Thesis supervisor: Dániel Palkovics
Location of studies (in Hungarian): SE Abbreviation of location of studies: SE
Description of the research topic:
Over the course of the past 30 years regenerative approaches in periodontal surgical therapy have focused on either (i) the surgical flap design or (ii) the applied regenerative strategy. The development in these two areas have vice-versa propagated the other. In the original clinical description of guided tissue regeneration (GTR) barrier membranes where utilized in conjunction with traditional periodontal access flap procedures. However, flap dehiscences above the barrier membranes would commonly occur at the interdental area resulting in compromised surgical outcomes. In order to achieve primary closure, several authors suggested to displace the interdental incision to either the buccal or oral aspect to preserve the integrity of the papilla (i.e. so called papilla preservation procedures). As biomaterials developed and periodontal regeneration could be achieved without the use of a barrier membrane the need for an extended flap design was questioned. Based on the papilla preservation flaps Cortellini & Tonetti have developed minimally invasive surgical approaches for the treatment of intrabony periodontal defects. Instead of a barrier membranes authors described the use of an enamel matrix derivative (EMD) as the regenerative strategy. Nowadays the combination of minimally-invasive surgical techniques and EMD can be considered as the gold standard for the treatment of isolated intrabony periodontal defects.
In case of more extensive intrabony defects the sole use of EMD might not be sufficient for the resolution of the intrabony component resulting in residual periodontal pockets. Various types of particulate graft materials were suggested to be used in conjunction with EMD. Deproteinized bovine bone minerals (DBBM) are most utilized, however postoperative healing might be unpredictable due to occasional connective tissue encapsulation of graft particles. As an alternative autogenous bone chips might be used, however in case of a minimally invasive flap design the local harvesting of the material can be convoluted. As a novel approach the use of autogenous tooth bone graft (ATB) obtained by the grinding and chemical processing of extracted teeth might be considered as an alternative.
Besides novel surgical approaches and new biomaterials, diagnostic and surgical treatment planning can be more precise due to the application of virtual 3D treatment planning. Although it is not routinely used, cone-beam computed tomography (CBCT) scans have several advantages over conventional radiographic diagnostic modalities. Segmentation of CBCT scans provides the clinicians with a 3D virtual model of the dento-alveolar structures, subsequently, visualizing periodontal intrabony defects in three-dimensions. This allows a more elaborative surgical planning process, where the incision, the flap elevation and the applied regenerative strategy can be individualized to each defect configuration. Additionally, if CBCT scan are take prior to and 6 months following regenerative periodontal surgery volumetric hard tissue changes and 3D morphological alterations can also be assessed. Although qualitative analysis of newly formed tissues cannot be performed on CBCT scans alone, assessing quantitative 3D hard tissue alterations might provide a better understanding of wound healing characteristics.
Our aim is to investigate the effectiveness of different regenerative strategies for the treatment of isolated intrabony periodontal defects, and to evaluate hard tissue changes with the use of 3D technologies.
Referenciák
1. Li J, Jin F, Wang R, Shang X, Yang P, Zhu Y, Tsoi JKH, Chan K, Wang S. Guided Bone Regeneration in a Periodontally Compromised Individual with Autogenous Tooth Bone Graft: A Radiomics Analysis. J Funct Biomater. 2023 Apr 14;14(4):220. doi: 10.3390/jfb14040220. PMID: 37103310; PMCID: PMC10142001.
2. Trombelli L, Farina R, Franceschetti G, Calura G. Single-flap approach with buccal access in periodontal reconstructive procedures. J Periodontol. 2009 Feb;80(2):353-60. doi: 10.1902/jop.2009.080420. PMID: 19186978.
3. Cortellini P, Tonetti MS. Improved wound stability with a modified minimally invasive surgical technique in the regenerative treatment of isolated interdental intrabony defects. J Clin Periodontol. 2009 Feb;36(2):157-63. doi: 10.1111/j.1600-051X.2008.01352.x. PMID: 19207892.
4. Cortellini P, Cortellini S, Bonaccini D, Tonetti MS. Modified minimally invasive surgical technique in human intrabony defects with or without regenerative materials-10-year follow-up of a randomized clinical trial: Tooth retention, periodontitis recurrence, and costs. J Clin Periodontol. 2022 Jun;49(6):528-536. doi: 10.1111/jcpe.13627. Epub 2022 Apr 25. PMID: 35415940.
5. Palkovics D, Molnar B, Pinter C, Gera I, Windisch P. Utilizing a novel radiographic image segmentation method for the assessment of periodontal healing following regenerative surgical treatment. Quintessence Int. 2022 May 11;53(6):492-501. doi: 10.3290/j.qi.b2793209. PMID: 35274512.
Deadline for application: 2025-02-01
2024. IV. 17. ODT ülés Az ODT következő ülésére 2024. június 14-én, pénteken 10.00 órakor kerül sor a Semmelweis Egyetem Szenátusi termében (Bp. Üllői út 26. I. emelet).
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