Paradigm shift in periodontal therapy with CLEAN&SEAL
Periodontal therapy: Is non-surgical periodontal therapy the treatment of choice for many patients? But which materials promise the desired treatment outcome and what can the targeted treatment goal be?
Interview with Prof. Dr. Dr. h.c. mult. Anton Sculean, M.Sc., periodontist
What is the goal of regenerative periodontal therapy?
Anton Sculean: With regenerative therapy, we want to achieve the complete restoration of lost periodontal tissue. This means that we not only want to fill the periodontal pocket, but also aim to regenerate root cementum, periodontal ligament and alveolar bone. Clinically, we achieve this by reducing probing depths, gaining clinical attachment and radiologically filling bone defects. In the long term, we want to improve the prognosis for periodontally damaged teeth and help patients to keep their own teeth for life by using regenerative periodontal therapy.
Which techniques do you use in regenerative periodontal therapy?
Anton Sculean: In the past, we could only achieve the above-mentioned goals with a surgical procedure and with certain materials such as enamel matrix proteins or membranes. For about ten years, new data has been emerging that shows that a regenerative periodontal therapy is possible with a cross-linked form of hyaluronic acid. Admittedly, I was skeptical about this option at first. But during our laboratory tests, we quickly saw the strong effect that cross-linked hyaluronic acid has on periodontal desmodontal cells and gingival fibroblasts. As soon as the material is applied to the defect, it attracts these cells. We were able to demonstrate this preclinically and later clinically. Histologically, a new attachment formed. This raised the question of whether we could also achieve periodontal regeneration non-surgically.
So what happens if I clean the root surface in a closed procedure and apply cross-linked hyaluronic acid? The histological examination in animal testing showed that not only did the clinical parameters improve, but new cement, periodontal ligament and bone also formed. This was something completely new in periodontal therapy: predictable regeneration after non-surgical therapy – a real paradigm shift. Clinical studies confirmed the effectiveness of non-surgical therapy with cross-linked hyaluronic acid. Based on all these data, the CLEAN&SEAL concept was introduced into periodontal therapy.
Please summarize the CLEAN&SEAL concept for us again.
Anton Sculean: Periodontal inflammation is a chronic infection caused by a bacterial biofilm on the root surface. The aim of the CLEAN&SEAL concept is therefore the long-term destruction of the biofilm. For the careful removal of the biofilm and diseased tissue, we use a combination of mechanical cleaning with the additional application of a cleaning gel consisting of a sodium hypochlorite solution and an amino acid solution. The advantage of this is that the biofilm matrix is dissolved and the cleaning gel is gentle on the tissue. We then seal the periodontal pocket with cross-linked hyaluronic acid, as this material remains in the pocket for a longer period of time and is not washed out, stabilizes the blood clot and reacts positively with the periodontal cells. The CLEAN&SEAL concept has no side effects, which is why it can be repeated several times – of course only in places where it is necessary.
For which indications is the CLEAN&SEAL concept suitable?
Anton Sculean: For example, for patients with untreated periodontal pockets, for periodontitis patients in recall, or if there is a short-term deterioration in the periodontal pocket, such as an increase in pocket depth and bleeding. Clinical data also show that the CLEAN&SEAL concept can be used to treat peri-implant mucositis. In general, this provides us with a building block in our therapy concept, with which we can improve and stabilize the clinical situation in a minimally invasive, patient-friendly and biological way.
Published by pip editorial team Berlin | 12/03/2024 | PIP ASKS, Regedent
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