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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 12  |  Issue : 1  |  Page : 47-51

Bone one session treatment: A new concept of treating periodontal diseases


Department of Periodontics, Panineeya Institute of Dental Sciences and Research Center, Hyderabad, Telangana, India

Date of Submission04-Nov-2019
Date of Acceptance17-Dec-2019
Date of Web Publication24-Jan-2020

Correspondence Address:
Jammula Surya Prasanna
Department of Periodontics, Panineeya Institute of Dental Sciences and Research Center, Road No-5, Kamala Nagar, Dilsukh Nagar, Hyderabad - 500 060, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jorr.jorr_38_19

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  Abstract 


Periodontitis is an inflammatory disease of multifactorial origin that represents the destruction of periodontium due to the upregulation of immune response and in the presence of disease-causing pathogens, resulting in loss of attachment and bone loss. Advances in periodontal disease control cracked wide open various therapies that will successfully arrest periodontal infections. One such new technique is bone one session treatment (BOST) for the treatment of periodontal disease without an invasive procedure. BOST is an aerobic treatment that eliminates the periodontal disease in the deepest pockets and supporting alveolar bone. This technique predicts the same phenomenon in periodontal diseases healing and repair, works by influencing the disease etiological factors and aiding healing by three immune phases. This plays a role in altering the pathogenesis and disease progression by changing the defensive phase against bacteria and other microorganisms into a regeneration phase to achieve a new attachment. We conclude that a noninvasive technique (BOST) can alter the pathogenesis by removing the etiological factors as well as guide the tissue for regeneration and new attachment.

Keywords: Aerobic treatment, bone treatment, noninvasive, perio-aid, periodontitis, stretch flap


How to cite this article:
Priya JS, Yasaswini KP, Prasanna JS. Bone one session treatment: A new concept of treating periodontal diseases. J Oral Res Rev 2020;12:47-51

How to cite this URL:
Priya JS, Yasaswini KP, Prasanna JS. Bone one session treatment: A new concept of treating periodontal diseases. J Oral Res Rev [serial online] 2020 [cited 2020 Nov 30];12:47-51. Available from: https://www.jorr.org/text.asp?2020/12/1/47/276710




  Introduction Top


Periodontitis is a chronic inflammatory disease, which is characterized by the destruction of periodontium due to the upregulation of immune response, leading to the loss of attachment and bone.[1] Often, periodontal diseases characterized by the swelling and bleeding of soft tissue, if not treated in early stages, might worsen the condition and progress to attachment and tooth loss.[2] When the periodontitis spreads into underlined connective tissue and bone, the treatment becomes more complicated. The convoluted results are developing deeper periodontal pockets, and further, bacteria can agglomerate into the pockets that cause severe pain, swelling, bleeding, ulceration, and sensitivity and undoubtedly lead to tooth mobility and eventually tooth loss. Advances in periodontics have opened new prospects in nonsurgical periodontal treatments. Hoisington[3] has developed a technique called tri-immunophasic periodontal (TIP) therapy, which is a noninvasive microscopic periodontal treatment procedure based on influencing immune-released risk factors. The ideology is that the periodontal bone regeneration is as normal as the fracture healing if all other conditions such as personal and local factors are getting together in all three immune phases.[3] Bone one session treatment (BOST), an aerobic treatment, is a part of this TIP therapy that eliminates aerobic bacteria that cause periodontal disease in the deepest pockets and supporting alveolar bone.[4]

Immune system phases

  1. Vigilant readiness
  2. Defense phase
  3. Repair and regeneration.


BOST sets up all the conditions where the body can get out of the defensive phase against the bacteria and other microorganisms and enter a regeneration phase to heal back a new attachment.

Objectives

The objective is to tackle periodontal diseases without the need for surgery. BOST aims to enable the bone to heal and the pockets formed by periodontal diseases to fill with new, healthy tissue.

Indications

It is an alternative to extraction. If no other treatment options are available to save the teeth. If the patient is willing to retain natural teeth during the initial disease stage.

[TAG:2]Steps Involved in Bone One Session Treatment Procedure[5],[6],[7][/TAG:2]

  1. Bacterial DNA testing
  2. BOST treatment
  3. Controlling biting forces
  4. Aerobic oral hygiene regimen
  5. Lifestyle, nutrition, and exercise.


Bacterial DNA testing

The main goal of periodontal disease treatment starts by determining the type and the number of bacteria, which are present in the periodontal pockets. Using a bacterial DNA test can identify exactly which bacteria are causing periodontal infection. Such prior detection can prevent the unnecessary usage of antibiotics. However, some species such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans cannot be controlled by only treatment.

Why DNA test necessary?

It provides a scientifically accurate way of knowing which bacteria are causing the infection. To choose the right antibiotic combination, fight against the bacteria. The prior test may give good treatment results than producing the resistant strains.

Who should take the bacterial DNA test?

People who have symptoms of periodontal disease and before orthodontic treatment should take the bacterial DNA test.

Bone one session treatment

It uses a technique called “stretch flap” that allows access all the way down to the deep areas of the roots and surface of the bone without giving the incision. This is a total noninvasive microsurgical procedure. It removes local obstacles such as plaque and calculus along with the toxins produced by bacteria. This is helpful in faster healing.

Stretch flap method: Procedure[6]

  • Step 1: Universal 4R-4L curette is inserted inside the pocket, where the working end facing toward tooth surface and blunt nonworking end facing tissue to open the sulcus. Slight backward pressure is applied to the tissue to begin stretching, while removing plaque and calculus [Figure 1]
  • Step 2: Direction changes to circumferential motion starting at the corner to mobilize the tissue and avoid pulling papilla
  • Step 3: With the tip of the curette first advance toward the surface of the bone. And begin instrumentation to remove attached granulation tissue and plasty the surface porosities, which help to physically remove microorganisms and toxins in pockets through fresh bleeding [Figure 2].


The technique ensures that the periodontium is left in a state that can heal effectively. By stretching the tissue, there will be no scar tissue left behind. Scared tissue hinders the attachment to the tooth surface. This means that the attachment between the tissue and the bone will remain weak after the traditional periodontal treatment and this will allow bacteria to reinfect the tissue. Using the “stretch flap” method, a strong attachment can form in which healthy tissue can thrive. It is possible using BOST that the attachment between the periodontium and the tooth after treatment will be as strong as a healthy attachment.
Figure 1: Stretching of tissue as instrument advances in the deeper surface

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Figure 2: Cleaning and reshaping bone craters

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BOST procedure has some similarities with curettage but is dissonant from the latter. Curettage is employed in the treatment of osseous defects to remove the granulation tissue and pocket lining without stretching the flap.[[8]] However, in the BOST procedure, the flap has been stretched slowly and gets rid of granulation tissue to provide the stimulation of stem cells.[6]

Control of occlusal forces and splinting

Weakened periodontium causes normal occlusal forces to be traumatic. Treatment includes coronoplasty, enameloplasty, and splinting to redistribute the forces.

Aerobic oral hygiene regimen

BOST success also depends on patients maintaining a simple, painless daily hygiene regimen. This process allows oxygen to reach under the gums and directly stops bacterial growth. Bacteria can only thrive in the absence of oxygen. Along with other plaque control methods, using a special instrument called perio-aid all the way down to the attachment and into the root concavities helps in the reduction of bacteria [Figure 3]. Using this aid stops the epithelial migration from coronal to the apical direction. It stimulates the cells from the base of the pocket.
Figure 3: Perioaid assisting in new attachment formation

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Adequate and appropriate nutrition

Adequate diet and nutrition also play an adjunctive role. A balanced diet, which includes proteins, vitamins, and nutrients containing zinc, should be taken. Unsaturated fats and sugars, smoking, and alcohol consumption should be avoided and regular exercises have to be done.

Normal healing process occurs in four types of attachments:

  1. Connective tissue attachment
  2. Epithelial attachment
  3. Scar tissue attachment
  4. Mineralized acellular connective tissue (MAC) attachment.



  Phases of Healing After Bone One Session Treatment Top


  1. Defense phase
  2. Regeneration phase
  3. Healing with a new attachment.


  • Stage 1: Defense phase: Stem cells migrating phase [Figure 4]


Stem cells move along the root surfaces at the rate of 0.5 mm/day for 8 days and thicken the layer on the clot. This acts as a scaffold and helps in primary healing.
Figure 4: The clot that firmly attached to the clean bone serves as a scaffold. (1) Perio-aid, (2) tooth, (3) alveolar bone, (4) gingiva, (5) desmodont, (6) callus, (7 and 9) pluripotent stem cells, and (8) fibers

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  • Stage 2: Regeneration phase: maturation of attachment [Figure 5]


As healing progresses, pockets gradually fill from the bottom with very dense, partially mineralized connective tissue in the period of 4–6 weeks and finally become acellular.
Figure 5: The pockets gradually fill in from the bottom with very dense, partially mineralized connective tissue. (1) Perio-aid, (2) tooth, (3) bone, (4) gingiva, (5) desmodont, (6) mineralized acellular connective tissue, (7) pluripotent stem cells (8) New dense layer of osteoid formation

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Within the 1 month of the period after the formation of new mineralized MAC, bone naturally heals under it. A new dense layer of cortical bone forms over the healed inner cancellous bone in about 8 months.
Figure 6: Mineralized acellular connective tissue attachment. (1) Zone of attachment

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Total recovery process

Day 1 – BOST

Day 2 – Oral hygiene regimen starts

Day 3 – Clot is stabilized

Day 4 – Pockets start to fill in

Day 5 – Reduction of inflammation

Day 8 – Pocket sealing up

Day 14 – Normal chewing regimen starts

Day 30 – Complete pocket filled up

Day 35 – Esthetic restorations can be started

Day 45 – Bone begins to heal.

By 9 months, bone completely heals.

Advantages

Complete degranulation of the pockets without an incision and suture is noted. Damage to the underlying tissues is minimal. It is a full-fledged aerobic bacteria treatment. Within short period, full-mouth treatment can be performed. It personalizes the treatment. It gives chance to the body to heal faster. No surgery is required. The procedure is noninvasive. It is not much distressing. It is a single-session treatment with quick process. It helps to improve esthetics and oral health. This is a cost-effective procedure with high success rate. The recovery process is quick and easy. No necrosis of the bone is observed. Gingival tissue tends to maintain its original height.


  Conclusion Top


BOST has led to the rise of a new variation in treating periodontal disease. It overcomes the disadvantage of traditional treatment modalities in periodontics. It is a minimally invasive procedure, with cost-effectiveness and extended oral comfort. It sets up all the conditions where the body can get out of the defensive phase against bacteria and other microorganisms and sets into a regeneration phase to heal back a new attachment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hudwekar AD, Beldar A, Murkute S, Lendhey SS, Thamke M. Aloe vera on wound healing after periodontal flap surgery in chronic periodontitis patient: A randomized control trial. J Oral Res Rev 2019;11:72-6.  Back to cited text no. 1
  [Full text]  
2.
Rathi SM. Molecular mechanisms involved in making periodontitis – A painless disease entity. J Oral Res Rev 2019;11:84-8.  Back to cited text no. 2
    
3.
Hoisington W. New developments in perio: Tri-immuno-phasic therapy. Prev Dent 2006;1:30-4.  Back to cited text no. 3
    
4.
Parikh H, Agrawal C, Shah K, Duseja S, Sha M. Tri immunophasic periodontal therapy (Tip). World J Adv Sci Res 2019;2:192-8.  Back to cited text no. 4
    
5.
Kiran KN, Chandhra MP, Ramesh B, Srikanth C, Arpita PR. New trends in periodontics. J Evol Med Dent Sci 2012;1:546-58.  Back to cited text no. 5
    
6.
Kumar PY, Kalaivani V. Tri-immuno phasic periodontal therapy. World J Pharm Res 2016;5:356-60.  Back to cited text no. 6
    
7.
Arpita R, Swetha JL, Babu MR, Sudhir R. Recent trends in non-surgical periodontal care for the general dentist – A review. Bangla J Dent Res Educ 2012;4:78-82.  Back to cited text no. 7
    
8.
American Academy of Periodontology. The American Academy of Periodontology statement regarding gingival curettage. J Periodontol 2002;73:1229-30.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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