Peptide Enhanced Bone Graft in 3 Cases of Localized Aggressive Periodontitis

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Peptide Enhanced Bone Graft in 3 Cases of
Localized Aggressive Periodontitis
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Aggressive Periodontitis(common features)

• Presence of periodontitis in otherwise clinically
  healthy individuals
• Rapid attachment loss and bone destruction
• Familial aggregation

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Aggressive Periodontitis(secondary features)

• Amounts of microbial deposits inconsistent with
  severity and destruction
• Elevated proportions of Aa Pg
• Phagocyte abnormalities

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Aggressive Periodontitis(secondary features)

• Hyper-responsive macrophage phenotype, including
  elevated levels of PGE2 and Il-1?
• Progression of attachment loss and bone loss may
  be self-arresting

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PepGen P-15

• Bovine derived hydroxyapatite, which contains a
  synthetic peptide, P-15
• P-15 is a biomimetic cell binding region of type
  I collagen
• Radiopaque, rounded graft particles (250?-420?)

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P-15 Clinical Research

• Multicenter Clinical Evaluation of Combination
  Anorganic Bone Matrix (ABM)/Cell Binding Peptide
  (P-15) as a Bone Replacement Graft Material in
  Human Periodontal Osseous Defects.
• 6-months Results
• Yukna RA, et al. J Periodontol 1998

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P-15 Clinical Research

• Three Year Results with ABM/P-15 Grafts in Human
  Periodontal Defects
• Yukna R.A. et al. J Dent Res
• (IADR Abstracts) 2000 2059

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P-15 Clinical Research

• Multi-Center Clinical Comparison of Anorganic
  Bovine-Derived Hydroxyapatite Matrix (ABM)/Cell
  Binding Peptide (P-15)
• and ABM in Human Periodontal Osseous Defects.
  6-Months Results
• Yukna RA, et al. J Periodontol 2000

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P-15 Clinical Research

• Histologic Evaluation of ABM/P-15 in Human
  Periodontal Defects
• Yukna RA et al. J Dent Res
• (IADR Abstracts) 2000 2060

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Overall Advantages of PepGen P-15

• Mimics the inorganic and organic components of
  autogenous bone
• Minimizes crestal bone resorption
• No learning curve
• Can be re-sterilized

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Patient Information

• Gender and Age
• 2 females (16, 26) 1 male (18)
• All patients were unrelated
• Race African-Americans
• Medical history All healthy
• Family history Periodontal disease by report
• Dental history No previous periodontal treatment

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Timeline
Initial Therapy
Surgical phase
Re-evaluation
Baseline
6 mo. Post op
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Patient 1
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Patient 1 Surgery on 14
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Patient 1 Surgery on 14
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Patient 1 Surgery on 30
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Patient 1 Surgery on 30
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Patient 1 BW Pre and Post Tx (6 mo.)
Pre Tx
Post Tx
Pre Tx
Post Tx
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Patient 1 FMS Pre and Post Tx (10 mo.)
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Patient 2
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Patient 2 Surgery on 3
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Patient 2 Surgery on 3
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Patient 2 Surgery on 19
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Patient 2 Surgery on 19
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Patient 2 BW Pre and Post Tx (6 mo.)
Pre Tx
Post Tx
Pre Tx
Post Tx
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Patient 2 FMS Pre and Post Tx (8 mo.)
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Patient 3
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Patient 3 Surgery on 30
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Patient 3 Surgery on 30
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Patient 3 Surgery on 3
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Patient 3 Surgery on 14
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Patient 3 Surgery on 14
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Patient 3 Surgery on 19
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Patient 3 Subtraction Radiography
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Patient 3 Subtraction Radiography
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Patient 3 FMS Pre and Post Tx (8 mo.)
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Patient 3 BW Pre and Post Tx (6 mo. 1 y.)
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Pre Tx.
Post Tx.
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Pre Tx
Post Tx
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Pre Tx
Post Tx
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Pre Tx
Post Tx
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Comparison of results with the literature
PD Reduction
CA Gain
1998
2000
Yukna RA, et al. J Periodontol 1998 Yukna RA, et
al. J Periodontol 2000
Case Series
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Comparison of results with the literature
PD reduction
CA gain
PD Reduction
CA Gain
PD Reduction
CA Gain
Laurell et al. J Periodontol 199869303-313
Case Series
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Discussion

• Deep (2-3 walled) vertical bony defects
• Adjunctive antimicrobial therapy
• Periodontal maintenance every 2 weeks
• No initial gingival recessions
• Healthy young patients
• Enhanced osteoconductive effect of bone graft
  material
• Small sample size