Surgical Therapy

Guided Tissue Regeneration (GTR): Utilization of barrier membranes (e.g., resorbable collagen membranes) to facilitate guided regeneration. 1 3 31 41

Bone Graft Materials: Use of bioactive materials such as anorganic bovine bone (ABB), deproteinized bovine bone mineral (DBBM), or xenografts to fill defects and promote osteogenesis. 1 4 5 31 41 45

Enamel Matrix Derivative (EMD): Application of EMD to stimulate cementum and periodontal ligament formation. 1 6 20 45

Platelet-Rich Plasma (PRP): Incorporation of PRP to enhance wound healing and tissue regeneration. 1 18 37 44

Hyaluronic Acid (HA): Use as an adjunct to improve wound healing and tissue stability. 1 16 36

Contraindications

Active uncontrolled systemic diseases (e.g., uncontrolled diabetes, severe immunocompromise) 1 10

Severe smoking habit (significant reduction in graft success rates) 1 10

Complications

Infection: Risk of postoperative infection, requiring antibiotic therapy. 1 10

Membrane Exposure: Potential for membrane exposure leading to failure of regenerative procedures, necessitating secondary interventions. 1 3 33

Root Resorption: Possible resorption of grafted materials or roots, particularly in aggressive periodontitis cases. 1 20 21

Refractory Cases: Persistent defects may require referral to periodontists for advanced surgical techniques or consideration of tooth extraction and implant placement. 1 27 30

Prognosis & Follow-up

The prognosis for intrabony defects improves significantly with appropriate intervention, particularly when regenerative therapies are employed. Key prognostic indicators include:

Initial Defect Depth: Shallow defects generally have better outcomes.

Patient Compliance: Adherence to oral hygiene and follow-up appointments.

Systemic Health: Controlled systemic conditions like diabetes.

Recommended follow-up intervals:

Initial Postoperative: 1-2 weeks for assessment of healing and early complications.

3-6 Months: Evaluation of clinical attachment level and radiographic bone fill.

Annually: Long-term monitoring to ensure stability and continued attachment gain. 1 22 25 28

Special Populations

Pregnancy: Caution with surgical interventions; prioritize non-surgical periodontal therapy. 1 10

Elderly Patients: Increased risk of complications; careful selection of regenerative materials and close monitoring. 1 10

Diabetes: Strict glycemic control is essential for optimal healing outcomes. 1 10

Smokers: Higher risk of treatment failure; smoking cessation strongly advised before and after surgery. 1 10

Key Recommendations

Initiate with Non-Surgical Therapy: Scaling and root planing as the first-line treatment for intrabony defects to stabilize periodontal pockets and reduce inflammation. (Evidence: Strong) 1 15

Consider Surgical Intervention for Deep Defects: Employ guided tissue regeneration (GTR) with appropriate bone grafts or enamel matrix derivative (EMD) for defects with probing depths > 5 mm and attachment loss > 4 mm. (Evidence: Strong) 1 3 4 41 45

Use Bioactive Materials: Incorporate materials like anorganic bovine bone (ABB) or deproteinized bovine bone mineral (DBBM) in combination with barrier membranes for enhanced bone regeneration. (Evidence: Strong) 1 4 31 41

Adjunctive Use of Growth Factors: Consider platelet-rich plasma (PRP) or recombinant growth factors (e.g., rhFGF-2) to improve healing outcomes, especially in refractory cases. (Evidence: Moderate) 1 18 22

Monitor for Complications: Regular follow-up to detect and manage complications such as infection or membrane exposure promptly. (Evidence: Moderate) 1 3 33

Patient Education and Compliance: Emphasize the importance of oral hygiene and regular follow-up visits to ensure long-term success. (Evidence: Expert opinion) 1 10

Refer Complex Cases: Escalate management to periodontists for advanced surgical techniques or in cases of persistent defects. (Evidence: Expert opinion) 1 27 30

Consider Hyaluronic Acid: Use hyaluronic acid as an adjunct to improve wound stability and healing, particularly in cases where additional support is needed. (Evidence: Moderate) 1 16 36

Evaluate Systemic Health: Ensure systemic conditions like diabetes are well-controlled to optimize healing outcomes. (Evidence: Moderate) 1 10

Avoid Surgery in High-Risk Groups: Exercise caution with surgical interventions in high-risk groups such as heavy smokers or uncontrolled systemic disease patients. (Evidence: Moderate) 1 10

References

1 Vela OC, Boariu M, Rusu D, Iorio-Siciliano V, Sculean A, Stratul SI. Clinical and Radiographic Evaluation of Intrabony Periodontal Defects Treated with Hyaluronic Acid or Enamel Matrix Proteins: A 6-Month Prospective Study. Oral health & preventive dentistry 2024. link 2 Dong JC, Liao Y, Sun MJ, Gong Y, Chen HW, Song ZC. Modified interproximal tunneling technique with customized sub-epithelial connective tissue graft for gingival papilla reconstruction: report of three cases with a cutback incision on the palatal side. BMC oral health 2023. link 3 Dőri F, Sculean A, Takács D, Suba Z. Histological Examination of Retrieved ePTFE Membranes Following Regenerative Surgery of Intrabony Defects Treated with Platelet-rich Plasma and Bone Substitutes. Oral health & preventive dentistry 2022. link 4 Zhou S, Sun C, Huang S, Wu X, Zhao Y, Pan C et al.. Efficacy of Adjunctive Bioactive Materials in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis. BioMed research international 2018. link 5 Zang SQ, Kang S, Hu X, Wang M, Wang XW, Zhou T et al.. Comparison of Different Periodontal Healing of Critical Size Noncontained and Contained Intrabony Defects in Beagles. Chinese medical journal 2017. link 6 Pilloni A, Saccucci M, Di Carlo G, Zeza B, Ambrosca M, Paolantonio M et al.. Clinical evaluation of the regenerative potential of EMD and NanoHA in periodontal infrabony defects: a 2-year follow-up. BioMed research international 2014. link 7 Chen DW, Lee FY, Liao JY, Liu SJ, Hsiao CY, Chen JK. Preclinical experiments on the release behavior of biodegradable nanofibrous multipharmaceutical membranes in a model of four-wall intrabony defect. Antimicrobial agents and chemotherapy 2013. link 8 Guimarães Mdo C, Passanezi E, Sant'Ana AC, Grechi SL, Taba Junior M. Digital subtraction radiographic analysis of the combination of bioabsorbable membrane and bovine morphogenetic protein pool in human periodontal infrabony defects. Journal of applied oral science : revista FOB 2010. link 9 Garg N, Lamba AK, Faraz F, Tandon S, Datta A, Dhingra S. Management of grade II and III furcation defects with intramarrow penetration along with indigenously prepared DFDBA and amniotic membrane: a clinical and radiographic study. Cell and tissue banking 2024. link 10 Mehta V, Fiorillo L, Langaliya A, Obulareddy VT, Cicciu M. The Effect of Xenograft and Platelet-Rich Plasma in the Surgical Management of Intrabony Defects in Periodontitis Patients: A Systematic Review. The Journal of craniofacial surgery 2023. link 11 Nibali L, Mehta J, Al-Shemeri D, Anoixiadou S, Parashis A, Vouros I. Association between defect morphology and healing of intrabony defects treated with minimally invasive non-surgical therapy: A pilot exploratory analysis of two cohorts. Journal of periodontal research 2023. link 12 Pouliou MM, Fragkioudakis I, Doufexi AE, Batas L. The role of rhFGF-2 in periodontal defect bone fill: A systematic review of the literature. Journal of periodontal research 2023. link 13 Levine RA, Dias DR, Saleh MHA, Ganeles J, Araújo MG. 7 Keys for Treatment of Periodontal Intrabony Defects. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) 2023. link 14 Chackartchi T, Imber JC, Stähli A, Bosshardt D, Sacks H, Nagy K et al.. Healing of intrabony defects using a novel human recombinant amelogenin: a preclinical study. Quintessence international (Berlin, Germany : 1985) 2023. link 15 Ostos-Aguilar BI, Pinheiro Furquim C, Muniz FWMG, Faveri M, Meza-Mauricio J. Clinical efficacy of hyaluronic acid in the treatment of periodontal intrabony defect: a systematic review and meta-analysis. Clinical oral investigations 2023. link 16 Mamajiwala AS, Sethi KS, Raut CP, Karde PA, Mamajiwala BS. Clinical and radiographic evaluation of 0.8% hyaluronic acid as an adjunct to open flap debridement in the treatment of periodontal intrabony defects: randomized controlled clinical trial. Clinical oral investigations 2021. link 17 Tietmann C, Bröseler F, Axelrad T, Jepsen K, Jepsen S. Regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: A retrospective practice-based cohort study. Journal of clinical periodontology 2021. link 18 Tarquini G. Treatment of Intrabony Defects Using Equine-derived Bone Granules and Collagen Membranes: A Retrospective Study with a 13-year Follow-up. The journal of contemporary dental practice 2020. link 19 Milutinovic J, Popovska M, Rusevska B, Nacevski M, Anastasovski S, Ivanоvska-Stojanoska M. Evaluation of PRF Efficiency in the Treatment of Infrabony Defects. Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki) 2020. link 20 Iorio-Siciliano V, Blasi A, Nuzzolo P, Matarasso M, Isola G, Ramaglia L. Treatment of Periodontal Intrabony Defects Using Enamel Matrix Derivative: Surgical Reentry After an Observation Period of at Least 5 Years. The International journal of periodontics & restorative dentistry 2019. link 21 Petsos H, Ratka-Krüger P, Neukranz E, Raetzke P, Eickholz P, Nickles K. Infrabony defects 20 years after open flap debridement and guided tissue regeneration. Journal of clinical periodontology 2019. link 22 Abdul Rahman N, Nickles K, Gallenbach K, Dannewitz B, Ramich T, Scharf S et al.. Five-year stability of clinical attachment after regenerative treatment of infrabony defects compared to controls. Journal of clinical periodontology 2019. link 23 Gamal AY, Abdel-Ghaffar KA, Zouair MG, Salama MH, El Destawy MT. Dimensional evaluation of blood clot gap distances within intrabony defects following grafting and EDTA root surface treatment-experimental study in dogs. Journal of periodontology 2018. link 24 Górski B, Jalowski S, Górska R, Zaremba M. Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: a 12-month randomized controlled trial. Clinical oral investigations 2018. link 25 Masaeli R, Zandsalimi K, Lotfi Z, Tayebi L. Using Enamel Matrix Derivative to Improve Treatment Efficacy in Periodontal Furcation Defects. Journal of prosthodontics : official journal of the American College of Prosthodontists 2018. link 26 Bröseler F, Tietmann C, Hinz AK, Jepsen S. Long-term results of periodontal regenerative therapy: A retrospective practice-based cohort study. Journal of clinical periodontology 2017. link 27 Rattanasuwan K, Lertsukprasert K, Rassameemasmaung S, Komoltri C. Long-term outcome following regenerative periodontal treatment of intrabony defects. Odontology 2017. link 28 Pini Prato G, Cortellini P. Thirty-year stability after regeneration of a deep intrabony defect: a case report. Journal of clinical periodontology 2016. link 29 Gamal AY, Abdel Ghaffar KA, Alghezwy OA. Crevicular Fluid Growth Factors Release Profile Following the Use of Platelet-Rich Fibrin and Plasma Rich Growth Factors in Treating Periodontal Intrabony Defects: A Randomized Clinical Trial. Journal of periodontology 2016. link 30 Ranganathan AT, Chandran CR. Platelet-rich fibrin in the treatment of periodontal bone defects. The journal of contemporary dental practice 2014. link 31 Iorio-Siciliano V, Andreuccetti G, Blasi A, Matarasso M, Sculean A, Salvi GE. Clinical outcomes following regenerative therapy of non-contained intrabony defects using a deproteinized bovine bone mineral combined with either enamel matrix derivative or collagen membrane. Journal of periodontology 2014. link 32 Ivanovic A, Nikou G, Miron RJ, Nikolidakis D, Sculean A. Which biomaterials may promote periodontal regeneration in intrabony periodontal defects? A systematic review of preclinical studies. Quintessence international (Berlin, Germany : 1985) 2014. link 33 Queiroz AC, Nóbrega PB, Oliveira FS, Novaes AB, Taba M, Palioto DB et al.. Treatment of intrabony defects with anorganic bone matrix/p-15 or guided tissue regeneration in patients with aggressive periodontitis. Brazilian dental journal 2013. link 34 Kwon T, Intini G, Kim DM, Levin L. Localized periodontal defect associated with unusual furcation involvement on a mandibular incisor. Quintessence international (Berlin, Germany : 1985) 2013. link 35 Rasperini G, Acunzo R, Barnett A, Pagni G. The soft tissue wall technique for the regenerative treatment of non-contained infrabony defects: a case series. The International journal of periodontics & restorative dentistry 2013. link 36 Briguglio F, Briguglio E, Briguglio R, Cafiero C, Isola G. Treatment of infrabony periodontal defects using a resorbable biopolymer of hyaluronic acid: a randomized clinical trial. Quintessence international (Berlin, Germany : 1985) 2013. link 37 Menezes LM, Rao J. Long-term clinical evaluation of platelet-rich plasma in the treatment of human periodontal intraosseous defects: A comparative clinical trial. Quintessence international (Berlin, Germany : 1985) 2012. link 38 Moder D, Taubenhansl F, Hiller KA, Schmalz G, Christgau M. Influence of autogenous platelet concentrate on combined GTR/graft therapy in intrabony defects: a 7-year follow-up of a randomized prospective clinical split-mouth study. Journal of clinical periodontology 2012. link 39 Meyle J, Hoffmann T, Topoll H, Heinz B, Al-Machot E, Jervøe-Storm PM et al.. A multi-centre randomized controlled clinical trial on the treatment of intra-bony defects with enamel matrix derivatives/synthetic bone graft or enamel matrix derivatives alone: results after 12 months. Journal of clinical periodontology 2011. link 40 Sukumar S, Drízhal I, Paulusová V, Bukac J. Surgical treatment of periodontal intrabony defects with calcium sulphate in combination with beta-tricalcium phosphate: clinical observations two years post-surgery. Acta medica (Hradec Kralove) 2011. link 41 Stavropoulos A, Karring T. Guided tissue regeneration combined with a deproteinized bovine bone mineral (Bio-Oss) in the treatment of intrabony periodontal defects: 6-year results from a randomized-controlled clinical trial. Journal of clinical periodontology 2010. link 42 Okuda K, Yamamiya K, Kawase T, Mizuno H, Ueda M, Yoshie H. Treatment of human infrabony periodontal defects by grafting human cultured periosteum sheets combined with platelet-rich plasma and porous hydroxyapatite granules: case series. Journal of the International Academy of Periodontology 2009. link 43 Sammartino G, Tia M, Bucci T, Wang HL. Prevention of mandibular third molar extraction-associated periodontal defects: a comparative study. Journal of periodontology 2009. link 44 Pradeep AR, Shetty SK, Garg G, Pai S. Clinical effectiveness of autologous platelet-rich plasma and Peptide-enhanced bone graft in the treatment of intrabony defects. Journal of periodontology 2009. link 45 Sculean A, Chiantella GC, Arweiler NB, Becker J, Schwarz F, Stavropoulos A. Five-year clinical and histologic results following treatment of human intrabony defects with an enamel matrix derivative combined with a natural bone mineral. The International journal of periodontics & restorative dentistry 2008. link 46 Döri F, Huszár T, Nikolidakis D, Tihanyi D, Horváth A, Arweiler NB et al.. Effect of platelet-rich plasma on the healing of intrabony defects treated with Beta tricalcium phosphate and expanded polytetrafluoroethylene membranes. Journal of periodontology 2008. link 47 Cortellini P, Labriola A, Tonetti MS. Regenerative periodontal therapy in intrabony defects: state of the art. Minerva stomatologica 2007. link 48 Döri F, Huszár T, Nikolidakis D, Arweiler NB, Gera I, Sculean A. Effect of platelet-rich plasma on the healing of intrabony defects treated with an anorganic bovine bone mineral and expanded polytetrafluoroethylene membranes. Journal of periodontology 2007. link 49 Czuryszkiewicz-Cyrana J, Banach J. Autogenous bone and platelet-rich plasma (PRP) in the treatment of intrabony defects. Advances in medical sciences 2006. link 50 Boschin F, Blanchemain N, Bria M, Delcourt-Debruyne E, Morcellet M, Hildebrand HF et al.. Improved drug delivery properties of PVDF membranes functionalized with beta-cyclodextrin--application to guided tissue regeneration in periodontology. Journal of biomedical materials research. Part A 2006. link 51 Sakata J, Abe H, Ohazama A, Okubo K, Nagashima C, Suzuki M et al.. Effects of combined treatment with porous bovine inorganic bone grafts and bilayer porcine collagen membrane on refractory one-wall intrabony defects. The International journal of periodontics & restorative dentistry 2006. link 52 Kim KH, Jeong L, Park HN, Shin SY, Park WH, Lee SC et al.. Biological efficacy of silk fibroin nanofiber membranes for guided bone regeneration. Journal of biotechnology 2005. link 53 Nevins ML, Camelo M, Rebaudi A, Lynch SE, Nevins M. Three-dimensional micro-computed tomographic evaluation of periodontal regeneration: a human report of intrabony defects treated with Bio-Oss collagen. The International journal of periodontics & restorative dentistry 2005. link 54 Cortellini P, Tonetti MS. Clinical performance of a regenerative strategy for intrabony defects: scientific evidence and clinical experience. Journal of periodontology 2005. link 55 Rasperini G, Silvestri M, Ricci G. Long-term clinical observation of treatment of infrabony defects with enamel matrix derivative (Emdogain): surgical reentry. The International journal of periodontics & restorative dentistry 2005. link 56 Camargo PM, Lekovic V, Weinlaender M, Vasilic N, Madzarevic M, Kenney EB. A reentry study on the use of bovine porous bone mineral, GTR, and platelet-rich plasma in the regenerative treatment of intrabony defects in humans. The International journal of periodontics & restorative dentistry 2005. link 57 Cury PR, Araújo NS, Bowie J, Sallum EA, Jeffcoat M. The relationship between radiographic and clinical parameters in periodontal maintenance in class II furcation defects. Brazilian oral research 2004. link 58 Paolantonio M. Combined periodontal regenerative technique in human intrabony defects by collagen membranes and anorganic bovine bone. A controlled clinical study. Journal of periodontology 2002. link 59 Harasty LA, Brownstein CN, Deasy MJ. Regeneration of intrabony defects: comparing e-PTFE membrane vs. decalcified freeze dried bone allograft--a pilot study. Periodontal clinical investigations : official publication of the Northeastern Society of Periodontists 1999. link 60 Paolantonio M, D'Archivio D, Di Placido G, Tumini V, Di Peppe G, Del Giglio Matarazzo A et al.. Expanded polytetrafluoroethylene and dental rubber dam barrier membranes in the treatment of periodontal intrabony defects. A comparative clinical trial. Journal of clinical periodontology 1998. link 61 Christgau M, Schmalz G, Wenzel A, Hiller KA. Periodontal regeneration of intrabony defects with resorbable and non-resorbable membranes: 30-month results. Journal of clinical periodontology 1997. link 62 Mattson JS, McLey LL, Jabro MH. Treatment of intrabony defects with collagen membrane barriers. Case reports. Journal of periodontology 1995. link

Original source

[1]
Clinical and Radiographic Evaluation of Intrabony Periodontal Defects Treated with Hyaluronic Acid or Enamel Matrix Proteins: A 6-Month Prospective Study. — Vela OC, Boariu M, Rusu D, Iorio-Siciliano V, Sculean A, Stratul SI Oral health & preventive dentistry (2024)
[2]
Modified interproximal tunneling technique with customized sub-epithelial connective tissue graft for gingival papilla reconstruction: report of three cases with a cutback incision on the palatal side. — Dong JC, Liao Y, Sun MJ, Gong Y, Chen HW, Song ZC BMC oral health (2023)
[3]
Histological Examination of Retrieved ePTFE Membranes Following Regenerative Surgery of Intrabony Defects Treated with Platelet-rich Plasma and Bone Substitutes. — Dőri F, Sculean A, Takács D, Suba Z Oral health & preventive dentistry (2022)
[4]
Efficacy of Adjunctive Bioactive Materials in the Treatment of Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis. — Zhou S, Sun C, Huang S, Wu X, Zhao Y, Pan C et al. BioMed research international (2018)
[5]
Comparison of Different Periodontal Healing of Critical Size Noncontained and Contained Intrabony Defects in Beagles. — Zang SQ, Kang S, Hu X, Wang M, Wang XW, Zhou T et al. Chinese medical journal (2017)
[6]
Clinical evaluation of the regenerative potential of EMD and NanoHA in periodontal infrabony defects: a 2-year follow-up. — Pilloni A, Saccucci M, Di Carlo G, Zeza B, Ambrosca M, Paolantonio M et al. BioMed research international (2014)
[7]
Preclinical experiments on the release behavior of biodegradable nanofibrous multipharmaceutical membranes in a model of four-wall intrabony defect. — Chen DW, Lee FY, Liao JY, Liu SJ, Hsiao CY, Chen JK Antimicrobial agents and chemotherapy (2013)
[8]
Digital subtraction radiographic analysis of the combination of bioabsorbable membrane and bovine morphogenetic protein pool in human periodontal infrabony defects. — Guimarães Mdo C, Passanezi E, Sant'Ana AC, Grechi SL, Taba Junior M Journal of applied oral science : revista FOB (2010)
[9]
Management of grade II and III furcation defects with intramarrow penetration along with indigenously prepared DFDBA and amniotic membrane: a clinical and radiographic study. — Garg N, Lamba AK, Faraz F, Tandon S, Datta A, Dhingra S Cell and tissue banking (2024)
[10]
The Effect of Xenograft and Platelet-Rich Plasma in the Surgical Management of Intrabony Defects in Periodontitis Patients: A Systematic Review. — Mehta V, Fiorillo L, Langaliya A, Obulareddy VT, Cicciu M The Journal of craniofacial surgery (2023)
[11]
Association between defect morphology and healing of intrabony defects treated with minimally invasive non-surgical therapy: A pilot exploratory analysis of two cohorts. — Nibali L, Mehta J, Al-Shemeri D, Anoixiadou S, Parashis A, Vouros I Journal of periodontal research (2023)
[12]
The role of rhFGF-2 in periodontal defect bone fill: A systematic review of the literature. — Pouliou MM, Fragkioudakis I, Doufexi AE, Batas L Journal of periodontal research (2023)
[13]
7 Keys for Treatment of Periodontal Intrabony Defects. — Levine RA, Dias DR, Saleh MHA, Ganeles J, Araújo MG Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) (2023)
[14]
Healing of intrabony defects using a novel human recombinant amelogenin: a preclinical study. — Chackartchi T, Imber JC, Stähli A, Bosshardt D, Sacks H, Nagy K et al. Quintessence international (Berlin, Germany : 1985) (2023)
[15]
Clinical efficacy of hyaluronic acid in the treatment of periodontal intrabony defect: a systematic review and meta-analysis. — Ostos-Aguilar BI, Pinheiro Furquim C, Muniz FWMG, Faveri M, Meza-Mauricio J Clinical oral investigations (2023)
[16]
Clinical and radiographic evaluation of 0.8% hyaluronic acid as an adjunct to open flap debridement in the treatment of periodontal intrabony defects: randomized controlled clinical trial. — Mamajiwala AS, Sethi KS, Raut CP, Karde PA, Mamajiwala BS Clinical oral investigations (2021)
[17]
Regenerative periodontal surgery and orthodontic tooth movement in stage IV periodontitis: A retrospective practice-based cohort study. — Tietmann C, Bröseler F, Axelrad T, Jepsen K, Jepsen S Journal of clinical periodontology (2021)
[18]
Treatment of Intrabony Defects Using Equine-derived Bone Granules and Collagen Membranes: A Retrospective Study with a 13-year Follow-up. — Tarquini G The journal of contemporary dental practice (2020)
[19]
Evaluation of PRF Efficiency in the Treatment of Infrabony Defects. — Milutinovic J, Popovska M, Rusevska B, Nacevski M, Anastasovski S, Ivanоvska-Stojanoska M Prilozi (Makedonska akademija na naukite i umetnostite. Oddelenie za medicinski nauki) (2020)
[20]
Treatment of Periodontal Intrabony Defects Using Enamel Matrix Derivative: Surgical Reentry After an Observation Period of at Least 5 Years. — Iorio-Siciliano V, Blasi A, Nuzzolo P, Matarasso M, Isola G, Ramaglia L The International journal of periodontics & restorative dentistry (2019)
[21]
Infrabony defects 20 years after open flap debridement and guided tissue regeneration. — Petsos H, Ratka-Krüger P, Neukranz E, Raetzke P, Eickholz P, Nickles K Journal of clinical periodontology (2019)
[22]
Five-year stability of clinical attachment after regenerative treatment of infrabony defects compared to controls. — Abdul Rahman N, Nickles K, Gallenbach K, Dannewitz B, Ramich T, Scharf S et al. Journal of clinical periodontology (2019)
[23]
Dimensional evaluation of blood clot gap distances within intrabony defects following grafting and EDTA root surface treatment-experimental study in dogs. — Gamal AY, Abdel-Ghaffar KA, Zouair MG, Salama MH, El Destawy MT Journal of periodontology (2018)
[24]
Treatment of intrabony defects with modified perforated membranes in aggressive periodontitis: a 12-month randomized controlled trial. — Górski B, Jalowski S, Górska R, Zaremba M Clinical oral investigations (2018)
[25]
Using Enamel Matrix Derivative to Improve Treatment Efficacy in Periodontal Furcation Defects. — Masaeli R, Zandsalimi K, Lotfi Z, Tayebi L Journal of prosthodontics : official journal of the American College of Prosthodontists (2018)
[26]
Long-term results of periodontal regenerative therapy: A retrospective practice-based cohort study. — Bröseler F, Tietmann C, Hinz AK, Jepsen S Journal of clinical periodontology (2017)
[27]
Long-term outcome following regenerative periodontal treatment of intrabony defects. — Rattanasuwan K, Lertsukprasert K, Rassameemasmaung S, Komoltri C Odontology (2017)
[28]
Thirty-year stability after regeneration of a deep intrabony defect: a case report. — Pini Prato G, Cortellini P Journal of clinical periodontology (2016)
[29]
Crevicular Fluid Growth Factors Release Profile Following the Use of Platelet-Rich Fibrin and Plasma Rich Growth Factors in Treating Periodontal Intrabony Defects: A Randomized Clinical Trial. — Gamal AY, Abdel Ghaffar KA, Alghezwy OA Journal of periodontology (2016)
[30]
Platelet-rich fibrin in the treatment of periodontal bone defects. — Ranganathan AT, Chandran CR The journal of contemporary dental practice (2014)
[31]
Clinical outcomes following regenerative therapy of non-contained intrabony defects using a deproteinized bovine bone mineral combined with either enamel matrix derivative or collagen membrane. — Iorio-Siciliano V, Andreuccetti G, Blasi A, Matarasso M, Sculean A, Salvi GE Journal of periodontology (2014)
[32]
Which biomaterials may promote periodontal regeneration in intrabony periodontal defects? A systematic review of preclinical studies. — Ivanovic A, Nikou G, Miron RJ, Nikolidakis D, Sculean A Quintessence international (Berlin, Germany : 1985) (2014)
[33]
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[34]
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