THE REGENERATIVE POTENTIAL OF BONE TISSUE IN PATIENTS WITH GENERALIZED PERIODONTITIS STAGE II, II-III AND ANALYSIS OF IT`S ROLE DURING SURGICAL OPERATIONS ON PERIODONTAL TISSUES
The contemporary surgical approaches for operations on periodontal tissues have been considerably modified [5,12,15,16], became to be less invasive [5,15] and mainly aimed to provide regeneration of periodontal tissues simultaneously preventing the tissues relief [7,11,13,15,16]. However, generalized periodontitis (GP) still becomes to be the most widespread pathology of periodontal tissues which can be seen amoung working category of citizens [3-5,12,15,16]. Having big choice of modern devices and treatment protocols, the problem of effective treatment of GP appears until present times as unsolved [8,12,14,16]. GP characterized by its chonic course that can be followed by progressive periodontal tissue distraction and their loss [3,4,15,16]. During this process such significant structures as: alveolar bone, periodontal ligament and root cement, whose are characterized [3,4,7,10,12,13-16] by very slow reparation, need very longtime terms for regeneration that depends on condition of neighboring tissues of periodontal wound [3,4,12-16]. The complicity of periodontal tissues structure and their anatomical connections during functioning determine the main problems in reaching aimed regeneration using modern methods [3,4,10,11,13-16].
Using of modern types of surgical incisions, the protection of marginal soft periodontal tissues [5,15] can be accepted and due to sanation of existing periodontal lesion with manual currets and ultrasonic devices [5,12,15,16] the possibility to protect the marginal alveolar bone margin in area of periodontal pocket (PP) can be reached. Using such approach we can abandon from drilling of marginal bone PP walls [5,12,15] as it was established in previous surgical approaches. The maximal protection of marginal bone level in area of PP is the guarantee for better fixation and stabilization of blood clot in wound and bone substitute materials, postoperative longterm wound stability and also minization of recessions and unsuficient aestetic results after surgical procedure [5,11,15,16].
The condition of bone tissue and it`s regenerative potential in area of existing periodontal defect [1,3,4,5,8,11,13,14] may play crucial role in time of surgical interventions in patients with GP during surgical phase of complex periodontal therapy and preoperative prepartion stage of such patients to implants.
Taking into consideration the stated details the modern surgical treatment of GP aims to provide development of enhanced treatment protocol concerning bone tissue preparation in area of PP with support or stimulation of regenerative potential in area of infected periodontal wound. The knowledge of stated details promotes clinically based usage of special devices and surgical approaches for maximal bone sanation in area of PP and protection of marginal bone of periodontal defect.
The main aim of presented study was to investigate the regenerative potential of bone tissue in area of periodontal defect in patients with GP of II, II-III stage. For this in patients with GP stage II, II-III the cancellous alveolar bone was taken during surgical procedure on periodontal tissues according to MIST (Cortellini P., Tonetti M., 2007, 2009) from bony walls and bottom of bone PP. The date was comparwd with healthy patients who had indication for tooth extraction according to orthodontic or prosthodontic indications. The further investigation with vital osteogenous stromal cells was provided in vitro according to methodic of O.Y. Fridenstein (1973) in modification of Astachova V.S. (1982) [1,2,9]. The vital osteogenous cells – stromal fibroblasts were collected from patient and put into sterile box with nourishing solution “199”. According to the presented study the collected vital cells were immediately transferred to laboratory passing the preparation stages. The bone osteogenous progenitor cells are characterized by ability to multiply making colonies under influence of special conditions and presence of feeding serum prepared from mortaly irradiated cells of rabbit bone marrow. If the new built cell line from one osteogenous progenitor cell consists of more than 50 cells it can be called as colony. If the amount of cells is less than 50 cells it can be called as cluster [1,2]. The presence of GP may change the quality of bone in area of lesion that can influence on cells activity reducing their ability to multiply. This can lead to reduction of bone regenerative potential in area of PP.
The presented results can be useful in development of new surgical approach working in area of PP providing deep precise sanation and stimulation of bone tissue. These can be crucial for treatment of patients with GP in aim to reduce toothloss and provide long term stability of clinical results.
2. Bosshardt D.D. Biological mediators and periodontal regeneration: a review of enamel matrix proteins at the cellular and molecular levels / Bosshardt D.D. // J. Clin. Periodontol. – 2008.№35 (Suppl. 8):87-105 doi:10.1111/j.1600-051IX.2008.01264.x
3. Bosshardt D.D. Hertwig`s root sheath, enamel matrix proteins, and initiation of cementogenesis in porcine teeth / Bosshardt D.D., Nanci A.// Journal of Clinical Periodontology. – 2004.- №31.- Р. 184-192.
4. Cortellini P. Clinical and radiographic outcomes of the modified minimally invasive surgical technique with and without regenerative materials: a randomizedcontrolled trial intrabony defects / Cortellini P., Tonetti M. S.// J. Clin. Periodontol. – 2011.- № 38.- Р. 365-373.
5. Effects of phosphated titanium and enamel matrix derivatives on osteoblast behavior in vitro / Dacy J. A., Spears R., Hallmon W.W.[еt аl.] // International Journal of Oral and Maxillofacial Implants.- 2007.- №22.- Р. 701-709.
6. Amelogenin, a major structural protein in mineralizing enamel, is also expressed in soft tissues: brain and cells of the hematopoietic system / Deutsch D., Haze- Fildelman A., Blumenfeld A. [еt аl.] // Eur. J. Oral. Sci.- 2006. - № 114.- Р. 183-189.
7. Fong C.D. Expression of amelin and amelogenin in epithelial root sheath remnants of fully formed rat mo- lars / Fong C.D., Hammastrom L. // Oral Surg Oral Med Oral Pathol Oral Radio Endodon. - 2000; 90: 218-23.
8. Fridenstein A.J. Induction of bone tissue and osteоgenous progenitor cells / Fridenstein A.J., Lalikina K.S. – Moskow:Medicine, 1973.- 223 p.
9. Osteopretegerin and receptor activator of nuclear factor-kappa B ligand modulation by enamel matrix derivate in human alveolar osteoblasts / Galli C., Macaluso G.M., Guizzardi S. [еt аl.] // Journal of Periodontology.- 2006.- №77.- Р. 1223-1228.
10. In vitro biologic response of human bone marrow stromal cells to enamel matrix derivative / Guida L., Annunziata M., Carinci F. [еt аl.] // Journal of Periodontology.- 2007.- № 78.- Р. 2190-2196.
11. Soft-tissue wound healing following periodontal surgery and Emdogain applicaton /Hagenaars S., Louwerse P.G.H., Timmerman M.F. [еt аl.] // J. Clin. Periodontol. – 2004.- № 31.- Р. 850.
12. Hammastrom L. Enamel matrix, cementum development and regeneration/ L. Hammastrom // J. Clin. Periodontol. – 1997.- № 24.- Р. 658-68.
13. Hammastrom L. Periodontal regeneration in a buccal dehiscence model in monkeys after application of enamel matrix proteins / Hammastrom L., Heijl L., Gestrelius S. // J. Clin. Periodontol. – 1997.- № 24.- Р. 669-77.
14. Linares A., Cortellini P., Lang N. P., Suvan J., Tonetti M. S.; European Research Group on Periodontology (Ergoperio). Guided tissue regeneration/deproteinized bovine bone mineral or papilla preservation flaps alone for treatment of intrabony defects. II: radiographic predictors and outcomes // J. Clin. Periodontol. - 2006: 33: 351-8.