Discussion
necrosis
BLOOD CLOT, ADHESION, COLLAPSE, NECROSIS, CREST
The main three elements required for optimal regeneration are defect stability, space maintenance, and enhanced cellular and mediators’ availability. The present study suggested a combination of MIST—supposed to provide reliable defect stability, space maintenance, and growth factors containment—with RGD adhesion protein hydrogel, which was hypothesized to improve cellular availability since both options are capable of providing optimal outcomes. MIST was used instead of papilla preservation technique due to possible papilla issues, such as collapse or complete necrosis that lead to biomaterial exposure.Cell adhesion peptide RGD was reported to be incorporated into biomaterials to improve cell adherence due to the bioinert nature of most synthetic materials.A statistically significant improvement was observed in bone fill measured from CEJ to BD and from CEJ to BC in all groups, which may be explained by the effect of MIST space-making and enhanced blood clot stability that were reported in many studies.In this study, clinical attachment gain and pocket reduction were reported to be improved at 6-month evaluation period in all groups when compared to baseline. These findings highlight the significance of minimally invasive approaches in improving soft tissue parameters. Many studies claimed that MIST improved soft tissue stability, which is supposed to maintain and increase blood supply to the involved papilla and alveolar crest area.GCF analysis of BMP-2 reported a significant increase in its levels between days 1, 7, 14, and 21 (p=0.000) in the three groups. This could be also explained by the capacity of MIST to retain growth factors within the defect area without being rabidly washed away by crevicular fluid flow. The level of BMP-2 was reported significantly higher in Group 3 compared to Groups 1 and 2. This significant value may be explained by the presence of RGD peptide, which is supposed to stimulate cell migration, adhesion, and growth factors production, including BMP-2. Again, hydrogel could improve secreted growth factor availability and maintain its high level throughout the studied intervals. The addition of adhesive RGD peptide was reported to increase the osteoinductive impact of the BMP-2 peptide twofold.