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Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste

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Abstract

Objectives

The aim of the study was to clinically and histologically evaluate the healing of human intrabony defects treated with open flap surgery (OFD) and application of a new, resorbable, fully synthetic, unsintered, nanocrystalline, phase-pure hydroxyapatite (nano-HA).

Materials and methods

Six patients, each of them displaying very advanced intrabony defects around teeth scheduled for extraction due to advanced chronic periodontitis and further prosthodontic considerations, were included in the study. Following local anaesthesia, mucoperiosteal flaps were reflected; the granulation tissue was removed, and the roots were meticulously debrided by hand and ultrasonic instruments. A notch was placed at the most apical extent of the calculus present on the root surface or at the most apical part of the defect (if no calculus was present) in order to serve as a reference for the histological evaluation. Following defect fill with nano-HA, the flaps were sutured by means of mattress sutures to allow primary intention healing. At 7 months after regenerative surgery, the teeth were extracted together with some of their surrounding soft and hard tissues and processed for histological analysis.

Results

The postoperative healing was uneventful in all cases. At 7 months following surgery, mean PPD reduction and mean CAL gain measured 4.0 ± 0.8 and 2.5 ± 0.8 mm, respectively. The histological analysis revealed a healing predominantly characterized by epithelial downgrowth. Limited formation of new cementum with inserting connective tissue fibers and bone regeneration occurred in three out of the six biopsies (i.e. 0–0.86 and 0–1.33 mm, respectively). Complete resorption of the nano-HA was found in four out of the six biopsies. A few remnants of the graft particles (either surrounded by newly formed mineralized tissue or encapsulated in connective tissue) were found in two out of the six biopsies.

Conclusion

Within their limits, the present results indicate that nano-HA has limited potential to promote periodontal regeneration in human intrabony defects.

Clinical relevance

The clinical outcomes obtained following surgery with OFD + nano-HA may not reflect true periodontal regeneration.

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Acknowledgments

The study was funded by a research grant from Heraeus Kulzer. All aspects of the study design, conduction, evaluation of the results and publication were entirely independent of Heraeus Kulzer.

Conflict of interest

The authors declare that they have no personal financial interest in any association with the investigated material or its manufacturer.

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Authors and Affiliations

  1. Department of Periodontology, Semmelweis University, Budapest, Hungary

    Attila Horváth, Péter Windisch, László Lukács & István Gera

  2. Department of Periodontology and Oral Gerontology, Royal Dental College, University of Aarhus, Aarhus, Denmark

    Andreas Stavropoulos

  3. Department of Periodontology, Dental School, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland

    Anton Sculean

Authors
  1. Attila Horváth
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  2. Andreas Stavropoulos
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  3. Péter Windisch
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  4. László Lukács
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  5. István Gera
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  6. Anton Sculean
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Corresponding author

Correspondence to Anton Sculean.

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Horváth, A., Stavropoulos, A., Windisch, P. et al. Histological evaluation of human intrabony periodontal defects treated with an unsintered nanocrystalline hydroxyapatite paste. Clin Oral Invest 17, 423–430 (2013). https://doi.org/10.1007/s00784-012-0739-8

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  • DOI: https://doi.org/10.1007/s00784-012-0739-8

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