The efficacy of the local application of recombinant human fibroblast growth factor-2 (FGF-2) in periodontal regeneration has been investigated. In this study, a randomized, double-blind, placebo-controlled clinical trial was conducted in 253 adult patients with periodontitis. Modified Widman periodontal surgery was performed, during which 200 µL of the investigational formulation containing 0% (vehicle alone), 0.2%, 0.3%, or 0.4% FGF-2 was administered to 2- or 3-walled vertical bone defects. Each dose of FGF-2 showed significant superiority over vehicle alone (p < 0.01) for the percentage of bone fill at 36 wks after administration, and the percentage peaked in the 0.3% FGF-2 group. No significant differences among groups were observed in clinical attachment regained, scoring approximately 2 mm. No clinical safety problems, including an abnormal increase in alveolar bone or ankylosis, were identified. These results strongly suggest that topical application of FGF-2 can be efficacious in the regeneration of human periodontal tissue that has been destroyed by periodontitis.

The options for medical use of signaling molecules as stimulators of tissue regeneration are currently limited. Preclinical evidence suggests that fibroblast growth factor (FGF)-2 can promote periodontal regeneration. This study aimed to clarify the activity of FGF-2 in stimulating regeneration of periodontal tissue lost by periodontitis and to evaluate the safety of such stimulation. We used recombinant human FGF-2 with 3% hydroxypropylcellulose (HPC) as vehicle and conducted a randomized double-blinded controlled trial involving 13 facilities. Subjects comprised 74 patients displaying a 2- or 3-walled vertical bone defect as measured ≥3 mm apical to the bone crest. Patients were randomly assigned to 4 groups: Group P, given HPC with no FGF-2; Group L, given HPC containing 0.03% FGF-2; Group M, given HPC containing 0.1% FGF-2; and Group H, given HPC containing 0.3% FGF-2. Each patient underwent flap operation during which we administered 200 µL of the appropriate investigational drug to the bone defect. Before and for 36 weeks following administration, patients underwent periodontal tissue inspections and standardized radiography of the region under investigation. As a result, a significant difference (p = 0.021) in rate of increase in alveolar bone height was identified between Group P (23.92%) and Group H (58.62%) at 36 weeks. The linear increase in alveolar bone height at 36 weeks in Group P and H was 0.95 mm and 1.85 mm, respectively (p = 0.132). No serious adverse events attributable to the investigational drug were identified. Although no statistically significant differences were noted for gains in clinical attachment level and alveolar bone gain for FGF-2 groups versus Group P, the significant difference in rate of increase in alveolar bone height (p = 0.021) between Groups P and H at 36 weeks suggests that some efficacy could be expected from FGF-2 in stimulating regeneration of periodontal tissue in patients with periodontitis. ClinicalTrials.gov NCT00514657

Background: This in vitro study was performed to determine the appropriate power output setting for an erbium, chromium‐doped:yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser used in periodontal pocket irradiation by examining the morphologic alterations of the root surfaces and the efficiency of calculus removal.Methods: Sixty‐five non‐carious extracted human teeth were used in this study. For morphologic analysis of the root surface, the clean, single roots of 22 teeth were separated into 91 pieces, and these pieces were immersed in acrylic resin. The specimens with root‐surface exposure were prepared and divided randomly into three groups: a control group (N = 8), an irradiation without water group (no water [NW] group; N = 39), and an irradiation in water to simulate the conditions in a periodontal pocket group (in water [IW] group; N = 44). The power output settings for laser irradiation were 0.5, 1.0, 1.5, and 2.0 W for each group. The roughness (Ra), depth (Z), and width (X) of the disk specimens were determined after laser irradiation. Eight other single‐rooted teeth were examined by scanning electron microscopy (SEM) after laser irradiation under the same conditions. Thirty‐five single‐ or multirooted teeth with heavy subgingival calculus were used to test the efficiency of laser scaling. The efficiency of calculus removal was quantified by measuring the time needed to remove the calculus completely using the laser.Results: The mean Ra and Z values in the IW group were significantly higher than in the NW group with the same power output. In addition, these values with 0.5‐ and 1.0‐W power output settings were significantly lower than with 1.5‐ and 2.0‐W settings in the NW and IW groups. No obvious morphologic differences could be found between the 0.5‐ and 1.0‐W power output specimens under SEM. Additionally, thermal alterations, i.e., carbonization or melting, were completely absent in the IW group. Regarding the efficiency of calculus removal, the 0.5‐W setting (0.11 ± 0.036 mm²/second) was significantly inferior to the 1.0‐W setting (0.27 ± 0.043 mm²/second). However, there was no significant difference between 1.0‐ and 1.5‐W (0.36 ± 0.11 mm²/second). The 2.0‐W setting (0.63 ± 0.272 mm²/second) was much more efficient but resulted in significant morphologic alterations.Conclusions: Based on these findings, it is appropriate to use a 1.0‐W power output setting with an Er,Cr:YSGG laser for root scaling. This may be done without any conspicuous morphologic alterations to the root surface and with acceptably efficient removal of calculus.

Periodontal disease is caused by dental plaque biofilms, and the removal of these biofilms from the root surface of teeth plays a central part in its treatment. The conventional treatment for periodontal disease fails to remove periodontal infection in a subset of cases, such as those with complicated root morphology. Adjunctive antimicrobial photodynamic therapy (aPDT) has been proposed as an additional treatment for this infectious disease. Many periodontal pathogenic bacteria are susceptible to low-power lasers in the presence of dyes, such as methylene blue, toluidine blue O, malachite green, and indocyanine green. aPDT uses these light-activated photosensitizer that is incorporated selectively by bacteria and absorbs a low-power laser/light with an appropriate wavelength to induce singlet oxygen and free radicals, which are toxic to bacteria. While this technique has been evaluated by many clinical studies, some systematic reviews and meta-analyses have reported controversial results about the benefits of aPDT for periodontal treatment. In the light of these previous reports, the aim of this review is to provide comprehensive information about aPDT and help extend knowledge of advanced laser therapy.