A New Approach to Non-Surgical Periodontal Therapy by Fibrin Sealant on A Case of Generalized Aggressive Periodontitis

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Posted on By Vincenzo Foti In Periodontics

Woman 35 years old with generalized aggressive periodontitis and post-orthodontic external apical root resorption on several teeth. The power of Fibrin Sealant: hermetic seal of pockets for 2 weeks during the crucial processes of initial regeneration (angiogenesis & ECM induction), hemostasis, clot stability, early soft-tissue healing. A new way to gain patient satisfaction and compliance in order to achieve the better control of periodontal disease

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6 Comments

Great idea....how would this treatment compare with conventional therapy or laser treatment? Would have been interesting to treat one side with fibrin and the other conventional and compare...thanks Maurice


Reply

Thanks for your comment Maurice! I will follow your suggestion in the next cases. The periodontitis associated with the apex injuries induced me to use this protocol with fibrin sealant because I wanted to have a positive impact on the lady very concerned about her periodontal condition. The pocket seal was really effective during the first week and favored immediate oral hygiene.


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Vincenzo that is a great idea (using the EDTA as root preparation agent always made sense to me), thank you for sharing!
I have some questions that I would love to hear your opinion:

1) Do you use a disinfectant agent (POV, Chlorexid., etc) during this original phase in order to disinfect the pocket?

2) Do you think fibrin will work better than Emdogain? The latter has been used in these protocols with not major effect.

Thank you for bringing up this topic, I believe it is very important.

Yiannis


Reply

Dear Yiannis,

thank you so much for the questions. I don't use antibacterial solutions during the treatment because the evidence not recommend this.

I agree with you on Emdogain. It has not additional effects in the non-surgical periodontal therapy (Hagenaars 2004).

The fibrin sealant is effective on fast wound healing because protects soft-tissue and reinforces the sutures due to his insulating and impermeabilizing action.
For this reason i've applied it primarily to achieve the pockets seal during the first week.

Not forgetting its hemostatic and inductive action!

Best regards
Enzo


Reply

Enzo, it is very interesting and promising approach, thank you for sharing. Really nice healing - how much time between two radiograms?
I agree that it would be great to do at least some cases in split mouth design and compare Fibrin Sealant to SRP alone.
What do you think about the risk to develop a periodontal abscess for deep pockets when using a sealant? I recall few periodontal abscesses connected with Atridox application, something that I haven`t seen with other local disinfectant and antibiotics. Atridox gel also seals hermetic the pockets. The answer is probably in thorough scaling, but I would like to hear your opinion.
It`s great that you share your knowledge on Forum, welcome Enzo!
Best regards
Snjezana


Reply

Dear Snjezana,

thank you for your kind appreciation and questions.
I point out that the patient received a careful scaling one week earlier. He then started antibiotic treatment with Amoxicillin and Metronidazole the day before the full-mouth disinfection and continued for 1 week. There have been no adverse reactions and the patient has been able to perform oral hygiene immediately because he did not have pain thanks to FS protection. Regarding the risk of deep abscess, I have never had this complication by bone graft in infected sites when I used FS. It's very important to remove completely the deep necrotic tissue. The X-rays were performed before and after 1 week. Obviously, I will have in several months the results on depth probing and on regeneration. What matters now is the promising positive impact on soft-tissues. The next cases will surely performed as suggested by you and Maurice Albert Salama. Soon we will start a randomized controlled trial at the Dental Clinic of the University of Genoa on this novel treatment

Best regards
Enzo


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