Recombinant Human Fibroblast Growth Factor-2(SVS Institute of Dental Sciences)

Recombinant human fibroblast growth factor‐2 (rhFGF‐2) has been shown to effectively promote the formation of new periodontal tissues, and its efficacy has been demonstrated in clinical settings. Moreover, the clinical and radiographic outcomes in the treatment of periodontal infrabony defects can be improved by using rhFGF‐2 in combination with a bone substitute. Here, we present a case of four‐wall bone defect in a tooth treated by combination regenerative therapy using rhFGF‐2 and beta‐tricalcium phosphate (βo‐TCP).

A 43‐year‐old male with a four‐wall bone defect in tooth #28 was subjected to combination therapy with rhFGF‐2 and β‐TCP. Periodontal clinical parameters and radiographic images were evaluated at the first visit, after the initial periodontal treatment, and after 4 months and 4 years postoperation.

Although gingival recession and nonvital pulp were observed postoperation, improvements in the periodontal parameters and radiographic outcomes were subsequently recorded.

Periodontal regenerative therapy with a combination of rhFGF‐2 and β‐TCP showed great potential in the treatment of four‐wall bone defects of teeth.

Periodontal regenerative therapy using recombinant human fibroblast growth factor‐2 (rhFGF‐2) and beta‐tricalcium phosphate (β‐TCP) showed immense potential in the treatment of four‐wall bone defect in teeth.In addition to using computed tomography for assessing bone defects and root morphologies, an evaluation of root canal morphology and pulp diagnosis is essential for understanding the internal and external aspects of the defect, which would aid in tooth preservation.Appropriate periodontal and endodontic treatments enabled tooth preservation following apical periodontitis after periodontal regenerative therapy.

This case report focuses on a new approach for the treatment of a four‐wall bone defect, a significant dental issue in which the bone around the tooth is damaged, thereby decreasing the stability of the tooth. We treated a 43‐year‐old male patient with a combination of two key components: the growth factor rhFGF‐2, which helps promote the growth of new tissues, and the synthetic bone graft substitute β‐TCP, which acts as a substitute for the missing bone. Over the course of 4 years, we monitored the patient's progress using dental exams and X‐ray photos. Despite some minor side effects, such as gum recession and the loss of tooth vitality, the overall condition of the tooth and surrounding bone showed significant improvement. This combination therapy shows promise in repairing similar bone defects, which would help save teeth that might otherwise be lost.

Nonincised papillae surgical approach (NIPSA) preserves papillae by placing incision lines away from interdental areas, achieving good outcomes. However, these techniques may be unsuitable in cases with bone defect morphology or tissue anatomy. This case series introduces the modified nonincised papillae surgical approach (M‐NIPSA), which preserves papillae while providing adequate access for periodontal defect debridement and regenerative material placement.

Ten intrabony defects were treated with M‐NIPSA using recombinant human fibroblast growth factor‐2 and carbonate apatite (CO3Ap) as regenerative materials. Clinical parameters were assessed at baseline and 6 and 12 months. Early wound healing index evaluated primary wound closure 7 days postoperatively.

All cases achieved complete flap closure without wound dehiscence, with significant probing pocket depth and clinical attachment level (CAL) improvements compared to baseline (mean CAL gain: 3.65 ± 1.20 mm). No significant changes in gingival recession or keratinized tissue were observed.

M‐NIPSA overcomes anatomical limitations of conventional techniques, ensuring primary healing with minimal incision and flap reflection. Combined with effective growth factors, it significantly improves periodontal parameters.

Modified nonincised papillae surgical approach allows access to bone defects with a shorter incision range and reduced invasiveness by positioning the incision line more coronally compared to conventional nonincised papillae surgical approach.Ensuring an adequate width of keratinized gingiva (keratinized tissue width ≥3 mm) is essential. Incisions and flap elevation should minimize damage to the gingival tissue, and sutures with fine threads must be used to preserve blood flow.This incision technique is not suitable in cases with fragile gingiva due to inflammation or extensive bone defects spanning multiple teeth that could compromise blood flow.

This case series introduces a new surgical incision design for periodontal regeneration. Periodontitis, a disease that damages gum and bone, has long been treated with regeneration surgeries to restore lost tissues. Advances in materials and surgical methods have improved the predictability and effectiveness of these treatments. Recently, techniques have been developed to minimize surgical invasion and enhance healing. One innovation is avoiding incisions and tissue separating in the interdental area, preserving blood flow and keeping space for bone regeneration. In this study, the new incision design was applied to 10 patients undergoing periodontal regeneration therapy. After 12 months, evaluations showed improved soft and hard tissue healing. The results suggest that this new design addresses some anatomical limitations of traditional methods, offering effective healing with minimal surgical damage. Based on the results, this approach suggests the potential for faster recovery and better long‐term outcomes by combining precision and reduced invasiveness.