The Use of Adhesion Molecule Loaded Hydrogel With Minimally Invasive Surgical Technique in Treatment of Periodontal Intrabony Defect
Condition: Periodontitis
MeSH terms: Periodontitis; Tissue Adhesions
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      Primary aim of the study is to evaluate efficacy of RGD adhesion molecule loaded hydrogel
      with minimally invasive surgical technique in treatment of periodontal intrabony defect at
      baseline and 6months. Secondary outcome is the biochemical evaluation to detect bone
      morphogenetic proteins level
    

Detailed description: 
      Periodontitis is a multifactorial inflammatory disease associated with dysbiotic plaque
      biofilms and characterized by clinical attachment loss caused by the destruction of the
      periodontal ligament and loss of supporting bone. One of periodontal therapy goals is
      regeneration of the lost periodontal attachment apparatus.

      . To regenerate healthy periodontal tissue, various clinical techniques were developed to
      prevent downward epithelial migration and promote periodontal tissue regeneration by the
      remaining periodontal ligament (PDL) cells or osteoblasts such as open flap debridement
      (OFD), natural or synthetic filling materials and guided tissue regeneration (GTR).

      . Tissue engineering has become one of the most commonly used approaches for bone tissue
      reconstruction and regeneration, injectable hydrogels have attracted the attention of
      biomaterials scientists for bone tissue-engineering applications, because they can replace
      regenerative surgery with a minimally invasive injection method and can form any desired
      shape, to match irregular defects. Various injectable hydrogels with good moldability and 3D
      structures have been widely investigated for use in bone tissue engineering.

      . Recently a variety of bioactive peptides have been studied and applied for the promotion of
      bone regeneration to repair local bone defects or treat other bone diseases including
      extracellular matrix (ECM)- derived peptides, bone morphogenetic proteins (BMPs)-derived
      peptides and others.

      . The arginyl-glycyl-aspartic acid (RGD) peptide is one of bioactive peptides which is the
      cardinal integrin-binding domain and presents in many extracellular matrix proteins, such as
      fibronectin and vitronectin. As a part of cell surface signalling, RGD peptide can enhance
      the expression of osteocalcin (OCN), osteopontin (OPN) and BMP to ensure osteoblast
      proliferation, differentiation and mineralization.

      . The induction of bone depending on the concentration of BMPs which considered important
      bone biological factors that play essential roles in osteogenesis. BMPs are members of
      secreted signaling proteins that belong to transforming growth factor beta (TGF-β)
      superfamily. It has been demonstrated that BMPs induce bone formation by differentiating
      mesenchymal stem cells to osteoblastic cells
    

Intervention name(s): RGD Peptide
Intervention type(s): Drug
Intervention description(s): adhesion molecules
Intervention MeSH terms: Arginyl-glycyl-aspartic acid
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The total of 45 infra-bony defects were randomly divided into 3 equal groups (n=15 each) by simple randomization and all surgeries were done by the same periodontist (Sh.H):
Group 1: Fifteen intra-bony defect sites were treated with modified minimally invasive surgical technique M-MIST alone.
Group 2: Fifteen intra-bony defect sites were treated with M-MIST and placebo hydrogel injection.
Group3: Fifteen intra-bony defect sites were treated with M-MIST and RGD peptide hydrogel injection.
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: adhesion molecule; intrabony defect; hydrogel; Minimally invasive surgical technique