Consensus Reports for Periodontal Regenerative Therapies from 2014 AAP Spring Workshop

March 30, 2015

The American Academy of Periodontology held a workshop on regenerative therapies for periodontal disease in May of 2014. The workshop was titled “Enhancing Periodontal Health through Regenerative Approaches,” and its purpose was to organize the current research conducted on various topics regarding periodontal regenerative therapies, and once having done this, create consensus reports providing the information on future research and clinical applications of the material. Those at the workshop met to conduct a systematic review of the current literature on the topic, and from their findings developed five practical application papers and five consensus reports. These consensuses reported material and findings on certain topics as well as identified properties for future research.

The following are excerpts from the consensus reports:

• Periodontal Soft Tissue Root Coverage Procedures: Flap procedures alone or in association with biomaterials have been described as less painful, whereas use of palatal donor tissue has been associated with increased complications. Limited data suggest a positive effect of root coverage procedures on dentinal hypersensitivity. Other patient-reported outcomes (such as esthetics, patient satisfaction, and convenience) have not been adequately investigated.
To read the entire consensus report regarding these procedures click here.

• Periodontal Soft Tissue Non-Root Coverage Procedures: Restorative subgingival margins have been associated with greater plaque accumulation, inflammation, and gingival recession. When these subgingival margins affect areas of minimal amounts of KT, there might be a higher risk for gingival recession. In fact, some studies have reported that subgingival margin placement has led to early gingival recession and AL despite careful maintenance therapy, and gingival recession was more likely to occur at these sites. There is enough clinical evidence from classic literature to support maintaining an adequate band of gingiva for restorations with intracrevicular margins.
To read the entire consensus report regarding these procedures click here.

• Intrabony Defects: Consistent good-quality patient-based evidence indicates that EMD and rhPDGF-BB with b-tricalcium phosphate scaffold can provide comparable regenerative results as found with previously reviewed regenerative approaches, such as GTR, anorganic bovine bone matrix, and DFDBA. Currently, the largest body of evidence is available to support DFDBA as a predictable material for periodontal regeneration of intrabony defects.
To read the entire consensus report regarding these defects click here.

• Furcation Defects: The group appraised the systematic review and accepted the following conclusions: 1) Periodontal regeneration has been demonstrated histologically and clinically for the treatment of maxillary facial, mesial, distal, and mandibular facial or lingual Class II furcation defects; 2) Although periodontal regeneration has been demonstrated histologically for the treatment of mandibular Class III defects, the clinical evidence is limited to one case report; 3) Evidence supporting regenerative therapy in maxillary Class III furcation defects in molars and premolar furcation defects is limited to clinical case reports, which reported unpredictable outcomes; and 4) In Class I furcation defects, regenerative therapy may be beneficial in certain clinical scenarios, although most Class I furcation defects may be successfully treated with non-regenerative therapy.
To read the entire consensus report regarding these defects click here.

• Emerging Regenerative Approaches for Periodontal Reconstruction: When dealing with emerging technologies, there can be both positive and negative issues of clinician adoption and patient acceptance of treatment. Barriers to adopting this technology include limited evidence supporting efficacy and indications for use. With emerging technologies, safety issues include unknown long-term effects along with known risk for rare but serious side effects, such as sarcoma.
To read the entire consensus report regarding these approaches click here.

ADDITIONAL READING |Practical applications for periodontal regenerative therapies