1. Periodontal Bone and Tissue Engineering By: Alysia Silva & Crystal Terry Before ProcedureAfter Procedure http://www.praxiszentrum-aachen.com

2. ● Tissue engineering is regenerating a construct that matches the physical and biological properties of natural bone tissue. ● As dental hygienists, we can educate our patients on a possible cure for periodontitis. What Is It?

3. Periodontitis ● Inflammatory disease that destroys alveolar bone, cementum, periodontal ligaments, and gingiva. ● Is the result of accumulation of plaque. bizwire.net

4. The Future Of Periodontitis ● Studies show that 35% of adults suffer from moderate periodontitis. ● 15% of adults are affected by severe periodontitis. ● Has always been known as an irreversible disease.... Until Now! ● Current research indicates that there may be a possible cure for periodontitis.

5. What Is Needed For This Procedure? ● Mesenchymal Stem Cells (MSC's) ● Biomaterial scaffolds. ● Growth and differentiation factors. www.nidcr.nih.gov

6. Composition of Materials ● Mesenchymal Stem Cells are isolated from the patients dental tissues. ● A platelet-rich fibrin (PRF) clot consists of fibrin, platelets, and white blood cells that are freshly prepared from blood. ● Growth factors are added to the PRF and Mesenchymal Stem Cells.

7. How The Procedure Works ● First, elevate a full-thickness periodontal flap. ● Next, a mixture of MSC's and platelet-rich plasma (act as scaffold and growth factor) is applied to the root surface and surrounding area of the bone defect. ● Then, close the periodontal flap with sutures. ● A radiograph should be taken after the surgery. ● The patient will have a follow-up appointment 3 months after the procedure, where a new radiograph will be taken to evaluate the results.

8. ijdr.in hindawi.com Illustration drcaplanis.com adriaticdent.com

9. Results of Clinical Application ● Recent clinical studies were conducted by a group of scientists and dentists. ● The volunteers both exhibited substantial gaps between an implant and alveolar bone socket. ● The mixture was placed in a gap that was between an implant and adjacent bone. ● The surgical site was closed using silk sutures. ● Radiographs were taken immediately and three months after the surgery. ● Wound healing and bone levels were examined using intraoral photographs and oral radiographs. ● On the mesial of the incisor, there was a 5.4mm bone gain. There was also a 4.9mm bone gain on the mesial and distal of the molar implant.

10. Advantages of this procedure ● High-quality regeneration of bone tissues. ● No donor site harvesting. ● Low risk of disease transmission. ● Low risk of autoimmune rejection.

11. Disadvantages of procedure ● The outcome of this procedure is currently unpredictable. ● Cost-effectiveness may be an issue. ● Long-term effects are still unknown. ● Involve unavoidable operative stress.

12. Periodontal Tissue Engineering ● Periodontal Tissue Engineering can attribute to the regrowth of periodontal bone tissues by the use of mesenchymal stem cells mixture. ● The success rate of this procedure is undetermined due to the fact that this procedure is very unpredictable.

13. Relation to Dental Hygienists? ● As Dental Professionals, this procedure could allow us the opportunity to give our patient's another option concerning the outcome of periodontitis.

14. Further research needed? ● Before this procedure can be used as a definite procedure for patients with periodontitis, more research is needed. ● The realistic goal for this procedure is to develop safe, effective, and low cost biomaterials/drugs. ● Further studies to assess duration of outcome are necessary.

15. Citation References ● Li, Qi, et al. "Platelet-Rich Fibrin Promotes Periodontal Regeneration And Enhances Alveolar Bone Augmentation." Biomed Research International 2013.(2013): 638043. MEDLINE. Web. 25 Apr. 2014. ● Moshaverinia, Alireza, Chider Chen, Xingtian Xu, Kentaro Akiyama, Sahar Ansari, Homayoun H. Zadeh, and Songtao Shi. "Bone Regeneration Potential of Stem Cells Derived from Periodontal Ligament or Gingival Tissue Sources Encapsulated in RGD-Modified Alginate Scaffold." Tissue Engineering Part A (2013): 131106060201007. Www.ncbi.nlm.nih.gov. Mary Ann Leibert Inc., 6 Nov. 2013. Web. 28 Apr. 2014. ● Pejcic, A., D. Kojovic, D. Mirkovic, and I. Minic. "Stem Cells for Periodontal Regeneration." Balkan Journal of Medical Genetics 16.1 (2013): n. pag. Www.ncbi.nlm.nih.gov. Versita Emerging Science Pulishers, 03 Oct. 2013. Web. 28 Apr. 2014. ● Egusa, Hiroshi, et al. "Stem Cells In Dentistry – Part II: Clinical Applications." Journal Of Prosthodontic Research 56.4 (2012): 229-248. J-STAGE. Web. 25 Apr. 2014. ● Marolt, Darja, Miomir Knezevic, and Gordana Vunjak Novakovic. "Bone Tissue Engineering With Human Stem Cells." Stem Cell Research & Therapy 1.2 (2010): 10. MEDLINE. Web. 15 Apr. 2014. ● Sasikumar, Karuppanan P., Sugumari Elavarasu, and Jayaprakash S. Gadagi. "The Application Of Bone Morphogenetic Proteins To Periodontal And Peri-Implant Tissue Regeneration: A Literature Review." Journal Of Pharmacy & Bioallied Sciences (2012): S427-S430. Academic Search Complete. Web. 15 Apr. 2014. ● Rao, Subramaniam M., Gauri M. Ugale, and Shivaraj B. Warad. "Bone Morphogenetic Proteins: Periodontal Regeneration." North American Journal of Medical Sciences 5.3 (2013): 161-68. North American Journal of Medical Sciences. Medknow, 20 Mar. 2013. Web. 15 Apr. 2014.